Ms Pinkie Uddin

Profession: Speech and language therapist

Registration Number: SL33971

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 15/11/2021 End: 17:00 18/11/2021

Location: Virtual, via video conference

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Whilst registered as a Speech and Language Therapist (SL33971)

1. During 2016 and 2017, while employed at the Whittington Health NHS Trust, you:

a) Did not complete and/or upload, any, or any adequate, records in Rio, of contacts with service users and/or administrative tasks on the dates specified in Schedule A:

b) Did not provide and/or arrange the required number of speech and language therapy sessions as outlined in each child's Education, Health and Care Plan, for the service user outlined in Schedule B.

c) Did not visit schools 1,2,3 and/or 4 for the expected number of days.

d) Provided inaccurate and/or unverified reasons for rescheduling and/or cancelling visits at schools 1,2, and/or 4, on dates as outlined in Schedule C.

e) Did not routinely complete clinical notes to an appropriate standard, in that they lacked detail and/or were not contemporaneous.

2. On or around 20 July 2017, you provided an inaccurate reason for your unauthorized absence from the Islington Council Offices.

3. On around 14 August 2017, you provided a statement to your employer which contained falsified and/or inaccurate clinical notes as outlined in schedule D.

4. Between January 2018 to July 2018, while employed at the London North West University Healthcare Trust, you:

a) Provided inaccurate and/or conflicting reasons for rescheduling and/or cancelling visits at schools 5, 6, 8 and/or 9, on dates as outlined in Schedule E.

b) Did not upload and/or record contacts and/or case notes in System 1, on the dates specified in Schedule F,

5. On or around 21 March 2018, you did not complete case notes following planning meetings for child service users;

a) Child Service User 54
b) Child Service User 55
c) Child Service User 56
d) Child Service User 57

6. Your actions in paragraphs 1(d), 2, 3 and 4(a) were dishonest.

7. The matters set out in paragraphs 1 - 6 amount to misconduct and/or lack of competence.

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

Finding

Preliminary Matters

Virtual hearing

1. This Hearing has been conducted through virtual meeting media in accordance with the Health and Care Professions Tribunal Service (HCPTS) current COVID-19 Pandemic Protocol.

2. That Pandemic Protocol also provides for service of the letter of Notice of Hearing to be undertaken by email, and the electronic recording of an email receipt.
Service

3. The Panel had before it, in the 9-page bundle of service documents, evidence that on 12 March 2021, the letter of Notice of Hearing had been sent by email to the Registrant. The Panel had further electronic evidence that this email had been delivered to the Registrant. The Panel had further evidence of service of the Notice of the resumed Hearing on 15 November 2021.

4. The Panel took advice on whether there had, in the circumstances, been good service. The Legal Assessors drew the Panel’s attention to the position that under the Rules, postal service did not require confirmation of delivery, only proof of posting is necessary. Under the current Pandemic Protocol, the Panel had the additional evidence of successful email delivery. The Legal Assessors advice identified that the Panel must have proof that the Notice was sent at least 28 days in advance (Rule 6(2) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedural) Rules 2003 (as amended); and that the letter of Notice of Hearing must contain all relevant and correct information relating to the time, date and venue/mode of hearing.

5. The Panel considered the information before it and concluded that it had evidence of good service of the Notices of Hearing, as defined within the Rules.

Proceeding in absence of the Registrant

6. The HCPC made applications for the Panel to exercise its discretion to proceed in the Registrant’s absence. The Panel having accepted that there is good service should be content that the Registrant is aware of the hearings. The Registrant has not made an application for an adjournment. Further, the Registrant has not provided this Panel with any evidence as to why she is not present and given no indication that she is more likely to attend on another date, should this matter be adjourned.

7. The Panel was informed that the last communication received from the Registrant had been on 22 March 2019 and that there had been no engagement in these proceedings. The Registrant’s last stated position was that she did not intend to pursue her profession again in the future. The HCPC submitted that in all the circumstances it is appropriate to assume that she has voluntarily absented herself.

8. The HCPC stressed that it had witnesses in attendance who were ready and willing to give evidence. It was stated that there was broad public interest in this hearing proceeding without further delay given that the events to which the Allegation relate took place in 2016 and 2017.

9. The Panel took advice from the Legal Assessors who stressed that the Panel should give consideration to the rights of the Registrant in attending this hearing. In Ms Aldred’s advice she stated that the case of Tait v Royal College of Veterinary Surgeons highlighted that the Panel’s discretion to proceed in a registrant’s absence is not an unfettered one. This being the case, in accordance with the guidance given by the judge in the case of R v Jones and Hayward, the Panel should proceed with extreme caution, taking into account all possibilities for absence or reasons to support an adjournment before proceeding. She commended the HCPTS Practice Note on this issue, and reminded the Panel that it must give full written reasons for its decision to proceed should it decide to do so.

10. The Panel decided that in the public interest it would proceed in the absence of the Registrant. In reaching that decision the Panel took into account the following:

a. The notices of hearing having been successfully electronically served on the Registrant had not produced a request from her for an adjournment of this hearing.

b. There had been no communication from the Registrant for over two years.

c. It has been approximately 5 years since these events and any further delay would adversely affect recollections of those events.

d. The Registrant has clearly stated in a communication with the HCPC that she has no intention of pursing her career in the future and this supports the Panel’s conclusion that the Registrant has made an informed decision not to attend this hearing.

e. Adjourning the case in a situation where there is no confidence that the Registrant would be any more likely to attend or engage with the HCPC or HCPTS process would incur further cost and result in wasted effort.

f. There are public interest and public protection issues raised by this case and there are witnesses to hand to give evidence.

Conducting part of the hearing in private

11. In the absence of the Registrant, the HCPC made an application on her behalf for evidence in relation to matters relating to her personal life or health to be considered in private.

12. That application was heard in private as reference was made to those matters which it was argued would most properly warrant privilege. The HCPC application was for discrete parts of the hearing to be held in private with the vast majority of the evidence being considered in public.

13. The Panel accepted the advice of the Legal Assessor that as a starting point all hearings should be held in public and that there is a public interest in the administration of justice being undertaken in a clear and open fashion. Thereafter it was a matter for the Panel’s judgment as to whether the interests of the Registrant in relation to matters relating to her private life, which are enshrined in human rights legislation, outweigh those of the public interest in a public hearing.

14. The Panel noted that within the documentation there were several occasions where the issues raised related to the personal information about the Registrant and her family. It considered that these personal matters should not be within the public domain. This being the case, the Panel decided that when those issues were referred to, the hearing would be held in a private session.

Amendment of the Allegation

15. The Panel was directed to the letter, which was emailed to the Registrant on 27 January 2021, in which it was stated that the HCPC would at the outset of this hearing make an application to amend the Allegation.

16. It was stated that the decision to amend the Allegation, as indicated in that letter, arose from the need for further clarification of what was alleged, and for the Allegation to better reflect the evidence. It was submitted that these amendments did not extend the ambit of the Allegation nor cause the Registrant any injustice.

17. The HCPC drew the Panel’s attention to the fact that the application in relation to Particular 1(a), Schedule A, was for the discontinuance of dates of matters, which on further consideration, would have no reasonable expectation of being proved to the requisite standard of balance of probabilities. In respect of those matters the HCPC would be offering no evidence for the 10 dates that had been identified within the letter sent to the Registrant. It was stressed that this could not be considered to be an under prosecution by the HCPC given the number of other incidents identified in the schedule.

18. In relation to the amendment of Particular 3, the HCPC sought, by the inclusion of ‘and/or inaccurate’, to encompass within the allegation matters which were either untrue, half-truths, or inaccurate and misleading.

19. Before considering the amendments individually the Panel sought legal advice. The Panel noted within that advice the case of the HCPC v Ireland and Ma [2015] in which it was stated, obiter, that there is no statutory provision for this Panel to make substantive amendments to the Allegation, these are matters which the Investigating Committee should approve. There is however at common law the ability to make small amendments to the wording, provided that they do not extend the nature of the matters alleged and do not cause any prejudice to the Registrant.

20. The Panel notes the matters within schedule A on which there is to be no evidence produced by the HCPC, and accepts and records the discontinuance of those 10 matters. In making this decision the Panel has considered the public interest and whether there is under prosecution arising. The Panel has concluded that there is simply no evidence to support those matters and so the matters may rest there.

21. The Panel has considered each of the amendments proposed (the HCPC Schedule ‘The Proposed Amended Allegation’ attached as Schedule G). In undertaking this task, the Panel has viewed the potential impact on the Registrant of those proposed changes. The Panel has recorded its decisions below.

a. In relation to the main stem, the amendments made reflect changes to the wording and ordering of phrases to accord with normal HCPC format of an allegation. The Panel approves this rephrasing.

b. Amendment of Particular 1(a) wording, so that the issues previously set out at (i) and (ii) of the original drafting, have been subsumed into the revised wording. The restricted wording now also encompasses the ‘uploading’ rather than ‘recording’ of entries on the Rio system. This is more accurate in relation to the inputting of information into an electronic recording system. The changes are therefore approved.

c. Amendment to Particular 1(b) to include with the wording ‘and/or arrange’. The Panel has accepted that the documentary evidence includes the lack of arrangements for those service users who had provision of Speech and Language Therapy identified within their Education, Health and Care Plan. There is a further deletion of the word ‘child’ before the term ‘service user’. This an accurate description. The Panel approves those amendments.

d. Amendment of Particular 1(c) by the deletion of ‘required’ and replacement by the word ‘expected’ to describe the number of days which the Registrant was to visit the schools to which she had been assigned. Deletion of the (i) to (iv) which provided further particularisation that is no longer required following the inclusion of the term ‘expected’. The Panel has approved these amendments.

e. Amendment to Particular 1(d) by the replacement of ‘untrue’ with the words ‘inaccurate’ and the inclusion of ‘/or’ before reference to school 4, and inclusion of the words ‘on dates’. The Panel has concluded that these amendments better reflect what is alleged.

f. Amendment to Particular 1(e) by the inclusion of the word ‘routinely’ in relation to the completion of clinical notes. The Panel again considers that this better reflects the evidence before it and so approves the inclusion of that word.

g. Amendment to Particulars 2 and 3 to remove reference to where the Registrant was working on the dates specified. This information is subsumed within wording earlier in the Allegation and so is not required. The Panel approves the deletions.

h. Amendment to Particular 2 by the deletion of ‘untrue’ with inaccurate’. The Panel considers that this is an appropriate and more accurate term for what is alleged.

i. Amendment to Particular 3 by the insertion of the words ‘and/or inaccurate’ before clinical notes. The Panel approves this addition which better reflects the evidence.

j. Amendment to Particular 4(a) by the replacement of ‘untrue’ with ‘inaccurate’ and the inclusion of ‘on dates’ after reference to school 9. These amendments are approved as they better describe what is alleged.

k. Amendment to Particular 4(b) by the deletion of ‘complete’ and replacement by the word ‘uploaded’. There is also the proposed inclusion of ‘contacts and/or case notes’ to reflect the deletion of the matters previously itemised in (i) and (ii) which have now been deleted. These changes reflect what is expected in relation to the recording of information on the electronic system. The Panel approves those changes.

l. Deletion of reference to who the Registrant’s employer was at this time, this detail having been subsumed within wording earlier in the Allegation. This deletion is approved. No evidence offered.

22. At the close of the HCPC’s case, the HCPC, after further analysis and having heard the live evidence, offered no evidence on three matters identified within the Schedules that are attached to particulars of the Allegation.

a. Particular 1(a), Schedule A, matter identified as relating to lack of an entry on 7 October 2016. There is no probability of success of this matter for two reasons. First, it is an incident which took place before the change of Policy on the 1 April 2017 relating to recording of entries on the Rio. Secondly, there is a record of activity recorded on the Rio system at 12.04 hours to 15.30 hours; with an email recorded on that day at 13.04 hours.

b. Particular 3, Schedule D, relating to Service User 11 at School 2, is identified as taking place on ‘15/0/17’ This is clearly an incomplete date and cannot therefore be a valid reference to an event and so must fall for lack of specification and completeness.

c. Particular 4(b) Schedule F relating to School 10 Service User 40, whilst listed in the Schedule there is no mention of this service user within the supporting information. It therefore follows that this must fall for lack of supporting evidence.

23.The Panel, having checked the detail of these matters by reference back to the documentation, agreed that they were not well founded and accepted the HCPC’s position of offering no evidence.

Background

24. The Registrant was newly qualified when she started her employment as a Band 5 Speech and Language Therapist with the Whittington Health NHS Trust (Whittington Trust). She worked for the Whittington Trust from 11 April 2016 to the 11 September 2017. She had been responsible for managing a caseload of primary school aged children with Speech and Language learning needs who were attending mainstream state schools. The Registrant had resigned her position with the Whittington Trust whilst investigations into her conduct and performance were in progress.

25. On the 28 August 2018 the Whittington Trust sent a referral to the HCPC. In that referral concerns relating to the Registrant’s caseload management, and in particular the number of days which were unaccounted for in the Registrant’s electronic care record diary were highlighted. Further concerns about falsification of clinical notes, inadequate progress notes, missing documentation and unauthorised absences from work were also alleged.

26. On 15 October 2018, the HCPC received a further referral from the London North West University Healthcare NHS Trust (LNW Trust). In that referral the HCPC was informed of concerns about the Registrant’s performance and conduct across her caseload including failure to attend schools and providing conflicting reasons for non-attendance. The referral identified a failure to complete clinical notes in line with the note writing policy, failure to keep clinical notes and notes for child service users being written on a date when the Registrant had not attended the school.

27. From this referral it was established that the Registrant had gained employment as a Band 5 Speech and Language Therapist with the LNW Trust in December 2017 until 3 July 2018, when again she had resigned whilst there were investigations into her practice in progress.

28. Both Trust referrals identified similar issues relating to caseload management, record keeping and unexplained absences. This being the case, those referrals were joined and form the basis of the Allegation being faced by the Registrant at this hearing.

