Sarah Sikpa

Preliminary matters

Proceeding in private

1. Ms Sikpa was in attendance, in possession of the bundle of evidence submitted on behalf of the Health and Care Professions Council (“HCPC”) and ready to proceed with the matter. There was no initial application for the matter to be heard in private however, during the course of the hearing, it was necessary for the Panel to consider matters in private in relation to private information relating to health shared by one witness, and the need to review unredacted service user records.

2. The Panel was mindful that it possessed a discretion, pursuant to Rule 10(1)(a) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003, to hear matters in private that related to the private life of any individual. It had regard to the HCPC Practice Note in relation to “Conducting Hearings in Private” and was conscious that, whilst there is a presumption that proceedings will be in public, it was obliged to ensure the interests of justice were served, and that the private life of individuals in the proceedings was protected. It recognised that a witness disclosed private information relating to their health while giving evidence, and exercised its discretion to direct that that information should be received in private.

3. During the hearing it also became apparent that there was some doubt in Ms Sikpa’s mind as to whether the redacted service user records were correctly attributed, the suggestion being that some documents could have been misfiled and therefore concerns raised as to whether all records were accurate. Both parties indicated that they did not object to the Panel inspecting the unredacted documents, which the Panel considered was proportionate and appropriate to determine the facts of this matter. It therefore decided to view the unredacted documents in private for the purposes of considering the concerns raised, but was satisfied that it was appropriate for the remainder of the hearing to be conducted in public.

Hearing Chronology

4. The hearing did not conclude within the time originally listed. Accordingly, it was agreed between all concerned that the hearing would reconvene on 27 September, with 4 days being allowed to conclude the regulatory proceedings.

5. A preliminary hearing took place on 26 September 2022 before a differently constituted panel. On 27 September 2022 the Panel reconvened to proceed with the hearing. Ms Sikpa however did not attend the hearing at the scheduled start time, making the Hearings Officer aware that she was attending a medical appointment and would be supplying a letter from her GP to explain her absence. The Panel reconvened on 28 September 2022 and were provided with two documents:

a. An email from Ms Sikpa dated 27 September 2022 at 9.32 am
b. A letter from Dr A-M of the Partnership Primary Care Centre dated 27 September 2022

6. For the same reasons set out when the hearing commenced in June 2022, (health information revealed by a witness) the Panel determined that any information relating to the health of Ms Sikpa should be received in private.

Application for the reconvened hearing to proceed in absence of the registrant

7. Ms Sikpa not being in attendance on 27 September, or the morning of 28 September, Mr Chalmers applied to proceed with the hearing in her absence, submitting that Ms Sikpa is aware of the hearing taking place and it was implicit that she did not intend to join the hearing as she had expressed the view that the note from her doctor was sufficient to support her request for an adjournment. He suggested that it was appropriate for the Panel to proceed in her absence as, whilst it is preferable for a registrant to be present and participate, the hearing was part heard and she had engaged fully in the proceedings to date. Mr Chalmers closed his submissions by stating that Ms Sikpa had voluntarily absented herself from this part of the hearing and it was in the public interest for the hearing to proceed.

8. The Panel received advice from the Legal Assessor on the subject of proceeding in absence, which it accepted, and had regard to the practice notes issued by the HCPC in relation to proceeding in the absence of the registrant and unrepresented registrants. It was conscious that it was required to determine where the balance of fairness lay when reaching its decision, weighing Ms Sikpa’s interests against the public interest.

9. The Panel reflected that the hearing adjourned part heard on 16 June, with all parties contributing to the discussion as to the most appropriate date for its re-listing, confirming this was 27 September 2022. The listing was confirmed to the Panel by an HCPC email of 29 June 2022.

10. By an email timed at 8.33am on 27 September 2022 the Panel was provided with decisions from previous HCPC Conduct and Competence Committees in respect of Ms Sikpa as the preliminary hearing panel did not uphold her objection to the same being provided. The Panel was also informed that Ms Sikpa’s request to adjourn both the preliminary hearing and the reconvened panel on health grounds had been refused.

11. The Panel was mindful that it is always preferable for a registrant to attend a hearing and or be represented. Ms Sikpa was not represented in the proceedings but had been assisted in matters of procedure by the Legal Assessor and Mr Chalmers during the first eight days of the hearing. She cross-examined the HCPC witnesses and then gave evidence herself. She had expressed her views to the Panel in writing also and been provided with Mr Chalmers brief written submissions on impairment to aid her preparation for the reconvened hearing. Ms Sikpa had told the Panel at various points during the first hearing block of the impact of the regulatory proceedings upon her and her views on the same.

12. The Panel was satisfied that Ms Sikpa was aware of the hearing, having agreed to the date of the same and then attended a preliminary hearing on 26 September 2022, at which she requested it be adjourned. She also emailed to explain that she was seeking a letter from her GP, and then provided the same to it.

13. The Panel carefully considered the factors identified in the cases of R v Hayward [2001] EWCA Crim.168 and R v Jones [2002] UKHL 5 in respect of proceeding in the absence of the defendant or registrant:

a. The general public interest and, in particular, the interest of any victims or witnesses that a hearing should take place within a reasonable time of the events to which it relates;
b. The nature and circumstances of the registrant’s absence and, in particular, whether the behaviour may be deliberate and voluntary and thus a waiver of the right to appear;
c. Whether an adjournment is likely to result in the registrant attending the proceedings at a later date;
d. The extent of the disadvantage to the registrant in not being able to give evidence having regard to the nature of the case;
e. The likely length of any such adjournment.
f. Whether the registrant, despite being absent, wishes to be represented at the hearing or has waived that right;
g. The extent to which any representative would be able to receive instructions from, and present the case on behalf of, the absent registrant;
h. The effect of delay on the memories of witnesses.
i. Where allegations against more than one registrant are joined and not all of them have failed to attend, the prospects of a fair hearing for those who are present.

14. The last four points were not relevant to this case and therefore not considered further by the Panel. It did not explore in detail the likely length of an adjournment, should this be granted, but noted that Ms Sikpa’s GP suggested a delay of a month while Ms Sikpa settled into her new job. It anticipated that finding dates when all parties were available would be challenging and may in reality mean a delay of several months. It had reservations as to whether Ms Sikpa would attend the reconvened hearing given her feelings about the regulatory process and considered that any further delay in progressing the hearing would be a concern given the findings it made in June. The Panel considered that although the witnesses in the case gave their evidence in June, had been released and therefore would not be inconvenienced by any delay and there were no direct victims of the events, there was a clear public interest for the regulatory matters to be concluded given their age and the impact upon Ms Sikpa.

15. The Panel then considered the letter from Ms Sikpa’s GP, noting that the letter referenced a hearing “in the very near future” but not that the hearing was part heard within findings of misconduct having been made.

16. Given that the letter did not declare Ms Sikpa to be too ill to attend the hearing, and in fact confirmed she was well enough to attend her employment, the Panel was not satisfied that Ms Sikpa’s absence from the hearing had been adequately explained. Article 32(3) of the Health Professions Order 2002 imposed upon the Panel a statutory duty to deal with proceedings expeditiously, and the Panel was satisfied that, having already given evidence and submitted written documentation to the Panel, Ms Sikpa’s views were known to the Panel. It was content that both it and the Legal Assessor could robustly challenge the HCPC’s case and ensure that Ms Sikpa’s position on the proceedings was fully reflected in the proceedings. It noted that it could not draw an adverse inference from Ms Sikpa’s absence. Accordingly, the Panel concluded that any disadvantage to Ms Sikpa potentially caused by her absence from this stage of proceedings was mitigated to a large extent by the fact that she had given evidence to it and participated fully in the proceedings to determination of statutory ground, as well as providing written submissions to it in respect of impairment and sanction.

17. The above decision having been communicated to Ms Sikpa, she joined the hearing for a short time as the Panel received legal advice on impairment, provided written submissions and told the Panel via a third party that she would not be in attendance on 29 September due to ill health. The Panel therefore maintained its position that it was appropriate to continue the hearing in her absence, and was grateful to Ms Sikpa for notifying it that she would not be in attendance. It was satisfied that she had voluntarily absented herself from the regulatory proceedings.

Application to adjourn

18. The Panel interpreted Ms Sikpa’s email of 27 September 2022 and the supporting letter of her GP to amount to a request for the hearing to be adjourned. It therefore invited Mr Chalmer’s submissions in this regard.

19. Mr Chalmers referred the Panel to the relevant practice note and reiterated his comments in support of his application to proceed in absence. He added that the current situation is “unhappy” but reminded the Panel it had found her action in a professional capacity to amount to misconduct. He submitted that allowing Ms Sikpa to continue to practice in the light of its findings would not prioritise the public interest if an adjournment was granted. He was particularly concerned at the suggestion that an adjournment would allow Ms Sikpa to continue to attend her new job but supplied no evidence to show Ms Sikpa could not fairly take part in the hearing. He concluded by telling the Panel that there was a need to resolve the outstanding regulatory matters and issues to be determined, and this should be concluded without further delay. He therefore opposed the application.

20. The Panel was conscious that the test it was expected to apply in considering an adjournment request was broadly similar to that of proceeding in absence, and therefore could be applied to the factors it had to consider set out in the case of CPS v Picton [2006] EWHC 1108 as follows:

a. expedition – the regulatory concerns date back to 2018 and the hearing commenced in June, is part heard and was agreed to resume at this time
b. the adjournment was opposed by the HCPC, not sought by it;
c. compromise Ms’ Sikpa’s ability to present her case if the adjournment is not granted – the Panel accommodated Ms Sikpa’s wishes in relisting this matter and she had had since 16 June 2022 to prepare her case in respect of impairment. She has provided written submissions and a testimonial therefore there is minimal compromise to her ability to present her case;
d. consequences of the proposed adjournment – the Panel has heard from witnesses and Ms Sikpa and found facts proved and to amount to misconduct. Ms Sikpa is now working and appears to have prioritised her attendance at work over her attendance at these regulatory proceedings;
e. Reason – the request is not due to fault on the part of either party but rather apparently due to Ms Sikpa’s need to alleviate her stress levels while settling into a new job.
f. the history of the case – there have been no previous adjournments however the case is part heard, having been unable to conclude during the originally listed period. As such, findings have been made and there is an imperative to conclude the regulatory process.

21. Having regard to all of the above, the Panel was satisfied that the public interest in concluding these proceedings outweighed Ms Sikpa’s interest in requesting an adjournment of the proceedings. The Panel appreciated the stress regulatory proceedings can cause registrants but conscious that this stress will only be relieved by the proceedings concluding. Accordingly, the Panel concluded it was fair and appropriate to refuse the application for an adjournment.

Background

22. At the relevant time, Ms Sikpa worked as a Band 8a Practitioner Psychologist with Black Country Partnership NHS Foundation Trust (“the Trust”). She initially worked at the Trust through an employment agency from October 2015, but was employed directly by the Trust from 1 November 2016. The Trust merged with Dudley and Walsall Mental Health Partnership NHS Trust in April 2020 to form Black Country Healthcare NHS Foundation Trust, which is what the Trust is now known as.

23. Ms Sikpa was suspended by the Trust pending investigation in March 2018 – the investigation included conducting an audit of her clinical caseload.

24. On 25 April 2018, the HCPC received an anonymous referral about Ms Sikpa which identified a number of concerns about her practice.

25. The HCPC contacted the Trust about the concerns. The Trust supplied information to the HCPC in August 2018 which appeared to confirm that the Trust had identified issues with record keeping, including that Ms Sikpa did not complete care plans and risk assessments for some service users.

26. On 29 January 2020, an Investigating Committee Panel of the HCPC determined that the concerns should be referred to the Conduct and Competence Committee.

Assessment of witnesses

27. The Panel was mindful of the issues identified in the case of Dutta v GMC [2020] EWHC 1974 (Admin), confirmed in the case of Khan v GMC [2021] EWHC 374 (Admin), in respect of determining the credibility of witnesses but considered that this did not prevent it from reflecting generally on the witness evidence it received.

Witness 1

28. The first witness relied upon by the HCPC was Mr MW, an Occupational Therapist employed by the Trust in the Child and Adolescent Mental Health Service (“CAMHS”) and a service manager at the time of these events. Mr MW undertook the initial and subsequent audit of Ms Sikpa’s clinical records and had operational management responsibility for her for part of her employment. Mr MW provided two detailed witness statements which set out his methodology in approaching the audit of records and his findings. He provided oral evidence under affirmation, telling the Panel that his professional practice and expectations of those working within a multi-disciplinary team (“MDT”) was different to that of Ms Sikpa. Mr MW did not speculate if he could not answer a question and on occasion did not offer an opinion on matters that would have been within his knowledge but perhaps not his expertise – for example, in respect of the reliability and accessibility of IT systems used by the MDT, including Ms Sikpa and her trainee, he told the Panel that the IT team would need to provide evidence of any issues experienced in logging on or general system availability.

29. Mr MW provided his opinion on the quality of Ms Sikpa’s care planning, risk assessment and discharge paperwork and readily accepted in his evidence if information he had termed insufficient or missing had come to light subsequently. The Panel was grateful for the comprehensive nature of his written and oral evidence, which meant the Panel had few questions for Mr MW.

Witness 2

30. The second witness called by the HCPC was Dr SS, a Chartered Clinical Psychologist, who was Ms Sikpa’s clinical supervisor at the Trust between October 2016 and January 2018. Dr SS also provided two detailed statements as well as providing oral evidence under affirmation. She told the panel there were no clinical concerns while she was supervising Ms Sikpa and that the case notes she reviewed in supervision were up to date, legible, signed, dated and in accordance with the Trust’s record keeping standards. Dr SS was shocked to learn of the concerns raised about Ms Sikpa

31. Dr SS confirmed to the Panel that in relation to young people who were service users, care plans should be prepared with them and reflect their goals, which sometimes meant that they could not be prepared until a number of sessions had taken place. She said the case notes should identify what had happened in the session and what the plan was for the next session so that any clinician could understand the future plan for the patient. Dr SS said that she would expect risk to be assessed each time a clinician saw the patient, though this could be recorded within the case notes of the young person, rather than on the formal risk assessment form. The formal written assessment should be updated at least every six sessions, with a general risk review undertaken periodically.

