Alice Langley
Profession: Speech and language therapist
Registration Number: SL27744
Interim Order:
Imposed on 15 Sep 2023
Hearing Type: Final Hearing
Date and Time of hearing: 10:00 12/09/2023
End:
17:00 15/09/2023
Location:
Virtually via Video Conference
Panel: Conduct and Competence Committee
Outcome: Suspended
Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.
Allegation
As a registered Speech and Language Therapist (SL27744) your fitness to practise is impaired by reason of misconduct and/or lack of competence and/or health. In that:
1. Between June 2015 and June 2016, during your employment with The Royal Wolverhampton NHS Trust, you did not meet the competency for a band 5 Speech and Language Therapist, in that:
a. You did not complete the Identification of Need tool form for one or more of the Service Users set out in Schedule A
b. You did not complete reports in a timely manner for one or more of the Service Users set out in Schedule B
c. You did not close one or more of the Service User records, as set out in Schedule C, on the Trust’s case management system IPM.
d. You did not complete and/or save the Service User reports onto the Trust’s drives and/or case notes for one or more of the Service Users set out in Schedule D.
e. You did not ensure one or more of the Service Users, as set out in Schedule F, were regularly reviewed and/or you failed to set them review dates.
f. You did not complete case notes for one or more of the Service Users set out in Schedule G.
g. You did not document your clinical reasoning and/or your clinical reasoning was incorrect for one or more of the following Service Users in Schedule H.
h. You did not complete the Service Users reports to the required standard, for one or more of the Service Users set out in Schedule I.
i. You did not follow up with one or more of the Service Users as set out in Schedule J
j. You did not discharge one or more of the Service Users as set out in Schedule K
k. You did not complete the Service User plans to the required standard and/or did not review or update plans when necessary, for one or more of the Service Users set out in Schedule M.
2. You have a physical and/or mental health condition as set out in Schedule L.
3. Your actions in paragraph 1 constitute misconduct and/or lack of competence.
4. By reason of your misconduct and/or lack of competence and/or health your fitness to practise is impaired.
Schedule A
Service User 1
Service User 4
Service User 6
Service User 10
Service User 13
Service User 19
Service User 20
Service User 23
Service User 32
Service User 39
Service User 42
Service User 43
Service User 44
Service User 45
Service User 48
Service User 52
Service User 61
Service User 79
Service User 80
Service User 88
Service User 101
Service User 113
Service User 116
Service User 121
Schedule B
Service User 10
Service User 12
Service User 13
Service User 15
Service User 17
Service User 18
Service User 19
Service User 20
Service User 21
Service User 24
Service User 25
Service User 26
Service User 29
Service User 30
Service User 31
Service User 32
Service User 33
Service User 34
Service User 35
Service User 36
Service User 37
Service User 40
Service User 42
Service User 43
Service User 44
Service User 45
Service User 47
Service User 48
Service User 49
Service User 52
Service User 53
Service User 55
Service User 56
Service User 61
Service User 63
Service User 64
Service User 66
Service User 71
Service User 72
Service User 74
Service User 75
Service User 76
Service User 78
Service User 79
Service User 80
Service User 81
Service User 82
Service User 84
Service User 85
Service User 86
Service User 87
Service User 88
Service User 89
Service User 90
Service User 91
Service User 93
Service User 97
Service User 98
Service User 99
Service User 100
Service User 103
Service User 104
Service User 111
Service User 112
Service User 114
Service User 116
Service User 117
Service User 118
Service User 119
Service User 120
Service User 121
Service User 122
Service User 123
Service User 124
Service User 125
Service User 126
Service User 127
Service User 128
Service User 129
Service User 130
Service User 131
Service User 132
Service User 133
Service User 134
Service User 135
Service User 136
Service User 137
Service User 138
Service User 139
Service User 140
Service User 141
Service User 142
Service User 143
Service User 144
Service User 145
Service User 146
Service User 147
Service User 155
Service User 164
Schedule C
Service User 1
Service User 2
Service User 3
Service User4
Service User 5
Service User 6
Service User 7
Service User 8
Service User 10
Service User 66
Service User 67
Service User 68
Service User 69
Service User 102
Service User 108
Schedule D
Service User 3
Service User 4
Service User 7
Service User 12
Service User 13
Service User 15
Service User 17
Service User 18
Service User 19
Service User 22
Service User 23
Service User 24
Service User 25
Service User 26
Service User 28
Service User 29
Service User 30
Service User 31
Service User 32
Service User 33
Service User 34
Service User 36
Service User 37
Service User 38
Service User 39
Service User 40
Service User 41
Service User 42
Service User 43
Service User 44
Service User 46
Service User 47
Service User 48
Service User 49
Service User 51
Service User 55
Service User 56
Service User 57
Service User 61
Service User 62
Service User 63
Service User 67
Service User 71
Service User 72
Service User 73
Service User 75
Service User 76
Service User 77
Service User 79
Service User 81
Service User 82
Service User 83
Service User 84
Service User 85
Service User 86
Service User 87
Service User 88
Service User 89
Service User 90
Service User 91
Service User 92
Service User 93
Service User 94
Service User 95
Service User 96
Service User 97
Service User 98
Service User 99
Service User 100
Service User 101
Service User 102
Service User 103
Service User 104
Service User 117
Service User 119
Service User 120
Service User 121
Service User 126
Service User 127
Service User 136
Service User 137
Service User 139
Service User 140
Service User 143
Service User 144
Service User 147
Service User 156
Service User 157
Service User 158
Service User 159
Service User 160
Service User 161
Service User 162
Service User 163
Service User 165
Service User 166
Service User 168
Service User 169
Service User 171
Service User 173
Service User 174
Schedule F
Service User 11
Service User 14
Service User 16
Service User 17
Service User 27
Service User 35
Service User 38
Service User 50
Service User 55
Service User 59
Service User 60
Service User 62
Service User 65
Service User 70
Service User 74
Service User 86
Service User 88
Service User 89
Service User 95
Service User 97
Service User 106
Service User 116
Service User 122
Service User 130
Service User 147
Service User 169
Service User 170
Schedule G
Service User 4
Service User 7
Service User 12
Service User 15
Service User 19
Service User 23
Service User 24
Service User 25
Service User 30
Service User 31
Service User 38
Service User 39
Service User 41
Service User 43
Service User 44
Service User 46
Service User 47
Service User 48
Service User 49
Service User 51
Service User 55
Service User 61
Service User 62
Service User 71
Service User 72
Service User 75
Service User 76
Service User 77
Service User 79
Service User 81
Service User 82
Service User 83
Service User 84
Service User 85
Service User 86
Service User 87
Service User 88
Service User 89
Service User 90
Service User 91
Service User 92
Service User 93
Service User 94
Service User 95
Service User 96
Service User 97
Service User 98
Service User 99
Service User 100
Service User 101
Service User 102
Service User 103
Service User 104
Service User 118
Service User 126
Service User 127
Schedule H
Service User 42
Service User 44
Service User 48
Service User 74
Service User 77
Service User 81
Service User 85
Service User 87
Service User 99
Service User 140
Service User 167
Schedule I
Service User 6
Service User 24
Service User 28
Service User 29
Service User 30
Service User 31
Service User 32
Service User 33
Service User 35
Service User 36
Service User 37
Service User 40
Service User 44
Service User 50
Service User 56
Service User 57
Service User 62
Service User 68
Service User 72
Service User 73
Service User 75
Service User 78
Service User 80
Service User 84
Service User 85
Service User 86
Service User 87
Service User 88
Service User 89
Service User 90
Service User 91
Service User 93
Service User 94
Service User 96
Service User 97
Service User 99
Service User 100
Service User 101
Service User 103
Service User 104
Service User 105
Service User 113
Service User 114
Service User 115
Service User 119
Service User 122
Service User 125
Service User 126
Service User 127
Service User 128
Service User 129
Service User 130
Service User 131
Service User 134
Service User 138
Service User 139
Service User 140
Service User 143
Service User 144
Service User 145
Service User 150
Service User 164
Service User 166
Service User 171
Service User 173
Schedule J
Service User 11
Service User 16
Service User 38
Service User 42
Service User 45
Service User 49
Service User 50
Service User 59
Service User 60
Service User 65
Service User 70
Service User 74
Service User 77
Service User 79
Service User 84
Service User 88
Service User 89
Service User 93
Service User 94
Service User 95
Service User 96
Service User 97
Service User 100
Service User 105
Service User 106
Service User 107
Service User 111
Service User 116
Service User 120
Service User 130
Service User 162
Service User 172
Schedule K
Service User 1
Service User 2
Service User 3
Service User 4
Service User 5
Service User 6
Service User 7
Service User 8
Service User 10
Service User 20
Service User 21
Service User 35
Service User 66
Service User 67
Service User 68
Service User 69
Service User 92
Service User 102
Service User 108
Service User 176
Service User 177
Schedule L
In Private
Schedule M
Service User 43
Service User 44
Service User 46
Service User 47
Service User 48
Service User 49
Service User 51
Service User 55
Service User 63
Service User 76
Service User 78
Service User 105
Service User 139
Service User 145
Finding
Preliminary Matters
Service
1. The Panel has seen an unredacted letter dated 8 December 2022 which was sent by email to the Registrant’s registered email address. The letter gives notice of the date, time, and purpose of this hearing and that it will be conducted remotely. The Panel has seen two documents which confirm that the email was sent to the Registrant’s email address on the same date: (i) an email from Microsoft Outlook, and (ii) a signed Proof of Service document from the HCPTS. Accordingly, the Panel is satisfied that proper notice of these proceedings has been served on the Registrant.
Proceeding in the absence of the Registrant
2. Ms Saran applied for the hearing to proceed in the absence of the Registrant. She referred the Panel to a number of emails and telephone call notes which show that, between September 2022 and February 2023, Kingsley Napley LLP made a number of unsuccessful attempts to contact the Registrant about this hearing. Ms Saran submitted that the Registrant has voluntarily absented herself from the hearing and has not sought an adjournment.
3. Ms Saran submitted that the Registrant was notified of today’s hearing on 8 December 2022. Ms Saran reminded the Panel that registrants were under a duty to engage with their Regulator.
4. Ms Saran submitted that it was in the public interest for the hearing to proceed in the Registrant’s absence as the allegations related to events which occurred between June 2015 and June 2016.
5. The Panel has received and accepted legal advice. It has considered the various matters set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”. In reaching its decision, the Panel has exercised particular care and caution.
6. The Panel is satisfied that all reasonable steps have been taken to notify the Registrant of this hearing. It notes that in addition to the Notice of hearing email dated 8 December 2022, the Hearings Officer sent an email to the Registrant at her registered email address on 27 February 2023. This email reminded the Registrant of today’s hearing and sought confirmation from her of a number of matters including whether she would be attending, whether she would be represented, and whether she had accessed the HCPC’s bundle of documents. There has been no response from the Registrant. The Panel also notes the repeated unsuccessful attempts by Kingsley Napley LLP to engage with the Registrant in late 2022 and earlier this year.
7. The Panel accepts that there will be some disadvantage to the Registrant by not being present and participating in the hearing but considers that this is outweighed by the public interest in proceedings being heard when scheduled, especially where there is a witness who is waiting to give evidence. The Panel will be careful to consider all matters which are in the Registrant’s favour throughout the proceedings.
8. The Panel is satisfied that the Registrant has made a deliberate decision not to attend the hearing or be represented at it. The Panel has therefore concluded that the Registrant has voluntarily waived her right to be present.
9. The Panel is satisfied that there is a clear public interest in this case being concluded given that the matters which it has to consider cover a period from June 2015 to June 2016. The Panel considers that it is in the public interest for final hearings to proceed at the time they are listed to be heard.
10. In reaching its decision, the Panel has balanced fairness to the Registrant with fairness to the HCPC and the wider public interest. The Panel is satisfied that it is in the interests of justice to proceed in the Registrant’s absence.
Application to conduct part of the hearing in private
11. Ms Saran applied for those parts of the case where matters relating to the Registrant’s health are raised, to be heard in private in order to protect her private life.
12. In reaching its decision, the Panel has had in mind the HCPTS Practice Note on “Conducting Hearings in Private”. It has also received and accepted legal advice.
13. The Panel is aware that these proceedings should be heard in public unless there are exceptional circumstances which would dictate that either the whole or part of the hearing should be conducted in private. The Panel notes that matters of health are usually heard in private. It also notes that part of the Allegation relates to a health condition (Particular 2) and that there are many references to this in the case papers. The Panel is satisfied that where matters relating to the Registrant’s health arise during the hearing, these should be heard in private so as to protect her private life. The rest of the hearing will be conducted in public.
Other matter:
Application for an Interim Order
14. The case was originally listed between 13 to 17 March 2023. As the hearing had not concluded by 17 March 2023, Ms Saran applied for an Interim Order under Article 31 of the Health Professions Order 2001 (“the 2001 Order”) to cover the period between 17 March 2023 to the conclusion of the case. She submitted that an Interim Order was necessary to protect the public, or was otherwise in the interests of the public, or the Registrant herself. Ms Saran told the Panel that the Registrant was not currently subject to any Interim Order but could not say whether there had ever been an Interim Order following the referral to the HCPC in June 2017.
Service
15. Ms Saran first addressed the issue of service of notice of the application on the Registrant. She conceded the Registrant had not been given notice of the application but submitted that the Panel might infer that notice had been given in the Notice of hearing letter dated 8 December 2022. This had notified the Registrant that if the allegation was judged to be well founded and a sanction of either Conditions of Practice, Suspension Order or a Strike Off Order was imposed, there would be an application for an interim order to cover the period before that sanction came into effect or the period to the conclusion of any appeal.
Decision
16. The Panel received and accepted legal advice. The Panel was referred to Article 31 (15) of the 2001 Order which states: “No order …shall be made by any Practice Committee in respect of any person unless he has been afforded an opportunity of appearing before the Committee and being heard on the question whether such an order should be made in his case”. The Panel has also considered the HCPTS Practice Note on Interim Orders. The Panel has concluded that the reference in the Notice of hearing letter of 8 December 2022 is notice which specifically relates to an interim order application which may be made only after a panel has decided that the allegation is well founded and has imposed a specific type of sanction. This Panel has yet to reach either of those stages in this case.
17. The Panel has also concluded that Article 31 (15) of the 2001 Order makes it clear that a registrant has to be given the opportunity of being heard on an application for an Interim Order. While it does not specify that any particular notice period is required, it does not state that there could be circumstances in which no notice is required.
18. The Panel is satisfied that the Registrant has not been notified of this application for an Interim Order and so it cannot consider it.
Background
19. The Registrant is a registered Speech and Language Therapist (SLT) who was employed by the Royal Wolverhampton NHS Trust (“the Trust”) as a Band 5 SLT from 2 February 2009 to 20 January 2017.
20. In June 2015, the Trust carried out an audit of the Registrant’s caseload which revealed a number of concerns regarding her record-keeping. The concerns included:
• issues with the quality of reports produced.
• a lack of reports produced.
• a lack of treatment plans.
• a lack of Identification of Need Tool (INT) documentation.
• the recording of inaccurate information.
21. The Trust then carried out seven months of informal monitoring of the Registrant’s practice during which the Registrant met weekly with her Line Manager to review her progress.
22. In February 2016, as there had been no significant improvement in the Registrant’s record-keeping, the Trust commenced Stage One of its Capability Process. During a meeting in May 2016 the Trust’s on-going concerns were raised with the Registrant with a view to escalating to a Stage Two Capability Meeting. Subsequently, the Registrant was re-deployed to non-clinical duties from May 2016 to June 2016.
23. Between February and September 2016, Registrant’s health and capability issues were managed under the Trust’s Capability and Sickness and Absence Policies.
24. On 2 September 2016, a Stage Two Capability Meeting was held. From 2 September 2016 to January 2017, the Registrant was redeployed to a clerical role within the Orthopaedics department. The Registrant left the Trust on 20 January 2017.
25. On 28 June 2017 the Trust referred the Registrant to the HCPC.
26. On 12 March 2021, a panel of the Investigating Committee found that there was a case for the Registrant to answer and referred an Allegation to this Committee.
Decision on Facts
Evidence
27. The Panel heard evidence from one witness called by the HCPC. It also received in evidence a hearsay witness statement and a production statement. The HCPC produced a bundle which totals 1155 pages (of which some 1019 pages are documentary exhibits). The exhibits include:
a) notes of meetings held with the Registrant during the informal and formal capability process;
b) emails between DD, the Registrant’s Line Manager and others regarding the Registrant and the concerns with her practice;
c) Occupational Health reports and emails regarding the Registrant;
d) various audits of the Registrant’s caseload carried out in February, March and April 2016;
e) the Capability Investigation Management Report 18 July 2016
f) the Registrant’s response to the Capability Investigation Management Report dated 31 August 2016;
g) an email from the Registrant dated 19 July 2017 giving an update on her employment and health;
h) the Registrant’s GP’s medical records.
28. The Panel has borne in mind throughout that the burden of proving the Allegation is on the HCPC and that to discharge that burden, there must be sufficient evidence to satisfy the civil standard of proof. The Panel has considered Particular 1 and each of its sub-particulars separately.
29. The Panel notes that the total number of individual Service Users referred to in the Schedules to Particular 1a to 1k is 167 (although Service Users are identified by numbers 1 to 177, 11 of the numbers between 1 and 177 are not used). The Panel also notes that some Service Users are listed in more than one of those Schedules. The terms of Particular 1 require the Panel to consider if each sub-particular is found proved in relation to “one or more” of the Service Users set out in the relevant Schedule. The Panel has therefore considered each of the Service Users set out in each of the Schedules. This has involved the Panel making a total of 465 individual decisions in respect of all the sub-particulars of
Particular 1.
DD
30. The Panel did not hear live evidence from DD but received her witness statement as hearsay evidence. DD retired from the Trust in 2018. At the relevant time, DD was the Head of Speech and Language Therapy at the Trust and was the Registrant’s Line Manager. DD was also appointed by the Trust as the Investigating Officer for the Trust’s internal investigation under the Trust’s Capability Process. DD first met the Registrant in 2009 when she started her employment as a Band 5 SLT with the Trust. In that role, the Registrant carried out assessments and treatments of children who presented with communication difficulties. DD produced as exhibits (i) a copy of the Trust’s Job Description for a Band 5 SLT, and (ii) a Person Specification for a Band 5 SLT.
31. In her witness statement, DD told the Panel that initial concerns regarding the Registrant’s caseload arose in June 2015 following a routine case notes audit by the Speech and Language Therapy Manager, LP. The case notes audit identified that the case notes drafted by the Registrant did not comply with the Speech and Language Therapy Department Guidelines. The Registrant was sent an email by LP regarding her findings on 25 June 2015, but the Registrant did not respond. DD told the Panel that on 8 July 2015, the Registrant approached KW (at that time Joint Head of Children’s Speech and Language Therapy) and informed her that she was struggling with her caseload. KW gave the Registrant advice on how better to manage her workload and offered her suggestions on how she might be better supported.
32. On 14 July 2015, the Trust received a complaint from a member of staff at School A who was concerned about the Registrant’s lack of engagement with pupils and staff, and her failure to set targets for her caseload. At that time, the Registrant’s caseload covered two pre-school clinics, two special schools and an ‘Out of Area’ service. According to DD, the Registrant did not have an excessive caseload and she said that within the department, cases were allocated consistently amongst the staff.
33. As a result of the complaint, DD conducted an informal review of the Registrant’s caseload in July 2015 during which she identified a number of concerns:
a) failure to meet the required number of contacts/client appointments;
b) ineffective time management;
c) Ineffective caseload management;
d) failure to meet Trust Departmental and Professional Standards;
e) poor clinical decision making;
f) failure to write reports; and
g) poor quality of reports.
34. On 29 July 2015, DD invited the Registrant to attend a meeting to discuss the findings of her informal review. The meeting was postponed to 13 August 2015. DD kept notes of this meeting, and of other meetings she held with the Registrant. At the meeting, DD highlighted the areas of concern and proposed an informal Action Plan to assist the Registrant to address the concerns. The Registrant agreed the Action Plan and a timetable was set for her to address all the issues identified. DD also offered to proof read and review the Registrant’s reports going forward, and to meet with her on a weekly basis.
35. DD told the Panel that between 23 September 2015 to 5 February 2016, she (or in her absence LP) and the Registrant met on a weekly basis. DD also said that she continually supported the Registrant and gave her feedback with regard to the Action Plan. DD said she had encouraged the Registrant to make use of a Session Plan Pro forma during assessments to assist her in target-setting.
36. DD told the Panel that for 2 weeks after her return to work, no client appointments were scheduled for the Registrant to allow her to focus on the Action Plan. After the 2-week period, the Registrant returned to scheduled work, however her target contacts and client appointments were reduced from 202 to 162 to support her in meeting target contacts. DD explained that the minimum expected number of face-to-face contacts per quarter for a Band 5 SLT working 37.5 hours per hour was 202.
37. DD told the Panel that there was a second departmental case notes audit in December 2015. On this occasion, the Registrant had selected her own case notes for review. DD explained that as the case notes selected by the Registrant did not contain relevant reports, she scored only 55% for the audit. The departmental standard to pass a departmental case notes audit was 90%, and so the Registrant failed the audit.
38. DD told the Panel that between September 2015 and February 2016, there were continued concerns regarding the Registrant’s capability. DD said that on occasions the Registrant did not send reports to her for proof reading, and in January 2016, DD discovered 16 reports were outstanding for service users seen in November 2015.
39. DD said that on 19 February 2016, the Registrant was informed that the Trust’s Capability Process would be actioned. During the meeting an Improvement Schedule was agreed with the Registrant to start on 22 February 2016 and run until 18 April 2016. According to DD, the Registrant did not put forward any reasons as to why her performance had not improved. Throughout the formal Capability Process, weekly meetings were held between DD and the Registrant to monitor her progress. Notes were taken of these meetings.
40. On 3 March 2016, DD observed the Registrant in a clinic setting at School E. DD said that the Registrant had appeared to be well-prepared and gave a good overview of the service user’s presenting difficulties. Two other proposed observations did not take place.
41. DD said that on 7 March 2016, she had performed a departmental case notes audit. The Registrant had scored a “Nil” return and the audit raised concerns. DD said that the Registrant’s case notes from Schools A, B and D did not evidence an ability to maintain the expected levels of capability.
42. On 20 May 2016, DD told the Panel that she had invited the Registrant to attend a formal meeting in accordance with the Trust’s Capability Policy. DD had previously written to the Registrant on 24 April 2016 to inform her that she did not meet the required Trust and Speech and Language Therapy Department Standards with regard to the following:
a. client contacts
b. report writing
c. clinical decision making
d. organisation and management of caseloads.
43. DD told the Panel that on 26 April 2016, she had received a complaint about the Registrant from one of the schools where she worked. This related to a particular service user. The nature of the complaint was a lack of follow up by the Registrant since February 2016. Attempts by the School to contact the Registrant had failed as she had not responded to messages left for her.
44. DD said that on 3 May 2016, the Registrant was re-deployed from clinical duties to a temporary administrative role within the department. DD explained that on 24 May 2016, a meeting was held with the Registrant to discuss the Improvement Schedule. The Registrant had her Union Representative with her at this meeting. During the meeting, continued concerns were raised including the Registrant’s not meeting expected client contacts, draft reports, the quality of her reports, poor clinical decision making and failure to manage her caseload effectively. DD outlined the various mechanisms that had been put in place over a period of about 10 months, to support the Registrant, such as weekly meetings, proof reading reports, a reduced caseload, reduced client contacts and guidance forms. According to DD, the Registrant had confirmed in the meeting that there was nothing more the Department could have done to support her.
45. The Panel has considered DD’s hearsay evidence with care. Where possible, it has tested it against documents which were created during the relevant period as part of the informal and formal Capability Process. This includes audits of the Registrant’s caseload and case notes in February, March, and April 2016. The Panel has referred to these in coming to its decisions on facts, testing them where possible by reference to other contemporaneous documentary evidence. The Panel has decided that it can give significant weight to DD’s evidence regarding the Trust’s expectations of a Band 5 SLT and the informal and formal Capability Process. Where DD is expressing her opinion on the adequacy or otherwise of e.g., clinical decision making or whether Service User plans were to the required standard, the Panel has reached its own decision based on all the evidence it has received. A good deal of DD’s evidence was based on the results of audits of the Registrant’s caseload and case notes. The Panel has not been provided with all the case notes which were audited. Where case notes have been produced, this was by another witness. It does not appear that DD was asked to review many of these when making her witness statement.
CC
46. CC is a registered SLT and is employed by the Trust as Speech and Language Therapy Service Manager, a position she has held since November 2017.
47. CC told the Panel that when she started her employment, she noticed that there appeared to be insufficient time for SLTs to undertake quality interventions and complete essential paperwork for each episode of care. CC said that the Trust appeared stretched and targets set for clinical contacts were not always met. Most SLTs had a backlog of documents which required filing. Across the board, reports were frequently delayed and review dates missed. She said that it was typical for the review dates set for the children to be missed by many months. CC said some SLT’s chose not to put a review date in their case notes. CC said that INT paperwork was frequently not completed.
48. CC explained that on 19 May 2021, she was asked by the HCPC’s outside lawyers, Kingsley Napley LLP to provide service user case notes for various children who had been treated by the Registrant during the relevant period. CC obtained the service user case notes from the Trust’s files and from its archived files. At the request of the HCPC, CC reviewed 35 of these service user case notes. She told the Panel that the specific case notes had been selected for her.
