Sandra Marshall

Preliminary Matters
Service and Proceeding in Absence

1. Notice of this review hearing was sent to the Registrant on 14 May 2024 by email. The Registrant was informed of the date and time of the hearing and the purpose of the review hearing. The Registrant replied on 26 May 2024 to say that she will not be attending but is content for the hearing to take place in her absence. She said that she has not practised over the last 18 months.

2. The Panel accepted the advice of the Legal Assessor and was satisfied that good service had been effected. It noted that the email was sent to the Registrant’s registered email address 28 days before this hearing. Whilst the Panel was aware that all that the HCPC need to establish was the sending of the document, the Panel was additionally satisfied that the notice had been received, in view of the Registrant’s reply.

3. Ms Sampson applied for the matter to be heard in the Registrant’s absence in accordance with Rule 11 of the HCPTS Conduct and Competence Committee Procedure Rules. Ms Sampson submitted that in view of the Registrant’s email of 26 May 2024 in which she stated that she would not be attending and was content for the hearing to take place in her absence, it was proportionate to proceed. Ms Sampson submitted that in these circumstances it was unlikely that an adjournment would secure the Registrant’s attendance at a later date, and noted that this is a mandatory review of an Order which is due to expire on 5 July 2024. She submitted that proceeding in the Registrant’s absence was fair and was in the public interest.

4. The Panel accepted the Legal Assessor’s advice and was aware of the factors to take into account, as set out in R v Jones [2003] UKPC 34 (as modified for FTP hearings) when determining whether to proceed in absence. It was satisfied that the Registrant is aware of today’s hearing and has voluntarily waived her right to attend. The Panel considered that an adjournment would serve no purpose, and that it was in the interest of the Registrant, the HCPC and the public that the hearing proceed today. This was particularly so given that the Order is due to expire in less than 28 days’ time. The Panel determined that the hearing would proceed in the Registrant’s absence.

Background

5. The Registrant was employed as a Band 5 SLT by Oxleas NHS Foundation Trust (‘the Trust’) in March 2019. Very little information was provided about her previous employment as an SLT save that it was in a school and that her Royal College of Speech and Language Therapists (‘RCSLT’) competencies had been signed off while she was in that employment.

6. The Registrant’s work at the Trust was split between ‘Early Years’, being children aged between two and five years, and ‘School Years’, involving children between the ages of five and eleven.

7. She was supervised by Ms KR, a Band 7 Specialist SLT, and her line manager was Ms KP, who from February 2020 was the Trust’s Principal SLT and Head of Greenwich Children’s Integrated Therapies, but before that, and at the time of the Registrant’s employment, she was the Services Lead for the School Years Services.

8. All new employees of the Trust initially worked under a probationary period framework for a period of three months, which could be extended for a further three months. An aspect of this framework was that more frequent supervision was provided. The supervision sessions between the Registrant and Ms KR that were weekly (save when annual leave made that impossible) continued after the initial three months of the Registrant’s employment. Ms KR and the Registrant also worked together clinically on a fortnightly basis.

9. As a result of concerns being expressed about the Registrant’s performance, a first capability meeting took place on 9 September 2019. Competency goals were set for the Registrant to meet. The goals were framed using the RCSLT Newly Qualified Practitioner Goals. At this meeting it was decided that the Registrant should no longer work autonomously in schools, and that in a school setting her work would either be shared with another SLT or that she would undertake very specific assessments that were discussed both before and after the visit to the school.

10. The capability process was monitored by recording feedback received from SLTs with whom the Registrant worked over the course of 2020. Due to a lack of satisfactory improvement, the matter was referred to the HCPC, and a substantive hearing took place between 1-10 August and 7-8 December 2022. That panel found that the Registrant’s fitness to practise was currently impaired on the ground of a lack of competence, and imposed a Conditions of Practice Order for a period of 18 months.

11. The Conditions of Practice were:

1) You must not work for an agency or as a locum speech and language therapist.

2) At any time you are employed as a speech and language therapist at Band 5 or above, you must place yourself and remain under the direct supervision of a Workplace Supervisor. The Workplace Supervisor must be on the HCPC’s Speech and Language Therapists Register. You must attend upon that supervisor as required and follow their advice and recommendations.

3) You must supply details of your Workplace Supervisor to the HCPC within two weeks of commencing employment as a speech and language therapist.