32. The Panel was grateful to Dr SS for the comprehensive nature of her evidence, which meant the Panel had few questions by way of clarification for her.

Witness 3

33. The final witness to give evidence to the Panel was Dr JD who worked with Ms Sikpa at the Trust for 2 – 3 years. Dr JD provided a witness statement to the Panel and also gave evidence under affirmation. Her evidence mainly related to Service User 15 and was therefore far less comprehensive in nature than that of the other witnesses. She answered questions from Ms Sikpa and the Panel but said that her recollection of events was impacted by the time that had passed.

The Registrant

34. Ms Sikpa provided the Panel with a written document of 47 pages prior to giving evidence under affirmation. She answered questions from the Panel and the presenting officer to the best of her ability but understandably was emotional on occasion when giving her evidence. Ms Sikpa appeared to contradict herself - for example, her position in respect of allegation 5(a) was variously:

a. Initially denying the allegation outright, saying that she was not required to take the height and weight or calculate the BMI;
b. When questioning Dr JD, that she did not ask for advice and had no reason to discuss Service User 15 with Dr JD because Dr JD was not qualified at that point and Ms Sikpa was an experienced Band 8a Psychologist;
c. In her written 47 page submission, stating “The page where I recorded SU15 BMI and onward service recommendations (in this instance Core CAMHS as noted by the referent [sic] on page D83), appears to has been removed and replaced. Therefore, I cannot prove that I did record SU15 BMI.”
d. In cross-examination:
i. that she had taken the height and weight of Service User 15 but that it was her habit to write up her notes and she had left the Trust before completing the writing up process;
ii. that she must have taken height and weight and calculated the BMI for service user 15 otherwise it could not have been accepted as a “core” CAMHS matter.
e. In her submission on Facts, that the issue was that she “did not follow the option to record SU15 BMI”.

35. The Panel was however mindful that Ms Sikpa was unrepresented and attempting to handle a substantial volume of papers from the HCPC, as well as multiple witnesses, between 4 and 6 years after the events took place. It appreciated her efforts to produce written submissions for it to clarify her position and could see that she had taken on board its explanation of the different stages of the fitness to practise process. However, where Ms Sikpa’s evidence conflicted with that of another witness, the Panel did not generally prefer Ms Sikpa’s evidence.

Decision on Facts

36. The Panel was conscious that it was obliged to approach the consideration of allegations sequentially, deciding firstly whether the facts set out in the allegation are proved, then whether those facts amount to the statutory ground set out in the charge and if so, whether the Registrant’s fitness to practise is impaired, as set out in the case of Cohen v GMC [2008] EWHC 581.

37. The Panel considered each particular in turn, taking account of the documentary and oral evidence available to it, the submissions of Mr Chalmers and Ms Sikpa and the legal advice provided by the Legal Assessor. It also had regard to the practice notes issued to assist it.

38. In determining whether an allegation is “well founded” or “proved”, the Panel was required to decide firstly whether the HCPC, which has the burden of persuasion in relation to the facts alleged, has discharged that burden, regardless of any admissions that may have been made by Ms Sikpa.
1 (a) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 1 - PROVED

39. Mr Chalmers submitted that the requirement for clinicians to complete care plans for service users was contained within section 4.2.1 of the Trust’s Clinical Record Keeping Standards Policy. He reminded the Panel that all three HCPC witnesses told the Panel that a care plan should be completed after an initial assessment of a service user, though Dr SS accepted that in certain circumstances, the completion of the care plan may need to be delayed while a relationship was established with the service user.

40. The Panel was conscious that Ms Sikpa, having initially denied this allegation, admitted it prior to giving evidence, despite having said in her initial submission that she did not work with Service User 1 so she had nothing to record on a care plan. However, in her submission on facts, Ms Sikpa stated:
“Mr Chalmers appears to confuse the initial choice appointment with the initial appointment at the start of therapy. During the choice appointment, the witnesses and I agree that it is mandatory to complete a risk assessment and a care plan during the appointment. There is no such stipulation for the completion of either a risk / care assessment in the first therapy session.”

41. The Panel therefore reviewed the evidence provided to it in relation to the policy and process adopted within the Trust in relation to initial appointments so it was clear as to what was expected of clinicians at each stage of the service user’s engagement with CAMHS. It carefully considered the “Operational Policy, Child and Adolescent Mental Health Services, Children, Young People and Families Division” provided to it, which was adopted in September 2015 and was applicable while Ms Sikpa worked at the Trust. The Panel noted:

a. The purpose of the policy was to “provide operational guidelines under which the CAMHS team will provide a safe and evidence based service”. It applied to all staff, secondees, students and volunteers;
b. One of the objectives of the policy was to give families “access to timely, integrated, high quality, multi-disciplinary mental health services to ensure effective assessment, treatment and support”;
c. The policy sets out service aims, including that there is “timely assessment and early intervention appropriate to the needs of each child, young person and their family” and "To assess and treat the needs of children and young people with complex problems in a timely manner in accordance with national guidance.”
d. Exclusion criteria (which the Panel interpreted to mean those who should not be accepted to, or remain in, CAMHS) are also included in the policy, one of which is “Children / young people who are experiencing a normal reaction to a significant life event”;
e. The policy identifies the staffing groups within the CAMHS team at paragraph 6.3. It does not define “core CAMHS” but goes on to explain the four tiered strategic framework for the provision of service, placing the CAMHS team within the Tier 3 (specialist) category – “a multi-disciplinary service working in a community mental health clinic with an integrated child psychiatry outpatient service, providing a specialised service for children and young people with more severe, complex and persistent disorders.”
f. Paragraph 7.6 identifies “Initial Assessment ‘Choice’ Interviews” are to be offered to those considered suitable for the service, with all clients being offered a 1 hour appointment. It goes on to provide that “The team will undertake an assessment in partnership with service users, families and if appropriate other professionals. Following the appointment a summary of the management plan is sent to the family, appropriate professional, GP and referrer.”;
g. Paragraph 7.7 addresses case allocation, stating “A key part of CAPA is matching the young person and family’s choice of goals to a clinician with the right extended core skills to help them with these. This means choosing a core partnership clinician at the end of the choice appointment”;
h. The referral guidance confirms who will be accepted for specialist assessment and treatment, including “Eating disorders - Please consider an early/prompt referral where there are symptoms of emerging eating disorder. GP’s are asked to provide details of most recent assessment, including BMI, height, weight and any blood tests where possible”;
i. Appendix 4 sets out the referrals pathway for specialist CAMHS at Sandwell, which distinguishes between a referral sent via email to the team’s point of access and a telephone contact via A & E staff for self-harm referrals. This latter referral is progressed by a 7 day follow up appointment, after which the patient is either discharged to their GP or provided with targeted intervention for 6 – 8 weeks. The emailed referrals that are handled through a Choice initial assessment meeting can be assigned either a standard appointment (18 weeks) or a 14 day priority appointment if there is “imminent risk, e.g. Eating Disorder / low BMI (<17.5), Psychosis, Suicidal, Significant Low Mood”;
j. Appendix 8 summarises referrals to the CAMHS Crisis Assessment and Intervention Team (CAIT), which concludes with either admission to a ward for CAIT assessment, or discharge home with a follow up CAIT appointment within 72 hours.

42. The Panel concluded that a “Choice” appointment as referenced by those giving evidence to it was the service user’s first attendance at CAMHS and could be undertaken by a clinician from any of the “staffing groups” in the team because at the end of the appointment, the young person would be matched to “a clinician with the right extended core skills to help them”. The Panel formed the view that “core CAMHS” was the umbrella term adopted by clinicians in the service to distinguish them from specialist services. The Panel could not identify any reference in the policy to “Choice plus” appointments as referenced by Dr. JD in her evidence, but considered this may be because such an appointment should be required only in exceptional circumstances and did not therefore warrant identification in the policy. The Panel also noted that it had not been provided with policies or procedures which dictated how treatment or therapy should be delivered, and concluded this was because the Trust expected each clinician to treat their clients in accordance with their professional standards. However, it had been provided with a document entitled “Clinical Record Keeping Standards”, dated April 2017.

43. The Clinical Record Keeping Standards document includes an explanation of the terms used within it, and defines a clinical record as “A collection of information about the care of a service user, provided by a range of healthcare professionals accountable to the Trust. If inpatients this must be made available at all times during the service users’ stay”. At paragraph 4.2.1, it confirms that a health care record is the complete care record. This includes the care plan, which it defines as a “comprehensive plan of care formulated from assessment and incorporating a risk/ crisis plan”. The document goes on to explain that “Individual clinical records must be created after the multi-disciplinary team (MDT) has made the decision to accept the client into the care of the trust or when birth notification is received in CYPF” and elaborates further to confirm “All discussions, decisions and subsequent actions by the MDT, care delivered and the information shared must be clearly recorded and documented”. The Panel determined that this supported the HCPC witness testimony that each clinician was responsible for preparing a care plan in respect of their treatment of the service user. The service user could therefore have multiple care plans in their clinical record.

44. In respect of Service User 1, the Panel were supplied with copies of the patient records. Service User 1 was admitted to hospital in February and March 2016 and was accepted by Tier 3 CAMHS on 23 March 2016. She was seen by Ms Sikpa on 5 April 2016, 21 April 2016 and 5 May 2016. Ms Sikpa accepted that she had not produced a care plan but said that this was not required because “SU1 and I did not work together so I had nothing to record on a care plan”. She went on to say that a care plan had been completed for SU 1 by another qualified practitioner in March 2016 but she identified “no clinical concerns or risks”.

45. The Panel was satisfied that Ms Sikpa had seen SU1 on several occasions but did not complete a care plan for Service User 1 by her own admission and the interrogation of the evidence provided to it. Accordingly, this allegation is proved.
1 (b) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 2 - PROVED

46. The summary set out in respect of the policy position of the trust and the general evidence of HCPC witnesses in respect of Allegation 1(a) is equally applicable to this allegation and is therefore adopted as set out above and not repeated.

47. Ms Sikpa told the Panel that she “had three sessions in total with SU2 and given the complexities involved this was insufficient time to complete a care plan”. She has explained to the Panel why she did not complete the care plan, but has been reminded on several occasions that the allegation is essentially either that it was done, or it was not. Any reference to why it was not done would be relevant for the Panel, but not in respect of this factual stage of the proceedings.

48. The Panel was satisfied that Ms Sikpa did not complete a care plan for Service User 2 by her own admission and the interrogation of the evidence provided to it. Accordingly, this allegation is proved.
1 (c) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 3 – NOT PROVED

49. The summary set out in respect of the policy position of the trust and the general evidence of HCPC witnesses in respect of Allegation 1(a) is equally applicable to this allegation and is therefore adopted as set out above and not repeated.

50. Mr Chalmers submitted that Ms Sikpa was responsible for ensuring that her trainee completed a care plan for Service User 3 but accepted that there was no evidence available to the Panel to show that the proposed appointment with Service User 3 on 5 January 2018 actually took place.

51. Ms Sikpa told that Panel that this service user must have been included in error as neither she nor her trainee had worked with Service User 3.

52. Given the lack of evidence that Service User 3 had attended any appointment with either Ms Sikpa or her trainee, the Panel could not accept Ms Sikpa’s admission in respect of this allegation and found it not proved on the balance of probability.

1 (d) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 4 - PROVED

53. The summary set out in respect of the policy position of the trust and the general evidence of HCPC witnesses in respect of Allegation 1(a) is equally applicable to this allegation and is therefore adopted as set out above and not repeated.

54. Mr Chalmers submitted that Ms Sikpa saw Service User 4 on six occasions and that Service User 4 was happy, willing to engage and offering full answers and therefore Ms Sikpa should have completed a care plan.

55. Ms Sikpa told the Panel that her work was included on a “multi-agency / systemic care plan” which was an accurate and complete reflection of the work done with Service User 4 so she did not need to do her own care plan. She therefore admitted the allegation.

56. The Panel had not seen a central care plan for Service User 4. In any event the Panel did not consider that inclusion of Ms Sikpa’s work on a central care plan amounted to a care plan as set out within the Trust’s Clinical Record Keeping Standards document and therefore found this allegation proved.

1 (e) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 7 - PROVED

57. The summary set out in respect of the policy position of the trust and the general evidence of HCPC witnesses in respect of Allegation 1(a) is equally applicable to this allegation and is therefore adopted as set out above and not repeated.

58. Mr Chalmers submitted that Ms Sikpa did not complete a care plan for Service User 7 but instead relied upon the care plan of a nurse practitioner.

59. Ms Sikpa submitted that there was a care plan for Service User 7, which she reviewed, found to be clinically relevant and including the service users voice. She could not add anything new to the care plan. She also told the Panel that she had agreed the intended “care plan” when providing supervision to the trainee that wrote it. She admitted not completing a care plan herself for Service User 7.

60. Given the testimony and admission made by Ms Sikpa, the Panel was satisfied this allegation was proved on the balance of probability.

1 (f) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 9 – PROVED

61. The summary set out in respect of the policy position of the trust and the general evidence of HCPC witnesses in respect of Allegation 1(a) is equally applicable to this allegation and is therefore adopted as set out above and not repeated.

62. Mr Chalmers submitted that Ms Sikpa met with this service user on 10 October 2017 and there was no reason to not complete the care plan in accordance with Trust policies and procedure.

63. Ms Sikpa told the Panel she had 1.5 sessions with Service User 9 and that “Completion of the Care plan and Risk assessment was not possible due to lack of contact”.

64. The Panel was satisfied that Ms Sikpa had not completed a care plan in relation to Service User 9 in accordance with Trust expectations and therefore accepted her admission of this allegation and found it proved.

