Darren Adamson

Preliminary Matters
Bundle
1. The Panel has been provided with a substantive bundle of documents which runs to 50 pages.

2. The Panel was also provided with a Registrant’s bundle of 13 pages.

Background
3. The Registrant is a Practitioner Psychologist.

4. The Registrant was employed by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (“the Trust”) as a Band 7 Counselling Psychologist from November 2018.

5. In April 2019, concerns surrounding the Registrant’s practice were identified by the Registrant’s supervisors and colleagues. These concerns came about as a result of numerous complaints raised by patients and focused on the frequency of appointment cancellations. Following receipt of these complaints, an investigation into the Registrant’s caseload was conducted which led to the discovery of poor patient care and record keeping across the Registrant’s caseload.

6. Although the Registrant received continued supervisory support, a further complaint was received by the Trust in September 2019 raising concerns that were similar in nature to those raised earlier in the same year. A meeting was conducted between the Trust and the Registrant and it was agreed between the parties that the Registrant would leave the Trust’s employment in October 2019. A referral was made to the HCPC on 30 October 2019 by the Trust.

7. At its meeting on 13 May 2021, a panel of the HCPC’s Investigating Committee determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise.

8. A substantive hearing took place between 7 - 13 March 2023. At that hearing, the Registrant was neither present nor represented.

