Victoria V Asirvatham

Background

1. The Registrant qualified as an Occupational Therapist (OT) in India in 1995.

2. She became registered with the HCPC in 2005.

3. On 8 December 2008 the Registrant began employment as a Band 5 Occupational Therapist by 2Gether NHS Foundation Trust (the Trust), which provides mental health and learning disability services. She was responsible for adult patients with severe and enduring mental illness.

4. From 3 November 2014 to 2016, the Registrant was employed in the Wotton Lawn Inpatient Unit, which provides inpatient treatment for adults who require hospital treatment due to an acute episode of mental illness prior to returning to the community.

5. On 26 February 2018 to 2 March 2018, the substantive hearing panel of the HCPC determined that the Registrant’s fitness to practise was impaired by reason of lack of competence and decided that the appropriate and proportionate Order was a Suspension Order for a period of 12 months.

6. At the first review hearing, the panel found that the Registrant’s fitness to practise remained impaired and extended the period of suspension for a further 12 months.

7. In providing its reasons for this determination, the panel complimented the Registrant on her attendance at the hearing and took the view that she was enthusiastic and motivated in relation to her role as a support worker and her desire to return to practice as an OT. However, the panel also expressed its concern that the Registrant had not understood the seriousness of her lack of competence and said that, during the course of her evidence, she had failed to focus on the most serious findings made by the panel at the substantive hearing. Her level of insight, the review panel added, was limited and it found no evidence that the Registrant had remediated her deficiencies to the full.

8. At the second review hearing, that panel found that the Registrant’s fitness to practise remained impaired but considered that she had gained further insight into her deficiencies and decided to impose a Conditions of Practice Order for a period of 18 months.

9. At the third review hearing, the Registrant told the panel that she had applied for Band 5 OT positions but had not yet been successful. The Registrant told the panel that she continued to work part-time as a support worker at the Alders Clinic, a hospital providing rehabilitation for women with personality disorders and submitted a reference from her manager. She also explained that she had begun another, part-time role as a relief rehabilitation officer at Great Western Court (GWC), a rehabilitation unit for the elderly. She continued to work as a volunteer for CRUSE bereavement care, had completed the CRUSE training, and was studying for a qualification in counselling.

10. The Registrant provided the third review panel with reflective case studies, appraisals and supervision records from her work and provided information about training she had undertaken for her roles and of Continuing Professional Development (CPD) training undertaken at the Royal College of Occupational Therapy. The panel saw certificates attesting to that training, including training on risk assessments for OTs. She had also obtained support and guidance from a senior OT through online sessions, which had helped her to reflect on the requirements of risk assessments from an OT perspective.

11. The review panel acknowledged the proactive approach demonstrated by the Registrant but noted that she had not worked as an OT and so had not been able to demonstrate remediation in accordance with the conditions which aimed to address the concerns found proved at the initial hearing. In particular, the panel considered that the Registrant had not been able to provide substantive evidence of assessment observations, clinical reasoning, or treatment planning and observations to a standard expected of an OT.

12. At the fourth review hearing the Registrant told the panel that, since the last review hearing, she had not worked in an OT role. She said she had applied for Band 5 OT posts but had not been successful because the restrictions imposed on her registration caused potential employers’ concern.

13. The Registrant told the panel that she had done her best to comply with the conditions of practice which were effective. She provided a table showing how she said she has complied with each condition.

14. The Registrant stated that she had successfully applied for the Band 4 post of Health and Wellbeing Co-ordinator with the Complex Care team of Gloucestershire Health and Care NHS Foundation Trust (“the Trust”). She added that she was taking an integrated approach, utilising occupational therapy skills, counselling and psychotherapy skills for the wellbeing of the service users.

15. The Registrant said that she was also working alongside a Band 6 Occupational Therapist, LL. The panel noted that LL had agreed to support her with her return to practice and she had arranged regular meetings with LL and AK, Professional Adviser at the Royal College of Occupational Therapists (RCOT), to achieve this. The Registrant said that she hoped that these efforts would enable her to obtain an OT post requiring HCPC registration.

16. The Registrant stated that she had almost completed the second year of her counselling and psychotherapy course. She said she had passed all her examinations on the first attempt and was awaiting the result of her final assignment and presentation on integration.

17. The Registrant provided the reflective journals completed during her psychotherapy course. She provided an essay on integration together with a case study demonstrating how she had applied OT knowledge, skills and experience in her role as an integrated therapist.

18. The Registrant also attached certificates relating to CPD from the RCOT and CRUSE, together with her supervisor’s report and other relevant documents.

19. The Registrant was asked by the Panel about her understanding of key concerns arising from the original allegations and how she has moved on. She said that she understood that the issues concerned her assessment of patients’ clinical needs and making treatment plans. She had done this in her role as a support worker and currently as a health and well-being co-ordinator. She stated that her roles were different in that, as a Band 4, she was required to follow what the OT had decided rather than undertaking the assessment herself.