1 (g) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 12 - PROVED

65. Ms Sikpa was the supervising psychologist of EO, who was seeing Service User 12. As such, Ms Sikpa was responsible for ensuring that EO completed a care plan for Service User 12.

66. Mr Chalmers noted that this service user was seen by Ms Sikpa’s trainee twice but no care plan was completed.

67. Ms Sikpa acknowledged that her trainee saw Service User 12 but submitted that “sporadic attendance and the early opting out of the service meant there was insufficient contact time for the assessments to be completed”.

68. The summary set out in respect of the policy position of the Trust and the general evidence of HCPC witnesses in respect of Allegation 1(a) is equally applicable to this allegation and is therefore adopted as set out above and not repeated.

69. The Panel was satisfied that this allegation was proved on the balance of probability given the admission of Ms Sikpa and the failure to comply with Trust policies on recording care plans.

1 (h) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and / or ensure completion of a Care Plan for Service User 14 – PROVED

70. The summary set out in respect of the policy position of the trust and the general evidence of HCPC witnesses in respect of Allegation 1(a) is equally applicable to this allegation and is therefore adopted as set out above and not repeated.

71. Mr Chalmers reminded the Panel that Ms Sikpa met Service User 14 on 10 January 2018 and recorded an “agreed intervention” in her notes, but did not detail what this was in a care plan.

72. Ms Sikpa submitted that she had two sessions with Service User 14, 3 weeks apart and that “there was not sufficient contact time to complete the assessments, especially given SU14 well documented communication limitations”.

73. The Panel was satisfied that this allegation was proved given the admission by Ms Sikpa, the fact that some “intervention” work had been agreed but not noted down and the non-compliance with Trust expectations.

2 (a) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of Risk Assessments for Service User 3 – NOT PROVED

74. Mr Chalmers submitted that the requirement for clinicians to complete a risk assessment for service users is set out in section 4.2.1 of the Trust’s Clinical Record Keeping Standards Policy. He reminded the Panel that Dr SS told it that risk assessments are done by all clinicians when they undertake an initial assessment of a patient, while Mr MW stated that risk assessments should be on a separate document so they are accessible to the team, completed at the outset and periodically reviewed.

75. Ms Sikpa’s position was that she would usually complete a risk assessment for each service user, however she told the Panel “there are some instances where because of the nuances in a particular therapeutic relationship with a particular service user there are occasions when these will inform my clinical decisions and I may decide that it is important and in the SU interest for me to wait a while before completing the risk assessment. Not having completed a risk assessment (yet) does not mean I would not have completed the assessment when the reliable information was available to me.” She submitted that the trust policy recognises that the assessment of risk is “an ongoing live dynamic process”.

76. Ms Sikpa maintained that neither she nor her trainee had worked with Service User 3 so they could not complete a risk assessment and she considered this Service User had been included in error.

77. The Panel could not establish that either Ms Sikpa or her trainee had ever seen Service User 3. Neither could therefore reasonably be expected to complete a risk assessment for Service User 3. The HCPC had not persuaded the Panel that a risk assessment was required from Ms Sikpa or her trainee in respect of this service user. It therefore considered this allegation had not been proved on the balance of probability.

2 (b) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of Risk Assessments for Service User 4 – PROVED

78. Mr Chalmers reminded the Panel that Ms Sikpa saw Service User 4 on 6 occasions but did not complete a risk assessment.

79. Ms Sikpa told the Panel that she had 4 sessions with Service User 4 and that “SU4 presentations meant it was important for me as the clinician not to make any assumptions about our social interaction or styles of communication. This meant I had to take extra time to learn how to best work / communicate clinically with SU4.” She denied ignoring risk but rather told the Panel that she had nothing new to add but it was “clinically appropriate for me to engage in ongoing risk monitoring during the sessions, which I did and this is evident in the notes”.

80. The Panel then carefully considered the documentation provided to it, focusing in particular on the Clinical Record Keeping Standards document. Many of the elements of this policy had already been identified in respect of allegation 1, however the panel noted that the document references that it was a “minimum requirement” to include in the health care record a “completed risk assessment tool, e.g. Sainsburys risk assessment tool”. The document goes on to identify at paragraph 4.2.20 that “Significant risks must be recorded. There is a section in the health care record for filing risk assessments and risk management plans”. In addition to the record keeping document, the Panel also considered the Operational Policy for CAMHS, which was in effect from September 2015. As with the record keeping document, many of the observations contained in this decision in respect of Allegation 1 are equally relevant to the issue of recording risk. However, particular regard was had to the section on risk assessment management, which provides that the risk assessment tool used by the service is the Steve Morgan Model, which was implemented on 3 August 2016.

81. Appendix 10 of the operational guidance provides additional guidelines for working with risk and specifically provides that the assessment form is for:
“All people who are referred into any part of the statutory sector services, however long or short the duration of contact. This would include people who are only seen very briefly by one member of staff, and who have no previous history of contact with services; through to those with long histories of contact and/or multiple admissions to in-patient/residential units. Not all eventualities can be covered in these guidelines, but the brief nature of documenting your professional judgements means there should be no exclusions from using this tool.”
The guidance goes on to specify that risk assessment should be considered from the first point of contact but can be done from only the information on the referral. It includes a recommendation that the form be completed quickly immediately after a one-off and brief contact.

82. Given the above, and Ms Sikpa’s admission of this allegation, the Panel was satisfied that this allegation was proved on the balance of probability.

2 (c) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of Risk Assessments for Service User 7 – PROVED

83. Mr Chalmers submitted that Ms Sikpa had seven sessions with this service user between 18 September 2017 and 27 November 2017 but did not complete a risk assessment.

84. Ms Sikpa’s submissions in this regard were the same as in respect of allegation 1(e) in that she told the Panel that there was a risk assessment in the evidence bundle for Service User 7, completed by someone else, which she said was completed in preparation for transfer to “psychology / myself”.

85. Given the above, and Ms Sikpa’s admission of this allegation, the Panel was satisfied that this allegation was proved on the balance of probability.

2 (d) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of Risk Assessments for Service User 9 - PROVED

86. Mr Chalmers told the Panel that Ms Sikpa had not completed a risk assessment for this service user. Ms Sikpa’s submissions in this regard were the same as in respect of allegation 1(f) in that she told the Panel that she had only had 1.5 sessions with Service User 9 but her paperwork did show that she was monitoring risk.

87. The Panel accepted that there was reference to risk within Ms Sikpa’s notes, however, this did not amount to a risk assessment as required by the Trust. Accordingly, the Panel found this allegation proved on the balance of probability.

2 (e) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of Risk Assessments for Service User 12 - PROVED

88. Mr Chalmers told the Panel that Ms Sikpa and her trainee discussed risks regarding Service User 12 after an appointment on 6 October 2017, but no risk assessment was completed.

89. Ms Sikpa noted there had been two sessions but, as with allegation 1(g), said that there was insufficient contact time for the assessments to be completed. In her oral evidence, Ms Sikpa said that her trainee was usually very good at doing her assessments. She also told the Panel that a risk assessment had been completed less than 3 weeks before the trainee started working with Service User 12 so she did not consider that the service user was ”left without any sort of relevant risk assessment”.

90. The Panel accepted Ms Sikpa’s admission that no risk assessment had been completed for Service User 12, and therefore was satisfied that this allegation was proved on the balance of probability.

2 (f) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of Risk Assessments for Service User 14 - PROVED

91. Mr Chalmers told the Panel that Ms Sikpa had not completed a risk assessment for Service User 14.

92. As with allegation 1(g), Ms Sikpa maintained that there was insufficient time with the service user to complete the assessments, especially given the “well documented communication limitations” impacting Service User 14. She also drew to the Panel’s attention that the CAIT team were involved therefore there would have been a risk assessment but it was not included in the bundle,

93. For the reasons set out previously, the Panel considered that it was incumbent upon Ms Sikpa to undertake a risk assessment in respect of Service User 14, and the other service users, in compliance with the Trust’s expectations as set out in the record keeping document and the operational policy. It therefore accepted her admission that no risk assessment had been completed for Service User 14, and therefore was satisfied that this allegation was proved on the balance of probability.

3 (a) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not date Risk Assessments for Service User 1 - PROVED;

94. Mr Chalmers submitted that the failure to date a risk assessment was more serious than failing to date a care plan.

95. Ms Sikpa admitted this allegation but submitted to the Panel that 6 out of 8 completed risk assessments are dated, as are all of the case notes and she invited the Panel to find that these two missing dates were merely errors which, now she was aware of them, she would not repeat.

96. The Panel noted the admission by Ms Sikpa of this allegation, and the Trust’s expectations for the completion of risk assessments, including dating them. It was satisfied that the allegation was proved on the balance of probability.

3 (b) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not date Risk Assessments for Service User 5 - PROVED;

97. As with allegation 3(a), Mr Chalmers submitted that Ms Sikpa did not date the risk assessment completed in respect of Service User 5.

98. Ms Sikpa asserted, as with 3(a), that it was her normal practice to date risk assessments and that this had been a lapse.

99. The Panel was satisfied that the risk assessment for Service User 5 was not dated, and that this was admitted by Ms Sikpa, therefore this allegation was proved.

4 (a) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure timely completion of the Trust’s electronic patient note system, Oasis, to indicate contact with Service User 5 - PROVED

100. Mr Chalmers confirmed that Oasis was the electronic patient recording system which was in place at the time that Ms Sikpa worked at the Trust. She was required to record patient contacts on this system within 3 working days, and ensure her trainees did the same. The system assisted with reporting outcomes to the Trust's commissioners. The record showed that the contact with Service User 5 on 27 February 2018 was not recorded on the system until 7 March 2018.

101. Ms Sikpa told the Panel in her original submission that of the 56 entries highlighted by the Trust, there are no concerns with 47 of them, which cover a period of one year. Of the 9 alleged late diary entries, she is alleged to have entered 4 of them while her trainee entered the other 5. She termed the late entries as “anomalies” that were not reflective of a pattern of misconduct. She identified problems with Trust IT systems, and in particular that her trainee was not supplied with her own log in details “for some time”. A proposed interim solution suggested was for Ms Sikpa to share her log in details with her trainee, which she was not happy about. She invites the Panel to note that only managers could authorise electronic accounts for new starters. She also invites the Panel to note that “a limited three-day window is the primary focus” of this allegation and that she did not work Saturday and was therefore unable to explain one entry being recorded against a Saturday. She suggested that the reason a number of entries was made on one date was because of the IT reliability issues.

102. The Panel noted that Ms Sikpa admitted this allegation, and that the information provided to it identified that entries were made outside of the three day window. It was conscious that the extent of any delay was not a matter for it to consider at this fact finding stage, but would clearly be of relevance when considering the extent to which the same could amount to a statutory ground. It was satisfied that this allegation was proved on the balance of probability.

4 (b) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure timely completion of the Trust’s electronic patient note system, Oasis, to indicate contact with Service User 6 - PROVED

103. As with allegation 4(a), Ms Sikpa was expected to record contact with a service user within 3 days, but Mr Chalmers submitted that for Service User 6, the contact on 26 February 2018 was not recorded until 7 March 2018.

104. Ms Sikpa admitted this allegation but, as with 4(a) invited the Panel to conclude this was due to system access issues.

105. The Panel was satisfied that the contact with Service User 6 should have been entered within 3 working days but was not. The matter of why this was not done, or how long the delay was, is not a matter for this fact finding stage. It therefore found that this allegation proved on the balance of probability.

4 (c) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure timely completion of the Trust’s electronic patient note system, Oasis, to indicate contact with Service User 7 - PROVED;

106. Mr Chalmers told the Panel that Ms Sikpa’s contact with Service User 7 on 18 September 2017 was not logged into the Oasis system until 24 April 2018.

107. Ms Sikpa admitted this allegation but reminded the Panel that she left the Trust by the time the entry was added and therefore could not have made the entry dated 24 April 2018.

108. The Panel was satisfied that the contact with Service User 7 should have been entered within 3 working days but was not. It therefore found that this allegation was proved on the balance of probability. It was not relevant to this part of the process as to who made the later entry given Ms Sikpa admitted not entering the details into the Oasis system.

4 (d) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure timely completion of the Trust’s electronic patient note system, Oasis, to indicate contact with Service User 8 - PROVED

109. Mr Chalmers told the Panel that Ms Sikpa’s contact with Service User 8 on 8 January 2018 was not logged into the Oasis system until 12 January 2018.

110. Ms Sikpa admitted this allegation but said the delay of one day was due to her being “out on training”.

111. The Panel was satisfied that the contact with Service User 8 was entered one day late. The explanation for this was not of relevance to the fact finding exercise and it therefore found this allegation proved.

4 (e) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure timely completion of the Trust’s electronic patient note system, Oasis, to indicate contact with Service User 10 - PROVED;

112. Mr Chalmers told the Panel that Ms Sikpa’s contact with Service User 10 on 1 March 2018 was not logged into the Oasis system until 7 March 2018.

113. Ms Sikpa admitted this allegation but said the delay was due to her being unable to access the system, which was why there were multiple entries on 7 March 2018.

114. The Panel was satisfied that the contact with Service User 10 was entered outside of the required period. The explanation for this was not of relevance to the fact finding exercise and it therefore found this allegation proved.

4 (f) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure timely completion of the Trust’s electronic patient note system, Oasis, to indicate contact with Service User 13 - PROVED;

115. Mr Chalmers told the Panel that the entering of records of contact with Service User 13 were delayed for a number of appointments. The appointment of 24 November 20127 was recorded on 1 December 2017 and appointments on 13 November 2017, 1 December 2017 and 8 December 2017 were recorded on 12 February 2018.

116. Ms Sikpa admitted this allegation but said the delay was due to her trainee not having her own log in and being unable to access the system other than in Ms Sikpa’s name. She drew the Panel’s attention to the multiple duplicate entries.

117. The Panel was satisfied that a number of contacts with Service User 13 were entered outside of the required periods. The explanation for this was not of relevance to the fact finding exercise and it therefore found this allegation proved.

