Miss Anne G Shawyer
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While registered with the HCPC and employed by Somerset NHS Trust as an Occupational Therapist:
1) In relation to your assessment of Service User 1 on or around 20 January 2017, you:
a) Did not complete an adequate and/or comprehensive assessment.
b) Did not carry out an adequate assessment of risk.
c) Did not record a treatment plan following your assessment of Service User 1.
d) Did not record the assessment within the required timescale.
2) In relation to your assessment of Service User 2 on or around 12 January 2017 and/or the follow up visit that you made to Service User 2 on 19 January 2017, you:
a) Did not identify that Service User 2 presented with a shuffling gait and/or record a plan to address this issue.
b) Did not adequately identify and/or record all relevant problems.
c) Did not document an appropriate treatment plan.
d) Did not complete progress notes within the required timescale.
3) In relation to Service User 3, you:
a) Did not arrange a follow-up visit following Service User 3’s discharge from hospital on or around 3 January 2017.
b) Did not liaise with the Multi-Disciplinary Team prior to discharging Service User 3 from the Integrated Rehabilitation Service.
4) In relation to Service User 4, in or around November 2016 – January 2017, you:
a) Did not complete and/or record an adequate assessment;
b) Did not ensure that follow up actions were completed following a home visit on or around 09 December 2016.
c) Did not discuss and/or record discussing with Service User 4 his wish to self-discharge from hospital between 23 and 29 December 2016;
d) Did not carry out an assessment and/or record an assessment of Service User 4’s mental capacity and cognition.
5) In relation to your assessment of Service User 5 on or around 16 December 2016, you:
a) Did not complete and/or record the assessment to an acceptable standard.
b) Did not carry out and/or record an adequate assessment of risk.
c) Did not formulate an appropriate treatment plan and/or appropriate goals.
6) In relation to your assessment of Service User 6 on or around 13 May 2016 you:
a) Did not adequately complete and/or record an adequate assessment.
b) Did not adequately identify the risks to Service User 6 of sleeping in a chair.
c) Did not record a formal capacity assessment.
d) Provided equipment which was not suitable for and/or did not meet the needs of Service User 6.
7) In relation to your assessment of Service User 7 on or around 21 November 2016 you:
a) Did not complete an adequate assessment of needs.
b) [NOT PROVED]
8) In relation to Service User 8, in or around September – October 2016, you:
a) Ordered equipment without visiting Service User 8.
b) Ordered equipment without conducting an appropriate risk assessment;
c) Did not maintain adequate records;
d) Visited Service User 8’s home to assess his home environment, without carrying out and/or recording an assessment of Service User 8.
9) In relation to Service User 9, in or around December 2016 – January 2017, you:
a) Did not review Service User 9’s records before visiting on or around 22 December 2016.
b) Did not maintain accurate records.
c) Did not arrange a home visit after 29 December 2016 and/or did not record the clinical reasoning for this.
10) In relation to Service User 10, in or around December 2016 – January 2017, you:
a) Ordered equipment without assessing Service User 10.
b) Ordered incorrect and/or inappropriate equipment.
c) Did not record adequate clinical reasoning in respect of the equipment ordered for Service User.
d) Did not maintain adequate records.
e) Did not discuss and/or record discussing with a physiotherapist the concern about Service User 10’s left ankle.
11) The matters at paragraphs 1-10 above amount to a lack of competence.
12) By reason of your lack of competence your fitness to practise is impaired.
The panel at the substantive hearing found the following:
Facts proved: 1a) -1d), 2a) -2d), 3a - 3b), 4a) - 4d), 5a) - 5c), 6a) - 6d), 7a), 8a) - 8d), 9a) - 9c) and 10a) - 10e)
Facts not proved: 7b)
Grounds: Lack of Competence
The panel at the substantive hearing found the Registrant’s fitness to practise to be impaired and a Suspension Order for a period of 12 months was imposed as a sanction.
This decision was first reviewed on 01 February 2021 and the reviewing panel imposed a Suspension Order for a further period of 12 months.
