Arul Rathina

Preliminary Matters

Privacy

1. An application for part of the hearing to be held in private was not made at the outset of the hearing. However, during the course of the Registrant’s evidence, he referred to matters of a personal nature in relation to his health. His evidence was paused whilst Ms Khorassani made an application for the proceedings to be held partially in private. Ms Khorassani submitted that the hearing should be held partially in private in relation to the Registrant’s health or private life. Mr Hussain-Dupre supported the application.

2. The Panel heard and accepted the advice from the Legal Assessor who referred to Rule 10 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”) and to the HCPTS Practice Note ‘Conducting Hearings in Private.’

3. The Panel accepted the submissions made by Ms Khorassani, which it noted were supported by Mr Hussain-Dupre. The Panel acknowledged that there is a strong public interest in ensuring that hearings are conducted in public for transparency, however it agreed that matters relating to the Registrant’s health or family matters should be heard in private to protect his private life. The Panel therefore decided to hold the hearing partially in private.

Background

4. The Registrant qualified as a Physiotherapist in 2004. He was employed by Devon Primary Care Trust at Totnes Community Hospital between 3 October 2005 and 1 February 2007. The Registrant resigned from his employment on 1 February 2007.

5. On 28 July 2008, the particulars in the Allegation against the Registrant, which are set out at the outset of this decision, were found to be proved. It was accepted that during 2006, the Registrant was involved in incidents when he treated patients incorrectly. He failed to follow instructions to undergo regular clinical supervision and to refrain from treating patients with neurological conditions. Despite extended periods of supervision, he was found to have fallen below the level of competence expected of a Physiotherapist of his grade.

6. On 28 July 2008, the final hearing panel found that the failings identified constituted misconduct and lack of competence. It concluded that the Registrant’s fitness to practise was impaired. The panel determined that the Registrant’s name should be struck off from the HCPC Register.

7. On 26 October 2016, the Applicant [now Registrant] applied for his name to be restored to the HCPC Register. Following a hearing on 14 July 2017, the panel refused to make an order restoring his name to the Register.

8. The Applicant [now Registrant] made a second application to be restored to the Register as a Physiotherapist. The restoration hearing took place on 4 February 2019. The panel determined that the Registrant’s application should be granted with a Conditions of Practice Order being imposed. The February 2019 panel also directed that the Registrant must complete the recognised return to work procedures. This was due to the length of time since his name was struck from the Register.

9. A substantive review hearing was held on 13 March 2024 to review the Conditions of Practice Order. At the hearing, the HCPC submitted that the Registrant’s fitness to practise remained impaired on both the personal and the public component. The HCPC submitted that the Registrant still lacked sufficient insight and still posed a risk to potential service users. It was submitted that the Registrant was prone to blame communication problems when the real concerns lay with his clinical performance. The Registrant was lacking in a sense of personal accountability. The HCPC suggested that some variations could be made to the existing Conditions of Practice Order.

10. At the hearing on 13 March 2024, the Registrant gave evidence and supplied various supporting documents including his Personal Development Plan and Clinical Supervision records.

11. The panel on 13 March 2024 concluded that the Registrant’s fitness to practise remained impaired on both the personal and public components. Its reasons are set out below:

‘The Registrant has shown limited insight into his failings as found by the original panel in July 2008.In his evidence the Registrant appeared to attribute the concerns to language problems as opposed to deficiencies in his clinical skills.

The Panel noted that in his evidence to the Panel, the Registrant appeared to indicate that if he encountered issues of the kind that were found proved in July 2008, he would perform, as he had previously done, namely to act in accordance with his own judgement rather than in accordance with the directions of his clinical seniors. The Panel could not exclude that risk of repetition of the same or similar conduct as that found proved in July 2008.

The Panel noted that in the notes of the supervision meeting in December 2023, three areas of outstanding concern were noted. The Panel has not seen the notes of the supervision meeting which it understands was held in January 2024. There is currently no direct, independent confirmation that the Registrant is capable of autonomous, safe and effective practice.

