Miss Deborah J Watson

Preliminary Matters

Application to proceed in private

1. Mr D’Alton, on behalf of the HCPC, and Mr Oestreicher, on the Registrant’s behalf, made a joint application for parts of the hearing to be heard in private due to the potential inclusion of matters related to the Registrant’s health. Having accepted the advice of the Legal Assessor and considered the HCPTS Practice Note “Proceeding in Private”, the Panel determined that parts of the hearing would be held in private session where matters relating to the health or private life of the Registrant were raised.

Background

2. The Registrant is an Occupational Therapist registered with the HCPC. During the period referred to in the Allegation, she was employed as a Band 6 Care Co-Ordinator Occupational Therapist by Leeds and York Partnership NHS Foundation Trust. From 1 October 2016, the Registrant was employed by Tees, Esk and Wear Valleys NHS Trust (“the Trust”) in a community setting.

3. Concerns arose in respect of the Registrant’s practice and a Performance Improvement Plan (“PIP”) was implemented. The Registrant was moved to a role in a mental health ward, where she was subject to supervision. A further concern arose when the Registrant left a service user unaccompanied in a therapy suite. An investigation was undertaken, as a result of which further concerns about the Registrant’s practice were identified.

4. The Registrant referred herself to the HCPC on 20 October 2015. The Trust conducted a disciplinary hearing in March 2016 which resulted in the Registrant’s dismissal for gross misconduct.

5. The substantive HCPC Conduct and Competence Committee hearing took place on 11-13 December 2017. The substantive hearing panel found all the factual particulars of the Allegation proved and that the facts amounted to misconduct. The substantive hearing panel found the Registrant’s fitness to practise impaired in relation to both the personal and public components of current impairment. The substantive hearing panel determined to impose a Suspension Order for a period of 12 months.

1st Review: 7 December 2018

6. The Suspension Order was first reviewed by a panel of the Conduct and Competence Committee at a hearing on 7 December 2018, which the Registrant attended and at which she was represented. The first review panel considered the guidance given by the substantive hearing panel as to information which a future panel was likely to find helpful.

7. The Registrant presented information about actions she had taken since the Suspension Order was imposed. The first review panel considered information presented by the Registrant and heard oral evidence from her. She said she did not feel confident to return to her role and considered herself that her fitness to practise remained impaired.

8. The first review panel stated that it was impressed by the Registrant’s reflective statements and the development of her insight into the effect and consequences of her past failures. However, the review panel stated that it was not satisfied that the Registrant had demonstrated that she had applied her knowledge of theory to the specific failings identified at the substantive hearing. She admitted that there remained gaps in her knowledge and skills. In the view of the review panel, these gave rise to a risk of repetition which could potentially pose a risk to service users and undermine public confidence in the profession.

9. The Panel found that the Registrant’s fitness to practise remained impaired and determined to extend the Suspension Order for a further 12 months, as this would allow the Registrant to demonstrate at the next review hearing that she had made sufficient progress in her professional development to return to practice as an Occupational Therapist.

2nd Review: 12 December 2019

10. The Suspension Order was next reviewed by a panel of the Conduct and Competence Committee at a hearing which the Registrant attended and at which she was represented by Mr Oestreicher. The second review panel heard from the Registrant. In closing submissions, Mr Oestreicher said that whilst the Registrant accepted that her fitness to practise remained impaired and he acknowledged that the second review panel may decide that suspension continued to be necessary, he asked the second review panel to consider whether conditions of practice could be formulated which would allow the Registrant to work as an Occupational Therapist.

11. The second review panel did find that the Registrant’s fitness to practise remained impaired. It indicated that it hoped to hear how the Registrant coped with making progress going forward by the time of the next review of the Order. However, it determined to extend the Suspension Order for a further 12 months.

3rd review: 10 December 2020

12. At the third review, the Registrant admitted that she was still impaired as although she had made some progress, she was not confident to take on her previous role. She needed more time to complete the activities that she had outlined in her plan for remediation.

13. The third review panel was impressed by the reflection of the Registrant. She said that she did have an issue with confidence because she needed to undertake further study and thereafter consolidate her learning through practically applying it. The third review panel concluded that members of the public would be concerned if the Registrant, who admitted gaps in her skills and knowledge which posed a potential risk to the public and who accepted that she remained impaired, was found not to be so. Public confidence in the profession and the regulatory process would be undermined. The third review panel found that the Registrant’s fitness to practise was impaired on the grounds of public protection and the wider public interest.

4th review: 16 December 2021

14. At the fourth review, the Registrant told the fourth review panel that she had undertaken a placement with the Leeds and York Partnership NHS Trust and a fulsome reference had been provided. She spoke about her attempts to undertake further education in continuing her professional development. She explained that she had both read texts and accessed formal learning, while consolidating this learning through undertaking work in a voluntary capacity where she worked with a service user with vulnerabilities. She was able to put her learning into practice in this way.

17. She said that she planned to look for further placements that she could
undertake on a voluntary basis. She said that she would expand her search to different environments in non-clinical posts. She would also look at paid employment via NHS websites if she were able to practise. She said that she felt ready to undertake paid work at this stage and that this would evidence her progress.

18. The Registrant said that she was better able to manage her health through lifestyle changes.

19. She said that her future Continuing Professional Development (“CPD”) plans were two-pronged and would take into account both study and practice. She said that health concerns meant she had not had enough time to reflect on specifics, but she planned to do so. She planned to access more formal learning and undertake more volunteering work and pursue both clinical and non-clinical placements to put additional learning into practice.

