Jennifer Ward

Preliminary Matters

Hearing in private

1. Mr Bright, on behalf of the Registrant, made an application for part of the hearing to be heard in private. This application was made to protect the private life of the Registrant. His application was limited to the part of the hearing which involved details of the Registrant’s family member’s health. Mr Slack did not oppose the application.

2. The Panel accepted the advice of the Legal Assessor which confirmed the legal position referenced in Mr Bright’s submissions, that:

• Rule 10(1)(a) of The Health and Care Professions Council (Conduct and Competence Committee) (Procedure Rules) 2003 provided the Panel with the discretion to proceed in whole or in part in private;
• Article 8(1) of the European Convention of Human Rights as enshrined within section 6 of the Human Rights Act 1998 provided a right to a private life, which included that of the Registrant’s family.

3. The Legal Assessor also directed the Panel to the guidance set out in the HCPTS Practice Note “Conducting Hearings in Private”.

4. The Panel decided that it was appropriate, in the circumstances outlined in the submission, for part of the hearing to be heard in private, this was to protect the Registrant’s private life and that of her family.

Name on HCPC Register

5. The Panel noted that the Notice of Hearing had been sent to the Registrant in her maiden name, which did not reflect the fact that her name as shown on the HCPC Register had been changed from Carlaw to Ward.

Background as recorded in the decision of the past reviewing panel

6. Following her graduation from University after studying psychology, the Registrant obtained employment in a special needs nursery where she worked as a learning assistant, and subsequently as a speech and language assistant. Her application to study speech and language therapy in order to become a Speech and Language Therapist (“SLT”) was supported by that employer. The Registrant completed her post- graduate diploma in speech and language therapy in 2013. During that training she completed three placements, one of which was undertaken with the East Kent Hospitals University NHS Foundation Trust (the Trust).

7. The Registrant commenced employment as a Band 5 SLT with the Trust on 1 September 2014. She was based at the Queen Elizabeth the Queen Mother Hospital in Margate (“the Hospital”). The Registrant’s employment continued until she submitted her resignation on 10 October 2017. Her last official working day was 7 November 2017, but she was on sick leave for some of the period between the submission of the resignation and the end of the employment.

8. The Registrant’s line manager, JH, by May 2017 had identified significant concerns about the Registrant’s practice. JH instigated an informal performance review from 24 May 2017 that lasted until 29 August 2017 which included an action plan. The Registrant’s line manager considered that the informal procedure had not achieved the goals set and a formal review meeting was scheduled for 29 September 2017 in line with the Trust’s HR Guidance for Performance Reviews. A further action plan was set under the formal procedure. The Registrant submitted her letter of resignation on 10 October 2017.

9. At the substantive hearing, the panel found all of the facts proved. Although the Registrant did not attend the substantive hearing, she provided a statement, dated 28 January 2020, in which she accepted most of the allegations against her.

10. The panel at the substantive hearing found that the incidents, both individually and taken together, amounted to misconduct. In so doing, the panel found that the “knowledge and skills required to act appropriately with regard to each patient were fundamental. None of them was unusual or specialised and the failings were serious”. The decision continued: “For the avoidance of doubt, there were no factual particulars that the Panel considered to be too insignificant to be included in this finding. Furthermore, the Panel was satisfied that no issue of lack of competence arises”.

11. In relation to impairment, the panel found that the Registrant was impaired in respect of both the private and public component.

12. In respect of the personal component, the panel noted:

• The witnesses called by the HCPC accepted that the Registrant was hard working, caring and had a genuine regard for her patients and wished to advance their interests.
• The Registrant had shown some insight and had admitted many of the failings found proved.
• There was a likelihood of repetition as the Registrant had not been working and she would need to undergo training and supervision, if she were to return to work.

13. In respect of the public component, the panel found that the public “would be dismayed if a practitioner against whom these serious findings have been made, and who has not remediated the shortcomings, were to be permitted to return to practise without restriction. Furthermore, if the Panel did make a finding of current impairment of fitness to practise it would be failing in its obligation to declare and uphold proper professional standards”.

14. The panel imposed a two year Conditions of Practice Order which included the following conditions:

1. You must not accept any offer of employment for which your HCPC registration is required unless the post to which you would be appointed offers you weekly face to face supervision until such time as your Newly Qualified Practitioner (“NQP”) Competencies are signed off as having been met by your supervising SLT who must be working at Band 7 or above.