29. The Registrant initially engaged in the HCPC process, and it was considered at one point that this matter may revolve around health issues. However, no information was forthcoming from the Registrant and the matter passed to a Panel of the Conduct and Competence Committee. This Panel has before it information dated 19 February 2019 in which the Registrant states that she no longer intends to practise. The last communication between the HCPC and the Registrant, is dated 22 March 2019.

Decision on Facts

Documentary evidence

30. The Panel had before it, what was described by the HCPC as a ‘voluminous’ amount of documentation. This documentation extended to 1102 pages.

31. The Panel further noted that despite the extent of the documentation before it, the core information on which the Allegation is based is reliant on documentary reports of analysis of the records, rather than the source information recorded within the electronic systems on which those reports were based.

Witness evidence

32. The Panel received live evidence from four HCPC witnesses and a sworn statement. Three witnesses were from the Whittington Trust and one from the LNW Trust.

33. Elizabeth Relf (ER) is Team Leader for Islington Mainstream Therapies for the Whittington Trust. She had been the person within the Whittington Trust who had prepared the audit of the Registrant’s work on which Particulars 1, 2 and 3 of the Allegation derive. In support she had produced a 91-page sworn statement which, apart from a few minor corrections, reflected the evidence she presented to this Panel.

34. ER presented as a credible, honest witness who attempted to assist the Panel with its task. Despite her documentation bundle being in a different order from that presented to the Panel, she attempted to refer the Panel to the parts of her investigation which supported her sworn statement. She had been able to give the Panel a clearer understanding of the chronology of events and a better insight into the incidents that are alleged to have occurred in the Registrant’s personal life whilst she had been employed by the Whittington Trust.

35. ER confirmed that the Registrant had been newly qualified when she started with the Whittington Trust and had served a six-month probationary period which came to an end in October 2016. She gave the Panel an insight into how the team operated when the Registrant was first employed, with a hot desk arrangement in place and therapists working for the most part autonomously. She confirmed that in 2016 the working policy was one of ‘trust’. Since then, there has been a greater emphasis on oversight, with checks on, and supervision of, a therapist having been tightened up. The working practices within the team were now more robust.

36. ER had first become concerned about the Registrant’s practice from feedback from two sources; the Special Educational Needs Coordinators (SenCos) at the schools the Registrant attended, and from the Registrant’s senior line manager, Sally Anne Fraser. ER was able to tell the Panel the stages in which she had gathered information and to explain the interface of sources of such information. She said that this information had informed her conclusions, which identified that there were 94 days of professional activity unaccounted for. She was also able to confirm the rigorous steps taken by her and other members of the Whittington Trust to ensure that the information it had produced for the HCPC was supportable.

37. ER had exhibited to the Panel the audit reports which had been produced through the Rio system for the periods September 2016 to December 2016 and January 2017 to July 2017. These were entitled in the exhibits list as Progress Reports; but were in fact an extract of the information held in the Rio system. All the entries on these Progress Reports related to the Registrant’s caseload and entries for activity on those cases. ER had also exhibited the responses she received from the SenCos at each of the schools allocated to the Registrant. She had collated information from other sources including, training logs, sickness absence records and dates and times of internal meetings.

38. ER informed the Panel that there had been a change of policy relating to the way in which information was recorded on the Rio system and in particular the need to record non-clinical activity in the Rio diary (e.g., meetings, supervision and training). Those Policy changes were implemented on 1 April 2017.

39. Sally-Anne Fraser (SAF) is the Clinical Lead Speech and Language Therapist in the Islington Mainstream Speech and Language Therapy Service at Whittington Trust and the Registrant’s senior line manager. The Panel considered her to be an honest and credible witness who assisted the Panel in establishing the process by which it had been identified that there were issues relating to the Registrant’s performance.

40. SAF had been the Registrant’s Clinical Team Lead and had first met the Registrant upon her return to the office in March 2017 following a period of SAF’s maternity leave. SAF worked a four-day week and stated that she saw the Registrant around the office on most days. SAF was the manager of the Registrant’s line manager, Nicolina Van Der Woerd (NVDW).

41. SAF informed the Panel that therapists tended to be autonomous, attending schools in the morning and returning to the office in the afternoon to complete their paperwork. The Registrant had generally been noted at her desk and seen working on her computer. It was also noted that the Registrant had left promptly at 5pm and this was at variance, as even experienced therapists had, on occasion, to stay late. The Registrant had one admin day per week during which it was expected that she would be able to complete all record keeping and administrative tasks.

42. SAF confirmed that the impression given by the Registrant was that she had good time management skills, was organised, and had everything under control. This meant that the concerns relating to the Registrant’s caseload had only come to light gradually. At the appraisal which SAF had conducted with the Registrant in May 2017, some performance concerns were raised but the Registrant stated that she is able to manage “whatever is thrown at her”.

43. SAF confirmed that when the Registrant’s notes had been reviewed there had been quite a few entries. However, these entries related to the early stages of her employment and were likely to be during the Registrant’s probationary period.

44. By the end of the summer term in 2017, the Registrant had been seen returning to the office late. It was at this point that SAF had received an email from a colleague indicating that the Registrant was returning from schools late and she had not been asking a lot of questions. SAF had shared her concerns with ER.

45. SAF was able to outline the extent of the Registrant’s workload. It had however been ER who had undertaken the gathering and collation of information on the detail of the Registrant’s caseload, her conduct and performance. SAF’s role had been confined to commissioning the Rio ‘back-end’ review of the Registrant’s work and to undertake a review of the Registrant’s training log.

46. NVDW, Speech and Language Therapist for the Whittington Trust had been the Registrant’s line manager and she had undertaken supervision of the Registrant from a management perspective, with SAF undertaking clinical supervision. She does not recall being involved in the Registrant’s probationary period of work, when there would have been more frequent supervision, and the subsequent ‘sign off’ in October 2016.

47. NVDW was again considered by the Panel as someone who was trying to assist it in establishing a fuller picture of the Registrant. She told the Panel that the Registrant had made her aware of the personal challenges which the Registrant had been facing during her time at the Whittington Trust. NVDW had undertaken four management supervisions with the Registrant. Therapists generally had two such supervisions per school term, therefore six in a year. The Registrant had failed to attend a supervision session. NVDW noted that in supervision there was inconsistency in the Registrant’s responses to questions.

48. Rachel Smith (RS), Speech and Language Therapy Clinical Service Lead for the mainstream schools at LNW Trust provided evidence to the Panel in relation to the issues identified in Particulars 4 and 5. RS presented as a confident, credible, and honest witness. She had been personally involved in the preparation of the evidence of poor performance that was before the Panel and was able to provide detail on the Registrant’s conduct and performance during her time with LNW Trust.

49. RS had not been employed in the Registrant’s recruitment and was unable to confirm what information had been disclosed by the Registrant at the time of her recruitment. RS was therefore unaware of any previous concerns over the Registrant’s performance when she met the Registrant. RS had from the outset offered the Registrant informal support and had undertaken supervision with her on a roughly fortnightly basis. When RS was not available another senior, who RS job shared with, would undertake the supervision.

50. The Panel had copies of the supervision notes from LNW Trust which set out the observations on the Registrant’s caseload and identified the concerns which became apparent over time. The first supervision note is dated 13 December 2017 which was soon after the Registrant had started work for LNW Trust. It is noted within that supervision discussion record that there were ‘issues with smartcard from previous trust’ which would have impacted on access to the electronic record keeping system (SystmOne).

51. The Panel had before it a statement from a member of the HCPC case management team exhibiting information received from the Registrant during the initial stages of the HCPC investigation into the matters referred by the Trusts. The Registrant, having raised issues of health, did not provide a signed medical consent form as last requested by the HCPC on 22 March 2019, this was when the Registrant’s engagement ended. Therefore, this matter had been pursued as alleged misconduct/lack of competence.

52. The Registrant was not present at this hearing and so the Panel had no direct evidence from the Registrant. The Panel has however seen copies of handwritten notes and written responses produced by the Registrant. Some of these were in response to matters raised by the Trusts during their investigations of their concerns. To the degree that they provide an insight into the Registrant’s actions, they have been given weight by the Panel. The HCPC in conducting its presentation has, in fairness to the Registrant, highlighted to the Panel the evidence produced by the Registrant at the time of the alleged incidents.

HCPC’s submissions on the evidence

53. The HCPC has drawn the Panel’s attention to the information which is before it from the Whittington Trust. The Trust’s audit was undertaken by examining the following: the Rio system for record keeping, the hardcopy ‘whereabouts’ diary and records of training and absences.

54. It is submitted that whilst this Panel does not have each and every entry the overall approach taken to the investigation of the Registrant’s practice by ER is sufficiently robust and comprehensive as to allow the Panel to place weight and reliance on her findings and conclusions.

55. In relation to the evidence presented by RS the Panel noted an alleged pattern of behaviour, events and situations which mirror those identified by ER in her investigation. The HCPC stated that two Trusts making the same observations and coming to the same conclusions gave weight to the matters alleged. The Panel has however considered the matters separately.

Findings on Facts

56. The Panel appreciates that at this stage the burden of proving the matters alleged lies with the HCPC. That burden is to the civil standard of balance of probabilities. The Panel took and accepted the advice of the Legal Assessors.

57. The evidence upon which the Panel must base its conclusions is that which it has heard and read during this hearing. It is for the Panel to decide what weight to place upon that evidence having established the degree to which that evidence is supported by other evidence it has received. This is a complex case involving many dates and allegations as well as two sources of complaints.

Particular 1(a) – found proven in respect of 41 dates identified on Schedule A.

a) Did not complete and/or upload, any, or any adequate, records in Rio, of contacts with service users and/or administrative tasks on the dates specified in Schedule A:

58. There are offered by the HCPC, and accepted by this Panel, 88 dates, as set out in Schedule A, to be considered by this Panel ranging from 27 September 2016 to 20 July 2017 (HCPC having offered no evidence on one date at item 3).

59. The Panel is required by this particular to consider several variants of actions and recordings on any and/or all those 88 dates. In undertaking this task, the Panel has been presented with considerations in respect of each of these dates.

60. The wording of the sub-particular indicates a need for the Panel to consider the alternatives of the action to ‘complete’ a record and to ‘upload’ a document into the record. A record on the Rio system can either be a direct entry into the progress notes or the uploading of a document into the Rio record for that child. However, the Panel noted that all entries or tasks relevant to a child should be included as an entry into the Rio progress notes. The Panel therefore relied on the Rio audit of the progress notes when considering each date on sub-particular 1(a).

61. This sub-particular also identifies a requirement for the Panel to consider the ‘adequacy’ of records made by the Registrant on those dates. The Panel has before it an exhibit which is an appendix to the Whittington Trust Induction Pack. This appendix sets out examples of note taking. There has been no evidence of, and the Whittington Trust witnesses were not asked to comment upon, the adequacy or otherwise of entries on dates identified in Schedule A. The Panel therefore considered any Rio entries made by the Registrant to be adequate.

62. Also, the need to assess these 89 examples for their adequacy in the Panel’s view, overlaps with the alleged mischief as set out Particular 1(e).

63. The sub-particular then further identifies a need to assess whether there was an entry arising from ‘a contact’ or ‘an administrative task’. On the Rio audit there are dates provided for when the clinical contact happened and a date for when the details were entered into the record. These two dates are not always the same because on some occasions a therapist may not be able to enter the record on the same date that they saw a Child Service User. When the Panel examined the Rio progress notes, the Panel found a date not proved if it found evidence of:

⦁ The Registrant seeing a Child Service User on that date, or;

⦁ The Registrant entering information retrospectively on that date.

64. The Panel has undertaken a thorough assessment of any evidence of an entry made by the Registrant on the Rio system on the dates in question. The dates specified in Schedule A fall within the two periods of September 2016 to December 2016 and January 2017 to July 2017 and are covered by the documentation entitled ‘Progress Notes’ exhibited by ER. The recorded entries in those exhibits derive from the ‘back end’ printout of the Rio system for the relevant periods commissioned by SAF.

65. The Panel cross-referenced whether each date in question was one when the Registrant was in work; whether there was an expectation of an entry being made on that date, such as a planned school visit; and whether the day was identified as a clinical admin day when entries into the system would be expected.

66. ER told the Panel that SAF had printed out the Registrant’s Rio diary and cross-referenced this with the clinical notes and records of the children on the Registrant’s caseload to identify any dates that were unaccounted for. The Panel does not have the original information for those entries nor the information from other sources, such as the Registrant’s diary, or the team’s week planner. For this information the Panel relied on the evidence of ER and the findings of ER’s investigation.

67. Taking all this into account, the Panel has, in the Registrant’s interest, irrespective of the adequacy of the Rio entries, or the fact that there is only one entry on any given date, taken this as being evidence of some activity by her. Where however the Panel has not been able to find an entry within the Rio progress notes, it then considered the Registrant’s Statement (made in advance of her informal meeting with ER on 17 August 2017). If the Registrant gave an explanation within her Statement as to her whereabouts on a date within Schedule A, that related to clinical contacts, and therefore an expectation there would have been an entry into Rio, but no Rio record was subsequently found, then this date was found to be proven. Conversely, if the Registrant gave an explanation within her Statement as to her whereabouts on a date within Schedule A, that did not relate to clinical contacts, the Panel considered that the expectation to make an entry into Rio was not clear and therefore the Panel found that date not proven.

68. The Panel has found 41 of the 88 entries so proven. The Panel’s analysis of the evidence has, due to its length, been set out in tabulated form in an expanded version of Schedule A attached to this decision.

Particular 1(b) – proven with the exception of CSU4, CSU6, CSU17, CSU 18 and CSU19.

b) Did not provide and/or arrange the required number of speech and language therapy sessions as outlined in each child's Education, Health and Care Plan, for the service user outlined in Schedule B.

69. The evidence to support a finding of this particular comes from the information collected and collated by ER. The Panel do not have before it the individual Education, Health and Care Plan (EHCP) for every child and on this it has again relied on the detail supplied by ER.

