Miss Sutapa Halder

Preliminary Matters
Partly Private Hearing
1. The Chair confirmed at the outset of the hearing that the proceedings would be conducted partly in private in accordance with Rule 10(1) which states:
“At any hearing—
(a) the proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the registrant…the public should be excluded from all or part of the hearing;”

2. The Panel reached this conclusion having determined that any reference to the Registrant’s health, the health of members of her family, or the name of her current employer should not be disclosed in the interests of justice and in order to protect the Registrant’s right to a private life.

Background

3. The Registrant was employed as a Band 5 Speech and Language Therapist by the East London NHS Foundation Trust (the Trust) from 1 October 2014 to 22 July 2016 when she resigned. She was responsible for providing speech and language therapy to children between the ages of 4 and 11 with speech, language, and communication needs.

4. During the Registrant’s employment, concerns were raised about her clinical documentation and record keeping. Her employer provided joint supervision arrangements and additional support and she was placed on a performance improvement plan. The problems, however, continued and so the Trust referred the case to the HCPC.

5. On 8 November 2017 a panel of the Investigating Committee determined that the Registrant had a case to answer in relation to failures to:
• carry out and/or record appointments;
• complete or record contemporaneous clinical progress notes; and/or
• complete and/or record review reports and programmes reports in relation to three children (A, B and E) between October 2014 and September 2016. There were similar allegations in relation to two other children (C and D).

6. In a formal response to the allegation dated 27 September 2017, the Registrant accepted that her fitness to practise was impaired and that she was not yet ready to return to practice. She requested voluntary removal from the register until she was well enough to return. The Registrant set out mitigating circumstances in relation to her health and personal life and identified support mechanisms and coping strategies that would enable her to return to the profession.

7. On 4 February 2019 a panel of the Conduct and Competence Committee disposed of the matter by consent and imposed a 12-month suspension order, having determined that the Registrant’s fitness to practise was impaired by reason of her misconduct or lack of competence.

8. On 7 January 2020 at the first substantive order review, the panel determined that the Registrant’s fitness to practise remained impaired and extended the suspension order for a further period of 12 months. The panel also made recommendations that the Registrant should provide certain information and documents for the purpose of a future reviewing panel.

9. On 6 January 2021 at the second substantive order review, the Registrant provided the following:
• a letter from a Band 6 and 7 Speech and Language Therapist who confirmed her agreement to act as the Registrant’s mentor;
• evidence of her placement with the Robert Blaire Primary School;
• extracts from her PIP application on behalf of her sister;
• invoices from Asian Care in relation to homecare services provided to her sister.

10. Notwithstanding the above, the HCPC submitted that the Registrant‘s fitness to practise remained impaired and drew to the panel’s attention that the Registrant had not fully addressed the recommendations of the previous review panel; in particular:
• she had not provided any references or testimonials in relation to any paid or unpaid work;
• she had not yet applied for any courses that might help her address her deficiencies in practice, as recommended by the previous panel;
• she had not yet properly addressed the original concerns about her failure to keep proper records;
• she had been unable to obtain a letter from her GP about her health.

11. The Registrant herself acknowledged that she had been unable to fully comply with the recommendations of the previous review panel and did not oppose the imposition of a further 12-month period of suspension.

12. In light of the above, the panel at the second substantive order review determined that the Registrant’s fitness to practise remained impaired and imposed a further suspension order for a period of 12 months. The panel advised the Registrant that the next reviewing panel might be assisted by the following:
• references and testimonials relevant to her acknowledged impairment;
• evidence that she understands and follows a record-keeping policy;
• a CPD portfolio that meets all 5 of the HCPC’s standards;
• completion of an accredited Speech and Language Therapy return to practice short course;
• a personal action plan identifying objectives to be addressed and how to achieve them;
• evidence in relation to the management of her health;
• her attendance at the next review hearing.

13. The third review took place on 24 January 2022. The Registrant submitted that she had made good progress towards satisfying the recommendations of the previous review panel. However, she acknowledged that she had further work to do. In particular, she intended to resume regular sessions with her mentor, undertake CPD and enrol on a Return to Practice course. She told the Panel that she now felt fully motivated to address the outstanding issues relating to her practice and to implement the recommendations of the previous review panel.

