Mrs Ebele Nze
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Allegation
As a registered Dietitian (DT24917) your fitness to practise is impaired by reason of misconduct and/or lack of competence. In that:
1. Between 04 September 2017 and 31 December 2019, whilst employed at Bromley Healthcare, you did not record patient consultations on EMIS in a timely manner for the Service Users set out in Schedule A.
2. Between 04 September 2017 and 31 December 2019, whilst employed at Bromley Healthcare, you did not use the dietetics EMIS template to assess and conduct treatment plans for Service Users.
3. Between 03 October 2018 and 15 April 2019, whilst employed at Bromley Healthcare, you did not schedule appointments on the EMIS appointment diary for the Service Users set out in schedule B.
4. Between 11 October 2018 and 24 April 2019, whilst employed at Bromley Healthcare, you did not use the EMIS diary to indicate follow up requirements for the Service Users set out in Schedule C.
5. Between 21 February 2019 and 01 March 2019, whilst employed at Bromley Healthcare, you did not record the patient consultations on EMIS for Service User 71.
6. Between 26 September 2018 and 15 November 2019, whilst employed at Bromley Healthcare, you did not adhere to policies and procedures regarding record keeping, in that;
a. You completed handwritten records in a notebook
b. You stored handwritten records at your home
7. You did not inform the HCPC that you had been suspended from your duties on 09 January 2020.
8. You did not inform the HCPC that you had been dismissed from your role on 19 May 2020.
9. Between 15 October 2020 and 19 November 2020, whilst employed at CSH Surrey, you did not complete patient consultations notes in a timely manner for the Service Users set out in Schedule D.
10. Between 08 October 2020 and 19 November 2020, whilst employed at CSH Surrey, you did not process discharge letters to the patient and/or GP in timely manner for the Service Users set out in Schedule E.
11. Between 06 October 2020 and 12 November 2020, whilst employed at CSH Surrey, you did not process assessment letters to the patient and/or GP in a timely manner for the Service Users set out in Schedule F.
12. The matters set out in particulars 1, 2, 3, 4, 9, 10 and 11 constitute lack of competence.
13. The matters set out in particulars 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 constitutes misconduct.
14. Your fitness to practise is impaired by reason of your misconduct and/or lack of competence.
Schedule A
Service User 1
Service User 2
Service User 3
Service User 4
Service User 6
Service User 7
Service User 8
Service User 9
Service User 10
Service User 11
Service User 12
Service User 13
Service User 14
Service User 15
Service User 18
Service User 19
Service User 20
Service User 21
Service User 22
Service User 23
Service User 24
Service User 25
Service User 26
Service User 27
Service User 28
Service User 29
Service User 30
Service User 31
Service User 32
Service User 33
Service User 34
Service User 35
Service User 36
Service User 37
Service User 38
Service User 39
Service User 40
Service User 41
Service User 42
Service User 43
Service User 44
Service User 45
Service User 46
Service User 47
Service User 48
Service User 49
Service User 50
Service User 51
Service User 52
Service User 53
Service User 54
Service User 55
Service User 56
Service User 57
Service User 58
Service User 59
Service User 60
Service User 61
Service User 62
Service User 63
Service User 66
Service User 67
Service User 68
Service User 69
Service User 70
Service User 72
Service User 73
Service User 74
Service User 75
Service User 76
Service User 77
Service User 78
Schedule B
Service User 1
Service User 9
Service User 25
Service User 35
Service User 61
Service User 69
Service User 71
Schedule C
Service User 1
Service User 9
Service User 25
Service User 27
Service User 35
Service User 48
Service User 57
Service User 61
Service User 69
Service User 71
Schedule D
Service User B
Service User I
Service User J
Service User K
Service User L
Service User M
Service User N
Service User O
Service User P
Service User Q
Service User R
Service User S
Service User T
Service User U
Service User V
Service User W
Service User X
Service User Y
Schedule E
Service User A
Service User C
Service User D
Service User E
Service User J
Service User K
Service User L
Service User M
Service User S
Service User T
Service User AA
Service User BB
Schedule F
Service User F
Service User G
Service User H
Service User Z
Service User CC
Service User DD
Finding
Preliminary Matters
Service
1. The Notice of Hearing was sent to the Registrant to her registered email address on 20 October 2022.
2. The Registrant attended the hearing and was represented by Mr Marc Walker.
Background
3. The Registrant was employed as a Band 6 Community Dietitian by Bromley Healthcare (‘Bromley’). On 1 April 2017, the Registrant took on the role of Band 7 Team Leader for the Bexley Service. The Registrant therefore had two roles at Bromley: the Band 7 Team Leader role for fifteen hours per week, and the Band 6 Community Dietitian role for seventeen and a half hours per week.