70. ER had explained to the Panel that she had undertaken an audit of children the subject of EHCPs, who were assigned to the Registrant to establish if they were receiving their requisite number of sessions. This checking stemmed from the concerns which had been expressed by the SenCos within the four schools. Their perception was that the children who were the subject of EHCPs were not receiving the service they were entitled to, and that the Registrant had cancelled or rearranged sessions frequently.

71. Following a request from the HCPC, ER had undertaken another audit. The later one correcting some small errors in the initial audit and adding further detail. However, this later audit does not include, in the calculation the total number of sessions or the handwritten notes produced by the Registrant. ER did not include these handwritten notes as she believed them to be falsified by the Registrant. Both audits were before this Panel. The audits had been produced by way of report drawn from the Rio system by inputting the names of each of the children. The Panel relied upon both of ER’s audits. When the Panel conducted its assessment of the number of EHCP sessions completed, the Panel included information from both of ERs audits, noting that the earlier audit references the Registrant’s handwritten notes. This was on the basis that the Registrant claimed within her Statement to the Trust that she had "completed the correct number of sessions set out on the childrens’ EHCPs, again the reason why it appears as though I haven’t done this is because of my lack of ability to keep up with the note writing."

72. The Panel in undertaking this review has counted the information provided by ER from both audits, but unlike ER the Panel has added to its calculation any detail relating to handwritten notes. On this basis the Panel has made the following findings:

School 1

CSU 1 – number of sessions to be delivered 5 per term for 3 terms - 15. Those provided amounted to 9 sessions and this figure included those provided by other practitioners. The Registrant provided three further handwritten notes. This makes a total of 12. Proven.

CSU 2 – number of sessions to be delivered 4 to 6 per term, with a minimum of 12 per year. Number provided amounted to 3, including one delivered by an assistant. The Registrant provided 1 further handwritten note. This makes a total of 4. Proven.

CSU 3 – number of sessions to be delivered 3 per term for 3 terms – 9. Those sessions provided amounted to 3. The Registrant provided two further handwritten notes and 1 typed note. This makes a total of 6. Proven.

CSU 4 – number of sessions to be delivered 3 to 4 sessions per term making 9 -12 sessions per year. Those delivered amounted to 7. The Registrant provided 2 further handwritten notes and 2 typed notes. This makes a total of 11. Not Proven.

CSU 5 – number of sessions to be delivered 4-6 direct sessions per term with a minimum of 12 per year. 5 sessions were arranged and 4 were delivered. The Registrant provided 1 typed note. This makes a total of 6. Proven.

CSU 6 – number of sessions to be delivered 10-12 per year with a minimum of 10 sessions. 7 sessions delivered 2 of which were delivered by an assistant. The Registrant provided 4 further handwritten notes. This makes a total of 11. Not Proven.

School 2

CSU 7 – number of sessions to be provided 12. The number of sessions delivered was 7. The Registrant provided 2 further handwritten notes. This makes a total of 9. Proven.

CSU 8 – number of sessions to be provided 12. The number of sessions delivered was 8. The Registrant provided 2 further handwritten notes. This makes a total of 10. Proven.

CSU 9 – number of sessions to be provided 18 per year. The number of sessions delivered was 4. The Registrant provided 5 further handwritten notes. This makes a total of 9. Proven.

CSU 10 – number of sessions to be provided 9 plus attendance at an annual review. The number identified as delivered was 4. The Registrant provided 3 further handwritten notes and 1 typed note. This makes a total of 8. Proven.

CSU 11 – number of sessions to be provided 15 per year. The number delivered was 7. The Registrant provided 4 further handwritten notes, 1 typed note and an email note. This makes a total of 13. Proven.

School 3

CSU 12 – number of sessions to be provided 4 - 6 per term, 12 to 18 sessions per year. The number of sessions provided was 4. The Registrant provided 1 further handwritten note. This makes a total of 5. Proven.

CSU 13 – two blocks of 3 - 4 sessions a year with a minimum of 6 per year. 2 sessions were delivered. The Registrant provided no further notes. This makes a total of 2. Proven.

CSU 15 – number of sessions to be provided 2-3 per term with a minimum of 6 per year. The number of sessions delivered was 4. The Registrant provided no further notes. This makes a total of 4. Proven.

School 4

CSU 16 – number of sessions to be provided was 12. The number of sessions delivered was 5. The Registrant provided 2 further handwritten notes. This makes a total of 7. Proven.

CSU 17 - number of sessions to be provided was 9 with 6 sessions delivered. The Registrant provided 6 further handwritten notes. This makes a total of 12. Not Proven.

CSU 18 – number of sessions to be provided was 9 per year. The number of sessions delivered was 6 sessions. The Registrant provided 7 further handwritten notes. This makes a total of 13. Not Proven.

CSU 19 – number of sessions to be provided 9 per year with 7 sessions delivered. The Registrant provided 4 further handwritten notes. This makes a total of 11. Not Proven.

CSU 20 withdrawn.

Particular 1(c) – proven

c) Did not visit schools 1,2,3 and/or 4 for the expected number of days.

73. The Panel noted the evidence as to how many days the Registrant was expected to visit those four schools. There was evidence of how many days she did in fact attend those schools and the steps taken to establish whether the Registrant was where she said or was supposed to have been and the degree to which the information supplied by the schools could be relied on. There was information from ER relating to the monitoring of visitors that were employed in the four schools and how robust those systems were.

74. However, the mischief complained of here is not that the Registrant misled as to where she was, nor that there was any confusion about when she should have been there. It is purely that she did not visit for the expected number of days. Given the overlap with the allegation set out in particular 1(b) it was obvious to the Panel that the Registrant could not, if those particulars were found proven, have visited for the expected number of days. As indicated in the closing submissions of the HCPC, the evidence for this particular is that provided for other allegations and the correspondence with the SenCos of the four schools.

75. From the strands of information supplied, and the evidence of ER from her internal informal and formal investigations, the Panel has been able to make the following findings:

a. In relation to School 1, the Registrant had been expected to undertake 54 visits and had only undertaken 22, two of which are recorded by the electronic system used at the school as lasting only 20 minutes. The Registrant had a large caseload in this school and was expected to be there ‘as a minimum’ until the school lunchtime. ER records that in response to this allegation the Registrant had stated that she had been into the school for the requisite number of times, but this did not accord with the school log of visits and the entries made in the Rio system following those visits. The Panel noted that in relation to this school, there could be doubt about the accuracy of the recording of visits by the school because ER referenced within her statement that "there had been a couple of occasions throughout the year… " that the system for recording had been down.

b. As part of ERs formal investigation, School 2 had been requested for information of visits undertaken. School 2 had an electronic system of recording visits. If the system went down the school had resorted to a paper system of recording. The system had however only been down a very few times in the school year. School 2 was therefore able to confirm accurately that of the expected 24 visits there had been only 16. ER noted that of the 8 visits undertaken in the summer term 5 had lasted less than 90 minutes and one had lasted only 20 minutes.

c. In relation to School 3, the Panel noted that this school did not have an electronic system for recording visits and did not provide copies of its paper records but did undertake its own analysis of recordings made of the Registrant’s visits within those paper records. The Registrant was expected to visit for 30 days and had only attended on 9 occasions in the year and one of those visits had lasted for less than an hour.

d. In relation to School 4, the Panel noted that this school had only one entry point and that its system of entry had not been down at all during the year. This school considered that its recording of visits was totally accurate. The Registrant had been required to attend this school for an expected 24 days. The Registrant is recorded as attending School 4 only 11 times, 5 of which were in the autumn term of 2016.

76. Whilst the Panel has concluded that this particular is proven to the requisite standard, it is an overlap of particular 1(b).

Particular 1(d) – proven in relation to all 9 instances

d) Provided inaccurate and/or unverified reasons for rescheduling and/or cancelling visits at schools 1,2, and/or 4, on dates as outlined in Schedule C.

77. The investigation of the Registrant’s failure to attend or to rearrange or cancel was a matter raised by the SenCos at the four schools allocated to the Registrant. ER had collated the information received from those SenCos.

78. The Panel noted that in the informal performance meeting the Registrant had acknowledged that some of the reasons given to School 1 were not true. The Registrant had admitted to ER that she dreaded visiting School 1 and, on several occasions, panicked on route and cancelled the visit, and then instead came into the office.

79. Schedule C identifies nine dates between 19 October 2016 and 12 July 2017. Four dates related to School 1, three related to School 2 and two relating to School 4. The Panel has noted that the Registrant’s conduct in those nine cases may, as alleged in Particular 6, be considered as dishonest. Given the seriousness of the Panel’s findings on this sub particular the Panel undertook a thorough review of the evidence on which ER had based her findings.

80. In relation to each incident the Panel has identified and assessed whether there had been:

a. a reason given for the cancellation and/or the rescheduling;

b. whether the reason given for rescheduling or cancellation was inaccurate; and

c. was that reason unverified.

81. The dates in Schedule C are those on which the alleged inaccurate or unverified reasons for the Registrant’s change in her planned visits were tendered. The Panel has set out below the circumstances relating to each of those nine incidents and the reasons for its findings.

(1) 19 October 2016 (School 2)

In an email from the Registrant to the SenCo at School 2 dated 19 October 2016 timed at 08.32 hours the Registrant states:

‘Unfortunately I won’t be coming in this morning as my mum went into hospital last night. I’m sorry that all these issues come up around our sessions last week and today……..when I come back after half term I will make up this session without missing the allocations for the other children. So sorry Senco 2 I feel terrible.’

The Panel considered whether this reason was inaccurate and/or unverified.

In relation to its inaccuracy, the Panel has no evidence on which to make a finding.

This reason was capable of being verified but no steps had been taken to verify the reason.

This is therefore proven on the basis that the reason was unverified.

(2) 15 November 2016 (School 1)

In an email to the SenCo at School 1, timed at 08.08 hours in which the Registrant states:

Unfortunately I won’t be able to make it today as I’m in hospital after an accident. Would you please be able to let XXXX know as we were meant to have a group session. I will rearrange once I’m back. Sorry for the inconvenience.’

The Panel considered whether this reason was inaccurate and/or unverified.

In relation to its accuracy, the Panel has evidence that the Registrant was in fact working that day and subsequently provided her employer with copies of emails that she had sent to a parent and a Senco. This leads the Panel to the conclusion that this reason was inaccurate.

This reason was capable of being verified but no steps had been taken to verify the reason.

This is therefore proven.

(3) 5 December 2016 (School 1)

In an email from the Registrant to the SenCo at School 1 timed at 07.55 hours in which the Registrant states:

‘..I’ve just been on the receiving end of a racist attack on the train on the way here and am currently with police and paramedics, really horrified but does not seem like I will make it in time for the annual review this morning. Really sorry please give XXX my apologies.’

The Panel considered whether this was inaccurate and/or unverified.

In relation to its inaccuracy, the Panel has no evidence on which to make a finding.

The Panel noted however that in the Registrant’s Statement of 14 August 2017 produced in response to the invitation to attend an informal meeting to be held on 17 August 2017, she stated that she had let her line manager know at the time of the incident, However, there is no note or recollection by ER of that matter being reported to her by the Registrant nor of other senior staff members being aware of this incident.

This reason was capable of being verified but no steps had been taken to verify the reason.

This is therefore proven on the basis that the reason was unverified.

(4) 13 December 2016 (School 4)

In an email sent by the Registrant to SenCo at School 4 timed at 12.34 pm on 13 December 2016 the Registrant states:

‘sorry, I forgot to mention that I will probably get to School 4 at 10am as I’m coming from training in Brighton in the morning.’

The Panel considered whether this was inaccurate and/or unverified.

This training was capable of been verified and on investigation was found to be inaccurate.

Using the Registrant’s training log and from contact with relevant departments, ER confirmed that the training course that the Registrant stated she had attended in Brighton did not take place and there was no basis for her assertion that she had been on any other training course in Brighton. In addition, ER confirmed in her statement ‘that there was no record of Pinkie Uddin attending any training on or around 12 December 2016 on the staff electronic record.’

This reason is inaccurate and unverified.

This is therefore proven.

(5) 10 March 2017 (School 4)

In an email from the Registrant to the SenCo at School 4 timed at 11.56 hours dated 10 March 2017 the Registrant states:

‘I apologise for not emailing yesterday, I tried to ring the school many times in the morning but couldn’t get through and then forgot to email. We had a death via child abuse on Wednesday afternoon – the child was on my caseload so all the professionals involved with him were called in yesterday for a preliminary serious case review. Really horrible case and I’m really sorry it went into our day I will be in next Thursday and probably on the Friday too if that’s ok?’

The Panel considered whether this was inaccurate and/or unverified.

The Panel had evidence that this was possible of being verified for its accuracy. Investigation by ER established that this reason was inaccurate and false. SAF and ER told the Panel that a death of a child within the team is notable and rare. This being the case, both witnesses were adamant that this death never happened, and the Registrant’s statement was false.

This reason is inaccurate and unverified.

This is therefore proven.

(6) 19 April 2017 (School 1)

In an email dated 19 April 2017 timed at 09.07 hours the Registrant states:

‘I haven’t made it into work today as there’s been a flood in our office. Is there another time that we can rearrange for? Really sorry.’

The Panel considered whether this was inaccurate and/or unverified.

The reason given was established as inaccurate following investigation. The Panel heard from ER that there had not been a flood and SAF confirmed that this was the case.

This reason is inaccurate and unverified.

This is therefore proven.

(7) 27 April 2017 (School 2)

In an email on 27 April 2017, timed at 00.29 the Registrant states:

‘Apologies for the really late email, I just wanted to let you know I won’t be able to attend any of the meetings tomorrow.Unfortunately the older brother of my cousin who took her life a few months ago has also taken his own life this evening and we have had to come down to Brighton to be with their family.I’m really sorry to keep letting you down like this I feel really bad, please let both sets of parents know that I am going through a bereavement and that I apologise for not attending.’

The Panel considered whether this was inaccurate and/or unverified.

ER stated that no one in the office was informed at this time of this third bereavement, there having been one reported in November 2016, and another in January 2017.

