Sandra Marshall

Preliminary Matters

1. The Panel was convened to undertake the final hearing of the HCPC’s allegation against the Registrant, Miss Sandra Marshall, a Speech and Language Therapist (‘SLT’).

Support for the Registrant during the hearing

2. The limited engagement with the HCPTS, demonstrated by the Registrant, resulted in the Panel being unsure whether she would appear at the commencement of the hearing. She did in fact appear, but when she did, the Panel was informed that she had wished to be represented by someone from her trades union. Mr Philip Penny, of that union, explained that an application for representation had been made on behalf of the Registrant. It was unclear to the Panel why the requested representation had not been provided, and the Panel did not consider that it was either necessary or appropriate for the matter to be investigated by it. What the Panel did, however, consider to be appropriate was to establish what the Registrant’s attitude was to the hearing continuing in the circumstances described. The Registrant informed the Panel that she wished the hearing to continue, with Mr Penny remaining as a supporter. Mr Penny himself, on more than one occasion, described his role as supporter, rather than as a representative. The Panel was satisfied that the hearing could be conducted fairly by following this course. In the event, Mr Penny spoke on behalf of the Registrant, asking questions she wished to be put to the witnesses, and making the submissions she wished the Panel to consider.

HCPC’s application to amend the allegation

3. On 6 January 2022 the HCPC wrote to the Registrant informing her of its intention to apply at the commencement of the final hearing to amend certain aspects of the factual particulars of the allegation, the detail of the proposal being contained in the letter. The Registrant did not respond to the letter. At this hearing, the Registrant agreed to the amendments except for particular 1(b) in that she considered that it made the particular general rather than specific.
4. The proposed changes (apart from the correction of a formatting error) were as follows:
• To add to particular 1(a), the words, “and/or take clinical decisions” after reference to the management of caseload.
• In particular 1(b), it was proposed that the errors alleged should not be qualified by the word “significant”, and the questions by “unexpected”.
• In particular 2, the addition of “and/or” on two occasions made explicit that the HCPC’s case was that the contention related to the SOAP notes, care plans and discharge summaries, or to any combination of those written documents.
• In particular 3(a), it was proposed that the qualification that the service users were “very young” should be removed, and that the parents of service users should be included as additional or alternative people in relation to whom the Registrant’s communication style was not adapted.
• In particular 3(b), it was made clear that the criticism that appointment details were not clearly explained was that the explanation was in terms that could be understood by service users and/or their parents.

5. The Panel was of the view that the proposed amendments were minor in nature and they reflected the HCPC’s case and provided appropriate clarity on the concerns of the HCPC. The Panel took account of the Registrant’s objection to the amendment of paragraph 1(b). However, the Panel was also satisfied that, if allowed, the amendments would not result in the Registrant being prejudiced. Accordingly, the Panel acceded to the HCPC’s application. The allegation set out at the head of this document is the allegation as amended.

The Registrant’s response to the amended allegation

6. When invited to respond to the amended allegation, the Registrant indicated a number of denials, but also stated that in relation to some of the particulars that there were partial admissions. In relation to particular 1(d), the Registrant indicated that this particular was admitted. The Panel considered it appropriate to proceed on the basis that the HCPC would be required to prove all of the factual particulars.

Part of the hearing to be held in private

7. It was apparent to the Panel from its pre-reading of the hearing bundle that the Registrant is affected by dyslexia. The Panel therefore expected an application to be made for the hearing to be held partly in private so that any mention of this disability would not be publicised. The Panel acceded to the application, finding that it was necessary to direct that any mention of the Registrant’s disability should be dealt with in private, that being necessary to protect her private life.

Separation of decisions on different elements of the allegation

8. The Panel considered that this was a case in which fairness to the Registrant required a decision on the facts to be made and announced before any other elements of the allegation should be considered. The reason for this decision was that, in the event of factual findings being made against the Registrant, she should know what they are when making representations on the issues of lack of competence and current impairment of fitness to practise.
9. The Panel handed down its decision on the facts during the afternoon of the penultimate day of the scheduled listing. It allowed the parties until the morning of the final day of the hearing to make their submissions on the issues of lack of competence and current impairment of fitness to practice, issues the Panel could consider during one retirement.