14. The third review panel determined that the in the absence of evidence that the Registrant had fully gained insight into and addressed the deficiencies in her practice, her fitness to practise remained impaired in relation to the personal component and on public protection grounds. The third review panel decided that, in all the circumstances, the appropriate and proportionate sanction was to impose a further Suspension Order for a period of 12 months.

15. The panel advised the Registrant that the next reviewing panel might be assisted by the following:
• the Registrant’s attendance in person at the hearing;
• references and testimonials relevant to showing how she has addressed her shortcomings outlined in the original allegations relating to record-keeping and clinical documentation;
• a reflective statement on her past shortcomings in record keeping, demonstrating that she understands the expectations of a Speech and Language Therapist in relation to record-keeping as outlined in the HCPC’s policy and giving practical examples of meeting the required standards;
• a CPD portfolio structured around competencies, cataloguing examples of how she meets each of the 5 HCPC standards;
• evidence that she has satisfied the HCPC return to practice requirements (60 days of updating) for someone who has been out of practice for more than 5 years;
• a SMART personal action plan setting out how she will achieve the objective of remedying her deficiencies in record keeping and completing clinical documentation.
Today’s hearing

16. The Panel was provided by the HCPC with a bundle of documents including the decision of the panel at the Consent Hearing and the subsequent reviews. The Panel was also provided with documents from the Registrant. These documents included:
• An undated reflective piece prepared for consideration at this hearing which includes an example of how the Registrant is recording her CPD;
• Written confirmation, dated 27 June 2022 of the Registrant’s appointment as a Teaching Assistant and the unsigned acceptance form, dated 1 September 2022;
• Various medical letters and reports from 2020 to 2022;
• A screenshot of the Registrant’s acceptance at Birmingham City University to study on the Return to Practise Course via distance learning;
• Extracts of notes written by the Registrant in her current role as a Teaching Assistant.
The Registrant’s Evidence

17. The Registrant chose to give oral evidence. The Registrant stated that although she has made some progress towards demonstrating that she is fit to return to practise, she acknowledged that she has ‘more to do’. She invited the Panel to extend the current suspension order for a further 12 months.

18. The Registrant reiterated some of the content of her reflective statement and explained that she is currently working in a primary school as a Special Educational Needs Teaching Assistant. She has been in this role since September 2022. The Registrant stated that both the SENCO and Speech and Language Therapist (SLT) that were at the school when she joined, have since left. The Registrant informed the Panel that the new SENCO and SLT will be in post soon and she hopes, with their assistance, to develop a work-based plan which will enable her to demonstrate that her record-keeping skills meet the required standard. The Registrant explained the method she intends to use (SOAP: subjective; objective; assessment and plan) for recording her notes and confirmed that for ease of reference, she intends to record her notes electronically.

19. The Registrant stated that she started her Return to Practise course in June 2022 and hopes to complete it by May 2023. She explained that the course is flexible and consists of 45 days of formal education and 15 days of private study in addition to an opportunity to complete work-based placements. As the Registrant is currently in employment the placements will have to be completed during half-term and other school holidays and much of her private study will have to be completed during the weekends. She recognised that working and studying will be challenging but informed the Panel that she is motivated to complete the course and has a supportive partner and family.

20. The Registrant stated that the deficiencies in her practise were related to her poor health as she was “overwhelmed from the start” and now believes that she experienced an element of “imposter syndrome”. She informed the Panel that she now recognises that she did not understand the connection between her health and work at the time the concerns were raised and had been reluctant to ask for help. She stated that if she had asked for help things “could have been very different”.

21. In response to questions from Ms Welsh the Registrant explained the importance of prioritising her workload, discussing issues with her mentor, and making better use of supervision. In response to Panel questions the Registrant stated that she had a mentor for 2 years but that arrangement came to an end when her mentor moved away. She recognised the importance of having a SLT mentor and informed the Panel that she would contact the SLT from her previous job to see if she would be able to mentor her. Alternatively, she would speak to the new SLT once she has had the opportunity to meet her.
Submissions on behalf of the HCPC

22. Ms Welsh, on behalf of the HCPC, outlined the background circumstances of this case. During her closing submissions, she also outlined the key principles which should guide the Panel’s decision-making process.

