Ms Sarah Neita

Preliminary Matters

Proceeding in private
1. Ms Welsh made an application for part of the hearing to be held in private where the Registrant’s health was to be discussed to protect the private life of the Registrant. The Registrant agreed with the request.

2. The HCPTS Practice Note on Conducting Hearings in Private states that as a general rule hearings are to be in public in accordance with the ‘open justice’ principle. In certain circumstances it is in the interests of justice for the hearing to take place wholly or partially in private to protect where a Registrant’s health was to be discussed. The Panel considered the representations made and determined it was appropriate for the hearing to be heard in private where details of the Registrant’s health were being discussed to protect the private life of the Registrant.

Background
3. From November 2009 the Registrant was employed as an Occupational Therapist by Lewisham Healthcare NHS Trust (‘the Trust’). The Registrant was primarily responsible for working with children with coordination difficulties in mainstream schools and with children with severe learning and movement disorders within Special Schools.

4. The Registrant’s role was to meet patients and their families on both a one-to-one and group basis, assess patients, and set goals and targets for the development of their coordination. In November 2010, the case of Child 6 was allocated to the Registrant. She carried out an Initial Assessment in November 2010. By October 2011, the Registrant had still not written a report on Child 6 and there were concerns about the Registrant’s performance. Therefore a Performance Management Plan was put in place in May 2011 and satisfactorily completed by her. The Registrant was then promoted to a Band 6 role which required more complex clinical reasoning and assessment and she needed to work at an increased pace. The Registrant had demonstrated further poor record keeping by a failure to complete relevant paperwork following her assessment of three other children. There had been other examples of poor record keeping and failure to complete records within required timescales in June 2010, March 2011, October 2011 and January 2012. In March 2012, the Registrant submitted her resignation to the Trust. She took with her, on leaving, a number of documents which contained confidential information about children allocated to her and their families. These papers included supervision forms, caseload forms, reports and notes of action plans.

The Substantive Hearing on 20 - 28 February 2017.

5. The Substantive Hearing panel found there was misconduct and a lack of competence. Particular 2 alleged that the Registrant had not demonstrated satisfactory clinical practice in that, in a particular case, she had failed to follow up on her recommendation for a weighted hand-splint. In the view of the panel, this allegation was linked to the failures of record keeping, and amounted to another example of lack of competence. The panel determined that there had been a pattern of failure on the Registrant’s part to take required action on cases in a timely manner. Although health reasons had contributed to the level of the Registrant’s ability to meet the required standards, she was unable sufficiently or consistently to improve the standard of her work.

6. The panel determined that there was no justification for removing confidential documents and that the decision of the Registrant to do so amounted to disrespect of the confidentiality of service users and amounted to misconduct. The panel found the particulars set out above proved and concluded that the Registrant was impaired on both the personal and public components.

7. The panel imposed the following Conditions of Practice on the Registrant for a period of 2 years:
1. Within six months of the Operative Date you must:
(1) satisfactorily complete a course on data protection/information governance/confidentiality;
(2) forward a copy of your results or course certificate to the HCPC;
(3) write a reflective piece demonstrating your understanding of the importance to service users of maintaining confidentiality.
2. You must send a copy of your reflective piece on confidentiality to the HCPC at least four weeks before the date of the Review Hearing
3. If you engage in professional work as an Occupational Therapist you must place yourself and remain under the supervision of a supervisor and supply details of your supervisor to the HCPC within fourteen days of commencing such work.
4. If you engage in professional work as an Occupational Therapist you must:
(a) work with your supervisor to formulate a Personal Development Plan designed to address the following areas of your practice:
(i) Completing written assessments within the required timeframe;
(ii) Completing clinical records within the required timeframe;
(iii) Progressing cases by following up on recommendations for intervention.
(b) Within three months of commencing work as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC

(c) You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.
(d) You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.
5. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
6. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
7. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application)
8. You will be responsible for meeting any and all costs associated with complying with these conditions.

