Kelly Coburn

Preliminary Matters

Hearing to be in Private

1.Ms Sampson made a preliminary application for matters relating to the Applicant’s health and family life to be heard in private. Ms Sampson submitted that it is likely that references to medical issues and the Applicant’s family circumstances will arise during the hearing.

2. Ms Sampson referred the Panel to its powers in Rule 10(1) of the Health Professions Council (Conduct and Competence) (Procedure) Rules 2003 (“the Rules”), which highlights the “open justice principle” but confirms that the Panel has the discretion to exclude the press or the public from all or part of a hearing in appropriate cases, where it’s in the interests of justice to do so; or where it is done to protect the private life of the Applicant of any other relevant party.

3. Ms Sampson referred the Panel to the HCPTS Practice Note on Conducting Hearings in Private which reflects the same principles as outlined in the Rules.

4. The Applicant supported the application.

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

6. The Panel considered that in this case, the health considerations of the Applicant were interwoven throughout the facts contained in the evidence

7. The Panel was satisfied that it was necessary to hold at least part of the hearing in private to protect the Applicant’s privacy in relation to her health and family life. However, based on the nature of the information before it the Panel had concerns that it may become impractical not to hold the entire hearing in private so would keep this under review.

Background

8. The Applicant qualified as an Occupational Therapist in 2005. She previously worked at Gwent NHS trust as a band 5 Occupational Therapist in a mental health setting.

9. On 30 June 2008 the Applicant was appointed as a community Occupational Therapist in the Adaptations and Community Equipment Team of Rhondda Cynon Taff County Borough Council (“the Council”).

10. In her role as a Community Occupational Therapist the Applicant assessed patients in the community to find out whether they needed any equipment or housing adaptations to assist them with their daily living. She was also expected to take the needs of carers into consideration. The patients the Applicant worked with had long term health conditions and/or substantial disabilities.

11. The Applicant’s role involved assessing and balancing the risks to service users and their carers in a way that promoted the independence of service users and assisted their carers. The Applicant played a part in managing the process by which decisions about the allocation of resources were made. The Applicant was required to account for her actions through effective and accurate recording of her assessments, decisions, plans and outcomes.

12. During the first months of the Applicant’s employment her line manager became aware of issues concerning the Applicant’s report writing. These were primarily to do with the structure, spelling and grammar of the Applicant’s reports.

13. The Applicant undertook a range of training during the course of her employment with the Council. In November 2008 she completed modules C, D and F of the “All Wales Manual Handling Passport Training”. The passport training scheme was a national scheme designed to ensure consistency in manual handling training within the NHS in Wales. Module C of the course concerned ‘sitting, standing and walking’; module D ‘bed mobility’ and module F ‘hoisting’.

14. In January 2009 the Applicant also received manual handling training delivered by the Council’s own manual handling team.

15. The Applicant made a number of high-risk errors whilst on manual handling visits with her supervisor and another senior Occupational Therapist. As a result of these errors from 26 July 2009 the Applicant was not permitted to undertake the manual handling elements of her role.

16. In April 2009 concerns were raised by the Council’s Private Sector Housing Unit about the accuracy of the Applicant’s recommendations for the installation of stair lifts. Further concerns were raised in June 2009 which included concerns that the Applicant often did not complete the necessary functional assessments on visits but nevertheless proceeded to make recommendations for service users.

17. The Applicant returned to work on 28 June 2010. She attended a return-to-work meeting where she was allocated a new supervisor, who was advised of the concerns that had arisen in her absence. At the return to work meeting the Applicant agreed that the key areas of her development needs were: making clinical decisions, critical evaluation of information and assessment. It was agreed that the Applicant would benefit from revisiting the RCOT (Royal College of Occupational Therapists) process from the beginning building up to the full range of Occupational Therapist duties and responsibilities, including manual handling, in the long term.

18. The Applicant was willing to participate in the development work. She acknowledged the importance of becoming a fully rounded Occupational Therapist and remained willing and enthusiastic in working towards achieving these goals.

19. The Applicant was allocated Occupational Therapist assessments in respect of minor works, known as Community Care Worker Assessments, when she first returned to work. These assessments could be undertaken by staff that were not qualified Occupational Therapists and generally involved less complex cases with minor aids and adaptation referrals.

