Miss Lisa Hetreed

Profession: Occupational therapist

Registration Number: OT68628

Interim Order: Imposed on 03 Aug 2017

Hearing Type: Voluntary Removal Agreement

Date and Time of hearing: 10:00 29/01/2021 End: 17:00 29/01/2021

Location: This hearing will be taking place virtually

Panel: Conduct and Competence Committee
Outcome: Voluntary Removal agreed

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Allegation

The following allegation was found proved by a Panel of the Conduct and Competence Committee at the substantive hearing on 14 – 18 & 21 January 2019:

Between 20 October 2014 and 23 November 2016, whilst working as an Occupational Therapist at University Hospitals Bristol NHS Foundation Trust

1. You did not demonstrate that you could ensure patient safety in that:

a) On 28 December 2015, you did not ensure Patient A was wearing oxygen when being mobilised to the bathroom.

b) On 17 December 2015, when Patient B showed signs of deteriorating health you did not:

i. initiate the checking of Patient B’s observations and/or

ii. alert the medical staff until prompted to do so.

c) On or around 04 December 2015, you requested that Patient C be mobilised despite Patient C suffering from a possible vertebral compression fracture.

d) On 4 October 2016, you allowed Patient D to mobilise with only supervision when it was unsafe for him to do so.

e) In or around March 2016, in relation to Patient O, you did not consider the use of a commode (wheelchair) despite Patient O being hot, dizzy and needing assistance.

f) On or around 12 October 2016, in relation to Patient R, you persisted in an assessment despite Patient R reporting dizziness.

2. You did not demonstrate that you could carry out and/or record adequate and/or accurate assessments in that:

a) In relation to Patient G, on or around 14 December 2015, your analysis did not take into account that Patient G needed time to allow the delirium to settle

b) In relation to Patient H, on or around 8 January 2016, your assessment record:

iii. did not identify the appropriate equipment for discharge

iv. did not mention that Patient H was soiled and/or the management of Patient H’s incontinence should be reviewed

v. did not mention and/or recommend any coordination with other medical personnel.

vi. included that Patient H was hoisted into a smart careflex chair when Patient H was seated into a flo-teck chair

c) On 4 October 2016, you scored Patient D incorrectly on the National Early Warning Score (NEWS) chart

d) On 21 April 2016, in relation to Patient E who had visual inattention on the left, you:

i. Did not sit on the left side of Patient E to encourage scanning and improve Patient E’s awareness of the left side,

ii. Did not place any items on the left side to encourage scanning and improve Patient E’s awareness of the left side,

e) On 08 April 2016, in relation to Patient F,

i. You began Patient F’s apraxia assessment using the patient’s non affected hand,

ii. You asked Patient F ‘what a Cup was’ despite the patient presenting high functionality (cognitively and perceptually)

3. You did not demonstrate that you could undertake adequate discharge planning in that:

a) On or around 12 October 2016 you suggested referring Patient M to social services to help Patient M find employment, even though Patient M had not expressed a desire to work during your assessment

b) On or around 19 January 2016 you recommended that Patient N would be safe to discharge despite evidence of cognitive problems during her assessment

c) You recommended Patient F be discharged to his home despite evidence of significant weakness in Patient F’s hand

4. On 28 December 2015, you demonstrated poor understanding of observation charts and/or normal blood pressure ranges in that:

a) when assessing Patient X you did not understand that blood pressure recorded as 126 systolic was within the normal range, and

b) when assessing Patient Y you indicated your understanding to a colleague that blood pressure was scored by the diastolic value when this was not the case,

5. You did not demonstrate that you could communicate effectively in that:

a) [not proved]

b) [not proved]

c) On or around October 2016, you persisted with an assessment when Patient R put his hands on his head in discomfort

d) On or around 21 April, in relation to Patient S, you persisted with a clinical observation and /or grading the task despite Patient S demonstrating that she would be unable to grasp any of the task

6. You did not demonstrate that you could identify patients’ appropriate pathways and/or services in that:

a) On or around 8 April 2016, You did not identify that Patient F required ongoing therapy and/or follow up services despite clear evidence of Patient F’s hand weakness.

b) On or around 12 October 2016, in relation to Patient U, you did not attempt to communicate with a physiotherapist to discuss:

i. An appropriate rehab plan

ii. Follow up treatment/assessment

7. You did not demonstrate adequate preparation in that:

a) In or around 15 August 2016, you went to discuss Patient V’s need with Patient V and his family, without

i. Being fully aware of Patient V’s medical needs,

ii. Being fully aware of Patient V’s level of mobility and/or equipment needs

b) On or around 08 January 2016, you did not bring the measurements of the bed and/or hoist when attending Patient H’s access visit.

8. The matters set out in paragraphs 1 – 8 constitute misconduct and/or lack of competence.

9. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary Matters

Remote hearing conducted via videoconference

1. In light of the Government’s advice on containing the current Covid-19 pandemic, the HCPC suspended all public hearings to protect the health and safety of its registrants and stakeholders. This hearing was therefore conducted via videoconference.