In relation to its inaccuracy, the Panel had no evidence in relation to a bereavement on 27 April 2017. The Panel noted that in the Registrant’s Statement of 14 August 2017 in relation to 27 April 2017, the Registrant states "no schools booked so admin in the office." This appears to conflict with the email above, leading the Panel to conclude that the Registrant’s reason is inaccurate.

The reason was capable of being verified but no steps were taken to verify the reason.

This is therefore proven.

(8) 30 June 2017 (School 2)

In an email from the Registrant dated 30 June 2017 timed at 07.38 hours the Registrant states:

‘I wasn’t sure if my office had let you know this week so I thought I’d email you just in case. I won’t be able to come in as I’ve been away due to a sudden bereavement. So sorry about this and will talk to you upon my return’

The Panel considered whether this was inaccurate and/or unverified.

In relation to its inaccuracy, the Panel noted that in the Registrant’s Statement of 14 August 2017, in relation to 30 June 2017, the Registrant states "attended school 1 to make up sessions including XXX notes are attached and email to senco regarding being in that morning." The Panel had sight of the Registrant’s clinical notes in relation to Child Service User 6 (School 1), this appears to conflict with the email above, leading the Panel to conclude that the Registrant’s reason is inaccurate.

The evidence of ER is that the office was not informed of this further bereavement. The Registrant had reported two other bereavements to the Whittington Trust in November 2016 and January 2017. There was a further bereavement claimed by the Registrant in April 2017 which was not notified to the Trust but was reported to School 2. There is no documentation of this fourth bereavement within the Trust recording system for such matters. This reason for absence came to light through the investigations undertaken by ER with the assistance of the SenCo at the school.

This reason was inaccurate and unverified.

This is therefore proven.

(9) 12 July 2017 (School 1)

In an email dated 12 July 2017 at 08.30 hours the Registrant states:

‘I don’t think that I will make it to XXX’s review this morning, we were sent out of London yesterday for training and the trains this morning have been cancelled so we are stranded now. Really sorry about this, I’ll give you a quick overview of his XXX progress’

The Panel considered whether this was inaccurate and/or unverified.

ER stated that all mandatory training was undertaken between normal working hours Monday to Friday. There had been no request from the Registrant nor approval by any senior practitioner of any additional training which may have taken place out of normal office hours. There was no note in her training log of any outstanding training issues. There is nothing to support this assertion that she had been sent out of London by the Whittington Trust to undertake any training.

This is a matter which in her statement the Registrant acknowledged she had breached the trust and confidence with SenCo 1. It was stated by the Registrant to ER that she found going into School 1 made her anxious.

This reason is inaccurate and unverified.

This is therefore proven.

Particular 1(e) - proven

e) Did not routinely complete clinical notes to an appropriate standard, in that they lacked detail and/or were not contemporaneous.

82. The Panel has the evidence of ER and the specific four examples she exhibits of the Registrant’s poor record-keeping. Examples which in the view of ER, fell far short of what was required and expected. These were dated 20 March 2017, 23 May 2017, 7 June 2017 and 28 June 2017 and reference lack of detail and information. The Panel noted this covered a period of clinical case notes from March to June 2017.

83. The Panel has also undertaken an analysis of the entries specified in Particular 1(a) Schedule A, and from this, it has been not only able to identify the lack of any routine recording of contacts, but also the standard of those limited entries made by the Registrant.

84. The Panel has also seen the handwritten notes which the Registrant produced in response to the request for evidence of her contacts with child service users. Those notes, which had not been uploaded onto the system, did not contain the detail which would be expected of a qualified therapist.

85. From these three sources the Panel has been able to conclude that the Registrant’s notes lacked detail, and the vast majority were not of an appropriate standard that would be expected of a registered therapist.

86. From these same sources the Panel has been able to identify that in some cases there were notes which had not been prepared contemporaneously.

87. The Panel has therefore found this particular proven.

Particular 2 - proven

On or around 20 July 2017, you provided an inaccurate reason for your unauthorized absence from the Islington Council Offices.

88. This allegation relates to the Registrant’s failure to return to the office on the afternoon of 20 July 2017. The Panel heard evidence from ER that therapists usually attended school in the morning and then returned to the office to write up notes or complete administrative tasks in the afternoon. When the Registrant had not returned to the office on 20 July 2017, several members of the team were concerned, and they messaged the Registrant through the means of a WhatsApp network set up for therapists to communicate with each other. According to the ‘whereabouts diary’ kept in the office, the Registrant had not recorded that she was out of the office on the afternoon of 20 July 2017.

89. ER stated that she had also rung the Registrant and left a message on her telephone asking her to ring ER back, which the Registrant did some 20 minutes later. Whilst ER had not made a note of the content of that telephone call, she remembered clearly that the Registrant had appeared to have been quite dismissive of the concerns expressed about her welfare. The Registrant had told ER that she was on a fire safety training course.

90. In response to the team WhatsApp message, the Registrant had also responded saying that she was out on a fire safety training course. The Panel had a screen shot of that WhatsApp response dated 20 July 2017 sent at 17:14:40 as follows:

‘Hi guys I was at fire safety training! I had it down in the whereabouts diary but Liz and Jess said it might have been packed away with our stuff. See you bright and early tomorrow xx.’

ER was able to confirm that the Registrant’s training records did not show any booking of, or approval for, fire safety training. She further established with those who ran such courses that the Registrant had not attended any mandatory fire safety training that day.

91. In an informal meeting on 17 August 2017, the Registrant had admitted to ER that the reason given for her absence was false. The Registrant told ER that on the 20 July 2017, whilst on her way back from visiting a school, she had received a text. In that situation the Registrant said that she was fearful of returning to the office and so had made up the excuse of being on a fire safety training course as a reason for not returning.

92. The Panel has before it the Registrant’s Statement in which she confirms that she gave a false reason for not being in the office. From the evidence of the WhatsApp, the Registrant’s statement and the supporting testimony of ER, the Panel find this particular proven.

Particular 3 – partially proven, please see annotated Schedule D annexed which identifies the remaining 58 dates as 24 not proven, 33 proven for being inaccurate but not falsified and one instance of a clinical note being both falsified and also inaccurate (Schedule D, page 12).

On or around 14 August 2017, you provided a statement to your employer which contained falsified and/or inaccurate clinical notes as outlined in schedule D.

93. The Whittington Trust’s concerns about the Registrant’s conduct, and in particular the concern that she had been failing to attend work, led to the Registrant being invited to attend an informal meeting on 17 August 2017. The letter of invitation dated 10 August 2017 listed those specific concerns. Attached to that letter was supporting evidence such as the Registrant’s emails to SenCos cancelling or rearranging visits.

94. On the 14 August 2017 the Registrant provided ER with a statement that gave an insight into her understanding of her role, office processes, and issues which had arisen in her personal and family life. The Registrant denied that the concerns raised were well founded. To this statement she attached handwritten notes, typed notes, and copies of emails to support her contention that she was working on those days.

95. At the meeting on the 17 August 2017, the Registrant told ER that there were further ‘typed’ notes which she had and which she had failed to upload onto the Rio system. The Registrant was asked to produce those additional clinical case notes as soon as possible. Two reminder emails were sent to the Registrant on 18 August 2017, requesting the additional clinical case notes, and at 12.15 they were provided by the Registrant.

96. Following receipt of the Registrant’s Statement and supporting evidence on 14 August 2017, ER had undertaken an audit of those documents provided to ER by the Registrant. This was done in preparation for the informal meeting on 17 August 2017. ER cross-referenced the notes that the Registrant had provided with the attendance/visitor logs provided by each of the 4 schools allocated to the Registrant.

97. From conducting that audit ER established that some clinical notes related to visits that took place on dates that the Registrant was not recorded as being present in the corresponding school. This being the case, it is alleged that of those notes provided on the 14 August 2017, 58 were accordingly either false or inaccurate (annotated Schedule D).

98. The Panel noted that following the informal meeting on the 17 August 2017, the decision was made by ER to undertake a formal investigation, and on 18 August 2017 the Registrant was invited to a meeting to discuss those formal concerns. That meeting did not take place as the Registrant subsequently went on sick leave and then resigned.

99. Taking all this into account, and in fairness to the Registrant, because this particular is alleging dishonest behaviour, the Panel concluded that it needs to be able to assess whether the evidence it has before it was robust. To do this it was required to undertake an independent analysis. First, identifying whether there were clinical notes for the dates specified; secondly, by taking into account the Registrant’s recorded comments provided to

ER, and thirdly examining the entry logs for the relevant school. Finally, the Panel considered whether there was evidence from another source, as to whether these notes could have been constructed as purported by the Registrant.

Particular 4(a) – Proven in relation to 5 of the 8 incidents.

Between January 2018 to July 2018, while employed at the London North West University Healthcare Trust, you:

a) Provided inaccurate and/or conflicting reasons for rescheduling
and/or cancelling visits at schools 5, 6, 8 and/or 9, on dates as outlined in Schedule E.

100. The evidence for these 8 alleged incidents, relating to 4 schools, comes from RS. The dates derive from those set out in Schedule E. The dates cover the period 6 March 2018 to 11 May 2018, a period just over two months. RS was concerned about the Registrant’s failure to attend schools, rearranging of dates for visits, and giving false or inaccurate reasons for those actions. These concerns came to light fully for RS in May 2017.

101. From the evidence the Panel has made findings in relation to each as follows:

1. 6 March 2018 appointment with School 8 – Not Proven

RS stated that the Registrant contacted School 8 and cancelled her visit stating that she had to attend a funeral.

Was this reason inaccurate and/or conflicting?

RS stated there was no evidence from the employer’s records of any recent bereavements or of annual leave booked to attend a funeral.

The Panel cannot comment as to the accuracy of the reason.

There has been no verification of whether the reason given was inaccurate.

Was the appointment cancelled or rescheduled?

This visit was cancelled rather than rescheduled. There is no evidence of any conflicting reasons provided by the Registrant for cancelling her visit to School 8.

This is therefore not proven

2. 16 March 2018 appointment with School 8 – Proven

Was the reason given inaccurate and/or conflicting?

On 16 March the Registrant informed the school ‘unfortunately we had been reminded this morning via email by our team leaders but it is our team away day meeting.’ RS confirmed that she did not have any record of this training having been arranged or agreed.

In addition, the Panel had sight of information provided by RS to the HCPC regarding the Registrant (Ex 45) which states as follows ‘Pinkie’s System1 record for Friday 16 March shows 4 x 30minute contacts with teaching staff at School 8 for 4 different children on the caseload at the school.’

The reason given is inaccurate.

Was the appointment cancelled or rescheduled?

The Registrant had cancelled the visit.

This is therefore proven.

3. 21 March 2018 appointment with School 5 - Proven

On 21 March the Registrant cancelled her scheduled visit to School 5 stating that she had been in a car accident. RS had been informed of the Registrant’s non-attendance by email dated 26 March 2018. The information had been relayed by a team member. That team member had been contacted by a secretary at School 5 who was enquiring about the Registrant’s wellbeing. That secretary had previously worked within team and so had been concerned when she had learned that the Registrant had contacted School 5 on 21 March 2018, stating that she was unable to attend as she had been in a car accident.

Was the reason inaccurate and/or conflicting?

At the time of receipt of this information RS had not been aware of any car accident. RS had raised this with the Registrant informally and had been told by the Registrant that whilst there had been a mild car incident, she had in fact found herself double booked and that she had panicked and gave this excuse. She stated that she had gone to the appointment with the other school instead. The Registrant was embarrassed and apologetic.

The reason given had been inaccurate.

Was the appointment cancelled or rescheduled?

The Registrant had cancelled the visit.

This is therefore proven.

4. 18 April 2018 appointment with School 6 - Proven

On 18 April 2018 the Registrant had cancelled her appointment to School 6, emailing the SenCo and giving the reason that the Registrant was "sick."

Was the reason inaccurate and/or conflicting?

RS confirmed there was no record of sickness absence and if the Registrant had been absent due to sickness, the failure to report would be contrary to the sickness absence policy. The Panel also had sight of patient notes dated 18 April 2018 which confirm that the Registrant visited a School at 09:15am on this date for 45 minutes.

The Panel considered that the Registrant’s reason for not attending School 6 is inaccurate, telling the School 6 SenCo that she was ill but according to exhibit 46 she had attended a different School.

Was the appointment cancelled or rescheduled?

The appointment with School 6 was cancelled.

This is therefore proven.

5. 20 April 2018 appointment with School 8 – Not Proven

RS stated that the SenCo at School 8 reported to LNW Trust (via email on 22 May 2018) that on 20 April 2018 the Registrant had attended this school for 20 minutes and then left due to a bereavement.

Was the reason inaccurate and/or conflicting?

The Panel had sight of communication from SenCo 8 which confirmed that ‘On 20 April 2018 Pinkie did not come into School 8 at the scheduled time of 9.20am. she arrived at 12.20 and asked to meet with me and the Deputy SENCO. She explained that there had been another family incident which had meant she was unable to see any students that day. She left after our meeting.’

The Panel are unable to comment as to whether this reason given by the Registrant was inaccurate information. It has not been verified and so there is no evidence whether it was inaccurate.

Was the appointment cancelled or rescheduled?

It appears that the appointment was neither cancelled or rescheduled but took place on 20 April 2018 for a limited period of time.

This is therefore not proven.

6. 3 May 2018 appointment with School 6 – Not Proven

RS states that on 3 May 2018, the Registrant cancelled a further visit to School 6 citing a bereavement as the reason.

Was the reason given inaccurate and/or conflicting?

The reason given was a bereavement.

RS stated that the LNW Trust had been informed of a bereavement on 11 April 2018 but nothing was recorded to explain her absence from School 6 on 3 May 2018.

The Panel is unable to comment on the accuracy of the Registrant’s reason. There is no verification of whether this is an inaccurate reason.

Was the appointment cancelled or rescheduled?

This appointment was cancelled.

This is therefore not proven.

7. 11 May 2018 appointment with School 6 – Proven

RS stated on 11 May 2018 the Registrant was due to visit School 6 but failed to attend or contact this School to reschedule and/or cancel the visit. This was confirmed by a letter to RS from SenCo 6 on 4 June 2019.