The Panel remained concerned that the Registrant has not adequately remediated or addressed the concerns that were identified by the February 2019 panel and that the risk of repetition could not be excluded.

A well informed member of the public aware of the concerns previously identified and aware of the evidence given to the Panel, would be concerned if the Panel was to determine, that the Registrant’s fitness to practise was not now impaired and if the Registrant was enabled to practise unrestricted.

In substance, the Panel concluded that the Registrant had not discharged the persuasive burden of establishing that he was no longer impaired.’

12. The panel hearing the review on 13 March 2024, decided to impose a six month Conditions of Practice Order. It imposed the following conditions:

‘1. You must inform the HCPC of the details of your current employer.

2. Promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

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

4. 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 your application); and

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

5. You must place yourself and remain under the supervision of a workplace supervisor, being a Physiotherapist registered by the HCPC (the “Supervisor”) and supply details of your Supervisor to the HCPC within 28 days of taking up employment. You must attend upon that Supervisor as required and follow their advice and recommendations.

6. You must work with your Supervisor to formulate, develop and adhere to a Personal Development Plan (PDP) designed to address the following areas of your practice:

A. Assessment

B. Planning & Preparation

C. Resourcing

D. Discharge

E. Clinical Reasoning

F. Communication skills

7. You must provide the HCPC with an updated copy of your PDP no later than 14 days before the next review date.

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

9. You must provide copies of your Supervisor’s records of supervisions, including those addressing your progress towards attaining the goals set out in the Personal Development Plan, to the HCPC no later than 14 days before the date of any review of this Order.

10. You must use your best endeavours to obtain a comprehensive report from your Supervisor. That report should address each of the matters set out in Condition 6 (A) to (F) inclusive. The report should identify any issues still to be resolved in respect of any of the matters described in (A) to (F); also whether there are residual areas of concern outside the matters specified in Condition 6. Further, the report should state whether in the opinion of the supervisor you are capable of safe and effective practice as an unsupervised autonomous physiotherapist: if not, why not. The Report should be furnished to the HCPC not less than 14 days before the next review date.

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

12. The conditions requiring you to provide any information to HCPC are to be met by you sending the information to the Offices of the HCPC marked for the attention of the Director of Fitness to Practise or Head of Case Management.’

13. On 24 June 2024, the Registrant attended a disciplinary hearing at his place of work, the Royal Surrey NHS Foundation Trust (“the Trust”). The Allegations under consideration at the disciplinary hearing were:

‘Allegation 1: Whether there was intentional withholding all the information to line manager/team about the conditions of Arul’s practice.

Allegation 2: Whether there was a breach of the professional code of conduct/employment contract by not disclosing the hearing of 13th of March 2024.

Allegation 3 whether there was a potential breach of the professional code of conduct/employment contract by not disclosing the updated conditions of practice to the line manager/team.’

14. The Trust concluded that the Registrant had intentionally withheld some key information from his supervisor and managers and that resulted in the conditions of registration not being fully met. The Trust was concerned that the Registrant lacked insight and had not been an active agent in fulfilling his conditions of registration. The Trust accepted that the Registrant did genuinely believe that the Trust would be notified of the hearing by the HCPC, however the Registrant did not discuss this at all with his supervisor and the Trust considered that he would have done so if he was acting openly, honestly and transparently.

15. The Trust issued the Registrant with a final formal warning for 12 months.

16. On 5 August 2024, the Head of Therapies at the Trust wrote to the HCPC. The letter states as follows:

“Arul has definitely made some poor decisions, but he has also experienced detriment from others including ourselves and the HCPC, as discussed with [MH] on 11/07/24. The disciplinary hearing related to transparency regarding the conditions on his practice. We were unaware of the hearing in March 2024. We have confirmed that Arul had provided the name of Royal Surrey as his employer, the name of the Head of Physiotherapy, and the name and registration number of his supervisor. On this basis we would have expected the HCPC to notify us of any hearings. We were not advised of the hearing and therefore were unable to support and represent him. I believe Arul lacked insight into the consequences of the HCPC hearing and did not wish to burden us in supporting him, and felt a degree of shame which inhibited him. I offer this as explanation not justification.

