Mr Stephen G Morgan

Profession: Occupational therapist

Registration Number: OT35127

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 26/09/2022 End: 17:00 26/09/2022

Location: Virtual via video conference.

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

Whilst registered as an Occupational Therapist and during the course of your
employment at Cambridgeshire and Peterborough NHS Foundation Trust:

1. In relation to Service User A you completed a home visit on or around
28 October 2016 and:
a. Did not make a record of the visit;
b. Did not request the required equipment and / or adaptations until
around 1 December 2016.

2. [Not proved].

3. In relation to Service User C on or around 27 September 2016 you did
not demonstrate:
a. Collaborative working in that you misinterpreted what your colleague
said during a meeting;
b. Effective clinical reasoning in relation to the kitchen assessment.

4. In relation to Service User D you did not ensure that the required
equipment was available in time for the scheduled discharge on 21
September 2016.

5. In relation to Service User E you:
a. Did not complete and/or record a discharge assessment summary;
b. Did not arrange follow-up care following Service User E’s discharge
on or around 4 August 2016.

6. In relation to Service User F you did not write a report in relation to the
access visit completed on or around 31 October 2016

7. In relation to Service User G you completed a home visit on or around
9 November 2016 and you did not record:
a. A home visit report;
b. A transfer summary.

8. In relation to Service User H you completed an access visit on or around
20 October 2016 and did not complete an access visit report.

9. In relation to Service User I you called Service User I’s son on or around
13 October 2016 regarding a home visit and you:
a. Did not record a summary of the visit;
b. Did not record a report of the visit.

10.In relation to Service User J you did not record a home visit you
completed on or around 16 December 2016.

11.In relation to Service User K you:
a. On or around 15 November 2016 did not order the equipment which
you had identified as required for Service User K’s discharge in a
timely manner;
b. Did not record the equipment order in Service User K’s notes.

12.In relation to Service User L in approximately February 2017 you did
not facilitate the discharge in that you:
a. Did not successfully contact the housing team;
b. Did not arrange an access visit;
c. Did not arrange the required equipment.

13.In relation to Service User N in approximately April 2015 you did not
demonstrate adequate clinical reasoning in relation to the in that it was
inappropriate to select her as a service user for a demonstration kitchen
assessment.

14.The matters set out at paragraphs 1-13 constitute misconduct and / or
lack of competence.

15.By reason of your misconduct and / or lack of competence your fitness
to practise is impaired.

Finding

Preliminary Matters

Private hearing

1. Mr D’Alton applied for any references to the Registrant’s health to be in private. The Panel accepted the Legal Assessor’s advice and had regard to the HCPTS Practice Note on ‘Conducting Hearings in Private’. The Panel was satisfied that there was a need to protect the Registrant’s right to a private life. The Panel determined that the parts of the hearing pertaining to the Registrant’s private life and health should be considered in private, in accordance with the Rules.

Background


2. The Registrant is registered with the HCPC as an Occupational Therapist. He was employed by the Cambridge and Peterborough NHS Foundation Trust (‘the Trust’) from February 2005 until March 2017, as a Band 6 Occupational Therapist working in the Trust’s Inpatient Rehabilitation department.

3. In 2015 the Trust underwent a restructure and a number of separate teams (neighbourhood team, community nurses, occupational therapists and mental health workers) were formed.

4. In November 2015, an informal performance investigation was commenced into the Registrant’s record keeping, duty of care, collaborative working, communication, patient safety and professionalism. This progressed to a formal investigation in May 2016; and the Registrant’s case was referred to the HCPC. The Trust dismissed the Registrant in March 2017. The Registrant appealed against the Trust’s decision, and it was then agreed that the Registrant could leave his position on the grounds of ill health, in July 2017.

5. In November 2018, the Registrant appeared before a panel of the Conduct and Competence Committee. The particulars were found proved, save for Particular 2. The HCPC relied on the evidence of two witnesses who provided statements and exhibits including case notes of service users. The witnesses also gave oral evidence at the substantive hearing. The Registrant also gave evidence at the hearing and the Panel had regard to his evidence.

6. The substantive hearing panel found that Particulars 1(a), 1 (b), 4, 5(a), 5 (b), 6, 7(a), 7(b), 8, 9(a), 9 (b), 10, 11(a), 11(b), 12(a), 12 (b) and 12 (c) each amounted to misconduct, and that Particulars 3(a), 3(b), and 13 amounted to a lack of competence.

7. The matters found proved included failings in the Registrant’s record- keeping, his actions following assessments of patients’ needs, his communication with colleagues, and his clinical reasoning. The substantive panel heard and found proved that the Registrant had not achieved the required levels of competence with record-keeping, communication, clinical reasoning, and interpersonal relationships, including poor quality and sometimes inaccurate information handed over to colleagues; the Registrant consistently failed to take responsibility for himself and was unable to effectively manage his own time.