49. In answer to Panel questions, CC said that the Registrant’s standard of work was similar to other SLTs at the Trust. She said that the Trust’s Childrens’ Speech and Language Therapy Department was historically understaffed. CC explained that the setting of a specific number of contacts per day for an SLT to meet, was a blunt instrument which did not take account of the content of those contacts and what else was happening at that time. While the Panel has reached its own conclusions in relation to the allegations, it has given significant weight to CC’s evidence, particularly where she has reviewed the case notes for specific Service Users. CC was not employed by the Trust at the relevant time and did not know the Registrant.
OA
50. OA is a legal assistant employed by Kingsley Napley LLP. OA produced a number of exhibits in the case: (i) the Trust’s referral form together with Trust documentation attached to it, (ii) documents obtained by the HCPC from the Registrant’s GP, and (iii) service user case notes for children treated by the Registrant which had been obtained by CC.
The Registrant
51. Although the Registrant was not present during the hearing, the Panel has had the benefit of seeing notes of the weekly meetings held with her during both the informal and formal Capability Process. These document her response to the concerns raised about her performance. The Panel is aware that this is not evidence given on oath and that the Registrant has not been cross-examined or answered Panel questions. Nevertheless, the Panel considers that these notes do provide some context for the concerns raised, whether and to what extent the Registrant accepted the validity of the concerns, and how she responded to them.
52. In Private
The Panel has also had the benefit of the Registrant’s written response dated 31 August 2016 to DD’s Capability Investigation Management Report dated 18 July 2016. The Registrant accepted that there was evidence in the Report that she had not “reached department and trust standards”.
Particular 1 – the stem
53. The Panel is satisfied on the evidence that the Registrant was employed between June 2015 and June 2016 as a Band 5 SLT by the Royal Wolverhampton NHS Trust.
54. The Panel has seen the Trust’s Job Description for a Band 5 SLT which sets out under the heading “Job Summary” the following:
• To provide a high level of Speech and Language Therapy expertise to children
• To manage a defined Speech and Language Therapy caseload independently
• To participate in the development and delivery of training to others
• To supervise Speech and Language Therapy Support Practitioners, volunteers and students.
55. The Job Description provides more details of the competencies required under a number of headings. Under the heading “Main duties and responsibilities”, are the following:
“Clinical
To demonstrate developing clinical skills (para 1)
To communicate complex condition related information from assessment to clients, carers, families, multi-disciplinary team members and other professionals (para 2)
To be responsible for assessments, differential diagnosis, formulation of treatment plans, writing assessment reports, providing appropriate intervention and evaluation of treatment outcomes for each individual client in respect of communication and/or feeding and swallowing difficulties with access to a senior colleague (para 4)
Professional
To adhere to local clinical guidelines (para 4)
To maintain up to date and accurate case notes in line with professional guidelines and Trust policies (para 7)
Clinical Governance/Organisational
To structure clear intervention plans based on best practice (para 1)
To manage own time and prioritise tasks appropriately (para 3).
56. The Panel has considered whether, on a balance of probabilities, it is satisfied by reference to all the matters alleged in the sub-particulars to Particular 1, that the Registrant did not meet the competency of a Band 5 SLT with the Trust, as alleged in the stem of Particular 1.
Particular 1a is found proved - (did not complete the Identification of Need tool form for one or more of the Service Users set out in Schedule A)
57. The Panel notes that Schedule A sets out 24 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not complete an INT form in relation to each of the Service Users in Schedule A.
58. DD told the Panel that the Identification of Need Tool (“INT”) is used by SLTs to identify the needs and risks of clients and must be applied to all service users. DD explained how the INT tool assists SLTs to identify how much time should be allocated to service users and assists SLTs justifying why one service user might require more or less therapy. All the SLTs at the Trust were trained to use INTs and on-going training was available.
59. CC confirmed DD’s evidence as to the use of the INT tool. She said that it was an aid to decision making but was not part of the decision itself, and that it was an adjunct to a clinical assessment, but it was not the assessment. She told the Panel that the INT form was a separate sheet which was filed in the service users’ case notes folder. She confirmed that INT form had been used by the Trust during the relevant period and explained that they were no longer used. CC told the Panel that from her review of case notes folders for various service users, she had noted that INT forms were often not completed by SLTs. In answer to Panel questions, CC said that the INT tool had been replaced. She confirmed that it was the responsibility of the SLT who had conducted either the initial assessment or a review, to complete the INT form. CC stated that where the INT tool had not been used, this had no adverse impact on the service user concerned.
60. The Panel has seen the Trust’s Departmental Guidelines: Application of INT/Children’s Service which states that “This tool will be applied to every client at initial assessment appointment” and “This tool will be applied at the start of every subsequent episode of care”. The Guideline applies to all SLTs. The Panel is satisfied it is more likely than not that as this Departmental Guideline was in force at the relevant time, one of the competencies required of the Registrant in her role as a Band 5 SLT with the Trust was to complete INT forms for service users.
61. DD told the Panel that when she met with the Registrant on 13 August 2015 (the first weekly meeting during the informal review period), she had raised concerns that the Registrant did not prioritise using the INT tool. Following the meeting, an Action Plan was agreed with the Registrant in which one of her targets was to ensure INT data was completed in all case notes for service users seen from April 2015 by 1 October 2015. The Panel has seen a copy of the Action Plan. The Registrant was given a period time after the meeting on
13 August 2015 when she did not see service users so that she could catch up on a variety of tasks set out in the Action Plan, including completing the outstanding INT forms. The Panel notes that this required the Registrant to go back and complete INT forms for service users for a period which pre-dates the Allegation in this case. The Panel does not know how many outstanding INT forms there were and therefore how this added to the Registrant’s caseload during this period.
62. The Panel can see from weekly meetings notes that by 1 October 2015, the Registrant had completed the outstanding INT forms for two of the relevant schools. At the meeting on 8 October 2015, DD noted that all tasks on the Action Plan to be completed by 1 October 2015 (with one exception) had been completed. By 23 October 2015, the Registrant had resumed seeing service users and the notes of a meeting with DD that day show tasks such as completing INT forms were being “well managed” by the Registrant. However, at a meeting held on 6 February 2016, it was noted that the Registrant had admitted that her application of INT (and another task called WEKOS) had “slipped” recently and she needed to get these back on track.
63. DD told the Panel of a meeting held on 19 February 2016 under Stage 1 of the Trust’s Capability Process 2016. She said that one of the tasks set in an Improvement Schedule formulated to address the Trust’s concerns, was for the Registrant to demonstrate “consistent application of INT after each initial or review appointment… as per departmental guidelines”. This was to be reviewed weekly during Stage 1 (22 February 2016 to 18 April 2016). DD told the Panel that the case notes audit carried out in March 2016 had flagged up that the Registrant continued to use INT forms inconsistently. DD produced a number of exhibits identifying the service users where there was no INT form.
64. CC was also asked to review a number of service user case notes folders to see if an INT form had been completed by the Registrant. CC told the Panel that of the folders she had reviewed, she had found the Registrant had completed 3 INT forms for Service User 85. CC said that for some of the Service Users, the Registrant was not the only SLT who had not completed an INT form and she gave examples: Service Users 42 and 44 – 6 SLTs including the Registrant, only one of whom completed an INT form, Service User 48 – 6 SLTS including the Registrant, none of whom completed an INT form.
65. The Panel notes that in DD’s Capability Investigation Management Report, she wrote that the Registrant had made some progress in certain areas including “Application of INT to caseloads”.
66. The Panel has reviewed the audits carried out in February, March and April 2016 of the Registrant’s caseload and case notes. The Panel notes that there are handwritten entries on some of the typed audit notes for February and March which are apparently dated in mid-April (prior to 18 April 2016). There is no explanation in DD’s statement as to who made the entries. The Panel has considered these audits and it accepts that for a number of the Service Users in Schedule A there is no documentary evidence of a hard copy of the INT form being in the case notes folders and therefore no evidence of an INT tool form being completed by the Registrant.
67. The Panel has therefore concluded it is more likely than not that the Registrant did not complete INT forms for the following Service Users: Service Users 1, 4, 6, 10, 13, 19, 20, 23, 32, 39, 42, 43, 44, 45, 48, 61, 79, 80, 88, 101, 113, 116 and 121. The Panel therefore finds Particular 1a proved in relation to these Service Users.
68. In relation to Service User 52, Ms Saran in her closing submissions indicated that there was no documentary evidence that the Registrant had not completed an INT form.
69. The Panel notes that the allegation in Particular 1a is drafted in terms of “one or more” of the Service Users set out in Schedule A. Therefore, although it has concluded, on the balance of probabilities, that Particular 1a is not proved for Service User 52, this does not alter its overall finding that Particular 1a is proved.
70. The Panel finds Particular 1a proved.
Particular 1b is found proved – (did not complete reports in a timely manner for one or more of the Service Users set out in Schedule B)
71. The Panel notes that Schedule B sets out 99 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not complete reports in a timely manner in relation to each of the Service Users in Schedule B.
72. The Panel has seen the Trust’s Speech and Language Therapy Departmental Guidelines: Written Reports to Clients and Parents/Carers. These set time scales for a variety of reports and when these should be received by the client and parents/carers. For reports after initial assessment, after review and on discharge, the time scale is 4 weeks. DD told the Panel that a copy of the Guidelines is accessible to SLTs via the internet and in hard-copy form at the Trust. DD also said that all SLTs were aware of the reporting deadlines.
73. The Panel is satisfied that it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust was to complete reports in a “timely manner”.
74. DD told the Panel that throughout the informal review process, the Registrant had not demonstrated effective time management and case management. DD said that the Registrant did not have an effective system in place to manage her time and she did not appropriately allocate time to conduct assessments and write up case notes and reports. DD explained that it was essential that reports were drafted within a reasonable time frame so that interested parties were aware of the outcome of assessments and the service user’s condition.
75. CC told the Panel that when she first joined the Trust in November 2017, she had noticed that the SLTs were seeing a large number of service users and were drafting reports within 6 to 8 weeks which was in breach of the Trust’s Guidelines. CC said that the SLT Department had between 2500 and 3000 children on the SLT caseload at any one time and less than 20 SLTs. This meant that SLTs had to be pragmatic when deciding in which order to write up their reports.
76. The Panel notes that as part of both the informal Capability Process and Stage 1 of the formal Capability Process, the Registrant had to give her draft reports to DD (or in her absence to LP) so that these could be reviewed before being sent out. Where reports required amendments, these would be returned to the Registrant. The Panel notes that this would inevitably impact on when the reports would be ready for sending to the relevant parties.
77. The Panel notes that in her response to DD’s Capability Investigation Management Report, the Registrant refers to the impact that the Capability Process (informal and formal) had had on her ability to meet the Trust’s guidelines for reports. She said that the limited timeframe which she had to write and send reports had been reduced by her having to send all reports to DD for proof reading, await any amendments, make these, and then send the amended reports back to DD for approval so that they could go then to the administrative staff for formatting and printing before they could be sent out. The Registrant said she had found this a very stressful process.
78. The Panel notes that it has not been provided with any of the reports prepared by the Registrant for the 99 Service Users set out in Schedule B. The Panel considers that the allegation in Particular 1b requires it to make a judgement call as to what amounts to “in a timely manner” without any information as to how complex each service user was, or how many other people, the Registrant may have had to liaise with before being in a position to complete a report, or what other meetings or tasks she had to complete during the relevant period. The Panel also notes that the Registrant was on an informal and then a formal Capability Process which required her to attend weekly meetings. The Panel has therefore decided that “in a timely manner” allows for some slippage in the 4-week requirement. The Panel considers that a slippage of up to 5 working days would be acceptable but any slippage longer than that would result in a report not being completed in a “timely manner”.
79. The Panel is satisfied it is more likely than not that the Registrant did not complete reports in a timely manner in respect of 20 Service Users (Service Users 12, 24, 26, 29, 35, 61, 71, 72, 74, 76, 80, 82, 97, 125, 126, 127, 128, 129, 130, 137).
80. In respect of Service Users 24, 26, 29, 71, 76, 80, 97, 125, the Panel has seen a table which shows that the Registrant saw these Service Users between 8 November and 30 November 2015 but did not draft any reports until 19 January 2016. Even allowing for some slippage over the Christmas period, the Panel considers that the slippage here is outside what would be considered acceptable.
81. In relation to Service User 12, there is no evidence that the Registrant ever wrote a report and so it follows that she did not complete a report for Service User 12 in a timely manner.
82. In relation to Service User 35, the evidence shows that the Registrant saw Service User 35 on 2 November 2015 and did not draft a report until 11 December 2015. This is a slippage of more than 5 working days and so it is outside of what would be considered acceptable.
83. In relation to Service User 61, the Panel can see from the evidence that the Registrant wrote two reports. The Registrant saw Service User 61 on 15 October 2015 and wrote her report on 5 December 2015. This is a slippage of more than 5 working days and so it is outside of what would be considered acceptable. There were no concerns regarding the timeliness of the second report in 2016.
84. In relation to Service User 72, the Panel can see from the evidence that the Registrant saw Service User 72 on 23 November 2015 and wrote the report on 11 December 2015. This is a slippage of more than 5 working days and so it is outside of what would be considered acceptable.
85. In relation to Service User 74, the Panel can see from the evidence that the Registrant saw Service User 74 on 29 October 2015 and wrote the report on 25 January 2016. This is a slippage of more than 5 working days and so it is outside of what would be considered acceptable.
86. In relation to Service User 82, the Panel can see from the evidence that the Registrant saw Service User 82 on 9 December 2015 and wrote the report on 25 January 2016. This is a slippage of more than 5 working days and so it is outside of what would be considered acceptable.
87. In relation to Service Users 126, 127, 128, 129, 130, and 137, the Panel can see from the evidence that the Registrant saw these Service Users on dates between 2 and 10 December 2015, or, in the case of Service User 137, on 9 November 2015. The Registrant wrote the reports on 25 January 2016, and they were all sent back to her for amendment on 1 February 2016, with the exception of Service User 137 where the report was sent back to her on 25 February 2016. This is a slippage of more than 5 working days in each case, and so it is outside of what would be considered acceptable.
88. Ms Saran conceded in relation to 19 Service Users that there was no evidence on which the Panel could find Particular 1b proved. These were Service Users 32, 33, 79, 84, 86, 89, 116, 117, 118, 119, 120, 123, 124, 132, 141, 143, 145, 146, 147. In these circumstances, the Panel is not satisfied, on the balance of probabilities, that the Registrant did not complete reports in a timely manner for these Service Users.
89. In relation to the remaining 60 Service Users listed in Schedule B, the Panel has seen from the evidence that while the Registrant may not have completed all their reports within the 4-week period set out in the Departmental Guidelines, she did complete them within 5 working days of the 4-week period and, on this basis and allowing for that level of slippage, the Panel has decided, on a balance of probabilities, it is not satisfied that Particular 1b is proved in relation to them.
90. The Panel notes that the allegation in Particular 1b is drafted in terms of “one or more” of the Service Users set out in Schedule B. Therefore, its findings in relation to these 60 Service Users and the 18 Service Users where the HCPC accepts that there is no evidence, do not alter the Panel’s overall finding that Particular 1b is proved.
91. The Panel finds Particular 1b proved.
Particular 1c is found proved – (did not close one of more of the Service User records, as set out in Schedule C, on the Trust’s case management system IPM)
92. The Panel notes that Schedule C sets out 15 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not close Service User records on the Trust’s case management system IPM (“IPM”) in relation to each of the Service Users in Schedule C.
93. The Panel notes that the allegation in Particular 1c is closely linked with that in Particular 1j which alleges that the Registrant did not discharge one or more Service Users. It also notes that DD links the two sub-particulars in her evidence. The Panel has taken care to distinguish between not closing Service User records on IPM (Particular 1c) and not discharging Service Users (Particular 1j).
94. DD told the Panel that SLTs are responsible for informing the appropriate agencies of a service user’s discharge and must electronically discharge a service user on IPM. The date of discharge on the case notes must correspond with the date of discharge registered on IPM. This formally closes a service user’s record. The Panel has seen the Departmental Guidelines – Discharge of Clients which sets this out.
95. The Panel is satisfied that one of the competencies required of the Registrant as a Band 5 SLT with the Trust was “to adhere to local clinical guidance”. It is satisfied it is more likely than not that it was part of the Registrant’s role as a Band 5 SLT with the Trust to close Service User records on IPM.
96. DD told the Panel that on reviewing the Registrant’s caseload in March 2016, she had found that several service users had been electronically discharged on IPM, however their case notes had not been discharged. For other service users, she found that electronic discharge had not been actioned on IPM and the case notes remained in the filing cabinet as if they were active clients. DD said that this latter situation applied to Service Users 1 to 8 and 10. The Panel understands that by ‘electronic discharge’, DD was referring to the closing of Service User records on IPM. The Panel notes that DD’s evidence in relation to Service Users 66, 67, 68, 69, 102 and 108 is directed to the correctness or otherwise of their discharge and not specifically as to whether these Service Users’ records had been closed on IPM.
97. The Panel has considered the case note audit results prepared by DD in February 2016 and March 2016. One of the aspects covered in those audits was to see whether Service User records has been closed on the IPM. The Panel has already referred to handwritten entries on the typed notes, apparently entered in April (prior to 18 April 2016), and notes that there is no explanation in DD’s evidence as to who made the entries. The Panel has considered the relevant evidence from these audits. The Panel has concluded it is more likely than not that the Registrant did not close Service User records on the IPM in respect of 9 Service Users (Service Users 1, 2, 3, 4, 5, 6, 7, 8, and 10).
98. In relation to the remaining 6 Service Users (Service Users 66, 67, 68, 69, 102, and 108), the Panel is not satisfied there is sufficient evidence to prove, on a balance of probabilities, that the Registrant did not close their records on IPM. The Panel has concluded therefore that Particular 1c is not proved in relation to them. The Panel notes that the allegation in Particular 1c is drafted in terms of “one or more” of the Service Users set out in Schedule C. Therefore, its findings in relation to these 6 Service Users, do not alter the Panel’s overall finding that
Particular 1c is proved.
99. The Panel finds Particular 1c proved.
Particular 1d is found proved – (did not complete and/or save the Service User reports onto the Trust’s drives and/or case notes for one or more of the Service Users set out in Schedule D)
100. The Panel notes that Schedule D sets out 101 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not complete and/or save the Service User reports onto the Trust’s drives and/or case notes in relation to each of the Service Users in Schedule D.
101. The Panel notes that there is some overlap between the allegation in Particular 1d and that in Particular 1f. The Panel also notes that none of the case notes folders containing all the hard-copy documents for the 101 Service Users listed in Schedule D have been produced in evidence and nor is there a download from the Trust’s w: drive showing which reports had been saved, by whom, and on what date. The Panel has been provided with the results of case notes audits conducted by either DD or LP in December 2015, and February, March, and April 2016. Some of these were departmental audits and some were specific to the Registrant’s caseload at a particular School or other location at which she worked. The Panel is aware that from May 2016, the Registrant was re-deployed to non-clinical duties.
102. The Panel notes that while Particular 1d refers to completing and/or saving reports to the Trust’s drives and/or case notes, Particular 1b refers to not completing reports in a “timely manner”. Although some of the Service Users appear in both Schedules B and D, the Panel considers that the two particulars address different aspects of the competencies expected of a Band 5 SLT with the Trust.
103. The Panel has seen the Trust’s Departmental Guidelines which cover the record storing process. These state “When formatting the reports, the office staff will add date typed and dated printed information to all reports”, and that “Electronic copies will be stored on the w: drive in the therapist’s own individual folder. Paper copies will be filed in the case notes within four weeks of printing”.
104. DD told the Panel that following a consultation with an SLT, reports are logged onto a computer on the w: drive and sent to the administration team for formatting. Once a report is in the correct format, it is printed and given back to the SLT for their review and signature. The SLT then files the signed report to the service user’s hard-copy case notes folder. Hard-copy case notes folders are kept in filling cabinets only. DD said that reports are stored both physically within case notes and electronically on the w: drive in the SLT’s folder.
105. CC told the Panel that reports were saved on the Trust’s w: drive which was a protected shared drive. She could not say whether it was the responsibility of the SLT alone to save these reports, or whether reports could be saved by the administration staff, or another person. CC said that she did not have the technical wherewithal to say when a report had been saved or if it had been corrected. She explained that the Trust no longer used the same system for saving Service User reports. CC told the Panel that there should be hard copies of reports filed in the case notes folders.
106. The Panel is satisfied it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust, was to complete reports for Service Users. The Panel is also satisfied that it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust was to file a hard copy of completed reports in the case notes folders.
107. However, while the Panel is satisfied that it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust was to save completed reports on the Trust’s drives, it is not satisfied that this was the sole responsibility of a Band 5 SLT. The Panel is unclear as to whose responsibility it was to save the completed reports on the Trust’s w: drive. This is a shared drive which it appears could be accessed by all SLTs and administration staff, and other persons. The administration staff had a role in formatting final reports. There is no computer evidence to show, by way of example, that completed reports are always and exclusively saved on the w: drive by the relevant SLT. Indeed, there is no computer evidence showing which reports completed by the Registrant were saved to the w: drive, by whom they had been saved, or when they had been saved. The Panel has seen documentary evidence that administrative staff can access and make corrections to reports on the w: drive. DD’s evidence has been admitted as hearsay evidence and so the Panel has been unable to clarify this with her. The Panel sought clarification from CC who was the only HCPC witness called to give evidence. CC’s evidence confirmed to the Panel that it was unclear whether it was the sole responsibility of the SLT to save completed reports to the Trust’s w: drive. In these circumstances, the Panel has concluded that the HCPC has failed to discharge the burden of proving, on the balance of probabilities, that the Registrant did not save reports on any of the 101 Service Users set out in Schedule D on to the Trust’s drives.
108. In light of this decision, the Panel has approached Particular 1d by first looking to see if there is evidence of a report for each of the Service Users in Schedule D. If there is a report, the Panel has then considered if there is evidence that this report was saved in the case notes. The Panel has taken “case notes” to mean the folders which contain the hard-copy documents.
109. The Panel is satisfied it is more likely than not in the case of 15 Service Users (Service Users 3, 4, 12, 13, 17, 18, 19, 37, 39, 48, 62, 77, 92, 101 and 165) that the Registrant did not complete a report and so there was nothing to file in the case notes folders. The Panel therefore finds Particular 1d proved for Service Users 3, 4, 12, 13, 17, 18, 19, 37, 39, 48, 62, 77, 92, 101 and 165.
110. In relation to Service User 3, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 15 February 2016 which refers to a contact on 27 May 2015 where there is no report at all. The Panel notes that the contact is a few days outside the start date of the Allegation. However, the time during which a report should have been completed falls within the timeframe of the Allegation. Where this is the position for other Service Users, the Panel has adopted the same approach.
111. In relation to Service User 4, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial assessment on 29 June 2015 for which no report has been found either on the w: drive or in the case notes folder.
112. In relation to Service User 12, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to a review appointment on 4 November 2015 for which no report has been found either on the w: drive or in the case notes folder.
113. In relation to Service User 13, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial appointment on 14 May 2015 and a review appointment on 28 October 2015 for which no reports have been found either on the w: drive or in the case notes folder.
114. In relation to Service User 17, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial [appointment] on 26 November 2015 for which no report has been found either on the w: drive or in the case notes folder.
115. In relation to Service User 18, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial appointment on 2 July 2015 for which no report has been found either on the w: drive or in the case notes folder.
116. In relation to Service User 19, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial assessment on 20 July 2015 for which no report has been found either on the w: drive or in the case notes folder.
117. In relation to Service User 37, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This refers to an initial contact on 16 November 2015 for which no report has been found on either the w: drive or in the case notes folder.
118. In relation to Service User 39, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This refers to an initial assessment on 28 January 2016. There is a handwritten note dated 11 April 2016 which indicates that no report has been found on the w: drive or in the case notes folder.
119. In relation to Service User 48, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016. This refers to the Registrant last seeing Servicer User 48 on 18 November 2015 and that no report has been found either on the w: drive or in the case notes folder.
120. In relation to Service User 62, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial assessment on 29 June 2015 for which no report has been found either on the w: drive or in the case notes folder.
121. In relation to Service User 77, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on an unknown date in February 2016. This refers to the Registrant having seen Service User 77 on 6 July 2015, 22 July 2015 and 29 July 2015 and there being no reports on either on the w: drive or in the case notes folder.
122. In relation to Service User 92, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to a review appointment on 4 November 2015 for which no report has been found either on the w: drive or in the case notes folder.
123. In relation to Service User 101, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial assessment on 14 December 2015 for which no report has been found either on the w: drive or in the case notes folder.
124. In relation to Service User 165, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial appointment on 14 May 2015 and a review appointment on 28 October 2015 for which no reports have been found either on the w: drive or in the case notes folder.
125. The Panel notes that in all these cases, the dates of the contacts with Service Users for whom the Registrant should have completed a report fall shortly before the period when the Registrant was first struggling with her caseload and at the beginning of the informal period of support provided to her by the Trust. For some of these Service Users the Registrant had later contacts for which she did write reports.