9. The substantive hearing panel found the majority of the facts of the Allegation proven. In relation to Particular 1(a), the panel found all of the particulars proved, with the exception of Patient O:
50. The Panel had regard to both witnesses’ evidence and noted that they both stated that the Registrant was employed by the Trust between 2018 and 2019. The Panel also noted that witness CM’s evidence to it was that the Registrant was employed between November 2018 and October 2019 as a Band 7 Counselling Psychologist. Further, the Panel also noted that the Registrant did not dispute in his written representations to the Panel, that he was employed by the Trust between November 2018 and October 2019. Additionally, the Panel also had regard to the entries contained within the patient notes exhibited and was satisfied that the Registrant was employed by the Trust between November 2018 and October 2019.
51. The Panel next considered the term “safe and efficient care” within the wording of the Particular. The Panel considered that the words should be given their ordinary natural meaning. The Panel had regard to the witnesses’ evidence and noted that both witnesses stated that the Registrant worked within the Service and was responsible for patients presenting with mental health issues over 65 years of age and also individuals under 65 years old with neurodegenerative conditions including stroke. The Panel accepted both witnesses’ evidence to it, that in treating patients with such conditions, continuity of care was vital to their ongoing recovery. Further, the Panel also noted that both witnesses stated that it was important that appointments were kept with patients because the disruption of treatment could have an impact on a patient and also on their trust and confidence in the service provided by the Trust. Additionally, both witnesses also told the Panel that the consequence of not seeing a patient within the specified time lines could lead, at worst, to a serious untoward incident such as the suicide of a patient. Further, the Panel also had regard to the Registrant’s job description, produced as part of the bundle of exhibits, and determined that the Registrant was under an obligation to provide each of the duties outlined within his job description and that he was also under an obligation to make and keep appointments with patients in order to deliver his obligation of “safe and efficient” care.
52. The Panel next considered whether the Registrant was under an obligation to see patients in a timely manner and/or within 28 working days of their referral to the Service. In forming the view that the Registrant was under an obligation to see patients within 28 working days of referral, the Panel had regard to the witnesses evidence. Both witnesses informed the Panel that the Registrant was under an obligation to see patients within 28 days of referral and CM also told the Panel that she expressly informed the Registrant of this when he re-joined the team in November 2018.
53. Further, witness CM also told the Panel that after having cause to speak to the Registrant in early 2019, regarding the patients who raised concern about cancelled appointments, that she reminded the Registrant of this requirement and she also stated that it was something that was discussed amongst practitioners working within the department because it was at the time, the only Key Performance Indicator (‘KPI’) required of the team. CM also told the Panel that there was an Operational Policy in existence and in force between November 2018 and October 2019 which highlighted that the Registrant (and all staff) were under an obligation to meet the KPI of 28 working days. CA also stated that the Registrant was very “aware” of the KPI and would have had access to the Operational Policy on the shared electronic EMIS drive. CA told the Panel that the Registrant knew where the electronic folder was because he had to access it to draft letters to send to patients.
54. The Panel considered the Registrant’s written representation’s that he was not aware of the 28-working day KPI. However, the Panel rejected the Registrant’s submission in this regard preferring the evidence presented by both witnesses and having regard to the Operational Policy before it and the fact that the Registrant did comply with this KPI in respect of some patients that he treated.
55. Having regard to the aforementioned, the Panel was satisfied that there was an obligation on the Registrant to see patients referred to the Service within 28 working days and that this time period was considered to be a ‘timely manner’ by those working within the Service.
56. Having determined that the Registrant was under an obligation to see patients within 28 working days, the Panel went on to consider whether each of the patients listed within Schedule A had been seen within this timescale by the Registrant. In undertaking this exercise, the Panel scrutinised the witnesses’ evidence, the patient notes and the audit report exhibited by CM. The Panel also had regard to the Registrant’s submission that ‘As far as I was aware, all patients were seen within this time scale but I had no information as to when the referral was originally received and processed by the team as he [sic] was not present at allocation meetings’.
57. Having scrutinised and compared each of these documents and considered the totality of the evidence before it, the Panel rejected the Registrant’s submission that all patients were seen within 28 working days and was satisfied that the Registrant failed to see Patients D, E, F, G, J and K within the 28-working days of their referral to the Service. The Panel was also satisfied that by failing to do doing so, the Registrant did not provide safe and efficient care to each of those patients.
10. The substantive hearing panel also found Particular 1(b) proved, save for in respect of Patients D and K which were not proved:
60. The Panel next considered whether the Registrant had repeatedly cancelled appointments or not attended appointments in respect of each of the patients listed within Schedule B. Again, in undertaking this exercise, the Panel scrutinised the witnesses’ evidence, the patient notes and the audit report exhibited by CM. The Panel also had regard to the Registrant’s submission that ‘Appointments were cancelled when deemed necessary due to illness or they were cancelled by the patient or on the patient’s behalf. As far as I am aware, all appointments that were scheduled were attended by me. There were several times when patients would fail to answer the door and this was recorded on EMIS. The trust does not have a cancellation policy in place in order to ascertain appropriate/inappropriate levels of cancellation.’.
61. Having carefully reviewed and compared each of these documents and considered the evidence before it, the Panel was satisfied that the Registrant repeatedly cancelled or failed to attend appointments in respect of Patients A, B, C, F, G, I, L, P, Q and R and that by doing so, he did not provide safe and efficient care to each of those patients.
62. In respect of Patient ‘D’, when undertaking its review of the documentation, the Panel noted that the audit report, compiled by CM, stated that the Registrant had not cancelled any appointments and that in the comments section of the report it stated “Patient seen once. Two further visits documented as unable to access communal residence”. Further, the Panel also had regard to CA’s evidence that she was also aware of the difficulties in accessing Patient D’s property as there was a communal entry system before you could access the patient’s individual property and that the communal area was not always staffed. Having regard to the aforementioned, the Panel was not persuaded on the evidence before it that the Registrant cancelled, or failed to attend, appointments with Patient D. The Panel therefore considered that in respect of Patient D, the Particular was not proved.
