Eleanor Hezelgrave

Preliminary matters

Application for part of the hearing to be in private

1. At the outset of the hearing Ms Bernard-Stevenson made an application under Rule 10 of the HCPC Practice Committee Rules, for part of the hearing to be in private. She indicated that some reference might be made to the Registrant’s health and if so those should be dealt with in private.

2. The Panel accepted the advice of the Legal Assessor that, although hearings are usually heard in public, the Rules allow for the hearing to be heard in private where matters pertaining to the health, or private matters, of the Registrant are to be referred to. The Panel therefore agreed that it was appropriate to hear those parts of the case relating directly to the Registrant’s health in private in order to protect the private life of the Registrant. However, the rest of the case would be dealt with in public in the usual way.

Background

3. The Registrant is a registered Speech and Language Therapist (SLT) with the HCPC.

4. The Registrant has been employed by Bradford District Care NHS Foundation Trust (the Trust) since January 2013. As part of her role, she worked with commissioned schools and Designated Specialist Provisions (DSP) units to support pupils. On 25 December 2017, the Registrant started maternity leave.

5. Between March 2018 and August 2018, concerns were raised by various SLT staff members who were providing maternity cover for the Registrant. These concerns related to documents that were found on the departmental shared drive that were not password protected; incorrect assessments that had been carried out by the Registrant; record keeping issues such as errors in assessment scoring, reports lacking detail and failures to appropriately manage ongoing clinical care.

6. On 25 September 2018, an investigation was commissioned due to the number of concerns that had been received. Further concerns were subsequently identified, such as delays in producing reports, gaps in care, failure to obtain informed consent before assessing pupils, failure to refer pupils to SLT services and the assessment of bilingual pupils using monolingual assessments.

7. On 11 July 2019, a referral was made to the HCPC by the Trust. identifying a number of deficiencies in the Registrant’s practice.

8. On 22 January 2021, a Panel of the HCPC’s Investigating Committee (IC) determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise.

9. Following the outcome of the IC, Kingsley Napley LLP was instructed by the HCPC to undertake an investigation in relation to the allegation detailed above. Clinical records were obtained from the Trust, which corroborated the concerns raised.

10. On 6 April 2022, the Registrant spoke to Kingsley Napley LLP to discuss disposing of the case by way of consent.

11. On 7 April 2022, the HCPC instructed Kingsley Napley LLP that they were happy to explore disposal by consent in this case. It was agreed that a Conditions of Practice Order was an appropriate consensual disposal.

12. On 13 April 2022, Kingsley Napley LLP sent the Registrant the proposed conditions.

13. On 27 April 2022, Kingsley Napley LLP received the Registrant’s completed Consensual Disposal Request Pro-Forma, together with confirmation that she accepts the proposed conditions.

14. The Registrant addressed the Panel and said how she had returned to work on 1 September 2022, working three days a week, in term time only to facilitate child-care. She said she had just been completing her induction and mandatory training during that time and that her employer was awaiting the outcome of today’s hearing before going forward. She said it had been a long time since she had worked clinically, but she had checked with the HCPC and she was not required to complete a return to practice course. She added that she had been taking the opportunity, to speak to colleagues and “get up to speed” with all the changes in the way in which the Trust operated. This included a significant increase in the amount of support being provided to everybody in the Trust. The Registrant spoke of how supportive her line manager had been, meeting with her nearly every other day, and of positive changes in the workplace setting. She said she had previously been working in the commissioned school service, an autonomous role, which was where the concerns about her practice had been raised, but that she would now be working in the core service, where there was always somebody to answer questions. The Registrant did not consider there to be any issues with the proposed conditions, but was content with the potential addition to condition 4, mentioned by the Chair, to relax the frequency of supervision meetings once it was felt the necessary competencies were being met.

15. Ms Bernard-Stevenson, on behalf of the HCPC, said that she too had no issues with the proposed addition to condition 4.

16. Before considering the facts, statutory ground, impairment and proposed sanction the Panel heard and accepted the advice of the Legal Assessor.

