Miss Clare D Beavins

Profession: Occupational therapist

Registration Number: OT26221

Interim Order: Imposed on 09 Aug 2018

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 14/06/2021 End: 17:00 07/07/2021

Location: This hearing will take place virtually

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

While registered as an Occupational Therapist and employed at South Gloucestershire Council:

1. With regard to Service User 1, you:

a) Approved the provision of equipment which was not suitable for and / or did not meet the needs of Service User 1.

b) Did not complete a risk assessment and / or ensure that a risk assessment was completed.

c) Did not report the incident where Service User 1 was injured.

d) Did not complete any follow up after Service User 1 was injured.

e) Did not complete a manual handling plan and / or ensure that a manual handling plan was completed.

f) Closed the case when it was not appropriate to do so.

2. With regard to Service User 3, you:

a) Provided inappropriate manual handling advice.

b) Recommended inappropriate equipment.

3. With regard to Service User 4, you:

a) Did not undertake visits in a timely manner.

b) Did not provide appropriate support to Service User 4’s family.

4. With regard to Service User 6, you approved recommendations for adaptations and / or equipment that were not necessary and / or not appropriate.

5. With regard to Service User 7, you approved a

recommendation for equipment without ensuring that an adequate assessment of Service User 7’s needs had been undertaken.

6. With regard to Service User 8, you:

a) Did not ensure that the needs of Service User 8 were met.

b) Closed the case when it was not appropriate to do so.

7. With regard to Service User 9, you did not carry out a follow up visit and / or ensure that a follow up visit was carried out following the provision of equipment.

8. With regard to Service User 10, you:

a) Closed the case when it was not appropriate to do so.

b) Did not submit the housing report within the required timeframe.

9. With regard to Service User 11, you did not undertake a joint visit with a Private Sector Housing Officer to assess whether the house was adaptable.

10. With regard to Service User 12, you:

a) Did not undertake a joint visit with a Private Sector Housing Officer to assess whether the house was adaptable.

b) Provided housing advice which was incorrect and / or inappropriate.

c) Provided advice in regard to Service User 12’s medical prognosis without medical evidence.

11. With regard to Service User 13, you:

a) Recommended inappropriate equipment.

b) Did not undertake a joint visit with a Private Sector Housing Officer to assess possible housing adaptations.

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

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

 

Finding

Preliminary Matters
Service
1. The Registrant did not attend this final hearing.

2. The Panel first considered whether a valid notice of hearing had been sent to the Registrant. The Panel concluded that the email sent to the Registrant on 15 March 2021 satisfied the notice requirements as it informed her of the date and time of the hearing as well as the manner in which it was to be conducted.

Proceeding in the absence of the Registrant
3. The Panel heeded the advice it received that the fact that a valid notice of hearing had been served on the Registrant was not a sufficient reason to proceed with the hearing in her absence; such a decision required the exercise of the discretion vested in the Panel that it would be fair and appropriate to do so. However, a material factor in the present case was that there had been a communication made on behalf of the Registrant by her union representative that stated in unequivocal terms that the Registrant would not be attending the hearing and that she would not be represented at it.

4. Having carefully considered the matter, the Panel concluded that the hearing should proceed in the absence of the Registrant. The reasons for that decision were the following:
• There had been a voluntary waiver on the part of the Registrant of her right to attend the present hearing.
• There was no application that the present hearing should be adjourned, and no suggestion that the Registrant would be likely to attend a hearing in the future if it did not proceed at the present time. Indeed, an element of the explanation given by the union representative for the decision not to attend was that the Registrant had retired from practice and had no desire to return to practise as an Occupational Therapist.
• The allegations concerned events that occurred some years ago. Although this was not a case in which witness recollection would be a critical, nevertheless further delay would be undesirable.
• The witness the HCPC proposed to call to give evidence was ready to give that evidence.
• In these circumstances the clear public interest in the Allegation being resolved expeditiously outweighed any disadvantages arising from the absence of the Registrant.

Amendment of the Allegation
5. A panel of the Investigating Committee determined that there was a case to answer on 29 July 2019, and it referred to this Committee an Allegation that the Registrant’s fitness to practise is impaired by reason of misconduct and/or lack of competence. Factual Particulars of the misconduct and/or lack of competence were included in the referred Allegation. On 26 January 2021, after the matter had been investigated by the HCPC’s Solicitors, a letter was written to the Registrant informing her that it was proposed to apply at the final hearing for various amendments to the factual Particulars of the misconduct and/or lack of competence alleged. The Presenting Officer duly made that application. At no stage had any objection been made by or on behalf of the Registrant to the proposed amendments.

6. The proposed amendments fell into two broad categories, namely:
• Elements of the case in relation to which the HCPC considered it did not have evidence to advance against the Registrant. In particular the case referred to this Committee had included contentions in relation to a service user identified as “Service User 9”. Upon investigation it was not considered appropriate to persist in that case.
• Other minor alterations to the wording of criticisms previously formulated to ensure that the HCPC’s case was clarified.

