Sandra Marshall

Preliminary Matters

Service and Proceeding in Absence

1. Notice of this review hearing was sent to the Registrant on 10 November 2025, by email. The Registrant was informed of the date time and format of the hearing as well as its purpose. This was followed by email exchanges in which the Registrant confirmed that she will not be attending the hearing because she is away celebrating her 60th birthday. She provided some information on her work over the last 18 months, and asked about being removed from the register, whilst at the same time stating that she wished to remain a Speech and Language Therapist (SLT).

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

3. Ms Oliver applied for the matter to be heard in the Registrant’s absence in accordance with Rule 11 of the HCPTS Conduct and Competence Committee Procedure Rules. Ms Oliver submitted that it was clear from correspondence that the Registrant was aware of the hearing and had voluntarily absented herself. She submitted that it was fair for the review to be conducted in the Registrant’s absence, noting the HCPC’s overarching objective, and that the current order is due to expire in 27 days, meaning that the required notice could not be given if the matter were not heard today.

4. The Panel accepted the Legal Assessor’s advice and was aware of the factors to take into account, as set out in R v Jones [2003] UKPC 34 (as modified for FTP hearings) when determining whether to proceed in absence. It was satisfied that the Registrant is aware of today’s hearing and had voluntarily waived her right to attend. No adjournment had been requested, notwithstanding that the Registrant was made aware of her right to request this. The Panel was cognisant that this is a mandatory review of the substantive order imposed in January 2023, which is due to expire within the next 28 days. The Panel determined that it was fair to proceed in her absence.

Background

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

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

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

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

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

10. The capability process was monitored by recording feedback received from SLTs with whom the Registrant worked over the course of 2020. Due to a lack of satisfactory improvement, the matter was referred to the HCPC, and a substantive hearing took place between 1-10 August and 7-8 December 2022. That panel found that the Registrant’s fitness to practise was currently impaired on the ground of a lack of competence, and imposed a Conditions of Practice Order for a period of 18 months.
On 11 June 2024, a reviewing panel found that the Registrant had not worked under the conditions and confirmed the conditions for another 18 months. This was with a view to giving the Registrant time to secure a Band 5 role and work under supervision. In addition to this, recommendations were provided in the form of reflections and Continuing Professional Development (CPD).

Submissions

11. Ms Oliver on behalf of the HCPC submitted that strike off is appropriate as the Registrant has been subject to a substantive conditions of practice order for almost three years. That order had been imposed because the Registrant had, when assessed, been unable to meet the standards of a newly qualified practitioner.

12. Ms Oliver noted that since the order was imposed, the Registrant has worked in a Band 4 role which does not require registration. Indeed, she had been in such a role at the time of the substantive hearing.

13. Ms Oliver referred to the Registrant’s correspondence, in particular her reasons for not having applied for a Band 5 role (set out below). She had not responded to the HCPC further with regard to voluntary removal after having been told that she could not then be reinstated for five years.

14. Ms Oliver submitted that the question for the Panel today was whether the Registrant’s fitness to practice remained impaired, and if so, what order was now required. The Panel should look at any steps the Registrant had taken to address the concerns, assess her insight, and the extent to which she has complied with the existing order.

15. Ms Olivier submitted that the Registrant has not discharged the persuasive burden on her. She has not undertaken the work suggested by the previous panel and she had not provided a reflective statement or evidence of CPD. Whilst she had referred to training, there was no certification and nothing to indicate what was covered. Further, the training appeared to be that required for the Registrant’s current role, not training tailored to a Band 5 SLT.

16. Ms Olivier submitted that it would be very difficult for the Registrant to remediate and demonstrate the necessary improvements in practice unless she is working in a Band 5 role. She did not appear to recognise that, which demonstrated a lack of insight into what was needed to address the concerns. In view of her general lack of insight and failure to address her shortcomings, Ms Oliver submitted that it would be fair and proportionate for the Panel to make a striking off order.

17. In response to questions from the Panel, Ms Olivier stated that the HCPC’s position was that the Registrant had not clearly expressed a wish for voluntary removal to be considered. As such, the matter had not been escalated internally, and she was unable to say what the HCPC’s position on the appropriateness of that was.

Information from the Registrant

18. The Registrant, in her email of 25 November 2025, in response to the Notice of Hearing said she would not be attending today and continued:

“I am not currently practising as a Speech and Language Therapist; my role still remains as a Therapy Assistant Practitioner (TAP) [Redaccted]. No Band 5 SLT roles have come up in this team over the last 18 months, and therefore, I have not sought to apply for any other jobs.”