20. The Registrant said, to meet the requirements of a Band 5 post, she thought she would need refresher training on all areas because she has not practised as an OT since 2016.

21. She added that, to complete the return to practice course, she had been working with AK of the RCOT and with her manager, GP, who were all going to work together as a team. She believed she needed to undertake sixty days refresher training. She said that GP had agreed to contact the OT lead for the Trust but she was unaware of the outcome.

22. When asked what she thought she would need to demonstrate to an employer in job applications for Band 5 in OT roles she said she would have to show that she can work to Band 5 level and that employers would expect a comprehensive answer regarding the risk assessments she would be doing and in respect of decision-making and documenting.

23. The Registrant thought that the core skills for Band 5 level were experience in engaging patients and identifying their needs. She believed she had been able to show these skills in her current roles. She believes her current manager would support her to join the team as an OT.

24. The Registrant was asked what OT jobs she had applied for since the last review hearing and she said two, but both applications were unsuccessful.

25. She believed this was because the HCPC restrictions were a barrier.

26. The Registrant confirmed that she had not yet started a Return to Practice Course nor completed an OT Personal Development Plan. In relation to CPD undertaken since the last review hearing, the Registrant said that she had attended the regular journal club at RCOT, regular training in mental health forums and all mandatory training for her roles. She was receiving RCOT journals regularly.

27. In extending and amending the Conditions of Practice Order, the Panel, on this occasion, expressed its disappointment that the Registrant had only applied for two positions as an OT with the consequence that some of the conditions couldn’t be effective. Similarly, she had failed to follow the recommendation of the previous panel in applying for an OT assistant role.

28. Condition 1 required completion of the Return to Practice course. The non-achievement of this caused the Panel additional concern.

29. All in all, the Panel was not convinced that the Registrant had shown the requisite level of insight nor demonstrated a clear understanding of the impact her lack of competence had had upon patients, clients and her professional colleagues.

30. The fact that the Registrant had not worked for a long time as an OT meant, in the Panel’s view, that she was unable to provide substantive evidence of assessment observations, clinical reasoning or treatment planning that was required of a competent OT.

31. Furthermore, the fact that the Registrant had not worked as an OT for so long meant that she had not been able to demonstrate that she had achieved the remediation in line with the conditions that were specifically designed to cater for this.

32. The Panel at this fourth review hearing echoed a previous recommendation that the Registrant might benefit by obtaining work as an OT assistant.

33. After having found that the Registrant’s fitness to practise was impaired on the personal and public components, the panel imposed the following conditions upon her practice for a period of nine months:

1. Before practising as an OT, you must satisfactorily complete the HCPC return to practice requirements and forward confirmation of so doing to the HCPC.

2. You must place yourself and remain under the supervision of your workplace supervisor, who must be an OT registered by the HCPC and supply details of your supervisor to the HCPC within one month of beginning in a post as a Registered OT.

3. You must receive clinical supervision from a Registered OT and follow their advice and recommendations, and supply details of your clinical supervisor to the HCPC within one month of beginning in a post as a Registered OT.

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 must meet with your registered OT supervisor on a monthly basis:

a) to formulate and document a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

i. Assessment observation;

ii. Clinical reasoning;

iii. Treatment planning and evaluation; and

b) to document monthly progress against each of the above areas in the Personal Development Plan.

7. Within three months of beginning in a post as a Registered OT you must forward a copy of your Personal Development Plan, including the monthly progress updates, to the HCPC.

8. You must allow your OT supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

9. You must

a) Develop and submit at least 3 relevant cases studies process in respect of conducting observations; conducting assessments; devising written clinical reasoning, treatment planning and evaluation and demonstrating good documentation; and

b) You must submit a reflective piece which addresses the above areas of OT practice and sets out your progress in application and learning to the HCPC on a monthly basis, or confirm that there have been no such occasions in that period, the first reflective piece or confirmation to be provided within one month of your beginning in a post as a Registered OT.

Submissions

Evidence of the fifth review hearing

34. The Panel was aware that the process under Article 30 of the Order 2001 was one of review and not one of appeal and that its function was to determine whether the Registrant’s fitness to practise was still impaired and, if so, what the appropriate and proportionate sanction or outcome should be, so as to protect the public and safeguard the public interest.

35. In the course of its deliberations the Panel paid due regard to the HCPTS’ Practice Note ‘Finding Fitness to Practise Impairment’ (February 2022) and accepted the advice of the Legal Assessor.

36. The submission of Ms. Welsh was that the fitness to practise of the Registrant was still impaired in relation to both the personal and public components and that the appropriate and proportionate sanction to impose was to extend the current order of conditions by a further twelve months.