7. In relation to the former category, the Panel acknowledged that it had a responsibility to consider whether it was appropriate to permit the HCPC not to advance elements of the case referred to it. However, having undertaken that review, the Panel concluded that it was appropriate that the HCPC should not seek to advance those elements it had identified as not being supported by the evidence. In relation to the latter category, the Panel was satisfied that the minor alterations in the wording of the Particulars were appropriate in the sense that they reflected the evidence that the HCPC proposed to advance. The Panel also found that they would not result in prejudice to the Registrant. For these reasons the Panel acceded to the HCPC’s application to amend the Allegation. The Allegation set out above is the Allegation as amended by this decision. It should be noted that the words, “appropriateness of” appearing in Particular 1(a) had not been communicated to the Registrant in the letter dated 26 January 2021, but the Panel considered them to be necessary to give sense to the criticism advanced by that sub-Particular.

Proceeding in private
8. It was apparent from the hearing bundle of documents provided to the Panel in advance of the hearing that the Registrant had experienced episodes of ill health that had resulted in periods of sick leave during the period relevant to the Panel’s enquiry. Accordingly, at the commencement of the hearing the Panel stated that if during the hearing there was to be any investigation of specific health issues, that part of the hearing should be conducted in private in order to protect the Registrant’s private life.

Conduct of the hearing
9. The Panel decided that it would hear the evidence relating to the facts, make its decision on the facts and announce that decision before hearing any submissions that might arise in the event of factual findings being made against the Registrant.

Background
10. The Registrant began her employment as an Occupational Therapist by South Gloucestershire Council (“the local authority”) in April 2000. From 14 December 2009 she was employed as a Senior Children’s Occupational Therapist in the Children Adults and Health Department. However, following a period of sickness leave she requested that she relinquish her role as Senior Occupational Therapist, and so from 12 September 2016 she reverted to the role of Occupational Therapist in the same department, continuing to work with children. When the issues arising in this case came to the attention of the local authority, the Registrant was again on sick leave. Nevertheless, although she was not attending work at the time the decision was made, on 21 July 2017 she was suspended from duty.

11. The sole witness called by the HCPC to give evidence before the Panel was Mrs AM. Mrs AM began working as an Occupational Therapist with the local authority in early 2016 on a locum basis. For the first few weeks, the Registrant was Mrs AM’s manager. The Registrant was then absent on sickness leave and Mrs AM acted up in the Registrant’s role as Senior Occupational Therapist. When the Registrant returned from that sickness leave and requested to relinquish the Senior Role, Mrs AM retained the Senior Role, and as such, line managed the Registrant. Before Mrs AM arrived at the local authority, the Registrant had been line managed by a Social Worker Team Manager

Decision on Facts
12. The Panel began its deliberation on the facts by forming a general assessment of Mrs AM. The Panel found her to be a good and reliable witness who gave her evidence in a clear, balanced and professional manner. She had a good understanding of the issues involved and sought to help the Panel to understand the events, many of which occurred some years ago. It was evident to the Panel that she demonstrated no animosity towards the Registrant. Mrs AM was in an unusual position because in addition to being one of the two investigators for the purposes of the local authority’s internal investigation (the other being a member of the local authority’s Human Resources Department), she had worked alongside the Registrant. Although the periods when both the Registrant and Mrs AM had worked in the same department were limited because of the former’s absences on sick leave, nevertheless the Panel was able to form a better view of the Registrant as a result of that contact. Furthermore, although Mrs AM had not been directly involved with any of the relevant service users during the periods of the Registrant’s involvement with them, nevertheless, Mrs AM had had direct contact with Service Users 1, 3, 4 and 6 after those events, and this fact gave additional credibility to what she was able to tell the Panel.

13. In addition to the lengthy witness statement of Mrs AM and her oral evidence, the Panel was provided with a bundle of documentary exhibits that extended to over 600 pages. Included in the exhibits were case records of the relevant service users. These documents gave the Panel the opportunity independently to assess the criticisms advanced by Mrs AM.

14. The Panel approached the decision making on the facts by remembering throughout that it was for the HCPC to prove matters on the balance of probabilities. The Panel had regard to the totality of the evidence, both oral and written, and it considered the accounts given by the Registrant in the context of the local authority internal disciplinary process. In this regard the Presenting Officer very fairly prepared a document that collated and referenced the Registrant’s responses.

Particular 1(a) to 1(f) – found proved
15. Service User 1 was a girl who had long-term mobility problems and a diagnosis of Angelmans Syndrome. She also had learning difficulties, global development delay and no verbal communication. She also had an ataxic gait and suffered from occasional seizures. She lived at home with her parents and brother.

16. Service User 1’s notes for 2012 included an entry that her home had been fitted with a stair lift in approximately 2004 on the instructions of an Occupational Therapist who was not the Registrant. In 2015, Ms SH, an inexperienced Occupational Therapist who was being supervised by the Registrant, was allocated to Service User 1, and the records disclosed the Registrant herself undertook a home visit on 9 October 2015. The documents also included both a care plan and a referral record signed off by the Registrant on 4 February 2016.

17. In late 2015 an incident occurred when Service User 1 was being manually handled by her mother at the top of the stairs in order to effect a transfer onto the stair lift. Service User 1 had slipped and fallen down the stairs. Her mother reported that she would have also fallen and fallen onto her daughter had she not let go of her. Service User 1 suffered a suspected ruptured ligament on the inside arch of her left foot and had to have a cast on her foot, as a result of which she was not able to weight bear.