5 (a) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, on 27 March 2018, you were advised to measure the weight and height of Service User 15 but did not do so – PROVED

118. Mr Chalmers told the Panel that Ms Sikpa conducted an urgent initial assessment with Service User 15 on 27 March 2018. Dr JD told the Panel that she recalled speaking informally with Ms Sikpa about this appointment on the morning and suggested to her that she make sure that she at least recorded the height and weight of Service User 15 so that their body mass index could be calculated.

119. Ms Sikpa’s evidence in respect of this allegation was somewhat confusing. At the start of the hearing, when the allegation was read to her, she denied it. In her cross examination of Dr JD, she suggested that she did not discuss Service User 15 with Dr JD or ask for advice. However, in her first written submission, prior to giving evidence and being cross examined, she said:

“I appreciate that it appears I have been arguing against taking a client’s BMI. This is not the case. I am merely pointing out, in my defence, on this singular occasion of a missing BMI reading, Trust policy was not breached and the service users was not put at risk. It is my usual practice to take BMI, hence this being the singular example of allegedly not taking BMI.”

120. During cross examination, Ms Sikpa variously said she did take the BMI but did not put it in the notes, did not take the BMI because she was not required to and it was not the sole indicator of an eating issue; took the BMI of two service users but she could not recall which; and must have taken the BMI and put it on the referral “to core” otherwise it would not have been accepted.

121. Ms Sikpa’s written submissions on facts did not address this allegation but rather focused on allegation 5(b).

122. The Panel noted that the height, weight and BMI were absent from Ms Sikpa’s notes of her meeting with Service User 15 on 27 March 2018. When giving evidence, Dr JD was clear in her recollection as to how the conversation on 27 March 2018 had come about – she related that they both tended to get into the office early and that Ms Sipka was not eager for the appointment so Dr JD suggested either putting the meeting off or at least taking the basic measurements and doing a follow up appointment. Dr JD was clear that the conversation was informal and that Ms Sipka was not seeking her advice. In contrast, Ms Sikpa could not remember the conversation – understandably given it was more than 4 years ago – and did not think she would have sought advice on this matter. However, she did concede that she had had “bad news” at that time.

123. The Panel preferred the evidence of Dr JD in this instance. It considered her explanation of the conversation and circumstances more likely given the level of detail provided and Dr JD’s characterisation of it being no more than a passing conversation. It carefully considered the normal sense of the allegation and concluded that the reading of “advise” did not equate to “instructed” but rather “suggested”.

124. Accordingly, the Panel found it more likely than not that Dr JD discussed taking Service User 15’s height, weight and BMI with Ms Sikpa on the morning of 27 March 2018, but that Ms Sikpa did not do so. The allegation was therefore proved on the balance of probability. The issue as to whether this allegation can amount to a statutory ground is not one for the Panel at this stage but, given its finding on the facts, will be highly material to its determination later in the proceedings.

5 (b) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, on 27 March 2018, you did not identify that Service User 15 required urgent intervention for an eating disorder – NOT PROVED

125. Mr Chalmers submissions to the Panel in respect of this matter were limited, essentially reflecting that when Dr JD saw Service User 15 for a “Choice Plus” appointment on 16 April 2018 due to concerns about the information put in the case notes at the meeting that Ms Sikpa had with the service user on 27 March 2018, she was so concerned about the BMI she calculated that she immediately contacted the Eating Disorder Team (EDT).

126. Ms Sikpa told the Panel that she recalled Service User 15 being “a tiny thing” and that BMI was not necessarily an accurate tool when applied to young people. She said that she identified that food was an issue and, based upon her previous experience of eating issues, determined how to handle the matter. She believed that the EDT did not receive referrals for children under 14 and considered that her decision to not refer Service User 15 was justified given that the treatment recommended to Dr JD when she spoke to the EDT was no different to Ms Sikpa’s plan. Ms Sikpa was animated in telling the Panel that Service User 15 did not have a diagnosis of an eating disorder at that point, nor was it her place to make such a formal diagnosis – this was agreed by Dr SS.

127. The Panel carefully considered the documentary and oral evidence before it, noting the Trust expected that clinicians would make prompt referrals to specialists, particularly eating disorders as the earlier the intervention, the more successful it was likely to be. It noted that the Eating Disorder Service policy document suggests a BMI of less than 15 indicates there is a high level of risk to physical health, and when Dr JD assessed Service User 15 on 16 April 2018, she calculated the BMI as 14.2. However, there was no evidence before the Panel as to the nature of the “urgent intervention” that was said to be needed. Witnesses agreed that “urgent” did not mean in-patient treatment.

128. The Panel was satisfied that Ms Sikpa had identified that eating was an issue for Service User 15, and although no care plan or risk assessment was produced, recorded the concerns in her notes of the session. They also noted that it was not her role to diagnose an eating disorder. The Panel considered that while other clinicians may have reacted differently, it could not be said that Ms Sikpa did not identify the issues, or ignored them. Accordingly, this allegation was, on the balance of probability, not proved.

6 (a) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of appropriate discharge paperwork and / or did not indicate discharge on Oasis for Service User 1 - PROVED

129. The Panel heard that when a service user is ready to be discharged from CAMHS as a whole or in part, the clinician must prepare the discharge paperwork. This includes a discharge summary or letter confirming treatment has concluded. It is sent to the referrer, the patient's GP and the patient or their family or carer. The discharge process also applies when a treatment concludes, even if there are a number of professionals still treating the patient. As soon as a patient can be discharged by a clinician, the Oasis system must be updated to reflect the status of the patient. This is required to manage risk and liability, as well as to give the patient certainty and accurately reflect the clinician's caseload.

130. Mr Chalmers submitted that Ms Sikpa’s notes of the meeting with Service User 1 on 5 May 2016 suggest that it was agreed that they would be discharged but she did not complete discharge paperwork.

131. Ms Sikpa did not address this allegation in her written submissions on facts, but in her earlier written evidence she told the Panel:

“All the manual paperwork that should be completed on discharge is in the file. It appears that the discharge paperwork, completed electronically, is not present in the evidence bundle. At the time, I was a relatively new agency worker and unfamiliar with the electronic discharge system. SU1 was one of the first discharges I did whilst working in CAMHs; therefore, there is a possibility that I made a mistake.”

132. When she was cross examined on this allegation, Ms Sikpa said that she would send a discharge letter only to the party that referred the young person to CAMHS. She did not accept that a letter should be necessarily sent to the patient or their GP, saying the patient would know they had been discharged by the last appointment and that the discharge was effectively evidenced by the completion of the HoNOSCA assessment tool and updating the Oasis system. She did however admit the allegation.

133. The Panel considered the oral and written evidence carefully. It reviewed the Trust’s policy for Discharge and Transfer of Care but noted that this document was dated July 2018, after Ms Sikpa left the Trust. It was therefore of limited use to the Panel but did however articulate the general importance of the discharge process. The Panel noted that there were two HoNOSCA score sheets for Service User 1, the first dated 14 April 2016 showing a score of 7, and a second dated 10 May 2016 showing a score of 0. There was also an undated document entitled “Risk Assessment and Management Plan for Specialist Services” which identified no concerns and was signed by Ms Sikpa. The document was not however signed on the second page. Ms Sikpa did not accept, in cross examination, that she was required to complete the back page, and also suggested that she did not know how to discharge a patient on the Oasis system.

134. The Panel did not accept that the documentation provided to it for Service User 1 was a complete package of discharge paperwork. It determined that no discharge process could be complete without the patient and their GP being informed of the discharge in writing. It therefore found this allegation proved on the balance of probability.

6 (b) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of appropriate discharge paperwork and / or did not indicate discharge on Oasis for Service User 2 - PROVED

135. Mr Chalmers submitted that Ms Sikpa’s notes of the meeting with Service User 2 on 20 June 2016 identified that she would speak to a colleague in the team to guide future intervention, but that this was the last involvement – there was no record of what happened so it was not known if the conversation took place, and if it did, what the decision was. There was no record of the psychological input the service user had received and no completed discharge paperwork. Service User 2 was not discharged on Oasis.

136. In her written submission, Ms Sikpa told the Panel:
“At the time of this discharge, I was a relatively new agency worker and unfamiliar with the discharge system SU2 was among one of the first SU I had discharged from the service therefore there is a possibility that my performance in this arena was not perfect”

137. The Panel accepted the admission of this allegation by Ms Sikpa and noted that she made no reference to it in her submissions on facts. It was satisfied that this allegation was proved on the balance of probability.

6 (c) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of appropriate discharge paperwork and / or did not indicate discharge on Oasis for Service User 7 – PROVED

138. Mr Chalmers submitted that Ms Sikpa’s notes of the meeting with Service User 7 on 27 November 2017 indicated that discharge was agreed, however the paperwork was not completed nor was Oasis updated to that effect.

139. In her written submission, Ms Sikpa told the Panel:
“Discharge paperwork has not been included in the bundle but I recorded completing it with the SU7. Given the numerous instances of serious issues with paperwork handling and management in BCPFT it is not unreasonable to conclude that the absence of the paperwork is more about file mismanagement rather than fault on my part.
It should be clear that it would have made no sense for me to write about and thereby draw attention to work I had not done
In terms of the electronic discharge I was not able to complete this as a new electronic discharge process had been implemented. I struggled a bit with this new system, Therefore I booked a training session with the mobile specialist. To enable me to use the system competently. The wait for this did cause a small backlog of 3 in my cases awaiting discharge, SU7 was 1 of the 3“

140. The Panel recalled that when Ms Sikpa was taken to the page at which she said she referenced discharge, it was not the page she expected and she was unable to identify the correct reference. The Panel was not satisfied that documents were missing and it considered it more likely than not that the documentation had not been completed. Accordingly, it found this allegation proved.

6 (d) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of appropriate discharge paperwork and / or did not indicate discharge on Oasis for Service User 9 – PROVED

141. Mr Chalmers told the Panel that Service User 9 was last seen by Ms Sikpa on 14 November 2017. On 24 November 2017, she was told by Service User 9’s mother that they had broken their tibia but no further activity was recorded. On 22 February 2018 Ms Sikpa was asked what her involvement was at that time, to which she responded that Service User 9 did not want therapy and had not attended. There was no record of appointments made after 24 November 2017 that were not attended by the service user, and no evidence of any discharge paperwork being completed for Service User 9 by Ms Sikpa.

142. Ms Sikpa said of this allegation:

“In terms of the electronic discharge, I was not able to complete this as a new electronic discharge process had been implemented. I struggled a bit with this new system, Therefore I booked a training session with the mobile specialist. To enable me to use the system competently. The wait for this did cause a small backlog of 3 in my cases awaiting discharge, SU9 was 1 of the 3.”
143. The Panel was satisfied that Ms Sikpa had not completed the discharge documents for Service User 9 and therefore found this allegation proved on the balance of probability.

6 (e) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of appropriate discharge paperwork and / or did not indicate discharge on Oasis for Service User 11 - PROVED

144. The last session between Service User 11 and Ms Sikpa was recorded as 11 October 2017. Mr Chalmers told the Panel that no discharge paperwork for Service User 11 was completed by Ms Sikpa.

145. Ms Sikpa said of this allegation:
“I was not able to complete this as a new electronic discharge process had been implemented. I struggled a bit with this new system, Therefore I booked a training session with the mobile specialist. To enable me to use the system competently. The wait for this did cause a small backlog of 3 in my cases awaiting discharge, SU11 was 1 of the 3.”

146. The Panel was satisfied that Ms Sikpa had not completed the discharge documents for Service User 11, and had admitted the same, and therefore found this allegation proved on the balance of probability.

6 (f) Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust you did not complete and / or ensure completion of appropriate discharge paperwork and / or did not indicate discharge on Oasis for Service User 12 - PROVED

147. Mr Chalmers reminded the Panel that this service user was seen by Ms Sikpa’s trainee. On 5 December 2017 the trainee agreed with the mother of Service User 12 that they would be discharged but the paperwork was not completed.

148. Ms Sikpa’s position on this matter in her written submission was that as it was not her case, she could not reliably comment on the discharge.

149. The Panel noted the evidence of the witnesses that a supervisor is ultimately responsible for the activity (or lack thereof) of their trainee. In the absence of any alternative explanation, the Panel was satisfied that it was more likely than not that the discharge paperwork was not completed for Service User 12, and this allegation was therefore proved.

Decision on Statutory Grounds

150. Having determined all bar 3 of the allegations proved, the Panel invited the parties to provide it with submissions on statutory grounds. Mr Chalmers provided a written submission which was made available to Ms Sikpa. Ms Sikpa was then afforded time to consider the same and formulate her response, which she provided to the Panel in writing.

151. Mr Chalmers suggested that the allegations found proved by the Panel could be categorised as follows:

a. Failure to ensure a care plan was produced;
b. Failure to ensure an adequate risk assessment was produced;
c. Failure to ensure service user contact was recorded in time;
d. Failure to record a service user’s BMI; and
e. Failure to ensure the completion of discharge paperwork.

152. Mr Chalmers submitted that Ms Sikpa’s failings were repeated, widespread and serious, whether taken on their own or collectively. He invited the Panel to have particular regard to the following standards adopted by the HCPC:

a. The standards of proficiency for practitioner psychologists, in particular standards:
4 – be able to practise as an autonomous professional, exercising their own professional judgement; and
10 – be able to maintain records appropriately.
b. The HCPC standards of conduct, performance and ethics, in particular standards:
6 – Manage risk; and
10 – Keep records of your work.

153. In response to Mr Chalmers submissions, Ms Sikpa repeated that she could not create risk assessments and care plans if she did not have sufficient time with the service user to obtain the information she needed to inform those documents. She said that Dr SS agreed it was not unusual to have 2 – 4 sessions with a service user before completing a care plan.