Decision on Facts

17. The Panel accepted the Registrant’s admissions to the facts alleged, which were supported by the exhibits provided, and found all the alleged facts proved.

Decision on Grounds

18. The Panel next considered whether the facts found proved amounted to misconduct and/or a lack of competence. Whilst her failings were widespread, repeated over a long period of time and related to basic and fundamental areas of SLT practice, they were not deliberate or willful. She had a very heavy case load, was working in isolation with very little support and was relatively inexperienced. From her notes it was apparent that her actions were quite thorough at times and that it was the clinical reasoning that was lacking. The Panel was satisfied that the root cause was a lack of competence, she was not clear about what she should be doing or the processes she should have been following. The Panel did not consider her failings were so serious as to amount to misconduct, but concluded that the statutory ground of lack of competence was made out.

Decision on Impairment

19. The Panel noted the Registrant’s acceptance that her fitness to practise was currently impaired by virtue of her misconduct/lack of competence. Notwithstanding that acceptance, the Panel reached its own independent conclusion, which was that her fitness to practise was indeed impaired by virtue of her lack of competence. The Panel noted that the Registrant’s failures were extensive and spanned a period of three years, during which inadequate assessments were made of many pupils, records were not kept and the ongoing clinical care of pupils was not adequately managed. Whilst the Registrant has demonstrated significant insight and begun to take steps to address the shortcomings in her practice, she has yet to be in a position whereby she is able to demonstrate that she is safe to return to unrestricted practice (she has been on a career break). Until she is able to demonstrate that she is able to practise safely and effectively there is an ongoing risk of repetition and potential harm to those in her care and thus a finding of impairment on public protection grounds is necessary.

20. The Panel then went on to consider whether this was also a case that required a finding of impairment on public interest grounds in order to maintain confidence in the profession and also to maintain standards within the SLT profession. The Registrant’s failings were prolonged, widespread and fundamental to the role of an SLT. The Panel considered that with the continuing risk that the Registrant might repeat her conduct, members of the public would have their confidence in the profession and the HCPC undermined if a finding of impairment were not made.

21. The Panel therefore found the Registrant’s current fitness to practise to be impaired on both public protection and public interest grounds.

Decision on Sanction

22. In reaching its decision on whether the proposed sanction of a Conditions of Practice Order for two years was appropriate and proportionate, the Panel took into account the submissions made by Ms Bernard-Stevenson and the Registrant together with all the written evidence and all matters of personal mitigation. The Panel also referred to the HCPTS Practice Note on Consent Orders as well as the guidance issued by the Council in its Indicative Sanctions Policy. The Panel had in mind that the purpose of sanctions was not to punish the Registrant, but to protect the public, maintain public confidence in the profession and maintain proper standards of conduct and performance. The Panel was also cognisant of the need to ensure that any sanction is proportionate.

23. When considering the Registrant’s insight and plans to remediate her failings, the Panel was particularly assisted by the insight demonstrated in her email, dated 27 April 2022, in which she said:

“Whilst I acknowledge the significant errors in my previous clinical judgement I am hopeful that steps can be put in place to allow me to demonstrate that I am competent of continuing, and rectifying where necessary, my profession as a Speech and Language Therapist. I believe that along with continuing to educate myself, following a preceptorship programme, accessing supervision all through conditions of practice, I will be able to support my personal development to demonstrate this.

I chose this career with the intention of helping others and sharing knowledge and skills to enrich and better the lives of those with communication needs. I continue to have a passion for my career and am ashamed and embarrassed that the actions I have taken have consequently put service users at risk and not provided the level of service I am expected to deliver.

In an attempt to increase my knowledge to ensure I am able to remediate my actions from the first allegation I have spent time accessing a range of documents, articles and various resources. From doing so I understand that my actions taken during the time of the first allegation did not meet the professional and statutory requirements for record keeping as set out in standard 10 of the HCPC standards of conduct, performance and ethics; record keeping. I understand that by failing to create patient records on SystmOne for the pupils does not ensure that the correct and appropriate care can be given within a timely manner.

