Aleena Tahir

Preliminary Matters

Amendment of the Allegation

1. On behalf of the HCPC, Mr Slack made an application to amend the Allegation. The proposed amendments were set out in the HCPC statement of case. Mr Slack submitted that the proposed amendments were minor, did not change the substance of the Allegation, and properly reflected the evidence.

2. On behalf of the Registrant, Ms Williamson did not oppose the application to amend the Allegation.

3. The Panel accepted the advice of the Legal Adviser. She confirmed that the Panel has a discretionary power to make amendments to the Allegation, provided the amendments do not create unfairness for the Registrant and are appropriate.

4. The Panel decided that it was appropriate to amend the Allegation as set out in the HCPC statement of case. The amendments are not opposed and are appropriate to reflect the evidence and ensure that the Allegation is not defeated on a technicality.
Hearing in private

5. Ms Williamson made an application for part of the hearing to be heard in private to protect the Registrant’s private life, where any reference was made to details of the Registrant’s health.

6. Mr Slack did not oppose the application.

7. The Panel accepted the advice of the Legal Assessor. She advised that there is a public interest in open justice as explained in the HCPTS Practice Note “Conducting Hearings in Private”, but the Panel may exercise its discretion to hear all or part of the case in private to protect the private life of the Registrant or other individuals.

8. The Panel decided that it was appropriate to hear part of the case in private where references were made to details of the Registrant’s health. The remainder of the case should be heard in public in accordance with the principle of open justice.

Background

9. The Registrant is a registered Physiotherapist and at the time of the events she was employed by 1PhysioUK (“the Company”). The Company is described by the Registrant as A & A Medical.

10. The Company raised concerns about the Registrant after it was alleged that service users of hers were marked as having attended appointments when they had not, and treatment notes were subsequently added to the service users’ medical records via the Company’s online patient system, PracticePal, allegedly by the Registrant’s relative, who was not an employee of the company.

11. Concerns were identified by the Company when a member of the Company’s administration team spoke to Service User A regarding the rearranging of their appointment. Although there was a record of Service User A’s appointment with the Registrant on 27 July 2022, the Registrant had texted Service User A to rearrange the appointment.

12. Subsequently, BC, clinic and HR manager at the Company, contacted the service users about the appointments with the Registrant in the afternoon on 27 July 2022. Service Users A and B both had their appointments rearranged by the Registrant. Despite this, the Registrant had marked the appointment diary as “complete” for both service users’ appointments. Treatment notes had also been entered onto Service Users A and B’s notes despite the appointments not taking place.

13. BC conducted a disciplinary meeting with the Registrant on 3 August 2022. The meeting was recorded, and the recording was provided to the Panel as part of the evidence relied on by the HCPC. During this meeting, the Registrant gave different accounts, one of which was that she had allowed her relative to access the Company’s appointment diary system, to update Service Users A and B’s appointments as completed, and to add treatment notes.

14. Particular 1 of the Allegation states that the Registrant allowed a relative to access PracticePal and input notes for Service Users A and B when the relative was not an employee of the Company and so should not have had access to the system and the confidential patient information. Particular 2 of the Allegation alleges that the Registrant instructed or allowed her relative to input notes for Service Users A and b despite their appointments not taking place. In the alternative, it is alleged that it was the Registrant who recorded those notes without carrying out the appointments. Particular 3 of the Allegation alleges that the Registrant’s conduct in relation to Particulars 2(a) and/ or 2(b) was dishonest.

Registrant’s admission

15. The Registrant admitted particular 2(b) of the Allegation.

16. The Legal Assessor referred the Panel to the HCPTS Practice Note on Admissions. She advised that it is open to the Panel to find a fact proved on the basis of an admission, provided the admission is unequivocal. However, in this case the Panel should note the structure of particular 2 of the Allegation. Particular 2(b) is an alternative to the HCPC’s primary case, as set out in particular 2(a). The Panel may therefore decide to defer a decision on whether the accept the admission until it has heard the evidence and made a decision on particular 2(a).

17. The Panel accepted the advice of the Legal Assessor. It decided not to make any findings of fact on particular 2(b), because of the possible alternative finding as set out in particular 2(a).