18. On 4 December 2015 the Registrant and Ms SH undertook a joint visit to Service User 1’s home. It was recorded that the matter was to be closed.

19. As the person who at the material time was the Senior Occupational Therapist supervising Ms SH, it was the responsibility of the Registrant to ensure that appropriate steps were taken by the Occupational Therapist to whom the case was allocated. Having regard to all the evidence, the Panel is satisfied that the HCPC has produced evidence that:
a. The stair lift was not suitable equipment because it was unsafe, yet the Registrant took no steps to identify or address that fact.
b. The Registrant did not personally complete a risk assessment or ensure that Ms SH undertook one, the Panel being satisfied that had one been undertaken it would have appeared in the case notes.
c. The Registrant did not report the incident when Service User 1 was injured falling down the stairs, a fact admitted by the Registrant when interviewed in the local authority process.
d. The Registrant did not complete any follow-up after Service User 1 fell down the stairs.
e. The Registrant did not personally complete a manual handling plan or ensure that Ms SH undertook one. The Panel recognises that at the relevant time the preparation of free-standing manual handling plans was not embedded in the local authority’s Occupational Therapy service, but nevertheless, the basic requirements of safe and effective practice required the elements of such a plan to be included in the case notes, yet there were none.
f. The Registrant closed the case when it was demonstrably inappropriate to do so, not least because no steps had been taken to address the issue of the unsafe equipment represented by the stair lift.

20. It follows that each element of Particular 1 is proven.

Particular 2(a) & 2(b) – found proved
21. Service User 3 was a boy who was allocated to the Registrant as an Occupational Therapist; her involvement was direct, unlike the case of Service User 1 where her involvement was as the supervisor of the allocated Occupational Therapist. Service User 3 required a hoist to be moved when he was at school.

22. In an email sent by the Registrant to Service User 3’s mother on 3 April 2017, the former referred to having met Service User 3 the previous week. The Registrant wrote that she had identified a handling belt and suggested that it would be useful for “encouraging him up from the floor”.

23. A manual handling belt is a strap that goes around a child’s waist, and is intended for a child who requires a bit of extra support when getting up from the floor. It has handles on the back or sides, and the handles are used by the carer or parent to assist the child, but it would be the child who would do most of the work in getting up. It is not something that is used if a child has significant physical disabilities or mobility problems.

24. When Mrs AM interviewed the Registrant, the latter stated that the belt was not something that she had used before. She said that she thought that Service User 3’s mother would sit on a chair to help her son to rise from the floor. The Registrant stated that she accepted Mrs AM’s concerns about the recommendation she had made and stated that she would not use it for lifting a child again.

25. The Panel was satisfied that a manual handling belt was not an appropriate item of equipment for this child and should not have been recommended. Furthermore, the advice to the mother to sit on a chair and use the belt to transfer her son from the floor was not appropriate advice. It follows that both limbs of Particular 2 are proven.

Particular 3(a) & 3(b) – found proved
26. Service User 4 was a teenager who had a life-limiting diagnosis of a degenerative spinal condition, Neurofibratosis Type 1 and Scoliosis. However, she had no cognitive impairment. She used a wheelchair and in 2014 was discharged from hospital after undergoing surgery on her spine which had collapsed, there being a concern that bone could puncture her lung. Service User 4 was allocated to the Registrant.

27. There were other negative factors concerning the family and the home that it is not necessary to identify, but they resulted in additional safeguarding concerns. The family were concerned about Service User 4’s bedroom, which was narrow, particularly given the equipment she needed to have there. While she had been in hospital, Service User 4 had been using a height-adjustable “profiling bed”, and the family asked if one could be provided for use in the home. Although a profiling bed of the appropriate length was not an item of equipment listed in the catalogue from which practitioners could order, there was the ability to investigate whether other items could have been provided. The provision of a suitable profiling bed was something that the Registrant should have investigated, but did not. In the event, the family bought one themselves.

28. As early as 1 September 2016 there was discussion between the Registrant and the family about securing the input of other local authority employees whose involvement would be required if alterations to the home were to be made. Those other employees visited on 19 October 2016. Service User 4 also requested that a tray for seating be ordered, but when the case was reviewed on 1 November 2016 there was no indication that this had been done. On 15 November 2016, Mrs AM discussed her concerns about the space in the home with the Registrant, and they made a joint visit to the property on 22 November 2016. During the joint visit the Registrant undertook an assessment of Service User 4’s needs and what Occupational Therapy intervention was required. There was then a delay lasting from November 2016 until April 2017 before any work was carried out. There was a lack of communication by the Registrant to Service User 4 during this period of approximately five months. Furthermore, despite having made many home visits in 2016, the Registrant did not report these visits to the allocated social worker.

29. When interviewed about this matter, the Registrant sought to say that following the joint visit she made with Mrs AM in November 2016, she was awaiting advice from the employees who visited on 19 October 2016 about the financial assistance. The Panel accepted the evidence of Mrs AM that it was the professional responsibility of the Registrant to take all reasonable efforts to ensure that this information was provided to her. There is an absence of evidence that she chased to be provided with this information.