20. By October 2010 the Applicant was working on less complex Occupational Therapist assessments such as Adapted Housing Assessments. These required full functional assessments and recommendations in respect of future housing having regard to patient needs. All of the cases allocated to the Registrant were carefully screened to ensure that she could practise elements of her role without placing patients at undue risk. The Registrant continued to work on these less complex cases until she ceased to work as a Council Occupational Therapist and was redeployed in July 2012.

21. Between June and December 2010 further concerns were raised about the Applicant’s practice following a number of observed visits. The Department’s policy required all Occupational Therapists to undertake two such visits each year where a senior Occupational Therapist would observe them. Issues highlighted on these visits included a lack of knowledge in relation to medical conditions and Occupational Therapist skills, poor listening and interviewing skills and the production of subjective rather than factual functional assessment reports and documents.

22. In December 2010 the Applicant attended a number of meetings to discuss her work. It was agreed that she would type and edit her assessments before submitting them to her seniors. It was also agreed that observed visits would continue and seniors would intervene only where it was essential to do so.

23. On 2 February 2011 the Applicant was referred to occupational health for an urgent assessment of her abilities to undertake her role. The Applicant was reviewed by occupational health (“OH”) on 15 February 2011 and referred for a thorough psychological assessment “to try and work out what her capabilities are and what adaptations would be required to keep her in the workplace.”

24. A report was produced dated 22 June 2011. Thereafter, the Applicant was assessed by ‘Access to Work’ on 4 July 2011 and further recommendations as to equipment which might assist her were made.

25. As a result of further observational visit the Applicant was asked to undertake the even less complex work of disabled parking bay assessments.

26. The Applicant was invited to a meeting in March 2012 under the Council’s Capability procedure to discuss issues relating to her work performance. Her letter identified the issues, which she wished to discuss at the meeting. They were:

• Gathering and recording factual assessment information;
• Clinical judgment/rationale and risk analysis to support recommendations;
• Conduct of the assessment; and
• Imparting accurate information to the client in respect of the grant/adaptation process.

27. An interview with the Applicant and her trade union representative took place on 8 March 2012, an action plan was formulated and a support contract agreed both were put in place with effect from 21 March 2012.

28. It was agreed that the Applicant would seek to demonstrate sound clinical reasoning and identify, justify and rationalise clinical decisions made in relation to client needs during the course of observed visits, two-way reviews, discussions of recommendations and rationale on assessment reports. There would be constructive critique of the visits, outcomes and reflections. It was also agreed that supervisors would offer support by reviewing referral documents and assessment outcomes before the Applicant signed off her reports.

29. The action plan was reviewed at a meeting on 30 April 2012. It was felt that the Applicant had not yet met an acceptable competency level in relation to the areas of concern.

30. On 2 May 2012 the informal capability process was suspended at the Applicant’s request so that she could consider redeployment. The Applicant confirmed that she wished to be redeployed.

31. On 12 July 2012 the Applicant accepted a post as a support worker in the Council’s mental health team. She subsequently brought employment tribunal proceedings against her employer and left her employment with the Council under the terms of an agreed settlement of her claims. She has not worked as an Occupational Therapist since 2012.

32. On 3 May 2013 the Council’s Occupational Therapist department referred the Applicant to the HCPC.

33. The panel at the Final Hearing found the following proved:

Allegations (found proved at the Substantive Hearing):

During the course of your employment as an Occupational Therapist with Rhondda Cynon Taf County Borough Council between June 2008 and July 2012 you:

1. Did not identify and/or undertake the appropriate assessment based on the service users' presenting condition;

2. Did not conduct assessments in an appropriate manner in that you:

a. Asked inappropriate and/or irrelevant questions;
b. Gave inappropriate and/or incorrect advice;
c. [NOT PROVED]

3. Recommended and implemented adaptations which were not necessary;

4. Did not demonstrate a basic level of competency in:

a. Problem solving;
b. [NOT PROVED];
c. Manual handling;
d. [NOT PROVED]
e. Report writing;
f. [NOT PROVED]
g. Decision making;

5. Did not communicate properly and effectively with service users and/or carers;

34. The panel found that the particulars of the Allegation found proved amounted to a lack of competence, and that the Registrant’s fitness to practise was impaired by reason of her lack of competence.

