Miss Deborah J Watson

Preliminary Matters

Application to Proceed in Private

1. Ms Welsh on behalf of the HCPC applied for parts of the hearing to be heard in private due to the potential inclusion of matters related to the Registrant’s private life. There was support for this application from Mr Oestreicher. Having accepted the advice of the Legal Assessor, and taken into account the HCPTS Practice Note Proceeding in Private, the Panel determined that parts of the hearing would be held in private session when matters relating to the health or private life of the Registrant were raised.

Background

2. The Registrant is an Occupational Therapist registered with the HCPC. During the period referred to in the Allegation, she was employed as a Band 6 Care Co-Ordinator Occupational Therapist by Leeds and York Partnership NHS Foundation Trust. From 1 October 2016, the Registrant was employed by Tees, Esk and Wear Valleys NHS Trust (“the Trust”) in a community setting.

3. Concerns arose in respect of the Registrant’s practice and a Performance Improvement Plan was implemented. The Registrant was moved to a role in a mental health ward, where she was subject to supervision. A further concern arose when the Registrant left a service user unaccompanied in a therapy suite. An investigation was undertaken, as a result of which further concerns about the Registrant’s practice were identified.

4. The Registrant referred herself to the HCPC on 20 October 2015. The Trust conducted a disciplinary hearing in March 2016 which resulted in the Registrant’s dismissal for gross misconduct.

5. The substantive HCPC Conduct and Competence Committee hearing took place on 11-13 December 2017. The Panel at that hearing found all the factual particulars of the Allegation proved and that the facts amounted to misconduct. The Panel found the Registrant’s fitness to practise impaired in relation to both the personal and public components of current impairment. The Panel determined to impose a Suspension Order for a period of 12 months.

1st Review: 7 December 2018

6. The Suspension Order was reviewed by a panel of the Conduct and Competence Committee at a hearing, which the Registrant attended and at which she was represented, on 7 December 2018. The Panel considered the guidance given by the substantive hearing panel as to information which a future review panel was likely to find helpful.

7. The Registrant presented information about actions she had taken since the Suspension Order was imposed. The first review panel considered information presented by the Registrant and heard oral evidence from her. She said she did not feel confident to return to her role and herself considered that her fitness to practise remained impaired.

8. The first review panel stated that it was impressed by the Registrant’s reflective statements and the development of her insight into the effect and consequences of her past failures in care. However, the review panel stated that it was not satisfied that the Registrant had demonstrated that she had applied her knowledge of theory to the specific failings identified at the substantive hearing. She admitted that there remained gaps in her knowledge and skills. In the view of the review panel, these gave rise to a risk of repetition which could potentially pose a risk to service users and undermine public confidence in the profession.

9. The Panel found that the Registrant’s fitness to practise remained impaired and determined to extend the Suspension Order for a further 12 months. This would allow the Registrant to demonstrate at the next review hearing that she had made sufficient progress in her professional development to return to practice as an Occupational Therapist.

2nd Review: 12 December 2019

10. The Suspension Order was reviewed by a panel of the Conduct and Competence Committee at a hearing, which the Registrant attended and at which she was represented, by Mr Oestreicher. The Panel heard from the Registrant. In closing submissions, Mr Oestreicher said that whilst the Registrant accepted that her fitness to practise remained impaired and he acknowledged that the Panel may decide that suspension continued to be necessary, he would ask the Panel to consider whether conditions of practice could be formulated which would allow her to work as an Occupational Therapist.

11. The Panel did find that the Registrant’s fitness to practise remained impaired. It indicated that it hoped to hear how the Registrant coped with making progress going forward by the time of the next review of the order. It determined to extend the Suspension Order for a further 12 months.

3rd review: 10 December 2020

12. The Registrant admitted that she was still impaired as although she had made some progress, she was not confident to take on her previous role. She needed more time to complete the activities that she had outlined in her plan for remediation.

13. The Panel was impressed by the reflection of the Registrant. She said that she did have an issue with confidence because she needed to undertake further study and thereafter consolidate her learning through practically applying it. The Panel concluded that members of the public would be concerned if the Registrant, who has admitted gaps in her skills and knowledge which pose a potential risk to the public, and who accepts that she remains impaired, were found not to be impaired. Public confidence in the profession and the regulatory process would be undermined. The Panel found that the Registrant’s fitness to practise was impaired on the grounds of public protection and the wider public interest.

Update

14. The Panel has been provided with information about what the Registrant has done since the last review. It has seen supervision case notes, further reflection and a reference from someone who has been helped by the Registrant in a professional capacity.

