Margaret Ellis

Preliminary Matters

Service of Notice

1. The Panel was provided with service documents which showed that Notice of the hearing dated 05 March 2025 (“the Notice”) was served on the Registrant by email. The Notice informed the Registrant of the date, time, and place (virtual) for the hearing. The Panel was provided with a Certificate of Registration which confirmed the Registrant’s registered status and her registered address. It was also provided with a statement ‘Proof of Service’ dated 05 March 2025.

2. In addition, the Panel was provided with a further Notice of Hearing dated 07 March 2025, which it was informed had been sent by registered post to the Registrant’s registered postal address. The Panel was provided with proof of posting and evidence of the Registrant’s registered postal address.

3. The Legal Assessor advised the Panel of the requirement for the HCPC to serve notice of the hearing, containing details of the date, time, and place of the hearing and allowing at least 28 days’ notice of the hearing. Having considered the documents, the Panel was satisfied that proper notice of the hearing had been served on the Registrant in accordance with the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (as amended) (“the Rules”).

Proceeding in Absence

4. The Registrant had not attended the hearing in response to the Notice and was not represented. Ms Collins made an application to the Panel for it to proceed in the Registrant’s absence. She referred the Panel to the HCPTS Practice Notes “Proceeding in the Absence of the Registrant” and “Postponement and Adjournment of Proceedings”. Ms Collins submitted that there is a general principle that the Registrant has a right to be present at the hearing and to be represented. If deciding to proceed in the Registrant’s absence, the Panel had to be first satisfied that the Registrant had been served with notice of the hearing and decide whether it was fair to proceed in the Registrant’s absence.

5. In addition, the HCPC provided to the Panel copies of the correspondence with the Registrant over the listing of the hearing. Ms Collins submitted that the Panel must act fairly, but fairness involved being fair to both the Registrant and to the HCPC. She mentioned the case of R v Jones [2002] UK HL 5 and the general public interest in hearings being dealt with expeditiously.

6. Ms Collins submitted that the Registrant had been written to by the HCPTS asking for her dates to avoid. On 06 February 2025, the HCPTS had written with provisional dates for a hearing and on 05 March 2025, the dates of the hearing were again emailed to the Registrant. On 07 March 2025, the hearing dates had been again confirmed. The Registrant had not replied to state whether she would attend.

7. Ms Collins submitted that the Registrant had responded (on 16 April 2025) stating that she had not agreed to a hearing date. Ms Collins said that the HCPTS Hearings Officer had contacted the Registrant by telephone on 25 April 2025 to enquire if the Registrant would be attending the hearing today, but the Registrant did not state an answer.

8. It was submitted by Ms Collins that the Registrant was aware of the date of the hearing, but she had not made any request for an adjournment. She submitted that the Registrant had been made aware of the procedure and had expressed an intention to seek legal advice. No difficulty in attending the hearing virtually had been made known.

9. Ms Collins submitted that the Panel must consider the consequences of any adjournment. She said that the attendance of two witnesses had been arranged, who would need to re-arrange their attendance if there was an adjournment. There would be a delay in the resolution of the proceedings.

10. Ms Collins submitted that the Panel must take into account the extent of the disadvantage to the Registrant in considering whether to proceed in her absence. It would be preferable to hear the Registrant’s account; however, the Panel and/or the Legal Assessor would be able to ask the witnesses questions relating to the Registrant’s position. Ms Collins asked the Panel to conclude that the Registrant had voluntarily absented herself from the hearing.

11. The Legal Assessor advised that Rule 11 gave the Panel a discretion to proceed in the absence of the Registrant if the Panel was satisfied that all reasonable steps had been taken to serve notice of the hearing. He referred the Panel to the HCPTS Practice Notes “Proceeding in the Absence of the Registrant” and “Postponement and Adjournment of Proceedings” and the caselaw that they referred to, including R v Jones [2002] UKHL 5 and GMC v Adeogba [2016] EWCA Civ 162.

12. The Legal Assessor advised the Panel that in Adeogba the Court had said that the Panel must decide whether all reasonable steps had been taken to bring the hearing to the attention of the Registrant. If so, the question was whether the Panel should exercise its discretion to proceed, balancing the interests of the Registrant with the public interest. In Adeogba, the Court also referred to the public interest in the expedition of regulatory proceedings.

13. The Legal Assessor also referred the Panel to Sanusi v GMC [2019] EWCA 1172, in which the Court stated that what fairness demands in relation to the issue of proceeding in absence is a question of fact in each particular case. He advised the Panel to consider the information provided and the factors set out in the Practice Notes.

14. The Legal Assessor drew the Panel’s attention to the Registrant’s correspondence, in which she had mentioned, amongst other things, not having agreed the hearing dates, not being in London until mid-May, and intending to consult a lawyer. He advised the Panel that it was appropriate to consider the factors relating to adjournment in the relevant Practice Note, which was based on CPS v Picton (2006) EWHC 1108.

15. The Panel considered that it had no formal request from the Registrant for an adjournment but there was an implication in the information from the Registrant that she was not in London to attend and/or intended to seek legal advice. The Panel had no information before it that the Registrant had responded to the HCPTS “Response Pro-Forma and Pre-Hearing Information Form” concerning dates to avoid, sent in January 2025. The Panel was provided with information that by email dated 17 April 2025, the HCPC’s representatives had emailed the Registrant with information about attending the virtual hearing. In addition, the Registrant had been provided with information about making a formal adjournment request.

