Manna Reji

Preliminary Matters

Witness Key

1. Throughout this decision, the witnesses will be referred to as follows:

• HM, an Operations Manager for International Registrations at the HCPC. HM provided a witness statement, with exhibits, dated 6 February 2025.

• CL, a Clinical Manager at University Hospital Southampton (“the Hospital”), who is a registered Occupational Therapist. CL provided a witness statement, with exhibits, dated 23 December 2024. At the relevant time, CL was supporting PB and SP with the Registrant.

• SP, an Advanced Occupational Therapist at the Hospital. SP is registered as an Occupational Therapist with the HCPC and provided a witness statement dated 12 December 2024. At the relevant time SP was the Registrant’s supervisor at the hospital from approximately mid-February 2023 to mid-March 2023.

• PB, an Advanced Occupational Therapist at the Hospital, who is registered with the HCPC. PB provided a witness statement, with exhibits, dated 17 December 2024. At the relevant time, PB took over supervision of the Registrant from SP, and supervised the Registrant until her probationary period ended in June 2023.

• EE, a specialist Occupational Therapist at the Hospital. EE has not provided a witness statement for the HCPC hearing.

• DS, a specialist Occupational Therapist at the Hospital. DS has not provided a witness statement for the HCPC hearing.

Service

2. The Panel first considered the issue of service as the Registrant was not in attendance. The Panel was referred to the service bundle which had been provided to the Panel in advance of the hearing.

3. The Panel had been provided with a Certificate signed by the Registrar dated 26 August 2025, detailing the Registrant’s registered email address on the HCPC Register.

4. The Panel had also been provided with the Notice of Hearing letter dated 26 August 2025 sent to the Registrant, on that date, to her registered electronic mail address, as it appeared in the HCPC Register. The Notice of Hearing letter confirmed the dates and times of the hearing as well as informing the Registrant that this would be a virtual hearing. It also offered the Registrant an opportunity to attend at the hearing. The Notice of Hearing header noted that the email was sent to the Registrant’s registered email address on 26 August 2025 at 12:56:26.

5. The Hearings Officer submitted that good service had been effected. He drew the Panel’s attention to the fact that the Notice of Hearing letter had also been sent by post to the Registrant’s registered home address.

6. The Panel accepted the advice of the Legal Assessor who referred to the Health Professions Order 2001 and the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”), namely rule 6. The Legal Assessor advised that good service would be effected by notifying the Registrant of the time, date and venue (virtual) of the hearing at her registered electronic mail address, with 28 days’ notice.

7. The Panel was satisfied on the evidence before it, that fair, proper and reasonable notice of the hearing today had been served on the Registrant, having been sent to the Registrant at her registered electronic address on 26 August 2025. Furthermore, the Panel had evidence to show that the HCPC had also sent notice to the Registrant’s postal address on the same date. The Panel therefore determined that notice of the hearing had been properly served in accordance with the Rules.

Proceeding in absence

8. Mr Schofield submitted that as the Panel had found good service, it should proceed with the hearing in the Registrant’s absence. He submitted that the Registrant had voluntarily absented herself.

9. Mr Scholfield drew the Panel’s attention to the various emails sent by the Registrant to the HCPC which confirm that the Registrant would not be attending, and which indicate that she is no longer in the United Kingdom. Mr Schofield acknowledged that the case is about the Registrant’s struggle with the English language but that the Panel can be satisfied that it can rely on the Registrant’s emails because as well as stating that she will not be attending it also gives the rationale for why, that being that she is no longer in the country.

10. Mr Schofield submitted that there are four witnesses ready to give evidence at this hearing and that it is in the public interest to proceed.

11. The Registrant’s emails in terms of not attending at the hearing are as follows:

Email to the HCPC on 18 July 2024 – ‘I’m not gonna appear for hearing or come to uk again [sic].’

Email to HCPC on 28 October 2024 (11:17)– ‘…I will not present for final hearing…this will be my final email.’

Email to the HCPC on 28 October 2024 (11:21) – ‘Anyway I left uk…and km not coming for final hearing [sic].’

Email to HCPC on 3 March 2025 – ‘I’m not appearing for any hearing I left uk’.

12. The Panel heard and accepted the advice of the Legal Assessor in relation to the factors it should take into account when considering proceeding in the Registrant’s absence. This included reference to rule 11 of the Rules and to the case of GMC v Adeogba [2016] EWCA Civ 162, R v Jones (Anthony) [2003] 1AC1 and Sanusi v GMC [2019] EWCA Civ 1172. The Panel also had regard to the HCPTS guidance ‘Proceeding in the Absence of the Registrant’ dated August 2025.

13. The Panel considered all the information before it, together with the submissions made by Mr Schofield on behalf of the HCPC. The Panel was satisfied that the Notice of Hearing letter had been sent to the Registrant on 26 August 2025 informing her of the hearing.

14. The Panel concluded that it was reasonable and in the public interest to proceed with the hearing in the absence of the Registrant for the following reasons:

• The Registrant has communicated with the HCPC on numerous occasions over the past two years to state that she will not be attending any hearing. In the Panel’s view, her emails are unequivocal and explain that she is no longer in the UK and repeatedly say she will not come to a hearing. The Panel concluded that the Registrant has voluntarily and deliberately absented herself.

• The Registrant has not sought an adjournment of the hearing and there is no indication from her that she would be willing or able to attend on an alternative date. Therefore, re-listing this hearing would be unlikely to secure her attendance.

• This case dates back to 2023, and the witnesses are lined up to give evidence this week. Any delay would cause inconvenience to the witnesses, and the further passage of time if the case was adjourned, could have a negative impact on memory.

• The Panel recognised that there may be disadvantage to the Registrant in not being able to give evidence or make oral submissions. However, she has been provided with the opportunity to attend and/or provide written evidence but has not done so. Even in the Registrant’s absence, the Panel and Legal Assessor have a duty to ensure the hearing is fair and to take reasonable steps to test the HCPC’s case thus mitigating some of the disadvantage.

• The Panel considered that the public interest in proceeding with final hearings expeditiously, particularly as the witnesses are ready and able to give evidence, outweighed any disadvantage to the Registrant and concluded that the hearing should proceed in her absence.

