Mrs Jane Onoh

Preliminary Matters

Proceeding in private

1. Ms Sampson, on behalf of the HCPC, applied for parts of the hearing to be conducted in private to protect the private and family life of the Registrant where reference was made to such matters. The Registrant did not object to that application.

2. The Panel accepted the advice of the Legal Assessor in relation to proceeding in private and had regard to the HCPTS Practice Note “Conducting Hearings in Private”. It noted that section 10(1)(a) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules) provides that “proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the health professional … the public should be excluded from all or part of the hearing” and that it was therefore appropriate for it to consider whether all or part of the hearing should be conducted in private.

3. The Panel noted that reference would be made to the Registrant’s personal family circumstances and was satisfied that it was appropriate for the parts of the hearing which related to those circumstances to be heard in private. The rest of the hearing could proceed in public.

Background

4. The Registrant is an HCPC-registered Radiographer. She volunteered to work under supervision in the Community Radiology Department of Fraserburgh Hospital (“the Hospital”) from July to August 2017 to assist her to obtain a full-time role as a newly-qualified Radiographer.

5. Concerns were raised about the Registrant’s practice and despite further training and supervision, no improvement was identified. The concerns were then referred to the HCPC in September 2017 and were subsequently the subject of a hearing in January 2019. During the hearing the Registrant admitted allegations 1(a) to 1(d), and the substantive hearing panel found the allegations proved. She accepted that her practice was impaired and demonstrated insight, as well as a willingness to remediate the concerns.

6. However, the substantive hearing panel found that:

• the Registrant’s errors were not isolated;
• she demonstrated a lack of knowledge throughout her work;
• mistakes were repeated despite guidance given;
• she did not demonstrate the basic skills that would be expected of a qualified Radiographer.

The substantive hearing panel concluded that the Registrant had failed to meet the HCPC Standards of Proficiency for Radiographers: 13, 14.1, 14.18, and 14.24. She had fallen short of the standards of proficiency expected of a newly-qualified Band 5 Radiographer, giving rise to a finding of a lack of competence. It identified a risk of repetition and concluded that she was impaired on both the personal and public components. She had, however, demonstrated insight and it considered that her impairment was capable of being remedied. She recognised the need for supervision, had demonstrated improvement over a short period, and was willing to undertake further training and development. It found that the appropriate sanction was the imposition of conditions upon her practice and that a Suspension Order would be disproportionate and unduly punitive in the circumstances. It encouraged her to provide a written reflective piece to a reviewing panel which demonstrated how her practice had evolved.

7. This matter was referred for early review by the HCPC and considered by a reviewing panel in April 2019. Clarification was sought in respect of the practical operation of the conditions and to review progress generally. A comprehensive review was undertaken and the reviewing panel noted that although the Registrant was engaging with her regulator, there was little evidence of remediation and the Registrant’s fitness to practise remained impaired. She had not undertaken a period of supervised practice and had not demonstrated that she was able to safely practice without restriction. It was satisfied that a Conditions of Practice Order remained appropriate and proportionate, and varied and extended the Order to allow the Registrant sufficient time to comply with the Conditions.

8. The second review was conducted in July 2020, when the Conditions of Practice Order was again extended due to the Registrant’s personal circumstances and the impact of the Covid-19 pandemic.

Submissions

9. Ms Sampson told the Panel that it remained the HCPC’s position that the Registrant had not addressed the concerns in relation to her practice sufficiently. The Registrant had supplied to the Panel an email showing her attempt to secure employment with a local hospital, but submitted no other documents to evidence her learning or development since the Conditions of Practice Order had been extended. Further, the document that was provided was dated after the HCPC contacted her to ask her to provide updated information. Ms Sampson was, however, mindful of the context of the pandemic and the Registrant’s personal circumstances.

10. The HCPC considered that the failings were still capable of remediation and accepted that this was the Registrant’s desired outcome. However, Ms Sampson reminded the Panel that it had all options open to it when considering this matter, including the potential for striking the Registrant from the Register.

11. The Registrant gave evidence to the Panel under Affirmation and answered questions from Ms Sampson. She confirmed that she wished to practise as a Radiographer and accepted that her fitness to practise remained impaired. She considered that she needed more time to secure employment and to undertake additional training if necessary.

Decision

12. The Panel noted and accepted the advice of the Legal Assessor and had careful regard to the documentation, evidence, and submissions it had received. It also had regard to the Practise Notes issued by the HCPTS and the Standards of Proficiency set by the HCPC. It was mindful that the purpose of the review was not to go behind the findings of previous panels but to determine whether the Registrant’s fitness to practise remains impaired, and if so, to determine what action would be appropriate to address that impairment.

13. The key issue for the Panel to determine was what, if anything, had changed since the current Order was imposed. The factors to be taken into account included:

• the steps which the Registrant had taken to address any specific failings or other issues identified in the previous decision;

• the degree of insight shown and whether this had changed;

• the steps which the Registrant had taken to maintain or improve her professional knowledge and skills;

• whether any other fitness to practise issues had arisen;

14. The Panel must consider whether the concerns which led to a finding of impairment at a hearing in January 2019 remained. As the decision in Abrahaem v GMC [2008] EWHC 183 (Admin) indicates, in practical terms this placed a “persuasive burden” on the Registrant to demonstrate at a review hearing that she had fully acknowledged the issues which led to the original finding and had addressed them sufficiently, “through insight, application, education, supervision or other achievement...”.

15. The Panel reminded itself that when reviewing sanctions under Article 30 of the Health Professions Order 2001 (the 2001 Order), a reviewing panel may:

• confirm the order;

• extend, or further extend, the duration of the order;

• reduce the duration of the order;

• replace the order with any other order which the Panel could have made (to run for the remaining term of the original order); or

• revoke the order or revoke or vary any condition imposed by it.