Arul did declare his conditions to practice on occasions over the years, including when he applied for his band 5 job. This information was not cascaded within our organisation meaning his supervisor was not informed. Arul made an assumption his supervisor would have been informed and failed to directly discuss it with her. As a result he was not given the support to reflect on and learn from past events. I believe the disciplinary hearing has given him greater insight. (For awareness, we have conducted a lessons learnt exercise into our actions which contributed to this situation.)

As part of the disciplinary hearing we asked Arul if he had made HCPC aware of the disciplinary hearing. He confirmed he had done this via his solicitor, and sent us an email to support this claim. (He also shared the email he sent notifying you of his supervisor details.) I confirmed with [MH] on 11/07/24 that Arul had already shared the outcome of the disciplinary hearing. I additionally shared the hearing transcript with [MH]. I can also confirm the HCPC were aware of the disciplinary hearing in advance. [JW] had contact with HCPC. I personally emailed HCPC on 13/06/24 and 14/06/24. I also had a conversation with [MH] on 20/06/24, having phoned as I had had no response to my emails.

With regard to your questions, Arul’s employment history is: September 2017 Physiotherapy Technical Instructor (band 3) fixed term post May 2018 Physiotherapy Technical Instructor (band 3) permanent post April 2022 Physiotherapy Technical Instructor (band 4) permanent post August 2023 Physiotherapist (band 5) fixed term maternity leave cover

As discussed with [MH], Arul has now resigned and leaves us later this month”.

17. On 4 September 2024, the Registrant provided a bundle of documents for this reviewing Panel to consider. The bundle included:

• A four-page reflective piece dated 4 September 2024.

• Reflective practice documents relating to patient safety, clinical decision, communication, planning & preparation, learning, and assessment.

• A Personal Development Plan.

• An Achiever of the Month certificate dated April 2024.

• A list of CPD courses undertaken.

• Records of supervision.

• A skills to achieve document for a Band 5 Physiotherapist.

• Two audio updates from the Registrant’s (former) line manager at the Trust, relating to the Conditions of Practice Order and the Registrant’s clinical practice.

Evidence, Submissions and Advice

18. The Registrant gave evidence on oath. His CSP representative Ms Helen Troughton was present in the room with him as a support for him. He was cross examined by Ms Khorassani, and asked questions by the Panel.

19. The Registrant said that the disciplinary hearing at work had impacted on him [Redacted] and that it had been a learning process for him. He told the Panel that he had been open and honest about what has happened including ensuring that this information is provided to prospective future employers. He said that he has been open and honest in the four interviews he has attended recently and that he told them about the HCPC involvement and the Conditions of Practice Order.

20. The Registrant said that he had sought support both in work and by obtaining legal advice to support him in this process. The help he has sought and received has given him more confidence.

21. The Registrant said that he has followed every step requested by the HCPC such as providing supervision notes, and oral testimony from his manager, and by undertaking and providing reflections on his work.

22. The Registrant said that he was shocked when the Trust told him that they were not aware of the changed conditions of practice. He said that the Trust had supported him to continue to work and that they helped him to get other support including from the CSP. He said that although he is no longer working at the Trust, they are still supporting him. The Trust had allowed him use of the Head of Therapies office to enable him to attend online at the hearing today.

23. The Registrant told the Panel that he had recently attended an interview whereby he had undertaken a practical test which involved six stations relating to different physiotherapy work. He successfully completed these stations, as a result of which he was offered a second-round interview. He said that he already felt more confident and that he was achieving his aims.

24. The Registrant said that he was told by one interviewer that it would be easier to employ him if he was not subject to the HCPC Conditions of Practice Order, given the wide pool of candidates competing for the roles.

