Mrs Louise J Middleton

Background

1.    The Registrant commenced employment as a Band 7 Dietitian at Kirkcaldy and Levenmouth Community Health Partnership in December 2009. On 19 January 2019, a panel of the Conduct and Competence Committee found that the Registrant’s fitness to practise was impaired by reason of her lack of competence, having found a breadth of failings across a wide range of skills expected of a Band 7 dietitian and in relation to ten patients as set out in the allegation above. These occurred in the course of a twelve week return to work plan following a period of sick leave from May 2010 until February 2011. Prior to the period of sick leave, the Registrant had been under supervision due to perceived concerns about her ability to carry out the duties of a Band 7 Dietitian.

2.    On 19 January 2018 the Panel imposed a twenty-four month Conditions of Practice Order, having found that the Registrant had the required level of insight and understanding to indicate that a Conditions of Practice Order would be adhered to and that such an order would minimise the risk of future harm to patients.

3.    At the review hearing on 15 January 2020, the Registrant informed the Panel that she had been unable to obtain employment as a Dietitian because her prospective employers found the conditions to be too onerous to be workable. The reviewing panel therefore found that there was no evidence before it that the Registrant had complied with the conditions and therefore remedied the lack of competence found proved. The reviewing panel therefore found that the Registrant’s fitness to practise remained impaired. It therefore extended the Conditions of Practice order for a further period of 12 months in order to give the Registrant a further opportunity to seek employment and to comply with the conditions.
Decision

4.    In reaching its decision at this review, the Panel has considered all the information before it, together with the submissions of Ms Sampson and Mr Toms, the evidence of the Registrant and the documentary material she had provided. It has exercised the principle of proportionality at all times. It has accepted the advice of the Legal Assessor.

5.    Ms Sampson on behalf of the HCPC submitted that the Registrant’s fitness to practise remains impaired. She said that although the HCPC accepted that the Registrant had made efforts to obtain employment, she had been thwarted by the effects of the Covid-19 pandemic which had limited employment opportunities as a Dietitian. Her submission was that despite the significant efforts the Registrant had made to maintain her skills and knowledge she had been unable to demonstrate that she could return to practice unrestricted.

6.    Ms Sampson’s submission was that the current conditions of practice order should remain in place for a further 12 months to afford the Registrant the opportunity to demonstrate that she could engage in safe practice as a Dietitian.

7.    The Registrant gave evidence. She reiterated the matters set out in the documents she had placed before the Panel in regard to her efforts to obtain employment as a Dietitian and the difficulties that she had encountered. She expanded upon what she had said about her activities in the public health field and the practical experience she had gained, with particular regard to record-keeping, time-management and liaising with colleagues.

8.    Mr Toms on behalf of the Registrant referred to the matters described by the Registrant in the bundle she has placed before the Panel. He observed that she had been unable to obtain employment as a Dietitian in the light of the restrictive nature of the current conditions and also the effects of the Covid-19 pandemic. He made particular reference to what the Registrant has described as the efforts she has made to comply with the conditions despite being unable to obtain clinical employment. In this context he submitted that the Registrant had complied with the conditions relating to the three matters to which she made particular reference; namely, record-keeping, time-management and liaising with colleagues. He submitted that although not in a clinical setting this was indicative of competence in these fields.

9.    Mr Toms submitted that the Registrant’s fitness to practise is no longer impaired. He emphasised that, as she had said in her evidence, she had no intention in the future to practise in a clinical setting and that there was therefore no risk of repetition. However he said that if the Panel were to find that the Registrant’s fitness to practise remains impaired the appropriate sanction would be that of a Caution or an amendment to the Conditions of Practice order.

The Panel’s Findings

Impairment

10. The Panel has recognised the difficulties facing the Registrant since the last review, in obtaining employment as a Dietitian. It is impressed by the efforts that the Registrant has made by way of engaging in course material and reading in order to maintain her knowledge. Although she has demonstrated that she has achieved progress in record-keeping, time-management and liaising with colleagues, this has only been in relation to non-clinical matters. 

11. In summary there is nothing before the Panel to indicate compliance with the conditions imposed albeit this has not been due to any lack of endeavour by the Registrant. The Registrant has not been able to demonstrate that she can practise safely as a Dietitian. In these circumstances, although the Registrant has demonstrated significant insight there remains a risk of repetition. The Panel has therefore concluded that the Registrant’s fitness to practise remains impaired in terms of the personal component. In regard to the public component the Panel has concluded that the public would be concerned if the Registrant were able to practise unrestricted despite being unable to demonstrate that she could do so safely. Public confidence in the profession would be undermined if a finding of impairment were not made. 

Sanction

12. In reaching its decision the Panel considered all the information and evidence before it together with the submissions of Ms Sampson and Mr Toms. It had in mind the HCPC’s Sanctions Policy. It accepted the advice of the Legal Assessor.

13. The Panel first considered a Caution order but concluded that this would be insufficient to protect the public and to address public interest concerns.

14. The Panel then considered a Conditions of Practice order and concluded that the current Conditions of Practice order remains appropriate, proportionate and sufficient to protect the public and to address public interest concerns.  Further, it has determined that a further period of 12 months will afford the Registrant the opportunity to obtain employment as a Dietitian and to demonstrate compliance with the Conditions.

 
15. The Panel did consider imposing a Suspension Order but concluded that this would be disproportionate in the current circumstances. The lack of competence found proved is remediable and the Registrant has shown her willingness to comply with the conditions and she has shown a commitment to her profession

ORDER: The Registrar is directed to extend the Conditions of Practice Order against the registration of Louise Middleton for a further period of 12 months on the expiry of the existing Order.

1.    You must inform the HCPC within 14 days of your start date if you take up any employment or other engagement as a Dietitian in a clinical role which includes the giving of advice or treatment to individuals.

2.    While working as a Dietitian, either in an employed or voluntary capacity, you must promptly place yourself and remain under the indirect supervision of a workplace supervisor at Band 6 or higher, who must be registered as a Dietitian by the HCPC, and you must supply full details of your supervisor to the HCPC within 14 days of their appointment. You must attend upon that supervisor as required and follow their advice and recommendations.

3.    You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

(i)           Record Keeping;
(ii)          Time Management;
(iii)        Clinical practice;
(iv)        Communication with dietetic, nursing and medical colleagues.

4.    Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

5.    You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

6.    You must allow your workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

7.    You must provide a detailed report approved by your supervisor commenting on your practice as a Dietitian prior to every hearing to review this Order. That report must cover, at least, the follow matters:

(i)           Record Keeping;
(ii)          Time Management;
(iii)        Clinical practice;
(iv)        Communication with dietetic, nursing and medical colleagues.

8.    You must allow your supervisor to contact the HCPC to report any concerns with your practice as a Dietitian.

9.    You must comply with all requirements of the HCPC Registrations department regarding your return to practice.

10. You must promptly inform the HCPC if you cease to be employed as a Dietitian by any employer.

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

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

A.   Any organisation or person employing or contracting with you to undertake professional work as a Dietitian, at the time of application;
B.   Any agency you are registered with or apply to be registered with as a Dietitian (at the time of application);
C.   Any prospective employer, seeking to employ you as a Dietitian, (at the time of your application).

This Order will be reviewed again before its expiry.

History of Hearings for Mrs Louise J Middleton