23. Ms Welsh acknowledged that the Registrant has remained engaged with the HCPC regulatory proceedings. She also commended the Registrant for making some progress in addressing the deficiencies in her practice and the recommendations of the last review panel. However, she submitted that the Registrant had not yet completed the steps needed to remediate her practice and that currently her fitness to practise remains impaired in relation to both the personal component, the need to protect the public and in the wider public interest, which includes maintaining public confidence in the profession.

24. Ms Welsh further submitted that it would be appropriate and proportionate to impose a suspension order for a further period of 12 months, in order to give the Registrant a further opportunity to address the outstanding concerns.

The Panel’s Approach
25. In undertaking this review, the Panel took into account the documentary evidence, the submissions from Ms Welsh, and the Registrant’s oral evidence.
26. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt. In particular that:
• The purpose of the review is to consider the issue of impairment based on the previous panel’s findings of fact, the extent to which the Registrant has engaged with the regulatory process, the scope and level of her insight, and the risk of repetition.
• In terms of whether the concerns relating to the Registrant have been remediated, relevant factors include whether the Registrant:
i) fully appreciates the gravity of the previous panel’s finding of impairment;
ii) has maintained her skills and knowledge;
iii) is likely to place service users at risk if she were to return to unrestricted practice.
27. The Panel should have regard to the HCPTS Practice Note: Finding that Fitness to Practice is impaired and take account of the following components:
• the ‘personal’ component: the current competence, behaviour, etc. of the individual registrant; and

• the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.
28. It is only if the Panel determines that the Registrant’s fitness to practise remains impaired, that the Panel should go on to consider sanction by applying the guidance as set out in the HCPTS Indicative Sanctions Policy (ISP), and the principles of proportionality which require the Registrant’s interests to be balanced against the interests of the public.

Decision

Impairment
29. The Panel was encouraged by the Registrant’s continued engagement with the regulatory process. The Panel noted that the Registrant had taken the opportunity to consider the findings that had been made by the Consent Hearing panel and had begun the process of reflecting on her deficiencies and the underlying causes. During her oral evidence, the Registrant openly and candidly outlined the further steps that she will need to take to demonstrate that she is fit to return to the register unrestricted.

30. The Panel took the view that the efforts the Registrant has made thus far are worthy of significant credit. However, as the Registrant herself acknowledges, she still has some way to go. Although the Registrant has demonstrated that she has developed further insight since the last review, the scope and level of her insight is not currently sufficient. In reaching this conclusion the Panel noted that the Registrant is only part-way through her action plan which includes completion of the Return to Practise course and making use of her current employment to demonstrate that she has developed her skills and knowledge. The Panel recognised that the Registrant’s role as a Teaching Assistant will limit her ability to demonstrate all the skills of a SLT. However, the Panel noted that in that role she would be able to demonstrate the core skills of timely and appropriate record-keeping.

31. Whilst the Panel accepted that the Registrant’s record-keeping deficiencies were remediable, the Panel was not satisfied that she had yet provided sufficient evidence of remediation. The Registrant has not yet provided any documentary evidence of specific training or CPD undertaken relevant to record-keeping and SLT. In any event, the Panel recognised that although formal or informal CPD is important, it is the learning that has been achieved as a consequence which is of most significance. The Registrant has confirmed that this remains a work in progress.

32. In the absence of sufficient evidence of insight and remediation, the Panel could not be satisfied that the concerns highlighted by the Consent Hearing panel would not be repeated. Therefore, the Panel was led to the inevitable conclusion that, the Registrant’s fitness to practise remains impaired on the basis of the personal component, by reason of her previous misconduct and/or lack of competence.
33. The Panel went on to consider the wider public interest. The Panel concluded that the public would be concerned that the Registrant had not yet taken full advantage of the opportunity to demonstrate that the deficiencies in her practice have been appropriately remedied. In these circumstances, the Panel concluded that public confidence in the profession would be undermined if there was no finding of impairment. As a consequence, the Panel determined that the Registrant’s fitness to practise is impaired based on the public component.

