Sarah Sikpa

Proceeding in private

1. Ms Khan submitted that any references to the health of the Registrant should be received in private. Having heard and accepted the advice of the Legal Assessor, the Panel determined that any reference to the health of the Registrant should be received in private but otherwise this was a public hearing. The written determination of the Panel will reflect this ruling.

Background as taken from the determination of the panel that imposed the Suspension Order on 30 September 2022. [The Substantive Order Panel]

2. At the relevant time, Ms Sikpa [the Registrant] worked as a Band 8a Practitioner Psychologist with the Black Country Partnership NHS Foundation Trust (“the Trust”). She initially worked at the Trust through an employment agency from October 2015, but was employed directly by the Trust from 1 November 2016. The Trust merged with Dudley and Walsall Mental Health Partnership NHS Trust in April 2020 to form Black Country Healthcare NHS Foundation Trust, which is what the Trust is now known as.
3. The Registrant was suspended by the Trust pending investigation in March 2018. The investigation included conducting an audit of her clinical caseload.
4. On 25 April 2018, the HCPC received an anonymous referral about the Registrant which identified a number of concerns about her practice.
5. The HCPC contacted the Trust about the concerns. The Trust supplied information to the HCPC in August 2018 which appeared to confirm that the Trust had identified issues with record keeping, including that the Registrant did not complete care plans and risk assessments for some service users.
6. On 29 January 2020, an Investigating Committee Panel of the HCPC determined that the concerns should be referred to the Conduct and Competence Committee.

The hearing before the Substantive Order Panel.

7. The matters came before a Substantive Fitness to Practise Panel in 2022. The dates of the hearing were 7-16 June 2022 and 27 - 30 September 2022. The Registrant was present at the hearing for the period 7 - 16 June 2022. She gave evidence under affirmation and responded to questions from the panel. In addition, she provided the panel with a written statement of 47 pages.

8. The Substantive Order Panel made the findings of fact that are identified above. In summary, it determined that all bar 3 of the allegations were proved. The Substantive Order Panel concluded that the allegations that were found proved amounted to “serious misconduct” and met the threshold for the statutory ground of misconduct.

Decision of the Substantive Order Panel as regards impairment.

9. The Substantive Order Panel determined that the Registrant’s fitness to practise was impaired by reason of her misconduct. Its reasons for coming to this conclusion were fully set out in its determination and include those set out below. For ease of reference the paragraph numbers used in the determination of the Substantive Order Panel have been retained but are shown in brackets.

(226) The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective. It was concerned that Ms Sikpa did not appear to understand the gravity of the findings it had made in relation to her conduct, though undoubtedly she understood the impact of the same. The Panel was sympathetic to her personal circumstances, however her reaction to the allegations was a primary concern.

(227) The Panel found that Ms Sikpa demonstrated little insight into her standard of practice between 2016 and 2018, and almost no information in relation to her current practice. The limited information currently available to the Panel was superficial and not underpinned by any training or testimonials. The Panel is conscious that it is entirely possible for a registrant in a similar position to Ms Sikpa to maintain their views but be able to produce a reflective piece on the issues identified by the panel. Reflection involves reviewing experiences to help make positive changes for future practice, turning experiences into learning. Critical reflection evaluates a registrant’s approach, judgement, decisions and interventions and can incorporate objective assessments to identify learning needs and create a cycle of experience, reflection, learning and change. The Panel did not consider that Ms Sikpa had yet reached this level of reflective practice.

(228) The Panel considered that the areas of practice where misconduct had been found were capable, in themselves, of remediation. However, without appropriate insight, the effectiveness of remediation would be limited. It concluded that in the light of Ms Sikpa’s lack of meaningful insight and remediation, there was a real risk of the shortcomings being repeated and therefore it found her to be impaired on the “personal” aspect of the test for impairment.