19. She set out detail of the requirements of her current role. The HCPC sought clarification as to whether the Registrant wished to remain a SLT and reminded her of the matters the previous panel had indicated would likely assist the reviewing panel.

20. The Registrant said that she had not applied for roles outside her current employer because she was studying Licensed Lay Ministry and was working around that. She did not feel it would be feasible to work in a new environment. She explained that she needs to take time off work to undertake training relating to Lay Ministry and her current employer is supportive and accommodates this. She said she nevertheless wishes to return to work as a SLT and had been given opportunities to work alongside Band 6 and 7 SLT practitioners.

21. The Registrant provided what appears to be a reference from her current employer, although it was not on headed paper, signed or dated. It stated that there are no concerns with her current work as a TAP.

22. On 27 November 2025, the Registrant was informed that she could make a request for the hearing to be adjourned as she had said she would be away celebrating her birthday and then attending a course. She was asked to provide a signed reference and any evidence of CPD and was reminded that the previous panel had requested a reflective statement.

23. The Registrant replied on 1 December 2025, saying that she did not intend to request a postponement. Having considered the matter, she had decided she would like to be removed from the Register at this time. She planned to complete refresher training next year and then request to be re-registered. In response, the HCPC sent guidance on voluntary removal which explained that, in view of the current proceedings, a panel would need to agree to a voluntary removal request. If the Registrant were removed, she would not be able to apply for reinstatement for five years. Given the timescale the Registrant had mentioned, namely to undertake refresher courses the following year, the view given was that voluntary removal would not be appropriate. A call was offered if the Registrant wished to discuss the matter. No calls or correspondence regarding this was provided by the Registrant including during her more recent email of 4 December 2025, where she again confirmed that she would not be attending the hearing.

Legal advice

24. The Panel accepted the advice of the Legal Assessor. It was aware that the purpose of review is to consider:

• whether the Registrant’s fitness to practise remains impaired; and

• if so, whether the existing order or another order needs to be in place to protect the public.

25. If the Panel finds that the Registrant remains impaired, its powers in summary, in accordance with Article 30 Health Professions Order are to:

• Extend or vary the Order;

• Replace the Order with any other Order that could have been made at the substantive hearing;

• Impose a striking-off order as the Registrant has been subject to conditions of practice for more than two years.

26. The Legal Assessor advised that there is a persuasive burden on the Registrant as set out in Abrahaem v General Medical Council [2008] EWHC 183 (Admin).

27. In carrying out its role, the Panel must assess any evidence of insight and remediation and hence whether there remains a risk of repetition. It must determine whether there is current impairment on both the public protection and public interest limbs.

28. With regard to voluntary removal, referenced in an email exchange between the Registrant and the HCPC, this was not something that the Panel could deal with today, as it was subject to an agreement being reached between the parties. However, if the Panel considered that time should be given so that this can be explored, it had discretion under rule 10(1)(f) to adjourn proceedings to allow for this.

Decision

29. The Panel began by considering whether the matter should be adjourned to allow the Registrant and the HCPC to explore voluntary removal. The Panel noted that information about this had been provided to the Registrant on 1 December 2025, and a call to discuss it had been offered. No response had been received. The Panel therefore had no basis upon which to conclude that this was something that the Registrant genuinely wanted to explore. If the matter were adjourned today, it would not be possible for the Registrant to be given 28 days’ notice of a rescheduled substantive review hearing, given that the current conditions of practice order expires on 4 January 2025. Taking these things together, the Panel determined that an adjournment was not necessary, and that it was in both the Registrant’s interests and the public interest for the substantive order review to take place today.

30. The Panel, in determining whether the Registrant remains impaired, gave careful consideration to the information she had provided by email, including the nature of her Band 4 role and the training she referenced. The Panel had regard to the matters suggested by the previous reviewing panel, that the Registrant had been invited to provide, in order to assist it in its task today. These were a reflective statement addressing the risks to patients arising from the shortcomings in her practice, and evidence of CPD in the areas of concern: caseload management, clinical decision-making and clinical communication.

31. The Registrant had been reminded of this guidance in her email correspondence with the HCPC in the lead up to this hearing. This had led her to provide some additional information by email, but she had not provided a reflective statement or sufficient evidence of relevant training. The Panel considered that her failure to do so indicated a lack of commitment to the process and evidenced a passive approach.

32. More generally, the available evidence demonstrated a lack of commitment on the part of the Registrant to remedy her failings and return to safe and effective practice. She had, for over three years, been working in a Band 4 role. The conditions of practice order had been extended in June 2024, specifically to allow the Registrant opportunity to secure a Band 5 role and work under the conditions with a view to improving her competence. Whilst in her emails the Registrant had referred to working independently, the Panel considered that this was not an accurate reflection of the responsibilities required of a Band 4 practitioner. Ultimately, responsibility for decisions lies with the more senior registered practitioner.