16. The Panel acknowledged that there was a need for expedition in the conduct of proceedings, but this had to be balanced with the Registrant’s interests, which may be affected if the hearing went ahead.

17. The Panel took into account that it had no information from the Registrant as to the details of any legal representative or the purpose or length of any adjournment. Apart from the statement that the Registrant had not agreed to any dates for a hearing, her position on attending the hearing was not explicit in the correspondence.

18. In terms of proceeding in the Registrant’s absence, the Panel was satisfied that all reasonable steps had been taken to serve notice and bring the hearing to the Registrant’s attention. The Notice of Hearing had been served to the Registrant’s registered email address and from which address the Registrant had recently responded. A further Notice had been posted to the Registrant’s registered postal address two days after the emailed Notice. On 10 and 16 April 2025, the HCPC and HCPTS respectively had emailed the Registrant about the forthcoming hearing. Telephone contact had been made to the Registrant on the Friday before the hearing. The Panel was satisfied that all reasonable steps had been taken to bring the hearing to the Registrant’s attention.

19. The Panel bore in mind the Court’s guidance in Adeogba that registrant professionals bear an obligation to cooperate with their regulator in the public interest. The Panel was satisfied that the Registrant was aware of the hearing and was sent details of the dates in advance, but no formal request to adjourn the hearing had been received.

20. Although the Registrant had stated that she was not in London until the middle of the following month, the hearing was being conducted virtually. The dates of the hearing and its remote format had been provisionally indicated in the HCPTS’ email dated 06 February 2025. The Registrant had been informed in the Notice that the hearing would take place remotely and she had been provided with information about joining the virtual hearing. No difficulties with attending a virtual hearing had been notified to the Panel. The Notice had also warned the Registrant of the possibility that the Panel might proceed in her absence if the Registrant did not attend.

21. The Panel acknowledged that, in proceeding and not hearing from the Registrant, there may well be some disadvantage to her. However, the Panel considered that it could test the evidence with questions of the witnesses and the HCPC Presenting Officer. Although the Registrant had referred to consulting lawyers, there had been no contact with legal representatives made known to the Panel. The factual Allegation related to a single email allegedly sent by the Registrant and the consequences of it.

22. The Panel took into account the public interest in expeditiously dealing with regulatory proceedings. It took into account that the dates for the hearing had been first mentioned as a provisional listing by email dated 06 February 2025. The attendance of two witnesses had been arranged and adjourning the hearing would lead to delay and the need for further allocation of resources in the hearings calendar.

23. Having taken all the factors into account and balanced the Registrant’s interests with the public interest, the Panel concluded that the public interest in the matter being dealt with took precedence and it was fair and appropriate to proceed with the hearing notwithstanding the Registrant’s absence.

Proceeding partly in private

24. Ms Collins applied to the Panel to sit partly in private when considering details of Child A’s personal conditions [redacted] or the name of the Local Authority, in order to avoid any risk of identification. She referred the Panel to the HCPTS Practice Note “Conducting Hearings in Private”.

25. The Legal Assessor advised the Panel that Rule 10(1)(a) sets out that hearings are conducted in public unless the Panel is satisfied that the interests of justice, or the protection of the private life of the Registrant, the complainant, a witness, or any patient or client, requires it to sit wholly or partly in private. He advised the Panel that, although there was anonymisation, the Panel may wish to avoid sharing in public session any matters which might lead to ‘jigsaw’ identification.

26. The Panel took into account that the main persons referred to were anonymised and that there was nothing known about the Registrant which indicated a need to sit in private. However, the case involved a child’s educational needs and it was appropriate to protect the child’s identity. The Panel therefore resolved to move into private session whenever there might be reference to Child A’s personal conditions [redacted] or the name of the Local Authority. This is the redacted public copy of the private decision.

Background

27. The Registrant is an Occupational Therapist registered with the HCPC. On 13 September 2022, the HCPC received a referral from a member of the public, Person A. Person A is the father of Child A and he stated that the Registrant was engaged by [the Local Authority] to provide occupational therapy services to Child A.

28. Person A alleged that the Registrant sent an email to various parties on 13 September 2022 containing a large amount of confidential information regarding Child A and their family. The email was addressed to the Headteacher of School B, at which Child A had started being educated in September 2022. However, the email was also copied to various other parties. These included the Headteacher of Child A’s previous school and also to a Special Educational Needs and Disability (“SEND”) officer, a solicitor, and the Leader of [the Local Authority].

29. It was alleged that the email sent by the Registrant contained information concerning Child A’s occupational therapy, personal needs, and details of other teams concerned in Child A’s care. Person A stated that the Registrant was no longer involved in providing Child A’s care and that he had not given consent for the information to be disclosed. [redacted].

30. The HCPC provided a case summary, a hearing bundle, and written closing submissions. It relied on the evidence of two witnesses called to give oral evidence:

• Person A;

• Witness 1, who was at the time the Deputy Headteacher at School B.

Decision on Facts

Particular 1

31. The Panel first considered the factual allegation in Particular 1 of the Allegation. It considered that the mischief alleged was the sending of the email to ‘third parties’ which disclosed information which was confidential.

