Sarah Sikpa

Background

1. At the relevant time, Ms Sikpa (“the Registrant”) worked as a Band 8a Practitioner Psychologist with the Black Country Partnership NHS Foundation Trust (“the Trust”). She initially worked at the Trust through an employment agency from October 2015, but was employed directly by the Trust from 1 November 2016. The Trust merged with Dudley and Walsall Mental Health Partnership NHS Trust in April 2020 to form Black Country Healthcare NHS Foundation Trust, which is what the Trust is now known as.

2. The Registrant was suspended by the Trust pending investigation in March 2018. The investigation included conducting an audit of her clinical caseload.

3. On 25 April 2018, the HCPC received an anonymous referral about the Registrant which identified a number of concerns about her practice.

4. The HCPC contacted the Trust about the concerns. The Trust supplied information to the HCPC in August 2018 which appeared to confirm that the Trust had identified issues with record-keeping, including that the Registrant did not complete care plans and risk assessments for some service users.

5. On 29 January 2020, an Investigating Committee panel of the HCPC determined that the concerns should be referred to the Conduct and Competence Committee.

The substantive hearing

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

7. The substantive hearing panel made the findings of fact identified above. In summary, it determined that all bar three of the allegations were proved. The substantive hearing panel concluded that some of the allegations that were found proved amounted to “serious misconduct” and met the threshold for the statutory ground of misconduct.

The substantive hearing panel’s decision on impairment

8. The substantive hearing panel determined that the Registrant’s fitness to practise was impaired by reason of her misconduct. Its reasons for coming to this conclusion were fully set out in its determination and include those set out below.

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

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

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

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

The substantive hearing panel’s decision on sanction

9. Having considered the relevant aggravating and mitigating factors, the substantive hearing panel considered what sanction it should impose. It took account of the risk of repetition. It concluded that to take no action or to issue a Caution Order would not be appropriate. It further concluded that it could not formulate workable conditions which adequately protected the public and which did not amount to suspension.

10. The substantive hearing panel imposed a Suspension Order for 12 months. Its reasons for coming to these conclusions were fully set out in its determination and include those set out below.

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

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

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

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

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

Suggestions made by the substantive hearing panel as to what might assist a future reviewing panel

11. At the conclusion, in paragraph 258 of its determination, the substantive hearing panel made suggestions as to what might assist a future reviewing panel and these suggestions were in the following terms:

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

a. detailed written reflective piece focusing on:

i. Working in a multi-disciplinary team;

ii. Record-keeping;

c. information on her current health …

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

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

i. Risk assessment and analysis;

ii. record-keeping;

iii. Integrity and professional ethics;

iv. Working in a multi-disciplinary team;

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

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

The first substantive review hearing

12. The first reviewing panel’s conclusion in relation to impairment and sanction were set out in its determination as follows:

“Having taken account of the submissions made by Ms Khan and those of the Registrant, the Panel has concluded that the Registrant’s fitness to practise remains impaired. Its reasons are essentially the same as those given by the substantive hearing panel. The Registrant has not complied with any of the suggestions made in paragraph 258 of the determination of the substantive hearing panel. It also notes and agrees with the comments made by the substantive hearing panel in paragraph 256 of its determination. In substance, the Panel concluded that the Registrant had not discharged the persuasive burden of establishing that she was no longer impaired. It was of concern to the Panel that whilst the allegations related substantially to proper record-keeping and paper management, the Registrant had not produced any of the written material recommended in paragraph 258 of the determination of the substantive hearing panel. In the opinion of the Panel such documents could and should have been obtained.

The Panel has concluded that in all the circumstances it could not exclude a risk of repetition. It also concludes that public confidence in the profession and in the HCPC as its regulator, would be gravely undermined if the Panel was to determine that the Registrant’s fitness to practise was not now impaired and the Registrant was permitted to return to unrestricted practice. Consequently, for the same reasons that are set out in the determination of the substantive hearing panel, the Panel determines that the Registrant’s fitness to practise remains impaired on both the personal and the public components.