63. In respect of Patient K, also when undertaking its review of the documentation, the Panel noted that the audit report, compiled by CM, stated that the Registrant had 2 cancelled or missed appointments by the Registrant and that he had seen the Patient on two occasions. However, when the Panel compared this evidence to that contained within the patient record the Panel noted that the Registrant saw Patient K on three occasions (20 September 2019, 09 October 2019 and 18 October 2019). Further, the Panel also noted from the patient record, that it was only a single appointment which was moved or cancelled from the 04 October 2019 to the 09 October 2019. In considering whether this amounted to a cancellation or failure to attend, the Panel considered that it was also not outside the realms of possibility that the patient had cancelled and/or moved the appointment themselves, rather than the Registrant and had regard to CA’s oral evidence to it when formulating this view. Additionally, whilst the Panel accepted that there should have been a record in respect of why the appointment was cancelled or moved, the Panel noted that the Registrant saw the patient within 3 working days of the original appointment (04 October to 09 October 2019) and determined that it could not be said that this would amount to a derogation in his duty to provide safe and efficient care. Consequently, having regard to the aforementioned, the Panel was not satisfied, in respect of Patient K, that the Particular was proved.
11. The substantive hearing panel also found Particular 2 proved:
64. The Panel first considered the date range of November 2018 to October 2019 and was satisfied that these dates spanned the time when the Registrant was employed by the Trust.
65. The Panel next considered whether the Registrant was under a duty to maintain complete and accurate notes and considered that he was. In forming this view, the Panel had regard to the evidence of both witnesses, but in particular to the evidence of CM who stated that it should be routine for all clinicians, not just psychologists, to document all consultations, cancelled or rearranged appointments and contact with patients. CM told the Panel that this was important because it is the formal NHS record of care offered to that patient and the record enables other clinicians involved with the patient to understand the care being provided to the patient and enables others to provide continuity of care to the patient should the allocated clinician be unexpectedly unavailable.
66. The Panel next considered whether the Registrant did not maintain complete and accurate records in that he did not document in respect of each of the patients outlined in Schedule C: appointment dates; reasons for appointment changes; delays; and missed appointments within Outlook and/or EMIS.
67. Again, in undertaking this exercise, the Panel scrutinised the witnesses’ evidence, the patient notes and the audit report exhibited by CM. The Panel also had regard to the Registrant’s submission that ‘As far as I am aware, all appointments/ cancellations were noted on EMIS as well as being captured on Outlook.’. In respect of this submission, the Panel noted that this was at odds with the Registrant’s earlier submission to the HCPC, dated 31 October 2019, whereby he stated: “…I take full responsibility for the errors in my electronic schedule and in cancelling a number of appointments as a consequence of my increased anxiety… I agreed with everything [CM] said and felt as though it was a good decision [to leave the Service]…’
68. Having carefully reviewed and compared each of these documents and considered the evidence before it, the Panel was satisfied that the Registrant did fail to do the following in respect of each patient:
i. Patient B’s records did not include any recorded reasons for cancelling or moving six appointments and the moved / cancelled appointments were not recorded with reasons on EMIS;
ii. Patient C’s appointments which were cancelled and or moved did not have attached reasons on EMIS and only one of the cancellations had been recorded on EMIS and the others were not recorded at all;
iii. Patient E’s records did not outline why there was a delay between the Patient being referred to the Service on 18 February 2019 and their first appointment on 05 April 2019 and there was no reason provided on EMIS;
iv. Patient F’s did not document why two of their appointments were cancelled and three appointments were missed and no entries included on EMIS;
v. Patient G’s records did not outline why four appointments were missed or cancelled and three of the changes were not reported on EMIS;
vi. Patient H’s records did not document why his appointment on one occasion was not kept and there was no reason provided on EMIS;
vii. Patient I’s records did not record that Patient I had requested to be seen two weeks after their initial assessment and there was no record on EMIS that the second appointment had been made, missed or cancelled;
viii. Patient J’s records did not provide a reason for the delay between his referral and the Registrant’s first appointment with Patient J – a delay of 66 working days. Further, an appointment 29 23 made for 04 October 2019 was not kept and no reason provided as to why cancelled or moved on EMIS;
ix. Patient K’s records did not outline why appointments were moved or cancelled on EMIS;
x. Patient L’s record did not document why four appointments had been moved or cancelled and no record was made on EMIS;
xi. Patient O’s records did not document why three separate appointments were cancelled or moved and no record was made on EMIS;
xii. Patient P’s records did not document why fourteen of their appointments were cancelled or missed and no reasons provided on EMIS;
xiii. Patient Q’s records did not outline why two of their appointments had been missed or cancelled and no reasons provided on EMIS. Further, in respect of this patient the discharge letter which was uploaded to EMIS had no reasons for the patient’s discharge outlined within it; and
xiv. Patient R’s records did not outline why ten appointments were cancelled or missed and no reasons were outlined on EMIS.
69. Having identified and verified each of the aforementioned failings on the evidence presented to it, the Panel rejected the Registrant’s assertion that all appointments and/or cancellations were noted on EMIS as well as Microsoft Outlook (the Registrant’s own diary) and found Particular 2 proved in respect of the aforementioned patients.
12. The substantive hearing panel also found Particular 3 proved, in respect of Patient S and not proved in respect of Patient Q.
70. The Panel first considered whether the Registrant was under an obligation to perform a cognitive assessment and then if so, whether he was under an obligation to save it to an appropriate location.
71. The Panel had regard to the evidence of the witnesses and noted that CA stated that a cognitive assessment is an assessment of a patient’s cognitive function and that in the Service they utilised a number of cognitive assessments including the Addenbrookes Cognitive Examination (ACE-iii). CA stated that this assessment was used if there was an indication of a patient having issues with their memory or cognitive function. She further informed the Panel that the test was widely used for a number of cognitive domains and is widely used as a screening tool.
72. CA also told the Panel that the Registrant was versed in undertaking these tests and that he intended to perform a test on each of these patients (S and Q). CA stated that in respect of Patient S, Patient S’s husband had indicated that he was worried about Patient S’s cognitive decline and the Registrant arranged with Patient S and her husband that a cognitive test would be administered on 28 November 2018. CA told the Panel that upon review of Patient S’ records, the test was never administered by the Registrant and he did not arrange an appointment to administer the test. The Panel also noted that CA, in her evidence, drew its attention to supervision notes between the Registrant and CA whereby Patient S was discussed and the need for an assessment was also discussed.
73. On the basis of the evidence before it, the Panel was satisfied that a cognitive assessment was required for Patient S and that the Registrant did not conduct such an assessment and in failing to do so, the Registrant also failed to provide adequate care to Patient S. Consequently, this Particular in respect of Patient S, is proved.
74. The Panel next considered Patient Q and the evidence before it. The Panel noted that in respect of this patient the Registrant had provided the following submission: ‘As far as I am aware, the ACE III (Addenbroke’s Cognitve Assessment) letter was saved in his own folder on the Bensham Psychology server as well as being uploaded to EMIS.’