32. Person A exhibited a copy of the email dated 13 September 2022 (“the email”). The Panel observed that the email had come from the Registrant and it bore her name at the end of it. The email contained information which was clearly within the type of information which would be known to the Registrant in her professional role. The Panel was satisfied that the Registrant had sent the email.

33. The Panel accepted the HCPC’s submission that the ‘third parties’ were those other than the Registrant, Child A, Person A, or Child A’s family. It concluded that those names addressed as recipients in the email were ‘third parties’ as referred to in Particular 1.

34. The email was addressed to the Headteacher of School B, but the email address used was one which both Person A and Witness 1 told the Panel was a general administrative email address at School B. Witness 1 told the Panel that the email was passed to the Headteacher by a member of the administrative staff of School B. Therefore, the Panel concluded, the email had been available to be read by those administrative staff at the school and appeared to have been in the hands of at least one administrative person, and also School B’s Headteacher.

35. The Panel found Witness 1 to be a reliable and credible witness. She gave evidence on a limited range of matters over the receipt and availability of the email and the Panel accepted her evidence.

36. The Panel was informed by Person A of the identity of the other named recipients to whom the email was copied. Person A told the Panel that he had been a governor of School B and he had been involved with [the Local Authority] for the purposes of the SEND procedures. The Panel accepted that he was likely to be aware of the identity of the individuals copied in. The Panel considered these persons were also third parties, as referred to in Particular 1.

37. The Panel also found Person A to be a reliable and credible witness. It took into account that Person A was closely involved in matters as the parent of Child A. He gave evidence clearly and without embellishment, making appropriate concessions. The Panel accepted his evidence.

38. The Panel considered the email itself and noted that the information disclosed within it fell broadly into three groups:

• Information about the SEND meetings and engagement with professionals and organisations;

• Information about Child A and Person A’s family;

• Information about Child A’s [redacted] provisions.

39. The Panel accepted the HCPC’s submission that, in addition, the email also disclosed certain personal data such as Child A’s name and address, Child A’s mother’s previous occupation, and Child A’s father’s current occupation. There was also reference to [redacted] the Registrant’s recommendation of the engagement of an au pair.

40. The Panel considered that information would be confidential where it came to the knowledge of a person as a result of a professional relationship which was governed by a duty of confidence.

41. The Panel considered that a duty of confidence had attached to the Registrant’s knowledge of Child A and Person A’s family because it occurred in the context of her engagement as a private Occupational Therapist to Child A. Further, the information in each group referenced in paragraph 38 above had the potential to cause upset and embarrassment to Child A and Person A/the family. Person A had confirmed that he had been upset by the disclosure of the information.

42. The Panel noted that its approach was consistent with the HCPC guidance “Confidentiality – guidance for registrants”, a copy of which would have been in existence and accessible to the Registrant in September 2022. This guidance set out that there were categories of ‘identifiable’ and ‘anonymised’ information about a service user. Identifiable information included information which might lead to their identification, such as personal details of name and address and other information not strictly related to their care. The guidance stated that this “must” be treated as confidential.

43. Further, the ‘anonymised’ information was that from which identifiable information had been removed. The guidance stated that this might be shared, but “you should always consider carefully what you are sharing and who you are sharing it with”.

44. The Panel was satisfied, considering the nature of the Registrant’s engagement and the latter guidance, that the information in the email was confidential information.

45. The Panel was therefore satisfied that the Registrant had sent the email to third parties and the email made available, i.e. disclosed, confidential information.

46. The Panel found Particular 1 proved.

Decision on Grounds

47. Since the Panel had found the factual particulars proved, it next considered whether those facts amounted to misconduct, the statutory ground within Article 22(1)(a)(i) of the Health Professions Order 2001 (as amended) (“the Order”).

48. Ms Collins, in her written submissions, submitted that the behaviour of the Registrant amounted to misconduct, in that it had constituted a serious falling short of what would be proper in the circumstances. It was submitted that disclosing confidential information of a vulnerable service user and their parents to third parties without permission was a serious departure from expected standards and would be considered ‘deplorable’ by fellow professionals.

49. The Legal Assessor advised the Panel that, in order to find the ground of misconduct made out, it must be satisfied that the facts found proved were ‘serious professional misconduct’ as referred to in the case of Roylance v GMC no. 2 [2001] AC 311. Whether the conduct was so serious was a matter for the Panel’s judgement. The Courts had provided descriptions, for example, ‘deplorable’ conduct, in the case of Nandi v GMC [2004] EWHC 2317 (Admin). However, in every case it was for the Panel to decide. Not all misconduct is so serious as to satisfy the statutory ground. The Panel might look at the individual information disclosed in the email and the particular recipients or, in an appropriate case, regard the matter more globally.

50. In the case of confidential information, it appeared to the Panel that there might be circumstances when disclosure of the confidential information might be acceptable, as the HCPC Standards of Conduct, Performance and Ethics (“SCPEs”) set out.

51. The Panel took into account the SCPEs in force at the relevant time concerning the handling of confidential information.

5. Respect confidentiality

Using information

5.1 You must treat information about service users as confidential.

Disclosing information

5.2 You must only disclose confidential information if:

- you have permission;
- the law allows this;
- it is in the service user’s best interests; or
- it is in the public interest, such as if it is necessary to protect public safety or prevent harm to other people.

