Mr Stephen G Morgan

Profession: Occupational therapist

Registration Number: OT35127

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 15/10/2024 End: 17:00 15/10/2024

Location: This hearing is being held remotely via video conference.

Panel: Conduct and Competence Committee
Outcome: No further action

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Allegation

Allegations as proven at the final hearing

Whilst registered as an Occupational Therapist and during the course of your employment at Cambridgeshire and Peterborough NHS Foundation Trust:

1. In relation to Service User A you completed a home visit on or around 28 October 2016 and:
a. Did not make a record of the visit
b. Did not request the required equipment and / or adaptations until around 1 December 2016

2. Not proved

3. In relation to Service User C on or around 27 September 2016 you did not demonstrate:
a. Collaborative working in that you misinterpreted what your colleague said during a meeting
b. Effective clinical reasoning in relation to the kitchen assessment

4. In relation to Service User D you did not ensure that the required equipment was available in time for the scheduled discharge on 21 September 2016

5. In relation to Service User E you:
a. Did not complete and/or record a discharge assessment summary
b. Did not arrange follow-up care following Service User E’s discharge on or around 4 August 2016

6. In relation to Service User F you did not write a report in relation to the access visit completed on or around 31 October 2016

7. In relation to Service User G you completed a home visit on or around 9 November 2016 and you did not record:
a. A home visit report
b. A transfer summary

8. In relation to Service User H you completed an access visit on or around 20 October 2016 and did not complete an access visit report

9. In relation to Service User I you called Service User I’s son on or around 13 October 2016 regarding a home visit and you:
a. Did not record a summary of the visit
b. Did not record a report of the visit

10. In relation to Service User J you did not record a home visit you completed on or around 16 December 2016

11. In relation to Service User K you:
a. On or around 15 November 2016 did not order the equipment which you had identified as required for Service User K’s discharge in a timely manner
b. Did not record the equipment order in Service User K’s notes

12. In relation to Service User L in approximately February 2017 you did not facilitate the discharge in that you:
a. Did not successfully contact the housing team
b. Did not arrange an access visit
c. Did not arrange the required equipment

13. In relation to Service User N in approximately April 2015 you did not demonstrate adequate clinical reasoning in relation to the in that it
was inappropriate to select her as a service user for a demonstration kitchen assessment.

14. The matters set out at paragraphs 1-13 constitute misconduct and /or lack of competence.

15. By reason of your misconduct and / or lack of competence your fitness to practise is impaired.

Finding

Background

1. The Registrant is registered with the HCPC as an Occupational Therapist. He was employed by the Cambridge and Peterborough NHS Foundation Trust (‘the Trust’) from February 2005 until March 2017, as a Band 6 Occupational Therapist working in the Trust’s Inpatient Rehabilitation department.

2. In 2015 the Trust underwent a restructure, and a number of separate teams (neighborhood team, community nurses, occupational therapists and mental health workers) were formed.

3. In November 2015, an informal performance investigation was commenced into the Registrant’s record keeping, duty of care, collaborative working, communication, patient safety and professionalism. This progressed to a formal investigation in May 2016; and the Registrant’s case was referred to the HCPC. The Trust dismissed the Registrant in March 2017. The Registrant appealed against the Trust’s decision, and it was then agreed that the Registrant could leave his position on the grounds of ill health, in July 2017.

4. In November 2018, the Registrant appeared before a panel of the Conduct and Competence Committee. The particulars were found proved, save for particular 2.

5. The substantive hearing panel found that particulars 1(a), 1 (b), 4, 5(a), 5 (b), 6, 7(a), 7(b), 8, 9(a), 9 (b), 10, 11(a), 11(b), 12(a), 12 (b) and 12 (c) each amounted to misconduct, and that particulars 3(a), 3(b), and 13 amounted to a lack of competence.

