
Jeffrey Wager
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Allegation
As a registered Speech and Language Therapist (SL35174) your fitness to practise is impaired by reason of misconduct and/or lack of competence. In that:
1. In or around June 2021, you falsified a certificate to indicate you passed a course on assessment and management of adults with dysphagia and you:
a. Provided this to your locum agent, Maxxima, as proof of qualification and/or
b. On 8 June 2021, when you emailed Maxxima to retract the falsified document, you stated that you had received further correspondence when this not the case.
2. On 9 April 2021, you did not maintain accurate and complete records for a referral for Patient A, in that you:
a. Did not document the reason for Patient A’s admission to the Speech and Language Therapy department;
b. Did not document their chest status, communication needs, medical history, or allergy information; and/or
c. Did not detail what was carried out in the brief swallow assessment.
3. On 13 April 2021, you did not maintain accurate and complete records for a referral for Patient E, in that you:
a. Did not document their chest status;
b. Did not detail what was carried out in the swallow assessment;
c. Did not document an oromotor assessment;
d. Did not document how much level 0 fluids of the International Dysphagia Diet Standards Initiative were given;
e. Did not assess whether there was any residue on Patient E’s drooped left side;
f. Started with level 7 of the International Dysphagia Diet Standards Initiative and did not build up to this nor document what was consumed;
g. Did not describe the sprout of the beaker used to assist with fluid intake; and/or
h. Discharged Patient E too soon without permitting further review of their requirement for a spout and their ongoing drooping left side.
4. On 15 April 2021, you did not maintain accurate and complete records for a referral for Patient D, in that you:
a. Did not detail what was carried out in the swallow assessment.
b. Did not perform an oromotor assessment;
c. Did not describe the fluids, diet trialled, laryngeal movements, oral clearance or chewing; and/or
d. Did not indicate the reason for a review of Patient D, how this was communicated to the care home and to whom.
5. On 21 April 2021, you did not maintain accurate and complete records during a review appointment with for Patient C in that you:
a. Did not explain your reasoning for upgrading Patient C to level 1 fluids of the International Dysphagia Diet Standards Initiative;
b. Did not describe how level 2 fluids of the International Dysphagia Diet Standards Initiative were given and what they were; and/or
c. Did not explain why you did not try a higher level of the International Dysphagia Diet Standards Initiative diet.
6. On 22 April 2021, you did not maintain accurate and complete records regarding an initial assessment of Patient F in that you:
a. Did not perform an oromotor assessment;
b. Did not document what initial trials were given;
c. Did not specify what level 6 foods of the International Dysphagia Diet Standards Initiative were given and why that level was chosen;
d. Did not specify any detail about laryngeal movements, chewing, oral clearance or check for residue; and/or
e. Did not indicate where in the throat the food was stuck and what action was taken to clear the throat.
7. On 26 April 2021, you did not maintain accurate and complete records regarding a review assessment of Patient F in that you:
a. Did not refer to their dysarthria from the initial assessment; and/or
b. Did not describe any tests performed to diagnose the dysarthria nor the degree of dysarthria.
8. On 27 April 2021 you did not maintain accurate and complete records regarding an initial assessment of Patient B in that you:
a. Did not perform an oromotor assessment;
b. Did not comment on their facial droop from their case history.
c. Did not document adverse signs from levels 0 and 1 fluids of the International Dysphagia Diet Standards Initiative given;
d. Did not describe what level 2 fluids of the International Dysphagia Diet Standards Initiative were given or use this level as a starting point; and/or
e. Did not document your reasoning as to why you only trialled level 4 foods of the International Dysphagia Diet Standards Initiative during the initial assessment when there were no adverse signs.
9. On 28 April 2021, you did not delete irrelevant information relating to Patient F’s discharge from their discharge letter.
10. On 29 April 2021 you did not maintain accurate and complete records regarding a review of Patient B in that you:
a. Did not document your reasoning as to why you only trialled level 5 foods of the International Dysphagia Diet Standards Initiative during the initial assessment when there were no adverse signs.
11. On 29 April 2021 you did not maintain accurate and complete records regarding an initial communication assessment of Patient G in that you:
a. Did not document the assessment carried out.
b. Did not document Patient G’s attempts to communicate.
c. Did not describe the language comprehension tasks or commands, how many questions there were or to what extent this was assessed.
d. Did not devise a plan in respect of Patient G’s aphasia diagnosis.
e. Did not document whether the use of pen and paper had been trialled for Patient G.