52. The Panel was of the view that the justification of disclosure varied with the particular type of confidential information, such as the subject of the information and also which recipient was appropriate to receive it. The Panel noted that, in the case of the email sent on 13 September 2022, all of the information was sent to each of the recipients.

53. The Panel considered that the mischief of the allegation of ‘disclosing’ confidential information in Particular 1 referred to the situation where that confidential information was made known to the recipient in circumstances where there was no, or no sufficient, justification.

54. The Panel took into account that, at the time of sending the email, the evidence was clear that Child A had been at School B for a couple of weeks. Child A had left School A, at which the Registrant had been funded to provide occupational therapy support by [the Local Authority]. It did not appear to be in dispute that the Registrant had been contracted to provide services at School A by [the Local Authority] and it was therefore likely that [the Local Authority] had terminated its arrangement with the Registrant after Child A left School A. This appeared to be confirmed in the email itself, where the Registrant stated that the Senior Staff of [the Local Authority] knew that her responsibilities had finished.

55. Person A stated that at the time the email was sent, the Registrant was no longer engaged as Child A’s Occupational Therapist. He also stated that she was not asked to send the email and did not have “permission” to share that information with those recipients. Person A told the Panel that neither he nor his wife had been approached by the Registrant for their consent to the email being sent. The Panel accepted Person A’s evidence and considered that the Registrant did not have the permission of Person A and his family.

56. The HCPC guidance “Confidentiality – guidance for registrants” also gave further illustration around the obligations under Standard 5 of the SCPEs. It referred to the possibility of express and implied consent.

57. It appeared from the email that the Registrant had been waiting for a request for information: “I have been waiting for a short time to see if you or one of your staff made contact with me. This has not happened”. The email ended “with regards and concern”. It appeared that, not having had contact, the Registrant decided to provide the information of her own volition.

58. The Panel concluded on the evidence that there had been no permission for the Registrant to have provided confidential information. There was no evidence of a compulsion under law for her to have made a disclosure.

59. Neither was it apparent to the Panel that there had been a risk of harm to Child A which might otherwise justify a disclosure by the Registrant. The Panel accepted the evidence of Person A that the Education and Health Care Plan (“EHCP”) and relevant reports had been passed over to School B as part of the regular administrative process of transferring Child A from School A to School B.

60. The Panel accepted the evidence that the Registrant’s formal involvement and therefore her rights of disclosure had terminated with the ending of her engagement as Child A’s Occupational Therapist and the removal of Person A’s permission. In the email, the Registrant acknowledged that her responsibilities had terminated when she stated, “The Senior Staff of [the Local Authority] know that my responsibilities for this child have finished…”.

61. The Panel considered whether there was other implied permission for disclosure arising from her position (now former) as Child A’s Occupational Therapist. It concluded that this was not likely to be the case. Person A gave evidence that there had been an effective handover, with copies of the EHCP plan and reports being passed over previously to School B. There was no evidence that School B requested the information from the Registrant. In any event, the Panel did not believe that such implied permission would extend to anything other than information about Child A’s general needs.

62. The other potential justification was a disclosure in the ‘best interests’ of Child A. The Panel considered whether the Registrant’s duty to disclose might have survived the end of her engagement as to be exercised in Child A’s best interests. However, the Panel noted that the email was not limited to professional Occupational Therapist to Occupational Therapist disclosure or sharing of information, nor was it limited to purely professional information. The Registrant had not been asked for any information, as she acknowledged in the email. The Panel could not discern any particular safeguarding issues relevant to the disclosure. The Panel considered that there was a wide breadth to the disclosed information. It could not conclude that this would have constituted information to be shared in the best interests of Child A.

63. The Panel was of the view that, due to the content and particular recipients of the email, it did not regard that the Registrant’s email was simply an attempt to bring concerns to the attention of relevant parties. The information about the family appeared to extend to the Registrant’s opinion [redacted] and irrelevant personal information, which caused embarrassment to the family.

64. Further, in relation to the question of whether the Registrant was acting in the best interests of Child A, the Panel noted from the email dated 30 November 2022 to a Learning Disabilities Team that the Registrant had provided her notes in February 2022, but said that she had not subsequently been sent “a copy of the Team Meeting or of the actual Report provided by you to the Family”.

65. The Panel took into account the evidence of Person A, which it accepted, that all relevant reports and materials had been provided to School B prior to the Registrant’s email. The Panel therefore concluded that the Registrant had not been in possession of all up-to-date material and this made it less appropriate for her contribution to be relevant. The Panel considered that, whilst the new Occupational Therapist at School B would wish to have relevant prior material, it appeared that this had been available and that the next Occupational Therapist would have been expected to make their own assessment of Child A.

66. The Panel considered that, across the range of confidential information disclosed in the email, some was of a particularly high level of sensitivity or inappropriateness. For example, disclosures about intimate clinical information about Child A had been made available to the Leader of [the Local Authority], who had no clinical remit. The information had been also copied to a solicitor at [the Local Authority] who had no involvement in Child A’s case. Although some of the information might be relevant to School B, it included what appeared to be the Registrant’s opinion [redacted] which did not seem relevant to clinical care.

