Mr Stephen G Morgan

Background

1. The Registrant is registered with the HCPC as an Occupational Therapist. He was employed by the Cambridge and Peterborough NHS Foundation Trust (‘the Trust’) from February 2005 until March 2017, as a Band 6 Occupational Therapist working in the Trust’s Inpatient Rehabilitation department.

2. In 2015 the Trust underwent a restructure, and a number of separate teams (neighbourhood team, community nurses, occupational therapists and mental health workers) were formed.

3. In November 2015, an informal performance investigation was commenced into the Registrant’s record keeping, duty of care, collaborative working, communication, patient safety and professionalism. This progressed to a formal investigation in May 2016; and the Registrant’s case was referred to the HCPC. The Trust dismissed the Registrant in March 2017. The Registrant appealed against the Trust’s decision, and it was then agreed that the Registrant could leave his position on the grounds of ill health, in July 2017.

4. In November 2018, the Registrant appeared before a panel of the Conduct and Competence Committee. The particulars were found proved, save for particular 2.

5. The substantive hearing panel found that particulars 1(a), 1 (b), 4, 5(a), 5 (b), 6, 7(a), 7(b), 8, 9(a), 9 (b), 10, 11(a), 11(b), 12(a), 12 (b) and 12
(c) each amounted to misconduct, and that particulars 3(a), 3(b), and 13 amounted to a lack of competence.

6. The matters found proved included failings in the Registrant’s record- keeping, his actions following assessments of patients’ needs, his communication with colleagues, and his clinical reasoning. Furthermore, the substantive panel found that the Registrant had not achieved the required levels of competence in record-keeping, communication, clinical reasoning and interpersonal relationships, including poor quality and sometimes inaccurate information being handed over to colleagues; the Registrant consistently failed to take responsibility for himself and was unable to effectively manage his own time.

7. The substantive panel concluded that the Registrant’s conduct was remediable. However, that panel was not convinced by the Registrant’s assertion that he had developed the requisite skills as a result of a course he had taken two weeks before the substantive hearing. Nor was the substantive panel persuaded that the Registrant’s role as a Healthcare Assistant had required him to implement this learning to the same standard as that required of an Occupational Therapist.

8. The substantive panel was not satisfied that the Registrant had developed any insight into his failings in relation to clinical reasoning and his inability to make the judgments required when making a clinical decision. The substantive panel was also concerned about his lack of insight into the impact of his actions, or inactions, on the Trust and service users. Despite the Trust’s support, the Registrant still associated his conduct and competence with his working environment. The conclusion reached was that the Registrant’s failings were highly likely to reoccur.

9. The substantive panel concluded that the Registrant’s fitness to practise was impaired both on grounds of public protection and on grounds of the wider public interest. The substantive panel concluded that a Conditions of Practice Order for a period of 18 months was the appropriate sanction.

The first substantive review hearing on 15 September 2020

10. The Registrant attended the first substantive review hearing on 15 September 2020 and provided a reflective statement. At the commencement of his evidence the hearing had to be adjourned due to problems with the Registrant’s internet connection. The hearing resumed on 30 September 2020, when the Registrant provided a second reflective statement and gave evidence before the Panel.

11. The Registrant had been working as a Healthcare Assistant since October 2017, and the last time he worked as an Occupational Therapist was in March 2016. He had been looking for work as an Occupational Therapist but had been unsuccessful, although he was determined to return to work in his profession when a post became available.

12. He said that it had been his understanding that Condition 3 would only come into effect if he secured a position as an Occupational Therapist. He admitted that he had not immediately informed his employers of the existence of his Conditions of Practice, but that he had now done so, after this Condition had been explained to him.

13. The Registrant said he was doing well in his current employment. He had been permitted to stand in for senior health carers when they were not available. This had given him greater confidence and he was now able to delegate decisions effectively and communicate positively with members of staff. He asked for an opportunity to demonstrate his abilities as an Occupational Therapist.

14. The panel at the first substantive review hearing concluded that the Registrant’s fitness to practice remained impaired and decided to extend the Conditions of Practice Order for a period of 12 months.

The second substantive review hearing on 23 September 2021

15. At the second substantive order review on 23 September 2021 the panel found that there had been some engagement on the part of the Registrant with the HCPC but he had not complied with the suggestions of the previous panels as to what might be helpful steps to take in respect of the review hearing.

16. That panel concluded that the Registrant’s fitness to practise remained impaired. He had not practised as an Occupational Therapist since the imposition of the Conditions of Practice Order or remediated his failings and his insight was at an early stage of development. It was the judgment of that panel that there remained a high risk that the Registrant would repeat his failings, if permitted to practise unrestricted and he remained impaired on public protection grounds. Furthermore, the public interest demands a continued finding of impairment to uphold standards and confidence in the profession and the Regulator.