4. During the Registrant’s employment with Bromley, the Registrant did not record patient consultations on EMIS in a timely manner, she did not use the dietetics EMIS template to assess and conduct treatment plans, she did not schedule appointments on the EMIS appointment diary, she did not use the EMIS diary to indicate follow-up requirements, she did not record the patient consultations on EMIS for a Service User and the Registrant did not adhere to policies and procedures regarding record-keeping, as she completed handwritten records in a notebook and stored handwritten records at her home.
5. On 9 January 2020, the Registrant was suspended from her roles in light of these allegations. On 19 May 2020, the Registrant was dismissed from these roles at Bromley.
6. The Registrant did not inform the HCPC that she had been suspended from her roles by Bromley.
7. Further, the Registrant failed to inform the HCPC that she had been dismissed from her roles at Bromley.
8. The Registrant was reported to the HCPC by Andrew Hardman, Commercial Director at Bromley on 30 May 2020.
9. The Registrant was then employed as a Band 5 Locum Dietitian by Central Surrey Health (‘CSH’) from 28 September 2020 until 26 November 2020.
10. Following the referral to the HCPC from Bromley, on 3 November 2020, the HCPC contacted EU, the Registrant’s line manager at CSH, requesting that she confirm whether the Registrant was employed at CSH and whether she had disclosed that she had been dismissed by her previous employer due to poor record-keeping. EU then reviewed the Registrant’s case-load and discovered that the Registrant had not completed patient consultation notes in a timely manner, the Registrant had not processed discharge letters to patients and/or their GPs in a timely manner, and the Registrant had not processed assessment letters to patients and/or their GPs in a timely manner.
11. At its meeting on the 26 February 2021, the Investigating Committee (IC) of the HCPC determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise. The IC confirmed the allegation.
12. Following the outcome of the IC, Kingsley Napley LLP were instructed by the HCPC to undertake an investigation in relation to the allegation.
13. Simultaneously with the investigation, the Registrant liaised with the HCPC with a view to the proceedings being disposed of by consent. Upon being alerted to this on 10 May 2021, Kingsley Napley LLP thereafter communicated with the Registrant’s representative which resulted in this application being made, on the basis that it was agreed between the parties that Conditions of Practice should be imposed for a period of twelve months, subject to this Panel’s approval.
The Substantive Decision
14. The panel at the Final Hearing determined that the proposed agreed Conditions of Practice would secure the appropriate level of public protection. It took into account the evidence provided by the Registrant that supported the submission that she had demonstrated insight by fully reflecting on her previous failings and completing further training on documentation and record keeping. The panel further had regard to a positive reference that was received from the Registrant’s current employer and regarded this as an important indicator of progress in the Registrant’s practice. The panel concluded that a period of twelve months would be a sufficient period of time to enable the Registrant to continue to address these issues under appropriate supervision. It determined that the proposed Conditions of Practice order was appropriate and proportionate to the risk posed by the Registrant to members of the public.
15. The panel further determined that to dispose of the case by way of consent as proposed would not be detrimental to the wider public interest. It concluded that the wider public interest would be sufficiently protected by the Registrant agreeing to adhere to the proposed Conditions of Practice for a period of twelve months given the level of supervision of the Registrant and reporting requirement to the HCPC imposed by the conditions.
16. The conditions of practice imposed were:
(i) You must place yourself and remain under the supervision of [workplace supervisor] registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 21 days of the Operative Date.
(ii) You must attend upon that supervisor as required and follow their advice and recommendations. You must work with [supervisor etc.] to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice: record keeping/scheduling of appointments/referrals of service users/knowledge and application of relevant policies and procedures.
(iii) Within 1 month of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.