30. Having regard to these findings, the Panel is satisfied that the HCPC has demonstrated that, between November 2016 and April 2017, the Registrant did not undertake visits in a timely manner and that she did not provide appropriate support to Service User 4’s family. Accordingly, both limbs of Particular 3 are proven.

Particular 4 – found proved
31. Service User 6 was a young child who had a diagnosis of Autistic Spectrum Disorder. He had social communication difficulties, no speech and delayed development. He lived at home with his mother and sister.

32. The allocated Occupational Therapist was still working in a probationary period. In the event the Occupational Therapist did not complete the probationary period and was asked to leave the service. The Registrant supervised the allocated Occupational Therapist and was required to sign off any recommendation made.

33. Service User 6’s family requested that a “safe space bed” should be provided. Such a bed can be provided if a child has mental health problems as a last resort because it restrains the child and prevents them from getting out of bed. Safe space beds are controversial because of the degree of restraint they provide. The family also requested that flooring and a new boiler should be provided (the existing boiler having apparently broken down).

34. The allocated probationary Occupational Therapist undertook two home visits and commenced an assessment on 18 July 2016 that was completed on 7 September 2016. The assessment recommended a safe space bed, new flooring and a shower above the bath. The Registrant signed off these recommendations.

35. The Panel accepted the evidence of Mrs AM that a safe space bed was not appropriate as the child was young and the risk of injury could have been addressed by simple measures being taken, such as placing the mattress on the floor and installing stair gates. Further, the Panel accepted the evidence that the provision of new flooring and the shower were not issues that should have been addressed by Occupational Therapy input.

36. When asked during the local authority investigation why she had signed off on the recommendations, the Registrant’s reply was to the effect that she signed off on the recommendations without really looking at them in detail. It was the Registrant’s obligation actively to consider the appropriateness of members of staff whom she supervised, and that would have been so even if she had not known, as she did, that there were concerns about this particular probationary member of staff.

37. The Panel finds Particular 4 to be proven.

Particular 5 – found proved
38. Service User 7 had to wear a spinal brace for a recommended 18 to 23 hours a day. She also had to use a wheelchair and was in pain a lot of the time.

39. The allocated Occupational Therapist was the same probationary member of staff who had been involved with Service User 6. The Registrant also supervised the Occupational Therapist in respect of Service User 7.

40. The allocated Occupational Therapist did not undertake the core assessment, but following a home visit on 17 August 2016, she did recommend a bed lever, and the Registrant signed off on this initial visit record on 22 August 2016. On 8 September 2016, the Occupational Therapist completed an Equipment Request form, and the Equipment Record stated that the equipment request was completed and discussed with the Registrant on 9 September 2016. The report lacked any assessment of Service User 7 or any clinical justification for the equipment being provided, and there is no other evidence that the Registrant had any such evidence when she signed off on the Occupational Therapist’s recommendation or equipment order.

41. A bed lever goes under the mattress and the child uses it to help themselves get in or out of the bed. There is a risk of entrapment with a bed lever, and accordingly a risk assessment should be undertaken before one is recommended.

42. A note dated 5 October 2016 in the case records disclosed that the lever was to be collected from Service User 7’s home because she had injured her arm.

43. When Mrs AM subsequently reviewed this case she found that the core assessment remained incomplete and blank on the local authority’s system. It had been the Registrant’s responsibility to ensure that the allocated Occupational Therapist completed it.

44. When interviewed about this case the Registrant stated that she could not remember it. However, she subsequently wrote that on occasions equipment would be trialled as an element of an on-going assessment prior to the assessment being finalised. She stated that she would expect a separate risk assessment to be undertaken for each piece of equipment provided and had assumed the allocated probationary Occupational Therapist to have undertaken. The Panel accepted Mrs AM’s evidence that it is not sufficient for a supervising Senior Occupational Therapist to make assumptions as to what has been done; they should be satisfied that it has in fact been undertaken.

45. Accordingly, the Panel finds Particular 5 to be proven.

Particular 6 – found proved
46. Service User 8 had a diagnosis of Severe Autistic Spectrum Disorder, had social and communication difficulties and he tended to look peripherally, which resulted in him running into things. He had been referred to the Occupational Therapy Service by a Social Worker Assistant on 19 November 2012. An Occupational Therapy assessment was undertaken by an external Occupational Therapist in April 2013 and returned to the service on 13 September 2013. The Registrant’s role was as supervisor.

47. The external Occupational Therapist’s report recommended a stair gate. Following provision of the report in mid-September 2013, there were no further notes until 18 November 2013. There was a telephone call recorded to the effect that Service User 8 had fallen on the stairs as there was no stair gate. On 22 November 2013, the Registrant recorded that there were safety issues involved with the risk of harm to Service User 8, and requested that the Disabled Facilities Grant notification be prioritised. The Disabled Facilities Grant was not necessary for the provision of a simple item such as a stair gate. The Registrant did not complete the necessary minor works order for the stair gate in a timely manner.

48. It was the Registrant’s responsibility as supervisor to ensure that the recommendation of the installation of a stair gate was appropriately actioned, and in not doing so, Particular 6 is proven.

