HCPTS |

Profession: Speech and language therapist

Registration Number: SL05726

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 12/08/2021 End: 17:00 13/08/2021

Location: Virtually via videoconference

Panel: Conduct and Competence Committee

Outcome: Conditions of Practice

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Allegation

In your role as a Speech and Language Therapist at South Eastern Health and Social Care Trust (“SEHSCT”), you did not:

Complete and/or send onward referrals in a timely manner or at all for the service users
set out in Schedule A.
Undertake and/or record school visits in a timely manner for the service users set out in Schedule B.
Transfer service users to the appropriate services in a timely manner or at all, for the service users set out in Schedule C.
Record appointments and/or updates on the clinical database for the service users set out in Schedule D.
Discharge service users in a timely manner or at all for the service users set out in Schedule E.
Liaise adequately with other professionals and/or record this contact for the service users set out in Schedule F.
Adequate contact with the parents of service users set out in Schedule G.
Second opinions in a timely manner or at all for the service users set out in Schedule H.
Carry out and/or record review appointments in a timely manner or at all for the service users set out in Schedule I.
Arrange and/or record appointments in a timely manner or at all for the service users set out in Schedule J.
Appropriately store the case files of approximately 48 children, in that you stored them at your home.
The matters set out in paragraphs 1 – 11 constitute misconduct and/or a lack of competence.
Your fitness to practise as a Speech and Language Therapist is impaired by reason of your misconduct and/or lack of competence.

Finding

Preliminary Matters

Service

1. The Panel was satisfied that a Notice of Hearing had been sent to the Registrant by an email dated 18 January 2021. The Notice was sent to the Registrant’s email address held by the HCPC. This gave notice of the hearing date and informed the Registrant that the hearing was to be a virtual hearing. The Panel had sight of a confirmation of delivery email.

2. The Panel was satisfied that there had been proper service of the Notice of Hearing in accordance with the Health and Care Professions Council (Coronavirus) (Amendment) Rules 2021 Rule 3.

Proceeding in Absence

3. The Registrant was not in attendance at the hearing. Her husband had been in touch with the Hearings Officer to confirm that she was not attending, she struggled with the technology and felt the hearing would have an adverse effect on her health in particular due to the length of time that had elapsed since the events that were the subject of these proceedings. Miss Woolfson on behalf of the HCPC made an application to proceed in the Registrant’s absence.

4. The Panel listened to the submissions of the Presenting Office and considered the advice of the Legal Assessor, and the Practice Note on Proceeding in Absence.

5. The Panel considered that the Registrant had not made an application for an adjournment nor to participate in the hearing by another means e.g. telephone. Therefore, the Panel decided that she had waived her right to be present at the hearing. The Panel was mindful of the time that had elapsed since the alleged incidents. The Registrant had complained about the delay and therefore the Panel felt a further adjournment would neither secure her attendance nor be in the public interest. The Panel was satisfied that any disadvantage to the Registrant by not attending could be mitigated by the Legal Assessor and Panel testing the evidence.

6. Therefore the Panel decided to proceed with the hearing in the absence of the Registrant and drew no adverse inferences from her non-attendance.

Hearing in Private

7. It appeared likely on the papers that there would be reference to the Registrant’s health during the hearing. Miss Woolfson made an application to have those parts of the hearing that related to the Registrant’s health heard in private.

8. The Panel listened to the advice of the Legal Assessor which it accepted.

9. The Panel was mindful of the presumption that proceedings should be held in public unless

the interests of justice or the protection of the private life of the Registrant or other participant required that the public be excluded from all or part of the hearing.

10. The Panel was satisfied that in the interests of justice matters of health should be held in private.

11. Carrying out that balancing exercise the Panel decided that the balance could be struck if those aspects of the evidence that related to the Registrant’s medical condition would be held in private whilst the remainder of the hearing was conducted in public.

Amendment of Particulars

12. An application was made by the HCPC to amend the allegations before the Panel. These proposed amendments had been notified to the Registrant in January 2021 in advance of the hearing. A number of the amendments were typographical or stylistic amendments. However, there were several that were substantive.

13. As set out, the words in bold and italic were inserted and the words struck through removed.

In your role as a Speech and Language Therapist at South Eastern Health and Social Care Trust (“SEHSCT”), you did not:

1. Complete and/or send onward referrals in a timely manner or at all for the service users set out in Schedule A.

2. Schedule and/or complete Undertake and/or record school visits in a timely manner for the service users set out in Schedule B.

3. Transfer service users to the appropriate services in a timely manner or at all, as for the service users set out in Schedule C.

4. Record appointments and/or updates on the clinical database for the service users set out in Schedule D.

5. Discharge service users in a timely manner or at all as for the service users set out in Schedule E.

6. Liaise adequately with other medical professionals and/or record this contact for the service users set out in Schedule F.

7. Maintain and/or record adequate contact with the parents of service users set out in

Schedule G.

8. Complete and/or record second opinions in a timely manner or at all for the service users set out in Schedule H.

9. Carry out and/or record reviews appointments in a timely manner or at all for the service users set out in Schedule I.

10. Arrange and/or record appointments in a timely manner or at all for the service users set out in Schedule J.

11. Appropriately store the case files of approximately 48 children, in that you stored them at your home, without obtaining authorisation from SEHSCT.

12. The matters set out in paragraphs 1 – 11 constitute misconduct and/or a lack of competence.

13. Your fitness to practise as a Speech and Language Therapist is impaired by reason of your misconduct and/or lack of competence.

14. The Panel listened to the submissions made on behalf of the HCPC and the advice given by the Legal Assessor.

15. The Panel considered whether there would be any detriment to the Registrant in allowing the amendments. It took into account the nature and substance of the amendments and the length of time the Registrant had had to consider them. The Panel was satisfied that it was in the interests of justice that the Allegations be amended and there was no prejudice to the Registrant as she had had five months to consider them and had not made any representations.

16. There was application to discontinue five sub-allegations on the basis that having reviewed the evidence the HCPC would not be able to provide evidence to substantiate them. The Panel considered that in the context of over 70 allegations the discontinuance of the remaining allegations would not result in an under prosecution and would properly reflect the evidence before it.

17. The amendments were allowed as set out above.

Background

18. The Registrant was a Clinical Specialist and Service Lead for school age children with Developmental Language Disorder (DLD), part of the Speech and Language Therapy Community Children’s Team at South Eastern Health and Social Care Trust (“the Trust”). She was in this role from April 2016, but had been employed by the Trust for 27 years when concerns were raised about her. She was a Band 8a which is senior management level. She had management responsibility for one band 7, one band 5 Speech and Language Therapist (SLT), and one band 4 Speech and Language Therapy Assistant.