Decision on facts

Evidence

18. The Panel was provided with and read or listened to the following evidence:
• HCPC final hearing bundle (including statement of BC)
• Disciplinary meeting recording
• Registrant’s bundle (including statement of Ms AI, the Registrant’s relative)
• Registrant’s statement

19. The Panel heard evidence from BC. In her statement BC explained the circumstances in which the concerns relating to the Registrant’s records of appointments with Service Users A and B on 27 July 2022 had come to her attention. BC then provided a description of the disciplinary meeting with the Registrant and her perception of the Registrant’s responses. BC outlined that a further concern came to light during the disciplinary meeting because the Registrant admitted that she had allowed her “sister” to access PracticePal. The Registrant referred to her relative as her “sister” during the disciplinary meeting. During the disciplinary meeting BC’s perception was that the Registrant was laughing and, she told the Registrant that that this was not funny.

20. In answer to questions from Ms Williamson, BC confirmed that the appointments due to take place on 27 July 2022 for Service Users A and B were for 6 p.m. and 6.30 p.m. and both were follow-up appointments booked by the Registrant. BC took a screen shot of the Registrant’s diary, but this screenshot was not taken until after the disciplinary meeting on 3 August 2022. BC did not carry out an analysis of when the entries in the Registrant’s diary were made, but she said that when she first looked at the diary it only included the word “completed” and did not include the words “patient not seen”.

21. BC confirmed that her camera was not working during the disciplinary meeting and she agreed that the Registrant might have felt intimidated because she was unable to see the person who was asking questions. BC also agreed that the answers given by the Registrant were contradictory and suggested that the Registrant may have changed her narrative because she realised that what she had done was not right.

22. BC was asked about her perception that the Registrant was laughing and whether it crossed her mind that the Registrant was very anxious. BC said that she is experienced in conducting disciplinary hearings and was accustomed to all sorts of reactions. She could understand the Registrant being anxious, but that she appeared to be finding it funny.

23. BC was asked about the notes entered for Service User A and whether they could have been made by someone who is not medically qualified. BC said that the entries could have been made by someone who is not qualified if they were told what they should write.

24. The Panel heard evidence from the Registrant. In her written statement the Registrant stated that she, and not her “sister”, had entered information into Practicepal that the appointments with Service Users A and B had been “completed” and added the details of the patient appointments. In oral evidence she said that this was a “big mistake” and she acknowledged that she had lied to BC in the disciplinary hearing.

25. She said that her laptop battery was running down and she needed to complete the notes before midnight. She said that she completed notes on Practicepal for all of her afternoon patients and Service Users A and B at approximately 8.45 p.m. She said that she had forgotten that she had not seen Service Users A and B. She had contacted Service Users A and B by text message to rearrange their appointments and this change was not logged in the Practicepal diary system because she did not have access to the internet in her work location.

26. The Registrant told the Panel that on reflection she now acknowledges that it would seem ridiculous that she should have acted as she did without being dishonest, but she said that her brain was “stuck somewhere”. She said that her position at the Company was her first full time job in the UK and she was not aware at the time of the opportunity to obtain a sick note.

27. The Registrant said that her treatment notes for Service Users A and B were based on those from previous sessions she had conducted with those service users. She acknowledged that this was “really inappropriate”. She said that she had been told by the previous CEO of the Company that if the handwritten notes were missing the notes could be copied from the notes of previous appointments. She said that she has now learned that this was entirely unethical and inappropriate.

28. The Registrant agreed that in the disciplinary meeting with BC she had volunteered the information relating to the assistance provided by her “sister”. She said that in the disciplinary meeting she became confused and nervous and that it was too late to correct the information she had given. The Registrant said that her “sister” would not have been able to assist in the way described due to the limits of her education.

29. The Registrant was asked about her undated email to Mr Aarons, the Company’s managing director, which was sent following the disciplinary hearing. The Registrant stated that she had requested that her “sister” help her, but that she did not allow access to the software. The Registrant acknowledged she had not taken the opportunity in this email to clarify the exact role her sister played and did not say that she had lied to BC in the disciplinary hearing.

30. The Registrant said that she had not received any induction from the Company, had not been provided with a copy of the policies listed by BC, and at the time was not aware of GDPR requirements.

31. The Registrant was asked questions by the Panel about her previous training and experience. She said that her previous training at Sheffield Hallam University had not included patient confidentiality and that her university placements did not require her to complete service user records.