(iv) You must meet with [supervisor etc.] on a monthly basis to review your progress towards achieving the aims set out in your Personal Development Plan.
(v) You agree to [supervisor etc.] providing information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan. The HCPC require progress reports from [supervisor etc.] on a quarterly basis.
Today’s Hearing
17. The Panel had before it the HCPC bundle and two bundles prepared on the Registrant’s behalf. The second addendum bundle contained a reflective piece prepared by the Registrant and a reference from KLM, the Clinical Lead, dated 16 November 2022 as well as an Action Plan for addressing Capability Issues, Audits and a records of Supervision sessions. There was also a certificate from a Data Security Course that the Registrant had attended.
18. During the course of the hearing the Panel received a further letter/ email from KLM the Clinical Lead, dated 18 November 2021 which addressed a concern that had arisen during the course of the Registrant’s oral evidence.
19. In reaching its decision, the Panel has read the documentation carefully. In relation to the reference prepared by KLM, dated 16 November, the Panel notes the following:
“I have been conducting quarterly audits on Ebele’s clinical entries as well as regular review meetings with Ebele. From the audits completed. It is clear that Ebele has taken on board all recommendations I have made and there has been sustained improvement in the content and quality of Ebele’s clinical notes. I have also discussed Ebele’s progress with her line manager [LD] who confirmed Ebele’s clinical notes have been of good quality and timely, adding that there are no new concerns noted from Ebele’s clinical practice.
Throughout 2022, Ebele has continued to work well autonomously and has put herself forward for department projects/ presentations. At the moment Ebele is leading a project to increase the protein intake of frailty patients on the ward”.
20. KLM’s second letter dated 18 November 2022 produced during the hearing reads as follows:
“I can confirm that Ebele’s clinical notes have been of good quality and no issues raised since the latest audit was completed in July 2022. Ebele’s Line Manager [LD] have received the recommendations from the past audits so is aware of key points to look out for re Ebele’s practice.
Last month Ebele was off sick for a few weeks and [LD] covered Ebele’s caseload. [LD]’s feedback on 15.11.2022 re covering the caseload was positive. [LD] said there were no issues with the quality of Ebele’s entries and she felt the recommendations made in the July audit have been followed. [LD] was able to review Ebele’s caseload with ease.”
21. The Registrant’s reflective piece included the following:
“I have also found that the use of patient record templates helps me ensure consistency and acts as a checklist of all the relevant information that must be included in the patient records. Prioritising and allowing time for documentation helps me ensure that patient records are entered and completed in a confidential and timely manner. I now ensure that the documentation of the care given to patients (which is in line with local and national guidelines) is carried out contemporaneously.This ensures continuity of care, and that the information on dietetic care provided is confidentially available to other health professionals who need access to them, thus the HCPC standards are upheld but ultimately the safety of the patients is maintained.”
22. The Registrant gave oral evidence at the hearing. She acknowledged that there had been serious failings in her practice. She is now working as a Band 6 dietician in the Neurology Department within the Trust. She stated that she sees around 20-30 patients a week. Her job is strictly hospital based. She stated that she had been working in the community for a number of years and coming back to an acute setting had been important. The high levels of transparency and accountability had been helpful and she had benefited from the regular supervision she had received. She stated that she now ensures that she follows Trust guidelines and documents everything in a timely and full manner. She ensures that if she sees patients in the morning, she completes her notes in the afternoon. She uses templates which ensures consistency and quality of the content. The Registrant was asked how she would ensure that there would be no repetition going forward. The Registrant stated that she had a robust system in place which she had described. She said going forward she would always ask for advice before letting things get out of hand.
Submissions on behalf of the HCPC
23. At the end of the hearing, Ms Welsh made submissions on behalf of the HCPC. In terms of current impairment, the HCPC’s position was neutral.
24. She reminded the Panel that the Registrant bears the persuasive burden of showing that he/she is no longer impaired at a substantive review hearing.
25. She acknowledged that the Registrant had engaged in these proceedings, that there were no further regulatory concerns. The Registrant had complied with the Conditions of Practice Order imposed at the end of the substantive hearing.
26. Ms Welsh invited the Panel to look carefully at the Practice Note and the documentation that had been provided as well as the oral evidence to act proportionately but to keep at the forefront of its mind the duty on the regulator to ensure that the public are protected. She reminded the Panel that it could not go behind the findings of the panel at the substantive hearing.