Particular 7(a) & 7(b) – found proved
49. Service User 10 was a boy who had been born prematurely with a left cerebellar infarct. He had unexplained epilepsy and was under the care of a paediatrician who was investigating the cause of the epilepsy. The Registrant was the allocated Occupational Therapist and as her initial report dated 24 February 2017 recorded, the medical investigations were still on-going at that time. Service User 10 and his family lived in a flat. His mother was pregnant, but she had to physically help Service User 10 down the stairs, something that posed a risk to her and her unborn child.

50. The Registrant closed the case on 24 February 2017, the same date as her initial report. The family complained on 6 March 2017 and Mrs AM emailed the Registrant on 12 March 2017 stating that it was not appropriate to close the case without supporting the family’s desire to be re-housed and in the absence of further information concerning the on-going medical investigations. Mrs AM also spoke to the Registrant about the case on 22 March 2017.

51. In the event, in early May 2017 the Housing Panel met and determined that the family had a Band A and 4-bedroom need, the indication being that it was acknowledged that the situation was particularly serious. The Housing Panel decision was made without a report prepared by the Registrant, who should have provided one, but was made with the benefit of reports submitted, unusually, by the Social Worker and doctor. As the Housing Panel met monthly, timely preparation of a report by the Registrant, at the very least, could have resulted in the family being re-housed at an earlier date.

52. Accordingly, both limbs of Particular 7 are proven.

Particular 8 – found proved
53. The Registrant was the allocated Occupational Therapist in relation to Service User 11. The Registrant prepared the initial report, and the document records that it was started on 20 December 2016.

54. When an Occupational Therapist determines that the needs of the service user would be more appropriately met by adapting the home, as opposed to moving home or providing equipment to be used in the home, it is necessary to involve a Private Sector Housing Officer (“PSHO”) to do a joint report. Ultimately, it is the PSHO who will decide if the adaptations recommended by the Occupational Therapist are feasible.

55. In the case of Service User 11, the Registrant recorded in her initial assessment her view that the house was not adaptable. The Panel accepted the evidence of Mrs AM that this is not an appropriate decision for the Occupational Therapist to make; what is appropriate is for an assessment of what could be done to meet the needs of the service user, make recommendations and then arrange a joint visit with the PSHO who will determine if the house is suitable for adaptation. The Registrant did not arrange a joint visit with the PSHO, but rather informed the family that they would be eligible to be re-housed because the house was not adaptable.

56. Particular 8 is proven.

Particular 9(a), 9(b) & 9(c) – found proved
57. In 2017 Service User 12 was a 9-year old boy who had Spastic Diplegia Cerebral Palsy. He lived at home with his parents and sister. His sister also had a mild form of Cerebral Palsy. Service User 12’s main challenges were access through the front door and up the path, access to the garden and stability of the toilet frame and tap levers in the bathroom.

58. The Registrant was the allocated Occupational Therapist and she started an Initial Assessment on 3 April 2017. Concerns came to light after another Occupational Therapist, who eventually completed the Initial Assessment on 8 August 2017, visited the family at home on 28 June 2017.

59. As with the case of Service User 11, the Registrant did not arrange a joint visit with a PSHO, but rather reported to the family that their home was not suitable for adaptation and that they should move. The Occupational Therapist who took over responsibility for the case considered it appropriate to involve the PSHO.

60. As the Panel has found in relation to Particular 8, it was not the role of the Occupational Therapist to make a decision about the feasibility of adaptation. However, in the case of Service User 12, the Registrant went further because she advised Service User 12’s mother that she should speak to the housing department and consider social housing. This advice troubled the Occupational Therapist who followed the Registrant because she knew that Service User 12’s parents had a mortgage and it was her belief that having a mortgage would disqualify a person from applying for social housing.

61. It was reported that the Registrant had asked to speak to Service User 12’s mother in private and had expressed the opinion that his mobility would decrease in the future and that there would be a time when he would need to use a wheelchair. It was also reported that she expressed the same opinion concerning Service User 12’s sister. The Panel did not receive direct evidence as to this conversation, but the manner in which the Registrant responded to Mrs AM when this conversation was put to her has resulted in the Panel finding on the balance of probabilities that the Registrant did indeed make comments about future deterioration in the mobility of the children. The Panel is of the clear view that it was not appropriate for the Registrant to proffer these opinions without solid medical evidence justifying them.

62. It follows that each limb of Particular 9 is proven.

Particular 10(a) & 10(b) – found proved
63. Service User 13 experienced seizures resulting from epilepsy, had mobility problems and had sensory issues.

64. Service User 13 had been allocated to the Registrant, but concerns came to light when the case was re-allocated on 1 June 2017 when the Registrant was on sick leave. The newly allocated Occupational Therapist conducted a home visit on 1 June 2017 and observed Service User 13 sitting in a “Smirthwaite chair” that had been provided by the Registrant in March 2017. The chair was a specialist chair that is used for children to sit in while they are being fed. It keeps the child upright and it has a tray that keeps the child in place.