By not creating the SystmOne record, up to date information could not be communicated with other professionals as necessary. This puts the service user at risk of not receiving the appropriate care, including not having potential access to other services if required. With failings in record keeping there is also no evidence of the decisions made, nor a baseline provided to monitor the effectiveness of the clinical input.

I understand that with reports provided following assessments uploaded to SystmOne months after they were produced significantly impacts on the continuity of care for the service user. It does not allow access to all of the information that may be required in order to access and review the appropriate level of care provided.

I understand that a service user at the very minimum relies on health professionals to store up to date care plans and reports alongside documenting any form of contact e.g. face to face, phone call or text message at a standard level of storing personal information.

I am also aware that records also need to be up to date to meet trust expectations for statistical data, and have also fallen short of this trust record keeping expectation.

Within my future practice I endeavour to keep full, clear, and accurate records for each service user, completing all records promptly and as soon as possible after providing care. I will also ensure that I am up to date with current legislation, guidance or policies both locally and nationally with regards to record keeping.

In an attempt to increase my knowledge to ensure I am able to remediate my actions from the second allegation I have spent time accessing documents exploring Speech and Language Therapy assessments. From doing so I understand that a universal assessment provides a screening tool, a score and rating system, and activities to pick up and use straight away. They’re quick to use and to interpret, and are available to all, therefore not requiring a referral to the Speech and Language Therapy service. Targeted assessments require the direct involvement of a Speech and Language Therapist and therefore a referral with consent into the Speech and Language Therapy service. I understand that the incorrect assessment may provide incorrect and inaccurate information that may impact the pupils support if the level of intervention is not right.

I acknowledge that this failing occurred under an unusual circumstance, in that the school in which I was commissioned to work for had requested a screening of the pupils to be able to almost immediately begin their language groups. The school had ordered a universal screen but this had unfortunately been lost during the half term. I was due to go on maternity leave within a matter of weeks and felt under pressure to provide information as to my knowledge there would not be a cover therapist in place as soon as I left. I now fully understand that these actions were incorrect and should have taken my time to ensure the safety and well-being of the service users instead of feeling pressured into providing information.

In addition to this with regards to the second allegation, I understand that when working with bilingual pupils there is reason for alternative assessments to those that are for monolingual speakers. Language translated within an assessment may be altered through the act of translation, as languages do not encode concepts and grammatical relationships in the same way. Assessments should be used which examine speech and language skills appropriate to the child’s age and experience and include a range of spoken sentence structures. The language sample should be transcribed by a bilingual SLT, or more commonly a monolingual SLT working alongside a bilingual translation professional such as a translator, interpreter or bilingual assistant. I understand that by not assessing a pupil in their home language can lead to misdiagnosis and may provide inaccurate or inappropriate intervention.

I recognise that this is an area of clinical work that I need to spend time updating my knowledge on and ensuring I seek supervision on my return to work to support my practice. In future practice I will ensure to gather more in depth background to home language to be confident in which language to assess the pupils communication skills in and to be aware to assess different languages in separate sessions.

With regards to the third allegation I understand that this fails to meet standard 6; manage risk, of the standards of conduct, performance and ethics. I understand that gaps of significant lengths of time between sessions of assessment, review or treatment for that care of an individual poses a potential significant risk of harm to them.

By not providing ongoing input to the individual there is a risk that the findings of the assessment are no longer appropriate, that the intervention is no longer suitable and that the treatment is no longer serving its intended purpose. This therefore puts the individual at risk of limited if not no progress. This also relates to standard 11; be able to reflect on and revise practice of the standards of proficiency for Speech and Language Therapists, to understand the value of reflection. Without up to date information there is no evidence to base new or ongoing treatment which may ultimately impact the overall rate of progress and may also impact the individuals ability to function within day to day settings. I understand that by not providing regular input an individual’s wellbeing may be at risk if, without the support of a Speech and Language Therapist they are unable to explore ways to communicate functionally or to access their everyday environment.