2. You must not work alone with the following categories of patients:

• patients with dysphagia;

• patients with acute onset;

• end of life patients; and,

• patients with tracheostomies.

To the extent that you need to see patients falling into these prohibited categories in order to satisfy competencies, you are to shadow and/or be directly supervised by a practitioner working at Band 7 or above.

3. You are to attend and satisfactorily complete a Royal College of Speech and Language Therapists (“RCSLT”) accredited course on dysphagia.

4. You are to successfully complete the RCSLT NQP Competencies, starting that task afresh.

5. You are to successfully complete the RCSLT Dysphagia Training Competency Framework at Level B.

6. You are to complete a significant event analysis, using the RCSLT CPD Toolkit, in relation to the four patients concerned in this case.

7. You must provide not less than 28 days before the date of the review of this Order, the following documents:

• A certificate of completion of the course required to be undertaken by condition 3.

• Proof that your RCSLT NQP Competencies have been signed off by your supervising SLT.

• A certificate of completion of the Dysphagia Training Competency Framework at Level B required by condition 5.

• Copies of the significant event analyses required by condition 6.

• A report from your supervisor commenting specifically on your progress since this Order was made and your readiness to practise without restriction.

• Your CPD portfolio, demonstrating adherence to the five HCPC’s CPD standards.

8. You must promptly inform the HCPC if you take up any employment for which your HCPC registration is required.

9. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

10. 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).

15. The Registrant did not attend the review hearing on 9 February 2022. Her solicitors provided an update on her position. Information was provided that the Registrant had not worked as a Speech and Language Therapist. She had not satisfied any of the conditions on her registration. At that time the Registrant considered it “unlikely that she will wish to return the profession of Speech and Language therapy” [sic]. The Registrant’s solicitor stressed that the Registrant meant no disrespect to the panel by her failure to comply with the Conditions of Practice or her failure to attend that review hearing. The Registrant also “acknowledges that there were failures in her practice and is wholly understanding of the conditions that she would need to meet in order to practice”.

16. The review panel on 9 February 2022 decided that the Registrant’s fitness to practise remained impaired and that it was necessary and appropriate to continue the Conditions of Practice Order. It suggested that the Registrant should use the next twelve months to consider her position. If she no longer wished to remain on the register she should seek advice from her solicitor and take steps to apply for voluntary removal.

Last review on 6 February 2023

17. At the last review, the Registrant was in attendance and was supported at that hearing by Mr Bright. It was submitted that the documentation she had submitted on the 3 February 2023, supported her position that there had been a change of heart and she now wished to return to her profession.

18. The documentation provided to the panel on 3 February 2023 by the Registrant was, a Personal Development Plan (PDP) prepared by her in which she set out goals she had set for herself, including undertaking a Significant Event Analysis, training on dysphagia and record keeping, and refreshing her knowledge and skills. The Registrant had set out her plans as “urgent” or “longer term” goals.

19. Mr Bright had submitted on behalf of the Registrant that she acknowledged that her fitness to practise remained impaired. However, following a time of reflection she had come to the conclusion that she wished to undertake the appropriate steps that would allow her to return to practise. The Registrant was now ready to engage with the current conditions of practice. Mr Bright had sought a period of two years for conclusion of the appropriate training and courses.

20. The HCPC had submitted that a more appropriate period for this course of action to be concluded by would be twelve months.

21. The reviewing panel concluded the Conditions of Practice Order remained an appropriate and proportionate restriction on the Registrant’s practice in light of the recent change of mind and the information relating to her proposed course of remediation through a PDP. That panel confirmed the order for a period of 18 months.

Registrant’s documentation placed before this Panel

22. The Panel noted that the Registrant had provided the Panel with a 17-page bundle of documentation. That bundle included:

• A seven-page Significant Event Analysis (SEA) in which the Registrant addressed and commented upon her previous clinical and record keeping failings. In this document the Registrant expressed her remorse and insight for her previous actions.

• Certificate of attendance at a course provided by NCORE relating to Dysphagia.

• A reflective piece of writing relating to the Registrant’s attendance at the course on dysphagia.

• Certificate of attendance at an NCORE course relating to Record keeping.

• A reflective piece of writing relating to the Registrant’s attendance at the course on record-keeping.

• An electronically generated list of applications the Registrant had submitted for Band 5 positions. This schedule identified those which had not been pursued for a variety of reasons and those which had been unsuccessful. The last application was a current one, the outcome being awaited.