6. The matters found proved included failings in the Registrant’s record- keeping, his actions following assessments of patients’ needs, his communication with colleagues, and his clinical reasoning. Furthermore, the substantive panel found that the Registrant had not achieved the required levels of competence in record-keeping, communication, clinical reasoning and interpersonal relationships, including poor quality and sometimes inaccurate information being handed over to colleagues; the Registrant consistently failed to take responsibility for himself and was unable to effectively manage his own time.

7. The substantive panel concluded that the Registrant’s conduct was remediable. However, that panel was not convinced by the Registrant’s assertion that he had developed the requisite skills as a result of a course he had taken two weeks before the substantive hearing. Nor was the substantive panel persuaded that the Registrant’s role as a Healthcare Assistant had required him to implement this learning to the same standard as that required of an Occupational Therapist.

8. The substantive panel was not satisfied that the Registrant had developed any insight into his failings in relation to clinical reasoning and his inability to make the judgments required when making a clinical decision. The substantive panel was also concerned about his lack of insight into the impact of his actions, or inactions, on the Trust and service users. Despite the Trust’s support, the Registrant still associated his conduct and competence with his working environment. The conclusion reached was that the Registrant’s failings were highly likely to reoccur.

9. The substantive panel concluded that the Registrant’s fitness to practise was impaired both on grounds of public protection and on grounds of the wider public interest. The substantive panel concluded that a Conditions of Practice Order for a period of 18 months was the appropriate sanction.

The first substantive review hearing on 15 September 2020

10. The Registrant attended the first substantive review hearing on 15 September 2020 and provided a reflective statement. At the commencement of his evidence the hearing had to be adjourned due to problems with the Registrant’s internet connection. The hearing resumed on 30 September 2020, when the Registrant provided a second reflective statement and gave evidence before the Panel.

11. The Registrant had been working as a Healthcare Assistant since October 2017, and the last time he worked as an Occupational Therapist was in March 2016. He had been looking for work as an Occupational Therapist but had been unsuccessful, although he was determined to return to work in his profession when a post became available.

12. He said that it had been his understanding that Condition 3 would only come into effect if he secured a position as an Occupational Therapist. He admitted that he had not immediately informed his employers of the existence of his Conditions of Practice, but that he had now done so, after this Condition had been explained to him.

13. The Registrant said he was doing well in his current employment. He had been permitted to stand in for senior health careers when they were not available. This had given him greater confidence and he was now able to delegate decisions effectively and communicate positively with members of staff. He asked for an opportunity to demonstrate his abilities as an Occupational Therapist.

14. The panel at the first substantive review hearing concluded that the Registrant’s fitness to practice remained impaired and decided to extend the Conditions of Practice Order for a period of 12 months.

The second substantive review hearing on 23 September 2021

15. At the second substantive order review on 23 September 2021 the panel found that there had been some engagement on the part of the Registrant with the HCPC but he had not complied with the suggestions of the previous panels as to what might be helpful steps to take in respect of the review hearing.

16. That panel concluded that the Registrant’s fitness to practise remained impaired. He had not practiced as an Occupational Therapist since the imposition of the Conditions of Practice Order or remediated his failings and his insight was at an early stage of development. It was the judgment of that panel that there remained a high risk that the Registrant would repeat his failings, if permitted to practise unrestricted and he remained impaired on public protection grounds. Furthermore, the public interest demands a continued finding of impairment to uphold standards and confidence in the profession and the Regulator.

17. That second review panel concluded that to take no action or to impose a Caution Order would be insufficient in light of the seriousness of the allegation and a Conditions of Practice Order remained the appropriate and proportionate order in the circumstances. An extension of 12 months would be sufficient to enable the Registrant to develop the necessary insight and to remediate his deficiencies and it would be appropriate to add one further condition to the existing order, which would now become Condition 11. Accordingly, that panel varied the Conditions of Practise Order and extended the Order for a period of 12 months.