Background

10. The Registrant was employed as a Band 5 SLT by Oxleas NHS Foundation Trust (‘the Trust’) in March 2019. Very little information has been provided to the Panel about her previous employment as an SLT save that it was in a school and that her Royal College of Speech and Language Therapists (‘RCSLT’) competencies had been signed off while she was in that employment.
11. The Registrant’s work at the Trust was split between ‘Early Years’, being children aged between two and five years, and ‘School Years’, involving children between the ages of five and eleven.
12. She was supervised by Ms KR, a Band 7 Specialist SLT, and her line manager was KP, who from February 2020 was the Trust’s Principal SLT and Head of Greenwich Children’s Integrated Therapies, but before that, and at the time of the Registrant’s employment, she was the Services Lead for the School Years Services.
13. All new employees of the Trust initially worked under a probationary period framework for a period of three months, which could be extended for a further three months. An aspect of this framework was that more frequent supervision was provided. The supervision sessions between the Registrant and KR that were weekly (save when annual leave made that impossible) continued after the initial three months of the Registrant’s employment. KR and the Registrant also worked together clinically on a fortnightly basis.
14. As a result of concerns being expressed about the Registrant’s performance, a first capability meeting took place on 9 September 2019. Competency goals were set for the Registrant to meet. The goals were framed using the RCSLT Newly Qualified Practitioner Goals. At this meeting it was decided that the Registrant should no longer work autonomously in schools, and that in a school setting her work would either be shared with another SLT or that she would undertake very specific assessments that were discussed both before and after the visit to the school.
15. The capability process was monitored by recording feedback received from SLTs with whom the Registrant worked. In addition to the views of Ms KR and Ms KP, reports made by the three other witnesses called by the HCPC (Mr AA, Ms AW and Ms AJ) were included, as well as others who have not appeared as witnesses in this case. In view of the evidential significance of them for the present case, two documents produced in the course of that process should be specifically mentioned. They are:
• A document entitled “RCSLT Newly Qualified Practitioner Goals”, dated 10 September 2020. This document incorporated not only the assessment of whether the Registrant had met the identified competencies as of September 2020, but also incorporated the assessments that had been made in March 2020 and June 2020. This document was included at pages D19 to D26 of the hearing bundle.
• A document dated 17 October 2020 entitled, “Report into the Capability Performance of Sandra Marshall, Band 5 Speech and Language Therapist”. This report was prepared by the Registrant’s line manager, Ms KP, in accordance with the Trust’s Capability Policy and Procedure. This document was included in the hearing bundle between pages D2 and D12.

Particular 1(d) - Between 1 March 2019 and 31 March 2021 you did not maintain and develop your own knowledge and skills. In that:
d. You were unable to make appropriate decisions regarding ongoing care for service users.

45. On behalf of the HCPC, the Presenting Officer submitted:
• That the evidence of Ms AW to the effect that although the Registrant had worked with a child a week before, she was unable to choose the correct equipment for the targets she and Ms AW were working to achieve.
• The evidence of Ms AW that the Registrant was not able to generalise her knowledge and skills so as to be able to apply it as part of the therapy she offered.
• The evidence of Ms KP related to a child with selective mutism. The Registrant had been working with the child on three previous occasions and there were many recorded notes by previous therapists, yet the Registrant was unsure whether or not the child had receptive language difficulties. The Registrant was unable to name assessments that could have been used to determine whether the child had receptive language difficulties, having initially identified one that would not have been appropriate because it would have required the child to speak.
• The oral evidence of Mr AA was that the Registrant stated to him on more than one occasion that she did not know about speech, and that on another occasion, in the context of a discussion about a language disorder, that she did not know about language.
• It was also submitted that elements of the NQP Goals Competency Record demonstrated that this criticism was valid, in particular:
o P3: “Collaborates with relevant others and implements an appropriate therapy management plan based on functional outcomes and clearly defined goals including an understanding and use of preventative strategies.” This goal was not met in March 2020, June 2020 or September 2020.
o P5: “Identifies and collect relevant information through appropriate formal and informal assessment, including discussion with client/carer”. This goal was not met on any of the three reviews.
o PA2: “Provides safe care within the scope of practice, adhering to health and safety procedures and clinical guidance, and seeking support from supervisor where appropriate.” Again, this goal was not reached on any of the three reviews.
o PA10: “Makes a clinical judgement/diagnosis in relation to the nature and extent of less complex speech and language therapy difficulties”. This competency too, was not satisfied at any stage.