4) All aspects of your direct contact with service users or their families must be directly supervised at all times by a person who is a speech and language therapist registered with the HCPC. Such supervision is to consist of being directly observed by a registered speech and language therapist of at least one year’s experience.

5) You must meet with your Workplace Supervisor on a weekly basis to review your progress towards achieving the competencies identified in condition 7 below.

6) You must allow your Workplace Supervisor to provide information to the HCPC about your progress towards achieving the clinical competencies as set out in condition 7 below.

7) Your Supervisor must agree to provide three-monthly feedback Reports to the HCPC. This feedback must include your progress towards achieving clinical competence at the level of a Band 5 speech and language therapist in relation to:

a) Demonstrating:

(i) knowledge;
(ii) clinical skills;
(iii) clinical understanding;
(iv) capability for clinical reasoning;
(v) capability for clinical decision making.

b) Case management in accordance with departmental protocols;

c) Making clinical decisions independently and consistently;

d) Professional and therapeutic communication;

e) Making appropriate referrals and ensuring on-going care;

f) Making appropriate discharges;

g) Record keeping including completing appropriate SOAP notes, summaries and any other records required for patient care.

8) Your Supervisor must include in the three-monthly feedback Reports any other relevant information, and confirmation that you are complying with these conditions.

9) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

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

11) 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; and

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

12. The Registrant has informed the HCPC via email that she has not been practising over the last 18 months, and as such, has not worked under these Conditions.
Submissions on behalf of the HCPC

13. Ms Sampson reminded the Panel that the purpose of this hearing is to determine whether the Registrant remains impaired, and if so, to consider whether the existing Order, or another order is required to protect the public. She referred the Panel to the relevant HCPTS Practice Note which sets out the factors to consider, including the steps the Registrant has taken to address the original panel’s concerns.

14. Ms Sampson noted that there is a persuasive burden on the Registrant in accordance with Abraheam v GMC [2008] EWHC 183 (Admin) to demonstrate that she has fully acknowledged the deficiencies that led to the original finding, and addressed that impairment sufficiently “through insight, application, education, supervision or other achievement”.

15. Ms Sampson submitted that the concerns before the original panel about the Registrant’s practice were significant; she was unable to manage caseloads without significant support and unable to make independent clinical decisions safely. There had been no remedial action taken at the date of the substantive hearing, and the Registrant had not recognised the risk of harm created by her shortcomings. It was of note that the Registrant told the original panel that she had “decided not to address her failings until such time as the Panel indicated what failings she ought to address”.

16. In her email to the HCPC of 26 May 2024, the Registrant had stated that her circumstances had not changed. She was interested in applying for a Band 5 position and was aware that she would need to “redo all my competencies”.

17. It was submitted that in view of this email and in the absence of any evidence of remediation there was nothing before this Panel to demonstrate that anything had changed. The Registrant had not remediated her failings or demonstrated insight such that she is able to practise safely, effectively and autonomously. She had not discharged the persuasive burden and, it was submitted, her fitness to practise remains impaired.

18. Ms Sampson invited the Panel to extent the current Conditions of Practice Order for a further 18 months.

Decision

19. The Panel accepted the advice of the Legal Assessor. It was aware that its task is to determine whether the Registrant remains impaired on the personal and/or public component, and if so, decide whether to extend the current order, or replace it with another order that was open to the original panel. It was aware that strike-off is not an available sanction as the Registrant has not been subject to a conditions of practice order or suspension order for two years.

20. The Panel, having considered all the information before it, was of the view that nothing had changed since the Order was imposed. The Registrant had provided no evidence of developing insight or of remediation, nor had she taken any steps to improve her skills in the areas identified by the original panel as having fallen short, neither had the Registrant provided a reflective piece about the allegation against her.

21. The Panel noted that that the Registrant has been working in a Band 4 role, which does not require HCPC registration. As such, she has not been able to develop her clinical skills and competencies in the areas that need to be addressed, as she will not have been working autonomously at this level.

22. The Panel determined that the Registrant remains impaired on the personal component. She continues to present significant risks to patients because there is a high risk of repetition of the failings that led to the original panel’s findings. This is because the Registrant has taken no steps, such as CPD, to address the clinical failings, and nor has she reflected and demonstrated that, for example, she understands the risks associated with those failings. The Panel considered that the shortcomings in the Registrant’s practice were, and remain, wide-ranging and relate to fundamental aspects of the role of a SLT.