12. On 4 May 2021 you did not maintain accurate and complete records regarding a review of Patient B in that you:
a. Did not document your reasoning as to why you only trialled level 6 foods of the International Dysphagia Diet Standards Initiative during the initial assessment when there were no adverse signs
13. On 10 May 2021 you did not detail the process for Patient B’s discharge in their case notes and letter.
14. On 10 May 2021 you did not maintain accurate and complete records for Patient G in that you did not include pertinent medical information with regard to Patient G’s discharge, including why they had aphasia.
15. On 13 May 2021 you did not maintain accurate and complete records regarding an initial assessment of Patient J in that you:
a. Did not perform an oromotor assessment;
b. Did not start with level 0 fluids of the International Dysphagia Diet Standards Initiative;
c. Did not describe the swallow assessment in sufficient detail;
d. Did not explain your rationale for proceeding with level 3 and then level 5 of the International Dysphagia Diet Standards Initiative foods;
e. Did not assess communication;
f. Did not diagnose dysarthria;
g. Did not explain the rationale for the moderate aphasia diagnosis; and/or
h. Did not make a recommendation for further assessment or therapy regarding the aphasia diagnosis.
16. On 14 May 2021 you did not maintain accurate and complete records regarding an initial assessment of Patient I in that you:
a. Did not perform an oromotor assessment;
b. Did not describe how much fluids at levels 0,1 and 2 of the International Dysphagia Diet Standards Initiative were given and how these were administered;
c. Did not describe how level 3 foods of the International Dysphagia Diet Standards Initiative were administered;
d. Did not document why levels beyond level 4 of the International Dysphagia Diet Standards Initiative were not trialled; and/or
e. Did not document that Patient I required a communication assessment.
17. On 18 May 2021 you did not maintain accurate and complete records regarding an initial assessment of Patient H in that you:
a. Did not perform an oromotor assessment;
b. Did not describe what format levels 0 and 1 of the International Dysphagia Diet Standards Initiative were tried;
c. Did not describe laryngeal movement in sufficient detail;
d. Did not describe your rationale as to why level 5 of the International Dysphagia Diet Standards Initiative was started with after Patient H had consumed a pot of rice pudding; and/or
e. Made a dysphagia diagnosis without performing a full assessment.
18. On 20 May 2021 you did not maintain accurate and complete records regarding a communication assessment of Patient I in that you:
a. Did not document what communication assessment was performed and how long for.
19. Your conduct in relation to particular 1 above was dishonest.
20. The matters set out in particulars 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,16, 17, 18, and/or 19 above constitute misconduct.
21. The matters set out in particulars 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,16, 17, and/or 18 above constitute lack of competence.
22. By reason of your misconduct and/or lack of competence your fitness to practice is impaired.
Finding
Preliminary Matters
Service of Notice
1. The Notice of this hearing was sent to the Registrant at his registered email address as it appeared on the HCPC Register by email on 12 December 2024. The Notice contained the date, time of today’s hearing and confirmation that the hearing would be conducted remotely. Proof of delivery on the same day was also produced to the Panel.
2. The Panel accepted the advice of the Legal Assessor that, given the nature of this hearing, not being a substantive hearing, that the notice period should reflect the HCPTS’s Practice Note on Case Management, Directions and Preliminary Hearings which states that “Normally, the parties should be given at least 14 days’ notice of a preliminary hearing.”
3. In the circumstances, the Panel was satisfied that reasonable Notice of today’s hearing has been given.
Proceeding in the absence of the Registrant
4. The Panel then went on to consider whether to proceed in the absence of the Registrant, pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Mr Tobias on behalf of the HCPC.
5. Mr Tobias submitted that the HCPC had taken all reasonable steps to serve the Notice on the Registrant by email. He stated that the Registrant had chosen to voluntarily absent himself. He invited the Panel to proceed in any event given the nature of today’s hearing which in relation to a proposed consent order.
6. Mr Tobias referred the Panel to the HCPC’s practice note “Proceeding in the Absence of a Registrant”.
7. The Panel accepted the advice of the Legal Assessor. He referred the Panel to the case of R v Jones & Hayward [2002] UKHL 5 and GMC v Adeogba and Visvardis [2016] EWCA Civ 162. He advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and the public interest and that the “fair, economical, expeditious and efficient disposal of allegations made against medical practitioners is of very real importance” and that “where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed”. The Panel has borne in mind that “there is a burden on...all professionals subject to a regulatory regime, to engage with the regulator, both in relation to the investigation and ultimate resolution of allegations made against them. That is part of the responsibility to which they sign up when being admitted to the profession.”