46. In the Registrant’s earlier submission she wrote:
“Evidence shows that in my RCSLT Practice Goals in September 2020 ‘Able to select appropriate next steps within EY for 6/6 children. following other clinical processes well.’”
The later statement responded as follows:
“Partially denied – This was not all service users and feel that the majority of the time with time I was able to do so sometimes with support. This statement does not reflect the times I made appropriate decisions so cannot be described in my view as a global statement in the area regarding my ability to do so.”
47. The Panel accepted the evidence of Mr AA that in the context of a discussion about language disorder, the Registrant said, “I don’t know about language” or words to that effect. Mr AA gave evidence about another occasion when, in conversation with a student SLT, the Registrant stated that a particular therapeutic tool would not be used for a child, the reasons she gave, that the tool under discussion would not have been appropriate, were incorrect. Furthermore, the Panel accepted the evidence of Ms AW that despite the Registrant having spoken to the parents of the children on week one in connection with their perceptions of their child’s level, it being intended to use the parents’ input to work with the children in week two. When Ms AW spoke to the Registrant to discuss which toys should be used to facilitate pretend play, the Registrant was not able to choose the correct equipment for the targets being envisaged.
48. The Panel noted the Registrant’s response that she had been able to make some care decisions with support. The Panel gave weight to the evidence of the witnesses that the Registrant demonstrated on a number of occasions a lack of knowledge to underpin care decisions, and that they could not be certain that the Registrant would be able to make care decisions without support.
49. The Panel found particular 1(d) proved.

Particular 2 - Between 1 March 2019 and 31 March 2021 you did not keep accurate and complete records, in that you produced inadequate SOAP notes, and/or care plans and/or discharge summaries.

50. The HCPC’s case in relation to this particular can be summarised as follows:
• There was evidence from a number of the HCPC’s witnesses that the Registrant cut and pasted notes either from the notes relating to the same child, but from an earlier interaction, or from the notes of another child. It was submitted that this practice was poor practice for a number of reasons, including the scope for error if names and other details were not corrected, but also because it would not be possible to measure whether the child was making progress, and if there was progress, in which areas that was occurring.
• Ms AJ explained that the Registrant’s notes were not accurate, and were incomplete. She explained that the Registrant would, for example, give her information orally about her observations that would not be included in the written notes. Furthermore, Ms AJ also stated that the Registrant was unable to link her observations to her clinical decisions.

51. In her earlier submission the Registrant wrote:
“Evidence shows within my RCSLT Practice Goals in March, June and September 2020 for Discharging clients were signed off ‘Has made discharges in School after a review. Discharged child in Early Years after the family moved away. RIO (SOAP) processes followed accurately. Discharge reports reviewed by a supervisor.’”
In the later statement, the Registrant wrote:
“Partially denied – For factual correctness I started with the Trust on 27th March 2019 – initially i required assistance in this area. From feedback I took note although my work was checked the majority of time no amendments from supervisors or colleagues were required on SOAP notes or care plans, over time such amendments were reducing or not present at all.”