Submissions

23. The Panel heard submissions from Mr Slack in which he acknowledged the efforts made by the Registrant towards compliance with the current Order but emphasised that there is still much more to be undertaken for full compliance. He submitted that the Registrant’s fitness to practise remains impaired. The HCPC position was, he stated, that the current Conditions of Practice Order should be confirmed and continue for an agreed period of two years.

24. On behalf of the Registrant Mr Bright accepted that the Registrant’s fitness to practise remains impaired. He stated that the Registrant had demonstrated within her SEA that the Registrant had reflected on her actions and had demonstrated her remorse for her previous actions. He acknowledged that the Registrant has not yet undertaken all of the necessary steps and that this was for personal reasons.

25. [Redacted].

26. Mr Bright submitted that the Registrant had taken significant steps to complete her PDP proposals as outlined at the last review. In relation to Condition 3 it was submitted that whilst this course was not accredited by the Royal College of Speech and Language Therapists (RCSLT), it was a relevant and appropriate substitute. Mr Bright told the Panel that the HCPC had been supplied with information that the RCSLT did not accredit courses and so there were none available to fulfill the wording employed in Condition 3. The supporting reflective pieces of writing endorsed the learning gained at those courses.

27. Mr Bright clarified that there was some uncertainty surrounding the current status of the Registrant’s membership of the RCSLT. He was able to confirm that it was the settled intention of the Registrant to maintain her membership of this organisation.

28. It was submitted that the Registrant has gained insight into her former failings and has fully committed herself to completing her remediation of her former failings. The Registrant is focused on her further training and will continue to actively pursue a position as a Band 5 Speech and Language Therapist which will then allow her to demonstrate in a practical setting her refreshed knowledge.

29. Mr Bright submitted that, with the exclusion of Conditions 3 and 6, the current Conditions of Practice Order provided sufficient protection for the public. In respect of the length of the Order Mr Bright submitted that this was a matter for the Panel, and that the Panel might consider that two years was appropriate. Mr Bright emphasised that whilst the Registrant may require two years to complete full remediation and compliance with the conditions, she should not be restricted in terms of when she can seek an early review.

Panel Decision

30. The Panel heard and accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note Review of Article 30 Sanction Orders. The Panel accepted that the function of this review is to determine whether the Registrant’s fitness to practise remains impaired. If so, then to consider whether the Conditions of Practice Order under review today is still the most appropriate and proportionate means of public protection in light of the further information supplied by the Registrant, or should it be varied or replaced by some other Order.

31. Whilst undertaking this review, the Panel has noted that since the events in 2017 the RCSLT had moved towards dysphagia being subsumed within the defined pre-registration standards of proficiency at RCSLT Dysphagia Training Competency Framework Level B. Implementation of this during training began in academic year 2022/23 and that it was no longer solely the subject of post graduate study. This being the case, it was appropriate for the Registrant to continue with her improving knowledge of this area of practice, whether or not she was required to apply this knowledge in any future appointment.

32. The Panel noted that the Registrant’s membership of the RCSLT was going to be reinstated if this was required, and that she will going forward be able to avail herself of the Royal College’s professional publications, guidance and journals.

33. The Panel first considered whether the Registrant’s fitness to practise remains impaired. It has taken account of the submissions of both parties and the documentation from the Registrant as listed above. The Panel noted that in relation to both certificates from NCORE courses, one required for compliance with the Condition 3 and one relevant to the issue of record keeping, that:

• First, the certificates related to attendance at the courses and did not require an assessment of whether the Registrant had ‘satisfactorily completed’ the course.
• Secondly, that the courses were not an accredited course run by the Royal College of Speech and Language Therapists as required by condition 3.

34. The Panel acknowledged that the requirement for the Registrant to attend courses to be accredited by the RCSLT may have reflected a previous practice by that organisation. The Panel had been told and accepted that the RCSLT did not accredit courses and so full compliance with the wording set out in the conditions which were imposed in early 2020 was no longer possible.

35. The Panel noted that the Registrant has not complied with all of the conditions imposed by the previous panels, and this is in part due to her continuing inability to secure a position as a Band 5 Speech and Language Therapist. The completion of the conditions relating to her professional competences has also been hindered by her recent family circumstances. In light of those factors, the Panel has concluded that the Registrant’s fitness to practise remains impaired.

36. In considering the appropriate sanction, the Panel had regard to the Sanctions Policy published by the HCPTS in March 2019. The Panel has applied the principle of proportionality.

37. The Panel is aware that the purpose of a sanction is not to be punitive but that it must consider the risk the Registrant may continue to pose to service users in the future and determine what sanction is sufficient to protect the public and the wider public interest.