8. The Panel was mindful of the need to ensure that fairness and justice were maintained when deciding whether or not to proceed in the Registrant’s absence.
9. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPTS Practice Note entitled “Proceeding in the Absence of a Registrant”. The Panel weighed its responsibility for public protection and the expeditious disposal of the case against the Registrant’s right to be present at the hearing.
10. The Panel was satisfied that all reasonable efforts had been made by the HCPC to notify the Registrant of the hearing.
11. In reaching its decision, the Panel took into account the following:
• The Registrant had signed the proposed consent order in the expectation that this hearing would proceed on that basis;
• The Registrant was not asking for an adjournment and therefore the Panel concluded that it was unlikely that an adjournment would result in the Registrant’s attendance at a later date; and
• There was a public interest in hearings being held expeditiously.
12. Having weighed the public interest for expedition against the Registrant’s own interests, the Panel decided that the Registrant had voluntarily absented himself and determined that it was therefore appropriate to proceed in the Registrant’s absence and that there was no unfairness or injustice in doing so.
Background
13. The Registrant is a registered Speech and Language Therapist who undertook work as a locum Speech and Language Therapist within the Adult Speech and Language Therapy department at Barnsley Hospital NHS Foundation Trust (“the Trust”) for two months between March and May 2021.
14. On 11 June 2021, the HCPC received a referral from Complainant 1, the Manager of the Adult Speech and Language Therapy department. On 15 June 2021, Complainant 1 withdrew their concern. She later explained that the reason for the withdrawal was that she was unaware of the process she should have used, which was to initially raise concerns with the Locum Agency’s clinical governance department.
15. Complainant 1’s concern related to the Registrant’s performance or clinical practice in following protocols or procedures, effective communication with the team, and note-taking. Complainant 1 provided supporting evidence, including a witness statement and emails. The clinical concerns included concerns about accuracy and lack of sufficient detail in notes, appearing to make overcautious recommendations with dysphagia (swallowing difficulties) patients, and failure to act on a referral highlighting a patient’s communication difficulties.
16. On 21 June 2021, the HCPC received a referral from Complainant 2. Complainant 2 was the course leader for the Sheffield Assessment and Management of Dysphagia Course at Sheffield Hallam University. Complainant 2 explained that successful completion of the course confirmed competency and skill to independently assess and manage adults who present with dysphagia. Complainant 2 advised that the Registrant did not successfully complete two case studies to demonstrate his competency and that he received a formal letter and certificate advising that he had not met the course requirements. These documents were sent to the Registrant in June 2021. On 18 June 2021, Complainant 2 was contacted by Complainant 1 to verify that a letter sent by the Registrant’s locum agency confirming the Registrant’s successful completion of the course was accurate. Complainant 2 advised that the letter was not from herself and appeared to be fraudulently produced.
17. On 28 June 2021, the HCPC received a referral from Complainant 1 concerning the alleged fraudulent letter. Complainant 1 advised that she raised concerns with the Registrant’s locum agency after the Registrant stopped working for the Trust. The Registrant’s locum agency forwarded a document submitted by the Registrant. This document has the date “June 2021” and it included what appeared to be Complainant 2’s signature. It stated that the Registrant’s results from two assignments were that he passed both and ‘you are now able to practise as an independent dysphagia practitioner’
18. In an email dated 13 August 2021 sent to the HCPC’s Case Manager, the Registrant advised that he had sent the letter dated “June 2021” to his locum agency. He stated, ‘I believed the Sheffield Dysphagia markers had made an error and therefore changed some information on the original letter’. He added that he took this action because he:
“incorrectly believed that I only had to pass one of the case study assignments (and not both) in order to meet the course requirements. It transpired that I learned that I actually have to pass both case studies to meet the course requirements. At the time of receiving the feedback from Sheffield Speech and Language Therapy I was furious as I believed this was a huge injustice to not let me pass the course. My anger was exacerbated by my misunderstanding after I had spent much time and effort (nearly two weeks non-stop) entirely rewriting and resubmitting new case studies after been [sic] unsuccessful previously in December 2020 on both case studies.”
19. The Registrant further stated that he believed he was wrong to send the letter and he apologised.
20. The Registrant provided an account of his subsequent actions to the HCPC. He said that he consulted the course guidance and he then sent an email to his locum agency. The Registrant provided a letter signed by Complainant 2 with different results showing that he did not pass one of the case studies and that he had not met the course requirements. He also provided an email dated 8 June 2021 sent to his locum agency. This email stated:
“I regret to inform you that I have received further correspondence from Sheffield regarding dysphagia and they have now informed me that I have not passed both elements of the case studies (passed the acute but not progressive). I have been told I cannot pass the course because I have not passed BOTH elements. I was under the impression that I could pass both if I passed one of them but apparently I have to pass both to pass the whole course.”