154. In respect of misconduct, Ms Sikpa submitted she did not wish to minimise the incidents but “I strongly disagree that these occurrences reach the levels of seriousness implied. Notably there are no reports of injury or otherwise to any of the SU in this matter even several years after the event”. She went on to say “At all times I did what I believed was in my SU best interest, my actions were informed by my understanding of departmental policies.”. Ms Sikpa told the Panel that “technical issues should not be taken as evidence of misconduct. Particularly when there is evidence of sustained good practice.”

155. In respect of lack of competence, Ms Sikpa identified that “public in this instance would be parents” and rejected the assertion that parents would take a dim view of the profession or the professional due to her taking the time to build a “strong rapport” with their child because “most if not all of the information I will be recording has already been recorded by my colleagues”. In fact, she suggested that parents “may be reassured that the professional is handling their child with care and consideration”. She rejected the suggestion that there was any concern about how she exercised her clinical judgement or worked autonomously, saying “I worked with hundreds of SU during my time at CAMHS and not once was any concerns raised about how I exercised my clinical judgement and worked autonomously. Indeed in over half the cases in this matter there are no significant concerns. This is also true of my record keeping.” Ms Sikpa also rejected the HCPC suggestion that her failings were repeated and widespread, saying
“on their own each of these allegations relates to a relatively limited number of cases and in each instance there is significant evidence to suggest that this is not my normal practice (here i mean that in each case the evidence demonstrates that i have done more of the work than i had not. These being the facts I think it is an overstatement to suggest that any failings identified here are “repeated and Widespread”.
Dr SS confirmed in her statement that as my supervisor she reviewed my casework files fortnightly and identified no concerns. This i would argue demonstrates that these occurrences are not repeated and or as widespread as has been suggested”

156. The Panel received advice from the Legal Assessor, which it applied, and had regard to the practice notes issued, particularly those relating to unrepresented registrants and impairment (grounds usually being considered by panels alongside impairment).

157. The Panel was conscious it was required to judge whether the facts it found proved amounted to a statutory ground. Whilst this would usually be considered following submissions on grounds and impairment, in this case the Panel considered it appropriate address grounds first to assist Ms Sikpa. This approach would allow the Panel to explain which ground applied to which allegation, if any, and allow her to focus only on allegations that amounted to a statutory ground in addressing impairment if necessary.

158. The Panel noted that the two grounds which may relate to this case are those of misconduct or lack of competence. Aside from misconduct and lack of competence, the statutory grounds of impairment set out within the Health Professions Order 2001 at article 22(1) had not been alleged by the HCPC and were not therefore considered by the Panel. It determined the issue of grounds only in relation to the particulars it found proved. No further consideration was given to the allegations that were found not proved.

159. The Panel was aware that determining the issue of misconduct and / or lack of competence was a matter for its own judgement. In considering the grounds, the Panel took into account the written submissions of Mr Chalmers and Ms Sikpa in addition to the evidence it had received within the hearing.

160. The following authorities were considered by the Panel to be relevant to its considerations:
a. Roylance v General Medical Council No 2 [2000] 1 AC 311 - which advanced the premise that:
“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a .... practitioner in the particular circumstances. The misconduct is qualified in two respects. First it is qualified by the word ‘professional’ which links the misconduct to the profession ....Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious”
b. Holton v General Medical Council [2006] EWHC 2960 - the High Court held that in assessing lack of competence, the standard to be applied was that applicable to the post to which the registrant had been appointed and the work they were carrying out – i.e. a Band 8a practitioner psychologist.

c. Calhaem v General Medical Council [2007] EWHC 2606 (Admin) - the Court concluded that 5 principles were relevant to the issue of conduct:

i. Mere negligence does not constitute misconduct, however negligent acts or omissions which are particularly serious may amount to misconduct.
ii. A single negligent act or omission is less likely to amount to misconduct than multiple acts or omissions but in some circumstances a single act or omission, if grave, could be misconduct.
iii. Deficient professional performance is different to negligence and misconduct. It connotes a standard of professional performance which is unacceptably low and which, save in exceptional circumstances, has been demonstrated by reference to a fair sample of the doctors work.
iv. A single instance of negligent treatment, unless very serious indeed, would be unlikely to constitute deficient professional performance.
v. It is neither necessary nor appropriate to extend the interpretation of deficient professional performance in order to encompass matters which constitute misconduct
This case also explained the respects in which deficient professional performance differed from misconduct.

161. The Panel was aware that lack of competence can be distinguished from misconduct in that it indicates an inability to work at the required level and connotes a standard of professional performance which is unacceptably low, demonstrated by reference to a fair sample of a registrant’s work. The Panel was aware that a breach of professional standards alone does not necessarily constitute misconduct.

162. The Panel noted that all three HCPC witnesses confirmed, as registered professionals, that there were concerns as to Ms Sikpa’s record keeping. It had questioned Ms Sikpa on her practice, which was of particular relevance given that she admitted the allegations part way through the hearing and then somewhat undermined those admissions in cross-examination. The Panel had also interrogated the records provided to it for the service users identified in the allegations.

163. The Panel considered carefully whether it had been presented with a fair sample of the Registrant’s work. It noted Mr MW’s methodology for undertaking an audit of Ms Sikpa’s work:

a. Reviewing case notes and the Oasis system, identifying 47 open cases on Oasis and a further 3 not allocated to her on Oasis
b. Providing a list of cases to his manager;
c. Randomly selecting files to review;
d. As he found errors or omissions, he selected further files;
e. When it became apparent some service users had not been seen for “a significant period”, reviewing all files, albeit with assistance from colleagues.
Of the 50 cases open to Ms Sikpa at the time of the audit, Mr MW identified issues with the records for 14 service users. The Panel calculated that this equated to 28% of her cases. It found the allegations proved in respect of 13 of matters, which would equate to 26% of her cases. It therefore felt able to determine the level of competence shown by Ms Sikpa when operating as an experienced practitioner psychologist. The sample of work provided to the Panel covered more than a year of her practice and service users with a variety of presenting concerns.

164. The Panel found that Ms Sikpa’s assessment and management in respect of Service Users 1, 2, and 4 – 15 demonstrated an unacceptable level of performance far below the standards of proficiency of registered practitioner psychologists. She repeatedly failed to meet the standards expected of her in relation to her record keeping for the service users she saw, which was fundamental to her area of practice. The failures to document risk and care plans in particular exposed both the service users and the Trust to risk and the Panel did not consider that the failures could be described as limited in nature or momentary.

165. The Panel considered the HCPC Standards of Proficiency for Practitioner Psychologists (2015 edition) and considered that the following standards had been breached by Ms Sikpa:

8. be able to communicate effectively
8.6 understand the need to provide service users or people acting on their behalf with the information necessary to enable them to make informed decisions
8.7 be able to select the appropriate means for communicating feedback to service users
9. be able to work appropriately with others
9.1 be able to work, where appropriate, in partnership with service users, other professionals, support staff and others
9.4 understand the need to implement interventions, care plans or management plans in partnership with service users, other professionals and carers
9.7 be able to contribute effectively to work undertaken as part of a multi-disciplinary team
9.9 be able to support the learning of others in the application of psychological skills, knowledge, practices and procedures
10. be able to maintain records appropriately
10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines
10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines
12. be able to assure the quality of their practice
12.4 be able to maintain an effective audit trail and work towards continual improvement
14. be able to draw on appropriate knowledge and skills to inform practice
14.3 be able to conduct appropriate assessment or monitoring procedures, treatment, interventions, therapy or other actions safely and effectively
14.5 be able to formulate specific and appropriate management plans including the setting of timescales
14.7. be able to use psychological formulations to plan appropriate interventions that take the service user’s perspective into account
14.9 be able to gather appropriate information
14.10 be able to make informed judgements on complex issues in the absence of complete information
14.14 be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment
14.15 be able to choose and use a broad range of psychological assessment methods, appropriate to the service user, environment and the type of intervention likely to be required
14.16 be able to decide how to assess, formulate and intervene psychologically from a range of possible models and modes of intervention with service users or service systems
14.19 be able to analyse and critically evaluate the information collected
14.20 be able to critically evaluate risks and their implications
14.50 be able, on the basis of psychological formulation, to implement psychological therapy or other interventions appropriate to the presenting problem and to the psychological and social circumstances of the service user (Counselling psychologists only)

166. The Panel then considered the HCPC Standards of Conduct, Performance and Ethics (2016 edition). It found that the following standards had been breached by Ms Sikpa:

6. Manage risk - Identify and minimise risk
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
10. Keep records of your work - Keep accurate records
10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.1
10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.
167. The Panel recognised that the issue of insight was not relevant to its determination of whether allegations found factually proved amounted to a statutory ground. However, it could not ignore Ms Sikpa’s testimony to it that the failures in her record keeping were not omissions but rather conscious decisions on her part. She repeatedly told the Panel that the rest of her cases were not identified to be of concern by Mr MW and that she exercised her clinical judgement when deciding not to comply with the Trust’s expectations, for example as set out in the Clinical Record Keeping Standards document. The Panel noted that Ms Sikpa was adamant that for the service users referred to in the allegations:
a. the paperwork that she did complete was sufficiently detailed;
b. where she did not complete paperwork, she was entitled to rely on assessments and work carried out by other clinicians with that Service User;
c. papers on some cases had been misfiled;
d. her practice was to write up her notes and paperwork and she had not had the opportunity to do this for all of the service users before the end of her employment – the original notes would have been amongst the papers Mr MW confirmed were disposed of when her desk was cleared at the end of her employment.

168. Notwithstanding its concerns as to Ms Sikpa’s perception of her practice, the Panel was not persuaded that the failings it had identified in her practice stemmed from a lack of competence. Ms Sikpa was a Band 8 counselling psychologist in a multi-disciplinary team. She was responsible for supervising trainees and received supervision from Dr SS. Both Mr MW and Dr SS told the Panel they were not aware of any concerns as to Ms Sikpa’s competence or conduct prior to 2018. By that point she had been working for the Trust since 2015.

169. Both witnesses also reflected the context within the Trust at that time, with Dr SS saying that “Sarah Sikpa did not panic like others and had continued to do her job which I thought was quit [sic] admirable given the circumstances we were faced with”. Dr SS referred to that period as a difficult time in which employees were applying for their own jobs as part of the restructuring process, with the number of posts available being less than the number of staff applying for those roles. Ms Sikpa’s view of the work context was that “my working environment was chaotic, highly pressured, case loads exceeded practitioners & management procedures were weak. This is a very significant contributory factor in compromising the very high standards that I set for myself.”

170. Having determined that none of the proved facts amounted to the statutory ground of lack of competence, the Panel then proceeded to consider whether each allegation amounted to serious professional misconduct.
1. Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and/or ensure completion of a Care Plan for the following Service Users:

a. Service User 1

171. Service User 1 was admitted to hospital in February and March 2016. She was accepted by Tier 3 CAMHS upon referral through the CAIT. The concerns related to substance misuse, self-harm, hearing voices and assaulting her mother. She was seen by Ms Sikpa on three occasions and it was admitted by Ms Sikpa that no care plan was completed because “SU1 and I did not work together so I had nothing to record on a care plan”. She told the Panel that a care plan had been completed for SU 1 by another qualified practitioner in March 2016 but she identified “no clinical concerns or risks” and noted her intention to discharge Service User 1 on 5 May 2016. The second HoNOSCA toolkit was dated 10 May 2016 and signed by Ms Sikpa.

172. The Panel noted that the form headed “risk assessment and management plan for specialist services” completed by Ms Sikpa in respect of Service User 1 was undated however it referenced “no concerns identified following therapeutic intervention”. When questioned about the nature of this intervention, Ms Sikpa was unable to express what it was. The Panel found that to make this entry, Ms Sikpa must have believed she had provided therapy / treatment to Service User 1. This should therefore have been recorded on a psychology care plan so that others in the MDT knew what intervention had been utilised.

173. Ms Sikpa’s contemporaneous documenting of a therapeutic input on the form contradicted her submission to the Panel that she did not “work with” Service User 1. The Panel did not consider that both explanations could be true and preferred the more contemporaneous written entry to Ms Sikpa’s evidence.

174. The fact that a therapeutic intervention had taken place but was not visible to the rest of the MDT due to Ms Sikpa not completing a care plan which detailed what it was, was of concern to the Panel. In the absence of this information, the rest of the team would have no way of knowing what had been done with Service User 1, if anything, from a psychology perspective. This approach did not comply with either the standards of proficiency for psychologists or the Trust’s policies.

175. The Panel found that providing a therapeutic input but not documenting it in a psychology service care plan was professional conduct which fell below that which could reasonable by expected of an experienced Band 8 psychologist. This conduct amounted to misconduct. It considered the misconduct was serious - other professional colleagues had assessed the service user as presenting a risk of harm to herself on a number of occasions in the recent past and referred Service User 1 to CAMHS via CAIT. She was allocated a priority appointment in accordance with the operational guidance for the team. The therapeutic intervention should have been clearly documented by Ms Sikpa. The Panel found that the statutory ground of misconduct was made out in respect of this allegation.

b. Service User 2

176. Service User 2 presented with complex communication challenges and was being treated by a psychiatrist, who, Ms Sikpa said, was also finding it hard to make progress. Ms Sikpa was aware that the child psychiatrist had done two care plans (22 and 27 January 2016) and relied upon these documents rather than completing her own. She submitted that “The Child Psychiatrist continued to take responsibility for the care plan (whilst my assessment was ongoing) and appropriately included my name and a clarification of my clinical focus (see page D379)”.

177. Upon reviewing the document referred to by Ms Sikpa, the Panel noted that this was an individualised care plan review which had been completed on 7 October 2016 and contained the following entry in the evaluation of treatment goals box:

“continues to see S. Sikpa for psychological support”
The form went on to record the psychiatrist’s view that the psychological work should continue to get to the bottom of hoarding behaviour.