Service and Proceeding in Absence
1. The Panel has seen the Notice of today’s hearing dated 7 January 2022, which the HCPC sent by email to the Registrant at her registered email address. The Notice of Hearing made clear that this hearing would take place today as a virtual hearing. The Notice informed the Registrant of the time and date of this hearing. The Notice also invited the Registrant to make submissions and to provide any new information as to what may have happened since the last hearing.
2. Having seen the relevant documents and having heard and accepted the advice of the Legal Assessor, the Panel is satisfied that good service of the Notice of Hearing has taken place.
3. The Panel considered whether to proceed in the Registrant’s virtual absence and in the absence of any representation from her. It is aware that the discretion to proceed in absence is one which should be exercised with the utmost care and caution. The Panel took account of the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant”. It heard the submissions by Ms Khorassani on behalf of the HCPC. It heard and accepted the advice of the Legal Assessor.
4. The Panel determined to proceed in the absence of the Registrant. Its reasons are as follows;
• It is satisfied that there has been good service of the Notice of this Hearing.
• The Panel noted that the Registrant has not responded to an email to her dated 24 January 2022 from Ms Khorassani regarding this hearing. That email provided the Registrant with the details of this hearing and made suggestions as to the material which might assist the Panel when considering this matter.
• The Registrant has not applied for an adjournment.
• The Registrant did not attend and was not represented at the substantive hearing in February 2020 or at the first review hearing on 1 February 2021.
• The Registrant has not engaged with the HCPC as regards this hearing or at any previous time.
• This is a mandatory review and it is in the interests of the Registrant and in the public interest that it should proceed.
• In all the circumstances, it is proper to conclude that the Registrant has voluntarily decided not to engage with these proceedings.
5. The Registrant was employed as a Band 5 Rehabilitation Occupational Therapist by Somerset Partnership NHS Foundation Trust (the Trust) from May 2015 to February 2017. She was initially based in the Bridgewater Community Hospital and in January 2017 was relocated to the Community Rehabilitation Team. The Registrant’s Line Manager, BL identified concerns relating to the Registrant’s practice from approximately 2015. The concerns related to the Registrant giving her colleagues incorrect information about patients, her clinical reasoning and record-keeping. These concerns were managed informally until a formal action plan was implemented in June 2016. The Registrant resigned from the Trust in April 2017, having completed only one of the seven elements of her formal action plan.
The substantive hearing from 3 to 6 February 2020
6. The Registrant did not attend the substantive hearing from 03 to 06 February 2020. In an email dated 13 August 2017 she confirmed that she disagreed with the concerns raised. She felt that some issues stemmed from limited supervision or observation of her and inappropriately managed meetings early in her career. The panel heard evidence from three HCPC witnesses: HW (Team Manager in the Integrated Rehabilitation Team), BL (Band 6 Occupational Therapist) and HN (Band 6 Occupational Therapist); who were employed by the Trust at the relevant time. The panel found them to be credible and reliable witnesses. BL was a very supportive line manager who provided both formal and informal supervision and support over an extended time period, both in meetings and in clinical settings, a level of support which he described as “abnormal” and which did not lead to a sustained improvement in the Registrant’s practice. HN gave detailed evidence of her direct observations of the Registrant’s practice in relation Service Users 1 and 2.
7. As stated above, the panel found that the Registrant’s actions in relation to the proved factual particulars: 1a)-1d), 2a)-2d), 3a-3b), 4a)-4d), 5a)-5c), 6a)-6d), 7a), 8a)-8d), 9a)-9c), 10a)-10e) amounted to a lack of competence.
8. The panel heard consistent evidence from the HCPC witnesses that the Registrant’s practise was well below the standard of a Band 5 Occupational Therapist. Despite significant support and supervision the Registrant consistently failed to meet the required standards. Her actions potentially put vulnerable service users at risk of harm. The panel was satisfied that the particulars found proved demonstrated a fair sample of the Registrant’s work over an extended period of time and they demonstrated repeated failings, despite close supervision and support. The panel also concluded that the Registrant had breached the following HCPC Standards of Proficiency for Occupational Therapists: 1, 2, 4, 8, 9, 10, 12, 13, 14 and 15.