126. The Panel is satisfied it is more likely than not in the case of 32 Service Users (7, 22, 23, 33, 34, 40, 51, 61, 71, 72, 73, 75, 81, 84, 85, 86, 87, 90, 91, 93, 99, 100, 103, 104, 126, 127, 137, 139, 143, 144, 147 and 168) that the Registrant did complete a report but did not file a hard copy in the case notes. The Panel therefore finds Particular 1d proved for Service Users 7, 22, 23, 33, 34, 40, 51, 61, 71, 72, 73, 75, 81, 84, 85, 86, 87, 90, 91, 93, 99, 100, 103, 104, 126, 127, 137, 139, 143, 144, 147 and 168.
127. In relation to Service User 7, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016. This refers to an initial assessment being undertaken on 19 November 2015 and 10 December 2015 and a report being available on the w: drive but not in the case notes. The Panel has decided that when the completed report is uploaded to the w: drive, it is incumbent on the SLT whose report it is to file a copy of the report in the case notes folder.
128. In relation to Service User 22, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This refers to an initial appointment on 15 October 2015 for which a report has been found on the w: drive but not in the case notes folder.
129. In relation to Service User 23, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This refers to a review appointment on 13 October 2015 for which a discharge report has been found on the w: drive but not in the case notes folder.
130. In relation to Service User 33, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This refers to an initial contact on 20 and 22 January 2016 which a report has been found on the w: drive but not in the case notes folder.
131. In relation to Service User 34, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This refers to a reassessment appointment on 20 January 2016 for which a report has been found on the w: drive but not in the case notes folder. The Panel has decided that when the completed report is uploaded to the w: drive, it is incumbent on the SLT whose report it is to file a copy of the report in the case notes folder.
132. In relation to Service User 40, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This refers to initial contact being on 7 January 2016. A handwritten note dated 11 April 2016, states “no report in notes” followed by the words “or on system” which have been crossed out, followed by “on system” with a tick. The Panel has concluded that by 11 April 2016 there was a completed report on the w: drive but not in the case notes folder. The Panel has decided that when the completed report is uploaded to the w: drive, it is incumbent on the SLT whose report it is to file a copy of the report in the case notes folder.
133. In relation to Service User 51, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 with handwritten notes which appear to have been made on 14 April 2016. These refer to the Registrant last seeing Service User 51 on 17 November 2015 and there being no current report in the case notes folder.
134. In relation to Service User 61, the Panel has seen documentary evidence of a table of reports written by the Registrant. This refers to Service User 61 being seen on 13 October 2015 and the Registrant’s report being written on 5 December 2015. This was sent back to her by DD for amendments on 9 December 2015. The Panel has also seen an audit of the Registrant’s case notes carried out in February 2016 which refers to the Registrant not acting on those amendments and there being no report on the w: drive or in the case notes. However, a further document which lists items missing from the Case Notes which was prepared in February 2016 shows that the entry for Service User 61 was updated in January 2017 where it was noted that there was no report in the case notes folder.
135. In relation to Service User 71, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out in February 2016. This refers to the Registrant seeing Service User 71 on 30 November 2015 and writing a report on 19 January 2016 and after it being sent to DD for checking, it was approved for sending out on 27 January 2016. The audit note indicates that the report was not filed in the case notes folder.
136. In relation to Service User 72, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out in February 2016. This refers to the Registrant seeing Service User 72 on 16 November 2015, 23 November 2015, and 11 January 2016. It also states that there are no reports in the case notes and only the report for 16 November 2015 is on the w: drive. The table of reports written by the Registrant refers only to the 23 November 2015 contact and shows the Registrant wrote that report on 11 December 2015 and that it was “on the system” (which the Panel has taken to mean the w: drive). The audit refers to no reports being “filed in notes”.
137. In relation to Service User 73, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out in February 2016. This refers to the Registrant seeing Service User 73 on 9 December 2015 and 22 January 2016 and there being no report being written, on w: drive or in case notes. However, the Panel has also seen in the table of reports written by the Registrant that in relation to those contacts (there are inconsistencies in the dates which the Panel consider to be typing errors), the Registrant wrote a report on 15 February 2016 and that this was later saved on the w: drive but not in the case notes folder.
138. In relation to Service User 75, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out in February 2016 which refers to the Registrant seeing Service User 75 on 12 October 2015, 27 October 2015 and 21 January 2016. The audit note refers to there being no reports on the system or in the notes. The Panel has seen from the table of reports written by the Registrant, that she wrote a report on 19 November 2015 which was sent back to her by DD for amendments on the same day. The table indicates that there is a report on the system but that it has typing errors. The Panel has concluded that the Registrant did write a report but that she did not file a copy of this in the case notes folder.
139. In relation to Service User 81, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out in February 2016 which refer to the Registrant last seeing Service User 81 on 16 November 2015. It is clear from the audit that the Registrant wrote a report and that this was sent back to her for amendments on 15 December 2015. The audit note indicates that the report was uploaded to the w: drive but that it was not filed in the case notes folder.
140. In relation to Service User 84, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. These refer to there being “no report in notes following a review in November 2015. Report on w drive”. Handwritten notes on 13 April 2016, state “Report not in notes”.
141. In relation to Service User 85, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 which refers to “No report following review on 16.10.15 filed in casenotes; available on w drive”.
142. In relation to Service User 86, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. These refer to an initial assessment on 19 November 2015, and there being no report in the case notes, but it was available on the w: drive. Handwritten notes on 13 April 2016, confirm that this remained the position.
143. In relation to Service User 87, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. These refer to an initial assessment being on 19 November 2015 and 10 December 2016, and to there being a report available on the w: drive but not in the case notes.
144. In relation to Service User 90, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. These refer to a review on 4 November 2015, and to there being a report available on the w: drive but not in the case notes. A handwritten addition which appears to have been made on 13 April 2016, states “still not in notes” with a dash to the typed reference to the case notes.
145. In relation to Service User 91, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. These refer to a review on 19 November 2015 with the Registrant after a different SLT carried out an initial assessment on 25 September 2015. The audit records that reports for both of the contacts were on the w: drive but neither report had been filed in the case notes. A handwritten addition which appears to have been made on 13 April 2016, indicates that “reports not in notes”. The Panel has taken this to mean neither the Registrant’s report nor that of the other SLT was filed in the case notes. A ‘bracket’ linking the two contacts appears to confirm this.
146. In relation to Service User 93, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. The handwritten notes refer to the Registrant seeing Service User 93 on 19 February 2016 and the report being approved as ready to be sent out on 14/03/16. The handwritten note indicates that there is no report in the case notes folder. The Panel has concluded that once a report was approved to be sent out, a copy of it should be filed in the case notes folder within a reasonable time.
147. In relation to Service User 99, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. These refer to an initial assessment on 20 July 2015 for which there is no report on either the w: drive or in the case notes. The Panel has concluded that there is insufficient evidence that it was the Registrant who carried out the initial assessment of Service User 99. However, a handwritten addition indicates that the Registrant saw Service User 99 on 18 January 2016 and that her report was on the w: drive but not in the case notes folder.
148. In relation to Service User 100, the Panel has seen from the table of reports written by the Registrant that she saw Service User 100 on 15 October 2015 and wrote a report on 27 October 2015. The report was printed on 25 November 2015 and was noted to be on the system. The Panel has seen a document prepared in February and March 2016 from the various audits of the Registrant’s case notes which indicates that there was no report in the case notes for Service User 100.
149. In relation to Service User 103, the Panel has seen from the table of reports written by the Registrant that she saw Service User 103 on 12 October 2015 and 18 January 2016. She wrote reports on 16 October 2015 and 16 February 2016. These were printed on 5 November 2015 and 9 March 2016, and each was noted to be on the system. The Panel has seen a document prepared in February and March 2016 from the various audits of the Registrant’s case notes which indicates that there was no report in the case notes for Service User 103.
150. In relation to Service User 104, the Panel has seen from the table of reports written by the Registrant that she saw Service User 104 on 14 January 2016 and wrote a report on 16 February 2016 which was noted to be on the system. The Panel has also seen documentary evidence of an audit of the Registrant’s case notes dated 16 and 17 February 2016 which has handwritten notes apparently made on 13 April 2016. There is an entry which refers to the 14 January review and assumes the report is with DD. However, a handwritten entry states that the report was written in February and printed in March. There is an arrow to the typed entry which assumed the report was with DD. The Panel has concluded that if the report was printed in March 2016, a hard copy of the report should have been filed by the Registrant in the case notes folder before 13 April 2016 when the handwritten notes were made.
151. In relation to Service User 126, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 and 25 February 2016 which refers to reports for June 2015, October 2015 and December 2015 being available on the w: drive but not in the case notes.
152. In relation to Service User 127, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 and 25 February 2016 which refers to a report being available on the w: drive for a contact in December 2015 but not in the case notes.
153. In relation to Service User 137, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 and 25 February 2016 which refers to there being “no recent reports”. The Panel has also seen from the table of reports written by the Registrant that she saw Service User 137 on 9 November 2015 and wrote a report on 15 January 2016 which was sent back to her for amendments on 25 February 2016. The table indicates that the report was not on the system.
154. In relation to Service User 139, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 13 April 2016. This shows that the Registrant carried out an initial assessment on 28 January 2016 and that a report was available on the w: drive but not in the case notes.
155. In relation to Service User 143, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 14 April 2016 which refers a review appointment with Service User 143 on 10 February 2016 and a report being on the system but not in the case notes.
156. In relation to Service User 144, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 which has handwritten additions which appear to have been made on 13 April 2016. These refer to an initial appointment on 11 November 2015 and in the typed notes to there being no report on the w: drive or in the case notes. A handwritten addition refers to an unsigned copy of the report being in the case notes. The Panel has seen from the Trust’s Departmental Guidelines relating to written reports that these should be signed by the author of the report. The Panel has concluded that an unsigned report is incomplete and so it was not filed in accordance with the Trust’s Departmental Guidelines.
157. In relation to Service User 147, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 13 April 2016 which refers to an initial assessment on 20 January 2016 for which a report is on the w: drive but not in the case notes folder.
158. In relation to Service User 168, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 11 April 2016 which refers to Service User 168 being seen on 4 February 2016 and a report being written on 8 March 2016 and printed on 22 March 2016. The audit states that the report is not filed in the case notes.
159. In relation to Service Users 63 and 67, Ms Saran in her closing submissions indicated that there was no documentary evidence on which the HCPC could rely to prove Particular 1d.
160. The Panel is not satisfied it is more likely than not in the case of the remaining 52 Service Users (Service Users 15, 24, 25, 26, 28, 29, 30, 31, 32, 36, 38, 41, 42, 43, 44, 46, 47, 49, 55, 56, 57, 76, 79, 82, 83, 88, 89, 94, 95, 96, 97, 98, 102, 117, 119, 120, 121, 136, 140, 156, 157, 158, 159, 160, 161, 162, 163, 166, 169, 171, 173, 174) that there is sufficient evidence for it to find Particular 1d proved.
161. In relation to Service User 15, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 15 February 2016 which refers to an initial contact on 4 January 2016, and states that the report is not on the w: drive or in the case notes but adds, “May be with DD for checking”. The table of reports written by the Registrant shows that she wrote a report on 28 January 2016 which was marked as “ok to go” on 16 February 2016. The Panel notes that this was the day after the audit on 15 February 2016. The Panel considers that there is insufficient evidence to prove that the Registrant did not save a report in the case notes folder for Service User 15 after the date of the audit. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 15.
162. In relation to Service User 24, the Panel has seen from the table of reports written by the Registrant that she saw Service User 24 on 26 November 2015 and wrote a report on 19 January 2016 and that this was on the system. The Panel has also seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 which refers the Registrant seeing Service User for a review on 18 January 2016, it then says “Assume report is with DD for checking” followed by an entry which states a report which is on the w: drive, was written on16 February 2016 and printed on 9 March 2016. It is not clear to the Panel when then entry which refers to the report being printed on 9 March 2016 was typed. In another audit document dated 22 February 2016 and seen by the Panel, there are references to loose documents in the case notes and to there being no report for the November 2015 contact on either the w: drive or in the case notes. The Panel notes that if the report was printed on 9 March 2016, it must have been on the system. The Panel also notes that there is no reference to whether a copy of the printed report was in the case notes as at that date and so it has decided, on a balance of probabilities, that it cannot find Particular 1d proved in relation to Service User 24.
163. In relation to Service User 25, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 which states “Report following initial appointment available in casenotes but not securely filed”. The Panel has therefore concluded, on a balance of probabilities, that there was a report in the case notes folder and that it cannot find Particular 1d proved for Service User 24.
164. In relation to Service User 26, the Panel has seen documentary evidence which appears to be contradictory. Two audits both in February 2016 give different dates in 2015 for the initial appointment with Service User 26. In an audit conducted on 16 and 17 February 2016 there is also a reference to a review appointment on 18 January 2016 and a reference to it being assumed that the report is with DD for second reading. This would explain why there was no report yet on the w: drive or in the case notes. As there is no evidence to say when the report was approved to be uploaded to the w: drive, the Panel has concluded that there is no evidence of when the Registrant should have filed a copy of the complete report in the case notes folder. The Panel cannot therefore find, on a balance of probabilities, that Particular 1d has been proved for Service User 26.
165. In relation to Service User 28, the Panel has seen documentary evidence which appears to be contradictory. In an audit of the Registrant’s case notes carried out on 22 February 2016, it is stated that the initial assessment took place on 25 November 2015. However, in an audit of the Registrant’s case notes dated 16 and 17 February 2016, an initial appointment with Service User 28 apparently took place on 11 January 2016. This audit states that the report “maybe with DD for second reading” which would explain why it was not yet on the w: drive or in the case notes. However, in the next typed line of the audit, there is a reference to the report being on the w: drive, it being written on 16 February 2016 and printed on 6 March 2016. There is no evidence as to when this final typed entry was made. It clearly postdates the date of the audit itself. The Panel notes that whenever it was added, it makes no reference to whether or not the completed report has been filed in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 28.
166. In relation to Service User 29, the Panel has seen an audit of the Registrant’s case notes carried out on 22 February 2016 which states the front sheet has not been completed to show the Registrant’s involvement with Service User 29. It refers to contacts on 13 and 27 November 2015. The Panel has also seen an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 which refers to an initial appointment being on 3 February 2016. This audit states that the report “maybe with DD for second reading” which would explain why it was not yet on the w: drive or in the case notes. However, in the next typed line of the audit, there is a reference to the report being on the w: drive, it being written on 15 February 2016 and printed on 25 February 2016. There is no evidence as to when this final typed entry was made. It clearly postdates the date of the audit itself. The Panel notes that whenever it was added, it makes no reference to whether or not the completed report has been filed in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 29.
167. In relation to Service User 30, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016 which refers to an initial contact with Service User 30 being on 6 January 2016 and queries whether the report is with DD. The Panel has the table of reports written by the Registrant which shows that she wrote a report on 10 February 2016, and this was returned to her for amendment by DD on 16 February 2016. The table indicates that the report is not on the system. There is no evidence of when the report was approved by DD to be printed and sent out. The Panel considers there is insufficient evidence that the Registrant should have filed a completed report in the case notes folder as it appears the report was still being processed. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 30.
168. In relation to Service User 31, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out in February 2016 to which there are some handwritten additions. The typed entry refers to an initial contact on 27 July 2015 and to there being no report on the w: drive or in the case notes. However, an undated handwritten note refers to a later contact on 2 March 2016 and a report being written and “ok to go” followed by a dash and then on 8 April 2016 it was not yet on the system. There is no specific reference to whether or not the report is in the case notes folder. There is a “tick” next to the typed line referring to there being no report for the July 2015 contact on the w: drive or in the case notes. The Panel has no evidence of when the “tick” was added or what part of the sentence it might relate to. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 31.
169. In relation to Service User 32, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016. This shows that the Registrant’s initial contact with Service User 32 was on 20 January 2016. The typed audit note records that there is no report on the w: drive or in the case notes. However, the Panel has seen from the table of reports written by the Registrant that she wrote a report on 12 February 2016 and after some amendments it was marked as being on the system. There is no evidence as to when this was. The Panel notes that there is no reference to Service User 32 in the document which lists reports missing from case notes. The Panel has decided it cannot conclude, on a balance of probabilities, that the Registrant should have filed a copy of the report in the case notes folder as at that date. The Panel therefore finds Particular 1d not proved for Service User 32.
170. In relation to Service User 36, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016 which refers to an initial assessment being on 11 January 2016 and that there is no report on the w: drive or in the case notes and queries whether it is with DD. An undated handwritten entry refers to there being no report in the notes for the January 2016 contact. There is also a handwritten entry which states that the report was written on 10 February 2016 and printed on 22 March 2016. There is then no further reference to whether after being printed, a copy of the report was filed in the case notes folder. The Panel has also seen from the table of reports written by the Registrant that on 8 March 2016 the report was approved for printing and sending out. It clearly then took until the 22 March 2016 for the report to be printed. The Panel considers that there is insufficient evidence for it to conclude, on a balance of probabilities, that a copy of the printed reports was not filed in the case notes folder on a date after 22 March 2016. The Panel therefore finds Particular 1d not proved for Service User 36.
171. In relation to Service User 38, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 February 2016 that Service User 38 was seen by a different SLT in September and October. The entry refers to a report being on the w: drive but not in the case notes. DD referred to the Registrant being one of two SLT’s to review Service User 38 between September 2015 to March 2016. The Panel has no evidence as which of the two SLT’s wrote the report which is on the w: drive but not in the case notes. The Panel considers that there is insufficient evidence for it to conclude, on a balance of probabilities, that it was the Registrant who should have filed that report in the case notes folder. The Panel therefore finds Particular 1d not proved for Service User 38.
172. In relation to Service User 41, the Panel has seen documentary evidence of two audits of the Registrant’s case notes, one carried out on 13 April 2016 and the other on 8 June 2016. Neither audit refers to any report not being in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 41.
173. In relation to Service User 42, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016, part of which is obscured by a post-it note. There is no reference in either the typed entry or the handwritten entry to there being no report in the case notes folder. The Panel has also seen some of the case notes for Service User 42 which appear to show that the Registrant saw them in November and December 2015 when it was planned for further assessment and discussion with staff prior to writing the relevant report. The Panel does not consider that it has sufficiently clear evidence to conclude, on a balance of probabilities, that the Registrant should have written a report by the time of the audit. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 42.
174. In relation to Service User 43, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. Both the typed and handwritten notes refer to contact on 4 March 2016 and state that a report has not yet been received. The Panel notes that the Registrant was slightly over the 4-week period for writing a report, but it does not know whether one was written by her after 14 April 2016 and/or whether any report that she did write was filed in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 43.
175. In relation to Service User 44, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. The typed entry refers to Service User 44 having been seen on 12 February 2016. The handwritten note refers to contact on 12 February 2016, 8 March 2016, and 4 March 2016 (in that order). Both the typed and handwritten entries refer to no report being available. The Panel notes that the Registrant was slightly over the 4-week period for writing a report, but it does not know whether one was written by her after 14 April 2016 and/or whether any report she did write was filed in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 44.
176. In relation to Service User 46, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. The entries refer to a number of dates when the Registrant saw Service User 46 but there are no specific references to reports, the w: drive or the case notes regarding the period of the Allegation. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 46.
177. In relation to Service User 47, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. The typed note refers to the Registrant seeing Service User 47 on 4 occasions between since November 2014 and that there was no report or plan in place. The typed note does not indicate when it was that there was no report or plan in place and the Panel notes that November 2014 is well outside the period covered by the Allegation. The Panel also notes that the handwritten entry refers to the last contact being 12 November 2015 and there being no report. The Panel has seen Service User 47’s case notes from which is appears that no report or review was required for 3 months from the date of the last contact. There is no evidence that a report was due in this case given that clinical input was ongoing. The handwritten entry makes no reference to the case notes. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 47.
178. In relation to Service User 49, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. The typed note refers to the Registrant having seen Service User 49 on dates in November 2015, and in January and February 2016 and that there is no current report. The handwritten entry refers to there being no date on the report. The Panel is unclear as to when this undated report was written or if it had been approved for printing and sending out at some point between 7 March and 14 April 2016. The Panel has concluded that it cannot rule out the possibility that the Registrant filed the report after 14 April 2016. It notes that in the document which lists documents missing from the case notes, that there is no updated reference to Service User 49 in January 2017 which there is for some of the entries. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 49.
179. In relation to Service User 55, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. The typed note refers to the Registrant last seeing Service User 55 on 23 February 2016 for review. There is then an entry which is partially blurred but refers to a “report for proof reading”. The Panel notes that there is no evidence to show if or when the report was approved by DD for printing and sending out. The Panel has concluded that there is insufficient evidence that the Registrant was in a position to file a copy of the report in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 55.
180. In relation to Service User 56, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. The typed note refers to there being no report since one written by a different SLT in September 2015. The Panel has seen the Registrant’s case notes for those contacts. It notes that the Registrant saw Service User 56 in December 2016 and January 2016. The Panel considers that there is insufficient evidence that a report was clinically required at this time. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 56.
181. In relation to Service User 57, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 7 March 2016 which appears to have a handwritten note added on 14 April 2016. The typed entry refers to the Registrant seeing Service User 57 on 1 December 2015 and on 4 times since then. It refers to an EHCP (Education Health and Care Plan) report being written by the Registrant which was undated. A handwritten note refers to 6 January 2016 with an arrow and the words “no report”. In the document which sets out documents missing from the Case Notes, the reference for Service User 57 is not to a report but to an undated EHCP. The Panel has not been able to clarify with DD whether this refers to a plan or a report. It is clear that the Registrant wrote an EHCP report which was undated. The Panel considers that there is insufficient evidence that this had been approved for printing and sending out at the time of the audit. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 57.
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82. In relation to Service User 76, the Panel has seen documentary evidence of an audit carried out in February 2016 which refers to Service User 76 being seen on 19 November 2015. A report was received for proof reading on 19 January 2016 and sent back to the Registrant for amendment and for discussion on 1 February 2016. The note states that the report has not come back to DD for further proof reading. The Panel takes the view that the Registrant had yet to finish the report for Service User 76 and so she could not have filed a copy in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 76.
183. In relation to Service User 79, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out in February 2016 which refers to Service User 79 being seen on 30 November 2016. The note refers to there being no reports written or on the system. There is no reference to any report in the case notes folder. The audit which lists items missing from the case notes, shows that there was no report for this Service User. In her evidence, DD refers to the Registrant assessing Service User 79 on 25 January 2016 but not drafting a Treatment Plan until 22 March 2016 in breach of the Trust’s Departmental Guidelines. There is no reference to this contact in the audit carried out in February 2016. The Panel considers that the information before it is incomplete and has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 79.
184. In relation to Service User 82, the Panel seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 which refers to an initial appointment on 9 December 2015 and that there is “no report in casenotes or on the w drive”. The Panel has seen from the table of reports written by the Registrant that she did write a report on 25 January 2016 which was sent back to her for amendment on 1 February 2016 but had not been received back for further proof reading. The Panel considers that although it is suggested that there is no report in the case notes, there is a lack of clarity as to whether DD ever approved the report so that it could be printed and sent out. As this is unclear, the Panel considers that there is insufficient evidence that the Registrant had a finished report to file in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 82.
185. In relation to Service User 88, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. These refer to a review on 16 October 2015, and to there being a report available on the w: drive but not in the case notes. In a handwritten addition dated 13 April 2016, there is a “tick” above the typed note which refers to there being no report in the case notes. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 88.
186. In relation to Service User 89, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. The typed note refers to the Registrant reviewing Service User 89 on 12 October 2015 and to there being a report available on the w: drive but not in the case notes. There is then a “tick” above the entry relating to the case notes. The Panel is unclear if this “tick” means that there is still no report in the case notes or that there is now a report in the case notes. In these circumstances, the Panel has concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 89.
187. In relation to Service Users 94, 95 and 96, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten notes which appear to have been made on 13 April 2016. In each case, it would appear that the Service User was seen by a different SLT and that the references to there being no report on the w: drive or in the case notes refers to those SLTs and not to the Registrant. The Panel considers that there is insufficient evidence that the Registrant was required to write and/or file a report. In these circumstances, the Panel has concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service Users 94, 95 and 96.
188. In relation to Service User 97, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten entries which appear to have been made on 13 April 2016. Although the typed entry refers to there being no report on the w: drive or in the case notes, the handwritten entry suggest that a report was written and sent to DD. The note then states “1/3/16 (amendments). There are references to a report not being filed and to the March report not being filed. The Panel considers that these entries are unclear. The Panel also considers that if the report was sent to DD and that amendments were required, the Registrant might not have completed these and sent it back to DD for further proof reading before it could be approved. The Panel has concluded that there is insufficient evidence that the report was ready to be filed as the time of the audit. In these circumstances, the Panel has concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 97.
189. In relation to Service User 98, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten entries which appear to have been made on 13 April 2016. The typed note refers to an initial assessment on 26 November 2016 and to there being no report on the w: drive or in the case notes. In the handwritten notes there is a “X” by the side of the typed note about the report not being on the w: drive or in the case notes. There is no explanation as to the meaning of the “X”. There are handwritten references which refer to a report being on the w: drive for 11 February 2016 which then states, “not in notes” with a “tick” and the word “not” is crossed out. The Panel has had no explanation for these handwritten entries and has decided that there is insufficient evidence in relation to the saving of a report in the case notes folder. In these circumstances, the Panel has concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 98.
