Rosemarie A Noble

Preliminary Matters

Conduct of Hearing in Private

1. Ms. Saran applied for the hearing to be conducted in private for the protection of the private life of the Registrant, as provided for in rule 10(1)(a), Health and Care Professions Council (Health Committee) (Procedure) Rules 2003 as amended. Ms Saran also referred to the relevant parts of the HCPTS’s Practice Note, Conducting Hearings in Private, 22 March 2017. In summary, Ms Saran submitted that as this was a case based on impairment of fitness to practise on health grounds, the entire hearing should be conducted in private

2. Ms Noble supported the application. The Legal Assessor gave advice, which the Panel accepted.

3. The Panel decided that the entire hearing should be conducted in private for the reasons given by Ms Saran.

Background

4. The Registrant is an Occupational Therapist who was carrying out a return to practice programme at Lincolnshire Community Health NHS Trust (“the Trust”) in May 2020 following a period of absence.

5. Concerns as to the Registrant’s conduct first arose on the first day of a return-to-practice placement, which took place on 12 May 2020. It was considered that she had failed to draft a list of objectives for her placement despite having been asked to do so prior to beginning her placement.

6. Over the next few days further concerns arose regarding the Registrant showing signs of [health condition 1 of Schedule A] whilst working which resulted in her inability to adapt to her working environment, which was a rehabilitation ward.

7. On 20 May 2020, a meeting was held with the Registrant, attended by GW (Clinical Practice Educator), NB (the Registrant’s supervisor) and RH (Occupational Therapist), where the Registrant decided not to continue with the return-to-practice programme.

8. On 29 July 2020, GW submitted a referral to the HCPC outlining concerns about the Registrant’s health and ability to sustain work.

9. At its meeting on the 2 February 2022, a panel of the Investigating Committee determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise. The Panel confirmed the allegation set out above.

10. Following the decision of the Investigating Committee, Kingsley Napley LLP were instructed by the HCPC to undertake an investigation in relation to the allegation detailed above. As part of this investigation, evidence was obtained and prepared to pursue the case to a final hearing.

11. On 24 January 2023, Kingsley Napley were informed by the HCPC that the Registrant was liaising with it in relation to disposing of the matter by way of consent.

12. On 14 March 2023 the HCPC and the Registrant agreed to dispose of the case by consent in the form of proposed conditions of practice for a period of three years. That agreement was set out in a document to which further reference is made below, in the decision of this Panel.

Decision

13. The application before the Panel is made by the HCPC and is supported by the Registrant. It seeks disposal of the case by consent. A main hearing bundle of documents was provided as well as further documents. Although no oral evidence was given by the Registrant, she did provide further information in response to questions from the Panel.

14. The Panel heard oral submissions from Ms Saran and from the Registrant, assisted by Ms Evershed. The Panel received further advice from the Legal Assessor, which it has accepted.

15. In its consideration of the application, the Panel has been guided by the matters set out in the HCPTS’s Practice Note, Disposal of Cases by Consent, March 2018. The key considerations are these. As the HCPC’s overarching statutory objective is the protection of the public, a panel should not agree to a case being resolved by consent unless it is satisfied that:
a) the appropriate level of public protection is being secured; and
b) doing so would not be detrimental to the wider public interest.

16. The HCPC’s case is based on an expert’s report dated 27 June 2022, written by Dr Pardeep Grewal, Consultant Psychiatrist. Dr Grewal examined the Registrant on 18 May 2022 and considered her medical history. He concluded that, -
‘15.3.1 In my opinion Ms Noble presents with signs and symptoms consistent with a diagnosis of [health condition 2 of Schedule A].
…………
15.4.2 In general terms Ms Noble’s prognosis is good if she continues with medications, engages with treatment and develops further insight. However, even with treatment it is likely she will experience periods of relapse.’

17. Dr Grewal concluded that the Registrant’s fitness to practise was impaired (paragraph 15.5.1).

18. In the document titled ‘Consensual Disposal Request Pro Forma’ and signed by the Registrant on 9 March 2023, the Registrant expressly admitted the substance of the allegation, admitted that her fitness to practise was impaired on grounds of health and proposed a disposal of the case by means of conditions of practice. In the HCPC’s decision in response to that request dated 14 March 2023, it was stated that, ‘The HCPC consider that the proposed Conditions of Practice address the issues that are the subject of the allegation and is an appropriate and proportionate resolution for the case.’