Decision

15. The Registrant gave evidence under affirmation. The Panel found that the Registrant made effort to answer questions put to her. While she sometimes struggled to respond immediately to questions, this appeared to be because she was reflecting on what had occurred in difficult situations and she did provide relevant information, and seemed to be forthcoming in so doing.

16. The Registrant told the Panel that she had undertaken a placement with the Leeds and York Partnership NHS Trust and a fulsome reference had been provided to the last Panel. She spoke about her attempts to undertake further education in continuing her professional development. She explained that she had both read texts and accessed formal learning, while consolidating this learning through undertaking work in a voluntary capacity where she worked with a service user with vulnerabilities. She was able to put her learning into practice in this way.

17. She said that she planned to look for further placements that she could undertake on a voluntary basis. She said that she would expand her search for different environments, in non-clinical posts. She would also look at paid employment via NHS websites if she was able to practise. She said that she felt ready to undertake paid work at this stage and that this would evidence her progress.

18. She said that her future continuing professional development plans are two pronged. They would take into account both study and practise. She planned to access more formal learning and undertake more volunteering work and pursue both clinical and non-clinical placements to put additional learning into practice.

19. She said she felt that her professional knowledge and skills have significantly improved since her placement. She said that she felt that she now had knowledge about crisis situations and is confident that she would be able to practise safely if the suspension was lifted, albeit acknowledged that conditions may need to be in place. Conversely, she said that very onerous conditions may be unworkable given the pandemic and how difficult it would prove for any employer to accommodate stringent requirements.

20. She said that she would leave the question of whether she remained impaired for the Panel but she felt that she was at the, “base line of functioning,” but not beyond that. She said she remained concerned at the time these proceedings had continued before, but the pandemic and life events had contributed to unavoidable delays. She wanted these proceedings to end and was hopeful that nine months from now she would have all the evidence that the HCPC required. She said she was proud of what she had achieved in a difficult twelve-month period, and she is dedicating everything in her life to achieve the one purpose of getting her professional career back on track. She described her commitment as being at 120%.

21. In Panel questions, the Registrant said that she had used the return to practise course as a refresher to remind herself of analytic skills and research methodology. She said it had been many years since her BSc degree. She said that she preferred the use of “MOHO” rather than the “CLEAR” approach because she favoured a holistic method of care.

22. Ms Welsh submitted that the Registrant had made some efforts to remedy her misconduct, and acknowledged that some difficult personal circumstances and the global pandemic had impacted her efforts. Nonetheless, it was said that the efforts of the Registrant were insufficient to address her impairment. She submitted that the Registrant had failed to discharge the persuasive burden to indicate that she was no longer impaired.

23. Ms Welsh invited the Panel to consider the history of the case and pointed out that there had been a suspension in place since the end of 2017. She referred the Panel to the decisions of previous Panels acknowledging that this Panel was not bound by this. She commended to the Panel the Indicative Sanctions Policy (“ISP”) and reminded it that the option of Strike-Off was open to it, given the length of time that the Registrant had been continually suspended.

24. Mr Oestricher submitted that the Registrant was aware that it was not feasible to continue suspension indefinitely. He said that the Registrant had been warned that progress was required since the last review and that she had borne this in mind. He submitted that her efforts were commendable.

25. Mr Oestricher invited the Panel to consider the evidence provided by the Registrant, who for the first time in these proceedings has indicated that it is not simply further suspension that is required. He pointed out that she has undertaken education both by way of formal study and self-learning in order to address deficiencies and now simply needed an opportunity to demonstrate this by working in her chosen profession. He submitted that there were conditions that could restrict the Registrant, e.g. to practise at Band 5 rather than 6, so that the Panel could be assured that there were safeguards in place, while simultaneously providing her the opportunity to demonstrate her ability.

26. The Panel accepted the advice of the Legal Assessor. The Panel was referred to the HCPTS Practice Notes Finding That Fitness to Practise is Impaired and Reviews of Article 30 Sanction Orders, and to the HCPC Sanctions Policy. It was aware that in conducting a risk assessment it should consider whether the Registrant’s fitness to practise remains currently impaired and only thereafter consider sanction. Further it was cognisant of its powers at a mandatory review under Article 30(1) of the Health Professions Order if current impairment is found, and that it should impose the least restrictive order which appropriately protects the public and the public interest.