35. On 1 July 2015, that Panel determined that the appropriate and just sanction was a Suspension Order for a period of 12 months.

36. The Suspension Order was reviewed three times and extended on each occasion, the last review being on 22 September 2017 when the order was extended for a further 6 months.

37. On 19 March 2018 the HCPC decided to deal with the matter by way of voluntary removal agreement.

38. On 22 May 2024 the Applicant applied to be restored to the Register.

Evidence

39. In support of her application to be restored to the HCPC Register the Applicant had produced a substantial number of documents. Alongside her application she provided a Reflective Personal Statement, a 22-page addendum bundle including a character references, a supervision record, a training record of E-learning and classroom learning completed with her previous employer Lllamau and an Excel CPD (Continuing Professional Development) log.

40. The Applicant gave evidence under oath and was cross examined by Ms Sampson. The Applicant reflected upon what had gone wrong with her previous employer which led to her referral to the HCPC. The Applicant outlined to the Panel all the steps that she had taken to mature and grow from that experience.

41. The Applicant addressed with the Panel each of the Allegations which had been proven against her and what steps she had taken to remediate those concerns and ensure that she had overcome the issues and that they would not be repeated.

42. The Applicant outlined her career progression since the substantive HCPC proceedings. The Applicant explained how she had qualified as a childminder and set up a successful business which had provided her with a lot of transferrable skills. Since then, the Applicant has obtained a role as an Occupational Therapy assistant holding her own caseload. Since August 2023 she has been working full time and the work she has been carrying out has enabled her to put into practice the steps needed to overcome the concerns raised about her.

43. She outlined that she feels supported within her current role by her clinical lead and colleagues. She is enjoying the role as Occupational Therapy assistant in therapeutic focused practice. She has regained her confidence and, in the future, will be open and honest about any issues she has before impacts on her ability to conduct the role, and will not place service users at risk. The Applicant outlined the strategies she has in place to ensure that she never reaches the point that she did when she had to leave her previous employment.

44. She showed the Panel all the training that she has undertaken which is in excess of that requirement to make an application to be restored to the HCPC Register but reflects her passion and commitment to returning to the role of an Occupational Therapist. She explained to the Panel that she has undertaken 82 supervised practice days, 15 formal study day and 5 home study days as outlined on her spreadsheet and detailed what was involved.

Submissions

45. Ms Sampson made submissions on behalf of the HCPC. Ms Sampson submitted that the HCPC’s position is neutral as to whether the Applicant should be restored to the HCPC Register. Ms Sampson invited the Panel to have in mind the HCPC’s overarching objective and to ask itself whether public safety would be put at risk; or public confidence in the profession and in the regulator undermined, were the Applicant to be restored to the Register.

46. Ms Sampson referred to the HCPTS Practice Note on Impairment and the factors that the Panel should consider.

47. Ms Sampson outlined that the Applicant has completed in excess of the 60 days updating requirements to return to practice. She suggested that the Panel may be satisfied that the Applicant met the general requirements for registration.

48. She invited the Panel to consider the test of impairment, noting that the Applicant had requested a voluntary removal from the Register following findings of lack of competence.

49. Ms Sampson acknowledged the comprehensive documentary evidence provided by the Applicant in support of her restoration application, and the extensive oral evidence given by the Applicant and tested by cross- examination. Ms Sampson submitted that the Panel may reasonably conclude that the way in which the Applicant gave her evidence was open and candid, and that she had demonstrated reflections on the concerns and the steps taken to address them.

50. Ms Sampson invited the Panel to consider the steps that the Applicant had taken to work on herself and address any concerns and noted the Applicants own passion working in a therapeutic focused role helping clients reach their goals. She invited the Panel to consider whether the Applicant has demonstrated sufficient insight into the matters which led to her removal from the Register, whether the issues have been resolved and whether through her commitment to returning she has taken the necessary practical steps to improve her skills and knowledge so that she is a fit and proper person to be readmitted.

51. Ms Sampson invited the Panel to consider whether a reasonable and informed member of public would be shocked or troubled to learn that application was allowed to rejoin the HCPC Register.