23. In terms of the public component of impairment, the Panel was concerned by the Registrant’s attitude to addressing the shortcomings in her practice. The Panel would have expected the Registrant to take proactive steps to improve her practice rather than wait for the original panel to tell her which failings she ought to address. Notwithstanding this somewhat passive approach, the Panel was disappointed to see that, having been aware for 18 months of the areas in which development is required, the Registrant has still taken no steps to improve her knowledge and skills. The Panel acknowledged that in a Band 4 role, the Registrant would not be able to demonstrate these skills in her day-to-day work, but she could have undertaken learning and development through attending training courses and reading relevant materials.

24. It followed, in the Panel’s view, that the Registrant remains impaired on the public component. A member of the public would be very concerned if the Registrant, having made no effort to address her shortcomings, were no longer subject to restrictions on her practice. Such an outcome would significantly undermine confidence in the Regulator and the Regulatory process.

25. In summary, through the Registrant’s own admission, nothing had changed since the date the current Order was imposed. For the reasons set out above, the Panel determined that the Registrant remains currently impaired on both the personal and public components.

26. The Panel went on to consider the appropriate and proportionate order in these circumstances. Given that there remains a high risk of harm to the public, taking no action or imposing a caution order were not appropriate outcomes as these would not mitigate the risks.

27. The Panel noted that the Registrant is hoping to secure a Band 5 role, and has shown some commitment to her profession as she has been working the field in a Band 4 role. As such, the Panel determined that it was proportionate to extent the current Conditions of Practice Order. To take more restrictive action and suspend the Registrant would be punitive as she would be unable to address the failings in her practice.

28. As the concerns today were the same as those outlined by the original panel, nothing having changed, the Panel, having reviewed the current Conditions of Practice Order, determined that those conditions manage the risks identified and are workable. They are proportionate to the level of risk given the range and nature of the shortcomings in the Registrant’s practice.

29. The Panel extended the current Conditions of Practice Order for a further period of 18 months. This period should give the Registrant time to obtain any Band 5 role and work at that level under supervision to develop her skills and knowledge.

30. This Order will be reviewed before its expiry. The Panel considered that a future reviewing panel may be assisted by:

• A reflective statement from the Registrant addressing the risks to patients arising from the areas in which her practice fell short;

• Evidence of CPD in the areas of caseload management, clinical decision making and communication.

ORDER: The Registrar is directed to extend the current Conditions of Practice Order upon its expiry for a further period of 18 months.

1) You must not work for an agency or as a locum speech and language therapist.

2) At any time you are employed as a speech and language therapist at Band 5 or above, you must place yourself and remain under the direct supervision of a Workplace Supervisor. The Workplace Supervisor must be on the HCPC’s Speech and Language Therapists Register. You must attend upon that supervisor as required and follow their advice and recommendations.

3) You must supply details of your Workplace Supervisor to the HCPC within two weeks of commencing employment as a speech and language therapist.

4) All aspects of your direct contact with service users or their families must be directly supervised at all times by a person who is a speech and language therapist registered with the HCPC. Such supervision is to consist of being directly observed by a registered speech and language therapist of at least one year’s experience.

5) You must meet with your Workplace Supervisor on a weekly basis to review your progress towards achieving the competencies identified in condition 7 below.

6) You must allow your Workplace Supervisor to provide information to the HCPC about your progress towards achieving the clinical competencies as set out in condition 7 below.

7) Your Supervisor must agree to provide three-monthly feedback Reports to the HCPC. This feedback must include your progress towards achieving clinical competence at the level of a Band 5 speech and language therapist in relation to:

a) Demonstrating:

(i) knowledge;
(ii) clinical skills;
(iii) clinical understanding;
(iv) capability for clinical reasoning;
(v) capability for clinical decision making.

b) Case management in accordance with departmental protocols;

c) Making clinical decisions independently and consistently;

d) Professional and therapeutic communication;

e) Making appropriate referrals and ensuring on-going care;

f) Making appropriate discharges;

g) Record keeping including completing appropriate SOAP notes, summaries and any other records required for patient care.

8) Your Supervisor must include in the three-monthly feedback Reports any other relevant information, and confirmation that you are complying with these conditions.

9) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

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

11) 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; and
b) any prospective employer (at the time of your application).

The Order imposed today will apply from 5 July 2024.

This Order will be reviewed again before its expiry on 4 January 2026.

History of Hearings for Sandra Marshall