19. On 1 July 2016, the HCPC received a referral from the Registrant’s employer. They notified the HCPC that the Registrant was being reviewed under the Trust’s capability procedure due to ongoing concerns about her performance. In 2016 there had been some concerns raised in relation to the Registrant’s clinical practice which resulted to her being subject to a capability action plan. The action plan was signed off on 21 December 2016, citing significant progress. In addition to this, it was alleged that in March 2017 and April 2017, the Registrant had failed to carry out her clinical duties in relation to three children in particular, which had resulted in complaints from the children’s parents. In addition to the complaints, the Trust was concerned that the Registrant was failing to provide appropriate care for a high proportion of children on her caseload and this constituted a risk. Concerns were also raised about the Registrant inappropriately storing a large number of children’s files at her home. The Trust conducted a review of the Registrant’s files which brought to light the concerns that were put before the Panel.

Decision on Facts

20. The Panel considered the submissions of Miss Woolfson on behalf of the HCPC. She provided detailed written submissions to the effect that there was evidence in support of all the facts alleged, for the Panel to be satisfied that the facts were proved. The Panel accepted the Legal Assessor’s advice and bore in mind that the burden of proof of the facts is upon the HCPC and the standard of proof to be applied is the civil standard, on the balance of probabilities.

21. The Panel proceeded to consider all the evidence presented in support of the HCPC’s case and whether it was satisfied that the particulars of the allegation were proved on the balance of probabilities. As the Registrant had not attended the hearing, the Panel took great care to consider the evidence that the Registrant might have drawn their attention to had she been present. In particular the Panel considered the Registrant’s Aide Memoir prepared for the internal investigation, the minutes of meetings that the Registrant attended with her trade union representative with the Trust and her written responses to the file audits conducted by the Trust.

22. The Panel heard from two witnesses. LC who is the Lead Professional for Speech and Language Therapy at the Trust. She had been the Registrant’s line manager for 16 years. Her role involves leadership and strategic management of the SLT service.

23. The second witness was PM who is the Assistant Speech and Language Therapy Manager for Children’s Services. told the Panel that she had assisted with the investigation into the Registrant’s caseload. In particular, she had conducted the file review along with Jane McConn, who has since retired. PM and Jane McConn reviewed a total of 84 files, which amounted to the Registrant’s entire caseload. s PM explained that at the time of the investigation, she was also a Band 8A Speech and Language Therapist.

24. With respect of the witnesses who gave oral evidence, the Panel found LC to be very professional in her manner and found that her evidence was cogent and credible. The Panel noted that she was precise in recollections and if she was unable to answer a question, she made this known which gave the Panel confidence in her evidence.

25. With respect to PM the Panel found that she appeared to be very conversant with the facts, and she was able to answer questions precisely and quickly. If she needed to refresh her memory on the papers she did. The Panel found her reliable and credible and was impressed with her knowledge of the case and the investigation.

26. When considering the Registrant’s responses to the allegations, on a number of occasions she cited staffing pressures and or workload as an explanation for why some of the tasks were not completed. In particular the Registrant explained that she had limited Thursdays available which was the only time she could carry out certain duties. The Panel was shown an analysis of the Registrant’s available administration time which was protected and additional time for her to carry out these activities. The Panel considered the underlying summary documents from the Registrant’s scheduler which showed that she had between 35-70 hours of administration time each month. Therefore, the Panel found the Registration’s contention that she did not have time to fulfil the obligations of her role implausible.

27. The Registrant has also suggested that she was unaware of certain policies and procedures which meant she did not realise what was expected of her in the role. The Panel found that within the department some expectations of the Registrant are set out in policy documents, some are custom and practice but given the Registrant was in a leadership role and had many years of experience she ought to have been aware of, or made herself conversant with, the policies and practices within the service. In fact, the Registrant had been instrumental in creating a number of these documents.

28. The Registrant had suggested that the investigations were to deliberately target her and have her removed from the service. The Panel accepted the evidence of the witnesses that the allegations came to light following a review of her files, that had been directed by the HR department in the Trust, of the three complaints were made by the parents of service users. The Panel was told that the review was conducted with the view to identify any potential risk to service users on the Registrant’s caseload, and detected no animosity from the witnesses towards the Registrant.

29. Where the Panel has made a finding below that there was no evidence to satisfy itself that a step had been taken by the Registrant, it is implicit in this finding that the step was not recorded.

1. Complete and/or send onward referrals in a timely manner or at all for the service users set out in Schedule A. – Proved in Part

30. The Panel accepted that part of the Registrant’s role was to make onward referrals to other professionals if a child had additional needs. The Registrant would be expected to use her clinical judgement to determine which service would best meet the service user’s needs.

31. The Panel heard and accepted that there are a number of ways that onward referrals can be made. For example, a referral may require a Single Point of Entry (“SPOE”) form which is sent electronically. The Panel accepted that the Registrant would have been aware of the SPOE procedure from her induction. LC told the panel that onward referrals should be made within two weeks of obtaining parental consent for onward referral.

32. The Panel was referred to the Trust’s Procedure for Onward Referral which confirmed the expectation that a referral will be made within two weeks.

33. LC explained that referrals to SPOE could be made electronically or on a paper form, which would then be scanned and emailed. LC explained that there was secretarial assistant available to help with the mechanics of scanning and emailing if necessary.

34. SU1 - Proven

The HCPC’s case was that the Registrant ought to have made a SPOE referral within two weeks of 20 December 2020. The Panel had sight of SU1’s clinical notes which detailed the meeting on 20 December 2020 which satisfied the Panel that a referral did need to be made within two weeks of this date. The Panel accepted the clinical records which showed that a referral was not made until 8 March 2017 by SU1’s Health Visitor. The Registrant herself did not make the referral. This is a delay of over two months. The Registrant’s response as set out in her Aide Memoir for the internal investigation was that she had collated the information for the SPOE but did not complete it due to time pressures. For reasons outlined in paragraph 26, the Panel did not accept this explanation.

35. SU2 - Proven

The HCPC’s case is that the Registrant ought to have made a referral within two weeks of 6 December 2016. The Registrant had completed a draft SPOE referral on 6 December 2016. The SPOE referral was not made until 3 April 2017 by the Registrant’s Line Manager. The Registrant in her Aide Memoir appeared to accept that she ought to have sent the referral but was unable to do so due to the fact that she had a backlog of referrals and her poor IT skills. The Panel considered that the level of IT skills required of the Registrant was basic, and she ought to have been able to do this.

36. SU4 - Proven

The Panel found that the need to make a referral for SU4 arose on 20 February 2017. The Panel is satisfied that the Registrant completed a draft SPOE referral at this point. The referral was not completed until 27 April 2017 after the Registrant was spoken to by her Line Manager. This was a delay of 8 weeks. The Panel found that this referral had not been made in a timely manner.