The first review hearing

8. On 27 October 2017, the Registrant made an application for an early review as she had completed a Data Protection training course on 24 October 2017 and submitted a Reflective Learning piece that she had written for her course. At the time of her review application, the Registrant was employed as a Functional Analyst, but was on long-term sick leave. She stated that she was at risk of losing her job and wanted her case reviewed because the conditions were “harsh” and it was inappropriate for her practice to be subject to any restrictions. (PRIVATE) 

9. The Registrant submitted that the Substantive Hearing in February 2017 related to events which had taken place between 2010 and 2012, and that no service user had ever complained about her conduct or competence. She a general lack of support from the Trust. She had learnt from her errors and had taken steps to ensure that she had addressed the issues raised. The Registrant had not applied for a post as an Occupational Therapist; she was employed as a Functional Analyst.

10. The panel found conditions 1 and 2 of the Order could be deleted because the Registrant had successfully completed a Data Protection Course and shown insight in relation to her misconduct. The Registrant had remediated her misconduct in relation to Particular 3, had shown insight and the Conditions imposed in relation to her misconduct were no longer required. However, in relation to the other issues relating to her lack of competence, the panel found that she was still impaired under the components of public protection and the public interest. The panel considered that the Registrant was remorseful and had developed some further insight, but she had not fully remediated and without evidence of remediation and full insight, there was a risk of repetition, if restrictions were not in place upon her practice. The panel therefore extended the Conditions of Practice Order in relation to the remaining six conditions, adapting condition 4.

The second and third review hearings: 21 February 2019, 25 February 2020

11. There was another review of the Conditions of Practice Order on 21 February 2019 and on 25 February 2020. The Registrant represented herself at both these review hearings and made representations to the reviewing panels. The reviewing panel, on the 25 February 2020, determined that the Registrant’s fitness to practise remained impaired. It found that the Registrant was open and honest and that she had recently begun to take active steps to return to work. She had significant health issues and the panel was impressed by her level of commitment, determination and developing insight. However, the panel determined the Registrant's essential failings which had been identified, had still not been remediated. In particular, there was no evidence that she had remediated in relation to her report writing, note taking, completion and submission of records (in a timely manner), and follow-up work and there was a risk of repetition. The panel imposed a further Conditions of Practice Order for 12 months.

The fourth review hearing on 15 March 2021

12. At the fourth review hearing on 15 March 2021, the HCPC submitted that the Registrant’s fitness to practise remained impaired. There was no evidence the deficiencies in her practice had been remedied. The Registrant was unable to been able to obtain employment as an Occupational Therapist.

13. The Registrant gave oral evidence at this review hearing and expressed her remorse. She had reflected on matters and stated that part of the reason she had been unable to find employment as an Occupational Therapist was because Condition number 1 of her Conditions of Practice, was interpreted by potential employers as requiring direct supervision. She submitted that Condition number 1 should require the normal level of supervision of any Occupational Therapist in employment. (This Condition was interpreted by the HCPC, as not requiring direct supervision). (PRIVATE)

14. The panel noted the following: a) The engagement of the Registrant with the process and her commitment to remaining in the profession; b) The assessment by her current line manager in her voluntary role in relation to the transferrable skills of her current role.

15. The panel stated they were impressed by the Registrant’s level of commitment to remaining in the profession and her continued engagement with the HCPC process. The Registrant recognised the shortcomings in her practice in relation to timeliness of report writing and assessments, and had insight into those shortcomings. There were no attitudinal issues. An issue remained as to whether she has demonstrated that she had remediated those shortcomings and she is able to safely practise as an Occupational Therapist without restrictions. The panel took into account the employment that the Registrant had as a Functional Analyst and the overlap between that work and the work of an Occupational Therapist. (PRIVATE)

16. The panel determined that the only concern related to the Registrant's ability to maintain timeliness in her report writing and assessments under pressure, with reasonable adjustments for her health conditions. The Registrant had difficulty obtaining employment as an Occupational Therapist due to the manner in which prospective employers had misinterpreted Condition 1 as requiring 'direct supervision'. The Registrant had been doing voluntary work that required her to create and complete reports and assessments. However, the panel determined that these reports and assessments were not at the level of an Occupational Therapist. The Registrant stated that these reports and assessments, at the highest, would be at the level of Band 2 or Band 3 and she had not been able to demonstrate timeliness of writing reports and assessments at the level of an Occupational Therapist. Therefore the Registrant's fitness to practise remained impaired by reason of her lack of competence.