The third substantive review hearing on 26 September 2022

18. The third substantive order review took place on 26 September 2022. The Registrant attended that hearing and gave evidence. He acknowledged that his fitness to practice was still impaired in that he had not had a chance to fully remediate as he had been unable to find employment as an Occupational Therapist. He had, however, enrolled on a return to practice course which commenced in August 2022, and he had also been allocated a professional mentor. He asked for one last chance to prove that he could attain the skills required for an Occupational Therapist and asked for an extension of 12 months to the current Order.

19. The panel concluded that the Registrant’s fitness to practise remained impaired in respect of the personal component. The panel was of the view that, although the Registrant had provided evidence of the development of insight, his reflective piece failed to deal with the significance of his previous misconduct. Furthermore, as the Registrant had not worked as an Occupational Therapist, there was insufficient evidence to show that he had addressed the outstanding concerns about his practice and that they would not be repeated.

20. The panel also considered that the Registrant’s fitness to practise remained impaired in respect of the public component as public confidence in the profession and the regulatory process would be undermined if the Registrant were permitted to return to unrestricted practice.

21. The third review panel noted that the Registrant remained employed as a Healthcare Assistant and was working alongside registered Occupational Therapists in a clinical setting. The Registrant’s clinical lead, who was a registered nurse, had provided a positive testimonial as to his work ethic and commitment. The fact that the Registrant had started on a return to practice course provided him with the opportunity to improve his professional skills so that he might obtain employment as an Occupational Therapist after completion of his course in May 2023.

22. The panel therefore decided to extend the Conditions of Practice Order, for a further period of 12 months.

23. The third review panel advised that the next review panel might be assisted by the following from the Registrant:

 A reference from his mentor as to how he had engaged with the return to practice course, the skills he had developed and modules undertaken;

 A reference from his line manager detailing his work practices and work ethic;

 A full and detailed written reflective piece, perhaps with an input from his mentor, demonstrating full insight into his past failings, what he had learnt and how he intended to embed these lessons in his practice;

 The Registrant may wish to explore with his manager ways to undertake a placement with the Occupational Therapists in his work setting within the terms of this Conditions of Practice Order, so as to allow him demonstrate his practical Occupational Therapy skills.

The fourth substantive review hearing on 26 September 2022:

24. The fourth reviewing panel noted that the Registrant remained employed as a Healthcare Assistant and was working alongside registered Occupational Therapists in a clinical setting. The Registrant’s clinical lead, who was a registered nurse, had provided a positive testimonial as to his work ethic and commitment. The fact that the Registrant had started on a return to practice course provided him with the opportunity to improve his professional skills so that he might obtain employment as an Occupational Therapist after completion of his course in May 2023. The panel therefore decided to extend the Conditions of Practice Order, for a further period of 12 months.

25. The fourth reviewing panel varied and extended the Conditions of Practice Order for a further period of 12 months.

The fifth substantive review hearing on 26 September 2024.

26. The fifth reviewing panel was satisfied that the Registrant had gained sufficient insight into his past failings, what he had learnt and how he intended to embed his learning in his practice as noted in his reflective piece. It also took note of the CPD undertaken by the Registrant which included the HCPC’s:

• Duty of Candour

• Service User Engagement

• Updated Proficiency Training

• Safeguarding Training

• Maintaining fitness to practice


27. This panel noted that the Registrant had also undertaken training elsewhere which included Moving and Handling, Leading a Team and was accessing resources from the OT Hub.

28. The fifth reviewing panel gave credit to the Registrant for completing a return to practice course, for undertaking a placement at Addenbrookes Hospital and for obtaining a conditional offer of employment from Cambridge University Hospitals NHS Foundation Trust as a Band 5 Occupational Therapist.

29. This panel noted that the Registrant had only recently completed the return to practice course and that completion of the course did not in itself validate his competence to practise as an Occupational Therapist. The period of his voluntary placement with a supervisor at Addenbrookes Hospital had only lasted six weeks between May and June 2023 and the supervision notes indicated that he had not achieved full competence in clinical reasoning and there was further work required in time management including making referrals and completing patient reports in a timely manner.