(229) In considering the public component of impairment, the Panel had regard to the important public policy issues which include the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour. It considered that members of the public and members of the profession would be concerned to learn that a practitioner psychologist had supervised trainees while failing to record risk assessments and care plans in respect of a number of service users over a prolonged period of time, whilst under supervision due to a previous regulatory finding. It determined that public and professional trust and confidence in the profession, professional standards, and the regulator would be undermined if a finding of impairment was not made. The Panel concluded that Ms Sikpa’s fitness to practise is currently impaired on the basis of both the personal and public component.

Decision of the Substantive Order Panel as regards sanction.

10. Having considered the relevant aggravating and mitigating factors, the Substantive Order panel considered what sanction it should impose. It took account of the risk of repetition. It concluded that to take no action or to issue a caution order would not be appropriate. It further concluded that it could not formulate workable conditions which adequately protected the public and which did not amount to suspension.
11. The Substantive Order panel imposed a Suspension Order for 12 months. Its reasons for coming to these conclusions, were fully set out in its determination and include those set out below. For ease of reference the paragraph numbers used in the determination of the Substantive Order Panel have been retained but are shown in brackets.

(253) The Panel concluded that the nature of the misconduct, and the period of time during which it was perpetrated (i.e. when already subject to a conditions of practice order) was such that the public and the wider profession would consider anything less than a suspension order to be insufficient. It also considered that Ms Sikpa would benefit from some time to address her health concerns, focus on her reflections on these proceedings and her future intentions before addressing the failings identified by the panel.

(254) The Panel was content that fellow professionals, colleagues of Ms Sikpa and the public generally would, if aware of all of the circumstances of this case, recognise that a period of suspension was appropriate and proportionate to allow Ms Sikpa one further opportunity to demonstrate reflection, insight and remediation.

(255) The sanctions guidance also advocates that “It’s good practice to test the appropriateness and proportionality of a proposed sanction by considering the next sanction up against each of the limbs of the overarching objective that were found to apply at the impairment stage.” The Panel therefore considered whether a striking off order was more appropriate in the circumstances. It had careful regard to the non-exhaustive list of serious cases that could warrant a striking off order being made and was satisfied that such an action would be excessive in the circumstances of this case - Ms Sikpa had engaged with her regulator throughout and expressed her desire to continue practising, which the Panel did not doubt was genuine. It was mindful that the sanction of removal from the register should only be imposed when no other outcome would be enough to protect the public, maintain confidence in the profession or maintain proper professional standards. In this case, protection of the public would be achieved by the imposition of a suspension order and the public interest would be met by a period of suspension.

(256) The Panel sincerely hoped that the conclusion of these proceedings and a period of reflection will allow Ms Sikpa the time needed to focus on the steps required to demonstrate to her regulator that her insight, remorse and remediation are securely embedded in her methods of practice. The Panel had no doubt that Ms Sikpa was passionate about, and committed to, her profession. Its concern is her certainty that she does not pose a risk to service users despite the comments of her former colleagues and the findings of this Panel.

(257) Having determined that a suspension order is the appropriate and proportionate sanction to impose, the Panel then considered the length of time that it should be in place, conscious that it was in the public interest to support the return to practise of a qualified professional when this can be achieved safely. It determined that anything less than 12 months would be insufficient to mark the serious nature of the misconduct or ensure that Ms Sikpa could genuinely address the concerns. Accordingly, the appropriate length of the suspension order would be 12 months, though of course if Ms Sikpa is able to make good progress in taking on board the findings of the Panel, she may be able to request an early review of the order.  

Suggestions made by the Substantive Order panel as to what might assist a future reviewing panel.

12. At the conclusion, in paragraph 258 of its determination, the Substantive Order panel made suggestions as to what might assist a future reviewing panel and these suggestions were in the following terms; 