52. The Panel noted that in relation to particular 2, three elements fell to be decided, namely, SOAP notes, care plans and discharge summaries.
53. In relation to SOAP notes, the Panel accepted the evidence it received that the Registrant cut and pasted elements of SOAP notes from notes made in relation to the same child, and also from the notes of one child to those of another. Furthermore, the Panel accepted the evidence of Mr AA that on 22 November 2019 he noticed that the O (objective) section of SOAP notes was missing. Mr AA spoke to the Registrant about this and provided written feedback, but when the Registrant sought to remedy the omission, she added one line of text, which was insufficient in his opinion and still did not provide a true reflection of the session. The Panel was satisfied that the HCPC’s case in relation to SOAP notes had been proven.
54. With regard to care plans, similarly, the Panel accepts the evidence placed before it that the Registrant was not adequately producing care plans independently. For example, Ms AJ stated that she would often complete care plans with the Registrant.
55. So far as discharge summaries are concerned, the Panel noted that in the document recording the Registrant’s capability as of March 2020, June 2020 and September 2020, requirement P4, “discharging clients appropriately” was signed off as met in March 2020 and was not thereafter said to be an on-going problem. The Panel has carefully scrutinised the HCPC’s evidence, and has noted, for example, that Ms AJ stated that she did not recall whether the Registrant did a discharge summary for a case they did together. The conclusion of the Panel was that the HCPC has not provided sufficient evidence to prove that the Registrant produced inadequate discharge summaries.
56. The consequence of these findings is that particular 2 is proven on the basis of inadequate SOAP notes and care plans, but not with respect to discharge summaries.
57. The Panel noted from the Registrant’s statement that,”… the majority of the time no amendments from supervisors or colleagues were required on SOAP notes or care plans, over time such amendments were reducing or not present at all.” However, the Panel gave weight to the evidence of the witnesses that the Registrant continued to produce inadequate SOAP notes and care plans.
58. The Panel found particular 2 proved.

Particular 3(a) - Between 1 March 2019 and 31 March 2021 you did not communicate professionally with service users and their parents. In that:
a. You did not adapt your communication style for service users and/or their parents.

59. In relation to this particular, the HCPC’s case was:
• That it was the evidence of Ms AJ that when speaking to a parent whose first language was not English, instead of simplifying the words she used when explaining something to the parent, the Registrant raised the volume of her voice.
• The evidence of Ms AW was that at a summer school in 2019, when a child was reluctant to leave the accompanying parent, the Registrant pulled the child by the arm rather than using toys or games to try to persuade the child to enter the room.
• The issue of the SENCo’s concerns mentioned in relation to particular 1(b) when the Registrant delivered a power point presentation was also submitted to be relevant to the particular under present consideration.

60. In her earlier submission, the Registrant wrote:
“There is evidence in my RCSLT Practice Goals that states that I appropriately communicated with young service users in March 2020 ‘Able to adapt her language within specific intervention sessions following discussions in supervision. In early years, interaction with children is more playful and appropriate, giving praise and encouragement to children.’”
In the Registrant’s statement dated 5 August 2022 she wrote:
“- this was highlighted but not always the case and was a struggle to begin with. To state that I did not adapt doesn’t represent fairly the improvements commented on or the times when my communication style was adapted. Also this did not result in complaints from the schools or parents to my knowledge and is a view of particular circumstances and not a general inability as stated.”

61. The Panel heard evidence that it accepted about both verbal and non-verbal communication that is relevant to this particular. So far as non-verbal communication is concerned, the Panel accepted the evidence about the inappropriate manner in which the Registrant interacted with the child who was reluctant to be parted from their mother. A further example of non-verbal communication was when the Registrant was using a finger puppet with a child who became frightened, and the Registrant did not change her approach based on the child’s reaction. With regard to spoken communications, the Panel accepted the evidence it received that the Registrant would not always include all of the information she should. Furthermore, she did not always speak to parents in a manner they could understand, particularly if the first language of that parent was not English. Ms AW provided an example of this when she said that she heard the Registrant speak to parents about “receptive” and “expressive” language instead of “understanding” and “talking”.
62. The Panel took note of the Registrant’s statement that this was not always the case, and that she was able to adapt her language following discussions. However, the Panel gave weight to the evidence of the witnesses that the Registrant was not consistently able to adapt her communication style for service users and their parents.
63. The Panel found particular 3(a) proved.