75. The Panel noted that CA stated in her evidence to the Panel that the Registrant did complete an ACE-111 cognitive assessment on this patient on 05 December 2018 and the results of the assessment were noted in the comments section of the patient’s record on EMIS. The Panel also noted that CA’s criticism of the Registrant was that there was no scanned copy of the original completed assessment sheet uploaded to the same record and that it was also not located on the patient’s record.
76.Having regard to the wording of the Particular, the Panel was satisfied on the evidence before it that the Registrant did conduct a cognitive assessment for Patient Q. The Panel next considered whether the Registrant had saved the results from the assessment in the requisite place and determined that he had. In the Panel’s view, the outcome of the assessment was contained within Patient Q’s record and whilst this may not have included the original paper document upon which the assessment was undertaken, in the Panel’s view there was sufficient information saved within the patient’s record to outline to any other clinician who reviewed the patients notes, what the outcome of the assessment was and that the outcome could be used as a barometer for future assessments. Consequently, it was also the Panel’s view that the Registrant did not fail in his duty to provide adequate care to Patient Q and therefore this Particular, in respect of Patient Q, is not proved.
13. The substantive hearing panel also found the Registrant’s actions amounted to misconduct:
87. The Panel was aware that a breach of the standards alone does not necessarily constitute misconduct. However, the Panel was satisfied that the Registrant’s conduct in respect of Particulars 1a), 1b), 2 and 3 fell far below the standards expected of a registered Practitioner Psychologist and was satisfied that each of the aforementioned Particulars, individually and when taken together, amount to misconduct.
88. In forming this view, the Panel had regard to the fact that the Registrant was responsible for seeing patients allocated to him within 28 working days and that in respect of a large number of patients (identified within Schedule A) he had failed to do so. Further, he had also not provided sufficient explanation as to why there was a delay in seeing the majority of these patients. Whilst the Panel noted that both witnesses indicated that there were no known consequences for the patients identified, the Panel considered that harm could have been caused to very vulnerable patients by the Registrant unnecessarily delaying their treatment and by the Registrant not seeing patients within the 28 working day referral window. The Panel considered, this to be a serious failure on the Registrant’s part.
89. The Panel was also satisfied that the Registrant’s actions in repeatedly cancelling and/or moving appointments with patients was also very serious. In the Panel’s view, repeatedly moving patients’ appointments without sufficient notice, or any notice in some cases and/or without providing adequate reason or explanation for doing so, would be considered deplorable by fellow practitioners. Patients rely on practitioners to build trust with them, especially when they may go on to divulge personal matters to them during the course of their treatment. Repeatedly cancelling and/or moving appointments, for a large number of patients would have, in the Panel’s view, inevitably damaged trust in the service being provided to them. The Panel considered that this conclusion was borne out by the fact that some patients requested to see an alternative Psychologist and at least one patient (Patient I) left the care of the Service altogether. In the Panel’s view, the Registrant’s actions had a direct impact upon the level of trust placed in the Service and could, in this regard, be said to have caused harm to patients.
90. Further, the Panel considered that the Registrant’s actions in not maintaining accurate patient records was also very serious and would also be considered as deplorable by fellow practitioners. In reaching this conclusion, the Panel noted that both witnesses had given oral evidence to it which stated that accurate and up-to-date patient records are vital when clinicians are reviewing handover cases, or when other practitioners need to understand the stage at which a patients’ treatment had reached. The Panel also noted that both witnesses also stated that up-to-date records provide a sense of continuity for patients as well as providing core information in respect of the patients ongoing care or treatment. For these reasons therefore, the Panel considered that the Registrant’s failure to keep up-to-date records amounted to misconduct.
91. Lastly, the Panel also considered that the Registrant’s failure to undertake a cognitive assessment for Patient S was also deplorable and also amounted to misconduct. In the Panel’s view, Patient S and her husband, who had raised concerns about Patient S’s cognitive deterioration, had both been given an expectation that the Registrant would undertake an assessment of Patient S. The Panel considered that by not performing that assessment, the Registrant potentially placed Patient S at risk of harm because there was not a clinical snapshot, from that point in time, which demonstrated what the patient’s cognitive function was. This inaction on the Registrant’s part would, in the Panel’s view, have resulted in the patient not having any issues of potential cognitive decline being identified and/or recorded. This, in turn, would have meant that there was no outcome recorded to be used as a benchmark for a future test to determine whether her mental acuity was indeed declining or not. Cognitive decline could present risks to the patient which could have been missed due to the cognitive assessment not taking place as planned.
14. The substantive hearing panel also found the Registrant’s fitness to practise was impaired, having considered both the personal and public components if impairment:
98. The Panel first turned its mind to the ‘personal’ component of current impairment.
99. The Panel considered whether the Registrant’s conduct was remediable and if so, whether he had remediated his conduct. The Panel determined that the Registrant’s conduct was remediable. In the Panel’s view, whilst the Registrant’s conduct did fall far below that expected of him, the Panel noted that it related mainly to his record keeping and communication with patients and that both CA and CM had given evidence to the Panel that the Registrant was capable of performing his role as a Band 7 Psychologist but had failed to do so in respect of the patients outlined within the Allegation.
100. The Panel next considered whether the Registrant had remediated his misconduct and determined that he had not. In the Panel’s view, the Registrant had demonstrated very limited insight into his failings. In forming this view, the Panel noted that when the Registrant first engaged with the HCPC, in October 2019, he stated “I take full responsibility for the errors in my electronic schedule and in cancelling a number of appointments as a consequence of my increasing anxiety”. The Panel further noted that in his most recent submissions to the Panel he refuted the entire Allegation, which the Panel considered was a significant shift and inconsistency in terms of his responses and approach to the concerns raised.
101. Whilst the Panel had regard to the Registrant’s submission that he was suffering from anxiety at the time, the Panel noted that neither CA or CM supported the Registrant’s submission, and both witnesses refuted the Registrant’s assertion, that he had raised anxiety and excessive workload with them during supervision. Additionally, the Panel also noted that the Registrant had not provided any independent evidence to support his written submissions that he was suffering from anxiety at the time. Consequently, the Panel placed limited weight on this aspect of the Registrant’s submissions.