8. The substantive panel concluded that the Registrant’s conduct was remediable. However, that panel was not convinced by the Registrant’s assertion that he had developed the requisite skills as a result of a course he had taken two weeks before the substantive hearing. Nor was the substantive panel persuaded that the Registrant’s role as a Healthcare Assistant had required him to implement this learning to the same standard as that required of an Occupational Therapist.

9. The substantive panel was not satisfied that the Registrant had developed any insight into his failings, in relation to clinical reasoning and his inability to make the judgments required when making a clinical decision. The substantive panel was also concerned about his lack of insight into the impact of his actions, or inactions, on the Trust and service users. Despite the Trust’s support, the Registrant still associated his conduct and competence with his working environment. The conclusion reached was that the Registrant’s failings were highly likely to reoccur.

10. The substantive panel concluded that the Registrant’s fitness to practise was impaired both on grounds of public protection and on grounds of the wider public interest. The substantive panel concluded that a Conditions of Practice Order for a period of 18 months was the appropriate sanction.

11. The Registrant attended the substantive review hearing on 15 September 2020 and provided a reflective statement. At the commencement of his evidence the hearing had to be adjourned due to problems with the Registrant’s internet connection. The hearing resumed on 30 September 2020, when the Registrant provided a second reflective statement and gave evidence before the Panel.

12. The Registrant had been working as a Healthcare Assistant since October 2017, and the last time he worked as an Occupational Therapist was in March 2016. He had been looking for work as an Occupational Therapist but had been unsuccessful, although he was determined to return to work in his profession when a post became available.

13. He said, in relation to Condition 3, it had been his understanding that the Condition would only come into effect if he secured a position as an Occupational Therapist. He admitted that he had not immediately informed his employers of the existence of his Conditions of Practice, but that he had now done so, after this Condition had been explained to him.

14. The Registrant said he was doing well in his current employment. He had been permitted to stand in, for senior health carers when they were not available. This had given him greater confidence, and he was now able to delegate decisions effectively and communicate positively with members of staff. He asked for an opportunity to demonstrate his abilities as an Occupational Therapist.


Decision of the last (second) reviewing panel

15. The last reviewing Panel found that there had been some engagement on the part of the Registrant with the HCPC but he had not complied with the suggestions of the previous panels as to what may be helpful steps to take in respect of the review hearing.

16. That Panel concluded that the Registrant’s fitness to practise remained impaired. He had not practised as an Occupational Therapist since the imposition of the Conditions of Practice Order or remediated his failings and his insight was at an early stage of development. It was the judgment of that panel that there remained a high risk that the Registrant would repeat his failings, if permitted to practise unrestricted and he remained impaired on public protection grounds. Furthermore, the public interest demands a continued finding of impairment to uphold standards and confidence in the profession and the Regulator.

17. The aggravating and mitigating factors that were found by the substantive panel remained, namely:

18. That reviewing panel concluded that to take no action or to impose a Caution Order would be insufficient in light of the seriousness of the allegation and a Conditions of Practice Order remained the appropriate and proportionate order in the circumstances. An extension of 12 months would be sufficient to enable the Registrant to develop the necessary insight and to remediate his deficiencies and it would be appropriate to add one further condition to the existing order, which would now become Condition 11. Accordingly, that panel varied the Conditions of Practise Order and extended the Order for a period of 12 months.

Submissions at today’s hearing

19. Mr D’Alton submitted that the Registrant’s fitness to practise remained impaired as he had not been able to demonstrate that he had remedied his misconduct and lack of competence or that his failings would not be repeated. Mr D’Alton submitted that the HCPC would take a neutral stand as to sanction but in light of the Registrant’s evidence that he had now embarked on a return to practise course, it may be appropriate to extend the current order for a further 12 months to enable the Registrant to finish his course and obtain employment as an Occupational Therapist. Mr D’Alton also drew the Panel’s attention to the length of time since the original conditions of practice order was made and asked it to consider whether it was a realistic position for the Registrant to return to practice as an Occupational Therapist.
20. The Registrant gave evidence under oath at the hearing. He agreed that his fitness to practice was still impaired in that he had not had a chance to fully remediate as he had not been able to find employment as an Occupational Therapist. In the last six months he said that things were coming together for him in that he had managed to enrol on a return-to-practice course which commenced in August 2022, and he had also been allocated a professional mentor. He had asked for one last chance to prove that he could attain the skills required for an Occupational Therapist and asked for an extension of 12 months to the current Order.

Advice of the Legal Assessor

21. The Panel is dealing with a Review under Article 30(1) of the Health Professions Order 2001 and should take into account the HCPTS Practice Note: Review of Article 30 Sanction Orders. He advised that the purpose of this review was to consider: whether the Registrant’s fitness to practise remains impaired; and, if so, whether the existing order or another order needs to be in place to protect the public.

22. The key issue which needs to be addressed is what, if anything, has changed since the current order was last reviewed. The factors to be taken into account include: the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decision; the degree of insight shown and whether this has changed; the steps which the Registrant has taken to maintain or improve his or her professional knowledge and skills; whether any other fitness to practise issues have arisen; whether the Registrant has complied with the existing order and, if it is a conditions of practice order whether the Registrant has practice safely and effectively within the terms of that order.