Particular 3(b) - Between 1 March 2019 and 31 March 2021 you did not communicate professionally with service users and their parents. In that:
b. You did not clearly explain appointment details in terms service users and/or their parents would understand.

64. The HCPC’s case was advanced on the basis that:
• It was Ms AJ’s evidence that the Registrant began her sessions without explaining the purpose or structure of the appointment. Ms AJ also stated that the Registrant was unable to simplify or adapt her language to enable families to understand. Ms AJ stated that because of this families were struggling to understand the information the Registrant was giving them as she often used technical, specialist vocabulary.

65. In her original submission, the Registrant wrote:
“Evidence in March 2020 demonstrates my capability in this areas For example, within my RCSLT Practice Goals, it clearly states ‘is able to manage her school caseloads through discussion with her supervisor. Able to plan activity for the term after discussion with the supervisor. however, has reduced caseload’”
In the later statement she wrote:
“Partially Denied – I felt that all times I kept service users up to date and explained all appointment details, who and when I was seeing the children and what I would be doing with them in sessions. On times when I utilised technical terms where lay terms should be considered for understanding this was not throughout and a point of learning I adjusted. I felt improvements were made which were reflected in feedback.”

66. The Panel accepted the evidence of Ms AJ that, in relation to an appointment that was currently being undertaken, the Registrant began her session without explaining the purpose or structure of the appointment. Furthermore, the Panel also accepted the evidence of Ms AW that the Registrant used language that would have been confusing for parents, such as internal Early Years Team terms such as “social group A” and “social group B”.
67. The Panel noted the Registrant’s statement that she was able to explain to service users and their parents the details and purpose of appointments. However, the Panel gave weight to witnesses AJ and AW with regards to their concerns in relation to the Registrant’s ability to consistently explain the purpose of appointments in language that service users and their parents would understand. Both these witnesses worked alongside the Registrant on a regular basis and had first-hand experience and observation of how the Registrant communicated with service users and their parents.
68. The Panel found particular 3(b) proved.
69. The Panel’s decision on lack of competence and impairment of fitness to practice could not be handed down on the final day of the hearing due to a lack of time, but was handed down on the first day of the resumed hearing.

Submissions

93. Ms Simpeh stated that the HCPC did not make any particular suggestion as to sanction save to say that the available options were: to give a Caution; make a Conditions of Practice Order; or make a Suspension Order.
94. Ms Simpeh suggested that the following were the Mitigating factors:
• All the HCPC’s witnesses had told the Panel that the Registrant was willing to learn and to take feedback; and
• The Registrant had received positive feedback (and a reference) from her employers with regard to her current Band 4 role.

95. Ms Simpeh also suggested that the following were aggravating factors:
• There had been a repetition of the competence concerns over a substantial period of some 18 months;
• There had been the potential of harm to particularly vulnerable service users, namely young children; and
• The Registrant had not taken any steps to remedy her failings even though they were remediable.

96. Mr Penny made various observations upon the Panel’s determination in relation to Grounds and Impairment. He once again argued that the Registrant’s failings were not due to her lack of capability but were because of her employer’s failure to make reasonable adjustments. He said that the Registrant’s reported success in her Band 4 role was because she now had the appropriate support.

97. Mr Penny also stated that the Registrant had not sought to remedy any of her failings before this stage as she considered that it was more appropriate to “step back” into a lesser role until such time as the Panel indicated what specific failings she had to address. She had been cautious and had “exercised due diligence” in removing herself into another role. This was not a failing on her part but a responsible approach.

98. Mr Penny went on to draw the Panel’s attention to paragraph 113 of the SP, which states:
“113. While conditions of practice may be imposed on a registrant who is currently not practising, before doing so, panels should consider whether there are equally effective conditions which could be imposed and which are not dependent on the registrant returning to practise. For example, not all training, reflection or development requires a registrant to be in practice or have a workplace-based mentor.”