102. Further, the Panel also noted that both sets of the Registrant’s submissions focused predominantly on how he had been impacted by the situation arising at the Trust, rather than considering the impact on his patients, his colleagues and the wider Psychologist profession. Additionally, the Panel also considered that the Registrant had failed to engage, in any meaningful way, with the regulatory hearing; had failed to provide any evidence of meaningful remorse for his actions; and had failed to provide the Panel with any evidence of his attempts to remediate his conduct, save for completion of a single course relating to record keeping. In respect of the course completed, the Panel formed the view that the five hour course did not address the wider communication failings identified in this case, when the Registrant had cancelled multiple appointments, for multiple patients, without explanation or record being made as to the reasons why. Whilst the Panel noted that the Registrant had also provided a document from the Information Commissioners Officer (‘ICO’), the Panel noted that there was no detail or explanation as to what training the Registrant had undertaken in order to achieve it. In the absence of an explanation as to its relevance, the Panel considered this document related the Registrant’s handling of data under The General Data Protection Rights (‘GDPR’) and determined that this document also did not demonstrate any remediation towards the identified failings.
103. Consequently, in the absence of full insight, any meaningful reflection, remorse or remediation, the Panel concluded that there was a real risk of repetition of the Registrant’s conduct. In forming this view, the Panel also determined that the Registrant’s conduct could not be said to be an isolated incident. It had occurred over a significant period of time (9 months), when he was only working two days a week and with a caseload which both witnesses described as ‘manageable’. Further, his failings concerned a large proportion of his patients. Therefore, having regard to all of these factors, the Panel considered there is a real risk of the Registrant repeating the identified failings.
104. For all of these reasons, the Panel concluded that the Registrant’s fitness to practise is currently impaired based on the personal component.
105. The Panel next considered whether this was a case that required a finding of impairment on public interest grounds in order to maintain public confidence in the profession and in the regulator. In considering the public component the Panel had regard to the public interest, which included the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour.
106. Having considered the matter, the Panel was satisfied that an informed member of the public, who was aware of the full facts in this case, would have their confidence in the profession and the regulator undermined if a finding of impairment were not made given the failings identified and the lack of insight, remorse and remediation shown by the Registrant. In the Panel’s view, the Registrant’s cavalier conduct demonstrated a blatant disregard of his professional obligations and members of the public would be extremely concerned to learn that a registered Psychologist had not attended appointments with vulnerable patients when scheduled; had not undertaken assessments of patients; and had not completed accurate records. The Panel considered it was critically important for the profession to have integrity and for the public to be able to trust the actions of a Psychologist and a significant aspect of the public component is upholding proper standards of behaviour. The Registrant’s conduct fell far below those expectations. The Panel concluded that public confidence in the profession would be undermined if a finding of fitness to practise was not made, given the seriousness of the Registrant’s conduct and behaviour.
107. The Panel therefore concluded that the Registrant’s current fitness to practise is impaired on the personal component and the wider public interest.
15. The substantive hearing panel imposed a suspension order for twelve months.
16. The panel considered the aggravating and mitigating factors, as set out below:
114. To assist it in assessing the relevant level of sanction, the Panel identified the following mitigating and aggravating factors.
Aggravating factors:
(i) breach of trust of vulnerable service users, colleagues and the wider public in not performing his role as required;
(ii) repetition of concerns and a clear pattern of behaviour;
(iii) no patient or colleague focussed remorse;
(iv) no apology;
(v) very limited remediation;
(vi) failure to work in partnership with colleagues for the benefit of service users; and
(vii) the Registrant had been subject to other recent fitness to practise proceedings where he was suspended by the HCPC in 2020 for a period of 6 months and that the suspension was extended for a further period of 3 months.
Mitigating factors:
(i) the Registrant was relatively new to practice and this was his first qualified role as an autonomous practitioner; and
(ii) some very limited insight demonstrated by the Registrant in his reflective piece dated April 2022.
17. The panel concluded:
118. The Panel noted that this was a case in which the Registrant had failed to engage in any meaningful way. The Panel had regard to its earlier findings that the Registrant was capable of remediating his failings however, it also noted that the Registrant had also failed to provide any evidence of remorse and very limited evidence of remediation and further, that the Registrant had not indicated to the Panel that he would be willing or able to comply with a conditions of practice order. Having regard to the lack of meaningful engagement by the Registrant, the Panel considered that it did not have sufficient information before it to determine appropriate, workable or proportionate conditions of practice in this case at the current time. Additionally, having regard to the case as a whole, the Panel was also not satisfied that a conditions of practice order was the appropriate sanction having regard to the seriousness of the facts found proved.
119. The Panel next considered whether to make a suspension order. Such an order would, in the Panel’s view, provide the necessary degree of protection for the public, whilst leaving open the possibility of remediation. The Panel noted that the Registrant was at the beginning of his Psychologist career when the matters arose and the Panel had nothing before it to suggest why the Registrant cannot address his conduct and concluded that he can remediate his conduct. In the Panel’s view, a suspension order would provide the Registrant with an opportunity to demonstrate further remediation and meaningful insight. The Panel also considered that a Suspension Order would also reflect the seriousness of the Registrant’s conduct and the Panel’s findings and would send a clear message that such conduct was not acceptable to the Registrant and also to the wider profession.
120. In light of all of the aforementioned matters, the Panel considered that this was a suitable case for a period of suspension. The Panel also determined that to strike the Registrant from the Register, which is a sanction of last resort, would be disproportionate at this stage and that a lesser sanction was therefore appropriate in this case.
121. Accordingly, the Panel make an order directing the Registrar to suspend the registration of the Registrant for a period of twelve months.
122. The Panel recognised that there was a risk of de-skilling, by imposing a suspension order for a period of twelve months. However, the Panel was of the view that a twelve-month period of suspension is appropriate, as this will allow the Registrant sufficient time to demonstrate sufficient remorse, insight and remediation. The Panel was also of the view that this period of suspension would satisfy the public interest, in terms of maintaining public confidence in the profession and regulatory process and that this outweighed any detriment that the Registrant may suffer as a result of not being able to practise as a Psychologist.
18. The substantive panel thereafter made the following recommendations for the reviewing panel:
123. The Panel considered that a reviewing panel would be assisted by the following: (i) the Registrant’s attendance at a future review hearing; (ii) a reflective piece; (iii) evidence of on-going and continuous professional development (‘CPD’) and/or evidence of self-directed learning and/or training; (iv)testimonials from any training providers in respect of the aforementioned; and (v) up to date testimonials or references from: any employer, whether paid or unpaid, specifically addressing the issues identified in the Panel’s determination.