25. The Registrant said that he is currently applying for Band 5 roles. He felt confident that he was able to show all of the elements required to practise in physiotherapy. His most recent Band 5 role was a fixed term contract which ended on 27 August 2024. The Trust had offered for him to return to his Band 4 role, but he did not want to step back because of how this might reflect on his CV, so he left to seek other Band 5 opportunities.

26. The Registrant said that in relation to his clinical practice he has learnt from what happened before and will ensure it is not repeated. He said that he is safe and clear in his work. [Redacted].

27. The Registrant said that in future roles, he would ensure he continued to seek help when required and to reflect on his work, and to continue with supervision, as he finds it to be a great help. These things have become embedded for him, and he will continue to work on them going forward.

28. The Registrant told the Panel about his passion for the role of Physiotherapist. He enjoys being able to help people. His greatest satisfaction is knowing that he has been able to successfully help patients.

29. The Registrant acknowledged that when he came to the UK from India there was a different system, and he had made mistakes, and it took time for him to understand the new environment. He said that in his first role he did not feel supported by his seniors but since then he has learnt a lot. He talks to other juniors about what he has learnt and what they need to look out for. He acknowledged that he should have asked for help at the time. He said in his reflections evidence that he does now ask for help to ensure patient safety.

30. The Registrant said his fitness to practice was not impaired but that he would abide by any conditions of practice if the Panel imposed them.

31. The Registrant explained what he considered to be the importance of CPD and how learning impacts positively on safe practice. He explained the importance of being part of a Multi-Disciplinary Team and having an awareness of his limitations.

32. The Registrant told the Panel that it took a while to be restored after the 2019 hearing due to the Covid Pandemic which impacted on the availability of training and return to practice courses.

33. The Registrant said he assumed the Trust knew about the conditions of practice which were varied in March 2024, but accepted that he should have told the team. He said the process had been stressful and he used to self-censor but now he is open to everyone. He said that he had always mentioned the Conditions of Practice Order in any job application including any job applications he made to the Trust. The Registrant thought he was undertaking the terms of the Conditions of Practice Order even though these were not specifically known by his manager. He said that he only knew that his manager was not aware when she called him to say that they needed to look into this, following him mentioning the HCPC hearing, in his March 2024 supervision.

34. Ms Khorassani submitted that the HCPC remains neutral as to whether the Registrant’s fitness to practise is impaired. Ms Khorassani drew the relevant legislation and case law to the Panel’s attention as per the HCPTS Practice Notes ‘Review of Article 30 Sanction Orders’ and ‘Fitness to Practise Impairment’.

35. Ms Khorassani submitted that all Registrants must abide by the Standards of Conduct, Performance and Ethics and highlighted the following standards for the Panel to reflect on:

‘Standard 6.1:

You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

Standard 6.2:

You must not do anything or allow someone else to do anything which could put the health or safety of a service user, carer or colleague at unacceptable risk.

Standard 9.1:

You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.’

36. Mr Hussain-Dupre submitted that until March of this year, the Registrant had navigated this process alone. He drew the Panel’s attention to the letter from the Trust in which the Trust accepts that their lack of communication contributed to this situation. Mr Hussain-Dupre submitted that the Trust disciplinary hearing had given the Registrant greater insight into this process, and he understands that he cannot manage this alone. He submitted that the Registrant has drawn on the support offered by the Trust who had faith in him, and who continued to support him.

37. Mr Hussain-Dupre referred the Panel to the reflections produced by the Registrant in which he focuses on communication, enhanced relationships with colleagues, neurological care, following instructions and how important this is for the care of patients. He submitted that the Registrant acknowledges fully how the support he got from his colleagues has helped him. He submitted that the Registrant now realises that he needs to communicate more clearly, and that mentorship and supervision are important supports for him to have in place when he moves to his next role.

38. Mr Hussain-Dupre referred to the Achiever of the Month certificate and submitted that this shows the Registrant can inspire colleagues and receive recognition from them.