33. The Panel noted that the Registrant’s current interests appear to lie elsewhere, namely in Lay Ministry. Indeed, it appeared that the main reason for her not having wished to apply for roles outside her current employer was that her employer allows her flexibility to undertake training in this area. Whilst that was a commendable activity, it demonstrated a lack of commitment to returning to professional practice as a SLT.

34. Considering current impairment against this background, the Panel was of the view that whilst the concerns with the Registrant’s practice were in principle capable of remediation, no steps had been taken with a view to achieving this. The Panel noted that the areas of practice where the Registrant had failed to meet the competency level of a newly qualified practitioner related to fundamental and wide-ranging aspects of the role. It was concerning that the Registrant had not evidenced any relevant CPD training in these areas. Nor had she demonstrated any insight into the impact of her shortcomings on patients and their carers. She did not appear to understand the seriousness of the concerns outlined by the original panel, or have insight into what was required in order to persuade a reviewing panel that the concerns were being addressed. The positive reference from her current employer, if recent (it was not dated), did not assist the Panel in assessing the Registrant’s ability to work at Band 5 level. This almost complete lack of remediation led the Panel to conclude that there remains a significant risk of repetition and that the Registrant remains impaired on the personal component. If she were to return to unrestricted practice she would pose serious risks to patients, because her standard of practice would continue to fall far short of that expected of a competent practitioner.

35. The Panel additionally considered that the public interest requires a finding of current impairment. This was because the public would lose confidence in the regulatory process if the Panel were to accept that the steps taken amounted to acceptable remediation. Further, an informed member of the public would not expect the regulatory process to be protracted for longer and additional time given to the Registrant to take steps to seek to persuade a panel that she is fit to return to unrestricted practice. The Registrant, for a period of almost three years had failed to demonstrate a commitment to the profession or any meaningful insight.

36. The Panel therefore determined that an order remains necessary both for the protection of the public and public interest. It was aware that it could extend the current Order, or impose any order available in accordance with the sanctions policy, as the Registrant has been subject to a Conditions of Practice Order for over two years.

37. The Panel began by considering whether to extend or vary the current Order. It had regard to when, in accordance with the sanctions policy, a conditions of practice order may be appropriate. This includes where the Registrant has insight, the concerns are capable of being remedied and where the Registrant is likely to comply with conditions. Whilst having demonstrated some limited insight initially, the Registrant had not followed the guidance she had been given by the previous panel and had taken no further steps in this respect. Nor had she taken steps to remedy her practice, having made no effort to secure a Band 5 role or undertake relevant CPD. Having failed to secure a job that would allow her to work under conditions for three years, the Panel had no confidence that the Registrant would take steps to secure such a role if the order were extended. The Panel concluded that the Registrant was not genuinely committed to resolving the concerns and as such, extending or varying the order was not appropriate.

38. The Panel next considered a suspension order. Such an order may be appropriate, according to the sanctions policy, when the concerns cannot be addressed by conditions of practice. Here, the nature of the concerns was such that previous panels had determined that they were capable of being addressed in such a way. However, this Panel had concluded that due to the Registrant’s lack of insight and lack of motivation and willingness to address these concerns, this was no longer the case.

39. It followed that nothing would be achieved by imposing a suspension order. It would merely serve to prolong the process and keep the Registrant in the review cycle, which is neither in her interest or the public interest. There was no basis to conclude that such an order would allow time for the Registrant to reflect, for example, as she had already had almost three years in which to do so.

40. The Panel therefore acceded to the HCPC’s submission that in the circumstances, strike-off was the appropriate and proportionate outcome. As noted above, the Registrant has failed to work under conditions of practice and failed to take meaningful steps to remediate for almost three years. Her position with regard to the regulatory process was unlikely to change in the foreseeable future, notwithstanding her stated intention to undertake refresher courses next year. The only conclusion the Panel could reach in view of the Registrant’s attitude to this process was that she was unwilling to resolve matters. There was a public interest in bringing finality to the process, which cannot continue indefinitely. Such an order would protect the public and meet the public interest. The Registrant will no longer be allowed to practise as a registered SLT, meaning patients are protected. The regulatory process will have been brought to a timely conclusion in circumstances where no further progress towards a return to practice by the Registrant is a realistic prospect.

ORDER: The Registrar is directed to strike the Registrant’s name off the Register

The Order imposed today will apply from 4 January 2026.

History of Hearings for Sandra Marshall