In supervision on 15 May 2018 the Registrant informed RS that there was some confusion and that she had attended School 9 on 11 May 2018. RS’s job share had then contacted School 9 to establish whether the Registrant had been logged in at this school and/or whether the relevant class teacher was able to verify if the Registrant had been in school 9 that day. SenCo 9 confirmed in writing (dated 11 July 2019) to RS that the Registrant did not attend School 9 on 11 May 2018 and goes on to state ‘I checked with the students she was due to see, and the school sign in book or confirm this’. RS confirmed that despite enquiries she was unaware of the Registrant’s whereabouts on this date.

Was the reason inaccurate and/or conflicting?

The Panel considers that the Registrant’s reason for not attending School 6 on 11 May was inaccurate. Her explanation was that on this date she was attending School 9 which is refuted by the School 9 SenCo.

Was the appointment cancelled or rescheduled?

The appointment was neither cancelled nor rescheduled. The Registrant did not attend. The Panel considered the wording of this particular and concluded that the Registrants failure to attend could fall within the meaning of cancelling/rescheduling.

This is therefore proven.

8. 11 May 2018 appointment with School 9 – Proven

Within exhibit 39, appendix D there is an email dated 11 May 2018 from a therapy assistant confirming the Registrant was ‘timetabled for school 9 today.’ RS states that she followed up with the Registrant where she was on 11 May 2018. The Registrant confirmed to RS that she had attended School 9 but must have forgotten to sign in. The Registrant maintained that she had carried out a classroom observation. As stated in 7 above, SenCo 9 confirmed that the Registrant did not attend School 9 on this date.

Was the reason given inaccurate and/or conflicting?

The Panel conclude the Registrant’s explanation is inaccurate.

Was the appointment cancelled or rescheduled?

The appointment was neither cancelled nor rescheduled.

This is therefore proven.

Particular 4(b) – Proven

Did not upload and/or record contacts and/or case notes in System 1, on the dates specified in Schedule F,

102. The issue of notetaking had been a theme in supervision sessions according to RS. In January and February 2018, the Registrant had recorded issues with gaining access to the SystmOne. In subsequent supervision sessions the need for accurate, thorough and contemporaneous notes had been emphasised by RS. The Panel has evidence from RS’s sworn statement, her live evidence and her supervision notes of the discussions which had taken place around the issue of recordkeeping and good time management of appointments.

103. At the supervision session on 8 May 2018, RS had been unable to conduct an audit of the Registrant’s caseload due to a lack of notes on the SystmOne for the relevant period. Following that supervision on 8 May 2018 an action plan was agreed that the Registrant would provide RS with a list of notes that were outstanding.

104. On 8 May 2018 the Registrant emailed RS a list of case notes that needed to be uploaded from visits with children in January and February 2018, when she did not have access to SystmOne. The Registrant indicated that she would upload some of those case notes each afternoon. RS stated that standard practice was that any note which could not be uploaded should be recorded in a WORD document. The Registrant had been informed of this requirement in her supervision on 13 December 2017.

105. On 15 May 2018 the Registrant had sent to RS additional case notes which had not been uploaded. The Registrant then reported sick on 16 May 2018 and subsequently resigned on 3 July 2018.

106. Following further concerns about the Registrant’s conduct, an audit was carried out of the Registrant’s case notes and the list of outstanding notes that needed to be uploaded which the Registrant had supplied to RS. RS stated that she used each Schools register to see which contacts the Registrant had put in on those dates and if the register confirmed that the child had been seen on that date. RS then looked back at the child’s notes to see what had been recorded. This identified outstanding notes for service users in Schools 5, 7, 8 and 10.

107. The methodology used by RS to undertake this audit was the same throughout. The dates and service users for which there are no recorded case notes on SystmOne are set out in Schedule F.

108. The Panel has before it the relevant source material and has had the opportunity to review the findings of that audit. From that review the Panel has found all the entries on Schedule F proven: there are no uploaded or recorded contacts nor any case notes within SystmOne for the dates specified. The Panel noted from the source material that CSU 30 was ‘blacked out’. However, in relation to CSU 30 the Panel took into account the statement of RS at paragraph 57.

109. The Panel therefore finds all elements of particular 4(b) proven.

Particular 5 – Proven for all four service users

On or around 21 March 2018, you did not complete case notes following planning meetings for child service users;

a) Child Service User 54

b) Child Service User 55

c) Child Service User 56

d) Child Service User 57

110. The Panel had before it the audit which RS had completed in relation to case notes following planning meetings. This audited information had been prepared by RS from access to SystmOne for that particular date.

111. RS told the Panel in evidence that she was able to see from the Registrant’s rota that she had recorded a planning meeting with SenCo 6 but there was no specific information recorded under that. RS said that she would have expected details of their discussion to be recorded. Without this detail another therapist would be unable to identify what was expected for this child service user.

112. The Panel has reviewed RS’s audit of case records for School 6 for the date of 21 March 2018. Taking into account RS’s statement paragraphs 96 to 103 and her audit the Panel has concluded from the evidence before it that this particular is proven in respect of all four child service users identified.

Particular 6 – dishonesty proven in relation to particulars 2 and 3, and 7 of the 9 incidents identified in 1(d), and 5 of the incidents identified in 4(a).

Particular 6

Your actions in paragraphs 1(d), 2, 3 and 4(a) were dishonest.

113. In assessing this matter, the Panel accepted the guidance given by the Legal Assessor in relation to the case of Ivey and Genting Casinos. The Panel was advised that it should first establish a registrant’s actual state of knowledge or belief as to the facts: a subjective test. A registrant’s actions will often be determinative on this issue. Having done this, the Panel should then undertake an objective test, establishing whether a member of the public would view that registrant’s conduct as honest or dishonest. There is no longer a requirement that the registrant knew that their belief or knowledge would be considered dishonest by a member of the public.

114. In this regard the Panel took into account that prior to these incidents there was nothing known about the Registrant’s propensity to lie or be dishonest. The Panel has considered each of the alleged dishonest incidents individually.

Particular 1(d) – 9 incidents – dishonesty proven in relation to 7 of the dates

115. The 9 incidents identified in 1(d) are:

(1) 19 October 2016 – Dishonesty Not Proven

This reason of the Registrant’s Mother going into hospital the previous night has been found by the Panel to be unverified. As it was not verified by the Registrant nor was verification sought by ER, it is unknown whether this reason is accurate or not.

The Panel noted that the Registrant had not informed others of this family situation nor had she booked the day as holiday leave nor sought leave of absence on compassion grounds. The Panel further noted that this incident was not one of the matters that had been put to the Registrant by ER in her letter of 10 August 2017, a letter in which she had outlined causes for concern arising from the Registrant’s conduct.

The Panel therefore has nothing from the Registrant that gives an indication into her state of understanding or belief on this issue.

The Panel has therefore concluded that there is insufficient evidence to support a finding that in providing this reason for her absence the Registrant’s conduct was dishonest.

(2) 15 November 2016 – Dishonesty Proven

This reason of being in hospital following an accident has been found by the Panel to be inaccurate and unverified.

In the Registrant’s Statement received 14 August 2017 she records this date as being. ‘Used as admin day. email sent to parent from work’. The Registrant then provided a copy of the email to the parent and an email to a SenCo.

It is clear from this information that the Registrant’s excuse of being unable to visit the school has been fabricated.

The Panel considers that from her actions the Registrant was aware that she was being deceitful. The Registrant’s actions would, in the Panel’s view, be considered dishonest and so makes a finding of dishonesty.

(3) 5 December 2016 – Dishonesty Not Proven

This reason of being the subject of a racist attack on a train and ‘was currently with Police and paramedics’ was not verified and so it is unknown whether it is an accurate excuse.

The Panel noted that this was a matter that ER specified as being considered as false information in her letter to the Registrant on 10 August 2017. A letter in which she sets out a list of concerns. The Registrant’s state of mind or belief in relation to this incident is found within her Statement of 14 August 2017, in which she states that she had been the subject of a racist attack and when she had arrived in the office, she had told others of this incident including ER.

ER states that there is no recording of this information of a racist attack on the Registrant having been shared with the team. The evidence of ER and SAF is that they knew nothing of this event until provided with a copy of the email sent by the Registrant to SenCo 1 at School 1.

The Panel has therefore concluded that there is insufficient evidence to support a finding that in providing this reason for her absence the Registrant’s conduct was dishonest.

(4) 13 December 2016 – Dishonesty Proven

This reason of being on a training course in Brighton the previous day was found by the Panel to be both unverified and inaccurate: there had been no such training. The Panel had relied upon the investigation ER had undertaken.

This is not however an incident which was included within ER’s letter of 10 August 2017, and so is not a matter on which the Registrant has responded in her Statement received on 14 August 2017. There is therefore no evidence as to what the Registrant’s position was on this issue of alleged dishonest conduct.

The Panel relied upon the evidence of ER that there had been no such training. The Panel is of the view that member of the public would rightly consider that fabrication of attendance at a training course was dishonest. The Panel therefore makes a finding of dishonesty.

(5) 10 March 2017 -– Dishonesty Proven.

The death of a child service user being given as a reason for cancelling a visit has been verified as inaccurate. The evidence of ER and SAF was that such an incident would have been memorable as they are so very rare. Such an event would have triggered a safeguarding issue and would have been the subject of a serious incident report. No such things took place.

This incident is not mentioned in ER’s letter of 10 August 2017 and there is therefore no response on this in the Registrant’s response of 14 August 2017.

The Panel is of the view that members of the public would rightly consider that fabrication of such a tragic reason for non-attendance was dishonest. The Panel therefore makes a finding of dishonesty.

(6) 19 April 2017 – Dishonesty Proven

The evidence of ER and SAF is that this flood did not happen and would have been a notable event if it had.

This is an incident which was include in ER’s letter of 10 August 2017. In her Statement sent in reply, the Registrant does not specifically deal with this incident on this date, but she does however restate that she was anxious when required to go to School 1 and had difficulty in making herself attend. This particular cancellation is one of a series of cancellations of visits to School 1.

This is a fabricated excuse for not attending and would be considered by the public as dishonest. The Panel has concluded that this is dishonest.

The Panel notes that this excuse of a flood in the office was used again in relation to the Registrant’s failure to attend another school, School 2, on 7 June 2017.

(7) 27 April 2017 – Dishonesty Proven

This death of the older brother of a cousin who committed suicide was not a matter that was verified by reference to an outside agency or third party.

This is a matter that was raised in ER’s letter of 10 August 2017. The Registrant had reported a family death in November 2016 and another in January 2017. There was no notification of this further death to her employer or line manager and the only reference to it is in an email to the SenCo at School 1.

The substance of the reason for absence, the suicide of an older brother of a cousin who had also committed suicide, was the same excuse for absence used on a previous occasion. The fact that this further death stemmed from similar causes to previous incidents was considered by the Whittington Trust to be suspicious and treated as such.

The Registrant makes no representations in relation to this particular incident but in her statement refers to the difficult time she and her family have had in recent months.

The Panel considers the Registrant’s conduct in not making this information more widely known, as she had previously, to be indicative of the reason being unsupportable.

A member of the public would rightly be concerned if they were aware that such a personally tragic reason had been a falsehood. They would consider this to be dishonest behaviour.

The Panel has concluded that this is dishonest.

(8) 30 June 2017 – Dishonesty Proven

The Panel has found that this reason of recent bereavement is a matter that was not verified it cannot determine whether it is accurate excuse

This matter was not a matter referred to in ER’s letter of the 10 August 2017 to the Registrant. The Registrant’s position in her Statement sent in response stated that generally had been that it is had been a difficult year for her family and her personally.

ER stated that she had not been made aware of a bereavement and could not find any other evidence of this bereavement from any other source except it being referenced in this email.

This further incident of a bereavement was considered by the Whittington Trust to be unsupportable.

The Panel has noted that there a pattern of using bereavements and funerals as excuses for non-attendance whilst the Registrant was working for both Trusts had emerged. The Registrant’s conduct in not sharing this information more widely was indicative of dishonest behaviour.

Members of the public would be surprised and shocked that this has been used as a fabricated reason.

The Panel find this proven.

(9) 12 July 2017 – Dishonesty Proven

The excuse of cancelled trains flowing from being sent for an out-of-town training course the previous day, was verified as being inaccurate.There had not been any out of town training the previous day. The excuse of cancelled trains from a seaside resort was therefore considered by the Whittington Trust to be a false excuse.

The Registrant’s position on this is matter is unknown.

The Panel considers that a member of the public would consider making up such false reasons for non-attendance as dishonest. This Panel has therefore also concluded that it is dishonest behaviour.

Particular 2 – Dishonesty Proven

116. The Panel has made a finding that the reason given for her absence was inaccurate. She was not on a fire safety training course. The Panel noted the Registrant’s admission that the reason given had been made up on the spur of the moment.

117. The excuse of having to attend a fire safety training course had been provided by the Registrant on the telephone in a personal conversation with ER which ER recalls clearly. ER told the Panel that the Registrant’s tone in that telephone conversation had been ‘casual’ and ‘almost dismissive of her colleagues’ concern for her welfare’. This was at variance with the subsequent admission by the Registrant that she was in a state of panic at the time.

118. The Registrant had given the same reason for her absence from the office in a group WhatsApp message stating ‘Hi guys I was at fire safety training’ a message which alerted SAF to the fact that this must be false, as the Registrant was up to date with her mandatory training.

119. The evidence of ER that at the time the Registrant had seemed calm and dismissive of concerns better informs the Panel’s view of the Registrant’s conduct at that moment. The Registrant was aware that she was providing a false reason in the phone call and the text message. The Panel noted that it was not until challenged that she had admitted to the fact that a reason for having to lie had been fabricated. This is conduct indicative of someone who was being dishonest.

120. The Panel considers that a member of the public would, given all the fact known to this Panel, consider that this incident was evidence of dishonest behaviour. The Panel has accordingly concluded that it is dishonest.