178. The Panel was however aware that having seen Service User 2 twice, in February 2016, Ms Sikpa suggested discharge from psychology services in May 2016. There was therefore no ongoing psychology work, continuing hoarding tendencies and other clinicians were not aware that Ms Sikpa was no longer working with Service User 2. The Panel considered that this situation showed precisely why each clinician should maintain their own care plan for service users, and make that plan available to their MDT colleagues. Accordingly, it found that this allegation amounted to the statutory ground of misconduct.

d. Service User 4

179. Service User 4 presented at CAMHS with Autism, Tourettes syndrome, OCD and insomnia and had a care plan said to have commenced in 2013. Service User 4 was seen on 6 occasions by Ms Sikpa between 22 November 2017 and 7 March 2018 according to the records provided to the Panel. Ms Sikpa told the Panel she saw Service User 4 on 4 occasions. She told the Panel that there was a “multi-agency / systemic care plan” in place which included her work.

180. When the Panel reviewed the two pages referred to by Ms Sikpa as containing her work, it found that the first document related to the Service User being referred to CAMHS on 1 November 2017 while the second reference was contained within a document entitled “CAMHS Statutory Advice (Report) for Education, Health and Care Plan” which was completed on 2 February 2017 and identified Ms Sikpa as being ”currently involved, but not contributing directly to the report or contributing separately”.

181. The Panel found that the lack of information as to Ms Sikpa’s involvement in the treatment of Service User 4 was misconduct which may not cross the threshold of seriousness on its own, but taken collectively with all the other failings, did amount to serious professional misconduct.

e. Service User 7

182. Service User 7 presented from foster care with flashbacks, nightmare, disrupted sleep and hypervigilance.

183. Ms Sikpa told the Panel that she had reviewed the transferring care plan and found it clinically relevant and reflecting the service user’s voice. She concluded she had nothing to add to it despite there being 7 attendances of Service User 7 between 18 September 2017 and 27 November 2017, which included EMDR treatment sessions.

184. Given that Ms Sikpa had been providing treatment to Service User 7, the Panel had no hesitation in finding that an individual psychology focused care plan should have been completed by Ms Sikpa. Failing to complete such a document to record treatment provided did amount to misconduct which was serious. Accordingly, the statutory ground of misconduct was made out in this matter.

f. Service User 9

185. Service User 9 presented with issues around schooling and aggression and between October and November 2017 in the HCPC’s submission. Ms Sikpa told the Panel that she only saw this service user for one full session and one half session (because they arrived late). Thereafter, Service User 9 broke their leg and attended no further sessions. There was therefore no information to record in a care plan.

186. The Panel was satisfied that in the circumstances, it was potentially reasonable for Ms Sikpa not to have prepared a care plan for Service User 9. Accordingly, it found this allegation did not amount to the statutory ground of misconduct.

g. Service User 12

187. This service user presented with anger, anxiety, fear and sadness and was seen by Ms Sikpa’s trainee on two occasions. It is recorded that the care plan was not completed due to sporadic attendance by Service User 12. Ms Sikpa also told the Panel that Service User 12 was not left at risk by the lack of a care plan as one had been completed by another colleague 3 weeks before her trainee had the first psychology session. That plan outlined that Service User 12 should be referred to “Medics” for further assessment, with there being “core work” around “mood emotions and anxiety”. This did not amount to a care plan for psychology services in the Panel’s opinion. However, given the early stage of engagement, the Panel was prepared to allow that this could amount to misconduct, but was not serious. It did not therefore meet the threshold for the statutory ground of misconduct.

188. Accordingly, the Panel was satisfied that, in the circumstances, it was potentially reasonable for Ms Sikpa not to have prepared a care plan for Service User 9. Accordingly, it found this allegation did not amount to the statutory ground of misconduct.

h. Service User 14

189. Service User H presented as depressed and suicidal and was working with psychiatrists who made the referral to psychology. Ms Sikpa pointed out to the Panel that she only saw Service User 14 twice, and that if referral paperwork had been done it was not in the file of papers. She offered no explanation as to what difficulties she had formulating a plan for Service User 14 other than the reference to communication difficulties.

190. As above, given the early stage of the psychology involvement with Service User 14, and the lack of any evidence to suggest that treatment was provided by Ms Sikpa, the Panel find that while the conduct could amount to misconduct, the failure to complete a care plan is not sufficient to cross the threshold of the statutory ground of misconduct.

2. Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and/or ensure completion of Risk Assessments for the following Service Users 4, 7, 9. 12 and 14.

191. Mr Chalmers told the Panel that a failure to properly record risks to a service user is serious. It causes colleagues in the department to not have a clear picture of the risk. He submitted that the Registrant was “well aware that risk assessments needed to be completed and has failed to do so without justifiable reason”.

192. Ms Sikpa submitted that of the 13 service users considered by the Panel, 8 have a risk assessment completed by her, demonstrating that “it is the norm for me to complete risk assessments”. Despite admitting all of these allegations, she goes on to say that “where it is alleged that I did not complete a risk assessment, there may be a valid reason.” She elaborated further in her submission on statutory grounds, stating that although she would usually do a risk assessment at the first session, there were some occasions when it was not appropriate as “ because of the nuances in a particular therapeutic relationship with a particular service user there are occasions when these will inform my clinical decisions and I may decide that it is important and in the SU interest for me to wait a while before completing the risk assessment. Not having completed a risk assessment (yet) does not mean I would not have completed the assessment when the reliable information was available to me.”

193. She reminded the Panel that there was evidence of risk monitoring in her session notes and also evidence that she was monitoring and gathering risk information which she would have recorded on a risk assessment in due course.

194. The Panel was content to deal with allegation 2 globally as it considered that the management of risk was of paramount importance when dealing with vulnerable young people. It was conscious that risk can take many forms and is far wider than risk to the service user alone – it covers risk to family members, those in authority, fellow professionals, the public and the Trust. Ms Sikpa’s failure to adequately document risk meant that those risks were not visible to her colleagues, the Trust or the parents and carer’s of the young people. The Panel was satisfied that these failures did amount to misconduct, and that they were serious. Accordingly, these allegations all crossed the threshold for the statutory ground of misconduct.

3. Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not date Risk Assessments for Service Users 1 and 5.

195. The Panel considered the need to date risk assessments as an important part of producing a robust risk assessment. Without a date, it is not possible to see how current and relevant a risk assessment is. Ms Sikpa’s failure to accurately date any assessments she completed undermined the document and meant that those risks were not visible to her colleagues, the Trust or the parents and carer’s of the young people. The Panel was satisfied that these failures did amount to misconduct, and that they were serious. Accordingly, these allegations all met the threshold for the statutory ground of misconduct.

4. Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and/or ensure timely completion of the Trust’s electronic patient note system, Oasis, to indicate contact with Service Users 5, 6, 7, 8, 10 and 13.

196. Mr Chalmers reminded the Panel that the Trust had clear policies for data entry and record keeping but Ms Sikpa did not always record contacts with clients on the Oasis system in accordance with those policies. He invited the Panel to find the repeated failings to amount to misconduct.

197. Despite the findings of the Panel at the facts stage, Ms Sikpa maintained her view that “47 out of 56 entries are correct and demonstrate a sustained pattern of good practice - 47 of the 52 entries were made by me are correct.”. She went on to tell the Panel that “to say that 5 late entries made over the course of a year (and relevantly concentrated into 3-4 days) is evidence of misconduct / impairment strongly demonstrates a totally unacceptable level of perceptual bias. This remains the case even if you add the trainees 4 late entries to my 5 totaling[sic] 9 irregular enteries[sic].”

198. The Panel was disappointed that Ms Sikpa was unable to complete all entries into the system in compliance with the Trusts policy and procedures, or ensure that her trainee met those standards, however it noted that Ms Sikpa was able to identify dates that had been missed due to training and holiday, as well as entries of multiple contacts on one date, which the Panel considered was consistent with her reporting that the Oasis system was frequently “down” and therefore not available.

199. Whilst not condoning Ms Sikpa’s failure to ensure electronic records were kept up to date, the Panel did not consider that these failures amounted to serious misconduct. They did not therefore cross the threshold of the statutory ground of lack of competence.

5. Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, on 27 March 2018, you were advised to measure the weight and height of Service User 15 but did not do so.

200. Mr Chalmers reminded the Panel of the evidence provided to it on the importance of measuring a service user’s BMI when eating disorder issues are suspected. Despite this, Ms Sikpa did not record Service User 15’s height and weight, despite being reminded of the need to measure BMI on the morning of the appointment. It is submitted that this was a serious failing, particularly because it affected the ability to assess risk.

201. Ms Sikpa reminded the Panel that neither Mr MW nor Dr JD identified any errors or misunderstanding in her assessment of Service User 15’s need. Rather, she said their concern was that Ms Sikpa referred Service User to “core” and failed to record the BMI. She also reminded the Panel that the guidance offered by the specialist EDT to Dr JD was essentially the same as her plan for dealing with Service User 15.

202. The Panel recalled that Service User 15 was seen by Ms Sikpa as a priority patient. As such, she should have been aware that there were serious concerns as to the health and well-being of Service User 15. The relevant policies in respect of those presenting with eating concerns repeatedly highlighted the BMI calculation as an important determinative factor when considering how to handle a review, and provided the figures for the same. Ms Sikpa also appears to have volunteered information about the forthcoming appointment with Dr JD and was reminded that she could rearrange the appointment or just take the basis measurements initially and then arrange a follow up meeting.

203. A number of explanations have been proffered by Ms Sikpa as to why the BMI of Service User 15 was either not taken, lost or misfiled. It is however beyond doubt that a child with a BMI of 14,2 (as calculated by Dr JD several weeks later) is in urgent need of assistance. The Panel considered this failure to be fundamental, going to the heart of Ms Sikpa’s professional practice. The fact she told a colleague at the start of the day that she did not want to do the meeting, and was advised to just make sure she got the BMI, aggravates the seriousness of the misconduct as far as the Panel are concerned.

204. The Panel were satisfied that Ms Sikpa’s failure to take the BMI of a child referred to the service as a priority appointment due to eating issues was conduct which fell seriously short of the standard to be expected of an experienced Band 8a practitioner. This failing was compounded by the fact that Ms Sikpa had discussed the case that morning with Dr JD but not followed her suggestions.

6. Whilst registered as a Practitioner Psychologist (PYL20548) with the Health and Care Professions Council and during your employment with Black Country Partnership NHS Foundation Trust, you did not complete and/or ensure completion of appropriate discharge paperwork and/or did not indicate discharge on Oasis for Service Users 1, 2, 7, 9, 11 and 12

205. Mr Chalmers reminded the Panel why discharge paperwork was important – so that it is clear to any professional reviewing the file that the family, a GP, and other relevant professionals have been updated when a service user is discharged from a service or therapeutic arm. He noted that Ms Sikpa suggested in her evidence that at the start of her time with the Trust, she was unaware of the need to complete discharge paperwork. She later accepted in cross examination that a number of the failures to complete discharge paperwork were at the end of her time at the Trust when she knew that such paperwork was required. Mr Chalmers submitted that it was likely that Ms Sikpa was well aware that discharge paperwork needed to be completed and failed to do so without justifiable reason.

206. Ms Sikpa did not address the Panel in respect of this allegation in her submissions on statutory grounds. She had however previously indicated that, despite admitting the allegation, she considered that she had done what was necessary in respect of the discharge process.

207. The Panel was particularly concerned at Ms Sikpa’s responses in respect of this allegation. Failing to notify a GP that their patient had been discharged from a specialist services was, in its view, a basic requirement of professional practice given that the GP holds the primary care responsibility for the service user. Further, patients and their families should have a written record of the conclusion of any treatment or indeed any consultation.

208. Further, the records of cases open to a clinician should be accurate. Failing to discharge non-active patients restricts the ability of managers to understand the pressures on their teams, and hampers their ability to allocate new clients to clinicians in a fair and responsible manner. It also means that performance information (e.g. waiting times, length of treatment etc) is compromised, which can bring additional scrutiny which may not be justified.

209. The Panel was entirely satisfied that the failure to complete discharge paperwork and processes on Oasis was serious misconduct and met the threshold for the statutory ground of misconduct.

Decision on Impairment

210. Having found that Ms Sikpa’s actions, or lack thereof, amounted to the statutory ground of misconduct in respect of allegations 1a, 1b, 1d, 1e, 2b, 2c, 2d, 2e, 2f, 3a, 3b, 5a and 6, the Panel next considered whether her fitness to practise is currently impaired. It was mindful that the allegations are now of considerable age, dating back to 2018.

211. Mr Chalmers reminded the Panel it was considering conduct which arose between 2016 and 2018 but that its role was to determine current impairment, reflecting changes since that date, based upon the evidence before it. He reminded the Panel the only new evidence before it related to the previous decisions following an earlier finding of misconduct in 2016 – Ms Sikpa was put on notice that it was up to her to put current information before the Panel as to her reflection and remediation. He directed the Panel to the findings in the case of Grant v NMC [2011] EWHC 927 (Admin) and the comments of Dame Janet Smith in the Shipman enquiry, which could be summarised such that Panels should consider whether registrants put service users at risk of harm, brought the profession into disrepute, breached fundamental tenets of the profession or were dishonest.

212. Mr Chalmers invited the Panel to consider the personal and public elements of impairment. He described the personal elements of impairment as relating to Ms Sikpa’s insight, remediation and risk of repetition. Mr Chalmers referred to the case of Cohen when inviting the Panel to consider the public element of impairment – that is, safety of the public, the reputation of the profession and the trust and confidence of the public in the regulator and the profession.

213. The history of proceedings involving Ms Sikpa could not be ignored in Mr Chalmers’ submission, as they amounted to a pattern of behaviour, being concerned with similar issues to these proceedings in that she failed to keep records of her work with young vulnerable service users. Mr Chalmers informed the Panel that those proceedings resulted in a Conditions of Practice order being imposed upon Ms Sikpa. Those conditions included a requirement to work within a workplace where she was supervised, and to work with her supervisor to formulate Personal Development Plans to address the identified deficiencies in her record keeping and professional practice. Despite this, the majority of the issues found proved by this Panel occurred when Ms Sikpa was subject to conditions on her practice. Further, he reminded the Panel that the evidence it received demonstrated a lack of insight in that Ms Sikpa admitted she made a conscious decision to not complete records of service users.