In considering the appropriate order the Panel had regard to the HCPC’s Sanctions Policy updated in March 2019, to the submissions of Ms Khan, to those of the Registrant and to the advice of the Legal Assessor.

The Panel has applied the principle of proportionality. The Panel is aware that the purpose of sanction is not to be punitive and that it must consider the risk of repetition and public confidence in the profession and its regulator.

The Panel has considered the sanctions available in ascending order of restriction. The Panel considered that to take no action or to impose a Caution Order would be wholly inappropriate.

The Panel gave very serious consideration to the possibility of formulating a Conditions of Practice Order. However, it concluded that it could not formulate appropriate conditions which were not tantamount to suspension.

The Panel next considered a continuation of the Suspension Order. It has concluded that a further period of suspension for 6 months would be both appropriate and sufficient to address the concerns set out above and which are reflected in the Panel’s finding of current impairment. The Panel determined that at this stage a Striking Off Order would be disproportionate.

This Order will be reviewed before it expires on 28 April 2024. The Panel stresses the importance of the Registrant complying with all suggestions made by the substantive hearing panel on 30 September 2022, which this Panel now repeats. These suggestions are those set out in paragraph 258 of the determination of the substantive hearing panel. In particular, the Panel stresses the importance of:

1) The Registrant participating at the next review hearing.

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

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

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

c. Her aspirations for the future.

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

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

The second substantive review hearing

HCPC submissions

13. Ms Khorassani, on behalf of the HCPC, outlined the background. She submitted that the Registrant’s fitness to practise remained impaired on both the personal and public components. An Order remained necessary to protect members of the public, to ensure public confidence in the profession, and to uphold the standards of conduct.

14. Ms Khorassani submitted that the current Suspension Order should be extended for a further period and this would give the Registrant another opportunity to demonstrate remediation. Ms Khorassani submitted that the Registrant had not fully engaged with the process and did not submit written evidence until the morning of the hearing.

Registrant’s evidence

15. On the morning of the hearing, the Registrant provided the panel with the following written evidence:

• A written reflective piece;

• A list of theoretical learning comprising a list of articles and books;

• Two testimonials relating to her voluntary work;

• A testimonial from a Counselling Psychologist who has engaged in peer discussions with the Registrant.

16. The Registrant also gave oral evidence to the Panel, was questioned by Ms Khorassani on behalf of the HCPC, and answered questions from the Panel.

17. The Registrant’s oral evidence included the following:

• Her provision of documentation to comply with the recommendations of the last reviewing panel;

• Her initial response to the decision of the substantive hearing panel was to feel overwhelmed, but she has now had the opportunity to reflect on what happened and to consider the HCPC perspective;

• An outline of her understanding of the decision made by the substantive hearing panel;

• A reiteration of her continuing belief that she acted in the best interests of her clients and that it was appropriate to develop the trust of her service users and gather information before preparing written documentation;

• References to the fact that prior to the substantive hearing she worked under interim conditions of practice and multiple reports from her supervisors confirmed that there were no concerns about her practice;

• Her statement of what she would now do differently, including the importance of writing a clear note if she was unable to complete written documentation in accordance with her employer’s expectation;

• Her understanding of the importance of record-keeping as part of the communication with her colleagues, ensuring that service user files are up-to-date if she is not available;

• Her acknowledgement that in certain circumstances there was a potential risk of harm to service users if risk assessment/care plan documentation is not completed;

• The importance of risk assessment and communicating risk assessments to ensure that service users are kept safe;

• Her reassurance to the Panel that there will be no repetition of similar conduct;

• That her own interests are less important than ensuring that the public is kept safe;

• The impact of the Suspension Order and the ongoing fitness to practise process on herself, particularly the severe financial impact given her personal and family circumstances;

• The length of time over which this matter has been outstanding given that it dates to conduct in 2016 and 2017;