Particular 3 – Dishonesty Proven

121. Particular 3 related to clinical case notes which are not only inaccurate but are also false documents. This being the case, it is further alleged that in producing these notes the Registrant was being dishonest. The Panel has given very careful consideration to the documents which it is alleged were inaccurate and/or false as listed in Schedule D and has concluded that there is only one which it can with confidence state could only have been false as well as inaccurate.

122. The clinical case note produced by the Registrant, for a session at School 2 on 7 June 2017, is, by her own actions false, for on this day the Registrant sent an email to that school saying that she could not attend due to a flood at the office. That is a flood which has not been established as having happened. However, in relation to the evidence of ER and SAF in relation to the excuse of a flood given on 19 April 2017, they stated categorically that there had not been a flood at any time, and it would have been a notable event. This is therefore evidence of multiple falsehoods being made relating to the excuse of a flood [schedule D].

123. The Panel considers that a member of the public would consider this conduct by the Registrant to be dishonest. The Panel has also concluded that the Registrant’s conduct was dishonest.

Particular 4(a) – 5 dates - Dishonesty Proven

124. This sub-particular identifies 8 dates relating to the Registrant’s non-attendance at 4 schools. These dates were set out in Schedule E. The Panel was required to consider whether the Registrant had provided either inaccurate and/or conflicting reasons for her rescheduling and/or cancelling visits to those 4 schools on those 8 dates The Panel has set out earlier in the body of this decision, its findings in relation to those 8 dates. The Panel has found 3 of those not proven.

125. In relation to the remaining 5 incidents, it is further alleged that those inaccurate or conflicting reasons for cancelling, or rescheduling were dishonest. The Panel’s decisions on those are:

(1) 16 March 2018 – Dishonesty Proven

The reason given for non-attendance was planned training at a team away day. This was found to be inaccurate as there had not been any training organised nor any team away day.

The Registrant’s position on this matter is unknown.

The Panel noted that having provided a false reason for non-attendance at this school, the Registrant produced entries for CSUs at that school that day.

The reason being given was verifiably not true. The Panel has concluded that members of the public would consider this conduct was dishonest.

The Panel has found dishonesty.

(2) 21 March 2018 – Dishonesty Proven

The reason given had been that the Registrant had been in a car accident. This incident was raised with the Registrant by RS out of concern, at which point the Registrant had admitted that it had been an overstatement and a fabrication. Whilst there had been a "mild car incident", she had used the excuse to cover over the fact that she had double booked herself.

The Panel has concluded that this is dishonest behaviour and members of the public would consider that the admission of making up a reason to cover up the problem of conflicting appointments to be dishonest.

(3) 18 April 2018 – Dishonesty Proven

The reason provided for the cancellation at School 6 was sickness. This sickness was not recorded elsewhere. However, the Registrant was recorded as attending another school on this same date for a period of 45 minutes. It is clear that the reason given to School 6 was not true.

The Panel considers that this behaviour of giving false reasons to cover up for problems with diary arrangements to be dishonest. The Panel concluded that members of the public would consider this pattern of false reasons for non-attendance to be dishonest.

(4) and (5) - 11 May 2018 – Dishonesty Proven

These two incidents are interrelated in that the Registrant was expected at one and stating she was at the other when she was not.

On this occasion no excuse was given to School 6 for her absence. The mischief arises from the Registrant telling her manager and Supervisor in Supervision that she had in fact been at School 9.

The Registrant has maintained that she had attended School 9, but must have forgotten to sign in. She had said that she had undertaken a classroom session. No one at School 9 had seen the Registrant. The Registrant’s position in relation to School 6 is that she was elsewhere which has been found as unsupportable.

The Panel considers that the Registrant’s attempt to divert adverse criticism for her non-attendance at one school, with the excuse of going to another when she had not, was dishonest and would be considered as such by members of the public.

Grounds

HCPC submissions

126. The HCPC invited the Panel to consider the HCPC Standards of Conduct, Performance and Ethics, 2016 (the HCPC Standards) in particular:

a. 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.

b. 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.

c. Standard 2.2 - You must listen to service users and carers and take account of their needs and wishes.

d. 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.

e. 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.

f. 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.

g. 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 user, carer or colleague at unacceptable risk.

h. Standard 8.1 – You must be open and honest when something has gone wrong with the care, treatment or other services you provide by:

i. Informing service users or, where appropriate, their carers, that something has gone wrong;

ii. Apologising;

ii. Taking action to put matters right if possible; and

iv. Making sure that service users or, where appropriate, their carers, receive a full and prompt explanation of what has happened and any likely effects.

i. Standard 9.1 – You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

j. Standard 10.1 – You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

k. Standard 10.2 – You must complete all records promptly and as soon as possible after providing care, treatment or other services.

127. The HCPC submitted that, taken together or individually, the behaviour outlined in the proved factual particulars amounts to the statutory ground of misconduct, in that it constitutes a serious falling short of what would be proper in the circumstances.

128. The HCPC further submits that there was also a lack of honesty and integrity in this case. The Registrant’s provision of an inaccurate reason for failing to attend Islington Council Offices on 20 July 2017, and inaccurate and/or conflicting reasons for rescheduling and/or cancelling visits at schools 5, 6, 8 and 9, were dishonest.

129. The HCPC stated that the Registrant repeatedly abused the trust and support given to her by her colleagues and there was a pattern of consistently poor and at times discreditable behaviour, which had profound implications – namely the likely impact on vulnerable children and the development of their speech, language and communication skills.

130. The Courts have repeatedly stated dishonesty is likely to attract a finding of misconduct. In Khan v General Medical Council [2015] EWHC 301 it was stated that: “The decisions from this court have demonstrated that a very strict line has been taken in relation to findings of dishonesty… for all professional men and women, a finding of dishonesty lies at the top end of the spectrum of gravity of misconduct.”

131. In the HCPC’s submission, the Registrant’s actions should, therefore, properly be considered as amounting to misconduct. Furthermore, in this case, lack of competence has been demonstrated in relation to a fair sample of the Registrant’s work. The proved allegations in this case pertain to events which span the course of two years. The evidence is voluminous and the examples pertain to numerous dates during this period.

Legal Assessor’s advice

132. Whether the factual particulars which have been found proved amount to misconduct or lack of competence and whether, by reason of either of these, the Registrant’s fitness to practise is impaired, are matters for the Panel’s judgment and there is no burden of proof on the HCPC.

133. Misconduct is a word of general effect, involving some serious act or omission which falls short of what would be proper in the circumstances. In the case of R v Meadow [2006] EWCA Civ 1390 it was stated misconduct has to be serious and could encompass incompetence or negligence.

134. The case of Nandi v General Medical Council [2004] EWHC 2317 states that seriousness needs to be given proper weight and was referred to as conduct which would be regarded as deplorable by fellow practitioners. Misconduct may also be conduct of a morally culpable or otherwise disgraceful kind, which may bring the practitioner or the profession into disrepute.

135. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner. The rules and standards ordinarily required to be followed by the Registrant would have been the HCPC Standards.

136. A lack of competence connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of work. The standard to be applied is that applicable to the post to which the Registrant had been appointed and the work she was carrying out. In this case the Registrant was employed as a Band 5 Speech and Language Therapist. The Legal Assessor confirmed that if misconduct is found in relation to a particular, there is no need to go on to also consider lack of competence.

137. The Tribunal must give reasons for the decision on grounds. The case of Phipps v GMC [2006] EWCA Civ 397 establishes the proposition that the Tribunal is under no obligation to record in its reasons every point in favour of the Registrant in the evidence it has heard or read. Sir James Munby P in Re F (Children) [2016] EWCA Civ 546 (22) stated: The task facing a judge is not to pass an examination, or to prepare a detailed legal or factual analysis of all the evidence and submissions it has heard. Essentially, the judicial task is two-fold: to enable the parties to understand why they have won or lost; and to provide sufficient detail and analysis to enable an appellate court to decide whether or not the judgment is sustainable. The judge need not slavishly restate either the facts, the arguments or the law. Mostyn J in KP [2014] EWHC 3964 (Fam), stated: there is no need for the judge to ‘incant mechanically’ passages from the authorities, the evidence or the submissions, as if he were a pilot going through the pre-flight checklist.

Decision on Grounds

138. The Panel has taken into account that misconduct is a word of general effect involving some serious act or omission which falls short of what would be proper in the circumstances. The Panel has considered the HCPC Standards in relation to the proved factual particulars.

139. In relation to factual particular 1a) the Registrant was found in relation to 41 dates to have failed to complete and/or upload any adequate records in Rio. This was in serious breach of HCPC Standards 2.5, 2.6, 10.1 and 10.2. The Registrant’s conduct fell seriously below the standard to be expected of a practitioner in her role because she breached the relevant standards over a prolonged period (September 2016 – July 2017). There were opportunities to raise any difficulties with her manager during supervision. On the contrary, the Registrant told her supervisor, SAF, that she was able to manage “whatever is thrown at her.”

140. In relation to factual particular 1b) the Registrant did not provide and/or arrange the required number of speech and language therapy sessions as outlined in the EHCPs for 13 children, as identified in Schedule B. These 13 children have been identified, though the EHCP, as having acute communication needs. In their EHCPs the Local Authority will have set out exactly what is required to help these children and the minimum service required. It is a statutory requirement for the children to receive the number of speech and language therapy sessions outlined in their EHCP, and all parties would have proceeded in good faith on the basis that this will be done. The Registrant’s failings caused these children to be deprived of much needed support in their formative years, with the possibility of a lasting impact on their speech and language skills. By failing to attend these statutory appointments, the Registrant was unable to share relevant information with colleagues and the schools concerned. This was a serious breach of HCPC Standards 1.2, 1.3, 2.5, 2.6, 6.1 and 9.1.

141. In relation to factual particular 1c) the Registrant did not visit schools 1,2,3 and 4 for the expected number of days. The Panel found in relation to school 1 the Registrant was expected to undertake 54 visits but had only attended 22 times; for school 2, the Registrant was expected to undertake 24 visits but had only attended 16 times; for school 3, the Registrant was expected to undertake 30 visits but had only attended 9 times and for school 4, the Registrant was expected to undertake 24 visits but only attended 11 times. The Panel concluded that this amounted to numerous sessions that the Registrant failed to attend, over a prolonged period, depriving children of their speech and language therapy support. This may have had a serious impact upon those children from the 4 different schools. This was in serious breach of HCPC Standards 1.2, 1.3, 2.5, 2.6, 6.1 and 9.1.

142. In relation to particular 1d) the Registrant provided inaccurate and/or unverified reasons for rescheduling and/or cancelling visits at schools 1,2, and 4, on dates as outlined in Schedule C. This gave rise to a finding of dishonesty, under particular 6, in relation to 7 of the 9 dates. The inaccurate reasons included reference to the death of a child “via child abuse” and a “sudden bereavement”. This behaviour was in serious breach of HCPC Standards 8.1 and 9.1.

143. In relation to particular 1e) the Registrant did not routinely complete clinical notes to an appropriate standard, in that they lacked detail and/or were not contemporaneous. This was in breach of the HCPC Standards 10.1 and 10.2. The Panel considered this to be a serious breach because numerous notes lacked sufficient detail, were very brief, contained limited information and were not specific about the child’s targets or abilities.

144. In relation to particular 2, on or around 20 July 2017, the Registrant provided an inaccurate reason for her unauthorised absence from the Islington Council Offices (Whittington Trust) giving rise to a finding of dishonesty under particular 6. This was in serious breach of HCPC Standards 8.1 and 9.1.

145. In respect of particular 3, on around 14 August 2017, the Registrant provided a statement to her employer which contained falsified and/or inaccurate clinical notes as outlined in schedule D. The Panel noted that one of the documents provided by the Registrant was proven to be false and inaccurate (school 2, 7 June 2017), as admitted by the Registrant. This gives rise to a finding of dishonesty under particular 6 and is in serious breach of the HCPC Standards 9.1, 10.1 and 10.2.

146. In respect of particular 4 (a), between January 2018 to July 2018, while employed at the LNW Trust, the Registrant provided inaccurate and/or conflicting reasons for rescheduling and/or cancelling visits at schools 5, 6, 8 and/or 9, on 5 of the 8 dates as outlined in Schedule E. This gives rise to a finding of dishonesty under particular 6 and in serious breach of HCPC Standards 8.1 and 9.1.

147. In respect of particular 4 (b), the Registrant did not upload and/or record contacts and/or case notes in System 1, on all the dates specified in Schedule F in breach of the HCPC Standards 10.1 and 10.2. The Panel considers this breach to be serious because Schedule F covers a prolonged period from January 2018 to May 2018, several schools and multiple Child Service Users.

148. In respect of particulars 5 (a) – (d), on or around 21 March 2018, the Registrant did not complete case notes following planning meetings for 4 Child Service Users, in breach of the HCPC Standards 10.1 and 10.2. The Panel considers this to be serious because it relates to more than one Child Service User.

149. The Panel finds each proved factual particular, when taken together, would be regarded as deplorable by other members of the profession and the public, because of the lengthy period of time spanned, the potential detrimental impact on numerous children, some of the behaviour encompassing dishonesty and that the misconduct took place in relation to two periods of employment with two separate employers. Therefore, the Panel finds that the allegation of misconduct arising from the proved factual particulars is well founded.

150. The Registrants failings arising from the proved facts are all determined by the Panel to amount to misconduct, rather than lack of competence. This is a case in which the Registrant knew what was required of her. It was noted that the Registrant successfully passed her probationary period with the Whittington Trust. The Registrant was capable of carrying out her employed role but chose not to do so.