65. Service User 13’s mother reported that the chair was not suitable; the gap between the child and the tray was such that he could not feed himself, and his posture was compromised because he often fell asleep in the chair. The Occupational Therapist who visited was also concerned, not only because the chair was too big for the child, but also because he moved continuously while in the chair with the risk that the chair could be made unstable by rocking. There is an available chair with feet designed to ensure stability in the event of the child rocking, and the Panel accepted the opinion of Mrs AM that such a chair should have been provided in preference to that provided by the Registrant.

66. Service User 13’s sensory issues resulted in him not being able to tolerate showers. The family requested that their home be adapted to provide a bedroom for Service User 13 on the ground floor because of the risk of him falling as result of seizures, along with a bathroom also on the ground floor. Again, as with Service Users 11 and 12, the Registrant advised that the home was suitable for adaptations. For the reasons already explained, this was not advice it was appropriate for the Registrant to give. What she should have done, but did not do, was arrange a joint visit with a PSHO, something that the Occupational Therapist who followed her did.

67. Both limbs of Particular 10 are proven.

Summary
68. In summary, all factual Particulars are proven. The Panel must therefore proceed to consider whether those facts amount to a statutory ground of misconduct and/or lack of competence, and, if a statutory ground is established, whether there is current impairment of fitness to practise.

Decision on Grounds
69. The Panel allowed the Presenting Officer time to consider the determination on the facts after it was handed down. When the Panel reconvened, the Presenting Officer made submissions on behalf of the HCPC on both the statutory grounds and current impairment of fitness to practise. In advancing his submissions on the former, the Presenting Officer suggested that the Panel would be more likely to consider that this is case of misconduct rather than one of lack of competence. He drew the attention of the Panel to judicial guidance on the issue of misconduct and to the Standards the HCPC alleges were breached by the Registrant.

70. The Panel began its deliberations by assessing the seriousness of the breaches it had found. Those breaches occurred both during the period when the Registrant was in the Senior Occupational Therapist role supervising others and also after she relinquished that role and reverted to direct work with service users. They spanned a significant period of time, occurred with regard to ten acutely vulnerable service users and involved basic, core responsibilities arising from the roles the Registrant was performing. The Panel is satisfied that the Registrant was an experienced Occupational Therapist. She had been working in the field in which these shortcomings were demonstrated for many years, some 17 years at the local authority. The Panel is also satisfied that the Registrant had the knowledge and ability to perform to an adequate standard in all the respects in which she defaulted.

71. The Panel considered the breaches of the HCPC’s Standards involved. With regard to the HCPC’s Standards of conduct, performance and ethics, the following standards were breached:
• Under the heading, “Promote and protect the interests of service users and carers”, standard 1.2, “You must work in partnership with service users and carers, involving them, where appropriate, in decisions about the care, treatment or other services to be provided”; and standard 1.3, “You must encourage and help service users, where appropriate, to maintain their own health and well-being, and support them so they can make informed decisions.”
• Under the heading, “Communicate appropriately and effectively”, standard 2.2, “You must listen to service users and carers and take account of their needs and wishes”; standard 2.3, “You must give service users and carers the information they want or need, in a way they can understand”; 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”; and 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.”
• Under the heading, “Delegate appropriately”, standard 4.1, “You must only delegate work to someone who has the knowledge, skills and experience needed to carry it out safely and effectively”; and standard 4.2, “You must continue to provide appropriate supervision and support to those you delegate work to.”
• Under the heading, “Manage risk”, standard 6.1, “You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible”; and standard 6.2, “You must not do anything, or allow someone else to do anything, which could put the health or safety of a service users, carer or colleague at unacceptable risk”.
• Under the heading, “Report concerns about safety”, standard 7.1, “You must report any concerns about the safety or well-being of service users promptly and appropriately”; standard 7.2, “You must support and encourage others to report concerns and not prevent anyone from raising concerns”; standard 7.3, “You must take appropriate action if you have concerns about the safety of well-being of children or vulnerable adults”; standard 7.5, “You must follow up concerns you have reported and, if necessary, escalate them”; and standard 7.6, “You must acknowledge and act on concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so”.
• Under the heading “Be open when things go wrong”, standard 8.1, “You must be open and honest when something has gone wrong with the care, treatment or other services that you provide ….”.
• Under the heading, “Personal and professional behaviour”, standard 9.1, “You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.”

In addition to these breaches of the Standards of conduct, performance and ethics, the manner in which the Registrant conducted herself had the consequence that she failed to practise in a manner that corresponded with the requirements of the HCPC’s Standards of proficiency for Occupational Therapists.

72. In the event, all the service users relevant to this case were exposed to the risk of harm. The nature of the harm differed, so, for example, Service Users 1 and 7 suffered injury. Service User 3 (and his mother), Service User 10 (and his mother) and Service User 13 were exposed to the risk of physical harm. Other service users experienced unwarranted delay in obtaining the assistance they were entitled to receive, in the case of Service User 4 that being particularly serious as she had a terminal condition. Others experienced unnecessary anxiety, for example, the family of Service User 11 over the issue of their housing and distress over the inappropriate expression of an opinion on prognosis of the children of that family. In addition to these factors, the inappropriate works undertaken to Service User 6’s home resulted in the local authority expending approximately £7,000.00 that should not have been paid.