Hearsay

15. Mr Schofield submitted that in relation to Particulars 3b and 3c, the evidence relied upon by the HCPC is hearsay. Mr Schofield submitted that the evidence is provided by PB, for each of those Particulars, but she was not a direct witness to the events. In relation to 3b, PB sets out the information she was told by EE, and exhibits a typed document produced by EE as part of the Hospital records relating to the Registrant’s employment. In relation to 3c, PB sets out the information she was told by DS.

16. Mr Schofield submitted that it was fair to admit the hearsay evidence as the Registrant has been given an opportunity to engage with the proceedings and comment on the evidence which is included in the bundle.

17. Mr Scholfield submitted that there does not appear to be any factual dispute about the evidence, as reference to the events of 3b is set out in the Hospital letter sent to the Registrant on 21 June 2023, setting out what was discussed in the probation review meeting. Mr Schofield submitted that there is also mention of the events of 3a and 3b in the meeting notes dated 14 June 2023, and it does not appear from the notes that the Registrant disputes them. Mr Schofield submitted that the evidence is therefore demonstrably reliable.

18. In response to Panel questions, Mr Schofield submitted that he did not have a reason as to why no direct evidence was called from EE or DS, but that his understanding was that PB could provide holistic evidence which is more proportionate than calling each and every clinician.

19. The Panel heard and accepted the advice of the Legal Assessor in relation to factors it should take into account in considering a hearsay application. The Legal Assessor referred to the principles derived from the cases of: Thorneycroft v Nursing and Midwifery Council [2014] EWHC 1565 (Admin), and Mansaray v Nursing and Midwifery Council [2023] EWHC 730. The Legal Assessor referred the Panel to the HCPTS Practice Note entitled ‘Evidence’ dated October 2024, paragraphs 31 – 36 and to Rule 10 of the Rules.

20. The Panel began its deliberations by asking itself whether the admission of the evidence would undermine the Registrant’s right to a fair hearing. The Panel took into account its duty to protect the public as well as its duty to ensure that hearsay evidence should only be admitted if it is relevant and fair.

21. The Panel considered the application in accordance with the approach set out in Thorneycroft v Nursing and Midwifery Council [2014] EWHC 1565 and the non-exhaustive list set out in the HCPTS Practice Note on Evidence.

22. In relation to the nature of the material, the Panel noted that there are no signed and dated witness statements from EE and DS, either for the HCPC or as part of the material provided by the Hospital. The information was given to PB by EE and DS as part of their professional duties in reporting issues to their manager. Their evidence is set out in PB’s witness statement and is referred to in some of her exhibit documents.

23. The Panel considered whether the evidence is the sole and decisive evidence. In relation to Particular 3b, the only known witnesses to those alleged events are EE and the Registrant. Therefore, the evidence is sole and decisive. In relation to 3c, the only known witnesses to those alleged events are DS and the Registrant, and therefore the evidence is sole and decisive.

24. In relation to the nature and extent of the challenge, the Panel took into account the meeting notes from 14 June 2025, in which the Registrant does not appear to deny issues in relation to handling patients correctly, and makes generic apologies. However, as the meeting was not a formal investigation or disciplinary meeting, these specific allegations are not put to her, and the discussion is more general in nature. Thus, the Panel could not be entirely satisfied that there is no challenge to what is now alleged. Furthermore, the Registrant successfully appealed her dismissal from the Hospital and was re-instated.

25. The Panel considered that there is no suggestion that either EE or DS had reason to fabricate. They are both referred to as registered professionals. There is nothing within the evidence to indicate they colluded and the description provided by PB of what was said to her is factual in nature.

26. The Panel considered the seriousness of the Allegation, taking into account the impact which adverse findings might have on the Registrant’s career. The Panel accepted that the Allegation is serious and if proven, Particulars 3b, and 3c, would show that the Registrant has acted in a way so as to put patients at risk of harm.

27. The Panel had regard to whether there was a good reason for the non-attendance of EE and DS. Whilst the Panel did not consider this was a deliberate attempt by the HCPC to prevent a proper evaluation of the evidence, it did not accept the submission about proportionality to be a sufficient reason to not obtain direct evidence from EE and DS, particularly as the evidence of each is sole and decisive.

28. The Panel considered that the HCPC had not taken reasonable steps to secure direct evidence from EE and DS, given that each of them are the sole witnesses to alleged serious incidences involving patient care.

29. Based on consideration of all the factors and overall fairness, the Panel considered that it was unfair to admit the hearsay evidence of EE and DS as set out in PB’s statement. Given that it is sole and decisive evidence, it is not capable of being tested by other evidence, and further steps should have been taken by the HCPC to obtain direct primary evidence.

Offer no evidence

30. In light of the Panel’s decision in relation to the hearsay application, Mr Schofield submitted that the HCPC would be offering no evidence in relation to Particulars 3b and 3c. Mr Schofield submitted that doing so would not amount to an under-prosecution as the key issue in the case relates to the Registrant’s lack of proficiency with the English language and her alleged dishonesty, and those parts of the Allegation still remain.

31. The Panel heard and accepted the legal advice of the Legal Assessor who referred to the HCPTS Practice Note ‘Discontinuance of proceedings’.

32. The Panel was satisfied that it was appropriate for the HCPC to offer no evidence in relation to Particulars 3b and 3c, as there is no realistic prospect of the HCPC proving the facts of those Particulars due to the application to rely on hearsay evidence having been rejected.

33. The Panel had regard to its options noting that it could adjourn the hearing to allow attempts to be made to contact EE and DS, to see if they would provide a witness statement and attend a subsequent hearing. However, that would involve a significant delay. The Panel had regard to its duty under the Health Professions Order 2001 which imposes a statutory obligation on panels to conduct proceedings expeditiously. The Panel did not consider that it was in the public interest to adjourn or delay the case. Furthermore, the Panel agreed with the HCPC submission that offering no evidence for Particulars 3b and 3c does not amount to an under-prosecution as the serious alleged mischief in this case relates to the Registrant’s lack of proficiency in English and her alleged dishonesty in relation to that.

Background

34. The circumstances of this case predominately take place at the Hospital.

35. In the summer of 2022, the Registrant was in touch with the Hospital, via Solent HR, in regard to its recruitment programme for employing international Occupational Therapists. Part of those discussions included reference to the Registrant undertaking the International English Language Testing System (‘IELTS’) proficiency test.