32. Through an interpreter, the Panel heard oral evidence from Ms AI, who is the Registrant’s relative, and described as the Registrant’s “sister”.

33. Ms AI was asked questions about the preparation of her witness statement and struggled to answer those questions. The Panel was informed by Ms Williamson that the statement was prepared in a meeting with the Registrant’s solicitor with the benefit of assistance in translation for Ms AI.

34. Ms AI stated that she did not use the Registrant’s work computer and that she was unable to do so. She said that she stayed with the Registrant for a week and provided assistance with childcare while the Registrant was unwell. Ms AI was unable to answer questions about the Registrant’s work, and was only able to state that the Registrant was not well and decided to finish her work at home.

Submissions on facts

35. In relation to the HCPC primary case, Mr Slack submitted that the Panel should find particulars 1(a), 1(b), 2(a) and 3 proved and he referred to the evidence of BC and the transcription of the disciplinary hearing. He submitted that limited weight should be given to the evidence of Ms AI. In relation to the HCPC’s alternative case, Mr Slack submitted that the Panel should find 2(b) proved on the basis of the Registrant’s admission and that the conduct in particular 2(b) could only be dishonest.

36. Ms Williamson submitted that the Panel should find particulars 1(a), 1(b) and 2(a) not proved and she referred to the evidence of Ms AI and the Registrant. She pointed out that the entries contained no spelling mistakes and that the documentary evidence demonstrated that there was a time gap of only 60 seconds between the entries for Patient A and Patient B. In relation to particular 3, Ms Williamson referred to the Registrant’s evidence that her mind was not working properly and the Panel should conclude that her admitted conduct in particular 2(b) was not dishonest.

Decision

37. The Panel accepted the advice of the Legal Assessor. The Panel had in mind that the burden of proof is on the HCPC and that the standard of proof is the balance of probabilities. The Panel noted the evidence as to the Registrant’s good character, which may be relevant to the assessment of credibility, propensity, and to any inferences to be drawn as to the Registrant’s state of mind.

38. During the Panel’s deliberations the Legal Assessor gave additional legal advice to the Panel and the hearing was reconvened to enable that legal advice to be provided to the parties. The Panel had noted that the HCPC alternative case (particulars 2(d) and 3) did not include an allegation that the Registrant had given an inaccurate and potentially dishonest explanation of events to BC. The Legal Assessor advised that the Panel has a responsibility in accordance with the overarching objective to ensure that there is no under-prosecution of the case. The Panel has a pro-active role, as confirmed in case law including Council for the Regulation of Health Care Professionals v GMC and Ruscillo [2005] 1 WLR 717. If the Panel were to conclude that there had been under-prosecution by the HCPC, the Panel has options open to it, which might include raising the issue with the HCPC or proposing an amendment to the Allegation of its own motion.

39. Mr Slack had no comment on this legal advice, but added a reference to a case involving late amendment of the Allegation (PSA v HCPC and Doree [2017] EWCA Civ 319.

40. Ms Williamson made submissions on the Registrant’s position if the Panel were to conclude that there had been under-prosecution by the HCPC. She submitted that the Registrant would oppose any application for an amendment, that in the event of an amendment it would be necessary to recall the Registrant and her witness to give further evidence, and that it was likely that an adjournment would be required.

41. Having considered the position, with careful consideration of the Panel’s responsibilities and the public interest, the Panel decided that the Allegation was adequate, and that it was not necessary to take further steps. The HCPC has been aware of the Registrant’s account of events and has had the opportunity to consider that account and formulate the appropriate Allegation. The allegation of dishonesty is central to either of the alternatives within the case, and on either of the alternative bases, the Panel’s findings will address the question of the Registrant’s honesty and integrity.
Particular 1(a) and 1(b)

42. Having reviewed the evidence the Panel concluded that the HCPC has not discharged the burden of proof. The Panel found that, when considered in the round, the evidence was confused and contradictory. The contradictions were apparent within the contemporaneous accounts as well as between the contemporaneous accounts and the witness evidence. The HCPC relies upon the Registrant’s account given to BC in the disciplinary meeting on 3 August 2022. There are no doubts about the content of the meeting because it was recorded, but the panel noted significant internal inconsistencies within it and examples are as follows:

• The Registrant said that her sister had marked the two patients as “completed”;
• The Registrant said that she (rather than her sister) added the treatment notes;
• The Registrant said that she dictated the notes and her sister typed them in.