Impairment

HCPC submissions

151. Under the “personal component” of impairment the HCPC stated that due to the lack of engagement by the Registrant since 22 March 2019, there is little if any material upon which the Panel could safely conclude that the Registrant has any insight. In fairness to the Registrant the HCPC referred the Panel to the contents of her statement provided to the Whittington Trust in 2017, and notes from meetings she participated in on 17 August and 8 September 2017. The HCPC submits the Registrant’s expressed level of insight is somewhat minimised by her insistence that she had completed the correct number of sessions set out on the children’s EHCPs. She had stated in 2017 to the Whittington Trust that: “the reason why it appears as though I haven’t done this is because of my lack of ability to keep up with the note writing”. The Panel’s finding that allegation 1(b) was proven shows that this assertion is incorrect. Her account was given in 2017, and the Registrant has not engaged with the HCPC since 22 March 2019. In the absence of any engagement from the Registrant in the Fitness to Practise process for over 2 years, it is submitted that the Panel cannot sensibly conclude, that the Registrant has demonstrated any understanding of the following matters:

a. of the seriousness of the entirety of her conduct;
b. of the potential impact of her conduct on vulnerable child service users;
c. of the potential impact of her conduct on the public and public perception;
d. of the impact of her conduct on the profession;
e. of the impact of her conduct on her colleagues;
f. of the causes of her behaviour and how to properly address those causes.

152. Accordingly, a finding of impairment may be required under the personal component.

153. In the HCPC’s submission, a finding of impairment is also required under the “public component”. If this finding was not made, public trust in the profession, the regulator and its ability to uphold proper professional standards, would be significantly undermined. This case involves repeated failings in documentation, the abandoning of vulnerable patients and dishonesty – conduct which must be decried by the regulator and which, if public confidence in the profession is to be maintained, must be marked. Members of the public would undoubtedly be appalled to learn that vulnerable children, had been deprived of what they were entitled to, by way of speech and language sessions; with serious potential consequences.

154. In the HCPC’s submission, members of the public would expect conduct in breach of such tenets to be marked by the regulator: a failure to mark such misconduct would undermine confidence in the regulator, the regulatory process, and regulated professionals themselves.

Legal Assessor’s advice

155. The Legal Assessor advised the Panel to consider the HCPTS Practice Note on Finding that Fitness to Practice is Impaired, in order to determine whether the Registrant’s fitness to practise is currently impaired. The Panel must take account of a range of issues, which in essence, comprise two components:

(1) the ‘personal’ component: the current competence, behaviour etc. of the Registrant; and

(2) the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

156. The test of impairment is expressed in the present tense: that fitness to practise is impaired at the current date.

157. The Panel should take into account the lapse of time since these matters occurred and examine the Registrant’s past actions in order to assess her likely future performance. Under the personal component, the Panel should decide if the Registrant has taken steps to remediate her misconduct or lack of competence. Also does she have a lack of insight as to its impact upon service users and is there a risk of repetition of the Registrant’s misconduct or lack of competence?

158. As regards the public component, Mrs Justice Cox stated in the case of CHRE v (1) NMC and (2) Grant [2011] EWHC 927 that in determining whether a practitioner’s fitness to practise is impaired, by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public, in his or her current role, but also whether the need to uphold proper professional standards, and public confidence in the profession, would be undermined, if a finding of impairment were not made in the particular circumstances. Mr Justice Silber stated in R (on the application of Cohen) v GMC there is a need to declare and uphold proper standards of conduct, and behaviour, to maintain public confidence in the profession.

159. The Panel should therefore consider whether public confidence in the profession would be undermined, and the public would lose confidence in the profession and the regulatory process, if a finding of current impairment was not made. Also is it necessary to make such a finding in order to uphold the HCPC Standards of Conduct or Proficiency?

160. The case of PSA v HCPC and Roberts [2020] EWHC 1906, decided that the Panel is not obliged to set out detailed case law, in its determination; but should take into account the treatment in the case law of the tension between the public interest and the private interests of the Registrant; and the need to consider the wider public interest.

161. A finding of impairment does not necessarily follow upon a finding of dishonesty, although it will be a frequent one. In the case of Hassan v GOC [2013] EWHC 1887 (Admin) it was stated that dishonesty encompasses a very wide range of different facts and circumstances. Any instance of it is likely to impair a professional person’s fitness to practise, and in that sense is a serious matter. While each case will turn on its own facts, it will therefore be an unusual case where dishonesty is not found to impair fitness to practise. The case of PSA v HCPC and Ghaffar [2014] EWHC 2723 (Admin) decided that: honesty is a fundamental tenet of the profession, which lies at the heart of professionalism, as it is essential to the public’s trust in all health and care professions.

162. When considering impairment, the Panel should also bear in mind the tests formulated by Dame Janet Smith in her Fifth Shipman Report and applied by the High Court in the case of Grant:

“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

a) has in the past acted and/or is liable to act in the future so as to put a patient or patients at unwarranted risk of harm; and/or

b) has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

d) has in the past acted dishonestly and/or is liable to act dishonestly in the future?”

163. The Panel must therefore consider not only whether the Registrant continues to present a risk to the public but also whether the public interest (i.e. the need to uphold proper professional standards and public confidence in the profession) would be undermined if a finding of impairment was not made. The more serious the misconduct found, the more difficult it will be to justify a finding that fitness to practise is not impaired.

164. Where there has been a fundamental breach by a practitioner of a tenet of the profession, and a firm declaration of standards is required to promote public confidence; the efforts of a practitioner to address his/her problems, and reduce the risk of recurrence in the future, are of far less significance than in other cases, such as clinical error: Yeong v General Medical Council [2009] EWHC 1923.

Decision on Impairment

165. The Panel accepted the Legal Assessor’s advice and considered the Practice Note on Finding that Fitness to Practise is Impaired noting that the test of impairment is expressed in the present tense. The Panel has taken into account the lapse of time since these matters occurred and has looked at the Registrant’s past actions in order to assess her likely future performance.

166. There was initial engagement by the Registrant with the HCPC but there has been no further engagement since March 2019. She has limited insight based on her account given to the Whittington Trust in 2017, in which she apologised “for all of this” and for “the trouble it has caused in regards to opening up an investigation”. She added that “most of this is due to not being able to complete my own to do lists, that I had set for myself and then letting it build up so much over time to the point where I could not even recall that it is a task I need to complete.” The Registrant also stated that she “takes complete responsibility” for the high number of unaccounted for days on the Rio diary, and that “all notes not on RiO were handwritten in the session”. Also that “it is now clearly evident through my lack of performance at work that something is not right as this is completely out of my character”. The Registrant apologised for not keeping up with her to do list and accepted that she lied about attending a fire safety training course on 20 July 2017, noting it was “extremely unprofessional of me and breaks all forms of conduct expected from work”. She also noted that she had “breached trust and confidence” and “it is a very serious matter” in that she had “on many occasions emailed to cancel sessions” at School 1.”

167. The Registrant has offered apologies in 2017 and explained her difficult personal circumstances. However, the Registrant has not engaged since March 2019 and there is therefore no evidence of her current insight. Indeed, the Registrant has not offered a response to the HCPC allegation nor this Panel’s findings. The Panel notes, the Registrant’s response to the Whittington Trust in 2017 was that the Registrant denied some of the particulars which the Panel have found proven.

168. The Panel has no evidence as to the steps taken by the Registrant to remediate her misconduct which includes dishonesty. In addition, there is no evidence as to how the Registrant has maintained her skills and knowledge as a Speech and Language Therapist. The Registrant’s last stated position was that she did not intend to pursue her profession again in the future.

169. In the absence of sufficient insight and remediation the Panel is concerned about a risk of repetition. The misconduct spanned a period of years; 2016/17 with the Whittington Trust and January to July 2018 with the LNWT. Within the allegation itself, which the Panel has found proven, there is evidence of the misconduct, including dishonesty, being repeated with two separate employers.

170. In its consideration of the personal component, the Panel finds the Registrant has taken no action to address her failures, remedy the potential harm to be caused and avoid future repetition. There has been no remediation or remedial steps taken and the Registrant was in a position of trust as an autonomous practitioner. A Registrant who takes insufficient or inadequate positive steps to acknowledge and address deficiencies in her practice or behaviour, is likely to pose a significant risk to the public.

171. In relation to the public component, the Panel considered that if a finding of impairment were not made in this case, public trust in the profession, the regulator and the upholding of proper professional standards would be significantly undermined. This case involves repeated failings in documentation, failing to provide required speech and language support for Child Service Users and dishonesty. This conduct must be decried by the regulator and if public confidence in the profession is to be maintained.

172. The Panel noted that members of the public would be appalled to learn that children were deprived of support they were entitled to, by way of speech and language sessions, and with such serious potential consequences. The public would be further appalled by the Registrant’s dishonesty. The Panel agreed that members of the public would expect conduct in breach of such fundamental tenets to be marked by the regulator.

173. In addition, the public would lose confidence in the profession and the regulatory process, if a finding of current impairment was not made by the Panel, in this case. It is necessary to uphold the HCPC Standards of Conduct and public confidence in the profession would be undermined if a finding of impairment was not made under the public component.

174. Accordingly, the Panel finds the Registrant’s fitness to practise is impaired under both components.

Sanction

HCPC Submissions

175. The HCPC submitted that the Panel has made a finding of impairment under both the personal and the public components and must now consider the question of Sanction. The HCPC Sanctions Policy (2019) states that the purpose of fitness to practise proceedings is not to punish registrants, but to protect the public. Inevitably a sanction may be punitive in effect; but it should not be imposed simply for that purpose. In making proportionate decisions on sanction, panels need to strike a balance between the competing interests of the registrant and the HCPC’s overriding objective to protect the public. Panels should take the minimum action necessary to ensure that the public is protected. This means considering the least restrictive sanction available first, and only moving on to a more restrictive sanction if it is necessary to protect the public. The Panel should explain the issues it has considered and the impact any aggravating or mitigating factors have had on the outcome. The Panel should assess the extent of the Registrant’s insight, remorse and remediation.

176. The HCPC referred the Panel to submissions previously made and in particular the following information. In the absence of engagement from the Registrant since 22 March 2019, there is little if any material upon which the Panel could safely conclude that there is any insight. The Registrant’s statement provided to the Whittington Trust in 2017 apologises “for all of this” and for “the trouble it has caused in regards to opening up an investigation”. She states that “most of this is due to not being able to complete my own to do lists that I had set for myself and then letting it build up so much over time to the point where I could not even recall that it is a task I need to complete.” The Registrant stated that she “takes complete responsibility” for the high number of unaccounted for days on the RiO diary, and that “all notes not on RiO were handwritten in the session…it is now clearly evident through my lack of performance at work that something is not right as this is completely out of my character”. The Registrant apologises for not keeping up with her to do list and accepts that she lied about attending a fire safety training course on 20 July 2017, noting it was “extremely unprofessional of me and breaks all forms of conduct expected from work”. She also notes that she had “breached trust and confidence” and “it is a very serious matter” in that she had “on many occasions emailed to cancel sessions” at School 1.

177. However, the Registrant’s expressed level of insight is somewhat minimised by her insistence that she had completed the correct number of sessions set out on the children’s EHCPs but that “the reason why it appears as though I haven’t done this is because of my lack of ability to keep up with the note writing”. The Panel’s finding that allegation 1(b) was proven, would indicate that this assertion is simply incorrect.

178. In the absence of any engagement from the Registrant in the Fitness to Practise process for over 2 years, it is again submitted that the Panel cannot sensibly conclude, that the Registrant has demonstrated any understanding of the following matters:

a) of the seriousness of the entirety of her conduct;
b) of the potential impact of her conduct on vulnerable child service users;
c) of the potential impact of her conduct on the public and public perception;
d) of the impact of her conduct on the profession;
e) of the impact of her conduct on her colleagues;
f) of the causes of her behaviour and how to properly address those causes.

179. The Panel has found the Registrant has limited insight based on her account given to the Whittington Trust in 2017 and there is no evidence of her current insight. Indeed, the Registrant has not offered a response to the HCPC allegation, nor the Panel’s findings and the Registrant denied some of the particulars which were later found proven. The Panel has found there was no evidence as to the steps taken by the Registrant to remediate her misconduct, which includes dishonesty. In addition, there is no evidence as to how the Registrant has maintained her skills and knowledge as a Speech and Language Therapist. The Registrant’s last stated position was that she did not intend to pursue her profession again in the future. In the absence of sufficient insight and remediation the Panel was concerned about a risk of repetition. The misconduct including dishonesty spanned a period of years, with two separate employers. The Panel found the Registrant has taken no action to address her failures, remedy the potential for harm to be caused and avoid future repetition. There has been no remediation or remedial steps taken and the Registrant was in a position of trust as an autonomous practitioner. A Registrant who takes insufficient or inadequate positive steps to acknowledge and address deficiencies in her practice or behaviour, is likely to pose a significant risk to the public.

180. The HCPC Sanctions Policy states whether or not remediation has been undertaken, and if any remediation can be considered successful, are important aspects of a panel’s assessment of what risk the registrant might pose to the public, and therefore what sanction, if any, is required to mitigate that risk.

181. There are the following aggravating features in this case:

⦁ Breach of trust in relation to her employers, colleagues and service users;

⦁ Repetition of the misconduct and a pattern of similar behaviour with different employers over a prolonged period;

⦁ A potential risk of serious harm to service users and to the reputation of the profession;

⦁ A failure to work in partnership with colleagues and;

⦁ Dishonesty.

182. The Sanctions Policy also states that trust is a fundamental aspect of the relationship between a registrant and a service user or carer. Breaching this trust can have significant impacts on public protection. For example, a service user may not engage with a registrant because they are concerned they cannot trust them, delaying treatment or support. Breaches of trust are of even greater seriousness where they involve a vulnerable service user or carer. Where there has been a breach of trust, panels are likely to impose the more serious sanctions and should provide clear reasons if they choose not to. The Registrant breached the trust placed in her by her employers, colleagues, community and child service users.

183. The HCPC referred to the HCPC Sanctions Policy and in particular “Registrants’ obligations to ‘promote and protect the interests of service users and carers’ (Standard 1) and to ‘work within the limits of [their] knowledge and skills’ (Standard 3). Where concerns are raised regarding their conduct, competence or health, registrants are duty bound to address these concerns, and ensure they do not compromise service user safety.” “A repetition of concerns, or a pattern of unacceptable behaviour, leads to greater potential risks to the public…” The HCPC submitted that the Registrant’s misconduct at the Whittington Trust was repeated at the LNW Trust, and there was a prolonged period of misconduct at both Trusts.