36. On 31 October 2022, the Registrant made an application to be registered as an Occupational Therapist with the HCPC. It is alleged that as part of that online application the Registrant answered ‘yes’ to the question ‘Is English your first language’.

37. The Registrant was subsequently registered and therefore able to practice using the protected title of an Occupational Therapist.

38. On 13 February 2023, the Registrant started working at the Hospital as a Band 5 Occupational Therapist. It is alleged that concerns quickly arose on her initial ward placement, where she was under the supervision of SP. These concerns centred around the ability of the Registrant to communicate in English. After a short period, the Registrant was moved to a different ward, under the supervision of PB, who also quickly had concerns regarding the Registrant’s ability to communicate in English.

39. On 14 June 2023, the Registrant’s employment with the Hospital came to an end following a probation review meeting.

40. The Registrant successfully appealed the decision on 5 July 2023 and was re-instated and assigned to the Acute Medical Unit at the Hospital. In December 2023, the Registrant resigned her position.

41. On 26 June 2023, the Hospital made a referral to the HCPC. Following preliminary enquiries by the HCPC, the matter was placed before a panel of the Investigating Committee on 15 December 2023. It determined that there was a case to answer in regard to the Registrant’s fitness to practice, based on the Allegation set out at the start of this decision document.

Evidence

HCPC

42. The HCPC called the following witnesses to give live evidence, under affirmation:

• HM
• SP
• PB

43. As the HCPC and Panel did not have any questions for CL, she was not called but her statement was incorporated into the transcript.

44. The witnesses adopted their witness statements and exhibits as their evidence in chief. They were asked supplemental questions by Mr Schofield, and some witnesses were also asked questions by the Panel, who took into account that in the Registrant’s absence it had a responsibility to test the witness accounts.

The Registrant

45. The Registrant did not provide any evidence or submissions for the hearing. The Registrant therefore had not raised any formal challenge or dispute in relation to the evidence on which the HCPC relied.

Legal Advice

46. Having heard the evidence and closing submissions, the Panel then received legal advice.

47. The Panel heard and accepted the advice of the Legal Assessor in respect of the approach to take in determining findings of facts and the burden and standard of proof. The burden of proof rests on the HCPC and it is for the HCPC to prove the Allegation. The Legal Assessor provided advice on the issues of:

• Credibility and reliability, as per the guidance in R (Dutta) v GMC [2020] EWHC 1974 (Admin), Byrne v GMC [2021] EWHC 2237 (Admin), and Hindle v NMC [2025] EWHC 373 (admin).

• Wording of the Allegation.

• Dishonesty as per the test in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67, and with reference to the HCPTS Practice Note on ‘Making decisions on a registrant’s state of mind’ dated August 2025.

• Weight of evidence including a direction on circumstantial evidence.

• Drafting decisions, as per the HCPTS Practice Note on Drafting.

Decision on Facts

1. You declared that English was your first language on your HCPC registration application form when this was not the case. Found Proved

48. The HCPC relied on the evidence of HM to seek to prove that the Registrant declared that English was her first language on her HCPC registration form.

49. In its consideration of the evidence, the Panel was confident in relying on the witness statement and exhibits of HM. The Panel placed weight on her being a professional witness who is providing a factual account and has no reason to fabricate. The Panel found her to be clear and concise in her oral testimony and to be entirely consistent with her written statement.

50. HM explains in her witness statement that:

‘Applicants applying through the international application route for HCPC registration are required to declare whether English is their first language. Those who declare that English is not their first language are required to submit English language proficiency test results. Applicants may submit the results of any language test conducted in a test centre environment. The results must meet the following criteria: a minimum score of 6.5 IELTS bands in each individual element (reading, writing, speaking, listening) and an overall score of 7.0 IELTS bands or higher.’

51. The Panel took into account the screenshots exhibited by HM which show the Registrant’s HCPC application. The screenshots show that the Registrant selected ‘yes’ in response to the question ‘is English your first language?’

52. The Panel was therefore satisfied that the Registrant had declared that English was her first language on her HCPC registration application form.

53. The HCPC sought to rely on circumstantial evidence provided by CL, PB and SP to prove that English was not the Registrant’s first language.

54. The Panel considered the evidence holistically. It took into account that the witness statement of PB states the Registrant had obtained her degree in Occupational Therapy in India. This evidence is corroborated by the exhibit to CL’s statement which is a letter from the SRM College of Occupational Therapy, India, confirming that the Registrant obtained her degree in India. PB exhibits an English Language ‘Placement Test Report’, dated 25 April 2023, which states the Registrant’s Nationality as ‘Indian’.

55. The Panel took into account the email exchanges exhibited to CL’s witness statement. These show emails between the Registrant and the recruitment agency (Solent HR) who are conducting the international recruitment. On 8 and 9 July 2022, the Registrant sends emails confirming that she has completed her IELTS exam, commenting that ‘it was tough’ and asking, ‘any other way if I am not getting the required IELTS score or else rewrite the exam.’ The Panel considered that if English was the Registrant’s first language, then why would she have been sitting the IELTS exams as they are only for international registrants for whom English is not their first language.

56. The Panel had regard to the letter of recommendation from SRM College, dated 19 September 2022, which is exhibited to CL’s witness statement. This provides an overview of the Registrant and specifically comments that ‘she is excellent in oral and written communication abilities in the English language.’ The Panel considered that it was unusual for a letter of recommendation to have commented on language proficiency, if English was the Registrant’s first language.

57. The Panel took into account the witness statement of SP and PB both of which identify that there were immediate and persistent concerns about the Registrant’s proficiency in English, such that it was felt unsafe to allow her to practise independently during her time under their supervision. The Panel noted the witness statements include examples of where the Registrant can give direct instructions to a patient but is not able to adapt her language style to expand the conversation. In the Panel’s view this reinforces the difficulties she had with the English language, as referred to by PB and SP.

58. In relation to the Registrant’s language skills, PB’s witness evidence is that in order to support the Registrant the Hospital provided 1:1 English tutoring. PB states that the Registrant sent her the IELTS results and that these low scores reflected what was seen in practice. The Panel considered that if English was the Registrant’s first language, she would have been able to meet the required scores without difficulty, particularly as by that time she had been working in the Hospital for over two months.