Background

2. The Registrant is a registered Occupational Therapist.

3. At the time of the events related to this matter the Registrant was employed by the University of Bristol NHS Foundation Trust (the Trust) at Bristol Royal Infirmary, as a Band 5 Occupational Therapist (OT) from 20 October 2014. She rotated between medical departments, working for six months in each. She joined the Acute Stroke Ward in October 2015, having completed a rotation in the Medical Respiratory Team.

4. On 6 April 2017 the Registrant was referred to the HCPC by the Trust, who informed the HCPC that, on 18 January 2017, it had dismissed the Registrant by reason of capability. The Trust had concluded that the Registrant was not able to practise safely as a Band 5 OT, either under supervision or independently, despite a structured management plan that had been put in place to support her.

5. On 14-18 January 2019 and 21 January 2019, a panel of the Conduct and Competence Committee considered a fitness to practise allegation against the Registrant at a substantive hearing. The full allegation is set out above. In summary, it was alleged that the Registrant’s fitness to practise was impaired by reason of her lack of competence. Specifically, that on multiple occasions the Registrant had placed service users at risk, including by:

• Mobilising patients without the correct equipment or adequate observation of their conditions;

• Poor assessment, poor discharge planning, and poor clinical analysis.

6. The panel at the substantive hearing found all particulars of the allegation proven except for particulars 5(a) and 5(b). That panel concluded that the Registrant’s failures amounted to a lack of competence and that her fitness to practise was impaired on both the personal and public components. A sanction of a Suspension Order for a period of 12 months was imposed.

7. The substantive order was reviewed on 7 January 2020 and extended for a further period of 12 months. The current Suspension Order is due to expire on 18 February 2021.

8. On 12 December 2019, prior to the first review hearing, the Registrant emailed the HCPC in response to the Notice of Hearing. The Registrant stated that she no longer wished to practise as an OT and would like to withdraw her registration. At that stage, however, the HCPC decided that more time was required to consider and process any application for voluntary removal.

9. In January 2020, there followed further correspondence from the Registrant’s Representative, reiterating the Registrant’s wish to apply for voluntary removal from the Register.

10. On 9 March 2020 HCPC received an email from the Registrant’s Representative asking the HCPC to start the disposal by consent process.

11. On 8 July 2020 the HCPC wrote to the Registrant confirming that the HCPC had “begun the process to obtain internal approval to dispose of this matter by consent.” The HCPC requested a statement from the Registrant to demonstrate her “insight into and willingness to address [her] failings which could include:

• Details of [her] current work circumstances
• Any comments in respect of the allegation
• Any evidence of any remedial action undertaken. This can be in the form of a reflective piece, references and / or evidence of training undertaken.”

12. In response the Registrant produced a personal statement dated 20 July 2020. In her statement the Registrant explained how she was diagnosed with two health conditions at the age of 17. Consequently, the Registrant developed strategies for dealing with any difficulties at work. However, when she began her “rotation in the Stroke ward” the Registrant stated that she faced a number of challenges, such as a change in routine, an expectation that she would know how to perform certain tasks that she had not come across before, and a “plethora” of unfamiliar acronyms. The Registrant described how she “quickly lost confidence in [her] own ability to make the right decision and was terrified of harming a patient.”

13. The Registrant accepted that whilst working as a Band 5 OT, “there were times” when she “was not fit to practise.” Further, that she “eventually became unable to do [her] job effectively” and her “performance plummeted.” The Registrant described how she became “… anxious and scared of doing the wrong thing ...”

14. The Registrant stated that she has “always recognised and acknowledged the failings in her performance”; further, that she has “always totally understood that the public needs to be protected and that [she] can no longer work as an OT.” The Registrant stated that she no longer wished to be an OT and that she “would never attempt to go back to a clinical setting at any level.”

15. The Registrant stated that she has pursued a new career path as a Band 4 OT technician working in mental health and that she has now found her “vocation”. She also provided a testimonial dated 22 July 2020 from her current line manager, where the Registrant works in the Band 4 OT technician role. The statement from the Registrant’s line manager described the Registrant’s current role and described the Registrant as “capable” and competent “at a performance level for her role and banding.”

16. On or around 9 December 2020 the Registrant returned a signed copy of the Voluntary Removal Agreement (VRA) dated 2 December 2020.

Decision

17. The purpose of today’s hearing is for the Panel to consider a joint application from the HCPC and the Registrant to dispose of this matter by consent. Should the Panel agree to a consent order, in line with the VRA, it would allow the Registrant to remove herself from the Register and the HCPC would take no further action in respect of the current fitness to practise matters.

18. In coming to its decision the Panel considered all of the material before it, including: the main evidence bundle of 128 pages; the HCPC Skeleton Argument of 22 January 2021 in support of the VRA and provided to the Panel in advance of the hearing; the email exchanges between the Registrant, her Representative, and the HCPC; and the signed copy of the VRA.