• Her commitment to her current voluntary work, her use of her transferable skills, and her interest in working with older adults and the insight she has gained from this work;

• Her continuing commitment to her profession, describing her role as a Counselling Psychologist as her vocation;

• Her value as a member of the profession assisting members of the public, and that it would not be in the public interest to withhold the services she can provide;

• Her acceptance of the need to make changes and enhance her practice with respect to record-keeping;

• Her position that a further extension of the Suspension Order would serve no purpose and would be disproportionate;

Panel’s decision

18. The Panel heard and accepted the advice of the Legal Assessor.

19. The Panel is aware that it has all the powers that are set out in Article 30(1) of the Health and Social Work Professions Order 2001 (the Order), which were set out in the email sent to the Registrant giving notice of this hearing.

20. The Panel is aware that the process under Article 30(1) of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise remains impaired and, if so, whether the Suspension Order under review remains appropriate and proportionate or should be varied or replaced by some other order.

21. The Panel was assisted by the Registrant’s engagement with the hearing and the evidence she gave. The Panel considered that the Registrant spoke frankly and openly about her recent experiences and her reflections on the substantive hearing decision, and that she did her best to answer questions from Ms Khorassani and the Panel.

22. Although the Registrant’s written evidence was presented very late, the Panel was of the view that she had genuinely attempted to engage with the recommendations of the last reviewing panel. In her evidence to the Panel, she demonstrated willingness to learn and improve her practice and to engage with any steps that might be necessary to enable her to return to safe practice. She also demonstrated her clear commitment to her profession and she has undertaken reading to keep her knowledge and skills up to date.

23. The Panel was of the view that the Registrant’s level of insight has developed since the last review. When assisted by questioning, she was able to speak about the potential risks to service users and the impact on her colleagues of her past misconduct. Although the Registrant at times was very focused on the impact of the Suspension Order on herself, she also acknowledged the Panel’s role in ensuring that the public is safe.

24. The Panel had some concerns about the level of the Registrant’s insight. It was concerning that she had not responded to correspondence from the HCPC inviting her to provide evidence in advance of the hearing and that her administrative preparation for the hearing was limited. She told the Panel that she had read the panel decisions, but that this was some months ago. The Registrant told the Panel that due to her current circumstances she did not regularly review email correspondence and that consequently, she had only two working days’ notice of this review hearing.

25. The Panel’s assessment was that the Registrant’s insight was developing and that she was now willing to remedy the deficiencies in her practice as found by the substantive hearing panel, even though she may not agree with that decision.

26. The Panel noted the Registrant’s fitness to practise history and the repetition of findings relating to record-keeping. In the Panel’s view the Suspension Order has had a salutary impact on the Registrant and the risk of repetition has reduced. However, the Registrant has not demonstrated full insight and she has also not had the opportunity to demonstrate that her learning and insight has been embedded in her practice. The Panel therefore concluded that there remains a risk of repetition of similar conduct and therefore a potential risk of harm to service users.

27. In light of the ongoing risk of harm to members of the public, the Panel found that public confidence in the profession would be undermined if the Panel were to conclude that the Registrant’s fitness to practise is no longer impaired.

28. The Panel therefore concluded that the Registrant’s fitness to practise remains impaired on the basis of the personal component and the public component.

29. The Panel next considered the appropriate order. It had regard to the HCPC Sanctions Policy and considered the sanctions available in ascending order of restriction. The Panel considered that to take no action or to impose a Caution Order would be insufficient to protect the public. These options would not restrict the Registrant’s practice and would not provide any measure of public protection against the risk of repetition.

30. The Panel gave consideration to the possibility of formulating a Conditions of Practice Order. The concerns relate to a deficiency in one area of the Registrant’s practice and the Panel considered that workable conditions of practice could be formulated that would address the risk of repetition. Although the Registrant was of the view that any Conditions of Practice Order would be tantamount to a Suspension Order, the Panel was of the view that the required conditions would not be so restrictive that it would be impossible for the Registrant to find employment with a supportive employer. The Panel was of the view that the Registrant had demonstrated sufficient insight for conditions to be appropriate.