17. The panel considered taking no action or the imposition of a Caution Order would neither protect the public nor be in the public interest. A Conditions of Practice Order remained appropriate and proportionate to protect the public and was in the public interest.

18. The panel stated the Conditions enable the Registrant to return to unrestricted safe practice because: a) They only apply if the Registrant is carrying out employment as an Occupational Therapist. b) The level of supervision that is envisaged is that which would be normal to the Occupational Therapist level at which the Registrant is to be employed. c) The supervisor does not have to be an Occupational Therapist so long as they are a healthcare professional registered with a healthcare regulator.

19. A sanction of suspension or striking off would be disproportionate in the circumstances where the Registrant has not been able to demonstrate remediation through no fault of her own. A Conditions of Practice Order for a further 12 months would enable the Registrant to obtain employment as an Occupational Therapist and demonstrate that she is no longer impaired.

20. The panel also stated a future reviewing panel may be assisted by:
a) Testimonials from current or recent employers or supervisors including (if relevant) to comment on the Registrant’s ability to consistently keep satisfactory and timely records. This does not necessarily have to be in the context of employment as an Occupational Therapist. The concerns relate to the Registrant's ability to produce reports and assessments in a timely manner under normal working pressures. Testimonials that address that point, particularly where they also deal with how technical those reports are and the time constraints would be particularly relevant.

b) Evidence that the Registrant continues to keep up to date with the appropriate CPD requirements for the profession.

The fifth review hearing on 22 March 2022

21. In July 2021, the Registrant contacted the HCPC and stated that she felt she was in an awkward position as, although at the last review the panel had clarified Condition 1 around supervision, she had still been unable to find work as an Occupational Therapist. The Registrant stated that she had been applying for positions but had been unable to obtain any work so far. The Registrant stated she was considering going back to her previous employer, but this would not meet the requirements set previously, and so at the next review she would be in the same position. The Registrant stated however that she needed to work to earn a living.

22. In January 2022, the Registrant again contacted the HCPC and stated she had been offered an Occupational Therapy position, but there was a significant pay drop. She wanted to be sure that after she had complied with the Conditions of Practice, she would be free to resume practice. She also stated her previous employer had sent her a letter about a disciplinary investigation, arising from her employment as a Functional Analyst. Her employer had stated that the HCPC contacted him about her Conditions, and he claimed she had been dishonest in not telling him about the HCPC proceedings. The Registrant stated when the HCPC investigation started she had informed her old boss, who had since left. She had not informed her employer about her Conditions of Practice but she had been off work due to health reasons so had not thought to do so, partly due to stress. Her employer had invited the Registrant to an initial meeting in relation to these matters in November 2021 but the Registrant had resigned. She felt her employer’s behaviour had been bullying and unacceptable.

23. The Panel considered that the Registrant had demonstrated a much fuller insight and had made significant progress. It was noted that the Registrant was in employment as an Occupational Therapist although was unable to work at that time due to ill health. The Registrant accepted herself that her skills required updating before removal of the Conditions of Practice Order. The Panel concluded that the Registrant’s fitness to practice remained impaired on the personal and the public component.

24. The Panel concluded that a further Conditions of Practice Order was the only appropriate sanction and would allow the Registrant to complete her probationary period at MCH and fully comply with the Conditions of Practice.

25. The Panel stated that the next reviewing panel would be assisted by the continued engagement with this review process by the Registrant, and:

a) Testimonials from current or recent employers or supervisors including (if relevant) to comment on the Registrant’s ability to consistently keep satisfactory and timely records. This does not necessarily have to be in the context of employment as an Occupational Therapist. The concerns relate to the Registrant's ability to produce reports and assessments in a timely manner under normal working pressures. Testimonials that address that point, particularly where they also deal with how t

echnical those reports are and the time constraints would be particularly relevant.
b) Evidence that the Registrant continues to keep up to date with the appropriate CPD requirements for the profession.

Submissions by the HCPC

26. Ms Welsh summarised the background of the case. She submitted that the current Order should be extended, to enable the Registrant to take the necessary steps to allow a Panel to decide that her fitness to practice is no longer impaired on both the personal and the public components of fitness to practise.