73. When the Panel considered the totality of the findings against the Registrant in the light of the factors identified above, it came to the clear conclusion that the threshold of seriousness to categorise them as misconduct was reached. It was behaviour that fellow professionals would regard as deplorable. The Panel considered whether there were any elements of the factual findings that should be excluded from the overall finding of misconduct, but concluded that there were not.

Decision on Impairment
74. The Panel next considered whether the established misconduct is currently impairing the Registrant’s fitness to practise. The Panel heeded the submission of the Presenting Officer of the necessity to address both the personal and public components relevant to that consideration.

75. The breaches identified by the Panel’s findings are all of a type that are capable of being remedied. However, when the Panel considered whether they had in fact been remedied, the Panel concluded that they had not. There was minimal insight demonstrated by the Registrant in the comments she made in the context of the local authority investigation as there were some limited apologies, but there was no recognition of the effect on service users and their families of what had occurred. Not only is there no evidence that the Registrant has taken steps to remedy her shortcomings, but the communication from her union representative was that the Registrant has retired from practice and has no desire to continue her career as an Occupational Therapist.

76. The absence of remediation had the consequence that the Panel was driven to conclude that if the Registrant were to be permitted to return to unrestricted practice, there would be a significant risk of repetition with the attendant risk of harm that flowed from the shortcomings identified by the Panel in respect of the ten service users relevant to this case. This finding necessitates a finding that the Registrant’s fitness to practise is impaired on the personal component.

77. In the judgement of the Panel a finding of current impairment of fitness to practise is also required with regard to the public component. So serious are the findings such a finding would be required to address the concern that fair-minded members of the public would have about an Occupational Therapist who had acted as the Registrant did even if there was a negligible risk of repetition; the fact that there is a significant risk of repetition makes that finding the more necessary. Furthermore, were the Panel not to make a finding of current impairment of fitness to practise it would fail in its duty to declare and uphold proper professional standards and to send a clear signal to other practitioners who might feel tempted to depart from the standards expected of them.

78. The consequence of the findings that the proven facts constitute misconduct currently impairing the Registrant’s fitness to practise is that the Panel must proceed to consider the issue of sanction.

Decision on Sanction
79. After the Panel handed down its decision on the statutory grounds and impairment of fitness to practise, and time was allowed for that decision to be considered, the Presenting Officer made submissions on sanction.

80. The Presenting Officer outlined the proper approach to the making of a decision about sanction and reminded the Panel of the HCPC’s Sanctions Policy. He referred the Panel to various paragraphs of the Sanctions Policy, and while stating that the HCPC was neutral on this issue and that the decision on the appropriate sanction was one for the Panel’s discretion, he suggested that the Panel’s decision on the grounds and impairment of fitness to practise would suggest that a caution order, a conditions of practice order and a suspension order might not be appropriate.

81. The Panel approached the decision it was required to make by accepting the advice it received that the finding that the misconduct allegation is well founded does not of itself require the imposition of a sanction. The first decision to be made, therefore, is whether the reasons for that finding require the imposition of a sanction in the present case. If a sanction is required, then the available sanctions must be considered in an increasing order of seriousness until one that sufficiently meets the circumstances is reached.

82. The Panel looked afresh at the factors that could be said to be aggravating and mitigating. In paragraph 72 above, the Panel identified various consequences of the Registrant’s actions that made this a serious case, and it is unnecessary to repeat them here. In addition to those factors the Panel considered that it was material that there had been very little insight demonstrated by the Registrant into her shortcomings. No significant remorse had been expressed or apology tendered, and there has been no remediation of the serious breaches committed by the Registrant. The effect of her behaviour was that the trust of service users and their families was diminished not only in the Registrant personally, but also in her profession. It is also relevant to record that the behaviour was repeated and extended over a lengthy period of time.

83. Against these aggravating matters, the only factor the Panel has been able to identify that can be recorded in the Registrant’s favour is that it has not been suggested that she has previously been the subject of regulatory proceedings.

84. The breaches in this case were far too serious to result in no further action being taken. Accordingly, the Panel had regard to the available sanctions.

85. The Panel first considered whether a Caution Order would be appropriate. The Panel accepted the guidance contained in paragraph 101 of the Sanctions Policy. In this case the issue is not isolated, it is not limited and it is not relatively minor in nature. There is a risk of repetition, and the Registrant has neither shown good insight nor has she undertaken appropriate remediation. A Caution Order would provide no protection from the significant risk of harm were the Registrant to choose to return to practise. The Panel rejected a Caution Order as an appropriate disposal.

86. The Panel next considered a Conditions of Practice Order. Again, the Panel accepted the guidance provided by the Sanctions Policy, and heeded the terms of paragraph 106. In relation to the factors identified in that paragraph, save for the fact that the failures are conceptually capable of being remedied, none of the suggested elements is present in this case. As stated in paragraph 107, for conditions of practice to be appropriate there would need to be grounds for believing that there was a genuine commitment on the part of a registrant to resolve concerns. The Registrant’s failure to engage in this process and her stated intention not to return to practise have the consequence that a Conditions of Practise Order would be wholly inappropriate.