37. There is no evidence, Ms. Welsh contended, that the first and critical condition requiring a return to practice as an OT had been met. Thus, conditions 2,3,6,7 and 9 were also unfulfilled. She stressed that all attempts in the past by the Registrant to obtain an OT post had been unsuccessful and noted that there had been no applications within the last twelve months.

38. The proposal to impose conditions for another twelve months was designed to give the Registrant sufficient time for her to acquire a placement as an OT and improve her skills to the requisite standard.

39. The Registrant made oral submissions to the Panel and provided a wealth of documents on her behalf. These included in her first bundle

a) an undated reflective piece

b) degree documents

c) counselling case studies

d) evidence of CPD training since September of 2022

e) what is termed ‘employer correspondence’

f) an email of 15 February 2023 from her mentor, a Health and Wellbeing Coordinator from the Complex Care and Home Team, confirming progress

g) evidence of positive feedback from a dementia nurse consultant

h) correspondence showing she was part of a team that won a Tackling Inequalities Award, presented by Gloucestershire NHS services

i) Email correspondence with AK, Professional Advisor, Royal College of Occupational Therapy

40. More recently, the Registrant submitted a second bundle, the contents of which showed that she has become registered as a counsellor and psychotherapist for the British Association of Counselling and Psychotherapist and was planning imminently to start work in this new role for Great Oaks Hospice in Coleford, Gloucestershire on a part-time basis. Also, she stated in an email of 27 May 2023 to the HCPC, that she remains a volunteer counsellor for CRUSE bereavement care.

41. The Registrant didn’t accept that her fitness to practise was currently impaired, but recognised, inferentially if not directly, that, if the Panel disagreed with this, she needed to continue with the steps already being taken to complete the enrolling process to join the return to practice course. AK and LL were continuing to help and support her with this and had discussed with her the topic of transferring the skills she had been honing to the role of an OT.

Decision

42. The Panel read with care the written material provided by both parties and paid due attention to their oral submissions.

43. Insofar as the question of current impairment is concerned, the Panel was not persuaded that the Registrant had lifted the burden placed upon her to demonstrate that she has properly addressed the issues of concern that have been identified.

44. Impressed though the Panel has been by the hard work the Registrant has put in over the last year to improve her knowledge and skills, it takes the view that she still doesn’t yet fully understand the importance of fulfilling the conditions as drafted. While she has developed considerable insight and she has shown that she is capable of making proper assessments and competent record keeping (the centrepiece of the case), there’s no evidence in front of the Panel that she has been able to do this from the perspective of an OT. No clinical reasoning has been provided within the otherwise helpful documents supplied by her.

45. The Panel has reminded itself of all the available sanctions it can impose and has determined that the appropriate and proportionate course to adopt is to extend the Conditions of Practice Order for nine months. However, they will be amended to read per the Order below.

46. The purpose behind the imposition of these conditions is to ensure that the Registrant enters a supervised OT practice to undertake assessments and demonstrate that she can perform an analysis of Service Users’ needs. She will need to show competence as an OT in the fields of assessment, intervention and reviews of intervention. It is fundamental that the Registrant completes a return to practice course satisfactorily. The Registrant is reminded that, if matters progress well, she can always apply for an early review before the expiry of the stipulated nine-month period.

47. The Panel suggests that the next reviewing panel would be assisted by the provision by the Registrant of three case studies to demonstrate completion of treatment plans with identifiable goals, reasoning and analysis of any activity within the OT process.

ORDER: The Registrar is directed to vary the Conditions of Practice Order against the registration of Ms Vicky Asirvatham for a further period of 9 months on the expiry of the existing order. The Conditions are:

1. Before practising as an OT, you must satisfactorily complete the HCPC return to practice requirements and forward confirmation of so doing to the HCPC.

2. You must place yourself and remain under the supervision of your workplace supervisor, who must be an OT registered by the HCPC or other appropriate statutory regulator, and supply details of your supervisor to the HCPC within one month of beginning in a post as a Registered OT.

3. You must receive clinical supervision from a Registered OT and follow their advice and recommendations, and supply details of your clinical supervisor to the HCPC within one month of beginning in a post as a Registered OT.

4. You must provide details of your supervision discussions in the following areas:

a) Assessment observation;

b) Clinical reasoning;

c) Treatment planning and evaluation.

5. You must provide a testimonial from your supervisor that demonstrates your ability to perform the OT therapy process in respect of conducting observations; conducting assessments; devising written clinical reasoning, treatment planning and evaluation and also reflects your ability to maintain good record keeping standards.

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).

The Order imposed today will apply from the expiry of the current order, 30 June 2023.

This Order will be reviewed again before its expiry on 30 March 2024.

History of Hearings for Victoria V Asirvatham