99. Mr Penny suggested that the Registrant had now demonstrated, in her Band 4 role, that she could attain the standards expected and therefore could, in effect, remedy her practice without being made specifically subject to Conditions of Practice. Having said that, he went on to say that he “generally” agreed with Ms Simpeh’s submissions and indicated that, if the Panel did not accept his submissions, it could consider a Conditions of Practice Order.
100. In answer to a Panel question: “what has changed which might reassure the Panel that the Registrant can now demonstrate competence?” Mr Penny reiterated that the Registrant had not been able to improve her practice when she was a Band 5 because “reasonable adjustments” were not in place.
101. After Mr Penny had concluded his answer to this question, the Registrant volunteered that what had changed was, “my environment; the support now given to me; the additional internal training on SLT issues, and working with adults, which has made me more confident so that I know what to do and how to change”.

102. The Panel reminded itself that it was not bound to accept any suggestion or concession by either party as to the appropriate sanction; the question of sanction was a matter for its independent judgement. It also appreciated that the sanction of Striking Off was not currently available to it since this was a Competency matter and the Registrant had not been subject either to a Conditions of Practice Order, or a Suspension Order, for a period of two years.

Mitigating and Aggravating factors

103. The Panel took account of the various mitigating factors namely:

• The Registrant’s previous good character as an SLT;
• The fact that she has engaged with the HCPC and with these proceedings;
• She had received positive feedback (and a reference) from her employers with regard to her current Band 4 role;
• All the HCPC’s witnesses had told the Panel that the Registrant was willing to learn and to take feedback.

104. The Panel noted that despite witnesses stating that the Registrant was willing to learn and accept feedback, little or no progress had been made over a period of 18 months. Moreover, the Panel was concerned to learn that the Registrant had, according to Mr Penny, decided not to address her failings until such time as the Panel indicated what failings she ought to address. The Panel considered that this was not what an autonomous practitioner should be doing; instead, the Registrant should have been addressing her failings independently, particularly in the light of the Panel’s findings of facts. The Panel therefore concluded that her failure to do so reflected her lack of full insight into her ongoing duty as an SLT to continue to improve her practice so as to ensure that she practised safely.
105. Having said all that, however, the Panel noted, from what the Registrant volunteered to the Panel at the end of the submissions, that she had grown in confidence in her current role and now felt able to know what, and how, to change. The Panel therefore considered that the Registrant be given some credit for, currently, practising within her limits as a Band 4 Therapy Assistant Practitioner, in a multidisciplinary team working with adult clients in the community.
106. Further, the Panel was not persuaded by Mr Penny’s submission that the Registrant had been prevented from improving her practice because she had not been given sufficient reasonable adjustments on account of her dyslexia. The Panel reminded itself that it had already rejected this argument at the Impairment stage. Moreover, the Panel also notes that the case before it is a Competence case and is not a Health case. It has received no independent expert evidence about the Registrant’s dyslexia and the effect it has, or has had, upon her clinical practice, nor has it been asked to decide such a question.
107. Moreover, the Panel was concerned that the Registrant appeared to be giving the impression that she sought to deflect some criticism of her practice by claiming that the issues arose primarily because she had not been given reasonable adjustments. The Panel considers it important to reiterate what it said in its decision on Impairment, namely that in her employment with the Trust she was given very significant extra supervision, support and time to undertake tasks, and she was also assisted and encouraged to find ways of addressing the problems she experienced. Accordingly, the Panel considered that it was the obligation of all registrants to take steps to ensure that they are practising safely and effectively. Consequently, the Panel was led to the conclusion, that the Registrant’s apparent failure to accept that she had some responsibility also suggested a lack of insight into the effect upon her practice due to her health condition.
108. Moving on, the Panel also noted the following aggravating features (the first three as proposed by Ms Simpeh) namely:
• There had been a repetition of the competence concerns over a substantial period of some 18 months;
• There had been the potential of harm to particularly vulnerable service users, namely young children;
• The Registrant had not taken any steps to remedy her failings even though they were remediable;
• Taking account of the discussion above, the Registrant had limited insight into her duty to independently improve her practice.