43. Although the Panel had reservations about the evidence of Ms AI, it did not discount her evidence. Ms AI’s stated level of educational attainment, and the assistance she had required in order to read her witness statement and send an email to the Registrant’s solicitor, and together with her inability to speak or write English, indicated that it was unlikely that she would have been able to access Practicepal or input notes for Service Users A and/or B.

44. The Panel gave weight to the contemporaneous documentary evidence. It showed that the notes for Service User B were added at 20.46 and the notes for Service User A were added at 20.47. The note for Service User B was “Improving now Vas = 1-3/10”. The Panel considered that it was not plausible that the Registrant could have dictated this note to her sister, who stated that she is unable to type, and this note be completed in less than 60 seconds.

45. The Panel considered that the account given by the Registrant in her oral evidence that she was responsible for accessing Practicepal, recording that the appointments of Service User A and Service User B were “complete”, and adding the treatment notes for those patients, to be more plausible than the account she gave to BC in parts of the disciplinary hearing. The Panel did not speculate on the reasons the Registrant gave an inaccurate account of the involvement of her “sister” to BC in the disciplinary hearing, and did not take the opportunity to clearly correct the position after that hearing. Having listened carefully to the recording of the disciplinary hearing, the Panel did not consider that the Registrant appeared to be unduly anxious, unwell, or under undue pressure, and the Panel was provided with no medical evidence of ADHD or any other health condition.

46. The Panel found particulars 1(a) and 1(b) not proved.

47. In reaching its conclusions on particulars 1(a) and 1(b) the Panel did not accept the Registrant’s evidence in its entirety. The Registrant has given varying and inconsistent accounts of the events, and the Panel did not find that her evidence was credible and reliable in all details. The Panel noted that in her evidence the Registrant emphasised the extent to which her pregnancy related symptoms had impacted her on 27 July 2022. However, the Panel noted that the Registrant completed a full schedule of patients up to 6 p.m. and was able to function as a Physiotherapist. Her reason for leaving work early was the train strikes, rather than ill health. The Registrant mentioned in the disciplinary meeting with BC that she was “suffering with vomiting due to my pregnancy”, but she did not state that she was not able to function or that she attended an Accident and Emergency department on that day.

Particular 2(a)

48. The Panel found particular 2(a) not proved for the same reasons it found particulars 1(a) and 1(b) not proved.

Particular 2(b)

49. The Panel found particular 2(b) proved by the Registrant’s admission.

Particular 3

50. The Panel accepted the advice of the Legal Assessor who referred the Panel to the case of Ivey v Genting Casinos and the guidance in the HCPTS Practice Note “Making decisions on a registrant’s state of mind”.

51. The Panel considered what the Registrant knew or believed as to the facts and circumstances when she entered the notes for Service Users A and B.

52. The Registrant knew that she had left work early due to the train strikes and that as a result she had taken steps earlier the same day to rearrange the appointments with Service Users A and B through an exchange of text messages. The Registrant told the Panel that she had entirely forgotten this when she entered the details for those service users. The Panel did not accept that the Registrant could have forgotten events which were so recent. The Registrant knew that she was either copying from previous service user notes, or fabricating service user notes, because she had not seen either patient.

53. There are no spelling or other errors within the limited service user notes.

54. The Panel did not accept that the Registrant genuinely believed on 27 July 2022 that it was acceptable to copy service user notes from previous appointments, regardless of any conversation she may have had with the previous CEO of the Company. The Registrant did not qualify as a physiotherapist in the UK, and as part of her application for registration she would have provided evidence to demonstrate that she met all the HCPC standards of proficiency. The requirement for accurate record keeping is a fundamental aspect of training and practice as a physiotherapist.

55. The Panel inferred from all the circumstances that the Registrant knew that she had fabricated records for service users A and B, when no appointments had taken place. In reaching this conclusion, the Panel noted the evidence of the Registrant’s good character, but decided that it was outweighed by other evidence as to the Registrant’s understanding of the circumstances.

56. The Panel next considered, given the Registrant’s knowledge and belief as to the circumstances, whether her conduct was dishonest by the standards of an “ordinary decent person”. In her evidence, the Registrant herself, looking back at her past conduct, described it as dishonest

57. The Panel found that an ordinary decent person would find the Registrant’s conduct to be dishonest. The fabrication of medical records for a service user is dishonest behaviour.