67. The Panel was also concerned that the email had been primarily addressed to a general email account at School B, even though nominally addressed to the Head Teacher. Therefore, it had been available to other administrative staff, which was inappropriate and failed to maintain confidentiality.

68. The Panel was concerned that the email had been sent to the various recipients in whole, without any attempt to edit or direct the information appropriately according to the particular recipient.

69. The Panel considered that several of the HCPC’s standards in the SCPEs were engaged, as follows:

1. Promote and protect the interests of service users and carers

Treat service users and carers with respect

1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.

…

Make sure you have consent

1.4 You must make sure that you have consent from service users or other appropriate authority before you provide care, treatment or other services.

…

5. Respect confidentiality

Using information

5.1 You must treat information about service users as confidential.

Disclosing information

5.2 You must only disclose confidential information if:
- you have permission;
- the law allows this;
- it is in the service user’s best interests; or
- it is in the public interest, such as if it is necessary to protect public safety or prevent harm to other people.

…

7. Report concerns about safety

Report concerns

…

7.3 You must take appropriate action if you have concerns about the safety or well-being of children or vulnerable adults

…

9. Be honest and trustworthy

Personal and professional behaviour

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

70. The Panel considered that the disclosure of the confidential information had not been justified. Although there may have been concerns held by the Registrant which she felt she needed to pass on, she had not gone about this in a proper way, making appropriate references to the appropriate parties. Her conduct had undermined the confidence of Person A in the profession and would alarm the wider public, if known, in the Panel’s view.

71. The Panel referred to the HCPC’s Standards of Proficiency for Occupational Therapists (“SOPs”) in place at the time. It referred to the following section:

7. Understand the importance of and be able to maintain confidentiality

…

7.2 understand the principles of information governance and be aware of the safe and effective use of health and social care information

7.3 be able to recognise and respond appropriately to situations where it is necessary to share information to safeguard service users or the wider public.

72. The Panel considered that Standard 7 applied, particularly in terms of standards 7.2 and 7.3. The Panel considered that the Registrant’s conduct had shown a disregard for these important principles.

73. The Panel took into account that the confidential information ran throughout the email and had been sent all together to all of the recipients. In the Panel’s view, none of the recipients were appropriate recipients of all the confidential information contained in the email. It was appropriate to consider the various disclosures globally as part of the email as a whole.

74. The Panel had found breaches of several provisions of the SCPEs and the SOPs. It considered that the misconduct in sending the email amounted to a serious falling short of the expected standards for the profession.

75. The Panel decided that the Registrant sending the email on or around 13 September 2022 was serious professional misconduct.

Decision on Impairment

76. The Panel, having found misconduct, next considered whether, as a result of that misconduct, the Registrant’s fitness to practise as a registered Occupational Therapist is currently impaired.

77. Ms Collins submitted in writing that the Registrant’s fitness to practise was impaired in respect of both the ‘personal’ and the ‘public’ components of impairment. She submitted that, from the CHRE v NMC & Grant [2011] EWHC 927 (Admin) test of impairment, the first three limbs were satisfied.

78. The Legal Assessor advised the Panel that the decision as to impairment of fitness to practise is a matter for its own judgement. It is not every finding of misconduct which will result in a finding of impairment. He referred the Panel to the HCPTS Practice Note on “Fitness to Practise Impairment”. He advised the Panel that it should consider what is there set out as two ‘aspects’ of impairment. It should consider the risk of repetition and what is termed the ‘personal’ component. With regard to the risk of repetition, he referred the Panel to the test taken from Cohen v GMC [2008] EWHC 581 (Admin). He advised the Panel to consider whether it regarded the misconduct as remediable, whether it had been remedied, and whether it was “highly unlikely” to be repeated.

79. The Legal Assessor advised the Panel that it should also consider matters of the wider public interest, termed the ‘public’ component. He reminded the Panel of the elements of the overarching objective of the Regulator and referred to the test of impairment referred to in Grant, taken from the Fifth Shipman report by Dame Janet Smith:

“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act dishonestly in the future.”

80. The Panel referred to its findings so far on facts and misconduct. It took into account the submissions from the HCPC and accepted the legal advice from the Legal Assessor. The Panel bore in mind that not every finding of misconduct will lead to a finding of impairment. The Panel carefully considered the HCPTS Practice Note “Fitness to Practise Impairment” and the two components of impairment in turn.

81. The Panel considered its findings of misconduct. The case concerned the sending of a single email disclosing confidential information which included, variously, information which should not have been disclosed and which should not have been sent to certain recipients. The Panel had considered that there was some indication that the Registrant had concerns for the appropriateness of provisions for Child A at School B and had wanted to impart information which she regarded as in the child’s best interests. However, the Panel considered that the Registrant had engaged in serious professional misconduct in the way in which this was undertaken.

82. The Panel considered, therefore, that in principle the misconduct was remediable. It should be possible, by way of reflection, professional development, and training, to gain the necessary insight to avoid a repetition of the misconduct.