30. The fifth reviewing panel found that the Registrant’s practice remained impaired on the personal component with regards to the demonstration of his clinical competence. There remained a risk of repetition until the concerns had been fully addressed. As a consequence of this, the public component was also engaged in terms of public confidence in both the profession and the regulator.

31. The Conditions imposed by the fifth reviewing panel, and which are still in place, are as follows:

1. You must inform the HCPC, within 7 days, if you cease to be employed by your current employer or take up any other or further employment.

2. You must inform the HCPC, within 7 days of any disciplinary proceedings taken against you by your employer.

3. 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).


4. You must confine your professional practice to that of a Band 5 Occupational Therapist.

5. You must place yourself and remain under the supervision of a workplace Occupational Therapist supervisor at Band 6 or above registered with the HCPC and supply details of your supervisor to the HCPC within 14 days of taking up a position as an Occupational Therapist. You must attend upon that supervisor and follow their advice and recommendations.

6. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice: a. Clinical reasoning (both written and oral); b. Record keeping; c. Report writing; d. Effective time management, which includes, if appropriate, making any referrals in a timely manner;

7. Within three months of taking up employment as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

8. You must meet with your supervisor on a fortnightly basis, or at a frequency directed by your supervisor, to consider your progress towards achieving the aims set out in your Personal Development Plan.

9. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.
Hearing on 15 October 2024.

Preliminary Matters

Proceeding in Private

32. Mr Fletcher applied for any part of the proceedings that related to the Registrant’s health to be heard in private. Ms Constantine confirmed that the HCPC agreed with this approach.

33. The Legal Assessor reminded the Panel of the principle of open justice, and that generally proceedings should be heard in public unless one or more of the exceptions applied. Rule 8(1) of the HCPC (Investigating Committee) (Procedure) Rules 2003 reflects Article 6(1) of European Convention on Human Rights and permits a hearing to be heard fully or partially in private to protect the private life of the Registrant.

34. The Panel determined to hear the proceedings partially in private and that any mention of the Registrant’s health condition should not be in the public realm in order to protect his privacy.

HCPC Submissions

35. Ms Constantine outlined the background to the case. She explained that this was the sixth review hearing. After a substantive review hearing which commenced in November 2018, the panel had found that the Registrant’s fitness to practice was impaired. Conditions of practice had been imposed for nearly five years in order to address the insufficiencies in the Registrant’s practice.

36. Ms Constantine confirmed that on 8 January 2024, the Registrant indicated to the HCPC that he had started in a Band 5 Occupational Therapist role. He had sent in his professional development plan (PDP) on 18 March 2024. The Registrant had submitted a 54-page bundle confirming the PDP along with a 7-page action plan.

37. It was confirmed that the HCPC did not take any issue with regards to the Registrant’s compliance with conditions of practice. The HCPC were neutral as to whether the Registrant’s fitness to practice remained impaired, and left this matter for the Panel to determine.

Submissions on behalf of the Registrant

38. Mr Fletcher submitted that the Registrant had finally reached the level which the substantive panel who imposed the original conditions of practice were setting him to achieve. He pointed out that these allegations go back, in some cases, to 9 years ago, so are somewhat historic now.

39. Mr Fletcher submitted that there had been considerable changes in the Registrant’s life and approach, which had ensured that any concerns with regards to his practice were addressed. He had been compliant with all of the conditions previously imposed, and provided references from senior colleagues.

40. It was submitted on the Registrant’s behalf that there was nothing within the PDP that should cause any concern about the Registrant’s current fitness to practice. The Registrant has gained employment and clearly impressed Addenbrookes hospital with both his ethos and commitment to the job. The references spoke to the effective and proper manner of his current practice, and it was submitted that the Registrant has now reached the stage where he should be allowed to return to unrestricted practice without HCPC oversight.

