Deborah J Watson

Preliminary Matters
Application to proceed in private
1. Ms Mills, on the Registrant’s behalf, made a joint application for the entire hearing to take place in private on the grounds that the matters in issue were inextricably linked with the Registrant’s health. Ms Khorassani supported that application. The Panel took into account the HCPTS Practice Note on “Conducting Hearings in Private” and accepted the advice of the Legal Assessor.
2. The Panel noted that previous panels had decided that only those matters relating to the Registrant’s health and private life should be heard in private. The Panel was not persuaded that it was necessary to depart from the open justice principle to the extent advanced by Ms Mills. The Panel therefore decided that only those matters relating to the Registrant’s health and private life should be heard in private and that otherwise the hearing should be conducted in public.
Background
3. The Registrant is an Occupational Therapist registered with the HCPC. During the period referred to in the Allegation, she was employed as a Band 6 Care Co-Ordinator Occupational Therapist by Leeds and York Partnership NHS Foundation Trust. From 1 October 2016, the Registrant was employed by Tees, Esk and Wear Valleys NHS Trust (“the Trust”) in a community setting.
4. Concerns arose in respect of the Registrant’s practice and a Performance Improvement Plan (“PIP”) was implemented. The Registrant was moved to a role in a mental health ward, where she was subject to supervision. A further concern arose when the Registrant left a service user unaccompanied in a therapy suite. An investigation was undertaken, as a result of which further concerns about the Registrant’s practice were identified.
5. The Registrant referred herself to the HCPC on 20 October 2015. The Trust conducted a disciplinary hearing in March 2016 which resulted in the Registrant’s dismissal for gross misconduct.