59. The Panel had regard to the evidence from SP who stated that she had observed the Registrant using ‘google translate’ on her phone. SP stated that this was happening multiple times each day and that the ‘Registrant was using it constantly to translate online training and patient notes.’ In response to questions in oral evidence, SP said that the concerns about the Registrant were not as a result of her being new or inexperienced, they were due to the language issues. Such was the concern that SP had raised it with her manager and with the Human Resources Team, within the Registrant’s first two weeks of employment. SP said that the Registrant did not understand the basics, and was not able to follow conversations, or engage in any depth, even in a social context such as with colleagues in the staff canteen. The Panel found it highly unlikely that this degree of concern about the Registrant’s language proficiency would have arisen if English was her first language.

60. The Panel was confident in relying on the evidence of PB, SP and CL all of whom are registered professionals, and whose concerns about the Registrant’s language skills are corroborative of each other. The Panel found the oral evidence of PB and SP to be clear and consistent with their written evidence, and there was no reason for them to fabricate. Their evidence was measured, and with close regard to the contemporaneous documents provided.

61. The Panel considered that when taking all of the above evidence holistically, it shows on balance that English was not the Registrant’s first language. Therefore, the Panel found that the Registrant declared that English was her first language on her HCPC registration application form when this was not the case.

2. Between 22 July 2022 and 21 June 2023, you were not able to communicate in English to the required standard for an Occupational Therapist, in that:

a. On one or more occasions, you reported that you were unable to understand what service users had said. Found Proved.

62. The Panel took into account the witness statement of SP. The statement, which was adopted within her oral evidence, states that:

‘The Registrant explained that the patients and I had strong accents and spoke at a fast pace and that was why she was unable to understand us…This happened on more than one occasion. I was trying to find patients without strong accents for the Registrant to speak to. I was picking patients for her who would articulate clearly and speak slowly and even then, the Registrant struggled, to fully understand the patients and would comment that the patients were speaking too fast or with strong accents. Registrant was unable to understand what was being said to them and often the patients were unable to understand what the Registrant was asking them and would look to myself for clarification.’

63. The Panel was satisfied that SP provides reliable evidence to support this Particular of the Allegation. The Panel found SP to be a reliable witness for the reasons already set out in this decision on facts. The Panel concluded that SP was well placed to give this evidence as she was directly supervising and observing the Registrant for eight hours per day across four days per week. The Panel noted that although the Registrant is reported to have said SP had a strong accent and speaks at a fast past, this is not what the Panel observed during SP’s oral evidence. The Panel found SP to be clear in her oral evidence, with no strong accent, and a steady pace of communication.

64. In relation to the stem of the Allegation, the Panel was satisfied that the dates relate to the relevant period as seen in the contemporaneous documents. Firstly, of when the Registrant was in initial communications with Solent HR regarding gaining employment at the Hospital and latterly the date of her contract at the Hospital ending following the unsuccessful probation period.

65. The Panel was satisfied that the Registrant was not able to communicate in English to the required standard for an Occupational Therapist, in that she on one or more occasions, reported that she was unable to understand what service users had said.

2. Between 22 July 2022 and 21 June 2023, you were not able to communicate in English to the required standard for an Occupational Therapist, in that:

b. On one or more occasions, you were not able to accurately summarise information provided by service users. Found Proved.

66. The Panel took into account the witness statement of SP, which describes an occasion where she saw a patient with the Registrant. SP states:

‘In one case, there was a patient that had said that he did not want to go into a nursing home and gave the reasons why. I then asked the Registrant what the patient had said and why and the Registrant said that the patient wanted to go into a nursing home, which was incorrect. The small word of "didn't" was missed which changed the understanding of the persons wishes, the patient clearly stated that they did not want to go into a Nursing Home, however the Registrant reported that this was not the case. This lack of awareness could have had a significant impact on treatment and discharge plans for patients.’

67. The Panel also had regard to the witness statement of PB, which provides four examples of occasions in which she states that the Registrant was not able to accurately summarise information provided by service users. PB states:

‘Most days I worked with the Registrant, I would have concerns about her communication and use of the English language. There were a couple of stand out incidents where I had to review at the time. The first of these was where a patient had explained to the Registrant that he had a catheter and could not feel the sensation to urinate but the Registrant took it that the patient did not want to leave hospital and wanted to go to a nursing home, which was not the case.

There was another occasion where a patient was talking about how she lived with her son and the son helped around the home. The Registrant did not write this information down and when asked what the Registrant understood about the conversation, she could not explain anything she had been told.

It was concerning as the Registrant did not understand what patients and other staff were telling her and this could have meant the wrong advice/treatment could have been given.
There were occasions where patients and family members became agitated during the communication.

There was also an occasion where a patient had talked about receiving an Alzheimer's diagnosis and the impact this would have on their life going forward. The Registrant did not pick up on this as afterwards I asked her what the patient was worried about, and she had not noticed that the patient had brought it up and the possible risk to the patient at home as result of this diagnosis.

… An example of this was a patient saying they lived in a flat, the Registrant would write down "flat" and not ask about stairs, lifts or what floor the flat was on. When I asked her for this information, she would just say the flat was on the second floor and that there was a lift, which was made up and filling the gap she had not asked the patient.’

68. The Panel relied on the evidence of both SP and PB to find this Particular of Allegation proved. In relation to both witnesses, for the reasons already set out in this decision, the Panel found them to be reliable. They provided fair and balanced evidence, which is consistent and against which no challenge has been made.

69. In relation to the stem of the Allegation, the Panel was satisfied that the dates relate to the relevant period as seen in the contemporaneous documents. Firstly, of when the Registrant was in initial communications with Solent HR regarding gaining employment at the Hospital and latterly the date of her contract at the Hospital ending following the unsuccessful probation period.

70. The Panel was satisfied that the Registrant was not able to communicate in English to the required standard for an Occupational Therapist, in that she on one or more occasions, was not able to accurately summarise information provided by service users.

2. Between 22 July 2022 and 21 June 2023, you were not able to communicate in English to the required standard for an Occupational Therapist, in that:

c. On one or more occasions, you were unable to convey information to service users in a way they could understand. Found Proved.