83. The Panel found, however, that it had no evidence from the Registrant that she had appropriately reflected, trained, or gained any insight into the issues. There was no information on how the Registrant had conducted herself since the events in question, and no testimonials or references as to her general character. The Registrant had not engaged with the hearing and no information was provided on her behalf from which the Panel might consider that she had developed her practice or insight since she had sent the email in question. Therefore, the Panel concluded that there remains a risk of repetition of past misconduct and it could not say the misconduct was “highly unlikely” to be repeated.

84. The Panel therefore found that the Registrant is impaired on the ‘personal’ component of impairment.

85. Further, addressing the wider public interest, the Panel also considered the important public policy issues, i.e. the need to protect service users, the maintenance of public confidence in the profession, and the maintenance of standards. These were issues which were also considered in the impairment test in the Grant case.

86. The Panel considered that the Registrant had caused a risk of harm to the family of Child A by the sending of inappropriate personal information about them. Her actions in breaching the professional duty of confidentiality had also breached fundamental tenets of the profession to maintain a duty of confidence. The Panel concluded that members of the profession and the public in general would be shocked at the extent of the information provided to an array of recipients. Therefore, the Registrant had also brought the wider profession into disrepute.

87. The Panel had no information about how the Registrant had addressed any of these matters and therefore concluded that there is a risk of repetition. As a result, the Panel decided that a finding of impairment of fitness to practise was also necessary in order to maintain public confidence in the profession and to declare and uphold proper standards of behaviour for the profession.

88. The Panel found the Registrant’s fitness to practise is also impaired on the ‘public’ component of impairment.

Decision on Sanction

89. The Panel had found that the Registrant’s fitness to practise is currently impaired. It therefore went on to consider what, if any, sanction it had to impose pursuant to Article 29 of the Order.

90. Ms Collins provided written submissions, upon which she expanded. She submitted that the HCPC was neutral as to any particular sanction to be imposed. It was submitted that the Panel should take the minimum action necessary to protect the public. Ms Collins referred the Panel to the HCPC Sanctions Policy (March 2019) (“the SP”). She confirmed that the Registrant had no previous fitness to practise history. Ms Collins submitted that no harm had come to Child A, but Person A and his wife had suffered stress through the misconduct of the Registrant. Ms Collins submitted that the case was also aggravated [redacted] by a breach of trust. She referred the Panel to the categories of ‘Serious cases’ in the SP, which referred to, amongst other types of cases, ‘Abuse of professional position’. Ms Collins also referred to the fact of Child A having been ‘vulnerable’, as referred to in the SP.

91. The Legal Assessor advised the Panel that, pursuant to Article 29(3) of the Order, having found the Allegation well-founded and that the Registrant’s fitness to practise is currently impaired, the Panel had to consider the available steps in the remainder of Article 29.

92. The Legal Assessor advised the Panel that it had to take into account its findings of fact, misconduct, and impairment and give careful consideration to the SP. The Legal Assessor set out the options and sanctions available pursuant to Article 29. He advised that the Panel must, in order to be proportionate, impose the least restriction which meets the level of impairment and the statutory objective of public protection. The Panel had to balance the interests of the Registrant with the public interest. Therefore, he advised, the Panel should first consider the least restrictive measure and move upwards in the increasing level of restriction, stopping at the minimum sanction which is necessary to protect the public. In the case of any sanction which is imposed for a period of time, the Panel must specify the period and the reasons for setting that particular period.

93. The Panel considered that the misconduct was serious and had involved inappropriate disclosures of confidential information which had caused embarrassment to the family of Child A. The misconduct had breached fundamental tenets of the profession and brought it into disrepute.

94. The Panel had found the Registrant’s fitness to practise impaired in respect of both a risk of repetition, the ‘personal’ component, and also in the wider public interest, the ‘public’ component. The Panel considered that, in seeking to protect the public by considering sanction, it would need to address both aspects.

95. As had been submitted and in accordance with the SP, the Panel considered what, if any, mitigating or aggravating factors there were in the case, taking into account the non-exclusive list of factors suggested in the SP. In terms of mitigating factors, the Panel took into account that the Registrant had no previous adverse regulatory findings against her. In addition, there was no evidence that any harm had been occasioned to Child A. The sending of the email had been a single incident and there was no suggestion of a repetition.

96. The Panel considered, in relation to factors which aggravated the case, that Person A and his wife had been caused embarrassment and distress by the disclosure of confidential information. The Panel had no evidence of any insight gained by the Registrant.

97. [redacted]. Although the Panel considered that there was a breach of trust inherent in the release of confidential information where a duty of confidence had existed, it was of the view that the breach of trust was the essence of the misconduct rather than an aggravating factor.

98. The Panel noted in the SP, and heard the HCPC’s submissions on, the ‘Serious cases’ which are set out as particularly of concern. Although the Panel had made reference to Standard 7.3 and the duty to raise concerns, it did not consider that this case demonstrated a failure to raise concerns which had resulted in an unaddressed risk to Child A.

99. The Panel was of the view that, although the Registrant had breached the trust of the family of Child A in disclosing the confidential information, it did not find that this was a case of the kind exemplified in paragraphs 69 to 77 of the SP under ‘Abuse of professional position’. The Panel did not consider that the Registrant had been in any way seeking personal benefit or advancement from misusing the professional relationship.

100. The Panel concluded that the case, although serious, did not fall within the listed categories of ‘Serious cases’ within the SP.