27. The decision in Abrahaem v GMC [2008] EWHC 183 (Admin) states there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that she has fully acknowledged the deficiencies which led to the original finding, and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”. The factors to take into account include the steps the Registrant has taken to address any specific failings or other issues identified in the previous decisions, the degree of insight shown and whether this has changed. The steps which the Registrant has taken to maintain or improve her professional knowledge and skills, whether any other fitness to practise issues have arisen and whether the Registrant has complied with the existing Order.

Submissions by the Registrant

28. The Registrant took the affirmation and gave evidence of the attempts she has made to comply with the Conditions of Practice Order since the last review hearing. The registrant sought to convince the Panel that she was fit to practise and that the Conditions of Practice were no longer required.

29. A number of documents were provided by the Registrant at the start of the day which were referred to by the Registrant in her evidence.

30. The Registrant outlined some difficulties she was encountering at work in terms of feedback from her supervisor to support her assertion that she was complying with the Conditions of Practice Order. The Panel had sight of the Testimonial of Natalie Pitt-Stevens which is undated.

31. In giving her evidence the Registrant indicated that she had complied with Condition 1 as the HCPC are aware of who her supervisor is.

32. The Registrant considered that she had to a large extent complied with Condition 2, and accepted that this was not supported by evidence from her supervisor due to the difficulties she had outlined in meeting with her supervisor.

33. The Registrant advised that she was finding the process quite stressful and was looking forward to returning back to unrestricted practice as she enjoys her work and is pleased with how she is progressing. The Registrant confirmed that she considers that she has learnt from her mistakes and where mistakes have been made she has rectified these as soon as possible.

Legal Assessor’s advice

34. The Legal Assessor advised that this is a Review under Article 30(1) of the Health Professions Order 2001, and the Panel should take into account the HCPTS Practice Note on Review of Article 30 Sanction Orders. The Panel were reminded that Article 30(2) of the Health Professions Order 2001 provides Panels with a discretionary power to review conditions of practice orders at any time on the application of the person concerned or otherwise, at any time it is in force and that the reviewing Panel may:
- confirm the order;
- extend, or further extend, the duration of the order;
- reduce the duration of the order
- replace the order with any other order which the Panel could have made (to run for the remaining term of the original order); or
- revoke the order.

35. Article 30(2) is a discretionary power and does not specify the circumstances in which it may be exercised. Consequently, reviews are not limited to cases in which new evidence has come to light but may encompass any case where a significant and material change in circumstances has occurred since the original order was made.

36. The Panel was reminded that the review process is not a mechanism for appealing against or ‘going behind’ the original finding that the registrant’s fitness to practice is impaired. The purpose of the review is to consider:
- Whether the registrant’s fitness to practise remains impaired; and
- If so, whether the existing order or another order needs to be in place to protect the public.

37. The key issue which needs to be addressed is what, if anything, has changed since the current order was imposed. The factors to be taken into account include:
- the steps which the registrant has taken to address any specific failings or other issues identified in the previous decision;
- the degree of insight shown and whether this has changed;
- the steps which the registrant has taken to maintain or improve his professional knowledge and skills; and
- whether any other fitness to practice issues have arisen.

38. The reviewing Panel’s task “is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed”. Abrahaem v GMC [2008] EWHC 183 (Admin).

39. The decision reached must be proportionate, striking a fair balance between interfering with the registrant’s ability to practise and the overarching objective of public protection.

40. The HCPC’s overarching objective is protection of the public and the purpose of fitness to practise proceedings is not to punish registrants for their past acts and omissions, but to protect the public from those who are not fit to practise.

Decision

41. In reaching its’ decision today the Panel considered all the information before it. The Panel first considered whether the Registrant’s fitness to practise remains impaired. The Panel was aware that the persuasive burden is upon the Registrant to demonstrate that her fitness to practise is no longer impaired. The Panel had regard to the decision of the substantive panel. However, it comprehensively reviewed the matter and exercised its own judgment in reaching its’ decision.