190. In relation to Service User 102, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten entries which appear to have been made on 13 April 2016. The typed note refers to a review appointment on 13 October 2015 and to a discharge report that is on the w: drive but not in the case notes. A handwritten note refers to a loose copy of the discharge report being in the case notes. The Panel has therefore concluded that there is no evidence to find Particular 1d proved for Service User 102.
191. In relation to Service User 121, the Panel has seen from the table of reports written by the Registrant that she saw Service User 121 on 6 November 2015 and wrote a report on 5 December 2015. This was sent back for amendments on 9 December 2015. There is no indication whether this report was received for further proof reading. There is an indication that it was not on the system. The Panel has also seen documentary evidence of an audit of the Registrant’s case notes carried out on 22 and 25 February 2016. This states that there are no reports available for the November 2015 contact. The entry does not refer either to the w: drive or to the case notes. The Panel takes the view that the Registrant did write a report for Service User 121. As the audit notes do not specifically refer to the case notes, the Panel has concluded that there is insufficient evidence for it to find, on a balance of probabilities, that Particular 1d proved for Service User 121.
192. In relation to Service User 136, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten entries which appear to have been made on 13 April 2016. The typed entry refers to an initial appointment on 11 January 2016 and to there being no report on the w: drive or in the notes. The handwritten entry refers to the report for January 2016 being on the w: drive and in the notes. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 136.
193. In relation to Service User 140, the Panel has seen from the table of reports written by the Registrant that she saw Service User 140 on 28 January 2016 and wrote a report on 26 February 2016 which was sent back to her for amendments on 8 March 2016, and again on 14 March 2016. The Panel has also seen documentary evidence of an audit of the Registrant’s case notes on 13 April 2016 which confirms what was in the table. The handwritten note also states that the report was not on the w: drive or in the notes. However, there is no evidence before the Panel as to the date on which DD approved the report for printing and sending out. It is unclear if this had been done by the time of the audit on 13 April 2016. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 140.
194. In relation to Service User 166, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 16 and 17 February 2016 with handwritten entries which appear to have been made on 13 April 2016. The typed note refers to an initial appointment on 3 February 2016 and to there being no report on the w: drive or in the notes and that it maybe with DD. The handwritten note states “Report not received for proof reading” which the Panel takes the view means that there is a report which has not yet been received for proof reading. This is then followed by an entry which reads “No report in notes (13/4/16). The Panel does not consider that it has sufficient information about where the report is and what stage it has reached, in particular whether the Registrant should have filed a copy in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 166.
195. In relation to Service User 169, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 13 April 2016 which refers to an initial assessment on 20 January 2016. It refers to the report having been proof read and that it is on the w: drive. There is no evidence as to when the report was completed or uploaded onto the w: drive. The Panel takes the view that if, for example, the report had been uploaded on the day of the audit, it cannot exclude the possibility that the Registrant may have filed a copy of the report in the case notes folder on the next day. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 169.
196. In relation to Service User 171, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 13 April 2016 which refers to the Registrant seeing Service User 171 on 20 January 2016 and also refers to the report not being on the w: drive but the report being in the notes. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 171.
197. In relation to Service User 173, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 13 April 2016 which refers to the Registrant seeing Service User 173 on 29 February 2016. The note refers to the report not being on the w: drive or in the notes. It also refers to a report being “sent to for proof reading on 7 April 2016 – 1 amendment then ok to go”. The Panel considers that these entries are contradictory and so it has concluded that the Registrant wrote a report which was still with DD for proof reading by the time of the audit on 13 April 2016 and so the Registrant had not yet had an opportunity to file a report in the case notes folder. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 173.
198. In relation to Service User 174, the Panel has seen documentary evidence of an audit of the Registrant’s case notes carried out on 13 April 2016 which refers to the Registrant seeing Service User 174 on 29 February 2016 for an initial assessment. The note also states Service User 174 is to be discharged. The note states “Report written – seen on 8/4/16 not yet on system or in notes”. The Panel has concluded that this shows that the Registrant did write a report but that it was still in the process and that as it had not yet been approved for printing or sending out, the Registrant could not save it to the case note folders. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1d proved for Service User 174.
199. In relation to Service Users 117, 119, 120, 156, 157, 158, 159, 160, 161, 162, and 163, the Panel considers that there is insufficient documentary evidence either that the Registrant did not complete a report or that it was not filed in the case notes folders. There is evidence in some cases that reports were written but no reference in the evidence to these reports not being filed in the case notes folders. None of these Service Users are referred to in the document which lists items such as reports were missing from the case notes folders. In one instance (Service User 159), an audit carried out on 22 and 25 February 2016 refers to there being no report on the w: drive or in the case notes and then states, “However, this may be appropriate as within the notes it says that the targets remain the same”. The Panel consider this to be a reference to the propriety of completing a report at this time. In relation to Service User 162, the audit of 16 and 17 February 2016 which has handwritten additions which appear to have been made on 13 April 2016, the only entry is in handwriting. This states that there was an initial appointment on 10 February 2016. It refers to there being no report on w: drive or in notes. Service User 162 was then seen by another SLT on 7 March 2016. The Panel considers that it has insufficient evidence as to whether or not the Registrant was still in the process of writing a report which would mean that there was no report yet available which she could file in the case notes. The Panel has therefore concluded that there is insufficient evidence for it to find Particular 1d proved for Service Users 117, 119, 120, 156, 157, 158, 159, 160, 161, 162, and 163.
200. The Panel notes that the allegation in Particular 1d is drafted in terms of “one or more” of the Service Users set out in Schedule D. Therefore, its findings in relation to the 52 Service Users where it has found Particular 1d not proved together with the 2 Service Users where the HCPC concedes there is no evidence, do not alter the Panel’s overall finding that Particular 1d is proved.
201. The Panel finds Particular 1d proved.
Particular 1e is found proved - (did not ensure that one or more of the Service Users, as set out in Schedule F, were regularly reviewed and/or you failed to set them review dates)
202. The Panel notes that Schedule F sets out 27 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not ensure those Service Users were regularly reviewed and/or whether the Registrant failed to set them review dates. The Panel notes that when considering setting review dates, Particular 1e is drafted in terms of “failed to” whereas the first part of this sub particular is drafted in terms of “did not”. The Panel has accepted legal advice that “failed to” involves finding that the Registrant did not set review dates and knew at the time that she should have set them.
203. DD told the Panel that SLT’s must set out a review date in their report following a service user assessment. This provides a timeframe which must be followed by the present SLT or a new SLT, and reviews ensure that service users receive the correct treatment. If there is no review, this represents a missed opportunity to potentially identify or act upon additional needs of service users. According to DD, the Registrant was expected to ensure that a review took place either by herself or another SLT for all service users. DD said that the Registrant’s caseload consisted of very vulnerable children with complex needs and therefore, reviews were essential for continued monitoring.
204. CC told the Panel that it was common for numerous SLTs to work with one child. This allowed for the running of a consistent Service. Service Users were reviewed in accordance with staff availability and a review period of either 3 or 6 months was usually set by SLTs.
205. The Panel is satisfied it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust, was to ensure that Service Users were regularly reviewed either by herself or another SLT, and to set dates for the reviews.
206. The Panel is also satisfied it is more likely than not that the Registrant, as an experienced Band 5 SLT, would have known the Trust’s Guidelines and its expectation that where it was her responsibility to do so, she must set a review date.
207. The Panel is satisfied it is more likely than not that the Registrant did not ensure the Service Users were regularly reviewed and/or failed to set them review dates in respect of 6 Service Users (Service Users 16, 35, 50, 59, 88 and 89).
208. In relation to Service User 16, the Panel has seen from typed notes of an audit of the Registrant’s caseload on 15 February 2016 that Service User 16 was transferred to her on 11 December 2015 and was due for review in January 2016, but the review had not taken place. The Panel finds Particular 1e proved on the basis that the Registrant did not ensure that Service User 16 was regularly reviewed. It does not find that the Registrant failed to set a review date.
209. In relation to Service User 35, DD told the Panel that a review was scheduled for February 2016, however at the time she audited the relevant case notes in March 2016, the review had not taken place. The Panel finds Particular 1e proved on the basis that the Registrant did not ensure that Service User 35 was regularly reviewed. It does not find that the Registrant failed to set a review date.
210. In relation to Service User 50, an audit of the Registrant’s caseload on 7 March 2016 shows that Service User 50 was seen on 18 November 2015 but had not been seen since and there was no indication when they would be seen next. The Panel finds Particular 1e proved on the basis that the Registrant did not ensure that Service User 50 was regularly reviewed within 3 months, and that she failed to set a review date for them when she knew that she should have done.
211. In relation to Service User 59, an audit of the Registrant’s caseload on 7 March 2016 shows that Service User 59 was last seen by a different SLT in July 2015 and had not been seen by the Registrant. A handwritten note added on 14 April 2016, states that Service User 59 was transferred to the Registrant on 13 July 2015, and eventually they had to be seen by another SLT. The Panel finds Particular 1e proved on the basis that the Registrant did not ensure that Service User 59 was regularly reviewed within 6 months, and that she failed to set a review date for them when she knew that she should have done.
212. In relation to Service Users 88 and 89, an audit of the Registrant’s caseload on 15 and 16 February 2016, shows that Service Users 88 and 89 were last reviewed in October 2015 and the case notes indicated that they were each due to be reviewed in January 2016, but this had not happened. A handwritten note apparently dated 13 April 2016, states that neither Service User had been reviewed since October 2015. The Panel finds Particular 1e proved on the basis that the Registrant did not ensure that Service Users 88 and 89 were regularly reviewed, and that she failed to set review dates for them when she knew that she should have done.
213. There are 18 Service Users (Service Users 11, 14, 27, 38, 62, 65, 70, 74, 86, 95, 97, 106, 116, 122, 130, 147, 169, 170) where the Panel is not satisfied, on a balance of probabilities, that the Registrant did not ensure that they were regularly reviewed and/or set them review dates. The Panel therefore finds Particular 1e not proved in relation to these 18 Service Users.
214. In relation to Service Users 11, 14, 27, 86, 95, 116, and 169, the Panel has not seen the case notes and so there is insufficient evidence that it was the Registrant’s responsibility either to review and/or to set a review date for them, or that the time limit for reviews had been breached.
215. In relation to Service User 38, the Panel has seen that an audit carried out on 15 February 2016 makes no reference to reviews of Service User 38. CC reviewed the case notes for Service User 38 and told the Panel that the Registrant and another SLT reviewed the child between September 2015 and March 2016. CC said that after the March review, the Registrant had sent a letter to schedule an assessment, however no response was received and so Service User 38 was due to be discharged.
216. In relation to Service User 62, the Panel has seen documentary evidence which shows that there was a review within the relevant time frame which took place after the Registrant’s caseload had been audited on 16 and 17 February 2016.
217. In relation to Service User 65, the Panel has seen no documentary evidence that relates to reviews and has concluded that there is no evidence in respect of Service User 65.
218. In relation to Service User 70, CC reviewed this file and told the Panel that the Registrant had seen Service User 70 for an initial appointment on 16 July 2015 and had reviewed them after 3 months in October 2015. The next review was not until March 2016. This was within 5 months and was set at that time because Service User 70 needed a break to settle into nursery. At the March review the Registrant set a date for a review in June 2016.
219. In relation to Service User 74, the case notes show that the Registrant saw Service User 74 in October 2015 and set a review date for 3 March 2016 which would be within the 6-month review period. CC reviewed this file and told the Panel that it was common for SLTs to set 6 monthly review dates.
220. In relation to Service User 97, the Panel has seen from the case notes for Service User 97 that the Registrant first saw them on 26 November 2015. A review was set for 29 March 2016, but the child did not attend. The Panel notes that the audit carried out on 16 and 17 February 2016 pre-dates the March review date. The Panel takes the view that it is not possible to review a service user who does not attend.
221. In relation to Service User 106, the Panel has seen some case notes which show that Service User 106, was last seen on 10 December 2014 and was due to be reviewed on 30 June 2015, a date which is marginally outside the six-month time limit for reviews. Service User 30 was not in the nursery that day. The Panel is of the view that it is not clear from the evidence whether it has seen the full case notes for Service User 106, or just an extract. The Panel has concluded there is insufficient evidence of what happened after Service User 106 did not attend for review in June 2015.
222. In relation to Service User 122, the Panel has seen an audit carried out on 22 and 25 February 2016 which indicates that Service User 122 was to be reviewed in February 2016, but the review had not taken place. The Panel notes that at the time of the audit, there was still time for the review to take place before the end of the month, or into March which would still be within the 6-month time period for reviews.
223. In relation to Service User 130, the Panel has seen an audit of case notes carried out on 11 April 2016. Handwritten notes show Service User 130 was seen in December 2015 and that a review due for March 2016 had not yet taken place. The Panel takes the view that there was still time for Service User 130 to be reviewed within the 6-month time period.
224. In relation to Service User 147, the Panel has seen a Treatment Plan dated 4 March 2016 in which the Registrant indicated that Service User 147 was to be reviewed in May 2016. The Panel takes the view that this is within the 6-month time period.
225. In relation to Service User 170, the Panel has seen an audit carried out in February and March 2016 to which handwritten notes were apparently added on 13 April 2016. These show that Service User 170 was seen by a different SLT on 17 December 2015, and that DD wrote the report on 31 December 2015. It does not say why this happened. Service User 170 was due to be reviewed in “Spring 16”. The Panel considers that there is insufficient evidence that it was the Registrant’s responsibility to set the Spring review date. It notes that if no review had yet taken place, it was still within the 6-month review period.
226. Ms Saran conceded that there was no evidence to prove Particular 1e in respect of 3 Service Users (Service Users 17, 55, and 60). The Panel has therefore concluded, on the balance of probabilities, that Particular 1e is not proved for those Service Users.
227. The Panel notes that the allegation in Particular 1e is drafted in terms of “one or more” of the Service Users set out in Schedule F. Therefore, its findings in relation to the 18 Service Users where it has found Particular 1e not proved together with the 3 Service Users where the HCPC concede there is no evidence, do not alter the Panel’s overall finding that Particular 1e is proved.
228. The Panel finds Particular 1e proved.
Particular 1f is found proved – (did not complete case notes for one or more of the Service Users set out in Schedule G)
229. The Panel notes that Schedule G sets out 56 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not complete case notes in relation to each of the Service Users in Schedule G.
230. The Panel has seen that the Trust’s Job Description for a Band 5 SLT under the heading “Professional” states at paragraph 5, the following: “to maintain up to date and accurate case notes in line with professional guidelines and the Trust’s Policies”. The Panel has not been provided with any specific Trust policy or departmental guideline that deals with case notes. However, in a note of a meeting held by DD with the Registrant on 19 February 2016 the following is noted in relation to when case notes should be written:
“Contemporaneous is defined as:
“As soon as possible after contact and within the same working day” although a record made within 24 hours of the event to which it relates would suffice. Records made after this time would suffer from variability of memory, would be difficult to validate and would reduce the status of credibility of the professional on record.”
231. The Panel notes that there is no evidence before it which shows the time when the Registrant completed her case notes. The Panel does not consider that the allegation in Particular 1f relates to this aspect of completing case notes.
232. CC told the Panel that case notes should be a comprehensive record of what took place during an assessment and what treatment, or action should take place following the assessment. CC explained that as case notes are only used by SLTs they contain a lot of jargon and acronyms. In answer to Panel questions, CC said that case notes would be incomplete if e.g., a date was missing, or a registration stamp was not used. She said that latter was a technicality. The Panel notes that CC was referring at all times to the case notes written up after each relevant action with regard to a service user. She was not specifically referring to the case notes folder.
233. The Panel has not been provided with all the relevant case notes for the 56 Service Users set out in Schedule G. The Panel notes that there is no overall assessment by either DD or CC as to the adequacy of the case notes for the 56 Service Users listed in Schedule G. It follows therefore that the Panel is not in a position to determine whether the respective case notes were “complete” in the sense of being “comprehensive”.
234. The Panel has seen in the weekly meetings notes that the issue of case notes was one of the matters raised by DD as a cause for concern. The detailed concerns regarding case notes ranged from missing client identifiers on all the documents, missing signatures, and use of the Registrant’s registration stamp, to the completeness of the information within the case notes including clinical decision making, planning and targets, and the discharge of service users.
235. The Panel sought clarification from Ms Saran as to the scope and meaning of the allegation in Particular 1f. In particular, whether the allegation related to the handwritten case notes alone or to the folder in which the case notes and other relevant documents such as a hard copy of reports were kept. Ms Saran confirmed that it was the latter. The Panel has therefore approached Particular 1f by considering whether there is sufficient evidence that the case notes folder was not complete i.e., because it was missing documentation that it should have contained. By approaching Particular 1f in this way, the Panel acknowledges that it does not wholly avoid the potential overlap with Particular 1a in relation to INT tool forms, and with a part of the allegation in Particular 1d where this alleges that the Registrant did not save reports to the case notes. When it comes to considering the statutory grounds of lack of competence and/or misconduct, the Panel will keep well in mind any findings of fact which may be overlapping to ensure there is no “double accounting”.
236. The Panel is satisfied, on the basis of this approach to Particular 1f, that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust, was the ability to complete case notes for Service Users by putting all the correct documentation in the case notes folders.
237. The Panel is satisfied it is more likely than not that the Registrant did not complete case notes for 34 of the Service Users set out in Schedule G (Service Users 4, 7, 12, 15, 19, 23, 39, 41, 43, 44, 46, 48, 49, 51, 61, 62, 71, 72, 75, 79, 81, 84, 85, 86, 87, 88, 91, 92, 93, 98, 99, 101, 126 and 127).
238. The Panel has seen documentary evidence of audits of the Registrant’s caseload and case notes which were carried out on various dates in February and March 2016, including an audit headed “Information Missing from Case Notes”. This audit was completed on 7 March 2016, and it does not contain any additional handwritten entries. The Panel notes that the references to what is said to be missing is a brief entry usually with no reference to dates, such as: “No INT” or “No report” etc. The Panel has looked to see whether there is other documentary evidence which shows that what was missing at the time of the audits, may have been added to the case notes folders at a later date, in order to complete them. The Panel has also considered whether, as at the date of the audits, the Registrant would have been expected to have completed the case notes folders by adding the hard copy document in question.
239. In the relation to 10 Service Users (Service Users 4, 19, 23, 39, 43, 44, 61, 62, 79 and 101), the Panel has seen documentary evidence from the audits that the case notes folder did not contain a hard copy of an INT form or a hard copy of a report.
240. In relation to 20 Service Users (Service Users 7, 12, 15, 51, 71, 72, 75, 81, 84, 85, 86, 87, 88, 91, 92, 93, 98, 99, 126 and 127), the Panel has seen documentary evidence that the case notes folder did not contain a hard copy of a report. In the case of Service User 87, there were two potential reports to consider. There was no report in the case notes folder for an appointment on 19 November 2015 and so the Panel has found Particular 1f proved for Service User 87 on this basis alone. The second report was for an appointment on 22 February 2016 which was written by the Registrant on 4 March 2016 and sent back to her on 8 March 2016 to make some corrections. The Panel takes the view that as the relevant audits were compiled in February 2016 and up to 7 March 2016, it is not possible to say that the Registrant did not complete Service User 87’s case notes as she may have added this second report sometime after 7 March 2016 after she had amended it.
241. In relation to Service Users 46, 48 and 49, the Panel has seen documentary evidence that the relevant case notes folders did not contain hard copies of a report or feeding plan for Service User 46, a report, an INT form or a therapy plan for Service User 48, and no report, or up to date feeding plan for Service User 48.
242. In relation to Service User 41, the Panel has seen from an audit of a school carried out on 8 June 2016, that the typed note states, “Nothing recorded in the casenotes regarding contact”. The contact had been on 10 March 2016. The Panel has inferred from this that there were no handwritten case notes of the March contact in the case notes folder.
243. The Panel is not satisfied it is more likely than not that the Registrant did not complete case notes for 22 of the Service Users set out in Schedule G (Service Users 24, 25, 30, 31, 38, 47, 55, 76, 77, 82, 83, 89, 90, 94, 95, 96, 97, 100, 102, 103, 104, 118).
244. In relation to all 22 of these Service Users, the allegation is that there was no report in the relevant case notes folders. In relation to Service User 47 the allegation is that in addition to there being no report, there was also no feeding plan in the relevant case notes folder.
245. In relation to Service User 24, the Panel has seen an audit carried out on 16 and 17 February 2016 which indicates that a report was written by the Registrant on 16 February 2016 and printed on 9 March 2016. The Panel notes that this is after the audit was completed. The Panel has decided that, even allowing for the unexplained matter of the dates in the audit notes, that there is insufficient evidence that the Registrant did not complete the case notes for Service User 24 at some point after 9 March 2016.
246. In relation to Service User 25, the Panel has seen an audit carried out on 22 February 2016 where the note states, “? whether another report is available following another contact on 5th February 2016”. The Panel notes that the Registrant would have had 4 weeks to write that report. The Panel has therefore concluded that there is no evidence that the Registrant did not complete case notes for Service User 25.
247. In relation to Service User 30, the Panel has seen an audit dated 22 February 2016 where the typed note states, “No reports on w drive or in casenotes ? with DD”. This refers to an initial contact on 6 January 2016. The Panel has seen documentary evidence that the Registrant drafted a report on 10 February 2016, and it was sent back to her for amendments on 16 February 2016. Given these dates, the Panel has concluded that there is no evidence that the Registrant did not complete case notes for Service User 30, as she may have done so after 22 February 2016.
248. In relation to Service User 31, the Panel has seen an audit carried out on 22 February 2016 where there is a handwritten note apparently added on 8 April 2016. It would appear that although initially it was thought there was no report on either the w: drive, or a hard copy in the case notes folder, by 2 March 2016 a written report was ready to be sent out. It was noted that, as of 8 April 2016, the report was not yet “on the system”. The Panel has taken this to mean that it was not on the w: drive. There is no reference to the report not being in the case notes folder. The Panel has decided that there is insufficient evidence that the Registrant did not complete case notes for Service User 31, as she may have done so after 8 April 2016.
249. In relation to Service User 38, the Panel has seen from the Registrant’s case notes that Service User 38 was seen on two occasions in September and October 2015 by another SLT. The Registrant’s only entry in the case notes is in March 2016 and refers to a letter being sent to Service User 38’s parents to book an appointment. The Panel does not consider that there is any evidence that the Registrant was required to write any report for Service User 38 and so cannot find that she did not complete the case notes for them.
250. In relation to Service User 47, the allegation is that there was no report or feeding plan in the case notes folder. The Panel has seen some but not all of the Registrant’s case notes for Service User 47 and considers that her feeding plan is listed under the ‘Recommendations’ of the entry of 10 February 2015 which is outside the start date of the Allegation. The Panel notes that the recommendations would continue into the period covered by the Allegation absent any other contradictory evidence. The Panel has also seen an audit dated 7 March 2016 on which there are handwritten additions apparently made on 14 April 2016 for this Service User. These indicate that the last contact was on 12 November 2015 and there was no report. The Panel considers that the evidence is unclear as to whether a report was due at the time of the audit. The Panel cannot therefore conclude that the Registrant did not complete the case notes for Service User 47.
251. In relation to Service User 55, the Panel has seen an audit carried out on 7 March 2016 with handwritten notes apparently added on 14 April 2016. At the time of the initial audit, it was noted that the Registrant last saw Service User 55 on 23 February 2016 and there was an entry which referred to “[blank] report for proof reading”. The Panel cannot make out the blank word. There was nothing in the handwritten notes which indicated when the report was ready for printing. The Panel cannot therefore conclude that the Registrant did not complete the case notes for Service User 55, as she may have done so after 14 April 2016.
252. In relation to Service User 76, the Panel has seen from the documentary evidence that the Registrant wrote two reports for Service User 76, one written on 19 January 2016 and one on 4 March 2016. The first report was sent back to the Registrant on 1 February 2016 for corrections to be made and it would appear it may have been sent back for further proof reading on 11 March 2016. The Panel has seen an audit carried out on an unknown date in February 2016 which refers only to the first report which had not been returned to DD for further proof reading at that time. The Panel considers there is insufficient evidence for it to conclude that the Registrant did not complete case notes for Service User 76 in respect of either report, as she may have done so after the reports had been passed by DD as ready for printing.
253. In relation to Service User 77, the Panel has seen an audit carried out on an unknown date in February 2016 where it is noted that the Registrant saw Service User 77 on three dates in July 2015, and that a review did not take place in October 2015, as Service User 77 was not in nursery. While the audit note indicates that no reports were written, it does not indicate what happened next. The Panel considers that it has insufficient evidence to conclude that the Registrant did not complete case notes on Service User 77.
254. In relation to Service User 82, the Panel can see from the documentation that the Registrant wrote a report on 25 January 2016, and it was sent back to her for amendments on 1 February 2016. It would appear that DD was still waiting for the amended report to be returned to her for further proof reading at the time of an audit carried out on 16 and 17 February 2016. This would explain the reference in the audit note that there was no report in the case notes. The Panel cannot conclude that the Registrant did not complete case notes for Service User 82, as she could not do so until the report was passed by DD as ready to be printed and sent out.
255. In relation to Service User 83, the only reference in the documentary evidence to Service User 83 is in an audit carried out in February and March 2016 which is headed “Information Missing from Casenotes”. There is no evidence as to which report this refers to and when it should have been written by. The Panel does not consider that it has sufficient evidence to conclude that the Registrant did not complete case notes for Service User 83.
