Jennifer Carlaw

Preliminary Matters

Hearing in private

1. Mr Bright made an application for part of the hearing to be heard in private to protect the private life of the Registrant. His application was limited to the part of the hearing which involved details of the Registrant’s health. Ms Welsh did not oppose the application.
2. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note “Conducting Hearings in Private”.
   
   
3. The Panel decided that it was appropriate for part of the hearing to be heard in private to protect the Registrant’s private life, covering any references to details of her health.

Background 

4. Following her graduation from University after studying psychology, the Registrant obtained employment in a special needs nursery where she worked as a learning assistant, and subsequently as a speech and language assistant. Her application to study speech and language therapy in order to become a Speech and Language Therapist (“SLT”) was supported by that employer. The Registrant completed her post- graduate diploma in speech and language therapy in 2013. During that training she completed three placements, one of which was undertaken with the East Kent Hospitals University NHS Foundation Trust (“the Trust”)./
5. The Registrant commenced employment as a Band 5 SLT with the Trust on 1 September 2014. She was based at the Queen Elizabeth the Queen Mother Hospital in Margate (“the Hospital”). The Registrant’s employment continued until she submitted her resignation on 10 October 2017. Her last official working day was 7 November 2017, but she was on sick leave for some of the period between the submission of the resignation and the end of the employment
   
   
6. The Registrant’s line manager, JH, by May 2017 had identified significant concerns about the Registrant’s practice. JH instigated an informal performance review from 24 May 2017 that lasted until 29 August 2017 which included an action plan. The Registrant’s line manager considered that the informal procedure had not achieved the goals set and a formal review meeting was scheduled for 29 September 2017 in line with the Trust’s HR Guidance for Performance Reviews. A further action plan was set under the formal procedure. The Registrant submitted her letter of resignation on 10 October 2017
   
   
7. At the substantive hearing, the panel found all of the facts proved. Although the Registrant did not attend the substantive hearing, she provided a statement, dated 28 January 2020, in which she accepted most of the  allegations against her. 

4. The panel at the substantive hearing found that the incidents, both individually and taken together, amounted to misconduct. In so doing, the panel found that the:- “knowledge and skills required to  act appropriately with regard  to each  patient were fundamental. None of them was unusual or specialised and the failings were serious”.  The decision continued: “For the avoidance of doubt, there were no factual particulars that the Panel considered to be too insignificant to be included in this finding. Furthermore, the Panel was satisfied that no issue of lack of competence arises”.
   
   
5. In relation to impairment, the panel found that the Registrant was impaired in respect of both the private  and public component. 
   
   
6. In respect of the personal component, the panel noted:-

• The witnesses called by the HCPC accepted that the  Registrant was  hard working, caring and had a genuine regard for her patients and wished to advance their interests.
• The Registrant had shown some insight and had admitted many of the failings found proved.
• There was a likelihood of repetition as the Registrant had not been working and she would need  to undergo training and supervision, if she were to return to work.

11. In respect of the public component, the panel found that the public “would be dismayed if a practitioner against whom these serious findings have been made, and who has not remediated the shortcomings, were to be permitted to return to practise without restriction. Furthermore, if the Panel did make a finding of current impairment of fitness to practise it would be failing in its obligation to declare and uphold proper professional standards”.

12. The panel imposed a two year Conditions of Practice Order which included the following conditions:

1. You must not accept any offer of employment for which your HCPC registration is required unless the post to which you would be appointed offers you weekly face to face supervision until such time as your Newly Qualified Practitioner (“NQP”)

Competencies are signed off as having been met by your supervising SLT who must be working at Band 7 or above.

2. You must not work alone with the following categories of patients:

• patients with dysphagia;
• patients with acute onset;
• end of life patients; and,
• patients with tracheostomies.

To the extent that you need to see patients falling into these prohibited categories in order to satisfy competencies, you are to shadow and/or be directly supervised by a practitioner working at Band 7 or above.

3. You are to attend and satisfactorily complete a Royal

College of Speech and Language Therapists (“RCSLT”) accredited course on dysphagia.

4. You are to successfully complete the RCSLT NQP Competencies, starting that task afresh.

5. You are to successfully complete the RCSLT

Dysphagia Training Competency Framework at Level B.

6. You are to complete a significant event analysis, using the RCSLT CPD Toolkit, in relation to the four patients concerned in this case.

7. You must provide not less than 28 days before the date of the review of this Order, the following documents:
   • A certificate of completion of the course required to be undertaken by condition 3.
   • Proof that your RCSLT NQP Competencies have been signed off by your supervising SLT.
   • A certificate of completion of the Dysphagia Training Competency Framework at Level B required by condition 5.
   • Copies of the significant event analyses required by condition 6.
   • A report from your supervisor commenting specifically on your progress since this Order was made and your readiness to practise without restriction.
   • Your CPD portfolio, demonstrating adherence to the five HCPC’s CPD standards.

8. You must promptly inform the HCPC if you take up any employment for which your HCPC registration is required.

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

10. You must inform the following parties that your registration is subject to these conditions:

i. any organisation or person employing or contracting with you to undertake professional work;

ii. any agency you are registered with or apply to be registered with (at the time of application); and

iii. any prospective employer (at the time of your application).

13. The Registrant did not attend the review hearing on 9 February 2022. Her solicitors provided an update on her position. Information was provided that the Registrant had not worked as a Speech and Language Therapist. She had not satisfied any of the conditions on her registration. At that time the Registrant considered it “unlikely that she will wish to return the profession of Speech and Language therapy” [sic]. The Registrant’s solicitor stressed that the Registrant meant no disrespect to the Panel by her failure to comply with the Conditions  of Practice  or her failure to attend today’s hearing. The Registrant also “acknowledges that there were failures in her practice and is wholly understanding of the conditions that she would need to meet in order to practice”.
    