42. The Panel had regard to the HCPTS Practice Notes “Review of Article 30 Sanction Orders” and “Fitness to Practice Impairment” and accepted the advice of the Legal Assessor.

43. The Panel were concerned that they had had shared with them by the Registrant unredacted patient notes and the Registrant had referred in evidence to a patient by name. The Panel considered whether the Registrant’s fitness to practice remained impaired with reference to the personal and the public component. The Panel were impressed by the level of commitment shown by the Registrant to the process but found that the current Conditions of Practice were not fully being complied with and the Registrant could be more proactive in managing the difficulties encountered with her supervisor.

44. The Panel found that there was insufficient evidence before them to be satisfied that the Registrant had adequately addressed the concerns raised. Specifically, they were not convinced that the Registrant had demonstrated full insight and could do more to demonstrate her compliance with the Conditions of Practice. In terms of remediation, the Panel found that whilst the Registrant is working towards achieving her objectives they were not fully evidenced at this time and there was no independent verification. It was therefore determined that on the personal component the Registrant’s fitness to practice remains impaired.

45. In considering the public component the Panel found that members of the public would not have confidence in the profession, or in the regulator, if the Registrant is permitted to return to unrestricted practice at present when full compliance with the Conditions of Practice Order is not apparent. The Panel found that the Registrant is not currently meeting the required standards and that her fitness to practice remains impaired on both the personal and public components.

46. The Panel reminded themselves that there is a persuasive burden on the Registrant to demonstrate at a review hearing that he or she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”.

47. The Panel then went on to consider the appropriate sanction with reference to the Sanctions Policy and consider that a further Conditions of Practice Order is the only appropriate sanction today. The Panel acknowledged the attempts made by the Registrant to address the concerns but considered that she had not yet fully complied and that more could be done to demonstrate that she can return to unrestricted practice.

48. The Panel has decided to extend and amend the existing order for a period of 12 months. This will allow for completion of the probationary period and should the Registrant be able to evidence compliance sooner she can of course request an early review hearing. Taking no action or a Caution Order would Suspension Order is not necessary and would be disproportionate.

49. The next reviewing panel will be assisted by the continued engagement with this review process by the Registrant, and:

a) a completed questionnaire from the Registrant’s employer confirming compliance or otherwise with Condition 2 (a) (i) and (ii);

b) Evidence that the Registrant continues to keep up to date with the appropriate CPD requirements for the profession, including reflective pieces to demonstrate insight, a personal statement showing the ways in which she has addressed Condition 2 (a) (i) and (ii), and a patient case study every three months showing how she has progressed a case from start to finish.

50. The Registrant should assist the Panel to ensure a prompt start of the next review hearing by submitting any documents to be relied upon by her at least 2 working days before the hearing.

ORDER: The Registrar is directed to vary the Conditions of Practice Order against the registration of Miss Sarah Neita for a further period of 12 months on the expiry of the existing Order. The Conditions are:

1) If you work as an Occupational Therapist, you must place yourself and remain under, the supervision of a supervisor who must be a healthcare professional registered with any of the healthcare regulators and supply details of your supervisor to the HCPC within fourteen days of commencing such work. For the avoidance of doubt, this condition envisages the level of supervision to be that which would be normal for the Occupational Therapist level at which the Registrant is employed.

2) If you engage in professional work as an Occupational Therapist you must:
a) Work with your supervisor to formulate a Personal Development Plan designed to address the following areas of your practice:
(i) Completing written assessments and clinical records within the required timeframe;
(ii) Progressing cases by following up on recommendations for intervention.

b) Within three months of commencing work as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.
c) Following the submission of your Personal Development Plan in accordance with (b) above, you must then provide, every three months, an updated Progress Report on your Personal Development to the HCPC, to be endorsed by your supervisor.

3) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

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

5) You must inform the following parties that your registration is subject to these conditions:
a) any organisation or person employing or contracting with you to undertake professional work
b) any agency you are registered with or apply to be registered with (at the time of application); and
c) any prospective employer (at the time of your application).

6) You will be responsible for meeting any and all costs associated with complying with these conditions.

The Order imposed today will apply from 28 March 2023.

This Order will be reviewed again before its expiry on 28 March 2024.

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 Ms Sarah Neita