256. In relation to Service User 89, the Panel has seen an audit carried out on 16 and 17 February 2016 where the typed note indicates that there is no report in the case notes. There is an undated handwritten “tick” immediately above this entry and the Panel can see that other handwritten entries may have been made on 13 April 2016. The Panel has received no evidence to explain what that “tick” denotes. It might denote that there is still no report in the case notes folder, or it might denote that a report has now been seen in the cases notes folder. The Panel does not consider that it can conclude that the Registrant did not complete case notes for Service User 89, as she may have done so.
257. In relation to Service User 90, the Panel has seen from an audit carried out on 16 and 17 February 20216 that the report was saved on the w: drive but not in the case notes for an appointment in November 2015. Undated handwritten notes indicate that Service User 90 was seen for review to discharge in February 2016 and that a report relating to this had been written and sent out on 8 April 2016. There is no information as to whether this report was in the case notes folder at the time the handwritten notes were made. The Panel has decided that it has insufficient evidence to conclude that the Registrant did not complete case notes for Service User 90 in respect of either report, as she may have done so in the weeks after the audits were completed.
258. In relation to Service Users 94, 95 and 96, the Panel has seen from an audit carried out on 16 and 17 February 2016 that in each case, the initial appointment with these Service Users was with another SLT. In each case, appointments in January did not take place (Service User 94 did not attend, Service User 95 cancelled, and Service User 96 did not attend). There is nothing in the typed note to indicate that the Registrant had any involvement with any of these Service Users. The Panel has therefore concluded that there is no evidence that the Registrant did not complete case notes for Service User 94, Service User 95, or Service User 96.
259. In relation to Service User 97, the Panel has seen from an audit carried out on 16 and 17 February 2016 that the typed note refers to the report for an appointment on 26 November 2015 not being in the case notes. There are also undated handwritten additions which appear to indicate that the report has been sent to DD on 1 March 2016 and also a reference to amendments. The handwritten notes also indicate that Service User 97 did not attend a further appointment on 29 March 2016 and was to be discharged and that the March report was not filed in notes. The Panel does not consider that the evidence before it is sufficiently clear as to what happened, and so it cannot therefore conclude that the Registrant did not complete case notes for Service User 97, as she may have filed hard copies of both reports after the handwritten notes were added.
260. In relation to Service User 100, the Panel has seen from an audit carried out on 16 and 17 February 2016 that the typed note refers to there being no report for a June contact (no year specified), followed by a reference that Service User 100 was due for review in January 2015, and a note that there are discrepancies with the dates in the case notes. There is also an undated handwritten entry which states that Service User 100 has not been seen since October 2015. The Panel has concluded that the evidence for Service User 100 is not only insufficient, but also that it is unclear. It cannot therefore conclude that the Registrant did not complete case notes for Service User 100.
261. In relation to Service User 102, the Panel has seen from an audit carried out on 16 and 17 February 2016 that in undated handwritten additions apparently made on or around 13 April 2016, the report was loose in the case notes. The Panel cannot therefore conclude that the Registrant did not complete case notes for Service User 102.
262. In relation to Service User 103, the Panel has seen from an audit carried out on 16 and 17 February 2016 that the original typed note indicated there was no report in the case notes for a meeting in November 2015, and it was assumed a report for a review appointment on 18 January 2016 was with DD. The Panel can see from undated handwritten additions that both reports are now marked with a “tick”. There is no reference to whether these reports are or are not in the case notes folder, and it is unclear what the “tick” denotes. The Panel cannot therefore conclude that the Registrant did not complete case notes for Service User 103, as she may have done so after the date on which the handwritten entries were added.
263. In relation to Service User 104, the Panel has seen from an audit carried out on 16 and 17 February 2016, that the Registrant reviewed Service User 104 on 14 January 2016. The note states “No report; assume with DD”. There is also an undated handwritten addition which indicates that the report was written in February and printed in March. There is no reference to whether or not the report was in the case notes folder. The Panel cannot therefore conclude that the Registrant did not complete case notes for Service User 104, as she may have done so after 17 February 2016.
264. In relation to Service User 118, the Panel has seen an audit dated 25 and 26 February 2016 which indicates “report not available in casenotes but only just written as initial assessment was on 13th January 2016”. The Panel is aware that the Registrant had to send her reports to DD for proof reading before they could be sent out. The Panel cannot therefore conclude that the Registrant did not complete case notes for Service User 118, as she may have done so after 26 February 2016.
265. The Panel notes that the allegation in Particular 1f is drafted in terms of “one or more” of the Service Users set out in Schedule G. Therefore, its findings in relation to the 22 Service Users where it has found Particular 1f not proved, do not alter the Panel’s overall finding that Particular 1f is proved.
266. The Panel finds that Particular 1f is proved.
Particular 1g is found not proved – (did not document your clinical reasoning and/or your clinical reasoning was incorrect for one or more of the following Service Users in Schedule H)
267. The Panel notes that Schedule H sets out 11 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not document her clinical reasoning and/or her clinical reasoning was incorrect in relation to each of the Service Users in Schedule H. The Panel notes that while the terms of this sub-particular refer to “clinical reasoning”, DD in her evidence uses the term “clinical decision making”. The Panel considers the terms to be interchangeable.
268. DD told the Panel that SLTs are expected to clearly interpret their assessment findings. She said that within reports, SLTs must set out their rationale for making decisions and targets set for service users. SLTs must obtain a holistic view of service users to ensure that targets are functional and intended to develop service users’ skills. SLTs must set out a clear plan of how service users shall progress.
269. The Panel notes that the Trust’s Job Description for a Band 5 SLT states:
“Clinical
To be responsible for assessments, differential diagnosis, formulation of treatment plans, writing assessment reports, providing appropriate intervention and evaluation of treatment outcomes for each individual client in respect of communication and/or feeding and swallowing difficulties with access to a senior colleague (para 4)”
270. The Panel is satisfied that it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust, was that she was able to reach correct clinical decisions which she could then document.
271. DD told the Panel that there were a number of concerns regarding the Registrant’s clinical decision making. DD said that throughout the whole Capability Process, the Registrant appeared to lose confidence in her clinical decision making. DD said that the Registrant carried out similar assessments and set similar targets for a large number of service users without consideration of service users’ individual and functional communication needs.
272. The Panel has reviewed the notes of the weekly meetings held with the Registrant during both the informal and the formal Capability Process. It is clear from these that at an early stage in this process, clinical decision making was noted to be a concern. The Registrant was set a date in the Action Plan by which she should demonstrate improved clinical decision making. This date which was later extended to 31 January 2016. At the meeting on 15 October 2015, the Registrant told DD that she felt she had lost a little of her confidence around her clinical decision making. DD noted that they had talked through the progress the Registrant had made and that the reports written by the Registrant had indicated appropriate decisions had been made. By the time of Stage 1 of the Capability Process, the Registrant’s clinical decision making was still of concern. The Panel has seen that there is a section in the Improvement Schedule prepared in February 2016, headed “Clinical Decision Making”.
273. CC told the Panel that the case note is a record of a service user assessment by an SLT. She said that case notes are not shared with parents or school staff, but they are an important document in the event that multiple SLTs work with one child. CC was asked to review a number of service user case notes and comment on the Registrant’s clinical decision making. She concluded that the Registrant’s competency did not appear to be of great concern. In answer to a Panel question about clinical decision making, CC said that nothing had concerned her about the Registrant’s specific clinical reasoning, and she would have commented if she had been concerned.
274. The Panel has reviewed all the information it has been provided with concerning the 11 Service Users set out in Schedule H (Service Users 42, 44, 48, 74, 77, 81, 85, 87, 99, 140 and 167). The Panel is not satisfied that it is more likely than not that the Registrant did not document her clinical reasoning and/or that her clinical reasoning was incorrect in respect of any of these Service Users.
275. In relation to Service User 42, the Panel has seen the relevant case notes which show that the Registrant and one other SLT were involved with their treatment. DD said that these showed that the Registrant had difficulty in arriving at the appropriate clinical decisions with the information available to her. However, DD does not explain why she formed this opinion. The Panel has not been able to ask about this as DD’s evidence was admitted as hearsay evidence. DD does not suggest that the Registrant did not document her clinical decision making for Service User 42.
276. The Panel notes that the copy case notes for this Service User produced by CC offer a more complete picture than the extract produced by DD. Work with Service User 42 began in 2013, and the Panel consider that these earlier cases note entries show the Registrant’s thinking and rationale for treatment from that time onwards. The Panel notes that while CC has commented on other aspects of the case notes, she does not specifically comment on the Registrant’s decision making for this Service User.
277. The Panel considers that the case notes which cover the period of the Allegation, show that the Registrant did set targets for Service User 42. The Panel understands that the setting of targets is part of clinical reasoning. In the absence of any specific evidence as to why the clinical reasoning and the targets set by the Registrant were incorrect, the Panel has found Particular 1g not proved for Service User 42.
278. In relation to Service User 44, DD said simply that the Registrant did not make appropriate clinical decisions. The Panel notes that CC also reviewed and commented on the Registrant’s case notes. CC was asked to comment on the Registrant’s timeliness of review and target appropriacy. On the latter, CC stated “10/12 Child was demonstrating sensory stimulation was needed and so the decision to see them in the sensory room on 12/2 was a good decision”. The Panel accepts this evidence.
279. In the absence of any specific evidence as to why the clinical reasoning and the targets set were incorrect in this case, and relying on the evidence of CC, the Panel has found Particular 1g not proved for Service User 44.
280. In relation to Service User 48, DD did not say whether the Registrant’s clinical reasoning was not documented and/or that it was incorrect. The Panel notes that CC was asked to review the Registrant’s case notes for Service User 48. CC concluded that “Targets set by [the Registrant] were appropriate and SMART with the exception of timebound”. The Panel understands that SMART is an acronym that stands for Specific, Measurable, Achievable, Realistic and Timely. The Panel considers that where the Registrant did not achieve the “timely” aspect of SMART, this would not impact on the correctness or otherwise of her clinical reasoning. CC set out in some detail her conclusions as to the appropriateness of the targets set by the Registrant. The Panel notes that the Registrant must have documented her clinical reasoning for CC to be in a position to comment on it. The Panel accepts CC’s evidence in relation to Service User 48. The Panel has found that Particular 1g is not proved for Service User 48.
281. In relation to Service User 74, the Panel has seen an audit of the Registrant’s case notes carried out in February 2016. The entry relating to Service User 74 states, “Clinical decisions are vague. Client reported to take turns – target set to take turns?”. DD did not explain in her evidence why she had thought the Registrant’s clinical decisions were vague or whether, even if they were vague, they were incorrect.
282. The Panel has seen the case notes for Service User 74 produced by CC. It notes that while CC has commented on these case notes, she makes no reference to the Registrant’s clinical reasoning or whether this was documented. CC told the Panel that if she had had concerns regarding these matters, she would have documented them. The Panel infers from this that CC had no concerns about the appropriateness of the Registrant’s clinical reasoning. The Panel has seen from the case notes that the Registrant set targets, gave full details of a clinical session with Service User 74, set out what needed to change and provided a plan going forwards. The Panel does not consider that the Registrant’s clinical reasoning was vague. The Panel has found Particular 1g not proved for Service User 74.
283. In relation to Service User 77, DD told the Panel that she had concluded following an audit in February 2016, that the Registrant was unable to come to the correct clinical decision for this Service User. The Panel has inferred from this that the Registrant did document her clinical reasoning. DD did not explain why the Registrant’s clinical decision was incorrect. The relevant case notes are not exhibited in the case and were not reviewed by CC. The Panel considers that there is insufficient evidence in respect of Service User 77 and has found Particular 1g not proved.
284. In relation to Service User 81, DD told the Panel that following an audit in February 2016 of the Registrant’s case notes, she had concluded that “Inappropriate targets set for speech sound development” had been set. DD did not expand on this in her evidence.
285. CC produced the case notes for Service User 81, and she reviewed these. She said that the case notes demonstrated a clear chronology of assessment conducted by the Registrant. CC said that the Registrant’s case notes could be clearly understood and that she had assessed Service User 81 using informal assessment techniques. CC said that is approach was appropriate given the Service User’s developmental level which would make a formal assessment inappropriate. CC described what skills an SLT would need to conduct an informal assessment and commented that it would require a full knowledge base and an SLT able to adapt their input to the child’s interests. CC concluded by saying “From my review, [the Registrant] worked appropriately to assess Service User 81, which demonstrates sound clinical reasoning”. The Panel accepts CC’s evidence. It has found Particular 1g not proved for Service User 81.
286. In relation to Service User 85, DD told the Panel that following an audit in February 2016 of the Registrant’s case notes, she had concluded that “Inappropriate targets set for speech sound development” had been set. DD explained that despite carrying out reviews for Service User 81 and the client making little progress, the Registrant did not change the target set for the client. DD said she asked the Registrant to change the targets. DD does not say when this was or what happened thereafter.
287. CC reviewed the case notes for Service User 85 and was asked to comment on whether the targets set were appropriate. Her conclusion was that on each of the occasions when the Registrant had treated Service User 85, she had set targets and that these targets were appropriate. The Panel considers that in respect of Service User 85, there has been a professional difference of opinion between DD and CC as to the appropriateness of the Registrant’s clinical reasoning. The Panel prefers the evidence of CC to that of DD as she identified the occasions on which the Registrant had seen Service User 85 and gave her views on the targets set on each occasion. The Panel has found Particular 1g not proved for Service User 85.
288. In relation to Service User 87, DD told the Panel that the Registrant had not documented her clinical reasoning within a Treatment Plan. The Panel has seen the relevant Treatment Plan which is dated 4 March 2016. The Panel considers that this sets out in a clear and understandable way the Registrant’s assessment of Service User 87. It sets out that the next step is to get them to follow instructions containing a single noun and sets other clear targets. The Panel has found Particular 1g not proved for Service User 87.
289. In relation to Service User 99, DD told the Panel that in a Treatment Plan drafted by the Registrant on 16 February 2016, she had identified that the main area of concern was their speech. DD said that the Registrant did not specify which assessments were used or give examples to support her findings. DD also said that the Registrant had not set out her rationale behind the targets set in the report.
290. The Panel has reviewed the Treatment Plan and notes that the Registrant carried out her review by listening to Service User 99 as he interacted with an SLT Support Practitioner (SLTSP). The review appears to have come during a period of block therapy. The Registrant set out the difficulties Service User 99 was having in relation to speech sounds which were impacting on his intelligibility. Immediately below this, under the heading “Current Targets”, the Registrant sets out clearly the steps being taken to address the problem. She then sets out the next steps which were that Service User 99 would complete the block therapy sessions and she would then conduct a further review. The Panel takes the view that the Registrant’s rationale can be gleaned from reading the whole of the Treatment Plan. The Panel has found that Particular 1g is not proved for Service User 99.
291. In relation to Service User 140, DD told the Panel that the Registrant did not evidence clinical reasoning in her plan. The Panel has seen a copy of the Treatment Plan dated 28 February 2016. The Registrant had clearly spotted a number of matters that needed to be treated. The Registrant has then two set targets based on what she has seen which do not appear to be inappropriate nor is it in any way unclear why she has set the targets, given her review findings. The Panel has found Particular 1g not proved for Service User 140.
292. In relation to Service User 167, DD told the Panel that she had audited the Registrant’s case notes in April 2016. She said that the Registrant had made clinical decision errors. Service User 167 was reported to have word order errors. However, DD noted that their first language was Punjabi/Hindi and queried whether on S.O.V. (subject, object, verb) “is there usual error?”.
293. The Panel has not seen the relevant case notes or any treatment plans or reports for Service User 167. It has concluded that there is insufficient evidence before it to decide if the Registrant’s clinical reasoning was incorrect. It appears from DD’s evidence that the Registrant did document her clinical reasoning. The Panel has found Particular 1g not proved for Service User 167.
294. Accordingly, the Panel has concluded on the evidence before it, that the HCPC has failed to discharge the burden of proving Particular 1g in relation to Service Users 42, 44, 48, 74, 77, 81, 85, 87, 99, 140, and 167, and finds that Particular 1g not proved.
Particular 1h is found proved – (did not complete the Service User reports to the required standard for one of more of the Service Users set out in Schedule I)
295. The Panel notes that Schedule I sets out 65 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not complete the Service User reports to the required standard in relation to each of the Service Users in Schedule I.
296. The Panel has seen from the Trust’s Job Description that a Band 5 SLT was expected to comply with local guidelines and from the generic Person Specification document that SLTs were expected to have communication skills which included oral and written communication.
297. The Panel has also seen the Trust’s Departmental Guidelines for Written Reports to Clients and Parents/Carers. It is clear from these Departmental Guidelines that the Trust expected the various reports written by SLTs to contain certain information, depending on what type of report it was. The Guidelines refer to the Plain English Language website and its advice as the approach that should be adopted which is then set out in clear bullet points.
298. The Panel is satisfied it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust, was an ability to complete reports to the required standard as set out in the Trust’s Departmental Guidelines. The Panel notes that the “required standard” was a high one.
299. According to DD, reports drafted by SLTs must contain short sentences, avoid nominalisations, use positive language, lists and locally agreed phrases. Reports must contain a summary of the assessment carried out, the findings of the assessment and summary of next steps. SLTs must review reports for accuracy prior to signing off, specifically the information contained in the report, grammar and spelling and the date set out. Reports must be stamped with a registration stamp if they are signed on behalf of the person who drafted it. The Panel has seen the Departmental Guidelines which confirm DD’s evidence.
300. CC told the Panel that following an assessment, SLTs first write their case notes and then prepare a report. CC said that reports set out the SLTs interactions with and assessment of the service user. The reports are usually sent out to GP’s, parents, school teachers and other professionals working with the service user. The SLT must be clear and understandable and avoid using too much jargon.
301. The Panel has seen from the notes of the weekly meetings held with the Registrant that her report writing was one concern which was regularly raised by DD. The Registrant was required to send her reports to DD for them to be proof read. The Action Plan prepared during the informal Capability Process indicated that the Registrant needed to improve on the clarity and content of her reports. In a meeting on 23 October 2015, DD noted that “Generally the content of your reports are fine, however please remember to check through your reports for typo’s, grammar, etc”. At a meeting on 11 November 2015, it was noted that the Registrant had written some good reports with regard to content and appropriate targets, but that there continued to be many typos and different service user names which suggested that the Registrant had not proof read the reports effectively before sending them to DD.
302. At a meeting on the 29 January 2016, DD recorded that the Registrant has said that she could see when errors or lack of content was pointed out to her but did not always identify these herself. The Panel has seen from the Registrant’s response to DD’s Capability Investigation Management Report (dated 31 August 2016), that she thinks DD has misunderstood what she had said at the meeting. The Registrant explained that she had said that when she was writing a large number of reports, it can be difficult to identify small typos and grammatical errors. The Registrant said that reports were often written where there were time constraints due to the number of tasks that had to be completed daily.
303. The Panel has seen that included in the Improvement Schedule as part of the Stage 1 of the Capability Process, that the Registrant was expected to improve the quality of her report writing. The Registrant was still expected to send draft reports to DD for proof reading. At a meeting on 4 March 2016, DD noted that there were still typos and phrasing issues but did not raise any issue with the content of the Registrant’s reports. At a meeting on 8 April 2016, there was a discussion of an analysis of the reports prepared by the Registrant between October 2015 to March 2016. It was noted that that there were typos and phrasing errors within the reports.
304. The Panel has seen a number of documents in which there are references to specific reports written by the Registrant including a table where there is a column which sets out whether the report needed to be amended and the type of amendment required. The Panel notes that it has not been provided with the reports for the 65 Service Users set out in Schedule I.
305. In relation to 35 of the Service Users, the Panel has seen documentary evidence which refers to there being typographical errors (“typos”), and/or grammatical errors, and/or phrasing issues with Service User reports prepared by the Registrant. Although the Panel has not seen the reports themselves, it has concluded it is more likely than not that the Registrant did not complete Service User reports to the required standard due to typing or spelling errors, and/or phrasing errors and/or ,grammatical errors as follows: Service User 24 (incorrect spelling of NHS number), Service User 30 (incorrect phrasing), Service User 32 (typos), Service User 33 (phrasing/typos), Service User 35 (typos), Service User 36 (typos/phrasing), Service User 37 (phrasing), Service User 40 (typos/phrasing), Service User 50 (typos/phrasing), Service User 78 (grammar/phrasing/typos), Service User 80 (typos), Service User 87 (phrasing/typos), Service User 88 (1 typo), Service User 89 (typos) Service User 90 (typos/phrasing), Service User 97 (typos), Service User 99 (typos), Service User 103 (typo), Service User 104 (typos), Service User 113 (grammar/typos/phrasing), Service User 114 (typos/phrasing), Service User 119 (typo), Service User 125 (phrasing/grammar), Service User 126 (typos), Service User 127 (typo), Service User 128 (typo), Service User 129 (phrasing/typos), Service User 130 (typos), Service User 134 (typo), Service User 139 (typos), Service User 143 (typos/phrasing), Service User 145 (typos). In relation to Service User 57, there was no date on the report. In relation to Service User 150, the report contained the wrong date for when the Service User had been seen. In relation to Service User 171, the address on the report was wrong. The Panel therefore finds Particular 1h proved for these Service Users.
306. In relation to 22 of the Service Users, there were a variety of alleged deficiencies, but these were not in the reports. In some cases, the alleged deficiency was on the front sheet of the case notes (Service Users 6, 29, 85, 86, 91, 93, 94, 96, 100, 105, 122, 144, 166). The Panel does not consider that the front sheet of the cases notes forms any part of a report, and so it has found Particular 1h not proved for these Service Users. In other cases, there was no evidence of any report being sent to DD for proof reading, or indeed of a report itself, or the document the Panel was directed to, was a Treatment Plan and not a report. The Panel does not consider that Treatment Plans form any part of Particular 1h. One or other of these factors arose in relation to: Service Users 62, 68, 72, 75, and 140. The Panel has found that Particular 1h is not proved for these Service Users. In relation to Service Users 73, 84, 131 and 173, the Panel has concluded that it has insufficient information to be able to conclude, on a balance of probabilities, that these reports were not to the required standard and so it has found Particular 1h not proved for these Service Users.
307. Ms Saran conceded that there was no evidence to suggest that the report for 8 Service Users listed in Schedule I (Service Users 28, 31, 44, 56, 101, 115, 138 and 164), had not been completed to the required standard. In these circumstances, the Panel is not satisfied, on the balance of probabilities, that Particular 1h is proved for these Service Users.
308. The Panel notes that the allegation in Particular 1h is drafted in terms of “one or more” of the Service Users set out in Schedule I. Therefore, its findings in relation to these 30 Service Users, do not alter the Panel’s overall finding that Particular 1h is proved.
309. The Panel finds Particular 1h proved.
Particular 1i is found proved – (did not follow up with one or more of the Service Users as set out in Schedule J)
310. The Panel notes that Schedule J sets out 32 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not complete follow up in relation to each of the Service Users in Schedule J.
311. The Panel is satisfied it is more likely than not that one of the competencies expected of the Registrant as a Band 5 SLT with the Trust, was an ability to follow up service users as part of “providing appropriate intervention and evaluation of treatment outcomes” (para 4 of the Job Description), for service users.
312. The Panel notes that the allegation in Particular 1i is linked to the allegation in Particular 1e which covers the regular review of Service Users. The Panel also notes that in her evidence, DD did not specifically set out what the difference is between not ensuring that service users are regularly reviewed and not following up with them. She produced notes of an audit of the Registrant’s case notes carried out in February and early March 2016. The Panel has seen this document which is headed “Caseload Management/Failure to Follow Up Clients”. There are only 2 entries in the typed audit notes which specify that there had been no follow up. The other entries state that there was no review or no action. Where the Panel has seen the relevant case notes, it has reviewed these to see whether there had been any follow up. Where there are no case notes, the Panel has had to consider the results of a number of audits of the Registrant’s caseload and case notes carried out in February, March, and April 2016, some of which contain handwritten entries apparently added in April 2016. The entries in these audit notes are in bullet point fashion and are not always sufficiently clear for the Panel to understand the precise nature of the concerns.
313. The Panel is satisfied it is more likely than not that the Registrant did not follow up with the following Service Users set out in Schedule J: Service Users 45, 49, 77, 79, 84, 88, 100, 105, 106, 107, 130.
314. In relation to Service User 45, the Panel has seen documentary evidence which shows that Service User 45 was transferred to the Registrant in May 2015, and she did not see them again until 4 March 2016. The Panel finds that the Registrant did not follow up with Service User 45.
315. In relation to Service User 49, the Panel has seen documentary evidence which shows that a feeding plan had been put in place by another SLT in 2014. This was due to be followed up by the Registrant in Spring 2015. However, the Registrant did not see Service User 49 until November 2015. Thereafter there appear to have been regular follow ups into 2016. The Panel takes the view that the gap between Spring 2015 and November 2015 indicates that the Registrant did not follow up with Service User 49.
316. In relation to Service User 77, the Panel has seen documentary evidence which indicates that the Registrant saw Service User 77 on three occasions in July 2015 and was due to see them again in nursery on 19 October 2015, but the child was not in that day. A review of the relevant case notes by DD indicated that there was no plan to follow up with this Service User. The Panel finds that the Registrant did not follow up with Service User 77.