71. The Panel took into account the witness statement of SP which states:

‘I was also concerned with the Registrant taking patient's social histories. When a patient first comes into hospital, we ask them questions to find out about their home environment, care and support at home, whether they live in a house or bungalow, can they get on and off the toilet and other questions. I had asked the Registrant to take a social history and we would run through it with these types of questions and practiced it prior to seeing patients. A couple of questions in and the patient was looking confused at how the Registrant was phrasing the questions and I had to take over, this happened on a number of occasions. The Registrant had asked if the patient had "caretakers" to come in to look after them rather than "carers". Even when I suggested more appropriate words, she would continue to use her word for it. The Registrant would then not listen to what the patient was saying back to her as she was not understanding the description of the home the patient would give and was not accurately writing it down.’

72. The Panel also had regard to the statement of PB which states:

‘When we would then visit the patient, the Registrant would just enter and say "hello, sit in the chair" or words to that effect. The patient would not always understand what she was trying to ask from them. There was conversational tone missing and the Registrant was not explaining to the patient why we were doing the things we asked them to do. At the end of the assessment, the patient would get to the chair and the Registrant would just say "goodbye" and walk away…

There was another example of this where we had a patient with a known mental health diagnosis and the Registrant and I had a discussion as to how that might present. When we met with the patient, the Registrant was trying to get the patient to practice the stairs. Rather than explaining to the patient why, the Registrant kept repeating the same words and did not recognise that the patient was getting more agitated. The patient had not understood the Registrant and she was not adapting her communication based on what he was saying. I had to intervene to help the communication with the patient on this occasion.’

73. The Panel relied on the evidence of both SP and PB to find this Particular of the Allegation proved. In relation to both witnesses, for the reasons already set out in this decision, the Panel found them to be reliable. They provided fair and balanced evidence, which is consistent and against which no challenge has been made.

74. In relation to the stem of the Allegation, the Panel was satisfied that the dates relate to the relevant period as seen in the contemporaneous documents. Firstly, of when the Registrant was in initial communications with Solent HR regarding gaining employment at the Hospital and latterly the date of her contract at the Hospital ending following the unsuccessful probation period.

75. The Panel was satisfied that the Registrant was not able to communicate in English to the required standard for an Occupational Therapist, in that she on one or more occasions, was unable to convey information to service users in a way they could understand.

2. Between 22 July 2022 and 21 June 2023, you were not able to communicate in English to the required standard for an Occupational Therapist, in that:

d. On one or more occasions, you were unable to understand instruction from senior colleagues. Found Proved.

76. The Panel took into account the statement of SP which provides several examples of when the Registrant was unable to understand instructions from senior colleagues. SP states:

‘There were also occasions where the Registrant would not appear to understand instructions I was giving her. One example is that I would tell her to not forget to pick up the catheter from the bed when mobilising a patient. Our patients are often catheterised and so if they were going to be mobilised, the catheter would need to be carried. The Registrant would still try to mobilise the patient with the catheter attached to the bed and I had to intervene to unhook it. This happened on a couple of occasions. The Registrant did not appear to see this as a problem, and they could have caused damage and pain to the patient if the catheter had been pulled out as a result.

There were also occasions where the Registrant would grab a patient by the arm when mobilising and I had told her a number of times that we did not do that. The Registrant did not take this instruction on board and continued to do this.’

77. The Panel was satisfied that SP provides reliable evidence to support this Particular of the Allegation. As already set out in this decision, the Panel found SP to be a reliable witness and concluded that SP was well placed to give this evidence as she was directly supervising and observing the Registrant.

78. In relation to the stem of the Allegation, the Panel was satisfied that the dates relate to the relevant period as seen in the contemporaneous documents. Firstly, of when the Registrant was in initial communications with Solent HR regarding gaining employment at the Hospital and latterly the date of her contract at the Hospital ending following the unsuccessful probation period.

79. The Panel was satisfied that the Registrant was not able to communicate in English to the required standard for an Occupational Therapist, in that she on one or more occasions was unable to understand instruction from senior colleagues.

2. Between 22 July 2022 and 21 June 2023, you were not able to communicate in English to the required standard for an Occupational Therapist, in that:

e. You did not attain the minimum required level on International English Language Testing System (IELTS) assessments and/or equivalent assessments. Found Proved.

80. The Panel took into account the statement of PB which set evidence that the Hospital had arranged for a language tutor to assist the Registrant with her English. PB states that she was in contact with the Registrant’s tutor who sent her the IELTS results. The Panel had regard to the contemporaneous exhibit which is the English Language Placement Test report. This states the Registrant as the candidate and that the test was undertaken on 25 April 2023. 

81. The Panel had regard to whether these results achieved the minimum required level. It took into account the evidence of PB who states:

‘When [the results] came through, I discussed them with the Registrant and explained that they were lower scores than we would have hoped for and lower than what was needed for HCPC registration. I told her that we were going to need to get her some language courses to improve the scores. The fact that the scores were lower reflected what we had seen in practice.’

82. The Panel noted that PB’s evidence that these results did not reach the minimum level required is corroborated by the statement of HM, who states that the results must meet the following criteria: a minimum score of 6.5 IELTS bands in each individual element (reading, writing, speaking, listening) and an overall score of 7.0 IELTS bands or higher. The Panel noted that HM also exhibits the guidance from the HCPC website for online applications which sets out this requirement.

83. Taking into account the evidence of PB and HM and relying on their evidence for the reasons already set out in this decision, the Panel found this Particular of Allegation proved.

84. In relation to the stem of the Allegation, the Panel was satisfied that the dates relate to the relevant period as seen in the contemporaneous documents. Firstly, of when the Registrant was in initial communications with Solent HR regarding gaining employment at the Hospital and latterly the date of her contract at the Hospital ending following the unsuccessful probation period.

85. The Panel was satisfied that the Registrant was not able to communicate in English to the required standard for an Occupational Therapist, in that she did not attain the minimum required level on International English Language Testing System (IELTS) assessments and/or equivalent assessments.

3. You did not mobilise service users in a safe and effective manner, in that: a. On 27 April 2023, you mobilised Service User A, who had an open wound to their heel. Found Proved.