9. The panel found the Registrant’s current fitness to practise was impaired by lack of competence. The Panel heard evidence from BL that the Registrant was open and honest in the course of supervision sessions and when issues were highlighted, she was receptive to his input; but she lacked insight into the cause of these issues. The panel had also heard from BL that the Registrant’s actions had the potential to cause a risk of harm to patients; particularly by discharging patients home when they were not able to support themselves. In addition, given her lack of engagement, there was no evidence of remediation and insight and a high risk of repetition.
10. The HCPC witnesses gave evidence that the level and period of support and supervision provided to the Registrant was unprecedented. Despite this, the Registrant failed to meet the required competencies, made repeated errors and was not able to practice safely as a Band 5 Occupational Therapist. The Registrant’s lack of competence was repeated over an extended period of time, despite support and supervision and would have impacted on public confidence in the profession; due to the potential to place vulnerable service users at significant risk of harm. The panel determined that there would be a serious risk of an adverse impact on public confidence in the profession and in the regulatory process, if a finding of impairment were not made.
11. The following mitigating factors were identified by the panel: the Registrant has had no previous findings made against her; the Registrant was recently qualified and appeared to have health issues which may have impacted on her practice. The panel also had regard to the following aggravating factors: the Registrant’s failings were in core occupational therapy skills, were repeated and involved multiple service users. Her failings continued despite an unprecedented level of support and supervision over an extended time period; there was potential for harm to vulnerable service users; there is no evidence of remediation or insight and a risk of repetition.
12. The panel considered that to take no action or to impose a Caution Order would not be appropriate, given that the lapse was not isolated or minor in nature, the panel had identified wide-ranging failings over an extended period and a risk of repetition. In addition, neither of these options would be sufficient to address the wider public interest considerations.
13. The panel next considered a Conditions of Practice Order and found that, in principle, the matters proved are capable of remediation. However, in the absence of the Registrant and of any information on her current circumstances, the panel was not aware if the Registrant is committed to resolving the issues raised. The panel also identified a pattern of repeated failings in core skills, no evidence of insight and no sustained improvement in the Registrant’s practice; despite one-to-one supervision over an extended period. The panel could not formulate conditions which would be realistic, workable and verifiable. Therefore, a Conditions of Practice Order would not be an appropriate or proportionate sanction; as it would not address the public interest considerations nor would it protect the public.
14. Accordingly, the panel concluded that a Suspension Order was the appropriate and proportionate sanction, to provide the necessary degree of public protection and address the wider public interest considerations. A 12-month period of suspension was imposed due to the seriousness of the matters found proved.
The first review hearing conducted on 1 February 2021.
15. At the first review hearing which was conducted on 1 February 2021, the panel concluded that the Registrant’s fitness to practise remained impaired under both the personal and the public interest components. It imposed a suspension order for a further period of 12 months. Its reasons for these decisions were as follows;
The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Notes on Article 30 reviews and Finding that Fitness to Practice is Impaired and the Sanctions Policy. The Panel finds the Registrant’s fitness to practise is currently impaired under the personal and public policy components. There has been no change of circumstances and no engagement with the HCPC for the last 12 months nor has the Registrant submitted any evidence or material for this reviewing Panel to consider. Therefore, there has been no remediation or insight demonstrated and a risk of harm to the public remains. The substantive hearing panel found that the Registrant’s failings continued despite an unprecedented level of support and supervision over an extended time period.
The Panel went on to consider what the appropriate and proportionate sanction should be, if any, starting with the least restrictive.
In the light of the lack of engagement the Panel determined that taking no further action, mediation or imposing a Caution would not be sufficient to protect the public or be in the public interest. The Panel considered whether to impose Conditions of Practice but this would be inappropriate because the circumstances are unchanged in that there is no likelihood of the Registrant meaningfully engaging with any conditions imposed. The Panel then went on to consider imposing a further period of suspension.