I understand the importance of multidisciplinary working and how essential a Speech and Language Therapist’s input can be to determine the level of care an individual may receive. Without this up to date information an individual may therefore not be able to access as much as they require, therefore putting them at risk of harm.

On reflection I acknowledge that the safest course of action would be to follow a process by which the appropriate care is given, and the service user is discharged with the advice to re-refer once the target/s have been achieved. By not following this process the individuals case has been left open, potentially based on a ‘review on request’ basis, whereby the carer of the individual or of those within the educational setting providing the advised treatment can seek further support when they feel it is required. This has therefore allowed a significant length of time to pass without providing an acceptable level of care, and I understand that ultimately it is my own responsibility to manage the reviewing process of my caseload.

I also acknowledge that there may be a level of incompetence with record keeping as set out in standard 10 of the HCPC standards of conduct, performance and ethics; record keeping. Where there may have been conversations with school staff or careers about the progress of an individual these have not been recorded to reflect this.

In future practice I endeavour to comply with local and National legislation and policies in maintaining or managing the level of input to ensure that the service users needs are met. I also endeavour to ensure to maintain up to date records.

In an attempt to increase my knowledge to ensure I am able to remediate my actions from the fourth allegation I have spent time accessing a range of documents and resources. From doing so I understand that my actions taken during the time of the fourth allegation did not meet the professional and statutory requirements for consent as set out in Standard 1; to promote and protect the interests of service users and careers with standard 1.4; to make sure that you have consent from service users or other appropriate authority before you provide care, treatment or other services of the HCPC standards of conduct, performance and ethics; record keeping.

I understand that consent is the process by which an individual gives permission for something to happen, or in the case of children; those with parental responsibility. Informed consent is the process in which a Health Professional informs the individual about a proposed intervention, when a service user has all of the necessary information, in a way that they can understand, they can make a decision about their care, treatment or other services.

Consent ensures shared decision making, which allows the Health Professional to address what matters to the service users and is therefore fundamental to good practice. Without consent, the service user is not only unable to access vital information in relation to a service that is based on themselves but unable to participate or be involved in the up to date decision making process of their development. This may have a detrimental impact on the service users ability to progress as consent is a dynamic and ongoing process, dependent on each decision, in each context and as the treatment progresses.

The principle of consent is an important part of medical ethics and international human rights law and fundamentally allows for the individuals best interests to be considered and discussed. By providing upfront information, through a referral form or during discussion in gaining consent, allows the parent or guardian time to process the information and make an informed decision as to whether they want their child to be involved in the Speech and Langauge Therapy service.

I understand that consent may be verbal or non-verbal or written. When documenting consent it must be transparent and clearly and routinely recorded in the individuals’ record including details of:

• What information was given
• What time consent was gained
• Third parties the consented information may be shared with
• How consent was gained and given, i.e. written, verbal, non-verbal

I understand that invalid consent includes when a Health Professional does not have clear records to demonstrate they consented which links with the importance of record keeping.

I understand that importance of accessing my trusts policies on consent to ensure that my actions are in line with local and national policy.

My current employment situation is that I am on a career break for Bradford District Care NHS Foundation Trust, I return to work on 1st September 2022. I continue to be a member of the Royal College of of Speech and Language Therapists (RCSLT).

When I return to work I will no longer work at Band 6, but at Band 5 and will have a preceptorship programme of a minimum of 6 months to support my clinical practice. When I return to work my job role will change in that I will no longer work within the commissioned school setting but will be clinically based in which there were no concerns about my professional ability raised in this area of practice.

I am aware that the trust has since introduced managerial supervision which ensures more regular and directed managerial supervision which was not in place when I first went on maternity leave in December 2017. I am confident that this process along with the preceptorship programme will be of significant benefit to myself and ultimately our service users whereby I can regularly access appropriate support.