37. SU5 - Proven

The Panel found that the Registrant documented the need to complete an SPOE referral form for SU5 on 14 March 2017. The Registrant did not complete the referral. On 17 May 2017 SU5 was seen by another SLT who made the decision that an SPOE referral was not necessary. The Panel found that a referral should have been made by the Registrant within two weeks of 14 March 2017 so was not therefore done in a timely manner.

38. SU6 - Proven

The Panel found a referral should have been made within two weeks of 24 January 2017. By 26 April 2017 the Registrant had still not made the referral which then had to be actioned by

another SLT.

39. SU7 - Proven

The Panel found that a referral ought to have been made within 2 weeks of 11 October 2016. The Registrant failed to make the referral at all and it was completed by a Health Visitor on 19 June 2017.

40. SU8 - Proven

The Panel found that the Registrant ought to have made a referral within two weeks of 18 January 2017. The Panel found that Registrant failed to make a referral at all as it was completed by the Health Visitor on 23 March 2017.

41. SU9 - Not Proven

The Panel considered SU9’s clinical notes of 21 September 2016 which indicated that the Registrant had an intention possibly to refer. SU9 was not reviewed and a referral was not sent. The Panel did not find that there was sufficient evidence to show that the Registrant had or ought to have made a clinical decision to refer SU9. Therefore, the obligation to make a referral in a timely manner had not arisen.

42. SU39 - Not Proven

The HCPC’s case is that the Registrant ought to have identified the need for a referral to a Paediatric Dysphagia SLT. This referral was not made until 11 May 2017 by a different SLT. The Panel studied the case notes which made reference to choking but was not satisfied that this demonstrated that there was a requirement to make an onward referral.

2.Undertake and/or record school visits in a timely manner for the service users set out in Schedule B.

43. The Panel heard evidence from LC that visiting the service users at school allows SLTs to observe the impact of a child’s difficulties in their education, and therefore build a full picture of their needs. It also provides an opportunity for the SLT to provide information that will assist other professionals in their management of the child. The Panel accepted that school visits are necessary and important to enable service users to receive appropriate help. The Panel found that school visits are standard practice for SLTs and the Registrant would be aware of the need to schedule and complete school visits as required.

44. SU11 – Proven

The clinical notes indicate that the Registrant would arrange a school visit for SU 11 on return from her annual leave in November 2016. The Panel was satisfied, having heard the evidence and viewed the clinical notes, that there was no record on file of this having been done. The Registrant said she had insufficient time to complete this task. Having considered the analysis outlined in paragraph 26, of the administration time available to the Registrant, the Panel did not accept her explanation.

45. SU12 - Not Proven

The Panel noted, having carefully examined the papers that there was no record in the clinical notes of a school visit having taken place. However, the Panel was not satisfied having heard the evidence and viewed the clinical notes that the Registrant had contemplated or was required to make a school visit

46. SU13 – Proven

The Panel read the clinical record completed by the Registrant dated 29 September 2016 “…agreed with mother that I would contact the school.” There was a further record on 14 December 2016 that stated that the Registrant had attempted to contact the school on that date but there was no record that the Registrant attempted to make contact again. The Panel found that even the attempt that was made was not made in a timely manner and ought to have been followed up.

47. SU14 – Proven

The Panel viewed the clinical notes which showed that on 2 March 2017 the Registrant had recorded the need to make a school visit. There was no record in the clinical notes showing that Registrant had arranged or made a school visit. The Registrant was on sick leave from 29 March 2017. The Panel found that there was sufficient time for the Registrant to have arranged a visit prior 29 March 2017.

48. SU15 – Proven

The Registrant had obtained consent to contact SU15’s school on 9 March 2017 but there was no record in the clinical notes of a visit or contact with school. During the internal investigation the Registrant explained that due to poor school attendance of the service user a school visit would not have been beneficial. The Panel found that, as the registrant had obtained consent to visit she would have felt that a visit should take place, and therefore the Panel did not accept the Registrant’s reason for not doing so.

49. SU16 – Not Proven

The HCPC’s case is that a school visit ought to have been arranged within 2-3 weeks of 20 March 2017. The Panel viewed the clinical notes showing that a visit had been intended after 20 March 2017 and there is no evidence of any contact being made. The Panel noted that the Registrant was on sick leave from 29 March 2017 so found that the Registrant did not have sufficient time to arrange a visit. Neither was the Panel satisfied that the clinical records they were shown related to SU 16 as the case notes were unnamed and there were no identifying details.

50. SU17 – Not Proven

The Panel considered clinical notes dated 24 April 2017 that according to HCPC related to SU17. These notes set out that the Registrant intended to organise a school visit and draw up work to take to the school. The Panel considered that the Registrant was placed on administrative duties on 24 April 2017 and therefore had insufficient time to have reasonably been expected to organise a visit in a timely manner. The Panel was not satisfied that the clinical records they were shown related to SU 17 as the case notes had no identification on them.

51. SU18 – Not Proven

The Panel viewed the 16 March 2017 entry in SU 18’s clinical notes that recorded that the Registrant was going to contact the school and make up a package of work. The Registrant was on sick leave from 29 March 2017. There is a further note in the records on 11 April 2017 that the Registrant was on sick leave and could not arrange a school visit. The Panel was not satisfied that the Registrant had the opportunity to arrange a school visit in a timely manner. The Panel was not satisfied that the clinical records they were shown related to SU18 as the case notes had no identification on them.

52. SU19 – Proven

The case notes record that a need for a school visit was identified on 29 September 2016 but the school visit was not completed until 9 February 2017. The Panel was satisfied that the clinical records they were shown related to this service user. The Panel was satisfied that the Registrant had not arranged a visit in a timely manner.

3.Transfer service users to the appropriate services in a timely manner or at all, for the service users set out in Schedule C.

53. The Panel was told that the Registrant would have been required to transfer a child to another service if additional needs are identified (i.e., autism, learning disability etc.) that would be better dealt with by another service. The Panel accepted that the Registrant would be aware of these expectations.

54. SU1 - Proven

The clinical notes show that on 30 November 2016 an onward transfer for the ASD Clinic was discussed by the Registrant. During the investigatory process, the Registrant explained that she was “unaware that in the community service once a child received a diagnosis of ASD the child should have been referred to the ASD services”. The Panel found that the clinical records state the need for a referral and gave a date for it. This transfer was completed by a Band 7 SLT on 10 April 2017. The Panel was satisfied that that the clinical record they had seen referred to the Service User 1. The Panel also expected the Registrant to be aware of the need to make a referral and she had failed to make the transfer.

55. SU2 - Proven

On 6 December 2016 the Registrant documented a plan to complete an onward referral. This was not done. On 6 April 2017 the Assistant SLT Manager Jane McConn completed the transfer. During the internal investigation the Registrant stated that she was not clinically qualified to express an opinion on a transfer to the Pre School Special Needs team (PSN). The Registrant said she had not had induction training that explained the role of the community Pre-School Special Needs Team. (PSN). The Panel was satisfied that this explanation was not relevant to the allegation as the Registrant had already identified the need for an onward transfer. Therefore, the Panel was satisfied that Registrant had not completed the referral in a timely manner or at all.