86. The Panel had regard to the witness statement of PB, who states that ‘on 27 April 2023 and related to Service User A, who had an open wound on her foot. I read the notes and told the Registrant that the patient had an open wound and that she needed specialist footwear and a dressing before she could weight bare through this foot. The following day, the dressing and footwear had not been actioned so I told the Registrant that we could not help the patient walk as the dressing and footwear had to be provided first. The Registrant was keen to speak with the patient, so I suggested she go and get a social history from the patient, but to make sure that she does not get out of bed. This had been communicated to the Registrant twice. When I came back to see how the Registrant had got on, the Registrant was writing on the patient's notes that the patient had gotten out of bed and the Registrant had assisted them to walk across the room. The doctors had been due to visit Service User A to come up with a plan on whether their foot needed to be amputated. Walking Service User A could have potentially put more trauma on the limb, meaning that more would have to be removed.’

87. The Panel noted that in relation to his incident PB had completed a contemporaneous diary note and had submitted a Hospital Incident Report at the time, due to the serious nature of the incident. PB had exhibited both of the contemporaneous documents and in the Incident Report, PB notes the root cause as an ‘error due to misunderstanding’.

88. The contemporaneous documents reflected PB’s witness statement and for the reasons already outlined in this decision, the Panel was confident in relying on the evidence of PB.

89. The Panel was satisfied based on the evidence of PB that the Registrant did not mobilise service users in a safe and effective manner, in that, on 27 April 2023, she mobilised Service User A, who had an open wound to their heel.

4. Your conduct in relation to particular 1 was dishonest because you knew that English was not your first language when you made the declaration. Found Proved.

90. The Panel considered the oral and written evidence and took into account the legal test of dishonesty as set out within case law and the HCPTS Practice Note. The Panel first considered what the actual state of the Registrant’s knowledge or belief was as to the facts in which the alleged dishonesty arose. The Panel then went on to consider the question of whether the conduct was honest or dishonest by applying the objective standards of ordinary decent people with full knowledge of the facts of the case.

91. The Panel considered any surrounding evidence speaking to what the Registrant knew or believed about what they were doing, what was expected in the circumstances, and any evidence relating to the Registrant’s understanding of the wider context.

92. The Panel took into account the statement of CL. This sets out that the Hospital had taken a collaborative international recruitment exercise with other local NHS Trusts. This process was managed by Solent HR. CL’s witness statement states that:

‘The Registrant had been in contact with Solent HR regarding her IELTS exams. I was made aware of these documents when I submitted the referral to the HCPC. A copy of the correspondence is exhibited at Exhibit CL/01. From the emails, the Registrant had stated she had found the exam tough. Solent HR then pushed her to the HCPC website for the English language requirements.

At that point, the Registrant provided two documents relating to her English level and that her qualification course was delivered in English. A copy of these documents is produced at Exhibit CL/02.’

93. The Panel had careful regard to the contemporaneous documentation provided by CL. The email chain between the Registrant and Solent HR starts on 7 July 2022, with the Registrant asking for help with the process and stating ‘Please help me…I need a job tats y I am striving this much’ [sic].

94. On 8 July 2022, the Registrant emails Solent HR stating, ‘I did my ielts speaking today. Ittu was tough. [sic]’ Solent HR reply to say ‘fingers crossed for a positive result – please let us know once you have your results’.

95. On 9 July 2022, the Registrant emails Solent HR stating, ‘I completed my ielts exam...and it was bit tough...any other way if i am not getting the required ielts score.or else rewrite the exam.’

96. On 11 July 2022, Solent HR reply to the Registrant providing the specific link to the HCPC website registration/getting on the register/international applications/English language, which they state, ‘outlines all routes of English Language proficiency for HCPC.’

97. On 11 July 2022, the Registrant sends two responses, the first stating ‘Kk tnku...i will inform you when the result came or can resit for the exam [sic]’ and the second, ‘If its not getting good scores? Shall I resit the exam?’

98. On 12 July 2022, Solent HR reply stating, ‘Please let us know once your results are through and we can discuss at that point – thank you.’

99. On 22 July 2022, the Registrant replies to confirm that her IELTS result ‘overall its just 6’. She also provides the breakdown of each result.

100. The Panel took into account the HCPC guidance exhibited to HM’s statement which in the Panel’s view provides clear guidance to HCPC applicants about language proficiency. It makes clear that ‘you should only indicate English is your first language if it is the main or only language you use on a day-to-day basis’. It further states that, ‘if English is not your first language then you must provide proof of your English language proficiency. Applicants whose first language is not English and who are required to provide a language test certificate as evidence of their proficiency must ensure that it is, or is comparable to, IELTS level 7.0 with no element below 6.5…’

101. The Panel had regard to the screenshots of the Registrant’s HCPC application which states that it was received by the HCPC on 31 October 2022.

102. Based on the above evidence, the Panel inferred that the Registrant made a purposeful act to join the HCPC Register. It was clearly important to her given the tone of her emails and that she was ‘striving’ for this.

103. The Panel took into account that the actual application was made on 31 October 2022, which was close in time after her correspondence with Solent HR who were conducting the recruitment for the Hospital. Therefore, the Registrant was already in the process of trying to secure a role with the Hospital and was aware that HCPC registration was required to secure a position.

104. The Panel took into account that if English was the Registrant’s first language, then she would not have needed to undertake the IELTS. The Panel inferred from the fact that she was undertaking them, that English was not her first language. Furthermore, Solent HR was aware that the Registrant was undertaking the IELTS. Given Solent HR’s knowledge of the HCPC requirements, which they directed the Registrant to, it is likely they would have told her that she did not need to complete the exams, if they knew that English was her first language, but this was not the case.

105. The Panel paid close regard to the tone of the emails and the questions contained within them. It is clear that the Registrant was finding the IELTS tough and it can be inferred that she knew that specific scoring was required for the HCPC because she explicitly states, ‘any other way if i am not getting the required ielts score.’ Furthermore, the Panel inferred that the Registrant would have been aware of the required scores needed for HCPC registration, firstly as she had been provided with the link to the HCPC guidance which specifies the required scores and secondly because when she sends her results she states, ‘its just 6.’ The Panel considered the use of the word ‘just’ signifies that the Registrant knew it was below the score of 7 which was required.

106. The Panel considered that based on the information before it, as set out above, that by the time of making her online HCPC application in October 2022, the Registrant’s knowledge and belief was that she had an insufficient IELTS result for HCPC registration.