21. This email formed the basis of the dishonesty concern set out at Particular 1b and 19.
22. On 29 September 2022, a Panel of the Investigating Committee determined that there was a case to answer against the Registrant and referred the above Allegation to a Conduct and Competence Committee of the HCPC.
23. The HCPC has sought witness statements from a number of relevant individuals. A signed statement has been obtained from SP who has provided evidence in relation to the relevant course and chronology:
a. the Registrant attended a 5 day taught component of the Assessment and Management of Adults with Dysphagia Course in September 2019;
b. assessed case studies were due to be submitted by January 2020 but a number of deferments were granted;
c. the Registrant took his first round of assessments in December 2020 and was unsuccessful;
d. new case studies were re-submitted in April 2021, which were also unsuccessful and his practice was considered unsafe.
24. On 6 February 2024, the Registrant requested Consensual Disposal/VRA, admitting the allegations, that his fitness to practise is impaired, that he has read the relevant HCPTS Practice Note. The Registrant further noted that he has no intention of returning to employment as a Speech and Language Therapist.
25. On 14 February 2024, the Registrant provided a reflective piece. In it, he states that he:
“cannot emphasise enough that the incident of dishonesty is a total one-off. I pride myself in general of being a hard-working and honest individual and all of my friends and family I believe would attest to this. I consider the forgery of the signature to be completely out of character for me and a moment of complete madness’… ‘I am, still, of course contrite about my actions and I apologise again for what I did.”
26. On 16 July 2024, the HCPC wrote to the Registrant in relation to a possible Consensual Disposal Strike Off. The Registrant agreed to a Consensual Disposal Strike Off and returned the completed Consensual Disposal Pro forma on 18 September 2024.
HCPC’s Submissions
27. It was submitted that this matter is suitable for disposal by consent in the terms set out in the draft Consent Order that was annexed to the HCPC’s Skeleton Argument (“the Consent Order”).
28. The HCPC relied on the signed admissions made by the Registrant in the Consensual Disposal Request Pro-Forma admitting the allegations against him, admitting that his fitness to practice is impaired. The Registrant is no longer practising in a role that requires his registration and has confirmed that he does not intend to practise in the profession in the future. The Registrant stated that he wished to accept a Striking Off Order so that the case can be disposed of by way of consent, without the need for a full contested hearing.
29. Pursuant to the terms of the Consent Order, the Registrant would be struck off from the register, thereby eliminating any outstanding risk posed by the Registrant to service users or the wider public as a result of his current and admitted impairment.
30. It was submitted that the public interest was satisfied in that a Striking Off Order is the highest sanction that could be imposed if this matter were to proceed to a contested substantive hearing.
31. As a result, it was submitted that the public will be adequately protected and the public interest satisfied by imposing a Striking Off Order, and that disposing of this case by consent would be proportionate.
32. It was the HCPC’s position that any other order would not be sufficient in light of the seriousness and wide-ranging nature of the allegations. In relation to dishonesty, whilst the Panel will have regard to the admissions of the Registrant and his apology, it was highlighted that the Registrant’s dishonest conduct:
a. was not isolated or a one off, noting that the Registrant actively prepared a false document, submitting it (Particular 1a) and thereafter also acted dishonestly when seeking to retract the information (Particular 1b);
b. involved falsifying a qualification that:
i. related to an assessment that he had previously failed;
ii. concerned areas in which significant clinical failings had been identified by his employer; and
iii. the Registrant had been unable to pass as he was ‘unsafe to practise’.
33. The Registrant has been properly advised by the HCPC, pursuant to the requirement in the HCPTS Practice Note on Disposal of Cases by Consent that this be done, that cooperation and participation in the consent process will not automatically lead to the Consent Order being approved.
34. For the reasons set out above, the Panel was invited, on behalf of the HCPC, to approve the terms of the Consent Order.
Registrant’s Submissions
35. Whilst the Registrant has not made any specific submissions, he has signed the Consensual Disposal Request Pro-Forma on 18 September 2024 confirming that:
• he admits the facts of the allegation;
• he admitted that his fitness to practise is impaired by reason of his misconduct;
• that he has read the HCPTS Practice Note on “Disposal of Cases by Consent”; and
• that he agrees to a Striking Off Order being imposed.