19. The conditions of practice order proposed by the parties is set out in a draft order before the Panel, which material part of which states, -
‘1) You must register with and remain under the care of a general practitioner, Care Coordinator and/or Psychiatrist and inform him or her that you are subject to these conditions.
2) You must inform your general practitioner, Care Coordinator and/or Psychiatrist about these conditions of practice and authorise the doctor to provide the HCPC with information about your health and any treatment you are receiving.
3) You must follow any treatment plan designed by your general practitioner and/or Care Coordinator and/or Psychiatrist for the medical conditions set out in Schedule A.
4) You must provide a progress report from your Care Coordinator and/or Psychiatrist and/or GP within 6 months from the date of this Order and every 6 months thereafter.
5) You must keep your professional commitments under review and limit your professional practice in accordance with the advice of your general practitioner and Care Coordinator and/or Psychiatrist.
6) You must promptly inform the HCPC if you take up any role which requires your professional registration with the HCPC.
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 the 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 and providing information and reports to the HCPC.
The Registrar is directed to annotate the register entry of the Registrant to show that, with effect from the date of the hearing (‘the Operative Date’) for a period of 3 years from the date this order comes into effect, ..’

20. The Panel has considered the nature of the mental health condition explained by Dr Grewal in his report, as well as the Registrant’s medical history concerning her mental health. It has borne in mind the Registrant’s admission that her fitness to practise is impaired as set out in the allegation. The Panel concluded that there was good reason to believe that a finding of impaired fitness to practise by reason of mental health would be made by a final hearing panel.

21. In considering whether or not the conditions proposed provided sufficient public protection, the Panel took into account a number of matters, particularly the original concerns arising out of the return-to-practice programme in May 2020, the nature of the mental health condition as explained by Dr Grewal, recent medical assessments of the Registrant’s dated 2 and 17 February 2023, the letter dated 26 October 2022 from the Community Nurse and other contemporaneous testimonials from a workplace colleague. The Panel also bore in mind the insight shown by the Registrant in the written reflective piece she provided to the Panel and the responses she gave to Panel questions.

22. The Panel considered that disposal of the case on the basis of ‘no action’, mediation or a caution would not provide the necessary degree of public protection.

23. The Registrant has developed very significant and meaningful insight into her health condition, has explained the several strategies that she uses to maintain good mental health and identified the signs that would alert her that she may be about to undergo a rapid decline in her mental health. The recent medical evidence indicates that the Registrant has been taking the necessary medication. The Panel also noted the insight shown by the Registrant in April 2021.

24. The Registrant also explained that she would start work part-time and not in a ward environment, but rather in a community setting or dealing with learning disabilities for young people.

25. The Panel does have some concern that the Registrant may not recognise early warning signs of a rapid decline in her mental health following a return to registered practice. However, the Panel considers that the conditions proposed are likely to contain this risk. Any agency or employer will be aware of the conditions, which require the Registrant to keep her professional commitments under review and to limit her professional practice if she receives medical advice to do so.

26. The Panel is satisfied that the Registrant has sufficient insight to comply with the requirements placed on her by the conditions proposed, which are workable and verifiable.

27. The Panel did consider whether or not a period of suspension would likely be a more appropriate outcome if the case went to a final hearing. However, it concluded that suspension would be disproportionate. This case is essentially one of public protection and the conditions proposed are a sufficient means of protecting the public. A period of three years for the conditions is appropriate, to enable the Registrant to develop further insight and to mitigate further the risks to service users posed by her mental health condition.

28. Disposal of the case without a final hearing and by the conditions proposed by the parties would not be detrimental to the wider public interest. Those conditions are likely to provide the necessary degree of public protection and a final hearing would serve no useful purpose in the circumstances.

29. The Panel was satisfied that all the circumstances required by the Practice Note on the Disposal of Cases by Consent have been met so as to merit disposal of the case as proposed by the HCPC and the Registrant.

30. Therefore, the Panel has decided to dispose of the case on this expedited basis and to impose the conditions of practice set out below for a period of 3 years.

Order: The Registrar is directed to annotate the HCPC register to show that for a period of 3 years from the date of this hearing, namely 28 March 2023, being the date this Order takes effect (‘the Operative Date’), you Rosemarie Noble, must comply with the following conditions of practice, -

1) You must register with and remain under the care of a general practitioner, Care Coordinator and/or Psychiatrist and inform him or her that you are subject to these conditions.

2) You must inform your general practitioner, Care Coordinator and/or Psychiatrist about these conditions of practice and authorise the doctor to provide the HCPC with information about your health and any treatment you are receiving.

3) You must follow any treatment plan designed by your general practitioner and/or Care Coordinator and/or Psychiatrist for the medical conditions set out in Schedule A.

4) You must provide a progress report from your Care Coordinator and/or Psychiatrist and/or GP within 6 months from the date of this Order and every 6 months thereafter.

5) You must keep your professional commitments under review and limit your professional practice in accordance with the advice of your general practitioner and Care Coordinator and/or Psychiatrist.

6) You must promptly inform the HCPC if you take up any role which requires your professional registration with the HCPC.

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 the 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 and providing information and reports to the HCPC.

No notes available

History of Hearings for Rosemarie A Noble