    
14. The review panel on 9 February 2022 decided that the Registrant’s fitness to practise remained impaired and that it was necessary and appropriate to continue the interim conditions of practice order. It suggested that the Registrant should use the next twelve months to consider her position. If she no longer wished to remain on the Register she should seek advice from her solicitor and take steps to apply for voluntary removal.
    
    
15. On 3 February 2023 the Registrant’s provided a Personal Development Plan (PDP) prepared by the Registrant. This plan set out goals the Registrant has set for herself, including undertaking a significant event analysis, training on dysphagia and record keeping, and refreshing her knowledge and skills. The Registrant set out her plans as “urgent” or “longer term” goals.

    Submissions

16. The Panel heard submissions from Ms Welsh. She submitted that there was no evidence that the Registrant has made progress since the last review to address the concerns and that the same risks remain as identified by previous panels. She submitted that the Registrant’s fitness to practise remains impaired. She acknowledged that the Registrant has attended the hearing and prepared a PDP plan. She submitted that the appropriate sanction would be to confirm and extend the current conditions of practice order and that the extension should be for at least twelve months.
    
    
17. On behalf of the Registrant Mr Bright accepted that the Registrant’s fitness to practise remains impaired. He stated that the Registrant has reflected on her position over the last twelve months and has decided that she does wish to return to the profession. He acknowledged that the Registrant has not yet taken any of the necessary steps and that this was for personal reasons. He submitted that the Registrant acknowledges that she is not now ready to return to practise and that she has drawn up her PDP as the first steps required in order to return to the profession. He submitted that the current conditions of practice include sufficient protection for the public and that the Registrant has insight into her need to refresh and update her knowledge. In respect of the length of the order Mr Bright submitted that this was a matter for the Panel, and that the Panel might consider that two years was appropriate.
    
    
18. The Panel heard and accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note “Review of Article 30 Sanction Orders”. The Panel’s function is to determine whether the Registrant’s fitness to practice is still impaired, and, if so, whether the Conditions of  Practice  Order under review remains the appropriate and proportionate means of public protection or should be varied or replaced by some other Order.
    
    
19. The Panel first considered whether the Registrant’s  fitness to practise remains impaired. It has taken account of the submissions of both parties. The Registrant has not  complied with any of the  conditions imposed by the previous panel and has not yet made progress in addressing any of the concerns. In light of these factors, the Panel has concluded that the Registrant’s fitness to practise remains impaired. 
    
    
20. In considering the appropriate sanction, the Panel had regard to the Sanctions Policy (SP) published in March 2019, and accepted the advice of the Legal Assessor. The Panel has applied the principle of proportionality. 
    
    
21. The Panel is aware that the purpose of sanction is not to be punitive but that it must consider the risk the Registrant may pose to service users in the future and determine what sanction is sufficient to protect the public and the wider public interest.
    
    
22. The Panel has considered the sanctions available in ascending order of severity. The Panel considered that to take no action or to impose a Caution Order would not be sufficient or appropriate, as neither outcome would afford the necessary public protection or satisfy the public interest.
    
    
23. The Panel next considered whether a Conditions of Practice Order would be sufficient and proportionate. The Registrant has not practised since the end of 2017 and the Panel was of the view that she has much work to do to update her knowledge and skills and to address the concerns identified by the substantive hearing panel. The Registrant was previously uncertain about her plans because of her personal circumstances, and the Panel recognised that there are personal reasons why she has not actively engaged with the conditions of practice. The Registrant has consistently acknowledged the findings of the substantive hearing panel and she is aware of the need to bring her knowledge and skills up to date.
    
    
24. The Panel considered carefully whether the conditions of practice remain appropriate, given that the Registrant has not practised for a long period of time. It was aware that the option of replacing the current order with an interim suspension order is available. The Panel reviewed the current conditions of practice and considered that they provide a sufficient degree of public protection. For example, they require the Registrant to work with the benefit of weekly face to face supervision meetings until she has demonstrated a minimum level of competency. Under the Registrant’s PDP her goal to obtain a Band 5 position is a “long term” goal, which will follow completion of training.
    
    
25. The Registrant has now decided that she does wish to pursue a return to practice as a Speech and Language Therapist. The Panel considered that the current conditions are sufficient to protect the public and that it is not necessary to vary them. It decided that a suspension order would be disproportionate, given the level of insight demonstrated by the Registrant and the sufficiency of conditions of practice.
    
    
26. The Panel next considered the appropriate length of the order. The Panel carefully balanced the need to ensure that the Registrant’s progress is appropriately monitored and the need to allow a realistic length of time for her to engage with suitable training opportunities, build her confidence, and, in due course, begin practising under the conditions of practice. The Panel decided that twelve months was an insufficient period of time, given the significant time the Registrant has not practised as a Speech and Language Therapist and the training she will need to complete. It was also of the view that two years was too long and might allow the Registrant to lose focus on progress with her PDP. The Panel decided that the appropriate and proportionate length of time for the order was eighteen months.
    
    
27. The Panel therefore decided to extend the current Conditions of Practice Order for a period of 18 months as the appropriate and proportionate order.

Order: The Registrar is directed to extend the Conditions of Practice Order against the registration of Jennifer Carlaw (now Jennifer Ward) for a further period of 18 months on the expiry of the existing order.

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 Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

History of Hearings for Jennifer Carlaw