Submissions on behalf of the Registrant
27. Mr Walker made submission on behalf of the Registrant. He invited the Panel to allow the current order to lapse when it expires in December. He submitted that the Registrant had complied with the Conditions of Practice Order. There had been a sustained improvement and that there was ample evidence that she was no longer impaired.
Decision
28. The Panel accepted the advice of the Legal Assessor.
29. In reaching its decision, the Panel has had regard to the HCPTS Practice Note on “Review of Article 30 Sanction Orders”.
30. This is a mandatory review under Article 30 (1) of the Health and Social Work Professions Order 2001 (The Order). The Panel is aware that the process under Article 30 (1) of the Order is one of review and not one of appeal. Its function is to determine whether the Registrant’s fitness to practice is still impaired, and, if so, whether the Conditions of Practice Order remains the appropriate and proportionate means of public protection or should be varied or replaced by some other order or whether the order should be allowed to lapse.
31. The Registrant bears the persuasive burden of satisfying the Panel that she is no longer impaired.
32. The Panel is aware that it must act proportionately in its assessment but that it has a duty to ensure that the public are protected.
33. The Panel has taken account the submissions made by Ms Welsh, and Mr Walker, the written and oral evidence of the Registrant and the references and documentation provided.
34. The Panel wishes to stress that the matters which gave rise to this allegation were serious. The failings in documentation went on over a significant period of time. The Panel is aware that the Registrant admitted the allegations very early on. By the time of the substantive hearing, the Registrant had undertaken significant work on insight and had done further training on documentation and record keeping and had produced a positive reference from her employer. The Registrant’s reflective piece provided for today’s hearing shows that she has continued to develop insight. This was reinforced by her answers to difficult questions asked by the Panel during the hearing.
35. In summary, having heard oral evidence from the Registrant, the Panel is satisfied that the Registrant has acknowledged the seriousness of her past failings. It is satisfied that she now understands the fundamental importance of accurate recording and the Panel has concluded that she has developed good insight.
36. In terms of remediation, the Panel looked at the evidence in relation to this carefully. The Panel notes that the Registrant has continued to work throughout the period of this investigation and the proceedings. It accepts that she is committed to her profession and that she has completed a number of courses, most recently on data security.
37. The Panel notes that the Registrant is well regarded by her current Clinical Lead, KLM. The Trust was aware of these proceedings throughout and has supported her. The Registrant has been promoted within the Trust from a band 5 Locum position to a permanent band 6 staff member.
38. From the audits, it is clear that there has been a sustained improvement in the Registrant’s recordkeeping over the year since the Conditions of Practice Order was imposed. No further issues have arisen. A significant piece of evidence came to light during the hearing, when in response to a query raised by the Panel the Clinical Lead, KLM sent in the second reference. It is clear from this reference which is set out in full in paragraph 20 above, that the Registrant recently had a period of unforeseen sickness and that her caseload had to be picked up by her Line Manager. She found that the notes were good and described being able to pick up the Registrant’s case load with ease. This resulted in a comprehensive review of the whole of the Registrant’s case load. The Panel is satisfied from this and from the references from the Clinical Lead that the Registrant has remedied her failings.
39. Finally, the Panel notes that the Registrant is a valuable member of her team. It has acknowledged the work she has done to remedy significant failings. The Registrant stated in her oral evidence that she intends to continue to work in the NHS, in a hospital setting and that the mandatory training, transparency and accountability that this setting provides is both reassuring and stimulating. It has concluded that on the personal component that the Registrant is no longer impaired and that the risk of repetition is low. The Panel is satisfied that the risk to the public is low.
40. The Panel has considered the public component. It is satisfied that the Registrant has complied with the Conditions of Practice Order imposed and that the wider public interest has been met.
Order
Order: The Registrar is directed to allow the current Conditions of Practice Order against the registration of Ms Ebele Nze to lapse upon its expiry, namely 15 December 2022.
Notes
No notes available
Hearing History
History of Hearings for Mrs Ebele Nze
Date | Panel | Hearing type | Outcomes / Status |
---|---|---|---|
18/11/2022 | Conduct and Competence Committee | Review Hearing | No further action |