39. Mr Hussain-Dupre submitted that the goals that are listed in the previous panel’s decision have all been met, and that the Registrant has been able to reflect and show demonstrable improvements in his practice. He submitted that as a result, there is a low risk of repetition.

40. Mr Hussain-Dupre submitted that the audio files were provided as the Registrant’s (former) manager was on holiday and wanted to ensure that the Registrant had the necessary information for the Panel. He submitted that all the conditions had been fulfilled and that the Registrant can work independently at the expected level aligned with a Band 5 role. Mr Hussain-Dupre submitted that the Registrant has been complimented on working with MDT by nursing staff. He can operate within a normal level of a Band 5 practitioner and there are no concerns.

41. Mr Hussain-Dupre submitted that public protection is not engaged as the Registrant can work without issues. He submitted that the outstanding HCPC process including the Conditions of Practice Order, is making it difficult for the Registrant to secure a role as a Physiotherapist. He submitted that the Registrant has fully engaged and that his fitness to practise is no longer impaired. He submitted that the public interest ground is not engaged as an ordinary member of the public would see that the regulator has taken enough steps, in line with the Registrant’s improvements, to satisfy public confidence.

42. Mr Hussain-Dupre submitted that if the Panel finds impairment, then any Order imposed should be the least onerous to allow the Registrant to continue in practice and to continue to make improvements.

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

Decision

44. The Panel retired to reach its decision. It became apparent during deliberations that there was insufficient time to finalise the decision and then commit it to writing. In the circumstances, the Panel informed the parties that the case would be adjourned part-heard until 9 a.m. on 25 September 2024. No objection was raised by the parties, and the Panel was satisfied that the adjournment would not adversely impact on the overarching objective, as the current Order does not expire until 13 October 2024.

45. The Panel was mindful of its powers upon a review of a Conditions of Practice Order under Article 30(1) of the Health Professions Order 2001 and had regard to the guidance contained in the HCPTS Practice Note: Review of Article 30 Sanctions Orders and the HCPTS Practice Note: Impairment and the HCPC Sanctions Policy.

46. The Panel noted that its task is to conduct a comprehensive review of the current order on the basis of the information available today. It must not seek to go behind the findings of the previous panel.

47. The Panel must first decide whether it finds the Registrant’s fitness to practise to be currently impaired.

48. The Panel noted that in accordance with the guidance in the case of Abrahaem v General Medical Council [2008] EWHC 183 (Admin), the persuasive burden to satisfy the Panel of fitness to practise at a review hearing is upon the Registrant.

49. The Panel further noted that if it found the Registrant’s fitness to practise to be currently impaired, then it should consider what steps to take in respect of the current order in accordance with its powers under Article 30(1) of the Health Professions Order.

50. In reaching its decision, the Panel carefully considered all of the documents provided to it in the substantive review hearing bundle, the Registrant’s bundle, the oral evidence, and submissions.

51. The Panel first considered whether the Registrant’s fitness to practise remains impaired.

52. The Panel considered what, if anything, had changed since the current order was last reviewed. It noted that the conditions of practice were initially imposed by the restoration panel as a result of some residual concerns in relation to the Registrant’s level of insight into the potential impact that his actions might have had on patients and the profession.

53. The Panel had regard to the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decisions.

54. The Panel placed significant weight on the audio testimony provided by the Registrant’s (former) manager at the Trust, who managed the Registrant from July 2024 to August 2024, and who was aware of the conditions of practice. Her audio testimony confirmed that the Registrant had been working under her supervision on Condition 6 (A – F) to address those specific areas of practice. The manager confirmed that the Registrant has been working at the expected level of a Band 5 Physiotherapist and has been safe and effective in his practice. The manager stated that the Registrant was readily seeking guidance recognising when he had limitations. She confirmed that he had undertaken the following:

(i) In service training.

(ii) Self-assessment on skills to achieve.

(iii) Frequent written reflections.

(iv) Self-reflected learning.

(v) Attending supervision.