56. SU52 – Not Proven

The case note for 28 March 2017 indicates that the Registrant was advised by Patrice PM that the Service User should be transferred to the PSN team. The Registrant went on sick leave on 30 March 2017 therefore she did not have sufficient time to make the transfer. The Service User was transferred by another SLT on 3 May 2017.

57. SU20 - Not Proven

The HCPC’s case is that there was a requirement to transfer the Service User to the PSN within a reasonable time after 27 January 2017. The Panel took the view that this is a clinical decision. The case notes showed that the Registrant made an SPOE referral for the PSN. The transfer to PSN was completed on 27 April 2017 by another SLT. The Panel did not find that there was sufficient evidence before them to show that the Registrant needed to make a PSN transfer, and that the decision to do so was a matter of clinical opinion.

58. SU21 - Not Proven

The HCPC’s case is that there was a requirement to transfer the Service user to a Band 5 SLT because they did not require the Registrant’s level of expertise. No transfer was completed. The Panel took the view that this was a management decision rather than a clinical decision and that there was no clinical risk to the Service User. The Panel is not satisfied on the balance of probabilities that the requirement to transfer the service user arose.

59. SU8 - Proven

The HCPC’s case is that there was a requirement to transfer the service user to the PSN team within two weeks of 18 January 2017 because of SU8’s significant needs. In the case notes the Registrant set out her management plan on 12 January 2017 to refer the service user onwards via SPOE. In her note on 8 March 2017 it was still the Registrant’s plan to complete the referral. The transfer to the PSN was completed on 3 May 2017 by another SLT. Therefore, the Panel found on the evidence presented to it that there was a requirement to transfer the service user which should have been completed within two weeks of 18 January 2017.

60. SU22 - Proven

The HCPC’s case is that there was a requirement to transfer the Service User to the ASD team within two weeks of 23 January 2016 when the parents reported an autism diagnosis. The Registrant confirmed the diagnosis of ASD in the case notes. On 26 April 2017 the service user’s mother was informed that they were being moved to the ASD service. The Transfer was not completed until prompted by Jane McConn on 24 April 2017. This transfer was not completed in a timely manner. The Panel found that the Registrant was aware of the need to transfer the service user but did not do so in a timely manner.

61. SU23 - Not Proven

The HCPC’s case is that the service user ought to have been transferred to a more generalist community caseload and that the transfer was competed by another SLT. The Panel took the view that this was a management decision rather than a clinical decision and that there was no risk to the Service User. The Registrant took the decision not to transfer. The Panel did not find that the HCPC had proven their case that her decision was unreasonable.

62. SU24 - Not Proven

The HCPC’s case is that the Registrant ought to have transferred the Service User to the PSN within 2 weeks of 14 December 2016 due to their significant needs. The Transfer was completed in May 2017 by a different SLT. This was a service user with complex needs and the Registrant had sought reports for the service user and planned a review in four months. The Panel took the view that the Registrant had taken a clinical decision to manage the child in this way and did not find that the evidence supported the allegation that there was a clinical need to transfer the service user.

63. SU25 - Not Proven

The HCPC’s case is that this service user did not require the Registrant’s expertise so should have been transferred to a lower Band 5 SLT and that the Registrant should have recognised this on 9 August 2016. The Registrant continued to see the service user until December 2016. The Panel took the view that this was a management decision rather than a clinical decision and that there was no risk to the Service User. The Panel found that there was insufficient evidence to conclude that the Registrant should have undertaken this transfer

4.Record appointments and/or updates on the clinical database for the service users set out in Schedule D.

64. The Panel accepted that the clinical database is a collection of spread sheets that contain each individual clinicians caseload and that SLTs are responsible for updating these daily. The Registrant suggested that she had been unable to update the database due to being locked out by other SLTs. Evidence supplied by PM was that whilst it is possible for this to happen, a maximum of three SLTs had access to the database, so this would have only inconvenienced the Registrant for a matter of minutes. It was also open to the Registrant to email or phone the person using the database to ask them to end their session. Therefore, the Panel did not accept the Registrant’s explanation.

65. SU26 – Proven

This service user was last seen by the Registrant on 30 November 2016. The HCPC’s case was that a further appointment should have been recorded but there were no further entries in the records. The Panel accepted that a review ought to have been recorded and therefore found this allegation proved.

66. SU6 – Proven

The HCPC’s case is that SU6 was last seen by Registrant on 24 January 2017 when the database was checked the Service User still had January listed as the next appointment. This shows that the database was not updated after the 24 January appointment. Having considered the evidence the Panel accepts this.

67. SU50 – Proven

This service user was last seen on 30 November 2016 when the decision was taken that they should be seen again by the Registrant in three months. The HCPC’s case is that the Registrant should have updated the database to reflect a review in February 2017. The Panel accepts that this was not done.

68. SU20 – Proven

The Service User was seen by the Registrant on 8 February 2017. When she reviewed the case file an appointment was required on 8 February 2017 but none had been entered on the database. The Panel accepted Mrs PM’s evidence on this point and found this allegation proven.

69. SU27 – Proven

SU 27 was seeing the Registrant for a block of Therapy which ended on 21 September 2016 and then needed to go into the cohort for the next block of therapy. The Panel accepted Mrs PM’s evidence that the clinical database was not updated with this information.

70. SU28 – Proven

The Registrant had recorded in the case notes that this service user required another appointment in February 2017. The Panel accept Mrs PM’s evidence that the clinical database was not updated with this information and the service user did not receive a February appointment.

71. SU5 - Proven

Service User 5 last saw the Registrant in March when she had agreed to refer her to SPOE. The Panel accepted PM’s evidence that the clinical database had not been updated to reflect this.

72. SU29 - Proven

Service User 29 was seen by the Registrant for a block of therapy that ended on 26 October 2016. The Panel accepted that the next block of therapy was not commenced until May 2017. The Panel accepted evidence that it had not been recorded in the database.

73. SU8 – Not Proven

The Panel was told that the Registrant had updated the database to say that Service User 8 require a review but the month had not been added. The Panel accepted this evidence but found that the database had been updated and that the omission of a date had been a clerical error by the Registrant. Therefore the Panel did not find this proven.

74. SU7 – Proven

This service user last saw the Registrant in September 2016. An appointment to SPOE was required in October 2016. The Panel accepted the evidence that it had not been recorded on the clinical database and that no appointment had been sent.

75. SU9 Proven

Service User 9 was seen on 21 September 2016. The Panel found that the database should have updated to show when Service User 9 needed to be seen again. This was not done.