Substantive Review
HCPC Submissions
19. Ms Khan submitted that the Panel’s role is to review the matter on the basis of the evidence available today, and to decide whether the Registrant’s fitness to practise remains impaired, and if so, to decide what the appropriate sanction should be.

20. Ms Khan submitted that the HCPC took a neutral approach to whether the Registrant remains currently impaired. She noted that the persuasive burden is placed on the Registrant by the case of Abrahaem v GMC [2008] EWHC 183 (Admin) to demonstrate that he has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement.”

Registrant’s Evidence & Submissions
21. The Panel has been provided with a Reflective Statement by the Registrant which is set out in full below:

Reflective Statement

Since the allegation were made against me in 2019, I have had a great deal of time to reflect upon the events that transpired and feel remorseful about my behaviour during this time. Although this period of my life was difficult both personally and professionally, this is no excuse for having let down my colleagues, my patients and the profession as a whole. I have been afforded a great deal of time to reflect upon and consider the wider implications of my actions on the levels of trust and confidence afforded to me and my profession by the general public and have been shamed by my response. The amount of time that has been taken in processing my response and subsequent action will, in my opinion, guarantee more considered action in the future. I have learned much from this experience which I shall continue to recall and reflect upon in the future with regard to informing my own practice.

I feel it should be stated that between the time of the allegations in 2019 and the time of my suspension from the HCPC register as a practitioner psychologist in March 2023, I had developed a thriving and well-respected private practice working with an associate psychotherapist providing mental-health support for clients in and around the local community. I provide an email from Mr Paul Moreels as evidence of the value of my work at this time. Although I found it difficult to inform clients of my suspension from the HCPC register, I understand and accept this reasoning. I also managed client records effectively throughout this time and include a letter of support from my supervisor Dr Louise McDonell dated 19/04/22 in support of this assertation. I feel it necessary to add this information as part of my current reflections as I feel as though many aspects of my life personally and professionally had changed dramatically since leaving Bensham hospital and the primary care sector in October 2019.

In April 2023, following my suspension from the HCPC register, I approached Christine Smith, who runs the ‘Mind and Sole’ hub in Alnwick, Northumberland. The hub provides mental health support for members of the local community, who may be struggling with mental health problems. I discussed my suspension from the HCPC register with Mrs Smith and provided her with a copy of the final decision from the hearing. Christine was encouraged by my honesty and openness and suggested that to begin with it would be suitable to develop a group for mental health support which would bring together members of the local community and would cover a range of topics relevant to mental health. I began work on a voluntary basis, implementing and developing a ‘mental health matters’ group who would meet on a weekly basis for two hours. This group proved to be successful and as Christine developed trust and confidence in my work, she suggested that it would be valuable if members of the group were provided with more focused one-to-one support. I made it clear at this point to Christine that I could not currently work as a practitioner psychologist due to my current suspension and that any form of work with individual members of the group would be informal and purely supportive in nature. As my involvement with ‘Mind and Sole’ increased throughout the year, Christine asked if I would consider volunteering as a trustee as an application for charitable status was to be made. I agreed and also contributed to the development and eventual submission of the application for charitable status. I have enjoyed my time working with ‘Mind and Sole’ and feel as though it has been a very grounding and humbling experience. I have also taken responsibility for maintaining records for group attendance and work completed with individuals and these records have been made available to Christine at all times. It is my hope that I will continue to work on a voluntary basis with ‘Mind and Sole’ for as long as possible as I believe that the work that they do and the service they provide is beyond measure.

Since my suspension from the HCPC register in March 2023 I have also completed a range of continued professional development including areas which had been highlighted a problematic during the hearing such as ‘Effective Planning’, ‘Confidentiality and Record Keeping’ as well as ‘Dialectical Behavioural Therapy skills training (essential and intensive). In particular, I have found the training in DBT to have been particularly helpful when working with groups at Mind and Sole who are experiencing issues with addiction and regulation.

I feel as though I am able to reflect upon the events of 2019 with clarity and I understand the need for continued clear and concise documentation of patient records as well as for consistency in my approach. It is my hope to be able to return to the HCPC register as a Counselling Psychologist and to be able to reflect the qualities inherent within this title. I will ensure that I communicate any issues that I may be having both personally and clinically with greater clarity in the future in order to avoid further confusion.

22. The Registrant has also provided evidence of CPD courses attended:

(a) Confidentiality and Record Keeping 04-05 August 2023,
(b) Effective Planning and Time Management 09-10 October 2023,
(c) Dialectical Behavioural Therapy 05-09 February 2024,
(d) Dialectical Behavioural Therapy 07-08 December 2023,
(e) Workshop entitled: “Working therapeutically with people who self-injure and self-harm” 19-21 June 2023.

23. The Panel has also seen testimonial evidence, submitted on the Registrant’s behalf, from:

(f) Mr Paul Moreels, dated 28 March 2024,
(g) Ms Christine Smith, (Managing Director of Mind and Sole) dated 12 March 2024,
(h) Dr Louise McDonnell, Chartered Counselling Psychologist & Clinical lead at Talk Durham, dated 09.04.22.