101. The Panel turned to the available steps, first considering Article 29(4) of the Order. The Panel considered the option of mediation. However, it noted in the SP that this sets out that mediation is only likely to be appropriate where the impairment is minor, isolated in nature, and unlikely to recur. There was also a reference to completed remediation. The Panel did not think this was a case of minor impairment and it had found a risk of repetition. It concluded that this was not a suitable case to end with mediation.

102. The Panel next considered whether it could end the case by taking no action. The SP sets out that this is “unlikely” following a finding of impairment. The Panel considered that there were no exceptional features about the case. Ending the case with no action would allow the Registrant to resume unrestricted practice and the Panel considered that this would fail to protect the public when it had found a risk of repetition of misconduct. Nor would taking no action serve to deal with the wider public interest concerns that the Panel had identified in its finding of impairment.

103. The Panel considered a caution order, which it was aware can be imposed for between 1 and 5 years. It noted that paragraph 101 of the SP states:

“101. A caution order is likely to be an appropriate sanction for cases in which:

• the issue is isolated, limited, or relatively minor in nature;

• there is a low risk of repetition;

• the registrant has shown good insight; and

• the registrant has undertaken appropriate remediation.”

104. In this case, the misconduct had been the sending of a single email, although the Panel did not consider that the amount of disclosed confidential information and the number of recipients fitted the description of “limited”. The Panel did not consider that the misconduct was minor and it had no demonstration of good insight or any remediation. The Panel had found that there was a risk of repetition of misconduct and it did not regard that there was a low risk.

105. The Panel concluded that a caution order was not a sanction which protected the public, either in terms of the risk of repetition or the wider public interest concerns.

106. The Panel then considered imposing a conditions of practice order. The SP sets out the circumstances where such an order is appropriate in paragraph 106, as follows:

“106. A conditions of practice order is likely to be appropriate in cases where:

• the registrant has insight;

• the failure or deficiency is capable of being remedied;

• there are no persistent or general failures which would prevent the registrant from remediating;

• appropriate, proportionate, realistic and verifiable conditions can be formulated;

• the panel is confident the registrant will comply with the conditions;

• a reviewing panel will be able to determine whether or not those conditions have or are being met; and

• the registrant does not pose a risk of harm by being in restricted practice.”

107. As stated above, the Panel had no evidence that the Registrant had insight into her misconduct. The Panel considered that the misconduct was remediable, but it had no evidence that any remediation had been undertaken. The Registrant had not engaged with the hearing and the Panel had no reassurance that she would comply with any conditions, if imposed. The Panel had no information about her current practice intentions and was not in a position to judge if conditions might be workable.

108. Moreover, the Panel considered that conditions of practice were not apt to deal with the risk of repetition arising from the Registrant’s failure to observe her duty of confidentiality. In this case, it had no information that the Registrant has now gained insight into her misconduct.

109. The Panel also heeded paragraph 107 of the SP, which states:

“When might a conditions of practice order not be appropriate?

107. Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings.”

110. The Panel had no information to suggest that the Registrant is committed to resolving the concerns and the Registrant had not engaged with the hearing.

111. The Panel therefore next considered a suspension order. It considered that such an order does serve to protect the public for the period of its currency. It also sends a message to the public and to the profession as to the expected standards.

112. The Panel took into account paragraph 121 of the SP. This states:

“121. A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:

• the concerns represent a serious breach of the Standards of conduct, performance and ethics;

• the registrant has insight;

• the issues are unlikely to be repeated; and

• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”

113. The Panel did consider that there had been serious breaches of the SCPEs, which it had set out above. The Panel did consider that the misconduct is potentially remediable. However, the Panel had no evidence from the Registrant of the development of any insight and it had found that, as a result, there is a risk of repetition of misconduct.

114. The Panel therefore considered that it should look to the next available sanction of a striking off order to see if this was necessary.

115. The Panel bore in mind that the SP, in paragraph 130, sets out that a striking off order is “a sanction of last resort for serious, persistent, deliberate or reckless acts”. The SP goes on to list a series of “not exhaustive” examples of types of misconduct, which did not include the misconduct in this case.

116. Paragraph 131 states that such an order is, “likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process”. The SP notes that this sanction has a significant impact on a registrant.

117. The Panel considered that this was a case of serious misconduct, but it did not consider that it was “persistent”. Rather, there had been a single email sent. It had been a deliberate act but the Panel could balance this with the Registrant’s previous good regulatory history. It was of concern that the Registrant had not engaged with the hearing nor provided any evidence of insight or remediation, but the Panel considered that the misconduct could be remedied in principle.

118. The Panel was concerned over the seriousness of the disclosure of confidential material and the distress caused to Person A and his wife. However, the Panel took into account that the release of the information had not been to the public at large but to persons who had some (although in some cases tenuous) connection to Child A’s case.

119. The Panel was mindful of the need to balance the protection of the public with the interests of the Registrant and the acknowledged serious effect of the most severe sanction.

120. Having weighed all the factors, the Panel concluded that it was able to stop short of imposing a striking off order and that the need for public protection and the wider public interest could be served by imposing a period of suspension. Therefore, a striking off order was disproportionate. The Panel decided that a suspension order is the appropriate and proportionate order.