Today’s review: 8 June 2022

20. The Registrant gave evidence under Oath. The Panel found that the Registrant was open and honest and she sought to assist the Panel. She told the Panel that, notwithstanding repeated efforts by her, she had been unable to secure any placements or other voluntary work since her placement with the Leeds and York Partnership NHS Trust. The Panel also heard in private evidence about the difficulties faced by the Registrant due to various health matters. The Registrant told the Panel that she was managing her health.

21. The Registrant accepted in her evidence that she remained currently impaired due to a continued lack of knowledge, which she had been unable to acquire due to her circumstances. The Registrant also acknowledged that she had been unable to demonstrate full remediation because of her inability to find any placements/work. She was, however, still being assisted by a mentor from the Royal College of Occupational Therapists. The Registrant told the Panel that she may not be able to return to unrestricted practice for another 18 months, as she planned to take six months to improve her health and then 12 months to work in a placement before returning to practice as an Occupational Therapist.

22. Mr D’Alton submitted that the Registrant had dealt with previous concerns regarding her lack of insight. He acknowledged that some personal circumstances and the Covid-19 pandemic had impacted her efforts. Nonetheless, he submitted that the Registrant’s fitness to practice remained impaired, both on the personal and public components of impairment.

23. Mr D’Alton invited the Panel to consider the history of the case and pointed out that there had been a suspension in place since the end of 2017. He commended to the Panel the HCPC Sanctions Policy (“SP”) and reminded it that the option of Strike Off was open to it given the length of time that the Registrant had been continually suspended, although he indicated that the HCPC remained neutral as to sanction and was not advocating a Strike Off at this stage, although it was likely to do so at any future review if no progress had been made by the Registrant.

24. Mr Oestricher submitted that whilst he had previously acknowledged that the Registrant was “in a last-chance saloon”, the Registrant deserved recognition for the efforts which she had made to find another placement. He submitted that her efforts were commendable and that were it not for her health over the last six months, there would have been evidence of even further progress. He asked the Panel to impose a further period of suspension for 12 months with a review.

Decision

25. The Panel accepted the advice of the Legal Assessor. The Panel was referred to the HCPTS Practice Notes “Finding Impairment” and “Review of Article 30 Sanction Orders”, and to the SP. It was aware that it should consider whether the Registrant’s fitness to practise remains currently impaired and only thereafter consider sanction. Further, it was cognisant of its powers at a mandatory review under Article 30(1) of the Health Professions Order if current impairment is found, and that it should impose the least restrictive order which appropriately protects the public and the public interest.

26. The Panel carefully considered the evidence and information presented by the Registrant. The Panel acknowledged the efforts which the Registrant had made to demonstrate remediation and the difficulties which she faced in doing so. The Panel agreed with previous review panels that the Registrant’s misconduct, although not persistent, was serious given that she was working in a high-risk environment. The Panel also considered that this misconduct was capable of remediation, albeit this remediation has not been completed.

27. The Panel took into account that the Registrant acknowledges that her fitness to practise remains impaired. Given her incomplete study and remediation, along with the risk this would mean for the public and the impact this could have, the Panel found the Registrant to be impaired on both personal and public components.

28. The Panel regarded the aggravating features to be that the risk service users were placed in could have had disastrous consequences and it was by chance rather than design that this did not occur. In mitigation, the Panel took into account the Registrant’s previous unblemished career as an Occupational Therapist for over 25 years.

29. The Panel considered the SP in terms of assessing what sanction was appropriate. The Panel adopted the reasoning of previous panels in determining that this was not a case where it would be safe to allow the Registrant to practise without restriction and discounted taking no action or imposing a Caution Order. It next considered conditions of practice, but was of the view that any conditions imposed would have to be so extensive that they would be tantamount to suspension and be unworkable.

30. The Panel carefully considered whether a further period of suspension would serve any useful purpose or whether this was the time to move to a Strike Off Order. This was because the efforts made on a previous occasion did not appear to have been built upon in the manner expected. The Panel had regard to the SP, which describes a Strike Off as being a sanction of “last resort” which is reserved for the most serious cases.

31. The Panel concluded that, at this time, a further period of suspension of 12 months would be appropriate and proportionate to address public protection and the wider public interest issues. The Panel considered that the maximum period of suspension was required in order to provide the Registrant with sufficient time to gather the required evidence of remediation, practical experience, and sufficient knowledge.

32. The Panel was heavily influenced by the Registrant’s continued full engagement with the HCPC and her further efforts to obtain work/placements. The Panel also acknowledged, as the previous panels did, the difficulties which the Registrant has faced due to personal and external factors.

33. Whilst this Panel cannot bind any future reviewing panel, such a panel is likely to be assisted by:

• The Registrant’s attendance at the review hearing;

• Documents supplied in advance of the hearing which comprise:

• Evidence of completed Occupational Therapy-related courses undertaken between July 2022 and July 2023;

• Evidence of any attempts the Registrant has made to obtain support work (paid or unpaid) in a role related to that in which her knowledge and skills as an Occupational Therapist can be deployed between July 2022 and July 2023;

• The completion of a development plan, including how it will be actioned;

• A log detailing the work that is done on a monthly basis, how this meets the development plan she has, and the progress that she is considered to have made by her line manager;

• References from any manager or supervisor under whom she works during this period.

The Registrar is directed to suspend the registration of Miss Deborah J Watson for a further period of 12 months on the expiry of the existing order.

This Order will be reviewed by 10 July 2023.

History of Hearings for Miss Deborah J Watson