55. Relying on that evidence, the Panel was satisfied that, unlike the previous panel, it had independent confirmation that the Registrant has the skills and knowledge to safely undertake the practical aspects of physiotherapy.

56. The Panel next considered the degree of the insight shown by the Registrant and whether this had changed since the previous review. The Panel had regard to the written reflections and oral evidence from the Registrant. It concluded that he had shown improved insight into the failings as found by the original panel in July 2008, and how he would now act differently if faced with similar situations. His evidence that he now acknowledges his limitations and seeks regular guidance and supervision, was corroborated by his (former) manager’s audio testimony.

57. The Panel next considered whether any other fitness to practise issues have arisen and whether the Registrant had practised safely and effectively within the terms of the current order. Whilst no further concerns have been referred to the HCPC for investigation, the Panel was concerned to note that the Registrant had not made his direct line manager at the Trust aware of his Conditions of Practice Order.

58. The Panel accepted the Registrant’s evidence, which was supported by the letter from the Head of Therapies, that he had disclosed the conditions of practice in his job application to the Trust. It was satisfied that the information had not been cascaded down to the direct line management team. However, the Panel concluded that the Registrant should have realised that his direct line manager was not aware of the conditions of practice. The original conditions place specific requirements on the workplace supervisor in terms of frequency of supervision, the formulation and development of a Personal Development Plan (“PDP”), and monthly meetings to consider progress of the PDP. The Panel considered that it was incumbent on the Registrant to have been transparent with his line manager and to ensure that they were working with him in addressing the imposed conditions. Whilst the Registrant acknowledged in his oral evidence that he needs to be more open in the future, he was not able to clearly articulate how his lack of candour about his conditions of practice, had, or could have, impacted on others.

59. The Panel took into account that the purpose of a Conditions of Practice Order is to ensure public protection when concerns have been identified about a professional’s fitness to practice. The Registrant’s lack of openness with his line manager could have compromised public protection, albeit that the Registrant was cooperating with regular supervision and personal development, and there were no clinical or attitudinal issues with his work with patients. Given the serious nature of a Conditions of Practice Order being in place, the Registrant should have understood how great his duty was to be absolutely clear with his line manager about the restrictions on his practice, and there was a period of approximately eight months when the manager was not aware.

60. The Panel recognised and acknowledged that the Registrant has taken on board that he should have been more open and that the Trust disciplinary process had been an awakening for him. Since then, he has sought support from the CSP, [Redacted], and instructed a legal representative to support him with the HCPC hearing process. The Panel accepted the Registrant’s evidence that he has been clear in all new job applications about the terms of the Conditions of Practice Order, and that he has repeated this information in oral interviews. Whilst the Panel considered that this was evidence of the Registrant’s developing insight, it concluded that the insight was not fully developed. The Panel noted, from the Trust disciplinary letter, that the lack of openness had impacted on the Registrant’s colleagues, who had felt that they had provided information which fell short of HCPC expectations, and thus felt it had compromised their professional credibility. The Panel considered that in his oral evidence, the Registrant did not provide sufficient insight into how his colleagues had been impacted by his lack of candour.

61. The Panel concluded that by failing to be open with his line manager, he had breached a fundamental tenet of the profession. Standard 9.1 of the HCPC Standards of conduct, performance and ethics, states that: ‘You must make sure that your conduct justifies the public’s trust and confidence in you and your profession’. The Panel considered that openness and transparency are key to this. The Panel found that whilst the Registrant has taken positive steps to remediate and show insight into his lack of openness this is still developing, the situation is recent (having been identified in March 2024), and accordingly there is insufficient evidence of him demonstrating his appreciation of openness in his practice. Without full insight, the Panel considered that a subsidiary risk of repetition remained related to the events that have arisen since the last review hearing.

62. For the reasons set out above, the Panel concluded that the Registrant remains impaired on the personal component.

63. The Panel also concluded that the Registrant remains impaired on the public component. The public, including the Registrant’s professionally registered colleagues, would expect Registrants to act with complete openness and transparency. The public should also be able to rely on the regulatory process to ensure it achieves the overarching objective. The Panel considered that a member of the public would be shocked that the conditions of practice imposed on the Registrant to ensure public protection were not disclosed by him to his direct line manager.