Decision on misconduct

58. The Panel heard submissions from Mr Slack. He invited the Panel to find that the statutory ground of misconduct had been established. He submitted that the Registrant’s conduct in the facts found proved by the Panel fell far below the relevant standards in force at the time.

59. Ms Williamson made no submissions on misconduct, save to point out that three of the factual particulars were found not proved.

60. The Panel accepted the advice of the Legal Assessor. Her advice included reference to the cases of Roylance v GMC [2000] 1 AC 311 and Nandi v GMC [2004] EWHC 2317 (Admin).

61. The Panel was aware that in respect of misconduct there was no burden or standard of proof and that it was a matter for the Panel’s own professional judgment. It bore in mind that breaches of the Standards did not automatically result in a finding of impairment.

62. The Panel considered that the Registrant’s conduct fell significantly below the standards to be expected of a registered Physiotherapist. In particular the Panel considered that the Registrant was in breach of the following standards:

HCPC Standards of conduct, performance and ethics

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

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

10.1 You must keep full, clear and accurate records for everyone you care for, treat or provide other services to.

63. The notes created by the Registrant gave the false impression that Service Users A and B had received treatment and described their presentation on 27 July 2022. This falsification of service user records, had the potential to harm Service Users A and/or B.

64. The Panel also considered that the Registrant’s dishonest conduct was in breach of a fundamental tenet of the profession. Dishonesty is a very serious matter which has a significant impact on public confidence in the profession. Such conduct is entirely contrary to the requirement for physiotherapists to behave ethically, acting with integrity, honesty, and openness.

65. The Panel considered that members of the profession and members of the public would consider the Registrant’s dishonest conduct to be deplorable.

66. The Panel decided that the Registrant’s conduct fell far below the standards of a physiotherapist and was sufficiently serious to amount to misconduct.

Decision on Impairment

67. The Panel was invited by Mr Slack to consider whether, in its judgment, the Registrant’s fitness to practise is impaired, and to consider all the relevant factors. Mr Slack submitted that the Registrant has not fully remediated her misconduct and that there is a risk of repetition. He also submitted that the Registrant’s dishonest conduct brought the profession into disrepute and all four limbs of the test for fitness to practise in the case of CHRE v Grant [2011] EWHC 927 were engaged.

68. In her submissions Ms Williamson reminded the Panel that the test is whether the Registrant’s fitness to practise is currently impaired. She submitted that the Registrant’s dishonest conduct involved an isolated incident which took place two and a half years ago, and that there has been no replication of the conduct. Ms Williamson also referred to the Registrant’s reflection on dishonesty, as set out within her witness statement, and submitted that the Registrant has demonstrated considerable insight. Ms Williamson also referred the Panel to the testimonials which describe the Registrant as a “great” physiotherapist, knowledgeable, caring, honest, dedicated, patient centered, and with strong clinical skills. Ms Williamson submitted that the Registrant’s conduct was out of character and that there is no evidence either before or after 27 July 2022 of any dishonesty. In the circumstances, Ms Williamson invited the Panel to conclude that there will be no repetition of similar conduct.

69. The Panel recognised that its findings in relation to misconduct did not necessarily mean that the Registrant’s fitness to practise is impaired.

70. The Panel accepted the advice of the Legal Assessor and took account of the guidance in the HCPTS Practice Note on Fitness to Practise Impairment.

71. The Panel firstly considered the personal element of impairment. It considered whether the misconduct is remediable. Dishonesty involves an attitudinal issue, and it is therefore more difficult to address such conduct and persuade a Panel that there will be no repetition. The Panel was of the view that with careful thought, reflection and targeted action the misconduct in this case may be remediable. The dishonest conduct in this case did not involve a pattern of conduct, nor was it the most egregious form of dishonesty. It was relatively narrow in scope, and any personal gain for the Registrant would have been limited.

72. The Panel noted that there was no early admission of dishonesty, nor was there a clear account given to BC of the Registrant’s involvement. There was no insight demonstrated immediately after the misconduct.