107. The Panel considered that the Registrant would have been fully aware that if she indicated that English was not her first language, the registration would have required her to upload her IELTS results, which were below the score required, and therefore her registration would have been unsuccessful. The Panel inferred from the information before it that the only way for the Registrant to get the Occupational Therapist role which she was seeking in the UK, was for her to select ‘Yes’ to the question ‘Is English your first language’, because doing so would bypass the requirement to upload any proof of English language proficiency. The Registrant therefore declared that English was her first language on her HCPC registration application form when this was not the case.

108. The Panel concluded that taking into account the Registrant’s understanding of the circumstances, as set out above, an ordinary decent person would find the conduct as dishonest. The Panel considered that deliberately answering a question incorrectly to hide the truth, particularly on such an important and significant application, would be held to be dishonest upon an objective test.

Decision on Grounds

Submissions

109. Mr Schofield submitted that the dishonest conduct found in relation to Particulars 1 and 4 amounts to serious professional misconduct, and that dishonest conduct is always deemed as serious given the implications for public trust and confidence.

110. Mr Schofield submitted that whilst the Allegation is pleaded as Particulars 2 and 3 amounting to misconduct and/or lack of competence, the HCPC’s primary submission is that they are misconduct.

111. Mr Schofield submitted that the findings made in relation to Particulars 2 and 3 are linked to the Registrant’s lack of proficiency in the English language. He submitted that in acting as she did in declaring English to be her first language, when this was not the case, she placed herself in the position of undertaking an Occupational Therapist role in the UK, knowing that she did not have the requisite skills to do that job due to her lack of proficiency in the English language.

112. Mr Schofield submitted that the Registrant’s approaches to her role are more indicative of behaviour amounting to misconduct. In terms of the Registrant’s communication issues, witness PB provided evidence about the Registrant making information up, in order to cover up her language issues. The example given by PB was of a patient saying they lived in a flat, and PB stated that ‘the Registrant would write down "flat" and not ask about stairs, lifts or what floor the flat was on. When I asked her for this information, she would just say the flat was on the second floor and that there was a lift, which was made up and filling the gap she had not asked the patient.’

113. Mr Schofield submitted that the Registrant also responded to a challenge by PB about her misunderstanding of language by screwing up patient notes. In relation to Service User A, PB states ‘I then prompted the Registrant that this should not have happened. She appeared surprised that I had told her not to mobilise Service User A, as if it was new information when it was not. The Registrant then began to screw up her notes, which I had to tell her she could not do and that it still had to be documented.’

114. Mr Schofield submitted that the above examples are not the hallmark of someone who is in the deep end but is doing all they can to put patients first. He submitted that this conduct is an example of someone who is placing themselves as the priority. Mr Schofield submitted that based on the personal culpability of the Registrant the conduct at Particulars 2 and 3 can better be categorised as misconduct rather than a lack of competence.

115. Mr Schofield submitted that the facts relating to Particulars 2 and 3 do not show any direct evidence of patient harm occurring. However, the risk posed by the Registrant due to her lack of proficiency in the English language, were such that during the relevant period, the Hospital did not allow her to practise without direct clinical oversight in order to ensure patient safety. He submitted that even with the direct oversight, there is evidence of the Registrant’s conduct having a negative impact on patients who did not feel they were being understood, and who were upset by the Registrant’s approach.

116. Mr Schofield submitted that the Registrant had breached a number of HCPC Standards of conduct, performance and ethics including:

1-Promote and protect the interests of service users and carers, which includes:

‘Treat service users and carers with respect’

‘Make sure you have consent’

2 - Communicate appropriately and effectively, which includes:

‘Communicate with service users and carers’

‘Work with colleagues’

117. Mr Schofield invited the Panel to consider all the Standards, submitting that it may consider that others are also engaged given the fundamental issue in this case being the lack of English language proficiency.

118. Mr Schofield also referred the Panel to the HCPC Standards of Proficiency for Occupational Therapists. He submitted that in acting as she did, the Registrant was in breach of Standard 8 which is ‘be able to communicate in English to the standard equivalent to level 7 of the International English Language Testing System, with no element below 6.5’.

119. Mr Schofield submitted that the Registrant’s conduct was not minor, it related to a fundamental part of safe and effective practice and thus her conduct fell far below the expected Standards, such that it crosses the threshold of misconduct.

120. Mr Schofield submitted that if the Panel found Particulars 2 and 3 amount to misconduct then it was not required to consider lack of competence. However, if it was not with him in relation to misconduct, then it should consider whether Particulars 2 and 3 amount to a lack of competence.

121. Mr Schofield submitted that the Registrant was a Band 5 and that her actions are unacceptably low in accordance with what is expected.

Legal Advice

122. The Panel heard and accepted the advice of the Legal Assessor in relation to Misconduct. The Legal Assessor referred the Panel to the case of Roylance v GMC (no.2) [2000] AC 311 and Nandi V GMC [2004] EWHC 2317 (Admin) and to the HCPC Standards. The Legal Assessor advised that there was no settled definition of misconduct, and it was for the Panel to say in the circumstances of the case whether the behaviour, if found proven, crossed the threshold properly to be categorised as misconduct. The Panel could approach the question by deciding whether an act or omission on the part of the Registrant represented a serious falling short of the standards to be expected of a HCPC registrant. However, it is important to note that not every omission or wrongdoing necessarily constitutes misconduct.

123. In relation to lack of competence, the Legal Assessor advised on the differences between the statutory grounds, with reference to the case of Calhaem v GMC [2007] EWHC 2606 (Admin), R (remedy UK ltd) v GMC 2010 EWHC 1245 (Admin), and R(Valin) v GOC 2011 EWHC 310 (Admin).

Decision

124. The Panel at all times kept in mind the HCPC’s overarching objective of protecting the public which includes protecting services users, protecting public confidence in the profession and the regulatory process, and declaring and upholding proper standards of conduct and behaviour.

125. The Panel took into account the Standards which were in place at the time to which the Particulars of Allegation relate. The Panel bore in mind that a departure from the Standards alone does not necessarily constitute misconduct.