76. SU30 – Proven

The Panel accepted that the database should have been updated by the Registrant to indicate that a review in January 2017 was required, The Panel found that this was not done.

77. SU16 – Proven

The HCPC’s case is that this service user required a school visit which should have been entered into the clinical database by the Registrant. The Panel, on the evidence presented to it, found that this was not done.

78. SU31 – Proven

The Panel found that Service User 31 was seen for an initial appointment on 13 December 2016 and the Registrant documented in a case note that she would see him again in January 2017. The Panel found that the database ought to have been updated to reflect this and was not.

79. SU: 32 – Proven

Service User 32 was seen on 21 September 2016 and was due for a review appointment in November 2016. The Panel found that the clinical database was not updated with this information and ought to have been.

5.Discharge service users in a timely manner or at all for the service users set out in Schedule E.

80. The Panel considered the Trust’s procedure for patient discharge which it accepted the Registrant ought to have been aware of. A service user may be discharged if their speech and language skills progress to where they are within normal limits and for non-attendance. The Panel accepted that service users that have not been discharged continue to attend appointments which is an ineffective use of clinical time that could be used to benefit another child. The Panel noted that this issue had been brought to the Registrant’s attention as part of a previous capability process.

81. SU: 33 – Not Proven

The HCPC’s case is that the Registrant ought to have discharged SU 33 on 18 May 2016 because her speech and language skills were within normal limits. The case note from 18 May 2016 sets out that neither the service user’s parents or the Registrant had any concerns. The Registrant scheduled a six month appointment. The service user was discharged on 21 June 1017 by another SLT. The Panel did not find that it had sufficient evidence to determine that the Registrant had made an inappropriate clinical decision

82. SU: 34 – Not Proven

The HCPC’s case is that SU 34 should have been discharged on 15 February 2017 because her speech and language skills were within normal limits. The Registrant made a clinical decision that the child should be reviewed. The Panel did not find that it had sufficient evidence to determine that the Registrant had made an inappropriate clinical decision.

83. SU: 35 - Not Proven

The case note for 1 March 2017 states that the child’s speech and language were within normal limits. Therefore, Service User 35 should have been discharged at this time. However, the Registrant planned a review at age three. The Panel did not find that it had sufficient evidence to determine that the Registrant had made an inappropriate clinical decision

84. SU: 36 - Not Proven

The HCPC’s case is that this Service User ought to have been discharged in 29 June 2016 and was not in fact discharged until 11 September 2017 by another SLT. The Panel did not find that it had sufficient evidence to determine that the Registrant had made an inappropriate clinical decision.

85. SU: 37 - Not Proven

The HCPC’s case is that service user ought to have been discharged in October 2016 but was not discharged until 22 August 2017 by another SLT. The Panel did not find that it had sufficient evidence to determine that the Registrant had made an inappropriate clinical decision.

86. SU: 38 – Not Proven

The HCPC’s case is that this service user ought to have been discharged after one non-attendance. Instead, the Registrant spoke to the child’s mother who said she had been unwell and the service user remained with the service. In this particular instance the Panel took the view that there was insufficient evidence in the case notes to suggest that the Registrant had made an inappropriate clinical decision.

6.Liaise adequately with other professionals and/or record this contact for the service users set out in Schedule F.

87. The Panel found that the Registrant was a Band 8a because she had special skills she dealt with more complex cases which often required multidisciplinary intervention. It is important that professionals share information to inform clinical practice and enable professionals to make any adaptations to their service that might be required. The Panel was satisfied by reference to the Trust’s policies and the Registrant’s experience that she knew or ought to have known of this expectation.

88. SU: 38 – Proven

The HCPC’s case is that the Service User was under the care of the Educational Psychologist and the Joint Cleft Palate Clinic (JCPC). There is no record in the clinical notes of the Registrant making contact with ether professional when she ought to have done. It was clear from the notes that the service user’s mother brought to the Registrant’s attention the fact that she had a problem with the Educational Psychologist’s. Despite repeated concerns expressed by the mother no contact was made. The Panel determined that contact ought to have been made with these professionals.

89. SU: 10 – Not Proven

The HCPC’s case is that this service user was at high risk due to frequently choking and required liaison with the Paediatric Dysphagia SLT service. The referral was not made until 11 May 2017 after the file has been transferred to another Band 7 SLT. The Panel found that there was insufficient evidence to support the allegation. The Panel note that the case notes these have been heavily redacted and the Panel were unable to determine that this was not done when it ought to have been.

90. SU: 40 – Proven

The HCPC’s case is that this service user was being seen by a private SLT as recorded in the case notes on 28 August 2016. The Registrant recorded on 14 February 2017 that she needed to contact the private SLT and there is no evidence in the case notes that this was done. The Panel determined that liaison ought to have taken place.

91. SU: 32 – Proven

The HCPC’s case is that the Registrant ought to have liaised with Great Ormond Street Hospital (GOSH) after 29 June 2016. The Panel determined that there is a further note on 14 September 2016 to contact GOSH. There was no evidence that this was done when it ought to have been.

92. SU: 41 – Proven

The service user was first seen on 28 February 2017. The HCPC’s case is that the Registrant ought to have liaised with Additional Support for Children in Education Team (ASCET). There is no evidence of contact. The Registrant recorded the decision on 21 March 2017 to contact school. This could have been done before the Registrant commenced her sick leave.

93. SU: 9 – Proven

The Registrant recorded that on or after 21 September 2016 it was necessary to discuss the case with SLT colleagues and potentially refer to SPOE. By April 2017 a file review noted that the Registrant needed to contact parents. In September 2016 there was no evidence in the notes of any contact with professionals. There was no evidence of any liaison with the PSN team. Therefore the Panel found this proven.

94. SU: 22 - Proven

The HCPC’s case is that the Registrant ought to have liaised with the ASD Service and there was no evidence of any contact. On 23 January 2017 the diagnosis of ASD was confirmed. By 26 April there was nothing in the case notes to show any liaison with the ASD service. Therefore the Panel found this proven.

7.Maintain and/or record adequate contact with the parents of service users set out in Schedule G.

95. The Panel found that there are no policies that outline expectations in relation to adequate parent contact but accepted oral evidence that this is inherent in SLT clinical practice. As a senior SLT with extensive experience the Panel would have expected the Registrant to have been aware of the role of parents and the importance of maintaining contact with them. The Panel accepted LC’s evidence that there was an expectation that parents should be contacted within a week of them leaving a message.

96. SU: 6 – Proven

On 4 January 2017 there was a note of contact with SU6’s parent and then on 10 March 2017 there was an email requesting contact as mother had checked on aspects of treatment. There was no evidence of contact being made. The Panel found this call should have been returned within approximately a week and was not.