The Registrant has not yet demonstrated insight into the matters giving rise to her suspension and there is a risk of repetition. Her fitness to practice is still impaired on personal and public policy grounds. There has been no engagement with the HCPC since the final hearing. The proved facts and consequent finding of impairment are sufficiently serious to justify a further suspension, to both protect the public from the risks identified and their possible repetition and to provide the Registrant with an opportunity to demonstrate meaningful insight and remediation of the failings identified a period of 12 months suspension from the HCPC register is necessary.
The review hearing conducted on 9 February 2022
Submissions made to the Panel on behalf of the HCPC:
16. Ms Khorassani on behalf of the HCPC submitted;
• that the Registrant’s fitness to practise remains impaired on both the personal and the public component. She submitted that there had been no change in the essential facts since the review hearing in February 2021. The Registrant had not engaged with the HCPC or produced any evidence of insight or remediation.
• As to sanction; Ms Khorassani reminded the Panel that all the sanctions are now available to it. She submitted that in this case, the appropriate order would be a Suspension Order for a further period of 6 months. This would enable the Registrant to reflect on whether she wishes to engage with the HCPC and whether she wishes to continue her career as an Occupational Therapist. She reminded the Panel that a Striking Off Order was available to it.
17. No submissions have been provided either by, or on behalf of the Registrant.
18. The Legal Assessor reminded the Panel that its function was to conduct a comprehensive review in order to determine whether the Registrant is fit to return to unrestricted practice. He advised that in carrying out this assessment, and if relevant in determining the appropriate sanction to impose, the Panel must apply the principle of proportionality. He reminded the Panel that in this case all the sanctions were available to it and should be considered in ascending order of restriction. He advised that the Panel should consider the document entitled “Sanctions Policy” [SP] published by the HCPC in March 2019. He suggested that the essential choice lay between a further Suspension Order or a Striking Off Order.
19. The Panel accepted the advice of the Legal Assessor. The Panel has had regard to the HCPTS’s Practice Note on Fitness to Practise Impairment and to the SP. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the documentation before it and the submissions of Ms Khorassani. The Panel has concluded that the Registrant’s fitness to practise remains impaired, on both the personal and the public component. Its reasons are essentially the same as those identified by the panel that reviewed the order in February 2021. These reasons include the following; there has been no material change in the underlying facts since either of the previous hearings. The Registrant has not engaged with the HCPC in any way. She has not participated in this Hearing. She has provided no references or testimonials. She has not informed the HCPC as to what she is now doing. There is no evidence of remediation or insight. The risk of repetition remains. Moreover, a well-informed member of the public would not understand, if given all the matters set out above, the Panel was to conclude that the Registrant’s fitness to practise is no longer impaired. The Panel has concluded that the only tenable view is that the Registrant’s fitness to practise remains impaired on both the personal and the public components.
20. Having concluded that the Registrant’s fitness to practise remains impaired the Panel considered what sanction would be appropriate and proportionate in order to address the risks that it has identified. In doing so it considered the guidance given in the SP. It has concluded that the necessary and proportionate order is a Striking Off Order. Its reasons are as follows;
• To take no action or to impose a Caution Order would not impose a restriction on the Registrant’s ability to practise. Such an outcome would not protect the public or address the public interest and would be wholly inappropriate.
• A Conditions of Practice Order would not be appropriate. Because the Registrant has not engaged with the HCPC with regard to this or previous hearings, the Panel cannot be confident that the Registrant would comply with conditions. Further, the Registrant has not provided the HCPC with any information as regards her present employment. Having regard to these considerations the Panel has concluded that appropriate conditions cannot be formulated.
• The Panel has concluded that a Suspension Order is no longer appropriate. The Registrant has not at any time engaged with the HCPC. She has not sought to demonstrate remediation or insight. She did not respond to the email dated 24 January 2022 from Ms Khorassani, which set out the material that the Panel would have found helpful. In the opinion of the Panel a further Suspension Order would serve no purpose. The Panel had in mind that there has been a period of two years since a committee made a Suspension Order. The Panel determined, that in all the circumstances only a Striking Off Order would address the public interest and protect the public.
That the Registrar is directed to strike the name of Ms Anne G Shawyer from the Register on the date this order comes into effect, namely the expiry of the current order.
The Order imposed today will apply from the expiry of the current Suspension Order on 05 March 2022.
Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.