214. In respect of the issue of remediation, Mr Chalmers invited the Panel to have regard to the steps taken to remedy the deficiencies it identified, and the previous conduct, when determining the extent of the risk of repetition.

215. Mr Chalmers then addressed the public component of impairment, stating with the level of support and scrutiny imposed as a result of the previous findings, Ms Sikpa should not have repeated that misconduct and that therefore an order may be required to protect the public and in the wider public interest. He invited the Panel to conclude Ms Sikpa’s fitness to practise is currently impaired.

216. Ms Sikpa having submitted a testimonial and written representations to the Panel by 29 September 2022, Mr Keating invited the Panel to form its own view of the insight demonstrated by Ms Sikpa in her written submission, having had the benefit of her live evidence in June. He confirmed that the HCPC had no evidence to contradict Ms Sikpa’s assertion that no issues had been raised as to her practice while working under conditions from September 2020 until June 2021, and this comment could therefore be taken at face value. However, he invited the Panel to be cautious in relying on findings of fact made by another panel or body, telling the Panel it should properly ignore or place little weight on findings of any other panel, as reported by Ms Sikpa (the findings of a panel reviewing an interim order in August 2022), particularly as the test applied by that panel was different to the exercise the Panel was conducting. He suggested that the information provided as a quote by Ms Sikpa – “it is highly unlikely that there is any continued risk to the public" should particularly be treated with some caution and invited the Panel to have regard to the principles identified in the case of Enemuwe v GMC [2013] EWHC 2081 (Admin). He also observed that the character evidence provided by Ms Sikpa is dated September 2020 the Panel may find it of limited use.

217. Ms Sikpa provided written submission to the Panel which she said “focused on the aspects of my learning, reflection and practice development that have proved to be very important over the years, when I have applied the learnings to my practice” with a view to current practice being consistently guided by what is in the service users best interest. Ms Sikpa comments that:
- “as a result of my learning during the FTP process” she will always ensure that she takes a patient’s BMI in future during an initial session as it informs ongoing monitoring and decision making;
- “I have learnt how crucial risk assessments are…. I will always make the completion of risk assessments a priority in my practice”;
- “This hearing has found that I failed to complete care plans for four service users. Reflecting on this, I have become more aware of a team-based need for the timely completion of care plans. This refreshed focus on care-plans will mean that I will complete care plans in no more than two sessions and, importantly, where this is not possible, I will place a preliminary care plan on file, which will be clearly labeled as such. This is not something I would have thought of doing before but now I can see how this would be helpful to those that I work with”;
- She struggled with discharges due to IT issues but should have sought further training on the systems and solutions;

218. In respect of her current practice, Ms Sikpa informed the Panel that since 2018, she has worked for The Priory and Walsall and Solihull Mental Health Trust and is currently employed by an unnamed organisation. As identified by Mr Keating, she asserts that she has worked under conditions without issue since 2018 and this “pattern is historical” and “not been found in my current practice”, demonstrating “there is no longer any risk of repetition”.

219. The Panel had regard to the documentation provided to it by Ms Sikpa and received legal advice from the Legal Assessor, which it accepted. It considered the guidance issued by the HCPTS. It was mindful that the test of impairment is expressed in the present tense in relation to the need to protect the public against the acts and omissions of those who are not fit to practise, but this cannot be achieved without taking account of the way a person has acted or failed to act in the past. When assessing the likelihood of recurrence of harm, panels must take account of the degree of harm caused by the Registrant and the Registrant’s culpability for that harm, recognising that the harm could have been greater or less than the harm which was intended or reasonably foreseeable. Panels may also take account of character evidence.

220. The Panel found a number of particulars proved which amounted to the statutory ground of misconduct and breached the standards of conduct, performance and ethics expected of registrants, and the standards of proficiency of practitioner psychologists as set out at paragraphs 165 and 166 above. It was mindful that a finding of impairment does not automatically follow a finding on that ground - the Panel could properly conclude the act or omission was an isolated error and the chance of repetition in the future is remote. They also noted the guidance in the case of Cohen v General Medical Council [2008] that it must be highly relevant when determining impairment that the conduct leading to the allegation is easily remediable, has been remedied and is highly unlikely to be repeated.

221. Ms Sikpa provided one testimonial from a long term colleague however this was dated 15 September 2020. As such, it was two years old and did not reference the nature of the concerns, or the concerns found proved. It spoke to Ms Sikpa’s therapeutic skills, training and experience but made no comment on the issue of record keeping or documentation. Accordingly, the Panel were not assisted greatly by this document in relation the extent of Ms Sikpa’s insight, remediation, remorse or the risk of repetition.

222. The Panel noted that Ms Sikpa reported undertaking the following “relevant” training:

a. Child protection level 3 2019
b. Safeguarding Level 3 2020
c. Information Governance 2020
d. Risk management 2020
e. Health and safety for health care workers 2020
f. Gib’s reflective practice 2021

223. Ms Sikpa did not identify with whom the training had taken place, the method of training delivery, the content of the training or provide certificates of completion. The Panel therefore could not determine how relevant the training cited was to the concerns identified. For example, it considered that training in risk assessments would be different to training in the management of risks in a work environment, but either could have been provided under the generic title of risk management. Similarly, training on information governance could relate to the quality and timeliness of data recorded in relation to service users, but equally could relate to dealing with subject access requests. The Panel was therefore unable to find that the training was of particular relevance to the concerns it identified in June 2022 or that it had any apparent impact on Ms Sikpa’s oral or written evidence. The training listed did not alleviate the Panel’s concerns in respect of the risk of repetition. The fact that there was no evidence provided to it that training had been undertaken in 2022 (which all registered professionals are required to undertake) was of concern. This concern was heightened given that Ms Sikpa had apparently not undertaken any training or reflective work since the Panel made its findings in June 2022.

224. Ms Sikpa has told the Panel that she has worked since these concerns occurred, but has provided no information from colleagues or supervisors in respect of the quality of her work. The Panel notes her assertion that reports have been provided to the HCPC in relation to this, and that this has not been disputed by the HCPC, but there is no information before the Panel in this regard and accordingly, the Panel is not greatly assisted. There is no burden of proof on the HCPC in relation to impairment, which means it is for the registrant to provide information which demonstrates that the concerns found proved have been mitigated through insight, remediation and remorse, such that there is little or no risk of repetition.

225. Ms Sikpa references experiencing “considerable remorse” in her written representations to the Panel on impairment and sanction, but does not specify why she is remorseful.

226. The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective. It was concerned that Ms Sikpa did not appear to understand the gravity of the findings it had made in relation to her conduct, though undoubtedly she understood the impact of the same. The Panel was sympathetic to her personal circumstances, however her reaction to the allegations was a primary concern.

227. The Panel found that Ms Sikpa demonstrated little insight into her standard of practice between 2016 and 2018, and almost no information in relation to her current practice. The limited information currently available to the Panel was superficial and not underpinned by any training or testimonials. The Panel is conscious that it is entirely possible for a registrant in a similar position to Ms Sikpa to maintain their views but be able to produce a reflective piece on the issues identified by the panel. Reflection involves reviewing experiences to help make positive changes for future practice, turning experiences into learning. Critical reflection evaluates a registrant’s approach, judgement, decisions and interventions and can incorporate objective assessments to identify learning needs and create a cycle of experience, reflection, learning and change. The Panel did not consider that Ms Sikpa had yet reached this level of reflective practice.

228. The Panel considered that the areas of practice where misconduct had been found were capable, in themselves, of remediation. However, without appropriate insight, the effectiveness of remediation would be limited. It concluded that in the light of Ms Sikpa’s lack of meaningful insight and remediation, there was a real risk of the shortcomings being repeated and therefore it found her to be impaired on the “personal” aspect of the test for impairment.

229. In considering the public component of impairment, the Panel had regard to the important public policy issues which include the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour. It considered that members of the public and members of the profession would be concerned to learn that a practitioner psychologist had supervised trainees while failing to record risk assessments and care plans in respect of a number of service users over a prolonged period of time, whilst under supervision due to a previous regulatory finding. It determined that public and professional trust and confidence in the profession, professional standards, and the regulator would be undermined if a finding of impairment was not made. The Panel concluded that Ms Sikpa’s fitness to practise is currently impaired on the basis of both the personal and public component.

Decision on Sanction

230. Mr Keating referred the Panel to the Sanctions Policy adopted by the HCPC, and confirmed the primary purpose of a sanction was to protect the public rather than punish a registrant, though a sanction may be punitive in effect. He reminded the Panel of the sanctions available to it and encouraged the Panel to take the minimum action necessary to ensure the public is protected.

231. The mitigating factors in this case were identified by Mr Keating as the “beneficial reflection” demonstrated by Ms Sikpa in her written submissions on impairment and sanction and the fact there had been no reported issues to the HCPC during her period of practice between September 2020 and June 2021. However, Mr Keating invited the Panel to disregard Ms Sikpa’s submission in respect of the interim order review panel in August 2022, or to place “very little weight on the Registrant’s submissions on this point, and treat with great caution the quoted passage when no copy of the source has been provided.”

232. Mr Keating also identified potentially aggravating factors of this case, particularly the concern that Ms Sikpa had engaged in a pattern of unacceptable behaviour given that the misconduct took place between spring 2016 and early 2018. He submitted that the duration of the misconduct increased the seriousness of it and could lead to a stronger sanction to protect the public, as did the fact that the misconduct occurred following an earlier finding by the regulator. Indeed, he suggested that the findings of the panel in 2016 were similar to those of this Panel in respect of the degree of insight and evidence of remediation, and Ms Sikpa’s response to the same “mirrors the Registrant’s attitude and response to the finding of misconduct in these proceedings up until the receipt of the Registrant’s submissions this morning,”. Mr Keating also pointed out that some of the misconduct found proved by this Panel occurred while Ms Sikpa was subject to conditions of practice following the 2016 regulatory decision, though he reminded the Panel it was apparently Ms Sikpa’s position that if a pattern of behaviour exists, it is historical in nature.

233. Mr Keating observed that a panel reviewing the conditions imposed by the 2016 substantive panel found that there were a number of shortcomings in Ms Sikpa’s compliance with the order, and he invited the Panel to find that there remained a risk of repetition, which he considered an aggravating factor of this case.

234. In respect of Ms Sikpa’s degree of insight, Mr Keating reminded the Panel it had already determined that some of the concerns found proved amounted to misconduct, were not omissions but rather conscious decisions taken, and defended, by Ms Sikpa. Mr Keating invited the Panel to give careful consideration to the timing of Ms Sikpa’s reflection when deciding what weight to attach to it.

235. The lack of unambiguous, or any, apology, was also drawn to the Panel’s attention as a potentially aggravating factor, as was the lack of meaningful remediation and the potential for harm to have been caused to vulnerable service users as a result of Ms Sikpa’s conduct. Mr Keating conceded that this matter did not fall “neatly” within the non-exhaustive list of serious cases set out within the Sanctions policy, but submitted that the Panel was “not precluded from finding that this is a ‘serious’ case” – it was a matter for the Panel’s judgement.

236. In respect of sanctions, Mr Keating submitted that taking no action or issuing a caution order would be inappropriate given the findings made by the Panel, and that it would need to be confident Ms Sikpa would comply with any conditions on her practice if contemplating a sanction of this nature. He also reminded the Panel that an order of suspension was appropriate where there was insight, a low risk of repetition and a manageable degree of risk. Striking a registrant from the register would be the sanction of last resort.

237. Ms Sikpa did not attend the hearing to provide her submissions but relied on the written submissions she filed prior to the Panel considering the issue of impairment. She referenced her IT problems and how she would respond differently if a similar situation recurred and invited the Panel to bear in mind that she had been subject to an interim conditions of practice between January 2020 and August 2022. Ms Sikpa asked the Panel to “consider how imposing any orders known to be restrictive, especially in the current cost of living crisis. would pose an undeniable risk to many areas of my life. Thus arguably the imposing of new conditions would be extremely punishing rather than being in the public's interest”. She also expressed her “hope that the panel will not negatively judge my inability to attend this final part of the hearing. Instead I hope the panel will take into account that I have engaged with this process and fully intended to do so until the end. However the mounting pressures I have coped with for quite some time have for me reached an unbearable pitch and I have been forced in the most painful ways to consider my health….”. She concluded her submission by stating “Despite the difficulties I have faced over the years I have continued to learn from my mistakes and make the necessary improvements. This means that I have been able to identify areas of good practice and build upon these to a point where I am certain that I do not pose any risk to service users and or the public perception.”

238. The Panel received advice from the Legal Assessor, which it applied, and was aware that each case must be determined on its own facts and merits. It was conscious the HCPC does not have a tariff of sanctions but has issued guidance in respect of sanctions to aid panels to make fair, consistent and transparent decisions. It was aware that clear and cogent reasons should be given if the Panel decided to depart from the guidance. The purpose of fitness to practise proceedings is not to punish but to:

a. protect the public by ensuring that registered professionals practise to a minimum universal standard;
b. maintain public confidence in the regulatory process and protect the reputation of the regulated profession;

239. The sanctions available to the panel are contained within the Health and Care Professions Order 2001 at paragraph 29(5):
a. make an order directing the Registrar to strike the person concerned off the register (a "striking-off order");
b. make an order directing the Registrar to suspend the registration of the person concerned for a specified period which shall not exceed one year (a "suspension order");
c. make an order imposing conditions with which the person concerned must comply for a specified period which shall not exceed three years (a "conditions of practice order"); or
d. caution the person concerned and make an order directing the Registrar to annotate the register accordingly for a specified period which shall be not less than one year and not more than five years (a "caution order").

240. When determining the appropriate level of sanction, the Panel is expected to ensure that the sanction is proportionate to the circumstances, protects the public in the least restrictive manner and takes account of the wider public interest, striking a proper balance between the interests of the registrant and the public.