Sanction
34. Having determined that the Registrant’s fitness to practise is impaired the Panel went on to consider what sanction, if any, should be imposed. The Panel bore in mind that the purpose of a sanction was not to punish the Registrant but to protect the public.

35. The Panel first considered taking no action. The Panel concluded that given the nature and seriousness of the Registrant’s previous misconduct and/or lack of competence which has not been remedied and in the absence of exceptional circumstances, it would be inappropriate to take no action. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

36. The Panel then considered a Caution Order. The Panel noted paragraph 101 of the ISP which states:
“A caution order is likely to be an appropriate sanction for cases in which:
• the issue is isolated, limited, or relatively minor in nature;
• there is a low risk of repetition;
• the registrant has shown good insight; and
• the registrant has undertaken appropriate remediation.”
37. The Registrant’s conduct and behaviour was not minor in nature and had the potential to have wide-ranging adverse consequences. Furthermore, the Registrant has not yet demonstrated that the skills and knowledge, specifically relevant to the issues outlined in the Consent Hearing, have been adequately addressed. Therefore, the Panel concluded that a Caution Order would be inappropriate and insufficient to meet the public interest.

38. The Panel went on to consider a Conditions of Practice Order. The Panel noted the Registrant’s engagement with the regulatory process which suggested that she would be willing to comply with a Conditions of Practice Order. However, the Panel noted that the record-keeping failings have not yet been adequately addressed to ensure that service users would not be put at risk if the Registrant was subject to conditional registration. In these circumstances, the Panel was unable to formulate conditions which would be appropriate, workable, and measurable.

39. The Panel next considered extending the current Suspension Order for a further period of time. A Suspension Order would send a further signal to the Registrant, the profession, and the public reaffirming the standards expected of a registered SLT. The Panel noted that a Suspension Order would prevent the Registrant from practising during the extended suspension period, which would therefore protect the public and the wider public interest. A Suspension Order would also provide the Registrant with the opportunity to continue the steps she has taken toward remediation and develop the skills and knowledge required to return to the register unrestricted.

40. The Panel determined that the Registrant should be given a further opportunity to properly focus on the issues that have been identified and provide evidence that she is fit to return to practise without restriction.

41. The Panel determined that the Suspension Order should be imposed for a period of 12 months. The Panel was satisfied that this period would be sufficient for the Registrant to demonstrate that she is committed to addressing the deficiencies in her practise and collating the evidence to put before a future reviewing panel.

42. The Panel decided that the appropriate and proportionate order is a Suspension Order. A Striking Off Order, would be disproportionate as the shortcomings in the Registrant’s practice are capable of being remedied and there remains a strong possibility that the Registrant will be able to demonstrate an appropriate level of insight and remediation.

43. The extended Suspension Order will be reviewed shortly before expiry. A future reviewing panel would be assisted by the following:
• the Registrant’s attendance in person at the hearing;
• references and testimonials from professional colleagues relevant to showing how she has addressed her shortcomings outlined in the original allegations relating to record-keeping and clinical documentation;
• an updated reflective statement on her past shortcomings in record keeping, demonstrating that she understands the expectations of a SLT in relation to record-keeping as outlined in the HCPC’s policy and giving practical examples of meeting the required standards;
• a CPD portfolio structured around competencies, cataloguing examples of how she meets each of the 5 HCPC standards;
• evidence that she has satisfied the HCPC return to practice requirements (60 days of updating) for someone who has been out of practice for more than 5 years;
• a SMART personal action plan setting out how she will achieve the objective of remedying her deficiencies in record keeping and completing clinical documentation.
• A report from an SLT mentor specifically covering record keeping and clinical documentation;
• Any evidence of work-based placements and/or shadowing placements including

ORDER: The Registrar is directed to suspend the registration of Miss Sutapa Halder for a further period of 12 months on the expiry of the existing order.

This Order will be reviewed again before its expiry on 4 February 2024.

History of Hearings for Miss Sutapa Halder