87. The Panel next considered a Suspension Order. The Panel considered the factors identified in paragraph 121. These findings do indeed represent a serious breach of the Standards of conduct, performance and ethics, but beyond that the present case does not meet any of the other suggested factors; the Registrant does not have insight, the issues are likely to be repeated and there is positive evidence that the Registrant will be unlikely to be able to resolve or remedy her shortcomings because she has stated an intention not to return to practise as an Occupational Therapist. It is true that the making of a Suspension Order would provide protection from the risk of future harm for the duration of the period of suspension, but it would not provide long-term protection because the risk to the public at the end of any period of suspension would be exactly the same as it is at the present time. Accordingly, the Panel rejected a Suspension Order as an appropriate sanction.

88. It follows that the Panel considered making a Striking Off Order. The Panel acknowledged the seriousness of making such an order. However, as reflected in paragraph 131 of the Sanctions Policy, such an order is necessary if a lesser sanction would be insufficient to protect the public, where there is a lack of insight and where there is an unwillingness to resolve matters by undertaking effective remediation. This case fitted these suggested circumstances. The Panel was satisfied that striking off is a proportionate response in the particular circumstances of this case.

Order

The Registrar is directed to strike the name of Ms Clare D. Beavins from the Register on the date this Order comes into effect.

Notes

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 Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Reasons for making the Interim Suspension Order
(1) After the Panel announced that it was making a striking off order, the Presenting Officer applied for an interim suspension order to cover the period during which the Registrant could appeal the Panel’s decision and Order, and, in the event that an appeal is made, the longer period pending the final resolution of that appeal.

(2) The Panel first considered whether it had jurisdiction to consider the matter. The Panel was satisfied that in the notice of hearing email sent to the Registrant on 15 March 2021, the Registrant was put on notice that in the event of a substantive suspension order being made, the making of an interim order was a possibility. This notification afforded the Registrant an opportunity to make representations on the issue of whether an interim order should be made, and that opportunity meant that the Panel had jurisdiction to consider the application.

(3) The Panel next considered whether it should exercise the discretion vested in it to decide the application in the absence of the Registrant. There were two factors that persuaded the Panel that it should deal with the application in the absence of the Registrant. They were:
• The very nature of an application for an interim order is such that there is a need to determine it expeditiously; if there is delay, and it is then decided that the interim order is necessary, the public will have been exposed to a degree of risk during the period of delay.

• For the same reasons explained by the Panel in relation to the decision to proceed with the substantive hearing in the absence of the Registrant, there were no grounds on which the Panel could conclude that the Registrant would be likely to participate to a greater extent in relation to the interim order application if consideration of it was adjourned.

(4) In relation to the decision whether an interim order should be made, the Panel accepted the advice it received from the Legal Assessor that the default position established by the legislation governing these proceedings is that when a substantive sanction is imposed there should be no restriction on the registrant’s ability to practise unless and until that registrant’s appeal rights are exhausted. It follows that positive reasons are required to justify departure from this default position. Those reasons are to be measured against the grounds that can justify the imposition of an interim order, namely that it is (i) necessary for protection of members of the public, (ii) otherwise in the public interest, or (iii) in the interests of the registrant himself or herself.

(5) In the present case the Panel determined that an interim order is required, the same being necessary for protection of members of the public and being otherwise in the public interest. The reasons for this decision were:
• For the reasons explained in the substantive decision, the Panel has found that there is a significant risk of repetition of serious misconduct that, if committed, would have serious implications for the safety and well-being of service users and their families. The public should be protected against the risk of repetition that would exist if the ability of the Registrant to practise during the appeal period is not restricted.

• Serious damage would be done to the reputation of the profession of Occupational Therapy and the regulation of it were there to be no restriction on the Registrant’s ability to practise while her appeal rights remain extant.

• The Panel had been informed that the Registrant had retired and formed an intention not to return to practise as an Occupational Therapist. The Panel did not doubt the honesty of this communication, but it is possible for people in good faith to have a change of mind about their intentions. It is for the Panel to determine what a registrant is to be permitted to do, not to reflect a stated intention that could change.

(6) An interim order being necessary, the Panel next considered whether the factors requiring it could be satisfactorily addressed by the imposition of interim conditions of practice. The conclusion of the Panel was that they could not. The primary reason for this decision was that the lack of engagement in this process on the part of the Registrant meant that there could be no confidence that the Registrant would observe conditions of practice even if appropriate conditions could be formulated, which itself is doubtful.

(7) For these reasons an Interim Suspension Order is required.

(8) As to the duration of the Interim Suspension Order, the Panel determined that it should be for the maximum period of 18 months. If the Registrant does not appeal against the substantive decision and Order there will be no prejudice to her because the Interim Suspension Order will simply fall away when the striking off order takes effect. However, if the Registrant does appeal within the 28 day period she has to take that step, the final determination of that appeal could well take 18 months, and for the reasons already expressed, her ability to practise should be restricted pending that final determination.

Interim Order
The Panel makes an Interim Suspension 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

Hearing History

History of Hearings for Miss Clare D Beavins

Date Panel Hearing type Outcomes / Status
14/06/2021 Conduct and Competence Committee Final Hearing Struck off