Decision
36. The Panel had regard to all of the evidence presented to it including the skeleton argument provided and the submissions made on behalf of the HCPC. The Panel accepted the advice of the Legal Assessor.
37. The Panel has applied its own discretion to the application to dispose of this case by consent and has had regard to the HCPTS’s Practice Note on “Disposal of Cases by Consent”. It noted that the HCPC’s overarching statutory objective is the protection of the public and that a Panel should not agree to resolve a case by consent unless they are satisfied that:
a) The appropriate level of public protection is being secured; and
b) Doing so would not be detrimental to the wider public interest.
38. The Panel is mindful that it can conclude the case on an expedited basis upon the terms of the draft Consent Order put before it or reject that proposal and set the case down for a full substantive hearing.
39. It has also had regard to the HCPC’s Sanctions Policy with particular reference to paragraphs 127-132 in relation to when a striking off order may be appropriate.
40. The Panel has taken into account:
• The nature of the case and the background to the allegation;
• The nature of the evidence available;
• The explanation provided by the HCPC as to why it considered that a consent order is appropriate in the circumstances, namely:
(a) the Registrant has admitted the allegation in full and did so at an early stage in the fitness to practise process;
(b) the Registrant has demonstrated insight by recognising the serious nature of the Allegation and that his fitness to practise is impaired;
(c) by imposing a striking off order, the public would be adequately protected by such an Order which is proportionate in the circumstances given the Registrant’s admitted serious failings, including dishonesty.
(d) The extent to which the proposed consent order would be consistent with the HCPC’s overarching objective of public protection.
41. In all the circumstances, the Panel accepted the HCPC’s submission that it was appropriate to make a Consent Order in the terms sought. The Panel was satisfied that imposing a Striking Off Order was the appropriate outcome given all the circumstances of this case which included allegations of misconduct, lack of competence and dishonesty.
42. The Panel concluded that, taking all the above into account, the HCPC would not be failing in its statutory objective of protecting the public and the wider public interest, if the Consent Order in the terms sought were made.
43. Accordingly, the Panel granted the HCPC’s application to impose a Consent Order in the agreed terms.
Order
That the Registrar is directed to strike the name of Mr Jeffrey Wager from the Register on the date this order comes into effect.
Notes
Right of Appeal
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.
Interim Order
Application
1. Mr Tobias initially applied to proceed to make an application for an Interim Order in the absence of the Registrant. He relied on his submissions made at the outset of the hearing for seeking to do so.
2. No submissions have been received by or on behalf of the Registrant.
3. Having heard and received the advice of the Legal Assessor, the Panel determined to proceed to hear an application for an Interim Order in the absence of the Registrant for the same reasons as set out above.
4. Mr Tobias applied for an Interim Suspension Order in light of the Panel’s endorsement of the proposed Consent Order to cover the appeal period. He referred to the Sanctions Policy with particular reference to paragraphs 133 onwards with reference to interim orders.
5. No submissions have been received by or on behalf of the Registrant.
Decision
6. The Panel was mindful that when a substantive sanction is imposed, even by consent, a Registrant’s entitlement to practise is unrestricted whilst their appeal rights against the substantive sanction remain outstanding. The Panel concluded that in view of its determination that a Striking Off Order should be imposed, it would not be appropriate for the Registrant to return to unrestricted practice given the reasons for a Striking Off Order being imposed.
7. The Panel therefore decided to impose an Interim Order under Article 31(2) of the Health Professions Order 2001, it being necessary to protect members of the public and being otherwise in the public interest, which outweighs the Registrant’s personal and professional interests.
8. It first considered an Interim Conditions of Practice Order. The Panel concluded that such an Interim Order would not be appropriate given its rationale for its earlier determination on sanction, noting that the Registrant consented to being struck off. It considered that in light of that determination, an Interim Suspension Order is necessary for protection of the public and is also in the public interest. It would be wholly incompatible with the Panel’s decision as to sanction, not to impose an Interim Suspension Order.
9. The Panel concluded that the appropriate length of the Interim Suspension Order should be 18 months, as the Interim rder would continue to be required pending the resolution of an appeal in the event that the Registrant submits a Notice of Appeal within the 28 day period despite his agreement to the Consent Order being agreed.
10. The Panel makes an Interim Suspension Order under 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.
11. This Interim Suspension 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.
Hearing History
History of Hearings for Jeffrey Wager
Date | Panel | Hearing type | Outcomes / Status |
---|---|---|---|
24/01/2025 | Conduct and Competence Committee | Consent Order Hearing | Struck off |