38. The Panel has considered the sanctions available in ascending order of severity. The Panel considered that to take no action or to impose a Caution Order would not be sufficient or appropriate, as neither outcome would afford the necessary public protection or satisfy the wider public interest.

39. The Panel next considered whether a Conditions of Practice Order remained sufficient and proportionate in all the circumstances of the current case. In this regard the Panel took into account the following:

• The Registrant has not practised since the end of 2017 and the Panel noted that there was still much work to do to update her knowledge and skills and to address the concerns identified by the substantive hearing panel.
• The Registrant was still certain about her plans to return to practise as evidenced by the number of applications for posts that had been submitted.
• The Registrant’s former failings had been acknowledged within her SEA (as required by Condition 6) and the reasons for those failings fully explored within that piece of reflective writing.

40. The Panel therefore concluded that in light of those matters a Conditions of Practice Order remained an appropriate and proportionate restriction in this instance.

41. The Panel considered carefully whether the conditions of practice as currently drafted remained appropriate. The Panel reviewed the current conditions of practice and considered that the necessity for Conditions 3 and 6 had been addressed by the course which the Registrant had attended and her SEA. Those two conditions had, in the Panel’s view, been discharged, if not in full, to the extent that they could in view of no accreditation being available through the means of the RCSLT.

42. In relation to the other conditions the Panel was content for them to remain but made two small drafting changes to conditions 2 and 10 as they formerly were and 2 and 8 as now redrafted. Those conditions are to be varied as follows:

• Condition 2 by the deletion of the words ‘need to see’ and replaced by ‘to assess and treat’. This change of wording better reflects the practical situation.
• Condition 8 (formerly 10) by the inclusion of the words ‘for any positions that require your registration as a Speech and Lanaguage Therapist’. The addition of this wording clarifies and limits the extent of the disclosure.

43. The Panel next considered the appropriate length of the order. The Panel carefully balanced the need to ensure that the Registrant’s progress is appropriately monitored and the need to allow a realistic length of time for her to engage with suitable training opportunities, build her confidence, and, in due course, begin practising under the conditions of practice. The Panel noted that the parties agreed that two years was an appropriate period. This Panel agrees with that length of time, particularly in light of the current family situation and the paucity of Band 5 positions that may be available. The Panel has not exercised its discretion to limit the Registrant’s ability to apply for an early review as this may prove counterproductive to her efforts to return as soon as possible to safe practice.

44. The Panel therefore decided to extend the Conditions of Practice Order as varied for a period of two years.

ORDER: The Registrar is directed to vary and extend the Conditions of Practice Order against the registration of Jennifer Ward (née Jennifer Carlaw) for a further period of two years on the expiry of the existing Order. The terms of the varied conditions are set out below:

1. You must not accept any offer of employment for which your HCPC registration is required unless the post to which you would be appointed offers you weekly face to face supervision until such time as your Newly Qualified Practitioner (“NQP”) Competencies are signed off as having been met by your supervising SLT who must be working at Band 7 or above.

2. You must not work alone with the following categories of patients:

• patients with dysphagia;
• patients with acute onset;
• end of life patients; and,
• patients with tracheostomies.

To the extent that you need to assess and treat patients falling into these prohibited categories in order to satisfy competencies, you are to shadow and/or be directly supervised by a practitioner working at Band 7 or above.

3. You are to successfully complete the RCSLT NQP Competencies, starting that task afresh.

4. You are to successfully complete the RCSLT Dysphagia Training Competency Framework at Level B.

5. You must provide not less than 28 days before the date of the review of this Order, the following documents:

a. Proof that your RCSLT NQP Competencies have been signed off by your supervising SLT.

b. A certificate of completion of the Dysphagia Training Competency Framework at Level B required by condition 4.

c. A report from your supervisor commenting specifically on your progress since this Order was made and your readiness to practise without restriction.

d. Your CPD portfolio, demonstrating adherence to the five HCPC’s CPD standards.

6. You must promptly inform the HCPC if you take up any employment for which your HCPC registration is required.

7. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

8. You must inform the following parties (for any positions that require your registration as a Speech and Lanaguage Therapist) that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;

B. any agency you are registered with or apply to be registered with (at the time of application); and

C. any prospective employer (at the time of your application).

The Order imposed today will apply from 5 September 2024.

This Order will be reviewed again before its expiry on 5 September 2026.

History of Hearings for Jennifer Ward