73. The Registrant has taken some steps to address her past misconduct. She has provided evidence that she has completed training on records management, and legal and ethical frameworks. The Registrant also included in her statement her reflections on her conduct, acknowledging the impact of dishonesty on public confidence in the profession. The Registrant apologised and within her statement and her evidence to the Panel she described her behaviour as unethical, dishonest, and a “big mistake”. She acknowledged the risk of harm to the service users because the service records were created when she had not seen the patients and gave examples of the risks that might arise.

74. The Panel’s assessment was that the Registrant has demonstrated some insight within her statement and in her evidence to the Panel. However, the Panel considered that the Registrant had not fully engaged with some of the underlying reasons for her dishonest behaviour on 27 July 2022, or considered protective factors that she could put in place to ensure that such conduct will not be repeated. The Registrant might have reflected on the circumstances and emotions that she felt on 27 July 2022, and whether she was open and transparent with her employer about her health and her circumstances. She might have reflected on her professional responsibilities to ensure that she is well enough to complete all her responsibilities as a physiotherapist, ensuring that there is no risk to the public. She might have reflected on her response to stressful circumstances, tension with or pressure from her employer, and what steps she would take as a professional, to address such issues. She might also reflect on the requirements to comply with her professional obligations, notwithstanding any advice or suggestions she might receive to the contrary.

75. The Panel was of the view that the Registrant had not fully reflected and acknowledged that there might in the future be circumstances in which there is a test of her honesty and integrity, particularly in circumstances where she is under stress. The Registrant might have considered what protective measures she would put in place to ensure that there will be no repetition of dishonest conduct.

76. In the Panel’s view the insight demonstrated by the Registrant was developing, but was insufficient.

77. In its assessment of the risk of repetition the Panel acknowledged that there is no evidence of any repetition of dishonest behaviour, and that there is testimonial evidence that the Registrant is a safe and effective practitioner. Nevertheless, the insight demonstrated by the Registrant was insufficient to satisfy the Panel that there will be no repetition of dishonest conduct. The Panel considered that in circumstances of stress or pressure, such as those which arose on 27 July 2022, there was a risk of repetition.

78. The Panel therefore decided that the Registrant’s fitness to practise is impaired on the basis of the personal component.

79. The Panel next considered whether, given the nature, circumstances, and gravity of the Registrant’s misconduct, public confidence in the Physiotherapy profession and the HCPC would be undermined if there was no finding of impairment. The Panel also considered whether it would be failing in its duty to declare and uphold proper standards of conduct and behaviour if there was no finding of impairment in this case.

80. The gravity of the Registrant’s conduct is that it is dishonest conduct, and directly relating to the care of service users. The falsification of patient records is very serious, and a finding of impairment is required to mark the Registrant’s departure from professional standards.

81. The Panel also considered the impact of the Registrant’s behaviour on public confidence in the profession. Dishonesty is unethical behaviour and it undermines public confidence in the profession, particularly where it has a potential impact on public safety. The dishonest behaviour in this case involved falsification of patient records, creating an impression that the Registrant had treated service users A and B when this was not the case. The Panel had no hesitation in concluding that public confidence in the profession would be undermined if a finding of impairment were not made.

82. The Panel therefore concluded that the Registrant’s fitness to practise is impaired on the public component.

Decision on Sanction

83. It was not possible to conclude the hearing in the original listing time available and thus the case was adjourned until 21 March 2025.

84. The case resumed on 21 March 2025, with the same persons present, save for a change of Legal Assessor, as detailed on the first page of this determination.

85. In reaching its decision on sanction, the Panel took into account the submissions made by Mr Slack and those made by Ms Williamson, together with all the relevant evidence and all matters of personal mitigation. The Panel also referred to the guidance issued by the HCPC, in its Sanctions Policy (“SP”). The Panel had in mind that the purpose of sanctions was not to punish the Registrant, but to protect the public, maintain public confidence in the profession and maintain proper standards of conduct and performance. The Panel was also cognisant of the need to ensure that any sanction is proportionate. The Panel accepted the advice of the Legal Assessor.

86. The Panel took into account the Registrant’s previous good character and the testimonials that describe the Registrant as a “great” physiotherapist, knowledgeable, caring, honest, dedicated, patient-centred, and with strong clinical skills. The Registrant also provided some patient feedback forms from early 2025, demonstrating that she is highly thought of and her clinical skills are not in doubt.