121. The Panel next considered for what period the Suspension Order should be imposed. It was aware that the maximum is 1 year, but this is not a default. The Panel considered that the period of suspension must allow time for the Registrant to undertake a period of reflection and remediation. It must also be sufficient to maintain public confidence in the profession and to declare and uphold standards for the profession.

122. The Panel decided that the appropriate period was 9 months. This would allow time for the Registrant to undertake appropriate remediation, including preparation of reflections and undertaking any necessary Continuing Professional Development (“CPD”) and training, and to have time to deal with the risk of repetition. It would also serve to mark the interests protected in the ‘public’ component of impairment.

123. The Panel acknowledged that imposing a Suspension Order for 9 months restricts the Registrant’s right to practise her profession and is therefore likely to have an effect on the Registrant professionally and/or financially. However, the Panel balanced the Registrant’s interests with the public interest in public protection and it considered that its order was appropriate and proportionate.

124. The Suspension Order will be reviewed before its expiry by another panel of the Conduct and Competence Committee. The Registrant will be invited to attend the review. This Panel cannot bind that other panel. However, the Panel suggests that the reviewing panel may be assisted by the Registrant attending the review and also, if she would like to provide to it:

• Written reflections on the Panel’s findings of impairment set out above, demonstrating the Registrant’s insight, linking to professional standards, and the effects on service users, the profession, and the wider public;

• Evidence of any CPD, training, or other learning in relation to the Panel’s findings and demonstrating that the Registrant has kept her knowledge and skills up to date.

• Any relevant references and/or testimonials.

• Any other material the Registrant considers relevant.

125. The Panel imposes a Suspension Order for 9 months on the Registrant’s registration.

That the Registrar is directed to suspend the registration of Mrs Margaret Ellis for a period of 9 months from the date this order comes into effect.

This Order will be reviewed again before its expiry.

Interim Order

Application

1. The Panel having determined to make a Suspension Order on the Registrant’s registration, Ms Collins made an application for an interim order to cover the period allowed for any appeal to be made and/or disposed of.

2. The Registrant not being present, Ms Collins applied to the Panel to proceed to hear the application for the interim order in the absence of the Registrant, pursuant to Rule 11. Ms Collins referred the Panel to the HCPTS Practice Notes “Proceeding in the Absence of the Registrant” and “Interim Orders”.

3. Ms Collins asked for an interim order to be granted for 18 months as an interim suspension order. She referred the Panel to the HCPTS Practice Note “Interim Orders” and reminded the Panel that it had found facts proved against the Registrant. Ms Collins submitted that an interim order was necessary for protection of the public and was necessary to maintain public confidence in the profession.

4. The Legal Assessor referred the Panel to Rule 11 and the HCPTS Practice Notes “Proceeding in the Absence of the Registrant” and “Interim Orders”. He reminded the Panel as to the previous advice on proceeding in absence and advised that the Panel had to decide as a separate matter whether it was appropriate to hear the application for an interim order in the Registrant’s absence. The Panel had to decide whether it should hear the application for an interim order or adjourn it to allow for the Registrant’s attendance.

5. The Legal Assessor advised the Panel that it could impose an interim order pursuant to Article 31(2) of the Order, provided it was satisfied that to do so was necessary for the protection of the public, was otherwise in the public interest, or was in the Registrant’s interests. The interim order could be either an interim conditions of practice order or an interim suspension order but should be the minimum restriction necessary in the circumstances of the case. The Panel had to set the period for which the interim order is imposed, which could be for up to a maximum of 18 months.

6. Shortly before handing down the Panel’s decision on the Interim Order application, but after the Panel had retired to make its decision on the application, the Panel was made aware of an email sent to the Hearings Officer from the Registrant. The email was dated 01 May 2025 and timed at 16:24:46. The Panel noted the content of the email but considered that it had earlier in the week already made a decision to proceed in the Registrant’s absence with the substantive hearing. It had already handed down its decision on a substantive Suspension Order earlier on 01 May 2025. The Panel considered that the content of the email did not affect its decision to proceed to hear the application for an interim order in the absence of the Registrant, or the decision on the application itself.

Decision

7. The Panel was satisfied that the Registrant was warned in the Notice of Hearing of the possibility of an Interim Order being imposed. The Panel decided, for similar reasons as applied to the decision to proceed in absence at the start of the hearing, to hear the application.

8. The Panel took into account its findings on misconduct and impairment. It took into account that it had found a risk of repetition of misconduct. It had determined to impose a Suspension Order for the protection of the public and in order to maintain public confidence and declare and uphold professional standards. The Panel decided that, in light of the need to protect the public from a risk of repetition, an interim order was necessary to protect the public. It was also necessary in the wider public interest. As the Panel had made findings as to a risk of repetition of misconduct, public confidence would be undermined if no interim order was put in place.

9. The Panel considered that, for the same reasons that it had been found necessary to impose a Suspension Order, the interim order could not be an interim conditions of practice order. The minimum restriction which met the need to protect the public was an interim suspension order.

10. The Panel decided to grant an Interim Suspension Order for a period of 18 months, to allow for the time any appeal might take to be disposed of if made.

11. The Panel makes an Interim Suspension Order pursuant to Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

12. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Margaret Ellis

Date	Panel	Hearing type	Outcomes / Status
28/04/2025	Conduct and Competence Committee	Final Hearing	Suspended