27. The Panel carefully considered the evidence and information presented by the Registrant. The Panel acknowledged the work the Registrant had undertaken and that she had made some progress. The Panel considered that the Registrant’s misconduct, although not persistent, was serious given that she was working in a high-risk environment. Nonetheless, it considered that this misconduct was capable of remediation, albeit this remediation has not been completed.

28. The Registrant’s responses showed that she had continued to apply her learning through a befriending role to a vulnerable adult but she acknowledged that she was unable to evidence a risk assessment, and that all contact had been by telephone. The Panel also noted that there were no certificates of completion regarding any learning that had occurred since the last reviewing panel had considered this case.

29. While it commended the Registrant for her voluntary work and noted that an excellent reference from York City Council had been produced last year, praising the Registrant for the diplomatic way she had dealt with a safeguarding issue, it considered that this was significantly different from a professional Occupational Therapist role and had been carried out for a limited time and for only one session per week. Further, this had not been built upon. There was no similar reference on this occasion, save for one unsigned electronic letter from the person she had assisted in a befriending role.

30. It noted that the Registrant was asked whether she considered herself to be impaired and said that this was a difficult question which she would leave to the Panel. This response, appeared to reflect that the Registrant’s confidence and insight while improved, was still not fully developed. The Registrant herself acknowledged that there was more she could have done, and planned to do in the future to remedy the misconduct.

31. Given incomplete study and remediation, along with the risk this would mean for the public and the impact this could have, the Panel found that the Registrant to be impaired on both personal and public components. It did not consider that she has discharged the persuasive burden upon her to evidence that she had remedied her failings and could return to practice.

32. The reason why this Registrant is before the HCPTS is serious. The risk that service users were placed in could have had disastrous consequences and it was by chance rather than design that this did not occur. The Panel did consider the ISP in terms of assessing what sanction was appropriate.

33. Although this is a new review, it adopted the reasoning of previous panels in determining that this was not a case where it would be safe to allow the Registrant to practise without restriction. It next considered the submissions of Mr Oestricher and what the Registrant had said carefully. It was of the view that any conditions imposed would have to be so extensive, that they would be tantamount to suspension, having borne in mind what the Registrant had herself said about the pandemic places pressure on employers such that more stringent conditions would be unworkable.

34. Having noted that on the last occasion, the Registrant’s Representative had indicated that the Registrant acknowledged this was her “last chance saloon”, the Panel carefully considered whether or not a further period of suspension would serve any useful purpose and whether this was the time to move to a Strike-Off Order. This was because the efforts made on a previous occasion did not appear to have been built upon in the manner expected. The Panel consulted the ISP and considered whether the Registrant was unable rather than unwilling to remedy her misconduct given the number of years this suspension has continued.

35. The Panel decided that the Registrant did need an opportunity to be able to demonstrate the improvement she feels she has made and to evidence if she can get her career back on track.

36. The Panel concluded that a further period of suspension of 6 months would be appropriate and proportionate to address public protection and the wider public interest issues. The Panel acknowledges that the Registrant believes she can return to practice and has a plan for how to address her skills and knowledge gaps, and put theory into practice. It encourages her to actively initiate and follow all parts of this plan and to evidence what she achieves.

37. The Panel took particular note of the global pandemic and how it has impacted many people in myriad ways. Given that the Registrant had engaged in the process and presented herself as someone who was determined to return to practice, the Panel was persuaded that a further period of suspension was proportionate in all the circumstances. It hoped that the Registrant would make good use of this further period to address her skills and knowledge gap and consider Occupational Therapy support placements in which to embed these.

38. Whilst this Panel cannot bind any future reviewing panel, such a panel is likely to be assisted by:

⦁ The Registrant’s attendance at the review hearing;
⦁ In addition to documents supplied in advance of the hearing which comprise:
⦁ Evidence of completed courses undertaken between December 2021 and July 2022.
⦁ Evidence of any attempts the Registrant has made to obtain support work (paid or unpaid) in a role related to that in which her knowledge and skills as an Occupational Therapist can be deployed between December 2021 and July 2022.
⦁ A log detailing the work that is done on a monthly basis, how this meets the development plan she has and the progress that she is considered to have made by her line manager.
⦁ References from any manager or supervisor under whom she works during this period, with whom the log detailed above is shared.

ORDER: The Registrar is directed to suspend the registration of Miss Deborah J Watson for a further period of 6 months upon expiry of the existing Order.

This Order imposed will apply from 10 January 2022.

This Order will be reviewed again before its expiry on 10 July 2022.

Right of Appeal

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

History of Hearings for Miss Deborah J Watson