41. In response to a Panel question, the Registrant set out that he had started his current role when participating in a 6-week placement whilst taking his course. He explained that he had told the employer about the conditions on his practice, but was still encouraged to apply for a role. When he started the role, the Registrant explained that he came back to the same team, and was set goals and signed a supervision contract. He met each week with a supervisor and received feedback. The Registrant explained that he took notes and was reflective in this, making notes as to what he needed to improve on.

42. The Registrant also explained that he was monitored on the ward. He also met with a professional development person who concentrated on assisting him with writing notes. This enabled him to improve. He wrote his own notes and his supervision notes.

Legal Advice

43. The Legal Assessor directed the Panel to the HCPTS practice note ‘Review of Article 30 Sanction Orders’ dated November 2023. She summarised relevant case law from the cases of Abrahaem V GMC (2008) EWC(Admin), Professional Standards Authority v Health and Care Professionals Council and Doree (207) ERWCA Civ 319. The Panel was also reminded of the Section 6 of the Equality Act 2010, as well as the public sector equality duty.

Panel Decision

44. The Panel had regard to the documents provided by the Registrant for today’s hearing. It also took note of all the documents he had provided previously, as set out in the individual decisions as recorded by past panels.

45. The Panel found that the Registrant had now completed everything that had been asked of him. He had provided documentation which had been signed off by his supervisor, indicating that he had achieved what had been required by the Conditions of Practice Order.

46. It was the finding of the Panel that the Registrant had now achieved what previous panels had hoped he would achieve. It noted that he was working within a supportive team, who would continue to support him and put in place reasonable adjustments to both assist him and to reassure the team of his ability to practise safely.

47. The Panel noted that the Registrant’s employer had been prepared to support him in complying with the current conditions of practice. It took the view that any further development and monitoring was now an issue for the employer.

48. The Registrant had demonstrated that his fitness to practice was no longer impaired on the personal component. He had demonstrated a sufficient level of competence that the risk of repetition was no longer evident. The Panel therefore found that HCPC oversight was no longer required.

49. It followed that an ordinary member of the public, aware of all the facts of this case, would not expect the Registrant to remain subject to conditions of practice. The Registrant had worked hard to achieve the required level of competency, and accordingly the reputation of the profession and the regulator would not be adversely impacted if he was permitted to return to unrestricted practice at this stage. The Panel determined that the public component of fitness to practise was no longer engaged and that the Registrant’s fitness to practise is no longer impaired on this ground.

50. It was determined by the Panel that the Registrant has shown resilience and commitment to his profession. The Registrant has continued to work on his fitness to practise throughout the proceedings, which had continued for almost 5 years. The Registrant had been able to give the Panel a summary of the process he had been through with his current employer, and the Panel had received evidence that this employer valued the Registrant’s skills and was willing to support him.

51. The Panel was mindful that what was required was safe and competent ‘good enough’ practice, not perfection. The Registrant had met this standard and accordingly the Conditions of Practice Order was no longer required. The Panel was satisfied that the Registrant would continue to obtain appropriate supervision from his employer in the future and that he was now safe to return to unrestricted practice.

Order

ORDER: The Registrar is directed to revoke the Conditions of Practice Order dated 26 September 2023 with immediate effect.

Notes

No notes available

Hearing History

History of Hearings for Mr Stephen G Morgan

Date Panel Hearing type Outcomes / Status
15/10/2024 Conduct and Competence Committee Review Hearing No further action
13/09/2024 Conduct and Competence Committee Review Hearing Adjourned
26/09/2023 Conduct and Competence Committee Review Hearing Conditions of Practice
26/09/2022 Conduct and Competence Committee Review Hearing Conditions of Practice
23/09/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
30/09/2020 Conduct and Competence Committee Review Hearing Conditions of Practice
15/09/2020 Conduct and Competence Committee Review Hearing Adjourned part heard
;