97. SU: 40 – Proven

SU 40’s mother telephoned on 10 January 2017 to say she was expecting another appointment for her child. The case note stated that mother was “not happy” and required a return call. The call was not returned until 9 February 2017. The Panel determined that this was not adequate contact.

98. SU: 3 - Proven

The HCPC’s case is that parents’ attempts to contact the registrant on numerous occasions following the initial appointment in October 2016. The Registrant did not return her call until 22 February 2017 which resulted in an informal complaint. The Panel determined that the Registrant had not maintained adequate contact.

99. SU: 1 - Proven

An email was received by the 15 February 2017 from the family support worker and the parents left on 23 March 2017 and 24 March 2017. HCPC case this resulted in a formal complaint (Exhibit 1 App 2). The Panel were satisfied that there is no record of any contact by the Registrant.

100. SU: 43 – Proven

The HCPC’s case is that after the Registrant had tried unsuccessfully to contact the parents on 6 February 2017 but there was no further attempt to contact them. The Panel determined that this was not adequate contact.

8.Complete and/or record second opinions in a timely manner or at all for the service users set out in Schedule H.

101. The Panel determined that the Registrant was expected to advise the more junior SLTs on the management of the case by way of providing a second opinion. The Trust’s second opinion procedure was available to the Registrant, and having provided other second opinions the Panel was of the view that the Registrant would be conversant with the procedure and she ought to have been aware of it. The Panel was satisfied that this issue had been raised previously with the Registrant.

102. SU: 44 - Proven

The HCPC’s case is that a second opinion was sought from the Registrant on 5 December 2016 but she did not arrange an appointment until 16 weeks later on 27 March 2017. There was no information in the clinical records to show the reason for that delay. The Panel found that this had not been completed in a timely manner.

103. SU:45 - Proven

HCPC’s case is that an SLT sent an email to the Registrant to request a second opinion on 23 December 2016. However, the Registrant did not see the Service User until 28 March 2017, over three months later, which would have significantly delayed the service user’s treatment. The Panel determined that this had not been completed in a timely manner.

104. SU: 49 - Not Proven

The HCPC’s case is that it was recorded in the case notes that on 14 March 2017 the Registrant would provide a second opinion. On 27 April 2017 the Registrant emailed her line manager, Jane McConn to inform her this was still outstanding. The Panel noted that the Registrant went on sick leave on 29 March 2017 and then on restricted duties from 24 April 2017. The Panel determined that it was not reasonable for her to have conducted this second opinion within this time frame.

105. SU: 42 – Proven

A second opinion was sought from the Registrant on 14 November 2016. The Panel accepted LC’s evidence that there was no second opinion recorded. Therefore the Panel found this allegation proven.

9. Carry out and/or record reviews appointments in a timely manner or at all for the service users set out in Schedule I.

106. The Panel determined that the Registrant would be expected to arrange a review appointment with service users to see if progress had been made with the homework and/or therapy. The Registrant should use her clinical judgment to decide the timeframe for review appointments. It should specify when the next review should be for the child. The Registrant, with her extensive experience, should have been aware of the expectation upon her in this regard.

107. SU:46 - Proven

The HCPC’s case is that this service user was transferred to the Registrant on 15 November 2016 and a review was required. The service user was not reviewed until July 2017 by another SLT. The Panel determined that the Review ought to have been done by the Registrant.

108. SU:9 - Proven

The HCPC’s case is that on 21 September 2016 the case notes indicate there are problems the Registrant needs to discuss with others. The next record is not until the April 2017 file review. The Panel determined that there ought to have been a review before the lapse of six months.

109. SU:30 - Proven

The HCPC case is that on 7 December 2016 the Registrant wrote “SLT to contact mother in the new year to set up at least one further appointment to determine SLT’s future role in this case”. The review was carried out on 28 May 2017 by another SLT. The Panel determined that the Registrant ought to have conducted this review.

110. SU: 53 - Proven

The HCPC’s case is that the Registrant should have carried out a review in early 2017 and that she failed to arrange the review. The Panel considered the clinical notes from 20 December 2016 which indicated that a review was necessary in the new year to discuss future management. The Panel accepted that a review was necessary and was not made.

111. SU:31 - Proven

The HCPC’s case is that there ought to have been a review by Christmas 2016 and that the Registrant failed to arrange the appointment. The Panel determined that on 13 December 2016 the clinical note records that the Registrant will contact the SU after Christmas and there is no evidence of any further contact until May 2017 which was by another SLT.

112. SU:32 - Not Proven

HCPC’s case is that there should have been a review in November 2016 but there was no appointment. The Panel considered the case notes and found that there was no date to indicate how long before the end of November the Registrant had decided to carry out the review. The only note the panel saw, was not dated in a way that they could be satisfied when it was written. Therefore, the Panel did not find that there was sufficient evidence to support that the Registrant had not carried out a review.

10.Arrange and/or record appointments in a timely manner or at all for the service users set out in Schedule J.

113. The Panel accepted that it would be part of clinical practice that if a further appointment was required it would be reasonable for the SLT to make and record arrangements for this appointment within 2 weeks.

114. SU: 3 - Proven

On 18 October 2016 the Registrant undertook to make an arrangement for the next block of therapy for this service user. The Registrant only contacted the service user’s mother on 22 February 2017 and no appointment was made until March 2017. The Panel determined that this was not timely.

115. SU:12 - Proven

This service user was referred to the Registrant on 12 November 2016. The appointment was only scheduled following contact from the child’s parent on 24 January 2014 and the child was eventually seen on 15 February 2017. This is a delay of four months. The Panel determined that this was not arranged in a timely manner.

116. SU:13 - Not Proven

The HCPC’s case is that following an appointment in August 2016 this service user ought to have been seen in the February 2017 cohort of service users. The Panel considered the case notes and the evidence given by LC but determined that there was insufficient information for them to establish when the next appointment should have been made.

117. SU: 19 - Not Proven

The HCPC’s case is that this service user ought to have been seen in the February 2017 cohort of service users. The Panel considered the case notes and the evidence given by LC but determined that there was insufficient evidence to determine when the appointment ought to have been made as there was no information as to when the appropriate 8 week treatment cohort to which service user was attached was in operation.

118. SU:11 – Proven

The Service user was seen at the end of October 2016. An email dated the 15 March 2017 stated that no further contact or appointment had been made since then. The Panel therefore determined that this had not been arranged in a timely manner.

119. SU:47 - Proven

The Panel identified a case note requiring the Registrant to arrange an appointment in

January 2017. An appointment was not arranged until 3 April. The Panel determined that this was not arranged in a timely manner.

120. SU:51 - Proven

The HCPC’s case is that this service user should have been seen for therapy in February 2017 following their initial appointment on 8 August 2016. The Panel could identify that an appointment was sent out on 28 March 2017 for 3 April 2017. The Panel accepted that the SU should have been seen in a timely manner which should have been February and the appointment was two months outside this.