Consideration of Sanction

109. The Panel first considered Taking No Action. However, given the nature and seriousness of the Registrant’s failings the Panel took the view that this was not a case that could be appropriately concluded without a sanction. The Panel therefore went on to consider the various sanctions, beginning with the least onerous.
110. The Panel first considered a Caution Order. It took account of paragraphs 101 and 102 of the SP, which state:
“101. 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.

102. A caution order should be considered in cases where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate. In these cases, panels should provide a clear explanation of why it has chosen a non-restrictive sanction, even though the panel may have found there to be a risk of repetition (albeit low).”
111. The Panel noted that the Registrant’s case did not fall into any of the criteria specified in paragraph 101 and, in any event, her failings were too serious to be dealt with in a manner which did not restrict the Registrant’s practice. Accordingly, the Panel considered that a Caution Order could not be an appropriate or proportionate sanction.
112. The Panel next considered whether it would be appropriate to impose the next most onerous sanction, that of a Conditions of Practice Order. It noted paragraphs 106 and 107 of the SP, which state:
“106. 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;
• appropriate, proportionate, realistic and verifiable conditions can be formulated;
• 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.
When might a conditions of practice order not be appropriate?
107. Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings.”

113. The Panel considered each of these factors. It noted that it could not be said that the Registrant “has insight”. At best, the Panel considered that she had insufficient insight, particularly in relation to those matters specified above in the discussion regarding mitigating and aggravating features. Further, it was arguable that there were no persistent or general failures which would prevent the Registrant from remediating her practice.
114. However, the Panel did consider that the failures or deficiencies are capable of being remedied. It considered that appropriate, proportionate, realistic and verifiable conditions could be formulated and it was confident that the Registrant would comply with such conditions. It also concluded that a reviewing panel would be able to determine whether or not those conditions have or are being met; and the Registrant would not pose a risk of harm by being in restricted practice. In addition, the Registrant had engaged with the HCPC and appeared to be keen to resolve the concerns raised. Accordingly, the Panel considered that a Conditions of Practice Order could be an appropriate and proportionate sanction in this case.
115. The Panel nonetheless went on to consider the next most restrictive sanction, namely a Suspension Order. However, it decided that such a sanction would give the Registrant little or no opportunity of addressing her failings whilst practising as an SLT and might adversely affect her current resolve to seek to improve her practice. Accordingly, the Panel concluded that the most appropriate and proportionate sanction would be to impose a Conditions of Practice Order upon the Registrant for a period of 18 months. This would, in the Panel’s estimation, give the Registrant sufficient time to address her failings and to develop further insight into, not only her duty to improve her practice in order to minimise the risk to service users, but also into how (if at all) her health condition affected her clinical practice and, if it did, how best she could manage it.
116. Accordingly, the Panel concluded that the proportionate response is to make a Conditions of Practice Order for a period of 18 months.

ORDER: The Registrar is directed to annotate the HCPC Register to show that, for a period of 18 months from the date that this Order takes effect (“the Operative Date”), you, Sandra Marshall, must comply with the following conditions of practice:
1) You must not work for an agency or as a locum speech and language therapist.
2) At any time you are employed as a speech and language therapist at Band 5 or above, you must place yourself and remain under the direct supervision of a Workplace Supervisor. The Workplace Supervisor must be on the HCPC’s Speech and Language Therapists Register. You must attend upon that supervisor as required and follow their advice and recommendations.
3) You must supply details of your Workplace Supervisor to the HCPC within two weeks of commencing employment as a speech and language therapist.
4) All aspects of your direct contact with service users or their families must be directly supervised at all times by a person who is a speech and language therapist registered with the HCPC. Such supervision is to consist of being directly observed by a registered speech and language therapist of at least one year’s experience.
5) You must meet with your Workplace Supervisor on a weekly basis to review your progress towards achieving the competencies identified in condition 7 below.
6) You must allow your Workplace Supervisor to provide information to the HCPC about your progress towards achieving the clinical competencies as out in condition 7 below.
7) Your Supervisor must agree to provide three-monthly feedback Reports to the HCPC. This feedback must include your progress towards achieving clinical competence at the level of a Band 5 speech and language therapist in relation to:
a) Demonstrating:
(i) knowledge;
(ii) clinical skills;
(iii) clinical understanding;
(iv) capability for clinical reasoning;
(v) capability for clinical decision making.
b) Case management in accordance with departmental protocols;
c) Making clinical decisions independently and consistently;
d) Professional and therapeutic communication;
e) Making appropriate referrals and ensuring on-going care;
f) Making appropriate discharges;
g) Record keeping including completing appropriate SOAP notes, summaries and any other records required for patient care.
8) Your Supervisor must include in the three-monthly feedback Reports any other relevant information, and confirmation that you are complying with these conditions.
9) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
10) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
11) You must inform the following parties that your registration is subject to these conditions:
a) any organisation or person employing or contracting with you to undertake professional work; and
b) any prospective employer (at the time of your application).