(258) The Panel recognises that it cannot bind or influence a future reviewing panel, however it considered that any such panel would be greatly assisted if Ms Sikpa was able to attend and engage fully in future hearings, and provide it with some or all of the following information in advance of the review hearing:

a. detailed written reflective piece focusing on:

    i.Working in a multi-disciplinary team;

    ii. Record keeping;

b. information on her current health, supported by medical evidence where appropriate which sets out the nature and extent of any ill-health as well as the treatment and prognosis;

c. information as to her personal circumstances insofar as this impacts upon her professional practice;

d: evidence of relevant training undertaken in contemplation of a return to the profession, in particular in respect of:

   i. Risk assessment and analysis;

  ii. record keeping;

  iii.  Integrity and professional ethics;

  iv. Working in a multi-disciplinary team

 e. details of any professional literature she reads, with her incorporating in her reflective work how the literature has impacted upon her practice;

f. recent testimonials in relation to her work, paid or unpaid, in the caring sector, with particular reference to issues of collaboration, openness, and record keeping. The author of any such testimonial should be fully appraised of the nature of the concerns that have led to the imposition of this suspension order :

The first review of the Substantive Order conducted on 27 September 2023.

The Submissions made on behalf of the HCPC.

14. Ms Khan made her submissions to the Panel before the Registrant addressed the Panel and were not subsequently changed.
15. Ms Khan on behalf of the HCPC took the Panel through the determination of the Substantive Order Panel. She submitted that the Registrant was still impaired on both the personal and the public components. She submitted that the current Suspension Order should be extended for a further period of 12 months. In summary she said as follows:

• The Registrant had not produced any evidence that she has addressed the concerns and failings that had been identified by the Substantive Order panel. Those failings were numerous, various, and serious and the risk of repetition could not be excluded.
• The Registrant had not complied with any of the suggestions made by the Substantive Order panel and set out in paragraph 258 of its determination; in particular she had not produced a reflective piece or evidence of relevant training and there was limited evidence of insight.
• An Order remained necessary both to protect members of the public and also to ensure public confidence in the profession and its regulator.
• Appropriate Conditions of Practice could not be formulated and the only appropriate order remained a Suspension Order.

Submissions by the Registrant 

15. The Registrant made an extensive statement to the Panel. She responded to questions from the Panel. The Registrant submitted that she was not now impaired. She said that she was anxious to resume her professional work as a Practitioner Psychologist and she argued against a Striking Off Order. In summary she said as follows:

• That following the Substantive Order made in September 2022, she has had time to reflect on what had been decided by the Substantive Order panel. She understood the reasons for the decision of that panel and the need for her to change her practice.
• She now understood the importance of good record keeping; the need to carry out appropriate risk assessments, monitoring and case studies. In future the importance of complying with the requirements of proper record keeping, work and paper management, would be paramount; she would always work within the protocols of her employing organisations. When in any doubt she would seek the advice of her supervisors and if necessary, that of the HCPC itself.
• She described in detail what she had done since the Substantive hearing. For much of 2023 she had worked in the UK on a voluntary basis; working at a Community Food bank; befriending the elderly and also working with children. This work occupied several days a week and with the exception of the food bank was continuing. All of this work involved working in a multi-disciplinary team and also risk assessment.
• She had worked in Nigeria with the Nigerian Navy from March to May 2023. This work was voluntary and had involved the development of therapeutic services. She had been engaged with members of staff and also with the maintenance of proper records.
• She had not been able to find any paid work since the hearing in September 2022. She had not been receiving statutory benefits and had been living primarily on her savings.
• Because she had been suspended, she had been unable to work as a Psychologist. This meant that it was very difficult for her to show that she had addressed or remedied the concerns identified by the Substantive Order Panel. However, she had done a lot of self-directed learning, in particular by watching videos and by reading.
• She was very anxious to renew her career as a Practitioner Psychologist. She felt that she could perform safely and effectively. She now fully understood her responsibilities and would not repeat her previous errors and failings.

• She stressed that the allegations arose many years ago and that she had completed much relevant training prior to the hearing last year. She also stressed that at no stage had she “disregarded” the importance of proper record keeping. She further emphasised that before the hearing last year and after the time to which the allegations related, she had held three paid professional posts, monthly reports had been made by her then supervisors and no criticism had been made as regards her practice.

• She has not fully appreciated that the suggestions made by the Substantive Order panel required her to provide written evidence to support the assertions that she was making today.

The decisions of the Panel made on 27 September 2023.