64. The Panel concluded that the Registrant had not discharged the persuasive burden of establishing that he was no longer impaired.

65. Having found that the Registrant’s fitness to practise remains currently impaired, the Panel next considered its powers as set out in Article 30(1) of the Health Professions Order.

66. The Panel considered the available sanctions in ascending order.

67. Having found that the Registrant’s fitness to practise remains impaired, the Panel did not consider taking no further action to be the appropriate and proportionate outcome. It would not satisfactorily deal with the subsidiary risk which has arisen since the last review and would not satisfy the public interest.

68. The Panel next considered a Caution Order.

69. The Panel took into account that a Caution Order would appear on the Register, but that it would not restrict the Registrant’s ability to practise.

70. The Panel considered the findings it had made at the impairment stage. It took into account that the lack of candour with his direct manager was serious because it related to the failure to mention the conditions of practice which had been imposed to protect the public. However, the Panel accepted that the issue was isolated, and was part of a bigger picture. It noted that the Registrant had disclosed his conditions of practice to the Trust at the outset, and when he applied for the Band 5 job, and there is evidence in the March 2024 supervision note that he discussed in general terms the ongoing HCPC involvement with his manager. The Panel took into account that the Registrant had worked at the Trust for seven years and during that time there was no other concerns arising about a lack of candour.

71. The Panel took into account that the Registrant had not caused any harm to patients and that his clinical skills and knowledge are of a standard to enable him to practise safely as a Physiotherapist. The Panel considered that the Registrant had shown good insight into the previous panel’s concerns and that the subsidiary risk found by this Panel arises from the specific circumstances of failing to be open with his line manager. Whilst the Panel acknowledged its findings that the Registrant’s insight in this regard is not yet fully developed, it did recognise that he has been on a journey of self-reflection since the disciplinary hearing in March 2024, and has equipped himself with the necessary and appropriate support to enable him to continue to develop his insight.

72. The Panel concluded that a Caution Order would achieve protection from the remaining risk about the lack of candour, as it would notify any prospective employer that the Registrant’s fitness to practise had been found to be impaired and that his practice is subject to this sanction. In turn, this would achieve the overarching objective of protecting the public and the wider public interest and ensure the integrity of the fitness to practise process is not compromised.

73. In order to satisfy itself that the Caution Order was the appropriate and proportionate order, it considered whether a sanction of a Conditions of Practice Order would be appropriate, bearing in mind its findings that the Registrant had the knowledge and skills to practise safely. The Panel considered that given the nature of the remaining mischief, namely the Registrant’s lack of openness with his line manager about his conditions of practice, it would not be possible to impose meaningful conditions.

74. The Panel considered that a Suspension Order would be disproportionate in light of the isolated nature and specific circumstances of the lack of candour.

75. Having concluded that a Caution Order was the appropriate and proportionate order, the Panel considered what length of caution to impose. The Panel concluded that three years would be the appropriate length of caution. It considered that one year would be insufficient as the Registrant is not currently employed and needs time to secure a new physiotherapy role. Further, when he starts in a new Physiotherapist role, he is likely to be subject to a six-month probationary period.

76. The Panel also concluded that a three year Caution Order would reflect the seriousness of the conduct and the Registrant’s culpability in failing to be transparent and open with his line manager, which ultimately harmed the integrity of the fitness to practise process as he was not fully adhering to what was expected of him in terms of the conditions of practice.

77. The Panel decided to use its powers under Article 30 (2) to replace the current order with immediate effect in accordance with Article 30 (4). Therefore, the Conditions of Practice Order is now replaced with the Caution Order.

ORDER: The Registrar is directed to annotate the register entry of Mr Arul Rathina with a Caution Order for a period of three years.

The Caution Order imposed today will apply with immediate effect.

History of Hearings for Arul Rathina