184. The Sanctions Policy further states where a registrant lacks insight, fails to express remorse and / or refuses to apologise in a timely manner, they may pose a higher risk to service users. Registrants who lack a genuine recognition of the concerns raised about their fitness to practise, and fail to understand or take responsibility for the impact or potential impact of their actions, are unlikely to take the steps necessary to safeguard service user safety, to address the concerns raised. In these cases panels are likely to take more serious action to protect the public. If a registrant chooses not to undertake remediation activities to address their deficiencies, it could indicate a lack of insight. This might significantly increase the risk of repetition and therefore risk to the public. It is likely that cases involving little, or no remediation, might require a more serious sanction to protect the public.

185. There was initial engagement by the Registrant with the HCPC, but there has been no further engagement since March 2019. The Registrant has offered apologies in 2017, and explained her difficult personal circumstances. However, there is no evidence of her current insight.

186. In cases where there is potential for harm to be caused, panels should be particularly mindful of any ongoing risk to service user safety, and any impact on public confidence in the profession. Service user harm, or the potential for this, will be of particular importance in cases involving vulnerable service users. In these cases the public expect that more serious action is taken, to address concerns around conduct or behaviour. The Registrant’s failure to provide the required input under EHPC plans, created a potential risk of serious harm to service users.

187. The HCPC Standards require registrants to ‘work in partnership with colleagues’ for the benefit of service users (Standard 2.5). As a result, registrants must share their skills, knowledge and experience with colleagues, and, where appropriate, relevant information about the care, treatment or other services provided to a service user. Cases where a registrant has therefore refused to cooperate with colleagues, whether that be the result of bullying, discrimination or dishonesty, are likely to result in a more serious sanction. The Registrant failed to work in partnership and to co-operate with her colleagues in this case.

188. Under the HCPC Standards, registrants must be honest and trustworthy (Standard 9). Dishonesty undermines public confidence in the profession and can in some cases, impact upon the public’s safety. Dishonesty, both in and outside the workplace, can have a significant impact on the trust placed in those who have been dishonest, and potentially on public safety. Serious cases of dishonesty are likely to lead to serious sanctions. As Mostyn J stated in Khan v General Medical Council: dishonesty will be particularly serious where it occurs in the performance by a Registrant of his or her duties and/or involves a breach of trust placed in the Registrant by the community; nothing short of erasure is likely to be appropriate in serious dishonesty cases.

189. The appropriate and proportionate sanction (if any) in this Registrant’s case, is a matter for the Panel’s judgment. The HCPC, while making submissions, did not make any bid for a particular sanction. The HCPC offered the following submissions each of the available options open to the Panel at the sanction stage:

(a) In view of the findings made in respect of current impairment, to take no action would not be appropriate or proportionate.

(b) A Caution Order is likely to be an appropriate sanction for cases in which the issue is isolated, limited, or relatively minor in nature; there is a low risk of repetition; the registrant has shown good insight; and the registrant has undertaken appropriate remediation; the above factors are not present in this case.

(c) Conditions of Practice Orders are less likely to be appropriate in the more serious cases such as cases involving dishonesty and failure to work in partnership.

(d) A Suspension Order is likely to be appropriate where there are serious concerns which cannot reasonably be addressed by a Conditions of Practice Order, but which do not require the registrant to be struck off the Register. For example, because the Registrant has insight, or is unlikely to repeat the misconduct and is likely to be able to remedy his or her failings.

(e) A Striking off Order is a sanction of last resort for serious, persistent, deliberate or reckless acts, including those involving dishonesty or failure to work in partnership. A Striking off Order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public and maintain public confidence in the profession and the regulatory process. For example, where there is a lack of insight, repetition of misconduct or unwillingness to resolve matters.

Legal Assessor’s Advice

190. The Panel was advised by the Legal Assessor to have regard to the HCPC Sanctions Policy (2019), which states:

“Panels make independent decisions, and must decide each case on its merits. The Policy is intended to be a guide and not to provide fixed ‘tariffs’ or constrain a panel’s independence in any way. However, where a panel deviates from the Policy, they must provide clear reasons for doing so.”

In addition, “The primary function of any sanction is to protect the public. The considerations in this regard include:

⦁ any risks the registrant might pose to those who use or need their services;

⦁ the deterrent effect on other registrants;

⦁ public confidence in the profession concerned; and

⦁ public confidence in the regulatory process...”

“In writing any decision on sanction, the panel must provide clear and detailed reasoning to support its decision, explaining the issues it has considered and the impact any aggravating or mitigating factors have had on the outcome.”

The Policy goes on to state “The panel’s written decision should clearly explain why the sanction is necessary to protect the public having regard to the full facts of the case and associated risks. It should also make clear what process the panel followed, by considering each available sanction in turn, in the same order in which the panel has assessed their suitability. Panels should explain why they have rejected one sanction before moving on to a more severe sanction, and outline why the less restrictive sanction is insufficient to protect the public. Where appropriate, they should also explain why the next more severe sanction is not required to protect the public, having regard to the specific circumstances of the case.”

191. In deciding what, if any, sanction to impose under Article 29 of the Health Professions Order 2001, the Panel must have regard to the principle of proportionality and the need to balance the interests of the public with those of the Registrant. The Panel should consider the wider public interest, which includes the need to uphold the reputation of the profession and maintain public confidence in the HCPC regulatory process. Once again, the public interest should be the lens through which the Panel view all decisions on sanction. The Panel’s task is to strike a fair balance between the interests of the Registrant and the public interest.

192. All sanctions up to and including a Striking off Order are available to the Panel in this case. The importance of honesty to the health and care professions is underlined by the fact that striking off may be an appropriate sanction under the Sanctions Policy and will often be proper even in cases of one-off dishonesty (see Nicholas-Pillai v GMC [2009] EWHC 1048).

Decision on Sanction:

193. The Panel has considered sanctions in ascending order of gravity in accordance with the HCPC Sanctions Policy and accepted the advice of the Legal Assessor.

194. The Panel identified the following mitigating factors:

⦁ The Registrant has expressed regret and remorse (for certain elements of her misconduct) and was open about her difficulties in completing records in her account to the Whittington Trust (notes from meetings she participated in) on 17 August and 8 September 2017.

⦁ The Registrant has arguably also displayed insight, in so far as her last stated position was that she did not intend to practise again in the future.

⦁ She was of previous good character with no previous disciplinary findings.

⦁ The Registrant was in the early stages of her post-qualification career as a Speech and Language Therapist.

⦁ She had personal problems during the relevant period.

195. The Panel has identified the following aggravating factors:

⦁ There were multiple serious breaches of the HCPC Standards of Conduct.

⦁ The Panel has found the Registrant was repeatedly dishonest to her employers and work colleagues, including in relation to her whereabouts and reasons for not visiting schools.

⦁ She undermined the trust placed in her by her employers and colleagues.

⦁ Her misconduct caused potential harm to service user’s because children did not receive support with their speech, language and communication including children subject to EHCPs to whom the Registrant had a statutory responsibility.

⦁ The Registrant is currently impaired under the public and the personal components and has not engaged with the HCPC since 22 March 2019.

⦁ She has not remediated her misconduct and there is a lack of insight.

⦁ The proved facts concern two different employers over an extended period and the Registrant failed to work in partnership with colleagues and schools.

196. The Sanctions Policy states “In cases where a service user has been harmed, or there was potential for harm to be caused, panels should be particularly mindful of any ongoing risk to service user safety, and any impact on public confidence in the profession… Service user harm, or the potential for this, will be of particular importance in cases involving vulnerable service users. In these cases, the public expect that more serious action is taken to address concerns around conduct or behaviour… Dishonesty, both in and outside the workplace, can have a significant impact on the trust placed in those who have been dishonest, and potentially on public safety. It is likely to lead to more serious sanctions…Cases where a registrant has therefore refused to cooperate with colleagues, whether that be the result of… dishonesty, are likely to result in a more serious sanction.”

197. The finding of impaired fitness to practise means that the Panel has concerns about the Registrant’s current ability to practise safely and effectively. It is unlikely that a panel would take no action following a finding of impairment. Taking no action would not be appropriate to mark the serious nature of the misconduct and to protect the public in this case.

198. A Caution Order is likely to be an appropriate sanction for cases in which: the issue is isolated, limited, or relatively minor in nature; there is a low risk of repetition; the registrant has shown good insight; and the registrant has undertaken appropriate remediation. A Caution Order is not appropriate in this case because the issues are not isolated, limited, or relatively minor in nature. There is a high risk of repetition, the Registrant has not shown good insight; and she has not undertaken appropriate remediation. The Panel finds the Registrant’s misconduct in this case arose from a pattern of behaviour and the factual particulars covered a significant period, during which the Registrant had two different employers.

199. A Conditions of Practice Order is likely to be appropriate in cases where the registrant has insight, the failure or deficiency is capable of being remedied, there are no persistent or general failures, which would prevent the registrant from remediating and where appropriate, proportionate, realistic and verifiable conditions can be formulated. Also, a Conditions of Practice Order is likely to be appropriate where the Panel is confident the Registrant will comply with the conditions, a reviewing panel will be able to determine whether or not those conditions have or are being met, and the Registrant does not pose a risk of harm by being in restricted practice. Conditions are less likely to be appropriate in the more serious cases. For example, those involving dishonesty and failure to work in partnership. The Panel has decided that a Conditions of Practice Order is not an appropriate sanction in this case, because there is a risk of harm to service users, there has been no remediation, there is a lack of insight and workable conditions cannot be formulated, which would address the misconduct including dishonesty and the failure to work in partnership.

200. A Suspension Order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a Conditions of Practice Order, but which do not require the registrant to be struck off the Register. The Panel had regard to the Sanctions Policy which describes the types of cases where a Suspension Order may be appropriate. This includes:

⦁ the concerns represent a serious breach of the Standards of conduct, performance and ethics;

⦁ the registrant has insight;

⦁ the issues are unlikely to be repeated and;

⦁ there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.

201. The Panel has decided that a Suspension Order is not appropriate or proportionate in this case because of the Panel’s findings of dishonesty which amount to a serious breach of the Standards. In addition, there is no evidence of the Registrant’s current insight, the Panel are not persuaded that the issues are unlikely to be repeated, there is no evidence of the Registrant taking any remedial actions and there is no assurance that the Registrant intends to resolve or remedy her failings. The Registrant has stated that she does not intend to practise again. In all the circumstances a Suspension Order would serve no useful purpose.

202. The Sanctions Policy states a Striking off Order is a sanction of last resort for serious, persistent, deliberate or reckless acts involving dishonesty or failure to work in partnership. A Striking off Order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, maintain public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant lacks insight, or is unwilling to resolve matters. The Panel concludes due to the multiple failings which includes repeated dishonesty and failure to work in partnership, that the only appropriate and proportionate sanction consistent with the Sanctions Policy in this case is a Striking off Order.

Order

ORDER: The Registrar is directed to strike the name of Ms Pinkie Uddin from the register, from the date this order comes into effect.

Notes

Interim Order

1. After the Panel had handed down the decision on Sanction, the HCPC made an application for the Panel to hear an application for an Interim Order in the absence of the Registrant. The HCPC invited the Panel to exercise its discretion to proceed in the Registrant’s absence and relied upon the notices of hearing sent to the Registrant including an email dated 18 October 2021; stating that an Interim Order application may be made by the HCPC at the conclusion of the proceedings.

2. The Panel is content that the Registrant is aware of the potential for an Interim Order application. The Registrant has not made an application for an adjournment of any Interim Order application and the Registrant has not engaged with the HCPC since March 2019. There is no indication that she is more likely to attend on another date should this application be adjourned.

3. The Panel granted the HCPC’s application to proceed in the absence of the Registrant and hear the Interim Order application, after considering the advice of the Legal Assessor.

4. The HCPC then made an application for an Interim Suspension Order to cover the 28-day appeal period and to cover a subsequent period in the event of an appeal being made by the Registrant because the Striking Off Order made today does not take effect until the end of the appeal period. The HCPC made an application for an Interim Order on the grounds of public protection and public interest. The Panel accepted the advice of the Legal Assessor that the Panel may make an Interim Order on the grounds of public protection, the public interest or in the Registrant’s interest. After considering the HCPTS Practice Note on Interim Orders, the Panel decided that an Interim Order is necessary to protect the public. There is a risk that the Registrant may return to practice if an Interim Suspension Order is not immediately in place. The Panel noted that the Registrant had moved on to work as a Speech and Language Therapist for a new employer, during November 2018, after leaving the LNW Trust and despite being aware of a referral to the HCPC about her Fitness to Practise. The Panel decided that an Interim Order is also necessary taking into account in the public interest for the reasons set out in the Panel’s decision above, due to the nature and seriousness of the findings of misconduct made against the Registrant. Taking into account the Panel’s findings, including dishonesty, an Interim Conditions of Practice Order would not be sufficient to protect the public.

5. 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. The Panel decided that the appropriate length of the Order is 18 months to cover the 28-day appeal period and the time it may take for any appeal, if made, to be determined. This order will expire: (if there is no appeal 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 period of 18 months.

 

Hearing History

History of Hearings for Ms Pinkie Uddin

Date Panel Hearing type Outcomes / Status
15/11/2021 Conduct and Competence Committee Final Hearing Struck off
30/09/2021 Conduct and Competence Committee Final Hearing Adjourned part heard
31/08/2021 Conduct and Competence Committee Interim Order Review Interim Suspension
05/07/2021 Conduct and Competence Committee Final Hearing Adjourned part heard
01/06/2021 Conduct and Competence Committee Interim Order Review Interim Suspension
04/09/2020 Conduct and Competence Committee Interim Order Review Interim Suspension
29/06/2020 Conduct and Competence Committee Interim Order Review Interim Suspension
03/03/2020 Investigating Committee Interim Order Review Interim Suspension
10/12/2019 Investigating Committee Interim Order Review Interim Suspension
03/06/2019 Investigating Committee Interim Order Application Interim Suspension