6. The substantive HCPC Conduct and Competence Committee hearing took place on 11-13 December 2017. The substantive hearing panel found all the factual particulars of the Allegation proved and that the facts amounted to misconduct. The substantive hearing panel found the Registrant’s fitness to practise impaired in relation to both the personal and public components of current impairment. The substantive hearing panel determined to impose a Suspension Order for a period of 12 months.
1st Review: 7 December 2018
7. The Suspension Order was first reviewed by a panel of the Conduct and Competence Committee at a hearing on 7 December 2018, which the Registrant attended and at which she was represented. The first review panel considered the guidance given by the substantive hearing panel as to information which a future panel was likely to find helpful.
8. The Registrant presented information about actions she had taken since the Suspension Order was imposed. The first review panel considered information presented by the Registrant and heard oral evidence from her. She said she did not feel confident to return to her role and considered herself that her fitness to practise remained impaired.
9. The first review panel stated that it was impressed by the Registrant’s reflective statements and the development of her insight into the effect and consequences of her past failures. However, the review panel stated that it was not satisfied that the Registrant had demonstrated that she had applied her knowledge of theory to the specific failings identified at the substantive hearing. She admitted that there remained gaps in her knowledge and skills. In the view of the review panel, these gave rise to a risk of repetition which could potentially pose a risk to service users and undermine public confidence in the profession.
10. The Panel found that the Registrant’s fitness to practise remained impaired and determined to extend the Suspension Order for a further 12 months, as this would allow the Registrant to demonstrate at the next review hearing that she had made sufficient progress in her professional development to return to practice as an Occupational Therapist.
2nd Review: 12 December 2019
11. The Suspension Order was next reviewed by a panel of the Conduct and Competence Committee at a hearing which the Registrant attended and at which she was represented by Mr Oestreicher. The second review panel heard from the Registrant. In closing submissions, Mr Oestreicher said that whilst the Registrant accepted that her fitness to practise remained impaired and he acknowledged that the second review panel may decide that suspension continued to be necessary, he asked the second review panel to consider whether conditions of practice could be formulated which would allow the Registrant to work as an Occupational Therapist.
12. The second review panel did find that the Registrant’s fitness to practise remained impaired. It indicated that it hoped to hear how the Registrant coped with making progress going forward by the time of the next review of the Order. However, it determined to extend the Suspension Order for a further 12 months.
3rd review: 10 December 2020
13. At the third review, the Registrant admitted that she was still impaired as although she had made some progress, she was not confident to take on her previous role. She needed more time to complete the activities that she had outlined in her plan for remediation.
14. The third review panel was impressed by the reflection of the Registrant. She said that she did have an issue with confidence because she needed to undertake further study and thereafter consolidate her learning through practically applying it. The third review panel concluded that members of the public would be concerned if the Registrant, who admitted gaps in her skills and knowledge which posed a potential risk to the public and who accepted that she remained impaired, was found not to be so. Public confidence in the profession and the regulatory process would be undermined. The third review panel found that the Registrant’s fitness to practise was impaired on the grounds of public protection and the wider public interest.
4th review: 16 December 2021
15. At the fourth review, the Registrant told the fourth review panel that she had undertaken a placement with the Leeds and York Partnership NHS Trust and a fulsome reference had been provided. She spoke about her attempts to undertake further education in continuing her professional development. She explained that she had both read texts and accessed formal learning, while consolidating this learning through undertaking work in a voluntary capacity where she worked with a service user with vulnerabilities. She was able to put her learning into practice in this way.
16. She said that she planned to look for further placements that she could undertake on a voluntary basis. She said that she would expand her search to different environments in non-clinical posts. She would also look at paid employment via NHS websites if she were able to practise. She said that she felt ready to undertake paid work at this stage and that this would evidence her progress.
18. She said that her future Continuing Professional Development (“CPD”) plans were two-pronged and would take into account both study and practice. She said that health concerns meant she had not had enough time to reflect on specifics, but she planned to do so. She planned to access more formal learning and undertake more volunteering work and pursue both clinical and non-clinical placements to put additional learning into practice.
5th review: 8 June 2022
19. The Registrant gave evidence in which she told the Panel that, notwithstanding repeated efforts by her, she had been unable to secure any placements or other voluntary work since her placement with the Leeds and York Partnership NHS Trust. The Panel also heard in private evidence about the difficulties faced by the Registrant due to various health matters. The Registrant told the Panel that she was managing her health conditions through holistic treatments.
20. The Registrant accepted in her evidence that she remained currently impaired due to a continued lack of knowledge, which she had been unable to acquire due to her circumstances. The Registrant also acknowledged that she had been unable to demonstrate full remediation because of her inability to find any placements/work. She was, however, still being assisted by a mentor from the Royal College of Occupational Therapists. The Registrant told the Panel that she might not be able to return to unrestricted practice for another 18 months, as she planned to take six months to improve her health and then 12 months to work in a placement before returning to practice as an Occupational Therapist.
21. The panel acknowledged the efforts which the Registrant had made to demonstrate remediation and the difficulties which she faced in doing so. The panel agreed with previous review panels that the Registrant’s misconduct, although not persistent, was serious given that she was working in a high-risk environment. The panel also considered that this misconduct was capable of remediation, albeit this remediation has not been completed.
22. The panel took into account that the Registrant acknowledged that her fitness to practise remained impaired. Given her incomplete study and remediation, along with the risk this would mean for the public and the impact this could have, the panel found the Registrant to be impaired on both personal and public components.
23. The panel decided that it would not be safe to allow the Registrant to practise without restriction and discounted taking no action or imposing a Caution Order. It next considered conditions of practice, but was of the view that any conditions imposed would have to be so extensive that they would be tantamount to suspension and be unworkable.