121. SU:32 - Not Proven

There was a note to see the service user at the end of November 2016 but no appointment was ever arranged. The Panel was concerned that it had seen limited documentation for the period between November and the review conducted on 18 May 2017. Therefore the Panel was not satisfied that this allegation had been proven.

122. SU:48 - Not Proven

The HCPC’s case is that following the initial appointment on 28 September 2016 there was an expectation that the Registrant would arrange a review. The Panel had considered the case notes that had been provided to it and found that these were insufficient for it to determine with any confidence when any such review should have taken place. The Panel could not conclude that there had been a delay in making an appointment.

11.Appropriately store the case files of approximately 48 children, in that you stored them at your home. - Proven

123. The Panel heard evidence that SLTs were permitted to take case files home with them on occasion because they worked across multiple sites and were not expected to call into the office at the end of their shifts. However, the expectation was that this would not be more than two or three files and that these should only be taken for a brief period of two to three days and only for operational necessity.

124. The Registrant accepted that she had 48 files at her home, and that these had been in her possession for a number of weeks. However, her position during the Trust investigation was that she had removed them for file reviews or for the completion of information for Quarterly Returns. Additionally, in her statement for the disciplinary hearing she stated that a Tracer card when and where available, or a notation sheet, where a Tracer card was unavailable, was completed, clearly identifying that the file was in her possession.

125. The Panel determined that there was no credible reason given as to why this number of files should be kept at the Registrant’s home for these lengths of time. The Panel took notice of its professional expertise and experience, and that of both witnesses, and determined that this was a highly unusual situation and that it was inappropriate that service users’ confidential information had been handled in that way. It found that these files should not have been taken and kept at home for such lengthy periods of time. Further, the Panel noted the evidence that some form of Tracer information had not been provided for some of the files, and that in some cases the Tracer information had been provided in a non-standard way that would make it more difficult for the location of the file to be determined. This would further limit access to the file held by the Registrant by other professionals involved in the care of management of the service users at several locations. The Panel also noted from the evidence before it that the Registrant did not know how many files she had at home and that they were eventually returned in a hap hazard manner. Notwithstanding the reasons given by the Registrant, the Panel determined that the sequestering of such a large number of files for any period was so far removed from the accepted informal policy that it was necessarily inconsistent with it.

Decision On Grounds

126. The HCPC submitted that the Registrant’s conduct was such that the Panel could be satisfied that the statutory grounds of lack of competence/and or misconduct are made out on the allegations found proven.

127. The Panel accepted the advice given by the Legal Assessor. The panel also took note of the cases of Holton v GMC [2006] EWHC 2960 and Calhaem v GMC [2007] EWHC 2606 (Admin). The Panel considered the definition of misconduct as given in Roylance v GMC (No 2) [1999] UKPC 16.

65. ‘Misconduct is a word of general effect involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner in the particular circumstances.’

128. The Panel took into account the fact that the Registrant’s entire caseload had been examined and there were numerous failings across a significant number of service users.

129. The Panel determined that the Registrant had breached the following standards of the HCPC Standards of Conduct, Performance and Ethics (2016):

a. Standard 2.5 You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers;

b. Standard 2.6 You must share relevant information, where appropriate, with colleagues involved in the care, treatment or other services provided to a service user;

c. Standard 10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to;

d. Standard 10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services; and

e. Standard 10.3 You must keep records secure by protecting them from loss, damage or inappropriate access.

130. The Panel also found there had been a breach of the HCPC Standards of Proficiency for Speech and Language Therapists (2014) in particular:

a. Standard 1.2 recognise the need to manage their own workload and resources effectively and be able to practise accordingly;

b. Standard 4.5 be able to make and receive appropriate referrals;

c. Standard 10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines; and,

d. Standard 10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.

131. These were in addition to the breaches of Trust policies which the Panel has already made findings about.

132. The Panel considered whether the failings amounted to lack of competence. It considered that as a band 8a the Registrant had significant skills, knowledge and experience to bring to her role. She had worked in the same organisation for over 20 years and therefore she would be aware of the procedures and policies that were in operation. There have been several iterations, as highlighted by the Registrant, of the organisation before it was renamed the South Eastern Health and Social Care Trust in 2007.

133. There was an expectation that the Registrant would be self-reflexive in her practice and ought to have recognised that there were significant problems in what she was doing. The nature of tasks that were subject to the allegations involved competencies that a much lower band of SLT would be expected to have developed. The Panel found that these competencies were embedded in the Registrant’s training.

134. Therefore, the Panel determined that the Registrant had fallen well short of the standard expected of her to the extent that the failings were so serious they could be considered deplorable. For these reasons the Panel found that the failings went beyond lack of competence. The Panel was satisfied that her standards fell well short of the rules and standards ordinarily required to be followed by a practitioner such that they individually and collectively amounted to misconduct.

Decision on Impairment

135. At the resumed hearing the Registrant attended and was given time overnight to prepare written submissions to address the Panel on impairment. The Registrant provided her submissions and answered the Panel’s questions. The Panel also heard submissions from Miss Woolfson on behalf of the HCPC.

136. Having determined that the Registrant's actions amounted to misconduct in respect of the facts found proved, the Panel went on to consider whether her fitness to practise was currently impaired as a consequence of misconduct.

137. The Panel heard and accepted the advice of the Legal Assessor. It had regard to the HCPC's Practice Note on impairment, and in particular the two aspects of impairment, namely the ‘personal component’ and the ‘public component’, based on the case of Cohen v GMC [2008] EWHC 581 (Admin). The Panel was aware that what has to be determined is current impairment, that is looking forward from today.

138. The Panel also had regard to the criteria that were set out by Dame Janet Smith in the Fifth Shipman Report, namely whether our findings of fact in respect of the Registrant’s misconduct show that her fitness to practise is impaired in the sense that she has put service users at risk, or is liable to do so in the future, whether she has brought her profession into disrepute or may do so in the future, and whether she has breached the fundamental tenets of her profession or may do so in the future. There was no need to consider whether she has acted dishonestly because this is not such a case.

139. In relation to remediation, the Panel firstly considered whether the Registrant’s misconduct was capable of remediation. The Panel considered in particular that her misconduct related to administrative functions and a failure to manage her workload but not her clinical decision making. In particular, relating to timely record keeping, making prompt onward referrals, liaising with professionals and parents, inappropriate storage of files and failing to manage her workload. The Panel considered that the misconduct was capable of remediation.

140. The Panel next considered whether the Registrant had taken remedial action to address her misconduct.

141. It noted that she has not been working since she left the Trust in 2017. It took into account the difficulties caused by the Pandemic for attendance at in person training or conferences. The Panel took account of the fact that the Registrant told it that she had been keeping up to date with clinical developments. But the Registrant had not provided details of any training courses she had identified or undertaken that would address the concerns raised such as time management and GDPR training.