317. In relation to Service User 79, the Panel has seen documentary evidence which indicates that the Registrant saw Service User 79 on 30 November 2015 and had planned to do a further assessment in their home language. This further assessment had not taken place by February 2016. The Panel finds that the Registrant did not follow up with Service User 79.
318. In relation to Service User 84, DD told the Panel that in April 2016, a complaint had been received from a school regarding the Registrant’s communication. The complaint was in regard to Service User 84 who the Registrant had seen on 26 February 2016. The Registrant had written in her case notes “seek advice from colleague re: AAC” (augmentative and alternative communication). The complaint from the school was that Service User 84 had not been seen since 26 February 2016 and there had been no communication in regard to next steps, despite attempts to contact the Registrant. There had been no response to messages left for her. DD told the school that another SLT would see Service User 84 as the Registrant was on sick leave. The Panel has concluded that the Registrant did not follow up with Service User 84 as she had a plan as to the next steps but did not do anything to implement it or to communicate it to the school or any other interested party.
319. In relation to Service User 88, the Panel has seen documentary evidence which indicates that the Registrant was due to review Service User 88 in January 2016, but the review had not taken place. The Panel has seen no evidence to indicate that the Registrant then followed this up. Service User 88 was eventually seen by another SLT in August 2016. The Panel finds that the Registrant did not follow up with Service User 88,
320. In relation to Service User 100, the Panel has seen documentary evidence which indicates that when the Registrant last saw Service User 100 on 15 October 2015, she had planned to review them. There is no evidence that she followed this up and the child was next seen by another SLT in June 2016. The Panel finds that the Registrant did not follow up with Service User 100.
321. In relation to Service User 105, the Panel has seen documentary evidence which indicates that the Registrant last saw Service User 105 on 4 February 2015 and there was no evidence of any further contact over the next 12 months. The Panel finds that the Registrant did not follow up with Service User 105.
322. In relation to Service User 106, the Panel has seen documentary evidence which indicates that Service User 106 was last seen on 10 December 2014 and had not been in nursery when they were due to be seen by the Registrant on 30 June 2015. There is no evidence that the Registrant did anything after 30 June 2015 to follow up. The Panel finds that the Registrant did not follow up with Service User 106.
323. In relation to Service User 107, the Panel has seen documentary evidence which states that Service User 107 was transferred to the Registrant on 29 July 2015 with a request to see them in school in the Autumn term. There is no evidence that the Registrant did this. The Panel finds that the Registrant did not follow up with Service User 107.
324. In relation to Service User 130, the Panel has seen the case notes for Service User 130, which show that at a meeting on 10 December 2015, the Registrant planned to assess them in their native language (Polish) at the next review. The Panel can see from the case notes that the next review was with another SLT and did not take place until August 2016. The Panel finds that the Registrant did not follow up with Service User 130.
325. In relation to 16 Service Users (11, 16, 38, 42, 50, 59, 65, 70, 74, 89, 93, 95, 97, 116, 120, 172) the Panel is not satisfied, on the balance of probabilities, that the Registrant did not follow up with these Service Users.
326. In relation to Service Users 11, 16, 65, the Panel notes that the only evidence is of an audit of the Registrant’s case notes carried out in February and March 2016 which does not show that the Registrant did not follow up with them. The Panel does not consider that this is sufficient evidence on which it can make a finding. In the case of Service User 11, the note simply states the date on which they were last seen. For Service User 16 there is no entry at all and for Service User 65 the note refers to them having been discharged.
327. In relation to Service User 38, the Panel has seen documentary evidence that Service User 38 was seen by a different SLT in on 29 September 2015 and 9 October 2015. The Panel has seen one page only of the relevant case notes and this shows that the Registrant did follow up on either 6 or 10 March 2016 (the date is unclear on the notes) when she noted that a letter had been sent to the parents to ring to book an appointment through “Choose and Book” and that if there was no response within 4 weeks, Service User 38 was to be discharged. This follow up would have been just within the time frame of 3 or 6 months. The Panel takes the view that there is no evidence that the Registrant did not follow up with Service User 38.
328. In relation to Service User 42, the Panel has seen case notes for Service User 42 which show that the Registrant saw them on 24 November 2015, 1 December 2015 and 8 March 2016. The Panel has also seen an audit of the Registrant’s case notes which was carried out on 7 March 2016, the day before she saw Service User 42 on 8 March 2016. Handwritten notes added to the audit note on 14 April 2016 do not indicate that there was no follow up by the Registrant. They refer only to the targets she has set. The Panel does not consider that there is any evidence to find the Registrant did not follow up with Service User 42.
329. In relation to Service User 50, the Panel has seen documentary evidence of an audit carried out on 7 March 2016, which indicates that Service User 50 was last seen on 18 November 2015. There is a reference “to discuss with AG” but no information who AG is. The Panel notes that time period for a review within 3 or 6 months had not yet expired and that there was still time for the Registrant to follow up on this Service User. The Panel does not consider that there is sufficient evidence to find that the Registrant did not follow up with Service User 50.
330. In relation to Service User 59, the Panel has seen documentary evidence that Service User 59 was last seen by another SLT in July 2015 and transferred to the Registrant on 13 July 2015 but had to be seen by another SLT. There is no information as to why another SLT had to see Service User 59 or when this was. The Panel takes the view that there is insufficient evidence for it to find that the Registrant did not follow up with Service User 59.
331. In relation to Service Users 70, 74, 89, the Panel notes that the only documentary evidence relates to reviews of these Service Users and not specifically to their not being followed up by the Registrant. The Panel considers that there is insufficient evidence to find that the Registrant did not follow up with these Service Users.
332. In relation to Service Users 93 and 95, the Panel has seen documentary evidence that an initial audit of the case notes for Service Users 93 and 95 shows that they were each seen by another SLT in October 2015. It is not clear when either Service User 93 or Service User 95 became part of the Registrant’s caseload. The case notes were re-reviewed in April 2016. There is no up-date in respect of Service User 95. In the case of Service User 93, the handwritten note states that they were seen on 19 February 2016 by the Registrant and a report was ready to be sent out by 14 March 2016. The Panel has seen no evidence that the Registrant did not follow up with Service User 93 and, as there is no evidence as to when Service User 95 was transferred to the Registrant, the Panel cannot find that she did not follow up with them.
333. In relation to Service User 97, the Panel has seen documentary evidence of an audit of the Registrant’s case notes showing that there had been three appointments with another SLT where Service User 97 did not attend. It is not clear when the case was transferred to the Registrant. In handwritten notes added to the typed audit note in April 2016, it would appear that there had been a further appointment arranged for 29 March 2016 which Service User 97 did not attend. It is not clear who arranged the appointment for 29 March 2016. The Panel does not consider that it has sufficient evidence to find that the Registrant did not follow up with Service User 97.
334. In relation to Service User 116, the Panel has seen the case notes for Service User 116 which show that the Registrant saw them on 3 March 2016 having previously seen them on 25 October 2015. The outcome of the review on 3 March 2016 was to discharge Service User 116. The Panel has also seen an audit of the Registrant’s case notes carried out in late February 2016 which refers to a review due in February 2016 which had not taken place. As the Registrant did see Service User 116 on 3 March 2016, the Panel has concluded that the Registrant did follow up with them.
335. In relation to Service User 120, the Panel has seen documentary evidence which indicates that Service User 120 was seen on 22 February 2016, and that there should be further assessment. The note is in handwriting and is dated 14 April 2016 and goes on to state that the further assessment had not yet taken place. The Panel does not consider that it has sufficient evidence on which to find that the Registrant did not follow up with Service User 120.
336. In relation to Service User 172, the Panel has seen documentary evidence of an audit carried out 13 April 2016 which refers to Service User 172 being seen for initial assessment on 30 March 2016 and refers to them being further assessed in nursery, but it is not clear when this is going to be. There is no other evidence relating to this Service User in the documents. The Panel does not consider that it has sufficient evidence on which to find that the Registrant did not follow up with Service User 120.
337. Ms Saran conceded that there was no evidence in relation to 5 Service Users (60, 94, 96, 111, 162). The Panel is not satisfied, on the balance of probabilities, that the Registrant did not follow up with these Service Users and finds Particular 1i not proved in relation to them.
338. Therefore, in relation to Service Users 11, 16, 38, 42, 50, 59, 60, 65, 70, 74, 89, 93, 94, 95, 96, 97, 111, 116, 120, 162, 172, the Panel is not satisfied, on a balance of probabilities, that the Registrant did not follow up with them. The Panel notes that the allegation in Particular 1i is drafted in terms of “one or more” of the Service Users set out in Schedule J and therefore, its findings in relation to these Service Users, do not alter the Panel’s overall finding that Particular 1i is proved.
339. The Panel finds Particular 1i proved.
Particular 1j is found proved – (did not discharge one or more of the Service Users as set out in Schedule K)
340. The Panel notes that Schedule K sets out 21 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not discharge Service Users in relation to each of the Service Users in Schedule K.
341. The Panel has already noted above that the allegations in Particular 1c and 1j are closely linked with the former relating to closing records where service users are discharged on IPM whereas this sub-particular relates to not discharging service users at all.
342. DD told the Panel that all discharges are at the discretion of SLTs. She said that the Departmental Guidelines require SLTs to send discharge letters and case notes within 4 weeks following a discharge recommendation. Discharge letters must be filed within service user case notes by the administration team at the instruction of the SLT. Discharges must be recorded on the front of a service user’s case notes. SLTs are responsible for informing the appropriate agencies of a service user’s discharge and must electronically discharge a service user on the Trust’s IPM. The date of discharge on the case notes must correspond with the date of discharge registered on IPM. This formally closes a service user’s record.
343. DD said that the Discharge Criteria concerned service users who did not attend their initial appointment. She said that where an initial appointment is cancelled, an SLT would send out a discharge pending letter. The service user’s guardians then had 4 weeks to request a replacement appointment. Once a second appointment is scheduled, the SLT would send out a letter of confirmation for the appointment. If the service user did not attend the second appointment, they would then be formally discharged.
344. DD told the Panel that SLTs were informed of the process for discharging service users during their departmental induction. She said that the discharge process and guidelines were often raised in sector and departmental meetings, and in the event of updates on the process, SLTS were always informed.
345. CC told the Panel that when she took up employment at the Trust, she had found 6000 open cases which should have been discharged. In some instances, there had been evidence of discharge in one part of the Trust’s system but not in the other part. She commented that if there is no entry of discharge in the case notes, then it did not take place.
346. The Panel can see from the Trust’s Departmental Guidance on Written Reports to Clients and Parents/Carers that discharge reports should be completed within 4 weeks of discharge. The Departmental Guidelines indicate that the responsibility of “Placing case notes i.e., all sheets with patients identifiable information in a plastic wallet and returning to the office within 6 weeks of discharge” was that of the SLT. Thereafter it was for the “admin and clerical staff” to do the appropriate filing. The Panel has therefore taken the period of time during which a discharge to be completed to be 4 weeks for writing the relevant discharge report and then 6 weeks after that for the relevant paperwork to be put in a plastic wallet and returned to the administration and clerical staff for filing, a potential total period of some 10 weeks.
347. The Panel is satisfied it is more likely than not that one of the competencies required of the Registrant as a Band 5 SLT with the Trust was to be able to discharge service users.
348. The Panel has reviewed DD’s notes of her weekly meetings with the Registrant during the informal review period and Stage 1 of the Capability Process. It is clear from these that discharging service users appropriately was identified as a concern from the outset. In the Action Plan, the Registrant was set the task of completing all outstanding discharges by 1 October 2015. She was also tasked with dealing with all future discharges in accordance with departmental guidelines. By 1 October 2015, the Registrant was noted as having completed all outstanding discharges appropriately. At meetings with LP (during DD’s absence) in November 2015, LP raised issues regarding Service Users 66, 67, 68 and 69 and revised dates for action by the Registrant were set. In January 2016, it was noted that in relation to unidentified service users that due to the discharge reports not yet being up to the required standard, the discharge letters could not yet be sent out.
349. Under the Improvement Schedule prepared as part of the Stage 1 Capability Process, one of the areas highlighted for improvement was discharges. The Registrant was required to “complete all discharge paperwork as per departmental guidelines”. At a meeting on 26 February 2016, it was noted that there were a number of discharges that needed to be completed at Schools C and E. The Registrant was given to the end of the day to complete them. At a meeting on 4 March 2016, the Registrant reported that she had a few outstanding discharges which she could not complete as she was awaiting paperwork. The Panel has inferred from this that the paperwork the Registrant was referring to was from third parties rather than paperwork she needed to complete herself.
350. In her Capability Investigation Management Report, DD referred only to the issue of discharges in relation to 7 sets of case notes that had been found in a filing cabinet in April 2016, where the service users had not been discharged appropriately.
351. The Panel has reviewed the various case notes audits of the Registrant’s caseload which took place in February, March, and April 2016. The Panel notes that these do not set out in any detail what has happened regarding the discharges of the Service Users listed in Schedule K. Where there are case notes for these Service Users, the Panel has reviewed these to get a fuller picture of what happened regarding their respective discharges.
352. The Panel is satisfied it is more likely than not that the Registrant did not discharge: Service Users 1, 21,102 and 108. The Panel therefore finds Particular 1j proved in relation to these Service Users.
353. In relation to Service User 1, the entry in the audit dated 15 February 2016 states “Report written on 5th December following an appointment on 4th November 2015. Report says discharge but notes still in a filing cabinet at School E”. The Panel has concluded that as there were still notes in a filing cabinet at School E on 15 February, that the Registrant did not discharge Service User 1 within the appropriate time frame.
354. CC told the Panel that she reviewed the case notes for Service User 21. She said that the Registrant had not discharged them after Service User 21’s family had moved out of the area. CC said that another SLT had completed the discharge later.
355. In relation to Service Users 102 and 108, the Panel has seen from an audit of case notes that Service User 102 was last seen on 15 October 2015 and the Registrant had not discharged them by February 2016. The case notes for Service User 108 show that they did not attend appointments on 4 June 2015 or 6 July 2015 and that, as of February 2016, they had not yet been discharged by the Registrant. In both these cases, the Registrant was well outside the 10-week period for completing the discharge of service users.
356. The Panel has considered the evidence relating to the other 17 Service Users set out in Schedule K (Service Users 2, 3, 4, 5, 6, 7, 8, 10, 20, 35 66, 67, 68, 69, 92, 176 and 177. It has concluded, on the balance of probabilities, that Particular 1j is not proved for these Service Users.
357. In relation to Service User 2, the Panel has concluded that there is insufficient regarding the child’s discharge. The only information appears to be that there was nothing on the file to indicate that the appropriate letter had been sent following Service User not attending an appointment on 14 December 2015. It is not clear whether this was a first or second non-attendance. In any event, the 4-week period to complete a discharge report followed by a 6-week period to complete the discharge had not expired by the time the case notes were audited. The Panel cannot therefore conclude, on the balance of probabilities, that the Registrant did not discharge Service User 2 on a later date within the relevant time limits.
358. In relation to Service Users 3 and 4, the audit note refers to non-attendance (“DNA”) in October 2015 and case notes still being in the filing cabinet. There is no information as to whether the DNA was followed-up in either case by the Registrant or whether there were any further non-attendances by the Service User. The Panel cannot therefore conclude, on the balance of probabilities, that the Registrant did not discharge Service Users 3 and 4 within the relevant period.
359. In relation to Service User 5, the Panel has seen that the audit in on 15 February 2016 indicated stated “6th January 2016 no response to choose and book. To be discharged.” The Panel has inferred from this entry that this was a second and last offer of an appointment for Service User 5. The Registrant would then have 4 weeks to complete a discharge report and a further 6 weeks to complete the discharge process. As of 15 February 2016, when the audit took place, this 10-week period had not expired. The Panel has found Particular 1j not proved for Service User 5.
360. In relation to Service User 6, the audit note refers to cancelled appointments in on 28 October 2015 and 9 December 2015. It also refers to the Service User’s mother contacting the department indicating that no further appointments were necessary. The Panel considers that the Registrant would then have 4 weeks to complete a discharge report and a further 6 weeks to complete the discharge process. As of 15 February 2016, when the audit took place, this 10-week period had not expired. The Panel has found Particular 1j not proved for Service User 6.
361. In relation to Service User 7, the audit note refers to the mother cancelling an appointment on 13 January 2016 as the Service User was now attending a school out of the area. The note states the case was to be transferred to a different Speech and Language Therapy area but there was no evidence that this had been done. The Panel considers that the Registrant would then have 4 weeks to complete a discharge report and a further 6 weeks to complete the discharge process. As of 15 February 2016, when the audit took place, this 10-week period had not expired. The Panel has found Particular 1j not proved for Service User 7.
362. In relation to Service User 8, the audit note refers to a no contact discharge dated 6 January 2016. The Panel considers that the Registrant would then have 4 weeks to complete a discharge report and a further 6 weeks to complete the discharge process. As of 15 February 2016, when the audit took place, this 10-week period had not expired. The Panel has found Particular 1j not proved for Service User 8.
363. In relation to Service User 10, the audit note refers to face to face meetings on 5 January 2015 (which is outside the period of the Allegation), on 30 June 2015 and 6 November 2015. The audit notes then state that there are notes on file which indicate that the Service User is “to be discharged”. There is no evidence as to when this entry was dated or when the 10-week period to complete the discharge process began. The Panel has found Particular 1j not proved for Service User 10.
364. In relation to Service User 20, the Panel has seen a discharge report prepared by the Registrant which was written on 16 February 2016 and sent on 9 March 2016. The Panel notes that the audit note was prepared on 15 February 2016 and there is nothing further in the papers to say that the Registrant did not go on to complete the discharge process. The Panel cannot therefore conclude, on the balance of probabilities, that the Registrant did not discharge Service User 20 It has found Particular 1j not proved for Service User 20.
365. In relation to Service User 35, the Panel has seen the relevant case notes. It is clear from these that the Registrant had seen Service User 35 in November 2015 and was planning to review the child in February 2016 with a view to discharging them if the progress she had noted was still being maintained. However, there is no note of any review taking place at that time and the next entry is not until 4 January 2017. This is made by another SLT who records that there has been no contact and a “did not attend” letter was to be sent out, pending discharge. As the Registrant did not review this Service User within the timeframe, the Panel cannot know if Service User 35 was due to be discharged within the period covered by the Allegation.
366. In relation to Service User 66 who was last seen in 2013 (which is outside the period of the Allegation) and Service User 67 who was last seen on 13 September 2015, there is a similar note that they had not been discharged as of 10 February 2016. There is no evidence that it was the Registrant who saw Service User in 2013. According to DD, at a meeting with the Registrant on 28 November 2015, the Registrant had not yet sent out appointment letters to Service Users 66 and 67 although she had drafted them. The Panel does not consider that it has sufficient information as to when the appointment letters were sent out and by when the appointment had to be booked, or what happened thereafter. The Panel has concluded that it cannot be satisfied, on the balance of probabilities, that the 10-week period to discharge these Service Users had expired by 10 February 2016. The Panel has found Particular 1j not proved for Service Users 66 and 67.
367. In relation to Service Users 68 and 69, the audit note simply says in each case “Notes not transferred to discharges”. According to DD, at a meeting with the Registrant on 28 November 2015, the Registrant had not yet discharged Service User 69. The Panel considers that it has insufficient evidence of dates to decide whether the Registrant did not discharge the Service Users within the 10-week period to complete the discharge process. The Panel has found Particular 1j not proved for Service Users 68 and 69.
368. In relation to Service User 92, the Panel has seen that the only case notes produced appear to relate to dates in 2010 which is outside the dates of the Allegation in this case. The Panel has found Particular 1j not proved for Service User 92,
369. Ms Saran conceded that there was no evidence in respect of Service Users 176 and 177.
The Panel has therefore found Particular 1j not proved for Service Users 176 and 177.
370. Therefore, in relation to 16 Service Users (Service Users 2, 3, 4, 5, 6, 7, 8, 10, 20, 66, 67, 68, 69, 92, 176 and 177), the Panel is not satisfied, on a balance of probabilities, that the Registrant did not discharge them. The Panel notes that the allegation in Particular 1j is drafted in terms of “one or more” of the Service Users set out in Schedule K and so, its findings in relation to these 16 Service Users, do not alter the Panel’s overall finding that Particular 1j is proved.
371. The Panel finds Particular 1j proved.
Particular 1k is found proved – (did not complete the Service User plans to the required standard and/or did not review or update plans when necessary, for one or more of the Service Users set out in Schedule M)
372. The Panel notes that Schedule M sets out 14 Service Users. It has considered the evidence to see whether it is satisfied it is more likely than not that the Registrant did not complete the Service User plans to the required standard and/or did not review or update plans, when necessary, in relation to each of the Service Users in Schedule M.
373. The Panel is satisfied it is more likely than not that one of the competencies required of the Registrant as a Band 5 SLT with the Trust was being able to complete Service User plans to the required standard, and to review or update these plans when necessary. It notes that in the Trust’s job description are the following competencies:
(i) under the heading “Main duties and responsibilities” at paragraph 2: “To communicate complex condition related information from assessment to clients, carers, families, multi-disciplinary team members and other professionals”.
(ii) under the heading “Professional” at paragraph 4 “To adhere to local guidelines”.
(iii) Under the heading “Clinical Governance/Organisation” at paragraph 1, “To structure clear intervention plans based on good practice”.
374. The Panel has also seen the Trust’s Departmental Guidelines for Written Reports to Clients and Parents/Carers which applied at the relevant time. While it is clear that these Departmental Guidelines are concerned with reports and not plans, the Panel can see that the Registrant was expected to follow them when drafting any treatment plans for Service Users so that these are clear, concise, and written with the reader in mind. The Panel notes that the wording of Particular 1k simply refers to “plans” and does not specify any particular type of plan.
375. DD explained that the Registrant’s caseload consisted mainly of school children, many of whom were vulnerable. She said that Developmental Plans are put in place for vulnerable children and children with complex needs to ensure that children were monitored by SLTs, schools and other interested parties. SLTs were responsible for the formulation of treatment plans, and they were required to produce structured and clear intervention plans based on best practice. DD specifically referred to three Service Users (46, 47, and 49) where the Registrant did not prepare feeding plans. She also referred to Service User 48 and said that the Registrant did not produce a therapy plan for them after an assessment she carried out in November 2015.
376. In answer to a Panel questions, CC said that there should be a plan in every episode of care: assessment appointments, reviews, blocks of therapy. The plan should set out what treatment comes next, the targets to be actioned and the relevant time frame.
377. The Panel is satisfied it is more likely than not that the Registrant did not complete Service User plans to the required standard and/or did not review or update them, when necessary, in the case of Service Users 44 and Service User 46. It therefore finds Particular 1k proved in each case.
378. In relation to Service 44, CC reviewed the case notes and told the Panel that while the Registrant’s assessment of Service User 44 had been good, the plan was not articulated in those notes. The Panel has also seen a handwritten entry which appears to have been added on 14 April 2016 to typed note of an audit carried out on 7 March 2016. The handwritten note states, “no clear plan”. As there was no clear plan, the Panel decided, on the balance of probabilities, that there was no plan for the Registrant to review or update when necessary, and so it does not find Particular 1k proved on the alternative basis.
379. In relation to Service User 46, the Panel has seen from an audit carried out on 7 March 2016 to which handwritten entries were added on 14 April 2016, that the Registrant saw Service User 46 on 8 March 2016. The handwritten note states that there is no clear plan of what will happen next. The Panel has seen also the case notes for Service User 46 and has concluded that the Registrant’s entries for 8 March 2016 do not show a clear plan of what will happen next. As there was no clear plan, the Panel has decided, on the balance of probabilities, that there was no plan for the Registrant to review or update when necessary, and so it does not find Particular 1k proved on the alternative basis.
380. The Panel is not satisfied, on the balance of probabilities that in respect of the remaining 12 Service Users set out in Schedule M (Service Users 43, 47, 48, 49, 51, 55, 63, 76, 78, 105, 139, 145) that Particular 1k is proved.
381. In relation to Service User 43, the Panel has seen typed notes of an audit carried out on 7 March 2016 which simply states, “No plan”. Handwritten notes which appear to have been made on 14 April 2016, do not specifically refer to any plan and the Panel has concluded that without either the case notes or any treatment plan prepared by the Registrant that it has insufficient information. The Panel has therefore decided, on the balance of probabilities, that Particular 1k is not proved for Service User 43.
382. In relation to Service User 47, the Panel has seen an audit carried out on 7 March 2016 where the typed note refers to the Registrant seeing Service User 47 on 4 occasions since 2014 but does not say when. A handwritten note apparently added on 14 April 2016, refers to the Registrant’s last contact being on 12 November 2015. The Panel has also seen a document headed “Information Missing from Case Notes”, where the entry for Service User 47 states, “No feeding plan”. The Panel does not consider that it has sufficient information for Service User 47 and so it has concluded, on a balance of probabilities, that Particular 1k is not proved for Service User 47.