16. The Panel heard and accepted the advice of the Legal Assessor.
17. The Panel is aware that it has all the powers that are set out in Article 30 [1] of the Health and Social Work Professions Order 2001 [The Order] and which are set out in the email sent to the Registrant giving notice of this hearing.
18. The Panel is aware that the process under Article 30 [1] of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise remains impaired: if so, whether the Suspension Order under review remains appropriate and proportionate or should be varied or replaced by some other order.

Decision of the Panel on Impairment

19. Having taking account of the submissions made by Ms Khan and those of the Registrant, the Panel has concluded that the Registrant’s fitness to practise remains impaired. Its reasons are essentially the same as those given by the Substantive Order p The Registrant has not complied with any of the suggestions made in paragraph 258 of the determination of the Substantive Order panel. It also notes and agrees with the comments made by the Substantive Order panel in paragraph 256 of its determination. In substance, the Panel concluded that the Registrant had not discharged the persuasive burden of establishing that she was no longer impaired. It was of concern to the Panel that whilst the allegations related substantially to proper record keeping and paper management, the Registrant had not produced any of the written material recommended in paragraph 258 of the determination of the Substantive Order Panel. In the opinion of the Panel such documents could and should have been obtained.
20. The Panel has concluded that in all the circumstances it could not exclude a risk of repetition. It also concludes that public confidence in the profession and in the HCPC as its regulator, would be gravely undermined if the Panel was to determine that the Registrant’s fitness to practise was not now impaired and the Registrant was permitted to return to unrestricted practice. Consequently, for the same reasons that are set out in the determination of the Substantive Order panel, the Panel determines that the Registrant’s fitness to practise remains impaired on both the personal and the public components.

Decision of the Panel on Sanction:

21. In considering the appropriate order the Panel had regard to the HCPC’s Sanctions Policy updated in March 2019, to the submissions of Ms Khan, to those of the Registrant and to the advice of the Legal Assessor.
22. The Panel has applied the principle of proportionality. The Panel is aware that the purpose of sanction is not to be punitive and that it must consider the risk of repetition and public confidence in the profession and its regulator.
23. The Panel has considered the sanctions available in ascending order of restriction. The Panel considered that to take no action or to impose a Caution Order would be wholly inappropriate.
24. The Panel gave very serious consideration to the possibility of formulating a Conditions of Practice Order. However, it concluded that it could not formulate appropriate conditions which were not tantamount to suspension.
25. The Panel next considered a continuation of the Suspension Order. It has concluded that a further period of suspension for 6 months would be both appropriate and sufficient to address the concerns set out above and which are reflected in the Panel’s finding of current impairment. The Panel determined that at this stage a Striking Off Order would be disproportionate.
26. This Order will be reviewed before it expires on 28 April 2024. The Panel stresses the importance of the Registrant complying with all suggestions made by the Substantive Order Panel on 30 September 2022, which this Panel now repeats. These suggestions are those set out in paragraph 258 of the determination of the Substantive order p In particular, the Panel stresses the importance of:

1) The Registrant participating at the next review hearing.

2) The Registrant producing prior to the next review and for the assistance of the review panel, a written reflective piece which sets out:

    a. her understanding of the importance of proper record keeping and case management.

    b. What she has learnt as a result of the fitness to practise proceedings and how she would apply that learning with regard to the future.

    c. Her aspirations for the future.

   d. What she has done to maintain her professional skills in contemplation of a return to work as a Psychologist.

3) The importance of producing references and testimonials from those with whom she has worked since 30 September 2022, in any role, whether paid or unpaid. Such persons should be aware of the present proceedings. It is not expected that the Registrant would be in position to produce documents from those with whom she worked in Nigeria.

27. If the Registrant is able to comply with the suggestions made above before the expiration of 6 months, she can seek an early review of the Suspension Order. The Registrant should understand that a continued failure to comply with the above suggestions could lead to a Striking Off Order.

Order: The Registrar is directed to further suspend the registration of Ms Sarah Sikpa for period of 6 months from the date that this order comes into effect.

The Order imposed will apply from 28 October 2023.

History of Hearings for Sarah Sikpa