Interim Order
Application for Interim Order

1. Having determined to conclude this case by imposing a Conditions of Practise Order on the Registrant, the Panel heard an application by Ms Simpeh for an Interim Conditions of Practise Order for 18 months.
2. Ms Simpeh submitted that such an order was necessary on both public protection and public interest grounds on the basis that the Panel had found that the Registrant was currently impaired due to her lack of competence and had considered that she should be made subject to a Conditions of Practise Order. Ms Simpeh referred the Panel to the SP and in particular to the criteria for such an order as set out in paragraph 135 (see below). Ms Simpeh stated that both of these criteria applied to the Registrant’s case. Further, she submitted that the Interim Order should be one of Conditions of Practice on the same terms as the substantive order already made by the Panel. She also asked the Panel to make an order for 18 months to cover any appeal period.
3. Mr Penny submitted that the Registrant did not oppose the application as she accepted the conditions already made by the Panel.
4. The Panel accepted the advice of the Legal Assessor, who referred it to paragraphs 133 to 135 of the SP, which state:

“What is an interim order?

133. If a panel imposes a conditions of practice order, suspension order, or striking off order, Article 31 of the Order provides the panel with the discretionary power to also impose an interim conditions of practice order or an interim suspension order. This will apply from the imposition of the substantive order, until the end of the appeal period, or where an appeal is made, the end of the appeal process.

When is an interim order appropriate?

134. The power to impose an interim order is discretionary, and so panels should not consider it to be an automatic outcome. The panel should carefully consider whether or not an interim order is necessary and should provide the parties with an opportunity to address the panel on whether an interim order is required.

135. An interim order is likely to be required in cases where:

• there is a serious and ongoing risk to service users or the public from the registrant’s lack of professional knowledge or skills, conduct, or unmanaged health problems; or

• the allegation is so serious that public confidence in the profession would be seriously harmed if the registrant was allowed to remain in unrestricted practice.”

5. The Panel also took account of the Practice Note on Interim Orders and first considered whether an interim order was necessary. It noted that the information before it indicated that the Registrant had not practised as a Speech and Language Therapist for around two years. It reminded itself that it had found that the Registrant was currently impaired due to her lack of competence and that there was a real risk of repetition of the Registrant’s failings due to her limited insight and lack of remediation. The Panel was therefore satisfied that there was a serious and on-going risk to service users and that, for the same reasons, public confidence in the profession or the regulatory process would be seriously harmed if the Registrant was allowed to practise unrestricted.
6. Having determined that an interim order was necessary, the Panel then considered the appropriate form of that order, beginning with the least restrictive. It first considered whether an Interim Conditions of Practice Order would be sufficient to protect the public, or meet the wider public interest. For the same reasons as given when deciding to impose a substantive Conditions of Practice Order on the Registrant, the Panel decided that such an Interim Order on the same terms would be appropriate to manage the risks identified and that it would be perverse to impose an order inconsistent with the substantive order.
7. The Panel therefore concluded that an Interim Conditions of Practice Order on the same terms as the substantive Conditions of Practice Order was the appropriate and proportionate order. It also determined that it should be for a period of 18 months since, if there was an appeal, the substantive order would not come into effect and the Registrant would be able to practise unrestricted until the outcome of the appeal.

History of Hearings for Sandra Marshall