383. In relation to Service User 48, the entry on the “Information Missing from Case Notes” document is “No therapy plan”. The Panel has also seen an audit carried out on 7 March 2016 which indicates that the Registrant last saw Service User 48 on 8 March 2016. There is a handwritten entry apparently made on 14 April 2016, which refers to there being a plan. CC reviewed Service User 48’s case notes and considered that the Registrant had set appropriate targets. The Panel takes the view that the setting of appropriate targets is part of a plan. It considers that, on a balance of probabilities, the targets set by the Registrant were adequate and to the required standard. The Panel accepts CC’s evidence that the targets set were appropriate. There is no evidence that the Registrant did not review or update these, when necessary. The Panel has therefore concluded, on a balance of probabilities, that it cannot find Particular 1k proved for Service User 48.
384. In relation to Service User 49, DD said that a feeding plan was put in place for Service User 49 in September 2014 and was scheduled to be reviewed in Spring 2015. The Panel notes that both these dates fall outside the dates of the Allegation. DD said that the Registrant did not see Service User 49 between February 2015 and January 2016. However, the Panel has seen the Registrant’s case notes for this Service User which show that she saw them in March 2015, and again in November and December 2015. The Panel has also seen an audit carried out on 7 March 2016 where a typed note states, there was no up to date feeding plan. The Panel has reviewed the case notes for Service User 49, and notes that after the November 2015 meeting, the Registrant sets out a plan, but this is a communication plan. The Panel also notes that after the meeting in February 2016, there is a reference to the then current plan continuing with the parents introducing new finger food. After a TAC (“Team Around Child”) meeting, the Registrant set out plans regarding the Service User’s communication skills as well as a plan to carry out a meal observation. The Panel has seen handwritten entries apparently made on 14 April 2016. These were unhelpfully badly copied and so the Panel cannot see the whole entry.
385. The Panel notes that CC reviewed Service User 49’s case notes from 2014. CC was asked to consider whether there was sufficient follow up for Service User 49. CC described the notes as setting out a nuanced picture as there appeared, at first glance, to be some gaps. However, CC explained that when the type of specialist school was factored in, this would explain the apparent gaps. CC said that Service User 49 was seen monthly from December 2015 to February 2016 when the assessment and liaison was complete. There is no mention in CC’s review of any issues regarding the planned treatment of Service User 49 or that these plans had not been reviewed or updated when necessary. CC told the Panel that if she had any concerns, she would have raised them. The Panel has concluded, on the balance of probabilities, that Particular 1k is not proved for Service User 49.
386. In relation to Service User 51, the Panel has seen typed notes in an audit carried out on 7 March 2016 to which there are handwritten additions apparently made on 14 April 2016. The Registrant saw Service User 51 on 17 November 2015. The notes suggest that although she set Objects of Reference for adults to use with the Service User, there was no indication of what these objects were. The note also refers to the plan being “poor” without any further explanation as to why. The Panel has seen the case notes for Service User 51. These were reviewed by CC who found no issues with “target setting, spelling, grammar and punctuation in the case notes”. The Panel accepts CC’s evidence. The Panel has therefore concluded, on the balance of probabilities, that the Registrant’s plan was adequate. The Panel has seen no evidence that the plan was not reviewed or updated when necessary. The Panel has found Particular 1k is not proved for Service User 51.
387. In relation to Service User 55, the Panel has seen typed notes of an audit carried out on 7 March 2016 to which there are handwritten additions apparently made on 14 April 2016. The handwritten notes suggest that the Registrant saw Service User 55 for a review on 23 February 2016 and it would seem from these notes that the Registrant had set out a plan. The Panel has not seen Service User 55’s case notes to verify precisely what she has recorded. It does not consider that it has sufficient information to decide whether the Registrant’s plan was adequate or not, or whether it should have been reviewed or updated when necessary. The Panel has therefore concluded, on a balance of probabilities, that Particular 1k is not proved for Service User 55.
388. In relation to Service User 63, the Panel has seen an audit carried out on an unknown date in February 2016 which indicates that the Registrant saw Service User 63 on 29 January 2016 and states “No further plan for client”. The Panel has seen from the Registrant’s case notes that she had seen Service User 63 on a number of occasions prior to January 2016. The case notes show that on 25 January 2016 the Registrant had tried to see Service User 63, but the child had just gone to sleep. She had obtained an update from one of the keyworkers. The Registrant noted that “current targets set by SNEYS (Special Needs Early Years Service)” and under ‘Plan’ “To attend TAC”. The Registrant attended the TAC meeting on 29 January 2016 (4 days later) where she spoke to Service User 63’s mother before carrying out a review of the child later that day. The Panel has seen under ‘Plan’ in the case notes for 29 January 2016 meeting, that the Registrant set out her plan under 5 different bullet points.
389. CC was asked to review the case notes for Service User 63 and her review covered all the Registrant’s meetings with the child. CC said that the SNEYS targets appeared to be appropriate for Service User 63 at that time and that these followed on from previous targets set for them. CC said, “It is routine for SLTs to work closely with services such as SNEYS and share target setting”. CC said that after the TAC meeting and her own review of Service User 63 on 29 January 2016, the Registrant “makes sound clinical judgements in the targets set”. The Panel accepts CC’s evidence and considers that the Registrant’s plan for Service User 63 was adequate. The Panel has seen no evidence which suggests that the time for any review or updating of the plan had arrived. The Panel has therefore concluded, on the balance of probabilities that Particular 1k is not proved for Service User 63.
390. In relation to Service User 76, the Panel has seen an audit carried out on an unknown date in February 2016 which indicates that the Registrant saw Service User 76 on 9 November 2015. The typed notes do not make any reference to plans or targets set for Service User 76. The Panel has seen the case notes for Service User 76. CC was asked to review these case notes and comment on whether the notes and targets were of an acceptable standard. CC’s evidence was that “Notes are of a good standard and targets set are appropriate”. The Panel accepts CC’s evidence. The Panel has seen no evidence that the targets set should have been reviewed or updated at a particular time. It has therefore concluded, on a balance of probabilities, that Particular 1k is not proved for Service User 76.
391. In relation to Service User 78, the Panel has seen an audit carried out on an unknown date in February 2016 which indicates “No clear plan in notes”. The Panel has not seen the case notes for Service User 78 and CC did not review these. The Panel has concluded there is insufficient evidence of what happened in the case of Service User 78. It has therefore concluded that Particular 1k is not proved for Service User 78.
392. In relation to Service User 105, the Panel has seen an audit carried out on 22 and 25 February 2016 which indicates that “No indication of what is planned to happen”. The Panel has seen the case notes for Service User 105. These show that the Registrant saw Service User 105 in January 2015 (outside the dates of the Allegation) and then another SLT saw the child on later dates in 2015 and 2016. There is a handwritten note which suggests that Service User 105 was transferred to the Registrant but does not say when this was. The Panel notes that the copying of these case notes is such that some entries and dates are impossible to read. The Panel takes the view that there is insufficient evidence in respect of Service User 105. It has concluded, on a balance of probabilities, that Particular 1k is not proved for Service User 105.
393. In relation to Service User 139, the Panel has seen an audit carried out on 13 April 2016 which indicates “Poor target setting” but does not explain why the targets set by the Registrant were poor. The Panel has seen a Treatment Plan dated 26 February 2016 which sets out a number of targets. The Panel has decided that it has insufficient evidence in respect of Service User 139 to find that the targets set were not to the required standard, or that the time for them to be reviewed or updated when necessary had arrived. The Panel has therefore concluded, on the balance of probabilities, that Particular 1k is not proved for Service User 139.
394. In relation to Service User 145, the Panel has seen the relevant case notes. These show that the Registrant saw Service User 145 in 2014 and in the early part of 2015. These times are outside the dates of the Allegation in this case. The Registrant saw Service User 145 in July, October, and November 2015 and again in January, February, and April 2016. CC was asked to review the case notes for Service User 145. She commented that the case notes for the earlier dates were “vague in places about when [Service User 145] will next be seen and state ‘continue’ as the plan on a number of occasions”. CC said that to use the word “continue” would not be expected of an SLT at the present time. CC also said that “Otherwise the notes are of a good standard. From 6/10/15 the plans/targets are clear and appropriate”. The Panel notes that the Registrant was not placed on an informal Capability Process until July 2015 and an Action Plan was not agreed with her until 13 August 2015. The Panel accepts CC’s evidence that from 6 October 2015 onwards the Registrant’s plans and targets were clear and appropriate. It appears that they were kept under review. The Panel has therefore concluded, on a balance of probabilities, that Particular 1k is not proved for Service User 145.
395. Therefore, in relation to 12 Service Users (Service Users 43, 47, 48, 49, 51, 55, 63, 76, 78, 105, 139 and 145), the Panel is not satisfied, on a balance of probabilities, that the Registrant did not complete Service User reports to the required standard and/or review or update them when necessary. The Panel notes that the allegation in Particular 1k is drafted in terms of “one or more” of the Service Users set out in Schedule M and so, its findings in relation to these 12 Service Users, do not alter the Panel’s overall finding that Particular 1k is proved.
396. The Panel finds Particular 1k proved.
Decision on Grounds
Submissions
397. Ms Saran submitted that the Panel should find that the Registrant’s performance over the relevant period constitutes misconduct. She submitted that the deficiencies in the Registrant’s competencies were serious and fell far below what was proper in the circumstances. Ms Saran submitted that the consequences of the Registrant’s deficiencies were potentially grave as these might have resulted in service users being less likely to achieve the speech and language milestones expected of them. Ms Saran submitted that the Registrant had breached Standard 10 (10.1 and 10.2) of the HCPC’s Standards of Conduct, Performance and Ethics in relation to her record-keeping. She also submitted that the Registrant had breached Standard 6 which covers managing the risk of harm to service users.
398. Ms Saran submitted in relation to lack of competence, that the Panel had seen a fair sample of the Registrant’s work and could therefore judge whether her performance was “unacceptably low”. She submitted that the Registrant had breached Standard 10 of the Standards of Proficiency for SLTs in relation to her record-keeping. Ms Saran accepted that over the course of the informal review and during the Stage 1 of the Capability Process, there was some evidence that the Registrant’s performance in certain areas had improved, and she cited the use of INT forms as an example of this. She conceded that in respect of the issue set out in Particular 1a, the Panel may conclude that by May 2016, this was no longer of concern.
399. Ms Saran referred the Panel to the case of Udom v GMC [2009] EWHC 3242 (Admin). The panel in that case had found that Dr Udom’s fitness to practise was impaired by reason both of his physical or mental health, and his deficient professional performance. That panel recognised that there may have been an “interlinking” of the doctor’s health and his deficient performance. However, the panel concluded that the doctor’s adverse physical or mental health did not fully explain his deficient professional performance. Ms Saran submitted that in this case, the Registrant’s health condition did not fully explain either her misconduct and/or lack of competence. Ms Saran submitted that the Panel had no expert evidence to assist it in this regard. She also submitted that the Registrant’s health condition was managed locally, and measures were implemented to allow the Registrant to reach the required standard of competence.
Decision
400. In reaching its decision on the two statutory grounds alleged in this case, the Panel has considered Ms Saran’s submissions and it has received and accepted legal advice.
401. The Panel notes that before it can find lack of competence, it must be satisfied that it has evidence of a fair sample of the Registrant’s work on which to judge her level of competency. The Panel also notes that for a finding of lack of competence, it must judge the Registrant’s performance as a Band 5 SLT to have been “unacceptably low” at the relevant time. The relevant time is the time when the facts found proved by the Panel occurred.
402. The Panel is aware that before it can conclude that the Registrant’s conduct at the relevant time amounted to misconduct, it must judge that her performance as a Band 5 SLT had fallen far below the standards expected of a competent practitioner at that level. The Panel notes that there is a “qualitative difference” between a lack of competence and misconduct.
403. In reaching its decision on the statutory grounds, the Panel has considered its findings of fact in relation to Particular 1 individually and cumulatively to judge if these establish lack of competence and/or misconduct. Due to the way in which the HCPC drafted its Allegation in this case, the Panel was required to make 465 individual findings of fact in relation to 166 different Service Users who were part of the Registrant’s caseload during the relevant period. In the case of some of those Service Users, the facts found proved relate to only one aspect of the competencies required of the Registrant as a Band 5 SLT with the Trust. However, for other Service Users, the facts found proved relate to a number of different aspects of the competencies required of the Registrant as a Band 5 SLT with the Trust.
404. The Panel has also had in mind the HCPC Standards of Conduct, Performance and Ethics, and notes that during the period of the Allegation (June 2015 to June 2016) both the 2012 version and the 2016 version (which applied from January 2016) are potentially relevant. It has also had in mind the Standards of Proficiency for Speech and Language Therapists (2014).
Lack of competence
405. The Panel has first considered whether the facts it has found proved amount to the statutory ground of lack of competence. The Panel is satisfied that the evidence before it does amount to a fair sample of the Registrant’s work on which to judge whether the level of her competency was “unacceptably” low. The Panel has seen evidence relating to 166 different Service Users who were being treated by the Registrant during the relevant period. The Panel is aware from the notes of DD’s weekly meetings with the Registrant that the Trust expected a Band 5 SLT to have 202 target contacts/client appointments per quarter. The Panel notes that to assist and support the Registrant, her target contacts/client appointments were reduced to 162 per quarter. The Panel takes the view that the evidence it has seen relates to the majority of the Registrant’s caseload during the period covered by the Allegation and it is satisfied that this is a fair sample of her work.
406. The Panel has considered whether the facts it has found proved in Particular 1 demonstrate that the Registrant’s level of performance as a Band 5 SLT was “unacceptably” low. The Panel notes that the Registrant had been a Band 5 SLT with the Trust since 2009 and that it appears that it was only in 2015 that concerns were raised regarding her practice.
407. The Panel has made findings of fact in relation to the various competencies of a Band 5 SLT with the Trust set out in Particulars 1a, 1b, 1c, 1d, 1e, 1f, 1h, 1i, 1j and 1k. In reaching its decision on whether its findings of fact amount to a lack of competence, the Panel has considered how to weigh the seriousness of the various competencies. It has also considered the number of Service Users concerned in each sub-particular of Particular 1 against the total number of Service Users in respect of whom evidence has been produced, so as to provide the context for its findings of fact in relation to the Registrant’s overall practice at that time.
408. Particular 1a - the Panel has found that the Registrant did not use the INT tool when treating 23 of the 24 Service Users listed in Schedule A. While this is almost 99% of those Service Users, it is approximately 13.5% of the 166 Service Users on the Registrant’s caseload seen by the Panel. The Panel notes that the INT form was developed by SLT’s at the Trust including the Registrant. It further notes that the Registrant was trained in the use of the INT form and that DD found the Registrant’s use of INT forms improved over the period of the Capability Process.
409. According to DD, it is a form which was designed to assist Therapists to identify how much time should be allocated to service users. For example, a high INT score would indicate a high level of attention or short-term intervention must be actioned for the service user. Where an INT score is low, it might be appropriate to discharge a client. CC told the Panel that the INT form was not the assessment itself, but it was an aide to an assessment. The Panel notes that the INT form is no longer used by the Trust. However, it was a clear requirement at the relevant time as it was considered to be an essential part of the assessment of a service user’s needs. It is also clear that it was a matter raised by DD in her meetings with the Registrant. The evidence suggests that the Registrant was able to use the INT form and did so. There is no explanation for why the Registrant did not complete an INT form for these 23 Service Users, other than it appears she struggled with being able to complete a number of the aspects her work as a Band 5 SLT at this time, including completing INT forms.
410. The Panel has concluded that the Registrant’s level of competency in not completing INT forms was “unacceptably” low in the 23 cases where this has been found proved. The Panel considers her “unacceptably” low level of competency in this regard to be at the lower end of seriousness regarding her lack of competence, particularly in light of the improvement noted by DD during the Capability Process.
411. The Panel has no evidence of any harm being caused to any of the 23 Service Users for whom the Registrant did not complete an INT form. The Panel does not consider that there was the potential to harm these Service Users as the INT form was not the assessment itself, merely an aid to it. However, the Panel takes the view that the Registrant’s not completing an INT form in these cases could potentially have impacted on the allocation of cases by the management within the SLT department.
412. Particular 1b - the Panel has found that the Registrant did not complete reports in a timely manner for 20 of the 99 Service Users listed in Schedule B. This is approximately 12% of the 166 Service Users who formed the Registrant’s caseload. According to DD, the Registrant did not have an effective system in place to manage her time and because of this she breached the 4-week timeframe required by the Trust for completing reports which were to be sent for review by medical professionals, therapists, and parents, where necessary. The Panel accepts DD’s evidence that it is important that reports are drafted within a reasonable timeframe so that all interested parties are aware of the outcomes of assessments and the service user’s condition.
413. CC’s evidence was that in November 2017 when she joined the Trust, the reports were being drafting within 6 to 8 weeks of a relevant assessment. CC accepted that this was in breach of the Trust’s Guidelines at that time. CC explained that because of the ratio of children on the SLT caseload and the small number of SLT’s in the Department, the SLTs had to be pragmatic when deciding in which order to write up their reports.
414. The Panel has explained how it has interpreted “in a timely manner” in its determination on facts for Particular 1b, and why it has allowed a bit of leeway in the timeframe for completing reports. The Panel notes that the writing of reports was a recurrent theme during the weekly meetings with DD who encouraged the Registrant to arrange her time so that she could complete reports within the Trust’s guidelines. However, the Panel also notes that the Registrant had to make time within an already busy schedule to attend the weekly meetings with DD, send each report to DD for checking before it could be sent out, and then make any amendments which DD may require. This inevitably added to the pressure on the Registrant’s already busy timetable.
415. The Panel notes that although its findings of fact relate to approximately 20% of the 99 Service Users listed in Schedule B, this is a small percentage of the Registrant’s overall caseload. The Panel has concluded that the Registrant’s level of competency in not completing reports in a timely manner was “unacceptably” low in those 20 cases where this has been found proved. The Panel considers the Registrant’s “unacceptably” low level of competency in this regard to be more serious than e.g., not completing an INT form.
416. The Panel has no evidence of harm being caused to any of the 20 Service Users where reports were not completed by the Registrant in a timely manner. However, the Panel considers that where reports are not completed in a timely manner there is a potential risk to service users as, for example, intervention by a medical professional or other therapist might be delayed.
417. Particular 1c - the Panel has found that the Registrant did not close the case on the Trust’s management system IPM in 9 out of the 15 Service Users listed in Schedule C. This is approximately 5.25 % of the 166 Service Users who formed the Registrant’s caseload. The Panel notes that DD’s evidence was that SLTs were responsible for electronically discharging service users on the Trust’s management system IPM, and that the Trust’s process for discharging service users formed part of a Band 5 SLT’s departmental induction. The Panel also notes that in the weekly meetings, DD and LP regularly raised the issue of discharging service users as a matter of concern.
418. Despite the relatively small number of cases where the Panel found Particular 1c proved, it considers that the Registrant’s level of competency in not closing those 9 Service User cases on the Trust’s management system IPM to have been “unacceptably” low. The Panel judges this shortcoming to be at the lowest level of the Registrant’s lack of competence.
419. The Panel notes that there is no evidence of any harm to the 9 Service Users. The Panel takes the view that this competency is more important for administrative reasons rather than clinical ones. It considers that the manager of the SLT department should know how many service user cases were “live” at any one time so that e.g., new cases could be allocated fairly and efficiently to the SLTs.
420. Particular 1d - the Panel has found that the Registrant did not complete and/or save reports to the case notes in 47 of the 101 Service Users listed in Schedule D. This is approximately 28.25 % of the 166 Service Users who formed the Registrant’s caseload. The Panel notes that report writing concerns were raised on a regular basis by DD in her weekly meetings with the Registrant. In the early part of the informal review, the Registrant was given time away from client facing work so that she could catch up on outstanding reports. The Panel also notes that in the majority of the cases where it has found the Registrant did not write a report at all, this related to the earlier period of the Allegation and that in some instances, it was clear that the Registrant had written reports for later appointments with the same Service Users.
421. The Panel is satisfied that when the Registrant did not complete a report or did not save a report to the case notes folders for 47 of the Service Users listed in Schedule D, her level of competency was “unacceptably” low. The Panel considers the Registrant’s shortcomings in this area of her work to be more significant in terms of the weight to be attached to her lack of competence. This is because of the number of service users involved, and the potential consequences for those service users.
422. The Panel had no evidence of any harm being caused to these Service Users. The Panel found that the Registrant did not complete a report for 15 of the 101 Service Users listed in Schedule D. It considers this to be a significant failing. The writing of reports is an important part of the competency expected of a Band 5 SLT. If there is no report, the parties to whom reports are sent (medical professionals, other therapists, and parents) will be unaware of the condition of the service user, the need for any ongoing treatment and the nature of that treatment. Reports are required for continuity of care.
423. The Panel found that the Registrant did not save a report to the case notes folders for 32 of the 101 Service Users listed in Schedule D. The Panel has considered the impact of this on the continuity of care. Any SLT who might have to take over cases from the Registrant would be hampered by there being no hard copy of the report in the case notes folder. They would not know if a report had been written and sent out to all relevant parties. They would have to rely on the handwritten case notes to discover what treatment was due.
424. Particular 1e - the Panel has found that the Registrant did not ensure that 6 of the 27 Service Users listed in Schedule F were regularly reviewed and/or she failed to set dates for reviews them. This is approximately 3.5 % of the 166 Service Users who formed the Registrant’s caseload. According to DD, the Registrant was expected to ensure that a review took place either by herself or another SLT for all service users. A review date should be set out in the Service User reports following an assessment and this provides the timeframe which must be followed either by her or any other SLT to whom the case is transferred. DD said that in schools, service users were usually seen on a termly basis subject to their needs. In the event that a service user is transferred, an SLT must review the service user before they are transferred. The Panel accepts DD’s evidence that reviews ensure that service users receive the correct treatment.
425. The Panel is satisfied that the Registrant’s level of competency in not ensuring regular reviews and/or in failing to set review dates for the 6 Service Users involved, to have been “unacceptably” low. The Panel considers that reviews are fundamental to proper, safe, and effective care of service users. It also considers that even though the number of Service Users involved is small, the potential consequences for those Service Users could be significant. A service user might not receive the appropriate treatment, or they might continue to receive treatment that was no longer necessary and when they should have been discharged. The Panel takes the view that the Registrant’s lack of competency in this regard is more significant in terms of the weight to be attached to it.
426. The Panel notes that there is no evidence of any harm caused to these 6 Service Users as a result of the Registrant’s either not reviewing them regularly or failing to set regular review dates for them. However, the Panel considers that there is the potential of harm being caused. The Registrant had missed opportunities to potentially identify, or act upon, additional needs which a review might have revealed. The Panel accepts DD’s evidence that the Registrant’s caseload consisted of very vulnerable children with complex needs and that therefore reviews were essential for continued monitoring. It considers that without regular reviews, an SLT cannot know what a service user’s clinical needs are, and therefore cannot provide the standard and type of care needed.
427. Particular 1f – the Panel has found that that the Registrant did not complete case notes for 34 of the 56 Service Users listed in Schedule G. This is approximately 20% of the 166 Service Users in the Registrant’s caseload.
428. The Panel notes the overlap in Particular 1f with both Particular 1a which relates to INT forms and Particular 1d which relates to filing reports in the case notes folders. It is obvious that where the Registrant did not complete an INT form, or did not save a copy of the report, these documents are not going to be found in the case notes folder where they should have been filed (by way of example, Service Users 4, 19 and 23).
429. The Panel accepts that it is not good practice to have incomplete service user case note folders. It makes it much difficult for another SLT taking over a case to assess the progress of any treatment. Some documents missing from a case notes folder will be more important than others. The Panel considers that the lack of an INT form is less serious in terms of the potential risk it poses to service users, than the lack of a report or plan. Although the Panel has no evidence of any harm being caused to the 34 Service Users listed in Schedule G, it has concluded that in not completing case notes the Registrant’s competency was “unacceptably” low and amounts to lack of competence.
430. Particular 1h - the Panel has found that the Registrant did not complete reports to the required standard in 35 of the 65 Service Users listed in Schedule I. This is approximately 21 % of the 166 Service Users who formed the Registrant’s caseload. The Panel has seen from the Trust’s Guidance on the writing of reports that it expects a very high standard. According to DD, reports must contain short sentences, avoid nominalisations, use positive language, lists and locally agreed phrases. As to the content of the reports, DD said that they must contain a summary of the assessment carried out, the findings of the assessment and summary of the next steps to be taken. The Panel has already noted that the HCPC did not produce in evidence any of the reports for the Service Users listed in Schedule I. The Panel has therefore had to rely on other documentary evidence such as a table prepared by DD of reports written by the Registrant to ascertain what was said to be wrong with the reports before DD would approve them.
431. Although the Panel has found Particular 1h proved in the case of 35 Service Users, it does not consider that its findings where these relate to typing, grammatical or phrasing errors, indicate that the Registrant’s competency in this regard was “unacceptably” low or that it amounts to a “lack of competence”. These are not matters that would mislead a reader as to the clinical content of a report. The Panel has seen many hand-written case notes by the Registrant, and it is clear that what she writes is legible and comprehendible, and she does not make spelling mistakes. It also notes that the Registrant indicated to DD that she found it difficult to proof read her typed reports, especially when she was writing a number of these at the same time. The Panel also considers that many of DD’s concerns were to do with her stylistic preferences.