241. The identification of aggravating and mitigating features can aid panels in making a decision on sanction. Aggravating factors are features which increase the seriousness of the concerns and are likely to lead to stronger sanctions in order to protect the public, while mitigating factors do not excuse or justify poor conduct or competence but can indicate a reduced ongoing risk posed to service user safety and therefore reduce the severity of the sanction required.

242. In this matter, the panel considered that there were the following aggravating features:

a. Some concerns relate to a period when Ms Sikpa was the subject of a regulatory sanction – a conditions of practice order;
b. Ms Sikpa was the subject of adverse findings for similar issues in 2016;
c. A reviewing panel in 2018 found Ms Sikpa had not complied with previous conditions imposed;
d. The misconduct spanned a substantial period of time, between 2014 – 2018;
e. Ms Sikpa was responsible for the supervision of trainees and expected to model good practice;
f. Ms Sikpa was employed as a Band 8(a) Practitioner Psychologist and therefore very senior;
and the following mitigating features:
g. Unreliable access to IT systems at the Trust;
h. Poor management oversight and support and restructures within the Trust team;
i. The substantial period of time taken to conclude the regulatory proceedings.

243. The Panel was troubled by the likelihood of the misconduct being repeated given the limited insight identified to date and the previous regulatory findings. Whilst it was pleased to receive Ms Sikpa’s submissions in relation to this matter, they were received on the morning of the second day of the reconvened hearing. They did not contain the detailed reflection the Panel would expect from a registrant given the nature and extent of the findings handed down in June and Ms Sikpa’s senior status. They also provided no detail as to the work that Ms Sikpa had engaged in since 2018, or examples of how her practice had changed.

244. Ms Sikpa could, for example, have set out a chronology of the roles she has fulfilled, including details of the size of the department, her position of responsibility within it and along with how she had applied her learning to similar cases she has dealt with recently, or provide examples of how she now works in practice within a multi-disciplinary team. She could have provided a list of relevant professional articles she has read to demonstrate how she has maintained and improved her practice, or completed recent relevant online courses related to the proven concerns - risk assessment and management, record keeping etc. She could also have taken up employment in roles that do not require registration, such as an Assistant Psychologist. None of this information had been supplied to the Panel, and this lack of information adversely impacted upon the Panel’s ability to make a robust assessment of Ms Sikpa’s fitness to practise. The Panel did not draw inferences from Ms Sikpa’s non-attendance at the latter stage of the hearing, but would have been greatly assisted by the ability to explore these issues with Ms Sikpa.

245. Given the Panel’s reservations as to Ms Sikpa’s current situation, it did not consider that it was appropriate to take no further action or issue a caution order and therefore moved on to consider whether a conditions of practice order would provide sufficient protection for the public given the risks it had identified.

246. The purpose of a conditions of practice order is to restrict a professional’s practice to protect the public while requiring them to take remedial action. Imposition of a conditions of practice order means that the Panel is satisfied that the practitioner psychologist may be capable of practising safely and effectively, beyond the conditions, provided those conditions are remedial or rehabilitative in nature. The sanctions guidance provided by HCPC does however provide that conditions are most commonly applied in cases of lack of competence or ill health and are less likely to be appropriate in cases of character, attitudinal or behavioural failings.

247. The Panel considered carefully whether any conditions could be drafted in this case to adequately protect the public from the failings it had identified. Although the misconduct related to issues of record keeping and risk assessment, which would usually be capable of being managed by suitable conditions, the Panel could not ignore Ms Sikpa’s evidence to it that some of the failings resulted from her conscious decisions. It also could not ignore the changeable nature of her accounts to it, as set out in detail in this decision, and her reticence to provide the Panel with information as to her current work situation or any professional activity she had engaged in since the concerns came to light. In addition it also took account of the fact that these failings had previously been identified in a 2016 finding.

248. The HCPC’s Sanctions policy provides at paragraph 107 that “Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings”. The policy also encourages panels to take account of the timing and level of remorse and insight shown when assessing whether it is genuine. The first information the Panel received which demonstrated any acknowledgement by Ms Sikpa of its findings in respect of her conduct was received on the 28 September 2022, the second day of the reconvened hearing. In that document, Ms Sikpa states “ This hearing has found that I failed to complete care plans for four service users. Reflecting on this, I have become more aware of a team-based need for the timely completion of care plans. This refreshed focus on care-plans will mean that I will complete care plans in no more than two sessions and, importantly, where this is not possible, I will place a preliminary care plan on file, which will be clearly labeled as such. This is not something I would have thought of doing before but now I can see how this would be helpful to those that I work with”. The Panel consider this a welcome start for Ms Sikpa to address the failings in her practice it identified, but still raises concerns. For example, she appears to be saying that the timely completion of care plans fulfills the needs of the team and will help those she works with. She does not address the nature, extent or function of care plans or mention why they are vital documents in the care of service users. The limited nature of Ms Sikpa’s submission did not provide the Panel with sufficient information or verifiable evidence to be confident that her very newly found insight was secure, genuine and likely to be maintained.

249. The Panel was also conscious that Ms Sikpa told it in June 2022 that her decisions in respect of care plans and risk assessments involved a degree of conscious thought. It therefore considered them to be potentially attitudinal in nature.

250. Further, the Panel could not ignore the fact that some of the failings identified occurred while Ms Sikpa was subject to conditions on her ability to practice, which included enhanced supervision. However, the Panel recalled that witness Dr SS, Ms Sikpa’s supervisor at the Trust, told it that she had no clinical concerns while she was supervising Ms Sikpa and that the case notes she reviewed in supervision were up to date, legible, signed, dated and in accordance with the Trust’s record keeping standards, and that she was shocked to learn of the concerns raised about Ms Sikpa. This again does not give the Panel confidence that Ms Sikpa would be proactive in drawing the attention of an employer to the adverse findings made by this Panel in order that it could support her.

251. Given all of the above, the Panel could not formulate workable conditions which adequately protected the public but were not tantamount to a suspension.

252. The Panel also could not formulate any conditions which would sufficiently mark the serious nature of, and protect the public from, a registered professional failing to adequately, or at all, record their interactions with vulnerable service users, contrary to standards of practice and guidance issued by their employer. Accordingly, the Panel found that a conditions of practice order was not an appropriate sanction to impose in this case.

253. The Panel concluded that the nature of the misconduct, and the period of time during which it was perpetrated (i.e. when already subject to a conditions of practice order) was such that the public and the wider profession would consider anything less than a suspension order to be insufficient. It also considered that Ms Sikpa would benefit from some time to address her health concerns, focus on her reflections on these proceedings and her future intentions before addressing the failings identified by the panel.

254. The Panel was content that fellow professionals, colleagues of Ms Sikpa and the public generally would, if aware of all of the circumstances of this case, recognise that a period of suspension was appropriate and proportionate to allow Ms Sikpa one further opportunity to demonstrate reflection, insight and remediation.

255. The sanctions guidance also advocates that “It’s good practice to test the appropriateness and proportionality of a proposed sanction by considering the next sanction up against each of the limbs of the overarching objective that were found to apply at the impairment stage.” The Panel therefore considered whether a striking off order was more appropriate in the circumstances. It had careful regard to the non-exhaustive list of serious cases that could warrant a striking off order being made and was satisfied that such an action would be excessive in the circumstances of this case - Ms Sikpa had engaged with her regulator throughout and expressed her desire to continue practising, which the Panel did not doubt was genuine. It was mindful that the sanction of removal from the register should only be imposed when no other outcome would be enough to protect the public, maintain confidence in the profession or maintain proper professional standards. In this case, protection of the public would be achieved by the imposition of a suspension order and the public interest would be met by a period of suspension.

256. The Panel sincerely hoped that the conclusion of these proceedings and a period of reflection will allow Ms Sikpa the time needed to focus on the steps required to demonstrate to her regulator that her insight, remorse and remediation are securely embedded in her methods of practice. The Panel had no doubt that Ms Sikpa was passionate about, and committed to, her profession. Its concern is her certainty that she does not pose a risk to service users despite the comments of her former colleagues and the findings of this Panel.

257. Having determined that a suspension order is the appropriate and proportionate sanction to impose, the Panel then considered the length of time that it should be in place, conscious that it was in the public interest to support the return to practise of a qualified professional when this can be achieved safely. It determined that anything less than 12 months would be insufficient to mark the serious nature of the misconduct or ensure that Ms Sikpa could genuinely address the concerns. Accordingly, the appropriate length of the suspension order would be 12 months, though of course if Ms Sikpa is able to make good progress in taking on board the findings of the Panel, she may be able to request an early review of the order.

258. The Panel recognises that it cannot bind or influence a future reviewing panel, however it considered that any such panel would be greatly assisted if Ms Sikpa was able to attend and engage fully in future hearings, and provide it with some or all of the following information in advance of the review hearing:

a. detailed written reflective piece focusing on:
i. Working in a multi-disciplinary team;
ii. Record keeping;
b. information on her current health, supported by medical evidence where appropriate which sets out the nature and extent of any ill-health as well as the treatment and prognosis;
c. information as to her personal circumstances insofar as this impacts upon her professional practice;
d. evidence of relevant training undertaken in contemplation of a return to the profession, in particular in respect of:
i. Risk assessment and analysis;
ii. record keeping;
iii. Integrity and professional ethics;
iv. Working in a multi-disciplinary team
e. details of any professional literature she reads, with her incorporating in her reflective work how the literature has impacted upon her practice;
f. recent testimonials in relation to her work, paid or unpaid, in the caring sector, with particular reference to issues of collaboration, openness, and record keeping. The author of any such testimonial should be fully appraised of the nature of the concerns that have led to the imposition of this suspension order.

That the Registrar is directed to suspend the registration of Ms Sarah Sikpa for a period of 12 months from the date this order comes into effect.

The order will be reviewed before its expiry.

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 Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Interim Order

259. Upon the Panel determining the appropriate sanction to be a Suspension Order, Mr Keating confirmed he intended to apply for an Interim Order but before he could do this, as Ms Sikpa was not in attendance, he was required to make a further application to proceed in her absence.

260. Mr Keating reminded the Panel that further delay in this case was not in the public interest and that Mr Chalmers had already addressed the Panel at length in relation to proceeding in absence generally and in relation to the medical evidence supplied by Ms Sikpa specifically. He referred the Panel to the practice note provided to assist Panels on the matter of interim orders and suggested that there was no evidence that Ms Sikpa would attend a future hearing if this matter were to be adjourned. Mr Keating submitted that the prejudice to Ms Sikpa caused by her non-attendance at the Interim Order stage was less than at other stages of the regulatory proceedings, as she had already provided live evidence to the Panel. He concluded by reminding the Panel that although fairness to the registrant is of prime importance, the overriding statutory objective of regulation is to protect the public. Given the Panel had found impairment and imposed a sanction of suspension to protect the public, Mr Keating submitted the overriding objective required immediate consideration of the interim order application in the absence of Ms Sikpa.

261. The Panel were satisfied that Ms Sikpa had been informed of the prospect of an interim order being applied for on 29 June 2022. It was unfortunate that this prospect had not been drawn to her attention again more recently as the proceedings approach a conclusion, however the Panel was satisfied that it was fair and appropriate for the application to be received now given the findings it had made. There was no indication Ms Sikpa would attend any adjourned hearing date, nor that she would seek to be represented at such a re-arranged hearing. The quality of the medical evidence available to the Panel had already been considered and did not indicate that Ms Sikpa was too unwell to attend the hearing. The Panel had found it necessary to impose a restrictive order upon Ms Sikpa for the protection of the public and it was therefore appropriate that the application for an interim order be considered forthwith and in the absence of Ms Sikpa.

262. Mr Keating then reminded the Panel that it’s power to make an interim order is contained at Article 31 of the Health Professions Order 2001 and the test for the same is whether it necessary for the protection of the public, is in the public interest or is in the interests of the registrant. The process for considering such an application is firstly to consider the basis for the application, then the grounds, and move on to the nature and then duration if appropriate. The basis for his application was the Panel’s finding of impairment and the determination that the appropriate sanction was suspension for a period of 12 months. The grounds for the application was the protection of the public and that the order was required in the public interest and the nature of the order sought was suspension, given the concerns expressed by the panel. The duration of the order sought was 18 months to allow time for any appeal to be concluded. If no appeal was made, the interim order would expire after 28 days.

263. The Panel considered Mr Keating’s submissions and the advice provided by the Legal Assessor, which it accepted. It also noted the provisions of the guidance note issued by the HCPTS in respect of Interim Orders. It reminded itself that an interim order may be appropriate where:
a. there is a serious and ongoing risk to service users or the public from the registrant’s conduct; or
b. the allegation is so serious that public confidence in the profession or the regulatory process would be seriously harmed if the registrant was allowed to remain in practice on an unrestricted basis.

264. The Panel were mindful that, in imposing a Suspension Order, it had found that there was an ongoing potential risk to service users from Ms Sikpa’s conduct. The facts found proved were serious, amounted to misconduct and the Panel had found her fitness to practise to be impaired. Ms Sikpa had been provided with notice that an interim order could be applied for following the conclusion of the substantive proceedings in June 2022 in the notice of the reconvened hearing. The factors which led the Panel to impose the Suspension Order were still highly pertinent. The Panel was conscious that the imposition of an interim order would have an immediate and detrimental impact upon Ms Sikpa, however it considered that this impact could not be prioritised over the need to protect the public and the wider public interest while the regulatory concerns about Ms Sikpa’s fitness to practice were addressed.

265. The Panel did not however consider that the interim order should exceed the term of the substantive order in this case and it accordingly imposed an interim order of suspension for a period of 12 months.

 

History of Hearings for Sarah Sikpa

Date	Panel	Hearing type	Outcomes / Status
25/03/2024	Conduct and Competence Committee	Review Hearing	Conditions of Practice
27/09/2023	Conduct and Competence Committee	Review Hearing	Suspended
27/09/2022	Conduct and Competence Committee	Final Hearing	Suspended
07/06/2022	Conduct and Competence Committee	Final Hearing	Adjourned part heard