24. The panel carefully considered whether a further period of suspension would serve any useful purpose or whether this was the time to move to a Strike Off Order. This was because the efforts made on a previous occasion did not appear to have been built upon in the manner expected. The Panel had regard to the Sanctions Policy, which describes a Strike Off as being a sanction of “last resort” which is reserved for the most serious cases.
25. The panel concluded that a further period of suspension of 12 months would be appropriate and proportionate to address public protection and the wider public interest issues. The Panel considered that the maximum period of suspension was required in order to provide the Registrant with sufficient time to gather the required evidence of remediation, practical experience, and sufficient knowledge.
26. The panel was heavily influenced by the Registrant’s continued full engagement with the HCPC and her further efforts to obtain work/placements. The panel also acknowledged, as the previous panels did, the difficulties which the Registrant has faced due to personal and external factors.
27. The panel advised the Registrant any future reviewing panel was likely to be assisted by:
• Her attendance at the review hearing;
• Documents supplied in advance of the hearing which comprise:
• Evidence of completed Occupational Therapy-related courses undertaken between July 2022 and July 2023;
• Evidence of any attempts the Registrant has made to obtain support work (paid or unpaid) in a role related to that in which her knowledge and skills as an Occupational Therapist can be deployed between July 2022 and July 2023;
• The completion of a development plan, including how it will be actioned;
• A log detailing the work that is done on a monthly basis, how this meets the development plan she has, and the progress that she is considered to have made by her line manager;
• References from any manager or supervisor under whom she works during this period.
Today’s hearing
28. The Panel was provided by the HCPC with a hearing bundle which included the previous decisions of the panels at the substantive hearing and the subsequent reviews.
29. The Panel was provided by the Registrant with a bundle of documents comprising:
• Her reflective statement
• Development log
• Training records
• Evidence of self-learning
• Evidence of searches for work and voluntary work opportunities
• A report from Anne Keene of the Royal College of Occupational Therapists dated 31 May 2023
• Health records
• The Registrant’s professional plans.
30. On behalf of the HCPC Ms Khorassani adopted a neutral stance on the issues of current impairment and sanction.
31. The Registrant gave evidence as to the efforts she had made since the last substantive order review to address the concerns relating to her practice. She stated that her mental health had recovered in May 2023 to the extent that she was then able to concentrate on obtaining a voluntary work placement working with autistic children. She was unsure of the hours she would be working, the exact nature of the work that she would be undertaking, or the extent to which her work would be supervised. She stated that her prospective employer was aware of the current Suspension Order.
32. The Registrant also stated that she had applied for the post of part time Learning Support Practitioner at York College, to start in September 2023, but would first have to obtain a qualification in Mathematics to be eligible.
33. The Registrant stated that, if permitted to practise as an Occupational Therapist, she would not work in an acute setting, because she would be unable to cope with the stress, and would limit herself to 20 hours work per week. She acknowledged that she would need supervision initially.
34. The Registrant stated that her health had improved and that she would recognise any deterioration in future, so as to avoid working when she was unfit to do so. She said that she now had a network of support, which she had previously lacked.
35. On behalf of the Registrant Ms Mills submitted that the Suspension Order should be replaced by a Conditions of Practice Order which could initially include a condition of direct supervision.
The Panel’s decision
36. The Panel took into account the HCPTS Practice Notes “Review of Article 30 Orders” and “Fitness to Practise Impairment” and accepted the advice of the Legal Assessor.
37. The Panel first considered whether the Registrant’s fitness to practise is currently impaired by reason of her misconduct.
38. The Panel took into account the decision of the High Court in Abrahaem v GMC where it was stated that in practical terms 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 findings and has addressed her impairment sufficiently “through insight, application, education, supervision or other achievement”.
39. The Panel found that the Registrant had failed to take effective steps to discharge this burden by addressing the fitness to practise concerns identified at the substantive hearing and that, accordingly, her fitness to practise remains impaired.
40. The Panel noted that, apart from undertaking some on-line training courses within a few weeks of today’s hearing, the Registrant had not taken effective steps to demonstrate how her learning would inform and remediate her practice. She had not undertaken any work since the last substantive order review and appeared not to have taken effective steps to adopt the recommendations of the last panel until a few weeks before today’s hearing.
41. In these circumstances, the Panel could not be satisfied that the Registrant had addressed any of the concerns relating to her fitness to practise. It followed that the Registrant had not discharged the persuasive burden referred to above. The Panel considered that the Registrant would not be safe to practise without restriction. The Panel therefore found that her fitness to practise remains impaired having regard to both the “personal” and “public” components of impairment.
42. The Panel was not satisfied that the Registrant, despite the passage of time since the substantive hearing in December 2017, had yet acquired insight into her responsibility for the failures in her practice which resulted in the findings of misconduct and impairment.
43. With regard to sanction, the Panel took into account the HCPC’s Indicative Sanctions Policy. The Panel gave appropriate weight to the wider public interest, which includes the reputation of the profession and public confidence in the regulatory process. The Panel applied the principle of proportionality and considered the available sanctions in ascending order of seriousness.
44. The Panel considered that the concerns about the Registrant’s fitness to practise were too serious for the imposition of a Caution Order.
45. The Panel considered that a Conditions of Practice Order would not be appropriate because conditions would not adequately protect the public unless they were so restrictive as to amount to suspension in all but name.
46. The Panel considered whether to impose a further period of suspension. However, in circumstances where the Registrant had been continuously suspended since 13 December 2017 and had not used the intervening period of 5 ½ years to address the failures in her practice, the Panel considered that no useful purpose would be served by a further period of suspension.
47. The Panel noted that the Indicative Sanctions Policy states that “A Striking Off Order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession and public confidence in the regulatory process, in particular where the registrant:
• lacks insight;
• where a registrant has been suspended for two years continuously, fails to address a lack of competence; or
• is unwilling to resolve matters.”
48. In the Panel’s judgment, the indicative criteria referred to above apply in this case and the appropriate and proportionate sanction is a Striking Off Order.

Decision
ORDER: The Registrar is directed to strike the name of Miss Deborah J Watson from the Register on the date this order comes into effect.

The Order imposed today will apply with immediate effect.

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 Deborah J Watson