432. Although the Panel has seen no evidence of any harm being caused to service users, there are four instances where the Panel does consider that the standard of the reports written by the Registrant was “unacceptably” low and amounts to a lack of competence. These were Service User 24 (incorrect NHS number), Service User 51 (no date in the report) Service User 150 (wrong date in the report) and Service User 151 (wrong address). To use the wrong NHS number or the wrong address in a report has the potential to breach the confidentiality of the person whose NHS number and/or address was used. It could cause confusion to those to whom the report was sent and potential delay in the continuity of care for that service user. To put an incorrect date on a report or no date at all, has the potential to cause confusion for any other SLT to whom these Service Users might be transferred.
433. Particular 1i - the Panel has found that the Registrant did not follow up on 11 of the 32 Service Users listed in Schedule J. This is approximately 6.5% of the 166 Service Users who formed the Registrant’s caseload.
434. DD did not specifically address the potential harm that might be caused in not following up on a servicer user. The Panel has concluded that the importance of following up with a service user is to ensure continuity of care, for example, that the treatment in place has continued, or planned treatment is implemented. Although the Panel has seen no evidence of any harm being caused to the 11 Service Users, it considers that there was a high risk of potential harm to them. The Panel has concluded that where the Registrant has not followed up with the 11 Service Users listed in Schedule J, this denotes an “unacceptably low” level of competence and amounts to lack of competence. In terms of how significant this lack of competence is, the Panel has accorded it a similar weighting to that found in relation to the Registrant’s lack of competence evidenced by not conducting regular reviews in Particular 1e. It is at the more serious end of the spectrum of lack of competence.
435. Particular 1j - the Panel has found that the Registrant did not discharge 4 of the 21 Service Users listed in Schedule K. This is approximately 2.5 % of the 166 Service Users who formed the Registrant’s caseload. The Panel notes that the number of service users who the Registrant did not discharge is very low. It also notes DD’s evidence that concerns regarding the Registrant’s discharge of service users were raised with the Registrant in their weekly meetings during the informal review and the formal Capability Process. DD noted some improvement in the Registrant’s ability to discharge service users during that time.
436. The Panel considers that the ability to appropriately discharge service users is an important part of treatment. In cases where no further treatment is required, service users need to know that their treatment has progressed to the stage where it is no longer required. Those who manage the caseloads of the SLT need to know how many “live” cases there are so that unnecessary appointments are not made where e.g., a service user has transferred out of the area and is now being treated by a different Trust. The Panel has therefore concluded that in not discharging the 4 Service Users, the Registrant’s level of competency was “unacceptably” low, and it amounts to lack of competence.
437. Particular 1k - the Panel has found that the Registrant did not complete plans to the required standard in 2 of the 14 Service Users listed in Schedule M. This is approximately 1.25 % of the 166 Service Users who formed the Registrant’s caseload. The Panel has accepted DD’s evidence that SLTs were responsible for the formulation of treatment plans which should set out clear interventions based on best practice. Developmental plans were put in place for vulnerable children and children with complex needs to ensure that they were monitored by SLTs, schools and other interested parties. If a plan is not documented, appropriate treatment will not happen to the potential detriment of a service users. The Panel has no evidence that either of the two Service Users where it has found Particular 1k proved suffered any harm. Nor has it seen any evidence that the Registrant’s SLT colleagues were inconvenienced in any way by her not completing Service User plans to the required standard. However, it has decided that there was the potential for harm not only to service users but also negatively impact on other SLTs’ practice. The Panel has therefore concluded that in not completing Service User plans to the required standard for these 2 Service Users, the Registrant’s level of competency was “unacceptably” low, and it amounts to lack of competence.
Standards of Proficiency for Speech and Language Therapists
438. In reaching its decision on lack of competence, the Panel has had in mind the HCPC Standards of Proficiency for Speech and Language Therapists (2014) and has concluded that the following standards are engaged and have been breached:
Standard 10 be able to maintain records appropriately
10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines.
10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
439. The Panel has concluded that the Registrant has breached Standard 10 in a number of aspects of her practice:
(i) by not completing INT forms, the Registrant did not demonstrate an ability to maintain records appropriately as she did not follow the Trust’s guidelines with regard to the use of INT forms (Particular 1a).
(ii) in not completing reports in a timely manner, the Registrant did not demonstrate an ability to maintain records appropriately as she did not follow the Trust’s guidelines with regard to the timeframes for completing reports (Particular 1b).
(iii) in not completing closing cases on the Trust’s management system IPM, the Registrant did not demonstrate an ability to maintain records appropriately as she did not follow the Trust’s guidelines with regard to electronically closing cases (Particular 1c).
(iv) in not completing reports or saving them to the case notes folders, the Registrant did not demonstrate an ability to maintain records appropriately as she did not follow the Trust’s guidelines with regard to writing and then filing of reports (Particular 1d).
(v) in not completing case notes, the Registrant did not demonstrate an ability to maintain records appropriately as she did not follow the Trust’s guidelines with regard to completing case notes (Particular 1f)
(vi) by using the wrong date or not putting a date in a report, the Registrant did not demonstrate an ability to maintain records appropriately as she did not follow the Trust’s guidelines with regard to dating reports (Particular 1h).
(vii) in not completing Service User plans to the required standard for 2 of the Service Users listed in Schedule M, the Registrant was not able to maintain records appropriately in accordance with the Trust’s guidelines (Particular 1k).
Standard 4 be able to practise as an autonomous professional, exercising their own professional judgement
4.2 be able to make reasoned decisions to initiate, continue, modify or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriately
440. The Panel considers that in not discharging the 4 Service Users, the Registrant was not able to make a reasoned decision to cease treatment (Particular 1j).
Standard 7 understand the importance of and be able to maintain confidentiality
7.1 be aware of the limits of the concept of confidentiality
441. The Panel has concluded that in giving the wrong NHS number and the wrong address, the Registrant showed that she was not aware of the limits of confidentiality (Particular 1h).
Standard 12 be able to assure the quality of their practise
12.6 be able to evaluate intervention plans using recognised outcome measures and revise the plans as necessary in conjunction with the service user.
442. The Panel has concluded that the Registrant was not able to assure the quality of her practise by properly evaluating intervention plans and implementing these accordingly (Particular 1i and Particular 1k)
Standard 14 be able to draw on appropriate knowledge and skills to inform practice
14.2 be able to conduct appropriate diagnostic and monitoring procedures, treatment, therapy, or other actions safely and effectively.
14.3 be able to formulate specific and appropriate management plans including the setting of timescales.
443. The Panel considers that in not regularly reviewing the 6 Service Users and/or in failing to set them review dates, the Registrant was not able to conduct appropriate monitoring procedures safely and effectively nor was she able to formulate specific and appropriate plans for reviews with set timescales (Particular 1e).
Udom v GMC
444. The Panel was referred to the case of Udom v GMC (ibid). It has considered the extent to which it applies, if at all, to this case where the Registrant’s fitness to practise is said to be impaired by reason of misconduct and/or lack of competence as well as by reason of a physical and/or mental health condition. The Panel notes that it is sitting as a Conduct and Competence Committee and cannot make any findings of fact in relation to Particular 2 of the Allegation, which is solely a matter for a Health Committee Panel. It follows therefore, that it cannot make any findings in relation to the alleged statutory ground of health. In any event, the Panel notes that there is no medical evidence before it which addresses the issue of whether the Registrant’s lack of competence as found proved, is wholly explained by a health condition. The Panel also notes that during the period covered by the Allegation, the Registrant was able to perform her role at an acceptable level of competence in relation to many of the service users who formed part of her caseload. Her lack of competence was in specific areas and in relation to specific service users only. In these circumstances, the Panel has concluded that the case of Udom v. GMC does not apply in this case.
Misconduct
445. The Panel has considered whether the facts it has found proved in Particular 1 demonstrate that the Registrant’s performance as a Band 5 SLT fell “far below” the standards expected of a Band 5 SLT. In doing so the Panel has had in mind the qualitative difference between lack of competence and misconduct. While the Panel has found some of the Registrant’s lack of competency in some aspects of her role as a Band 5 SLT were more serious than others, it has concluded that none were so serious, or fell so “far below” the standards expected of a Band 5 SLT as to amount to misconduct in this case. The Panel has concluded that none of the more serious competency shortcomings would be considered by fellow professionals, or the wider public, as being either “egregious”, “deplorable” or “morally wrong”, descriptions which are often applied to behaviour which amounts to serious misconduct.
446. The Panel notes that at all times the Registrant engaged with the Trust’s informal review and then the formal Capability Process. This is apparent from the notes of the weekly meetings between DD (or LP) and the Registrant. As part of the informal Capability Process (which ran for most of the period of the Allegation), the Registrant was required to catch up on outstanding reports, discharges and INT forms for a period which pre-dated the Allegation. She was taken off all client work for a short period in order to do this before client work was re-introduced at a reduced level. CC told the Panel that even the Registrant’s reduced level of client contacts would now be thought of as too high. The Panel also notes that being subject to an informal review followed by a formal Capability Process would inevitably have been stressful for the Registrant and would have eaten into the time she had available to complete the various aspects of her work as a Band 5 SLT.
447. At times, as the evidence shows, the Registrant was able to make progress in maintaining an appropriate level of competency for the vulnerable and complex Service Users in her caseload. However, there were also times when she was unable to maintain this progress across all the Service Users in her caseload. In these instances, the Registrant lacked competence and, it would seem, the ability to do anything about it at that time. The Panel accepts the evidence of CC that when she joined the Trust in November 2017, the standard of the Registrant’s work was similar to other SLT’s in the department. CC was asked by the HCPC to review a number of the Service User files relied on in evidence. CC said she had noted a few very small issues, but she was happy with the overall standard of the Registrant’s practice.
448. The Panel is satisfied that all the concerns regarding Registrant’s level of competency as a Band 5 SLT with the Trust, including those it has judged to be the more serious ones, are more properly and accurately characterised as showing a “lack of competence” rather than “misconduct”.
449. The Panel therefore finds that the statutory ground of lack of competence proved, and the statutory ground of misconduct not proved.
Reconvened hearing – 12 September 2023
450. The Panel reconvened to hear this case on 12 September 2023 when it handed down its decision on the facts and statutory grounds. Prior to doing this, the Panel considered whether there was any reason why it should not continue to hear the case in the absence of the Registrant.
451. The Panel has seen an unredacted copy of an email dated 31 May 2023 which was sent to the Registrant’s registered email address. This email informed her of the date of today’s reconvened hearing, that it is being conducted virtually and invited her to indicate if she intended to attend. The Panel has also seen confirmation from Microsoft Outlook that the email was delivered to the Registrant’s email address on the same date. The Panel is satisfied, on the basis of this documentation, that the Registrant has been served with notice of today’s reconvened hearing.
452. The Panel notes that the Registrant has not responded to the Notice of this reconvened hearing. It has also received confirmation from the Hearings Officer that the Registrant has not engaged with the HCPC, or with the HCPTS regarding this hearing since it started in March 2023. The Panel is satisfied that there is no reason to depart from the decision made then, namely that it is in public interest for the case to be heard in the absence of the Registrant.
Decision on Impairment
Submissions
453. Ms Saran submitted that the Registrant’s fitness to practise is impaired on both the personal and public components.
454. In relation to the personal component, Ms Saran submitted that while the matters which led to the finding of lack of competence were remediable, there was no evidence from the Registrant that she had taken any steps to remedy her lack of competence. Ms Saran submitted that in the absence of any such steps, the risk of repetition in this case was high.
455. Ms Saran submitted that the findings of fact showed that the Registrant’s lack of competence had exposed the Service Users to the risk of harm, although she conceded that there was no evidence of actual harm having been caused to any of them. Ms Saran cited as examples of the Registrant’s shortcomings which could have caused harm: the Registrant’s not completing reports either at all or in a timely manner, and the Registrant not reviewing the Service Users regularly and/or setting dates for such reviews. She submitted the likelihood was that the relevant Service Users would have been worse off as a result of the Registrant’s lack of competence.
456. Ms Saran submitted that the Registrant had breached fundamental tenets of the profession by not prioritising the Service Users, and by not practising effectively and safely so that the trust and safety of Service Users was compromised. Ms Saran submitted that the Speech and Language Therapy profession had been brought into disrepute by reason of the Panel’s findings which related to her treatment of over 100 Service Users. She also submitted (i) that as the Registrant had shown no insight into her shortcomings and the effect of these on her colleagues, on the Service Users, or on the profession as a whole, and (ii) because there was no evidence of what the Registrant would do differently were she permitted to practice without restriction, there was a risk of repetition.
457. In relation to the public component, Ms Saran submitted that public confidence in the Speech and Language Therapy profession would be undermined if there is no finding of impairment in this case. She also submitted that a finding of impairment was necessary in this case in order to uphold standards of behaviour and conduct in the profession.
Decision
458. In reaching its decision on impairment, the Panel has had regard to the HCPTS Practice Note “Fitness to Practise Impairment”. The Panel has taken account of Ms Saran’s submissions. The Panel notes that it has received no evidence or information from the Registrant to consider at this stage of the proceedings. It has received and accepted legal advice. The Panel has borne in mind that the purpose of this hearing is not to punish the Registrant for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise.
Personal component
459. The Panel first considered the personal component. It is satisfied that in its findings of fact and lack of competence, the Registrant had put those Service Users at risk of unwarranted harm. The Panel considers, by way of example, that this is shown by its findings in relation to the Registrant’s not writing reports either at all, or in a timely manner, and in her not undertaking regular reviews and/or her failure to set review dates for Service Users. The Panel considers that lack of competence in such areas has the potential to delay much needed interventions by medical professionals or other therapists. The Panel has already found that the writing of reports is required for continuity of care so that those parties to whom reports are sent (medical professionals, other therapists, and parents) are aware of the condition of the service user, the need for any ongoing treatment and the nature of that treatment. With regard to the regular review of service users, the Panel considers that the potential for harm arises because there may be missed opportunities to identify, or action needs which a review might have revealed.
460. The Panel is satisfied that the Registrant’s lack of competence is remediable. The Trust’s capability process which the Registrant was required to undertake, was intended to allow her to achieve and maintain the relevant standards of practice as a Band 5 SLT. However, as the Registrant has not engaged with these proceedings, there is no evidence before the Panel to show that she has taken any steps since leaving the Trust to remedy her lack of competence. The Panel notes that the Registrant was able to make some progress in some areas of her practice during the capability process, but that she was not always able to maintain this. The Registrant has not shown that she has insight into her lack of competence and its effect on the Service Users concerned, on her colleagues, or on her profession. There is no evidence that the Registrant has properly reflected on her lack of competence. The Panel also notes that while the Registrant’s state of health at the relevant time may have been a factor contributing to her lack of competence, it has no evidence of the current state of her health and how she is managing this. The Panel has concluded that, in the absence of any information to show that the Registrant has taken steps to remedy her shortcomings, there is a real risk of repetition in this case.
461. In these circumstances, the Panel is satisfied that the Registrant’s fitness to practise is impaired on the personal component.
Public component
462. In relation to the public component, the Panel has already found that the Registrant’s lack of competence has in the past put the public at unwarranted risk of harm. Looking forward, as there is no evidence of any remediation by her, there is a risk that the Registrant may put the public at risk of unwarranted harm in the future. The Panel considers that a finding of impairment is required on grounds of public protection.
463. The Panel is satisfied that its findings of lack of competence has brought the profession into disrepute: she has breached fundamental tenets of the profession in not prioritising service users and not ensuring that she was practising safely. This inevitably damages public confidence in the Speech and Language Therapy profession and brings it into disrepute.
464. The Panel is satisfied that public confidence in the Speech and Language Therapy profession would be significantly undermined if there is no finding of impairment in this case. It considers that a reasonable and well-informed member of the public would expect such a finding where (i) a registrant’s lack of competence had the potential to put service users at risk of harm, and (ii) where there was no evidence of insight or of any steps having been taken to remedy the lack of competence, so that there was a real risk of repetition.
465. The Panel also considers that such a member of the public would expect a finding of impairment in order to declare and uphold proper standards of conduct and behaviour within the profession. The Panel is satisfied that it would be failing in its duty to uphold and declare proper standards of conduct and behaviour in the Speech and Language Therapy profession if it did not find that the Registrant’s fitness to practise is impaired by her lack of competence. It considers that if there is no finding of impairment, it would send out the wrong message, namely that lack of competence of this nature, does not have any regulatory consequences.
466. In these circumstances, the Panel is satisfied that the Registrant’s fitness to practise is impaired on the public component.
467. Accordingly, the Panel finds, on both the personal and the public component, that the Registrant’s fitness to practise is impaired and the Allegation is well founded.
Decision on Sanction:
468. In considering the appropriate and proportionate sanction the Panel was referred to, and has taken account of, the HCPC’s Sanctions Policy. The Panel has received and accepted legal advice. The Panel is aware that the purpose of any sanction it imposes is not to punish the Registrant, although it may have that effect, but it is to protect the public, to maintain confidence in the Speech and Language Therapy profession and to uphold its standards of conduct and behaviour. The Panel has also had in mind that any sanction it imposes must be appropriate and proportionate bearing in mind the nature and circumstances of the lack of competence involved.
Submissions
469. Ms Saran set out the relevant principles regarding the imposition of a sanction. As is the HCPC’s usual approach at the sanction stage, Ms Saran did not advance any particular sanction, other than to suggest that in light of the Panel’s findings the appropriate and proportionate sanction was likely to be at the more serious end of those sanctions which were available to the Panel.
Decision
470. The Panel has considered mitigating and aggravating factors. The Panel first looked at the mitigating factors, including personal mitigation. The Panel has concluded that the following is a mitigating factor: that there have been no previous findings of impairment against the Registrant.
471. The Panel has also considered with care the evidence of the Registrant’s work environment in the SLT department at the relevant time. It is clear from the evidence of CC that the department was historically understaffed which put significant pressure on the SLTs. CC told the Panel that she had since restructured the department and reduced the caseload in such a way that it is not measured by reference simply to the number of face-to-face service user contacts. CC said that at the relevant time it was expected that SLTs would have 6 contacts a day regardless of anything else which was going on, and that this was too high. CC said that 4 to 5 contacts a day with no interruptions might be manageable but if an SLT was also attending capability process meetings as well as Occupational Health meetings, a workable caseload would be less than 4 to 5 contacts a day.
472. The Panel notes that the Registrant herself indicated both during her weekly meetings with DD and in her response to the Investigation Management Report, that she was finding the capability process to be stressful. She acknowledged that she was being supported by her line manager but also felt that the focus of DD’s concerns tended to be on the negative aspects of her work, e.g., on report writing and that DD had only once observed her when treating service users despite saying that she would do so on other occasions. The Panel has some concerns that DD, in concentrating on issues such as timeliness and correcting grammar and spelling, may not have properly understood the difficulties the Registrant was experiencing at the time so that she could put in place the best type of support for her. The Panel considers that the workload in respect of vulnerable children with complex needs expected of the Registrant was extraordinarily high. The Panel has therefore concluded that the Registrant’s work environment at the time amounts to a mitigating feature in this case.
473. The Panel has considered whether there was anything in the documents regarding the Registrant’s personal circumstances and her physical and/or mental health at the relevant time (June 2015 to June 2017) which might provide any mitigation in this case. The Panel has already indicated that it considers there were health issues which may have impacted on her performance during this period but that this did not fully explain her lack of competence. The Panel has therefore concluded, on the information before it, that it can take the Registrant’s health into account as personal mitigation.
474. The Panel also notes that it has not been provided with any testimonials by the Registrant.
475. The Panel considers the following to be aggravating factors:
- the Registrant has not shown any insight into the impact of her lack of competence on the Service Users, her colleagues, her profession, or the wider public interest. She has not shown any remorse.
- the Registrant has not taken any steps towards remedying her lack of competence;
- the Registrant’s lack of competence involved a repetition of concerns;
- the Registrant’s lack of competence had the potential to put vulnerable children at risk of harm and so impact adversely on public confidence in the SLT profession.
476. The Panel has considered the available sanctions in ascending order of seriousness. It has decided that this is not a case where mediation would arise as a possible sanction. It has also decided that to take no action or impose a Caution Order in this case would not be appropriate or proportionate given that the lack of competence was not isolated or limited, and nor could it be described as relatively minor in nature. The Panel is not able to conclude that there is a low risk of repetition because the Registrant has not shown any insight into the causes of lack of competence or the impact of it on the Service Users, her colleagues, her profession, and the wider public. The Panel is satisfied that to ensure public confidence in the profession is not undermined, it must consider a more severe sanction.
477. The Panel then considered a Conditions of Practice Order and in particular the matters set out in paragraph 106 of the Sanctions Policy which states:
“A conditions of practice order is likely to be appropriate in cases where:
• the registrant has insight;
• the failure or deficiency is capable of being remedied;
• there are no persistent or general failures which would prevent the registrant from remediating;
• appropriate, proportionate, realistic and verifiable conditions can be formulated;
• the panel is confident the registrant will comply with the conditions;
• a reviewing panel will be able to determine whether or not those conditions have or are being met;
• the registrant does not pose a risk of harm by being in restricted practice”.
478. The Panel has also had in mind paragraphs 107 which states:
107 “Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious and persistent failings”.
479. The Panel has found that the lack of competence in this case is capable of being remedied. The Panel considers that as the Registrant has shown no proper insight into her lack of competence, there remains a real risk that she will repeat it.
480. The Panel has also concluded that it is not possible to devise appropriate, proportionate, realistic, and verifiable conditions which would address the serious concerns regarding the Registrant’s lack of competence in this case. The Registrant is not engaging with the regulatory process and so the Panel has no confidence that she would comply with a
Conditions of Practice Order.
481. The Panel notes that as the statutory ground found proved is lack of competence, the most severe sanction that it can impose is a Suspension Order. A Strike Off Order is not available to it at this point in time. In considering whether to impose a Suspension Order, the Panel has had in mind the following guidance from the HCPC’s Sanctions Policy:
“121 A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:
• the concerns represent a serious breach of the Standards of conduct, performance and ethics;
• the registrant has insight;
• the issues are unlikely to be repeated;
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”
482. The Panel has also concluded that a Suspension Order for a period of 12 months would be the appropriate or proportionate sanction in this case. Such an Order would maintain public confidence in the Speech and Language Therapy profession, and it would also send out an appropriate message to the profession about this type of lack of competence. The Panel considers that a reasonable and well-informed member of the public would expect a registrant who had been found to lack competence in a number of areas of practise, and who was not engaging with the regulatory process, to be suspended.
483. The Panel has decided that the period of suspension should be for 12 months. This period would allow a meaningful opportunity for the Registrant, should she decide to do so, to change her mind and take steps to show that she wants to return to a career as an SLT. The Panel has no information as to whether the Registrant has been subject to an Interim Order during the course of these proceedings but, on the assumption that there is, it is likely that the Registrant would be required to complete a Return to Practice course. If the Registrant chooses not to return to practise as an SLT, and she continues not to engage with these proceedings, it will be inevitable that after the appropriate period of time has elapsed, she will be struck off the Register.
484. In the event that the Registrant has a change of heart and decides she does want to resume her career as an SLT, the Panel considers that the reviewing panel may be assisted by the following for the review hearing:
1. the Registrant’s attendance either in person or virtually by video conference, so that she can update the reviewing panel on her current employment position;
2. a reflective piece by her, evidencing her insight into the consequences of her shortcomings on not only the Service Users, but also on her colleagues, her profession and the wider public;
3. information about what she has been doing by way of employment since she left the Trust, including testimonials (from one or more employers) which address the Registrant’s abilities in relation to any record keeping and administrative aspects of her employment, as well as any other matter relevant to her shortcomings;
4. testimonials from work colleagues and/or personal colleagues;
5. evidence of any Continuing Professional Development (CPD) courses undertaken, and/or any informal training undertaken to maintain the skills and knowledge of an SLT, including any informal reading;
6. evidence from her GP as to the current state of her health, and how this is being managed, including any support mechanisms which she has put in place.
Particular 2 – health concern
485. The Panel has seen the HCPC’s skeleton argument dated 21 July 2022 in which it is submitted that the health concern alleged in Particular 2 of the Allegation above, should be transferred to a panel of the Health Committee so that it may be discontinued.
486. The Panel is satisfied that in imposing a Suspension Order for a period of 12 months it has fully discharged its duty to protect the public and the wider public interest. It has therefore decided to transfer the secondary health allegation to a panel of the Health Committee so that it can hear the HCPC’s application to discontinue the health allegation.
Order
The Registrar is directed to suspend the registration of Ms Alice Langley for a period of 12 months from the date that this order comes into effect.
Notes
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 Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.
Interim Order
Proceeding in the absence of the Registrant
1. Ms Saran applied for an Interim Suspension Order. Ms Saran submitted that given the Panel’s findings in relation to impairment, an Interim Suspension Order was necessary to protect the public from an ongoing risk of harm, and it was otherwise in the public interest.
2. The Panel has decided to proceed in the Registrant’s absence for the same reasons as set out in its determination above. The Registrant has received proper notice of the application in the email sent to her by the HCPC on both 08 December 2022 and 31 May 2023. The Panel considers that the Registrant has voluntarily waived her right to attend and that it is in the public interest that such an application is considered.
Decision
3. The Panel has decided to make an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest for the reasons set out in the determination above.
4. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
Hearing History
History of Hearings for Alice Langley
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 12/09/2023 | Conduct and Competence Committee | Final Hearing | Suspended |
| 15/05/2023 | Conduct and Competence Committee | Final Hearing | Adjourned part heard |
| 13/03/2023 | Conduct and Competence Committee | Final Hearing | Adjourned part heard |