52. She also noted that the Applicant has said that she welcomed some conditions to support her return including an element of supervision and invited the Panel to impose Conditions of Practice should it conclude that the Applicant could rejoin the Register.

53. The Applicant made closing submissions to the Panel. She explained that she had made a decision in July 2023 to work towards rejoining the Register as an Occupational Therapist supported by her clinical lead. She explained that she has demonstrated that she can complete a range of assessments in different settings over the last 12 months of carrying a full case load. She has been lone working and with Occupational Therapist. The Applicant explained that she has sound clinical knowledge ensures that she can clinically justify her plans and has demonstrated planning and support in her role. She explains that she can demonstrate accurate report writing, sound evaluation and reflection on the decisions she makes.

54. Overall, the Applicant told the Panel that she has regained her passion for Occupational Therapy which she finds rewarding and a privilege to help clients. She has demonstrated through her CPD that she has gone above and beyond and demonstrated the competencies required. Therefore, she invited the Panel to restore her to the Register which would mean everything to her. She understood if Conditions on her practice might be required and would welcome the opportunity to continue to make every effort to meet the standards expected of her, seek opportunities to continue her professional development and will be open and honest if she finds herself out of her depth and seek support and advice.

Decision

55. In reaching its decision the Panel considered all the documents before it marked Exhibits 1, 2 and 3. It had listened carefully to the evidence and the closing submissions from both parties.

56. The Panel heard and accepted the advice of the Legal Assessor. The Legal Assessor referred the Panel HCPTS practice note ‘Restoration to the Register’ and reminded it that this is an application under Article 33(5) of the Health Professions Order. Article 33(5) provides that a Panel must not grant an application for restoration unless it is satisfied, on such evidence as it may require, that the applicant:

a. meets the general requirements for registration; and

b. is a fit and proper person to practise the relevant profession, having regard to the particular circumstances that led to striking off.

57. The Panel accepted that the burden of proving that the Applicant is a fit and proper person to be restored to the Register is on the Applicant and that the applicable standard of proof is the civil one, namely on the balance of probabilities.

58. The Panel noted that it is not sufficient for the Applicant to establish that she meets the requisite standard of proficiency and the other general requirements for registration. The Applicant must satisfy the Panel that she is no longer impaired.

59. The Panel considered the following matters:

a. the matters which led to striking off and the reasons given by the original Panel for imposing that sanction;

b. whether the applicant accepts and has insight into those matters;

c. whether the applicant has resolved those matters, has the willingness and ability to do so, or whether they are capable of being resolved by the applicant;

d. what other remedial or rehabilitative steps the applicant has taken;

e. what steps the applicant has taken to keep his or her professional knowledge and skills up to date;

f. whether the Applicant is safe to practise as an Occupational Therapist;

g. whether, in the context of the concerns that led to the voluntary removal, public confidence in the profession would be undermined if the Applicant were restored to the register; and,

h. whether restoration would promote the overarching objectives of the HCPC.

60. The Panel was satisfied that it could consider the Applicant’s application in accordance with Article 33 (2) as the precondition that it is over five years since the Applicant was removed from the Register has been met.

61. The Panel was satisfied that the Applicant had successfully completed a return to practice course with Birmingham City University and had completed in excess of the 60 days of updating requirements, within the prescribed timescale. The Panel noted that the evidence it had before it was comprehensive and detailed and she has satisfied them that the general requirements for registration were met.

62. The Panel considered whether the Applicant had satisfied it that she was now a fit and proper person to be restored to the Register. The Panel noted the circumstances that led to the Applicant’s removal from the Register and the Allegations that had been proved against her. It noted the nature of the regulatory concerns.

63. The Panel found the Applicant’s oral evidence to be open and candid, and when tested in cross-examination she responded openly and honestly. The Panel was impressed by the efforts the Applicant had gone to to produce the evidence that was placed before the Panel. The Panel was satisfied that the Applicant had matured substantially in the 7 years since her voluntarily removal.

64. The Panel notes that the previous regulatory concerns could be grouped as follows:

a. Failing to identify or undertake the appropriate assessment based on service users' presenting condition.

b. Failing to conduct assessments in an appropriate manner by asking inappropriate or irrelevant questions and giving inappropriate or irrelevant advice.

c. Recommending and implementing adaptations which were not necessary.

d. Failing to demonstrate a basic competency in problem solving, manual handling and report writing.

e. Failing to communicate effectively with service users and or carers.