17. That panel concluded that to take no action or to impose a Caution Order would be insufficient in light of the seriousness of the allegation and a Conditions of Practice Order remained the appropriate and proportionate order in the circumstances. An extension of 12 months would be sufficient to enable the Registrant to develop the necessary insight and to remediate his deficiencies and it would be appropriate to add one further condition to the existing order, which would now become Condition 11. Accordingly, that panel varied the Conditions of Practise Order and extended the Order for a period of 12 months.

The third substantive review hearing on 26 September 2022

18. The third substantive order review took place on 26 September 2022. The Registrant attended that hearing and gave evidence. He acknowledged that his fitness to practice was still impaired in that he had not had a chance to fully remediate as he had been unable to find employment as an Occupational Therapist. He had, however, enrolled on a return to practice course which commenced in August 2022, and he had also been allocated a professional mentor. He asked for one last chance to prove that he could attain the skills required for an Occupational Therapist and asked for an extension of 12 months to the current Order.

19. The panel concluded that the Registrant’s fitness to practise remained impaired in respect of the personal component. The panel was of the view that, although the Registrant had provided evidence of the development of insight, his reflective piece failed to deal with the significance of his previous misconduct. Furthermore, as the Registrant had not worked as an Occupational Therapist, there was insufficient evidence to show that he had addressed the outstanding concerns about his practice and that they would not be repeated.

20. The panel also considered that the Registrant’s fitness to practise remained impaired in respect of the public component as public confidence in the profession and the regulatory process would be undermined if the Registrant were permitted to return to unrestricted practice.

21. The panel noted that the Registrant remained employed as a Healthcare Assistant and was working alongside registered Occupational Therapists in a clinical setting. The Registrant’s clinical lead, who was a registered nurse, had provided a positive testimonial as to his work ethic and commitment. The fact that the Registrant had started on a return to practice course provided him with the opportunity to improve his professional skills so that he might obtain employment as an Occupational Therapist after completion of his course in May 2023.

22. The panel therefore decided to extend the Conditions of Practice Order, for a further period of 12 months.

23. The panel advised that the next review panel might be assisted by the following from the Registrant:

• A reference from his mentor as to how he had engaged with the return to practice course, the skills he had developed and modules undertaken;

• A reference from his line manager detailing his work practices and work ethic;

• A full and detailed written reflective piece, perhaps with an input from his mentor, demonstrating full insight into his past failings, what he had learnt and how he intended to embed these lessons in his practice;

• The Registrant may wish to explore with his manager ways to undertake a placement with the Occupational Therapists in his work setting within the terms of this Conditions of Practice Order, so as to allow him demonstrate his practical Occupational Therapy skills.

Today’s hearing

24. The Panel was provided by the HCPC with a hearing bundle which included the decisions of the panels at the substantive hearing and the subsequent reviews.

25. The Registrant provided the Panel with a bundle of documents including:

• Certificates of attendance in relation to HCPC courses on Duty of Candour and Service User Engagement

• A certificate of having completed a Return to Practice course dated 1 September 2023

• An undated reflective piece

• A supervision record of his placement at Addenbrookes Hospital between 15 May 2023 and 21 June 2023

• A testimonial dated 25 September 2023 from the Registrant’s Mentor for his Coventry University Return To Practice Course confirming that the Registrant attended all 17 planned sessions and had always been dedicated, hard-working, motivated and willing to learn and develop his skills

• An email dated 25 September 2023 from Cambridge University Hospitals NHS Foundation Trust confirming that a conditional offer of employment is open to the Registrant for a Band 5 rotational Occupational Therapist

26. On behalf of the HCPC Ms Khorassani adopted a neutral stance as to whether the Registrant’s fitness to practise was currently impaired, although she indicated that the HCPC was satisfied that the Registrant had complied with the Conditions of Practice Order and followed the recommendations of the previous panel as to matters which the Registrant needed to address for the purpose of today’s review.

27. On behalf of the Registrant Ms Renou submitted that the Registrant’s fitness to practise was no longer impaired and that the Conditions of Practice Order should be revoked with immediate effect or cease to be renewed on the expiry of the current order.

The Panel’s decision

28. The Panel took into account the HCPTS Practice Notes “Review of Article 30 Orders Sanction” and “Fitness to Practise Impairment” and accepted the advice of the Legal Assessor.

29. The Panel first considered whether the Registrant’s fitness to practise was currently impaired by reason of his misconduct and/or lack of competence.