16. The decision reached by the Panel must be proportionate, striking a fair balance between interfering with the Registrant’s ability to practise and the overarching objective of public protection.

17. In determining whether fitness to practise is impaired, panels must take account of a range of issues which, in essence, comprise two components: the ‘personal’ component, i.e. the current competence, behaviour, etc, of the individual registrant; and the ‘public’ component, i.e. the need to protect service users, declare and uphold professional standards, and maintain public confidence in the profession. The personal component includes the risk of repetition and to what extent any lack of competence has been remedied. In respect of the public component the Panel has to consider public policy issues, which include the need to maintain confidence in the profession and to declare and uphold the HCPC standards of proficiency.

18. The Panel was satisfied that the Registrant has continued to demonstrate insight in relation to her practice, but considered that she had not evidenced learning and development. She had not provided evidence of putting her skills into practise and had not secured employment as a Band 5 Radiographer. The substantive hearing panel had identified a risk of repetition and this Panel did not consider that the Registrant had sufficiently addressed the concerns, and therefore this risk remained. The Panel was pleased that the Registrant continues to engage in the regulatory process and was conscious of both her personal circumstances and the exceptional context of the pandemic.

19. The Panel found that the Registrant’s fitness to practise remains impaired on both the personal and public components of impairment. There had been no significant change in the Registrant’s circumstances, and she acknowledged that her fitness to practise remains impaired.

20. The Panel therefore considered how to address the Registrant’s impairment, bearing in mind the provisions of the HCPC Sanctions Policy. It determined that taking no further action, mediation, or imposing a Caution Order would not be sufficient to protect the public nor be in the public interest or the Registrant’s interest. It then moved further up the ladder of sanctions to consider whether to extend and/or vary the current Conditions of Practice Order. It noted that both the Registrant and the HCPC submitted that extending the Order for a further period of two years would be appropriate and proportionate. Ms Sampson also raised the prospect of including recommendations for the Registrant in relation to evidencing learning and development.

21. The Panel concluded that a Conditions of Practice Order remains the appropriate and proportionate sanction to address the risk to the public and ensure the Registrant can pursue her chosen career. Although there had been no significant or meaningful progress made by the Registrant since the substantive hearing, this appears to have been largely as a consequence of her personal circumstances and the pandemic.

22. The Panel was conscious that the Registrant had not provided substantial information to it, or to preceding panels, in relation to the maintenance and development of her professional learning and skills. It was also mindful that the concerns were raised in 2017 and the Registrant has not worked in the profession since that volunteering experience. It considered that it was necessary, proportionate, and appropriate to vary the Conditions of Practice Order to address this. It had regard to the conditions bank published by the HCPTS and considered in particular those draft conditions identified in Section I.

23. Prior to deciding to impose a varied Conditions of Practise Order, the Panel considered other options open to it. Imposing a Suspension Order would secure the protection of the public but would not help the Registrant return to the profession. It was not therefore an appropriate sanction to impose. The Panel also considered the sanction of striking the Registrant from the Register. It was conscious that this may appear appropriate given the time elapsed since the finding of impairment was made; however, accommodation had to be made for the Registrant’s personal circumstances and the pandemic. The Panel was satisfied that varying and extending the Conditions of Practice Order was the most appropriate way to address the concerns identified. It therefore varied the Conditions of Practice Order and extended it for a further two years, and added further conditions as follows:

The Registrar is directed to vary the Conditions of Practice Order against the registration of Mrs Jane Onoh for a further period of two years on the expiry of the existing order. The Conditions are:

1. Within six months of the imposition of this Order, you must formulate a Personal Development Plan (PDP) which addresses, in particular:

a) Positioning of patients for X-ray examinations;

b) Limiting radiation dose;

c) Developments in radiography practice;

You must maintain this PDP as part of your ongoing Continuing Professional Development (CPD) before the next review.

2. No later than 14 days in advance of the next review of this Order, you must submit to the HCPC:

a) a copy of your PDP;

b) evidence of your learning and development as part of your PDP;

b) a written reflective piece demonstrating how the learning and development you have undertaken as part of your PDP has or will impact upon your practice.

3. Upon obtaining work as a Radiographer, either voluntary or paid, you must place yourself and remain under the direct supervision of a Radiographer registered by the HCPC. You must supply details of any supervisor(s) to the HCPC within seven days of obtaining any role as a radiographer. You must attend upon the supervisor(s) as required and follow their advice and recommendations.

4. Before undertaking any practice as a Radiographer without direct supervision, you must:

a) satisfactorily complete a period of directly supervised practice of no less than 60 working days under the supervision of the person(s) referred to in Condition 3; and

b) forward a written review by the supervising Radiographer(s) covering the period of direct supervision, to the HCPC, 14 days prior to the review of this Order. (This review by the supervising Radiographer(s) is to be the same type of review as is carried out with a newly-qualified Radiographer at the end of a probationary period).

5. You must continue to meet with your supervisor(s) on a fortnightly basis to monitor and review your practice, whether directly or indirectly supervised. Such meetings should be recorded by the supervisor(s) and a copy of those records made available by you, to the HCPC, 14 days prior to the review of this Order.

6. 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, either paid or voluntary;

b) Any agency you are registered with or apply to be registered with (at the time of your application); and

c) Any prospective employer (at the time of your application).

The order imposed today will apply from 20 August 2021.

This order will be reviewed again before its expiry on 20 August 2023.

History of Hearings for Mrs Jane Onoh