19. The Panel had regard to Ms Sampson’s written submissions to the Panel set out in her Skeleton Argument. She confirmed the HCPC’s position that voluntary removal from the Register would be an appropriate means of resolving this matter and that granting the application would not compromise the protection of the public or have any detrimental effect on the wider public interest. She submitted that public protection would be ensured as the agreement is equivalent, in effect, to a Striking Off Order. The Registrant would no longer be registered as an OT and has confirmed that she does not intend to practise as one in the future. In respect of the wider public interest, Ms Sampson submitted that confidence in the profession and the regulatory process has been maintained by way of the findings of fact and sanction imposed at the substantive hearing and the continuing Order that has subsequently been in place. She submitted that the public would not be concerned, nor would public confidence in the profession be put at risk, should the Panel grant this voluntary removal agreement in circumstances where the Registrant has accepted the allegations made and that her fitness to practise is impaired.

20. Ms Sampson further submitted that the Registrant has been provided with detailed information about the consent process and the effect of voluntary removal from the Register should the application be granted. She submitted that the Registrant has had time to review this information and has had the assistance of a representative throughout these proceedings. She submitted, therefore, that the HCPC is satisfied that the Registrant’s consent is informed.

21. The Panel also had regard to the Registrant’s Representative’s oral representations to the Panel on behalf of the Registrant. She reiterated her significant concerns, already set out in the bundle of correspondence before the Panel, around the length of time that it has taken to reach this point.

22. The Panel accepted the advice of the Legal Assessor. The process of disposing of a case by way of consent is an extra-statutory means of concluding a matter. However, before agreeing to such a course the Panel reminded itself that it has to be certain that, by adopting this process, there is the appropriate level of public protection and that to conclude this matter in this way would not be detrimental to the wider public interest. The Panel applied its own judgment and had careful regard to the content of the HCPTS Practice Note on “Disposal of Cases by Consent”. It had particular regard to the following part of the Practice Note:

“In cases where the HCPC is satisfied that it would be adequately protecting the public if the registrant was permitted to resign from the Register, it may enter into a Voluntary Removal Agreement allowing the registrant to do so, but on similar terms to those which would apply if the registrant had been struck off.”

23. The Panel was mindful of its overarching objective of protection of the public and the public interest. The Panel noted that the HCPC was satisfied that it would be meeting its statutory objective of protecting the public if the Registrant were permitted to be removed from the Register. She would not be able to apply to be re-admitted to the Register for a period of at least five years. The Panel was satisfied that the public would be adequately protected if the Registrant were permitted to have her name removed from the Register and leave the profession in accordance with the terms of the VRA. It was also satisfied that there are no overriding public interest factors that would make disposal of this case by VRA inappropriate. The Panel was of the view that confidence in the profession and the regulatory process has been maintained by way of the findings of fact and sanction imposed at the substantive hearing and the continuing Order that has subsequently been in place. The Panel was of the view that the public would not be concerned, nor would public confidence in the profession be put at risk, should the Panel grant this VRA in circumstances where the Registrant has accepted that her fitness to practise is impaired.

24. The Panel noted the content of the Registrant’s correspondence with the HCPC in which she repeatedly stated that she no longer wants to practise as an OT and wants to be removed from the Register. The Panel was of the view that the Registrant has been provided with detailed information about the consent process and the effect of voluntary removal from the Register should her application be granted. The Registrant has had time to review this information and has had the assistance of her Representative throughout these proceedings. The Panel was therefore satisfied that this was a considered and informed decision on her part.

25. In all the circumstances, the Panel was satisfied that both the public and the wider public interest would be adequately protected by the terms of the Agreement reached between the Registrant and the HCPC, as removal from the Register would prevent the Registrant from practising as an OT in the United Kingdom and, should she seek to return to the Register, her application would be treated as though she had been removed from the Register for a period of five years. In addition, the Panel was satisfied that this is an efficient method of disposing of this allegation in an appropriate and proportionate manner which is in the interests of the public, the HCPC, and the Registrant. It did not consider that it is in the public interest or in the Registrant’s own interest to be in a review cycle when she no longer intends to practise as an OT. Accordingly, the Panel approved the VRA to revoke the current Suspension Order so as to enable the Registrant to be removed from the Register.

26. The Chair of the Panel has, on behalf of the Panel, signed and dated the attached Notice of Withdrawal that is required as a consequence of the consent to the VRA, a copy of which has been dated today.

Order

The Panel granted the Voluntary Removal application.

Notes

No notes available

Hearing History

History of Hearings for Miss Lisa Hetreed

Date Panel Hearing type Outcomes / Status
29/01/2021 Conduct and Competence Committee Voluntary Removal Agreement Voluntary Removal agreed
07/01/2020 Conduct and Competence Committee Review Hearing Suspended
14/01/2019 Conduct and Competence Committee Final Hearing Suspended