87. The Panel also reminded itself of its reasoning in relation to current impairment, where it was of the view that with careful thought, reflection and targeted action the misconduct in this case may be remediable. The dishonest conduct in this case did not involve a pattern of conduct, nor was it the most egregious form of dishonesty. It was relatively narrow in scope, and any personal gain for the Registrant would have been limited. It appears to have been a decision made when the Registrant believed that she was under time pressure to complete service user notes.

88. The Registrant gave further oral evidence at the sanction stage. She was asked how she now deals with stress in the workplace. The Registrant said she was now working in the NHS and it was a different work environment, where she was not working autonomously. By not working autonomously she explained that in her role two and a half years ago there had been no-one around to help her if she needed assistance and there was no support. Now, however, where she is working is an office and there are staff around to help and provide guidance. She confirmed that she was still seeing patients on her own, but that there was now support around if she needed it.

89. The Registrant said that she had done training on how to cope with stress, including mindfulness training, meditation and yoga. She has attended relevant workshops and has much more support from her employer. She has been provided with a watch and if she is feeling under stress she can press a button and others around her will come to her assistance. She added that her supervisor has provided her with strategies about how to cope with stress, such as slowing down, breathing exercises and meditation. She said she could always ask for support when required.

90. The Registrant said that at the relevant time she had been working 60 hours a week and was now only working 36.5 hours a week, which meant she could pay more attention to her health and give her best to her patients.

91. The Registrant was asked about the impact on her if she were unable to work as a Physiotherapist for any length of time. She said being a Physiotherapist is her passion. This was relevant because the Registrant said she was in the UK on a sponsored work visa and if she was unable to work as a Physiotherapist then the visa would be removed and she would have to return to her home country.

92. The Registrant was asked about the risk to the public from falsifying records. She said that if you do not complete records correctly or honestly, that can affect the public because it affects the trust the public place in healthcare professionals. She said if information is missed then that can lead to a mis-diagnosis, which can lead to serious issues for the patient and can also impact on other practitioners as well, who rely on the records. The Registrant said the public would lose their trust with the organisation and healthcare providers and there is a risk that patients may not attend for treatment. She added that recording incorrect data was unethical and disrespectful.

93. The Registrant said if she found herself in a similar situation and she was feeling physically unwell, she would sign herself off sick and if not able to do that she would find someone to take over from her, so that the patient still received treatment.

94. With regards to falsifying the records, the Registrant said it was two and a half years ago, she would never do it again and had been working since then without issue. She said she knows “it sounds childish now”, but she accepted what her manager told her to do about completing the notes. She said she would not do that now, she would ask for evidence from the manager and if there were none she would not complete the records and would report the matter to a more senior manager.

95. The Registrant said she knows how important it is to keep accurate records. At the time, two and a half years ago, she had not realised that not giving the proper information could lead to dishonesty. She said that if patients knew she had falsified records they would not want to see her again and may not want to see any Physiotherapist, so her actions affect the whole profession. The Registrant said she was a different person now, she reflects on her notes every day and ensures they are accurate and correct, She said “I am trying my best to be honest and sincere.”

96. The Registrant was asked what would happen if she found herself in a different environment, where not supported. The Registrant said she would not go for such a job, as she needs to be in a good team. She acknowledged that she has to work autonomously and it can be stressful, but reiterated all the steps she has been taking to alleviate stress.

97. The Registrant confirmed her current employer is aware of these proceedings and is supporting her.

98. The Panel considered there to be one aggravating factor in this case, namely:
• a potential risk of harm to two service users.

99. The Panel considered the mitigating factors in this case to be:
• no previous disciplinary history;
• an isolated single act;
• no evidence of any harm to patients (albeit there was a risk of harm);
• no repeat of the behaviour and has worked for over two and half years since without complaint;
• a much improved level of insight and reflection since the last hearing;
• genuine remorse and apology;
• English is not the Registrant’s first language (meaning she was not always able to necessarily express herself clearly);
• no evidence of any personal gain;
• at the time the Registrant was working in difficult circumstances, where few safeguards were in place for an employee working as a sole worker, in inadequate conditions and working exceedingly long hours;
• positive testimonials and patient feedback;
• extensive evidence of remediation;
• a very low risk of repetition.