23. As is noted in the Practice Note the reviewing Panel’s task: “is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed”. The decision in Abrahaem v GMC [2008] EWHC 183 (Admin) states there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he or she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”
24. The decision reached today must be proportionate, striking a fair balance between interfering with the Registrant’s ability to practise and the overarching objective of public protection. The Panel’s task is to assess whether the fitness to practise of the Registrant remains impaired.

Decision

25. The Panel accepted the advice of the Legal Assessor. There has been increased engagement on the part of the Registrant with the HCPC and a material change in circumstances in that the Registrant has now secured a return to practise course and also now has a professional mentor.

26. The Panel today has concluded that the Registrant’s fitness to practise still remains impaired under the personal component. That is because although the Registrant has now provided evidence of the development of insight, his reflective piece failed to deal with the significance of his previous misconduct. Furthermore, the Registrant is still not currently working as an Occupational Therapist and therefore is not able to demonstrate that his past misconduct and lack of competence would not be repeated. There is insufficient evidence before the Panel today to show that the Registrant has addressed the concerns and the findings of the earlier panels.

27. The Panel today has also concluded that the Registrant’s fitness to practise remains impaired under the public component. That is because members of the public would not have confidence in the profession or this regulatory process, if the Registrant were permitted to return to unrestricted practice, in view of the seriousness and wide-ranging nature of the findings made by previous panels.

28. The Panel has however concluded that an extension to the current Order would be appropriate because of the Registrant’s change in circumstances in that he is commencing a return to practise course which provides some hope that he will be able to improve his professional skills and return to practise as an Occupational Therapist after his course finishes in May 2023. Moreover, the Registrant remains employed as a Healthcare Assistant and works alongside registered Occupational Therapists in a clinical setting. The Registrant’s clinical lead, who is a Registered Nurse has provided a positive testimonial as to his work ethic and commitment.

29. In all the circumstances, the Panel has decided that weighing the Registrant’s interests with the need to protect the public and maintain public confidence, the fair and proportionate decision today is to extend the current Conditions of Practice Order, for a further period of 12 months.

30. The Order will be reviewed again, before it expires. If at the next review the Registrant has failed to complete his course or has not demonstrated sufficient remediation by working as an Occupational Therapist, all options, including a Striking-off Order will be available to the review Panel.

31. A future reviewing panel may be assisted at a future review by the following from the Registrant:
• A reference from his mentor as to how he has engaged with the return-to-work course and the skills he has developed and modules undertaken;
• A reference from his line manager detailing his work practises and work ethic;
• A full and detailed written reflective piece, perhaps with an input from his mentor, demonstrating full insight into his past failings, what he has learnt and how he intends to embed these lessons in his practice;
• The Registrant may wish to explore with his manager ways to undertake a placement with the Occupational Therapists in his work setting, within the terms of this Conditions of Practice Order, to allow him demonstrate his practical Occupational Therapy skills.

Order

ORDER: The Registrar is directed to extend the Conditions of Practice Order against the registration of Mr Stephen G Morgan for a further period of 12 months on the expiry of the existing Order. The Conditions are:

1. You must inform the HCPC, within 7 days, if you cease to be employed by your current employer or take up any other or further employment.

2. You must inform the HCPC, within 7 days of any disciplinary proceedings taken against you by your employer.

3. 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;

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 your application).

4. You must confine your professional practice to that of a Band 5 Occupational Therapist.

5. You must place yourself and remain under the supervision of a workplace Occupational Therapist supervisor at Band 6 or above registered with the HCPC and supply details of your supervisor to the HCPC within 14 days of taking up a position as an Occupational Therapist. You must attend upon that supervisor and follow their advice and recommendations.

6. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice: a. Clinical reasoning; b. Record keeping; c. Report writing; d. Effective time management; and e. Making referrals.

7. Within three months of taking up employment as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

8. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

9. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

10. You must produce a written reflective piece reflecting on the implications of the findings of the Panel, including an account as to how your actions impacted service users and their families, your colleagues, the Trust and the wider profession. The reflective piece should also demonstrate an understanding of collaborative working, effective communication and clinical reasoning. This should be submitted to the HCPC at least 28 days prior to any future reviewing panel.

11. You must produce evidence of any relevant CPD and Return to Practice training you have undertaken. This should be submitted to the HCPC at least 28 days prior to any review.

Notes

The Order imposed today will apply from 22 October 2022.
This Order will be reviewed again before its expiry on 22 October 2023.

Hearing History

History of Hearings for Mr Stephen G Morgan

Date Panel Hearing type Outcomes / Status
26/09/2023 Conduct and Competence Committee Review Hearing Conditions of Practice
26/09/2022 Conduct and Competence Committee Review Hearing Conditions of Practice
23/09/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
30/09/2020 Conduct and Competence Committee Review Hearing Conditions of Practice
15/09/2020 Conduct and Competence Committee Review Hearing Adjourned part heard
25/03/2019 Conduct and Competence Committee Final Hearing Conditions of Practice
;