31. The Registrant directly provided confirmation that she would comply with any order imposed by the Panel, and the Panel had sufficient confidence that she would comply with the conditions of practice if she worked as a Practitioner Psychologist.

32. The Panel reviewed the HCPC Sanctions Policy paragraphs 106-107 and considered that the criteria for a Conditions of Practice Order to be considered were applicable. The Panel therefore decided to replace the current Suspension Order with a Conditions of Practice Order.

33. The Panel considered the option of extending the current Suspension Order for a further period of time. The Panel decided that an extension of the current order was not required because conditions of practice would be sufficient to manage the residual risk of repetition. The Panel was also of the view that a further extension of the Suspension Order would be disproportionate. In reaching this decision, the Panel carefully balanced the need to ensure a sufficient measure of public protection against the Registrant’s interests. The Panel took into account the detrimental impact on the Registrant of a continued Suspension Order and noted its negative financial and reputational impact. There is also a risk of the Registrant becoming deskilled. The Panel was also of the view that there is a realistic prospect that the Registrant will be able to return to safe practice with the assistance of supervision and monitoring of her practice and there is a public interest in her rehabilitation to safe practice.

34. The Panel decided that the Conditions of Practice Order should be for a period of 18 months to allow sufficient time for the Registrant to demonstrate that she has embedded her learning in her practice and for her to prepare evidence to present to a review panel.

The Registrar is directed to annotate the Register to show that, for a period of 18 months from the date that this Order comes into effect (“the Operative Date”), you, Ms Sarah Sikpa, must comply with the following conditions of practice:

1. You must not undertake professional practice as a sole Practitioner Psychologist.

2. You must inform the HCPC within seven days if you take up any professional work as a Practitioner Psychologist.

3. Within 14 days of taking up employment as a Practitioner Psychologist, you must place yourself and remain under the supervision of a workplace supervisor who is a Senior Practitioner Psychologist registered by the HCPC and supply details of your supervisor to the HCPC. You must attend upon that supervisor as required and follow their advice and recommendations.

4. You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the following areas:

• All aspects of record-keeping, with particular reference to:
­ Care plans;
­ Risk assessments;
­ Timely discharge.

• Reflection on the importance of the above to your professional practice.

5. Within three months of taking up employment as a Practitioner Psychologist you must forward a copy of your Personal Development Plan to the HCPC.

6. You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

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

8. You must arrange for an audit of the following areas of your practice by your supervisor (monthly for the first six months of taking up employment as a Practitioner Psychologist, and thereafter every three months):

• All aspects of record-keeping, with particular reference to:
­ Care plans;
­ Risk assessments;
­ Timely discharge.

This audit to be measured against:

• the policies and procedures of any organisation by whom you are employed as a Practitioner Psychologist;

• the HCPC Standards of Proficiency for Practitioner Psychologists;

• the HCPC Standards of Conduct, Performance, and Ethics.

You must send the HCPC a copy of the results of each audit within seven days of receipt.

9. You must inform the HCPC within seven days of becoming aware of:

A. any patient safety incident you are involved in;

B. any investigation started against you; and

C. any disciplinary proceedings taken against you.

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 to undertake professional work (at the time of application);

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

11. You must allow the HCPC to share, as necessary, details about your performance, compliance with, and/or progress under these conditions with:

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 to undertake professional work (at the time of application);

C. any prospective employer for professional work (at the time of your application);

12. You will be responsible for meeting any and all costs associated with complying with these conditions.

13. Any condition requiring you to provide information is to be met by you providing such information to the HCPC marked for the attention of the relevant HCPC Case Manager.

This Order will be reviewed before it expires on 28 October 2025.

History of Hearings for Sarah Sikpa