30. The Panel took into account the decision of the High Court in Abrahaem v GMC where it was stated that in practical terms there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he has fully acknowledged the deficiencies which led to the original findings and has addressed his impairment sufficiently “through insight, application, education, supervision or other achievement”.

31. The Panel was satisfied that the Registrant had gained sufficient insight into his past failings, what he had learnt and how he intended to embed his learning in his practice as noted in his reflective piece.

The Panel also took note of the CPD undertaken by the Registrant which includes the HCPC’s:
• Duty of Candour
• Service User Engagement
• Updated Proficiency Training
• Safeguarding Training
• Maintaining fitness to practice
The Registrant also undertook training elsewhere which included Moving and Handling, Leading a Team and was accessing resources from the OT Hub.

32. The Panel gave credit to the Registrant for completing a return to practice course, for undertaking a placement at Addenbrookes Hospital and obtaining a conditional offer of employment from Cambridge University Hospitals NHS Foundation Trust as a Band 5 Occupational Therapist.

33. The Panel noted that the Registrant had only recently completed the return to practice course and that completion of the course did not in itself validate his competence to practise as an Occupational Therapist. The period of his voluntary placement with a supervisor at Addenbrookes Hospital had only lasted six weeks between May and June 2023 and the supervision notes indicated that he had not achieved full competence in clinical reasoning and there was further work required in time management including making referrals and completing patient reports in a timely manner.

34. Given the wide-ranging and serious concerns about the Registrant’s competence at the original substantive hearing, and the outstanding work to be done as indicated in the supervision notes, the Panel was not satisfied that the Registrant had fully remediated the deficiencies in his clinical practice, particularly in relation to clinical reasoning and time management. The Panel therefore concluded that the Registrant had not discharged the persuasive burden to demonstrate that his fitness to practise was no longer impaired. Whilst such deficiencies are remediable, there remains a risk of repetition until they are fully remedied and in consequence a potential risk to patients and service users. It follows that some restriction is required on the Registrant’s ability to practise, having regard to the personal component of impairment.

35. The Panel also considered that, until the Registrant has fully remedied the deficiencies in his practice, there are potential risks to patient safety and public confidence in the profession and in the HCPC as its Regulator would be undermined if there were no finding of current impairment.

36. The Panel therefore determined that the Registrant’s fitness to practise remains impaired having regard to both the personal and public components of impairment.

37. With regard to sanction, the Panel took into account the HCPC’s Sanctions Policy and accepted the advice of the Legal Assessor.

38. The Panel considered the options by way of disposal in ascending order of seriousness.

39. Taking no further action would not be appropriate given the outstanding concerns about the Registrant’s practice.

40. A Caution Order would also not be appropriate because such an order would not provide any level of protection to the public.

41. The Panel considered that a further Conditions of Practice Order for a period of 12 months would be the most appropriate and proportionate sanction. This is because of the level of insight shown and the Registrant’s willingness to remediate his failings by securing an OT role following his return to practice course and placement. The Panel also note the Registrant’s engagement with the HCPC and its regulatory process. The Panel decided to vary the conditions of practice to reflect the progress that the Registrant had already made and to enable him to concentrate on addressing the outstanding issues.

42. The Panel considered that a Suspension Order would be disproportionate given the progress that the Registrant had made towards a safe return to practice.

The Registrar is directed to extend and vary the Conditions of Practice Order against the registration of Mr Stephen G Morgan for a further period of 12 months on the expiry of the existing Order. The Conditions are:

1. You must inform the HCPC, within 7 days, if you cease to be employed by your current employer or take up any other or further employment.
2. You must inform the HCPC, within 7 days of any disciplinary proceedings taken against you by your employer.

3. You must inform the following parties that your registration is subject to these conditions:

a. any organisation or person employing or contracting with you to undertake professional work;
b. any agency you are registered with or apply to be registered with (at the time of application); and
c. any prospective employer (at the time of your application).

4. You must confine your professional practice to that of a Band 5 Occupational Therapist.

5. You must place yourself and remain under the supervision of a workplace Occupational Therapist supervisor at Band 6 or above registered with the HCPC and supply details of your supervisor to the HCPC within 14 days of taking up a position as an Occupational Therapist. You must attend upon that supervisor and follow their advice and recommendations.

6. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice: a. Clinical reasoning (both written and oral); b. Record keeping; c. Report writing; d. Effective time management, which includes, if appropriate, making any referrals in a timely manner;

7. Within three months of taking up employment as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

8. You must meet with your supervisor on a fortnightly basis, or at a frequency directed by your supervisor, to consider your progress towards achieving the aims set out in your Personal Development Plan.

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

This Order will be reviewed again before its expiry on 22 October 2024.

History of Hearings for Mr Stephen G Morgan