24. The Registrant gave evidence today. He was also cross-examined by Ms Khan on behalf of the HCPC and was asked questions by the Panel. A summary of his evidence is:

(a) He felt “overwhelmed” at time of the concerns in 2018. He had issues in his personal life at the time. He accepted that he had not been “open and honest” about the extent of his problems, noting that the “wheels had come off in a dramatic fashion”.
(b) He expressed remorse but without providing any detail, aside from asserting there would not be a repeat of the concerns from 2018-19.
(c) He had used the time away from practice to undertake voluntary work to “ground him”. He was acting as a support worker and had “gone back to basics”. He had found the process “humbling.”
(d) If he is allowed to return to practice, he intends to continue to undertake voluntary work and he would now be able control his workload in private practice.
(e) The Registrant was cross-examined on the impact of his actions on service users, which he described as “massive”, citing a “lack of consistency” and patients feeling “let down.”
(f) The Registrant’s future plan was not to return to the NHS, but to gradually and very slowly increase his private practice work.
(g) When asked questions by the Panel, the Registrant stated that he was “deeply ashamed” and noted the “huge impact” on service users, again without providing much, if any detail. He conceded there was a wider impact on the profession, and colleagues, stating that he brought the profession “into disrepute.”
(h) The Registrant had spoken to Dr McDonnell about providing him with supervision in the future. He had last had contact with her some 4-5 months ago by email. He was confident that she would be able to monitor his record keeping and report back to the HCPC. He expected to only work part-time, perhaps 2 days per week, and only see 3 clients per day. He thought his workload would be manageable.
(i) Dr McDonnell has her own private practice and is seeking work in Dubai. He would be the sole trader in the business, although there is a psychotherapist also based in the same building. He has professional indemnity insurance.
(j) The Registrant had undergone therapy in 2019. He has not needed any further therapy in the last 12 months. He is conscious furthermore of the need to “self-care” going forwards. Money is not a motivating factor, although he had faced some financial challenges as a result of being suspended.
(k) He would obtain work through advertising and he would be accessible to his patients online and through face to face appointment.
(l) He had kept separate “process and clinical” records when he was in private practice, (after leaving the NHS) between 2019 and his suspension in 2023.

Legal Advice

25. In undertaking this review today, the Panel has reminded itself of the following matters, having accepted the advice from the Legal Assessor:

(a) A proper exercise of the review process must involve a comprehensive re-consideration of the initial order, in the light of all circumstances, which are before the Panel today. However, it is not the Panel’s role to go behind the previous Panel’s findings.
(b) The Panel’s role is to exercise its own judgement in determining whether the Registrant’s current fitness to practice remains impaired, and if so, what the least restrictive sanction is to meet the level of public protection which the Panel identifies as being required.
(c) The Panel in its deliberations applied the principle of proportionality and balanced the rights of the Registrant with the rights of the public.
(d) The Panel has, under Article 30(1) of the Health Professions Order 2001, the power to:
(i) With effect from the date on which the order would, but for this provision, have expired, extend, or further extend the period for which the order has effect,
(ii) With effect from the expiry of the order, make an order which it could have made at the time it made the order being reviewed,
(iii) With effect from the expiry of a suspension order, make a conditions of practice order with which the practitioner must comply if he resumes the practice of his registered profession after the end of his period of suspension.
(e) The Panel had regard to the HCPTS Practice Note, Fitness to Practice impairment, the HCPTS Practice Note, Review of Article 30 Sanction Orders and the HCPC Sanctions Policy document.

26. The Panel has comprehensively reviewed all the documentary and oral evidence before it, in particular relating to the period since the imposition of the original Suspension Order.

Decision
Fitness to Practice
27. The Panel first considered whether the Registrant’s fitness to practice remained impaired. The Panel considered the original panel’s findings, and the steps taken by the Registrant since, to address the specific failings identified.

28. The Panel first considered the personal component:
(a) The Panel noted that there was some evidence of developing insight. The Panel noted the Registrant’s engagement in attending the review hearing and providing the documents contained in his bundle, including evidence of voluntary work, a single testimonial from a former patient and evidence of CPD.
(b) However, the Panel concluded that the Registrant’s insight into his past failings was limited. The Panel noted the previous inconsistency as to the Registrant’s position as to whether he accepted the legitimacy of the identified failings (see paragraph 14 above (paragraph 100 of the previous decision)). The Panel concluded that there was little meaningful insight into the effect of his actions on service users, in terms of feelings of worthlessness, not being valued, abandonment and neglect, which may have occurred by the cancellation of multiple appointments. The Registrant’s insight, such as it was, was not volunteered, but had to extracted from him through cross-examination and very pointed questions from the Panel. The Registrant’s focus, in his evidence and reflective piece, was on how his failings had impacted upon him, rather than upon his patients, colleagues and the wider profession of Psychology.
(c) The Panel noted that there was an expression of remorse, however this was not elaborated upon in any detail. There was equally little insight into the impact from the various failings identified at the final hearing e.g. failing to keep adequately or timely clinical records.
(d) The Panel concluded whilst there was some evidence of remediation, in terms of voluntary work and attendance at CPD courses, this was inadequate. The Panel recognised the difficulty in remediating when suspended, but concluded that acting as a voluntary support worker, was very different to practicing as a Practitioner Psychologist, for example, the Registrant in his written submissions, notes his experience with recording keeping group attendance from ‘Mind and Sole’ this varies considerably to record keeping of a clinical workload.
(e) The Panel was concerned that the Registrant’s return to work plan involved operating as a sole practitioner in the private sector, which would lack the surveillance, management of the Registrant, a shared caseload and support available in the NHS e.g. the Registrant will gain a line manager who could overlook his work and he would be subject to audits. By working for himself, the Registrant will only be accountable to himself and with his limited insight, this would put patients at risk.
(f) The Panel were also concerned that there were no real mechanisms in place to mitigate against the Registrant repeating his past failings. The Registrant’s only control mechanism was that by limiting the number of patients he would see; he would not become overwhelmed. Furthermore, there was no real plan as to how the Registrant would operate as a sole practitioner, in terms of management and supervision. There was no evidence from Dr McDonnell as to her current grade, or the detail of what level of supervision she would be able to provide. Finally, there was no evidence of available peer support.
(g) The Registrant had undertaken a course in respect of record keeping, but he failed to provide any evidence as to how he would put this into practice, or evidence that he had reflected adequately as to his previous failings with regard to record keeping.
(h) The Panel concluded that there remained an ongoing risk of repetition. The Registrant had failed to provide any demonstrable objective or detailed evidence as to modifications in his practice since leaving the Trust in 2019. His evidence was generalised and superficial, with little in the way of substance, when explored in detail.
(i) In Summary, there is an increased risk in a return to private practice, as opposed to NHS work. The Registrant would be his own line manager, in circumstances where he has not worked for the NHS since 2019. The Registrant, although asserting he ran a successful private practice between 2019 and 2023, provided little by way of objective evidence to support this. There was, for example, no evidence of his ability to keep adequate clinical records over this period. In addition, the letter from Dr McDonnell was from April 2022, and there is no updated evidence from her, post-dating the previous panel’s decision. The Registrant had failed to demonstrate, in these circumstances that there was no longer any ongoing risk to service users, based on modifications to his practice and his future plans for returning to work.