100. The Registrant had clearly benefited from having the time to read the Panel’s decision on impairment and to reflect on the Panel’s findings and her actions in 2022. In her oral evidence she was able to show her awareness of the impact of her behaviour on patients, colleagues, the organisation, the public and the profession. The Panel was thus satisfied that her insight had developed well and the steps she had taken to remediate and have in place strategies to prevent a recurrence, meant there was a very low risk of her ever repeating such behaviour. She is clearly well thought of by her patients and provides a very good level of care. As such she would be a loss to the profession, were she not able to continue to work.

101. The Panel concluded that the Registrant no longer represented a risk of harm to patients. However, her dishonest actions were serious and accordingly this was not an appropriate case to take no further action or consider mediation, since neither would reflect the seriousness of the misconduct.

102. The Panel therefore went on to consider a Caution Order. The SP suggests a Caution Order might be appropriate in 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.

103. The Panel is satisfied that the misconduct in this case was isolated, essentially a one-off and very much out of character. It could not, however, be characterised as relatively minor in nature. Falsifying patient records is a serious matter and not to be taken lightly. That said, the Panel is now satisfied, following the information received at the sanction stage, that there is a low risk of repetition, the Registrant has shown good insight and has undertaken appropriate remediation.

104. However, in light of the seriousness of the behaviour, the Panel went on to consider more onerous sanctions before coming to a decided position.

105. Accordingly, the Panel went on to consider whether to place conditions of practice on the Registrant’s registration. The SP states that before imposing conditions a Panel should be satisfied that:

• the issues which the conditions seek to address are capable of correction;
• there is no persistent or general failure which would prevent the registrant from doing so;
• appropriate, realistic and verifiable conditions can be formulated;
• the registrant can be expected to comply with them; and
• a reviewing Panel will be able to determine whether those conditions have or are being met.

106. There are no clinical concerns in this case and thus no issues that could be addressed by way of conditions. There has never been any question about the Registrant’s skills as a clinician (and her patient feedback shows how impressed patients are with her) and thus no areas of her practice where conditions might have a role to play.

107. The Panel therefore looked at the guidance in the SP about when a Suspension Order might be the appropriate sanction. This is a case where, in the Panel’s view, a Suspension Order could be justified. However, in light of the extensive mitigation, the Panel formed the view that such a sanction would be disproportionate, in the specific circumstances of this case. A period of suspension, however short, would have a profound effect on both the Registrant and her family. It would result in her work visa being withdrawn and she would have to return to Pakistan. The profession would lose an otherwise very competent practitioner.

108. Furthermore, the context and circumstances of the misconduct had to be taken into account. This was an isolated instance of dishonesty, committed over a period of around 60 seconds. There was no pattern of behaviour, no repeat, no apparent personal gain. She has since shown good insight and demonstrated encouraging remediation. The Panel has already indicated that it considers there to be a very low risk that she would ever behave in this way again.

109. In all the circumstances, the Panel concluded that a Suspension Order would be disproportionate in this case. The Panel thus returned to the Sanctions Policy and noted the following guidance:
“A caution order should be considered in cases where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate. In these cases, panels should provide a clear explanation of why it has chosen a non-restrictive sanction, even though the panel may have found there to be a risk of repetition (albeit low).”

110. The Panel considered this case fell within that guidance and that accordingly a Caution Order would be appropriate. The Panel has chosen a non-restrictive sanction because there is a very low risk to the public. It was out of character and occurred once in an otherwise blemish-free career as a Physiotherapist. There are no concerns about the Registrant’s clinical skills and the testimonials and patient feedback forms attest to her professionalism as a Physiotherapist. Importantly, she has now shown much better insight into her behaviour and the risk of repetition has thereby been significantly diminished.

111. Accordingly, notwithstanding its earlier observations about the Registrants state of insight, the Panel is now much more reassured about the level of reflection and insight shown by the Registrant and considers there is not a need to restrict her practice.

112. The Panel therefore makes a Caution Order. The Order is for three years to reflect the seriousness of the misconduct. The Registrant should be in no doubt that any finding of current impairment by her regulatory body is a serious matter and she should not take this Caution Order lightly.

The Registrar is directed to annotate the Register entry of Ms Aleena Tahir with a Caution which is to remain on the Register for a period of three years from the date this Order comes into effect.

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.

History of Hearings for Aleena Tahir