Prior to returning to work I will be continuing to complete my Continuing Professional Development (CPD). I will familiarise myself with the HCPC return to practice process in preparation for returning. I will attend and participate in appropriate and relevant webinars. I have explored options of refresher courses in Speech and Language Therapy and also a course for returning to Practice. I am also keeping up to date with potential training opportunities that would be specific to my job role to undertake prior to returning to work.”

24. The Registrant admitted that her fitness to practise is currently impaired by reason of her misconduct and/or lack of competence. The Registrant has also demonstrated insight by fully reflecting on her previous failings, as well as furthering her knowledge of SLT assessments and record keeping requirements by accessing various documents and resources. The Registrant has been on a career break, but has recently returned to work, at the beginning of September 2022. Prior to returning to work, the Registrant had been continuing to complete her Continuing Professional Development. The Registrant has therefore already started to take steps to address the shortcomings in her practice. She also stated that she has agreed a plan with her employer for her return to work to ensure she undertakes work of an appropriate level and is heavily supervised to ensure no further issues arise. In such circumstances, the Panel was satisfied that 24 months would be a sufficient period of time to enable the Registrant to continue to address the highlighted issues under appropriate supervision. The Panel was satisfied that the public would be protected by such an Order and that such an Order is proportionate in the circumstances.

25. The Panel considered the proposed conditions were thorough, workable and proportionate and addressed the concerns raised. However, the Panel considered some more flexibility should be included in Condition 4, to allow for less frequent supervisory meetings once both the employer and the Registrant were satisfied the listed competencies were being met. Both parties agreed to the proposed variation to Condition 4.

26. Furthermore, the Panel was satisfied that such an Order would serve to maintain public confidence in the profession and the HCPC as Regulator in that the Registrant will not be able to return to unrestricted practice until she has satisfied a reviewing Panel that she is safe to do so.

27. In all the circumstances, the Panel was satisfied that a two-year Conditions of Practice Order would mark that the Registrant’s conduct was serious, had the potential at the time to cause harm to service users and also brought the SLT profession into disrepute. Importantly, such an Order would provide a framework and a timespan within which the Registrant could remedy her previous failings and thereby be able to demonstrate that she is capable of safe and effective practice. The Panel considered the public interest would be satisfied by a two-year Conditions of Practice Order and that resolving the case in this way would not, in the Panel’s view, be detrimental to the wider public interest.

28. The Panel did not consider a more onerous sanction was necessary or proportionate in this case.

29. Accordingly, the Panel agreed with the proposed Consent Order.

The Registrar is directed to annotate the register entry of the Registrant to show that, with effect from the date of the hearing (‘the Operative Date’) for a period of twenty-four months from the date this order comes into effect:

1. You must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within one month of you returning to practice.

2. Upon your return to practice you must work with your workplace supervisor to formulate a Personal Development Plan designed to address the following areas of your practice, and any other areas of your practice deemed necessary by your workplace supervisor:

a. Record Keeping;
b. Completing adequate assessments of patients;
c. Adequately managing on-going clinical care; and
d. Obtaining appropriate consent

3. Within three months of returning to practice you must forward a copy of your Personal Development Plan to the HCPC.

4. You must meet with your workplace supervisor on at least a fortnightly basis to consider your progress towards achieving the aims set out in your Personal Development Plan. The regularity of these meetings can reduce to monthly, by agreement between you and your supervisor, at a time when you are both satisfied that the above four areas of competence are being met.

5. You must provide to the HCPC records of the meetings with your workplace supervisor.

6. You must request that your workplace supervisor provides a report to the HCPC at least 14 days before any review of this Conditions of Practice Order.

7. You must promptly inform the HCPC if you change employment or take up any additional employment which requires registration with the HCPC or another statutory regulator.

8. You must promptly inform the HCPC of any capability or disciplinary proceedings taken against you by your employer.

9. 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 which requires registration with the HCPC or another statutory regulator;
b. Any agency you are registered with or apply to be registered with (at the time of application); and
c. Any prospective employer (at the time of application).

This Order will be reviewed before its expiry.

History of Hearings for Eleanor Hezelgrave