29. The Panel therefore concluded that the Registrant remained impaired having regard to the personal component of impairment.

30. The Panel next considered the public component of impairment. The findings of the previous panel, where that there had been multiple failings, amounting to misconduct, involving 29 service users. The Registrant’s failings could not be described as an isolated event. The Panel was not satisfied that the Registrant no longer posed a risk to the public, or that he had remediated his failings, such that a return to practice would not undermine confidence in the profession or the regulatory process. The service users which the Registrant would be likely to treat will be vulnerable and the Panel was concerned that there was a pattern of behaviour which had not been adequately addressed; an attitudinal issue which he had not demonstrated had been remedied, whilst noting the increased risks in working as a sole trader in private practice over and above the NHS, in terms of supervision, resources and peer support. The Panel concluded that an informed member of the public, being aware of the facts of this case, would have their confidence in the profession and the regulatory process undermined, if a finding of impairment was not made, given the ongoing limitations on insight and remediation, as found by the Panel.

31. In the circumstances, the Panel concluded that the Registrant’s current fitness to practice remains impaired having regard to the public component of impairment for similar reasons as the previous substantive panel. Both components are therefore engaged.
Sanction

32. The Panel has carefully considered what type of order should be imposed, starting with the least restrictive order. It has taken into account the principle of proportionality, and balanced the rights of the public and the rights of the Registrant to practice in his chosen profession. It has concluded that it would not be appropriate to take no action or to impose a caution order in light of the serious concerns that led to the previous substantive panel making findings of misconduct.

33. The Panel went onto consider whether to impose a Conditions of Practice Order. The Panel had regard to paragraph 106 of the HCPC Sanctions Policy. There was some, albeit limited, evidence of insight, and the deficiencies are capable of being remedied.

34. However, the Panel concluded that conditions were not practicable, realistic or verifiable, given the Registrant’s intention to return to private practice as a sole trader. There is no documentary evidence to support the Registrant’s assertion that Dr McDonnell is a suitable person to supervise him, and/or that she is willing to provide the level of supervision which the Panel would regard as adequate. There is no evidence as to what level of supervision she would be able to offer, working in a separate private practice, including for example, her ability to review the Registrant’s record keeping.

35. The Panel next considered whether to impose a further Suspension Order and concluded that this was adequate, appropriate and proportionate in all the circumstances. The Panel concluded that the Registrant has some level of insight and there is evidence to suggest that he is likely to be able to resolve or remedy his failings in the future.

36. The Panel considered imposing a short further period of suspension, between 6 and 9 months. However, the Panel was mindful of giving the Registrant sufficient time to address the ongoing concerns, and to consider implementing the suggestions set out below. The Panel was conscious that imposing too short a period of suspension would be setting the Registrant up to fail. The Panel therefore imposes a Suspension Order for a period of 12 months.

37. The Panel bore in mind that the Registrant could request an early review, if before the expiry of 12 months, he was able to demonstrate that he had addressed the ongoing failings identified by the Panel.

38. This Panel cannot bind a future panel. However, it is considered that a future panel is likely to be assisted by the following:
(a) The Registrant’s attendance and continued future engagement with the review process,
(b) Evidence of relevant ongoing and continuous professional development (CPD),
(c) Evidence of reflection in relation to record keeping and managing his caseload, detailing what changes the Registrant has made or will make in the future,
(d) Demonstrable evidence of the Registrant’s record keeping and the system(s) he had utilised from his period in private practice between 2019-2023,
(e) Detailed evidence of future supervision arrangements to be put in place. This might, for example, include a supervision contract, detailing the frequency of supervision, the content of future supervision, including review of record keeping and the identity and grade of the proposed supervisor.
(f) Further testimonial evidence from patients who were under the Registrant’s care between 2019-2023, over and above the single example provided,
(g) Evidence of professional and/or therapeutic and/or other support which could include ad hoc therapeutic intervention and regular peer review meetings,
(h) Evidence of relevant work experience, where the Registrant was able to work under the guidance of an appropriately qualified supervisor.

That the Registrar is directed to suspend the registration of Dr Daren Adamson for a period of 12 months from the date this order comes into effect.

The order imposed today will apply from 10 April 2024

This Order will be reviewed again before its expiry on 10 April 2025.

History of Hearings for Darren Adamson