65. The Panel noted that the evidence provided to it was very much focused on these issues. The Panel reached the conclusion that the Applicant through her reflective statement and oral evidence had demonstrated that she had good insight into the regulatory concerns that had led to the substantive hearing panel finding that she lacked competence and was unfit to practice. The Panel found that the Applicant had worked hard to ensure that she is capable of carrying out assessments both in client’s homes and a variety of community settings. The Panel was satisfied that the Applicant works collaboratively with others to ensure that appropriate adaptations are recommended. She has also worked hard to develop her report writing skills with appropriate assistance, to develop her problem-solving techniques and take on board manual handling training.

66. The Applicant has worked on her communication skills by completing the allied health professional return to practice course and counselling qualifications level 2 and level 3 as well the skills she has learnt in her child-minding business.

67. The Applicant has been clear about the environments she would like to work in, the type of work that she wishes to carry out and the level of support which she would benefit from.

68. The Panel was satisfied that Applicant has demonstrated that she has learned from her past mistakes they are unlikely to be repeated. The Applicant has addressed the concerns that were raised about her, has been open and transparent with herself and with the Panel today. The Panel found the Applicant to be very open and candid about her difficulties. The Panel was impressed by the way she has shown insight into what went wrong and worked hard to put in place effective ways of working to avoid a repeat of any of these concerns.

69. Therefore, the Panel was satisfied that the Applicant has demonstrated that she has matured, has a good understanding of how things went wrong and what measures can be put in place to avoid it happening again. Therefore, the Panel found that there is unlikely to be a repetition of the regulatory concerns.

70. The Panel was satisfied that the Applicant is a fit and proper person and that she is capable of safe and effective practice under the part of the Register concerned.

71. However, the Panel noted that the Applicant herself has indicated that she may be assisted by some supervision, at least during the early stages of her return to practice. The Panel agrees with the Applicants assessment.

72. The Panel also noted that the Applicant has been working in a supportive environment with a strong support structure in place. The Panel has reached the conclusion that to maintain a safe return to practice an element of support and supervision is required until the Applicant has demonstrated an effective return to work as an Occupational Therapist. The Panel has ensured that the conditions are proportionate to address the concerns.

73. In addition to the documents specified in paragraph 4 of the Conditions of Practice, a future panel may be assisted by:

• Your continued engagement and attendance at the review hearing
• Updated testimonials
• Evidence of compliance with the Conditions of Practice.

ORDER: The Registrar is directed to restore the name of Kelly Marie Coburn (the Applicant) to the Occupational Therapy Part of the Register, but restoration is only to take effect once the Applicant has:

(a) provided the Registrar with any information and declarations required for admission to the Register;

(b) paid the prescribed restoration fee; and

(c) satisfied the Registrar that, in relation to the Applicant, there is or will be in force appropriate cover under an indemnity arrangement.
And The Registrar is further directed to annotate the Register to show that, for a period of 12 months from the date that this Order takes effect (the Operative Date), the Applicant must comply with the following conditions of practice:

1. You must place yourself and remain under the indirect supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within two weeks of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

a. you must attend weekly clinical case review meetings;
b. you must attend a formal supervision meeting every three weeks.

2. You must keep a formal record of your every three week supervision meetings as part of your Personal Development Plan.

3. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

4. You must submit your personal development plan and an update from your supervisor two weeks before the next review of your Conditions of Practice.

5. You must inform the following parties that your registration is subject to these conditions:
a. any organisation or person employing or contracting with you to undertake professional work;
b. any agency you are registered with or apply to be registered with to undertake professional work (at the time of application);
c. any prospective employer for professional work (at the time of your application).

6. You must inform the HCPC within seven days if you take up any other or further professional work.

Right of Appeal

An appeal may be made to the High Court in England and Wales against the Panel’s decision and the order it has made.

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. The Panel’s order will not take effect until the appeal period has expired or, if an appeal is made, until that appeal is disposed of or withdrawn.

History of Hearings for Kelly Coburn