142. The Registrant placed weight on the fact that it was the circumstances she found herself in that contributed to the misconduct but noted that the Registrant’s solution was to avoid working for the NHS and work in private practice so that she was in charge of her own workload and could manage the pressures of work herself. The Panel found that this lacked such detail so as to be unrealistic. The Registrant has not given the Panel any workable solutions for how she would recognise when pressures arose or what she would do if she found herself in a similarly pressured environment to avoid the situation reoccurring.

143. The Panel found that the Registrant lacked insight as to the effect of her actions on other professionals or service users. She rather sought to place the blame for it on the situation she was in. The Panel did take into account the fact that the Registrant had no other fitness to practise proceedings during her career.

144. In these circumstances the Panel was not satisfied that she demonstrated an ability to recognise or respond to issues that might arise with her practice. The Panel concluded that it did not have evidence to demonstrate that the Registrant had remediated her misconduct.

145. The Panel further noted that there would be no oversight of the Registrant in her proposed working environment. She had not provided the Panel with any workable measures to show how her practice would be managed.

146. In the absence of fully developed insight and remediation, the Panel concluded that there remained a high risk of repetition, which in turn exposed patients to a risk of harm. Those risks could be significant given the fact that the Registrant proposes to work with children who are developing quickly and any delay can impact their ability to access education and function in society.

147. The Panel acknowledged that the Registrant had not set out to cause harm, but the failings occurred over a period of almost 12 months and affected a number of service users who were vulnerable by reason not just of their age but by the complexity of their needs.

148. In all the circumstances, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the personal component.

149. In relation to the public component, the Panel was of the view that members of the public need to have confidence that Paediatric Speech and Language Therapists are able to act in a timely manner to seek the appropriate treatment for young children. The Public would also expect that sensitive confidential information about young service users and their family would be stored in a secure manner. The Panel concluded that public confidence in the profession would be undermined if no finding of current impairment were made in the particular circumstances of this case.

150. Accordingly, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the public component.

Decision

151. Having determined that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on her registration. The Panel took account of the submissions of Miss Woolfson on behalf of the HCPC. It also had regard to all the evidence it had heard, and all of the material previously before it.

152. The Panel heard and accepted the advice of the Legal Assessor and it exercised its independent judgement. It bore in mind the Sanctions Policy (the Policy) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to punish but to protect members of the public and to safeguard the public interest, which includes upholding professional standards within the profession, together with maintaining public confidence in the profession. It therefore understood that it must impose the least restrictive sanction to address those risks which it had identified.

153. The Panel took into account the following mitigating circumstances that the Registrant has had a long career of safe and successful practice. The Registrant was suffering from ill health at the time but she has recovered. The Panel also considered the following aggravating factors that the Registrant had limited evidence as to insight and no evidence of remediation.

154. In light of the Panel’s conclusions that there was a risk of repetition, which in turn posed a potential risk of harm to patients, the Panel did not consider that the options of taking no further action or mediation were appropriate to protect the public or to safeguard the wider public interest. The Panel bore in mind that neither option would restrict the Registrant’s practice, and so neither option was sufficient to protect against the risk of repetition identified or to maintain public confidence in the profession.

155. The Panel next considered a Caution Order, and bore in mind that such an Order would not restrict the Registrant’s practice and so would not protect the public or the wider public interest. In addition, the Panel had regard to paragraph 101 of the Sanctions Policy and did not consider that any of the factors which might indicate that a Caution Order was appropriate were applicable in this case. In particular, the Panel considered that the misconduct was serious and wide-ranging with a consequent risk of harm to patients; there was a risk of repetition; the Registrant had not shown a ‘good level of insight’; and she had not provided evidence of appropriate remediation.

156. The Panel next considered whether the imposition of a Conditions of Practice Order was the appropriate and proportionate response in this case. The Panel noted its earlier observations that the misconduct was potentially remediable. The misconduct found did not relate to the Registrant’s clinical decision making. There are no persistent or general failures which would prevent the registrant from remediating the issues and, in the Panel’s view, realistic, appropriate conditions can be formulated.

157. The Registrant attended today and has notified the Panel that she is not currently in practice. She confirmed to the Panel that she will complete any courses or conditions that are put in place and the Panel is satisfied that she will comply with them.

158. The Panel is satisfied that the Registrant does not pose a risk of harm by being restricted in practice as it has identified the failings do not relate to her clinical decision making they relate to her administrative management of patients.

159. The Panel next considered whether a Suspension Order was the appropriate and proportionate response. It noted that a suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. It also noted that the Sanctions Policy identified that a Suspension Order was likely to be appropriate where there were serious concerns which could not reasonably be addressed by a Conditions of Practice Order.

160. As the Panel determined that Conditions of Practice were appropriate and the concerns were met by such an order. It determined that the suspension was too disproportionality high a sanction.

Order

Order: The Panel determined to impose a Conditions of Practice Order of 3 years. In the following terms:

1. Before undertaking any type of Speech and Language Therapy work you must:

a. satisfactorily complete a period of refresher training that complies with the HCPC return to practice requirements, such training to include courses on:

i. GDPR/confidentiality;

ii. Record keeping; and

b. forward a copy of your results/certificates of completion to the HCPC.

2. You must inform the following parties that your registration is subject to these conditions:

1. any organisation employing or contracting with you to undertake professional work;

2. any agency you are registered with or apply to be registered with (at the time of application); and

3. any prospective employer (at the time of your application).

3. You must promptly inform the HCPC if you take up any employment as a Speech and Language Therapist including setting up in private practice and/or any voluntary work.

4. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

5. Upon return to practice you should obtain a professional mentor who should be a Registered speech and language therapist. You should arrange to meet or speak with your mentor on a monthly basis and to review your case load with particular reference to its administrative management (i.e., referrals, transfer, discharge, record keeping, reviews, liaising with parents and professionals). After six months it is within the discretion of the Mentor to reduce to bimonthly mentoring sessions if no concerns had been identified.

6. You must maintain appropriate records of all contact with service users for whom you have a duty of care and make those records available for inspection at all reasonable times by any person authorised to act on behalf of the HCPC.

Given the wide ranging concerns, the fact that the Registrant has been out of practice for three years and the risk of repetition, the Panel considered that this length, the maximum, was required in order to protect the public and to safeguard the wider public interest.

Notes

Interim Order

The Panel makes an Interim Conditions of Practice Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

Hearing History

History of Hearings for Shirley A Munro

Date	Panel	Hearing type	Outcomes / Status
13/08/2024	Conduct and Competence Committee	Review Hearing	Hearing has not yet been held
12/08/2021	Conduct and Competence Committee	Final Hearing	Conditions of Practice
07/06/2021	Conduct and Competence Committee	Final Hearing	Adjourned part heard