126. The Panel first considered Particulars 1 and 4 which are interlinked, as dishonesty was pleaded as a secondary element in relation to the Registrant’s actions in Particular 1. The Panel concluded that the Registrant’s conduct in dishonestly declaring in her HCPC application that English was her first language when this was not the case, fell far below the standards expected of a registered Occupational Therapist. The Panel determined that the Registrant’s conduct was in breach of the HCPC Standards of Conduct, Performance and Ethics (2016), in particular standard:

‘9 Be honest and trustworthy

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

9.2 You must be honest about your experience, qualifications and skills.

127. The Panel considered that the Registrant’s actions in dishonestly declaring that English was her first language also breached the HCPC Standards of Proficiency, namely standard 8.2 ‘be able to communicate in English to the standard equivalent to level 7 of the International English Language Testing System, with no element below 6.5.’

128. In relation to the dishonesty, the Panel considered that the Registrant’s conduct was premeditated and was a positive deliberate action to circumvent the HCPC requesting her IELTS results, as she knew that she had not achieved the required pass marks for registration.

129. The Panel concluded that this is serious dishonesty, as the English language requirements for registration with the HCPC are in place to ensure public safety and quality of care. By dishonestly declaring that English was her first language, the Registrant deprived the HCPC an opportunity to consider her IELTS results which would have shown that she had not met the required standard, and thus her registration would have been unsuccessful. The Registrant’s actions prevented the HCPC from ensuring public protection in accordance with the overarching objective, and the HCPC relied on the Registrant’s declaration. Dishonesty of this nature towards her own regulator, erodes public trust in the profession and the HCPC.

130. The Panel concluded that the Registrant’s conduct demonstrated a disregard for the regulator and for the trust that is placed in registered Occupational Therapists who are expected to act with honesty and integrity.

131. The Panel next considered Particular 2, which is directly concerned with the Registrant’s inability to communicate in English to the required standard for an Occupational Therapist. The Panel took into account that this failure to communicate directly impacted on colleagues and patients to such an extent that during the Registrant’s employment from February 2023 to June 2023, she was unable to practise autonomously due to the significant risks she posed to patient safety.

132. The Panel had in mind that this occurred within the context of the Registrant dishonestly gaining registration with the HCPC by falsely declaring that English was her first language. The Registrant knew that she did not have the required standard of English language to enable her to safely practice as an Occupational Therapist in the UK. Nonetheless, for her own personal and financial gain, she commenced her role at the Hospital. Her inability to communicate in English language, which encompassed listening, oral, and written work, led to a risk of harm to patients and colleagues. The risk was largely mitigated because of the significant concerns identified by SP and PB, who therefore ensured that the Registrant was not permitted to practise autonomously, in order to preserve patient safety.

133. Given the level of concerns raised by SP and PB, there was an opportunity for the Registrant to acknowledge early on in her employment that she was having significant difficulties due to her not having the required standard of English, which she knew was the case having made the dishonest declaration on her HCPC application. She could and should have acknowledged that this lack of ability to communicate in English to the required standard was causing a risk to patients and colleagues. However, the Registrant did not take the opportunity to raise this. Instead, she continued to work in the Hospital and was unable to understand what patients said, was unable to accurately summarise information, was unable to convey information and was unable to understand instructions from colleagues.

134. The Panel found that such conduct is a departure from what is expected of a registered Occupational Therapist, falling far below the Standards expected.

135. The Panel considered that the Registrant’s conduct in not being able to communicate in English to the required standard breached Standard 8 of the Standards of Proficiency, which is being able to communicate effectively. The Panel found that due to not being able to communicate in English to the required standard, the Registrant’s actions essentially breached the majority of the Standards of Proficiency and the Standards of conduct, performance and ethics. That is because the Standards as a whole are based on the fundamental principles of Occupational Therapists having the correct qualifications and a minimum required standard of English and therefore encompass all aspects. By way of examples, without an ability to communicate effectively in English, the Registrant was not able to promote and protect the interest of service users, she was not able to work autonomously, she was not able to manage risk, and she was not able to report concerns about safety. In order to meet these standards, an ability to communicate in English to the required level is needed, and the Registrant knew she did not meet that requirement. In conclusion the Panel considered the conduct at Particular 2 does amount to serious professional misconduct.

136. In relation to Particular 3, the Panel considered for much the same reasons as in Particular 2, that this conduct does amount to misconduct. Whilst it was a single incident of not mobilising a service user in a safe and effective manner, the wider and persistent context of the Registrant’s inability to communicate in English to the required standard, is at the heart of the conduct. The Registrant was told by PB on two occasions not to get Service User A out of bed, but despite this the Registrant assisted Service User A to walk across the room. Service User A was a very vulnerable patient who was at risk of having their foot amputated. The Registrant’s actions could have potentially put more trauma on the patient’s limb, meaning that more of the foot would have to be removed. The Registrant’s communication issues meant that she did not act to safeguard the patient and did not follow PB’s instructions.

137. The Registrant’s conduct was such that she did not manage risk, she did not communicate appropriately and effectively, and she did not promote and protect Service User A’s interests. The Registrant therefore breached multiple sections of the HCPC Standards of Conduct, Performance and Ethics.

138. In conclusion, the Panel found that the facts of the Allegation which were proved, individually and collectively, do amount to serious professional misconduct, such to amount to the statutory ground of misconduct.

139. Having found that all matters amount to the statutory ground of misconduct, the Panel did not go on to consider the statutory ground of lack of competence.

Decision on Impairment 

Submissions

140. Mr Schofield submitted that patients could have been harmed by the Registrant’s actions. Mr Schofield submitted that the Registrant’s actions were a significant failing in the standards expected of a registered Occupational Therapist.

141. Mr Schofield submitted that the dishonesty in this case is serious. He submitted that whilst a lack of proficiency in English language may be remediable, the dishonesty in this case is not easily remediable.

142. Mr Schofield submitted that there has been no engagement from the Registrant in this hearing process and thus no evidence to explain why she took the actions she did. There is no evidence of insight or remediation, and therefore the risk of repetition is high. Mr Schofield submitted that the Panel should find the Registrant personally impaired.

143. Mr Schofield submitted that the conduct would lead to a material loss in public confidence if a finding of impairment were not made. The Registrant essentially sought to bypass the HCPC process of ensuing registrant’s have sufficient proficiency in English to protect the public and ensure Standards are met. He submitted that a finding of impairment on the public component should also be made.

Legal Advice

144. The Panel heard and accepted the advice of the Legal Assessor in relation to impairment. The Legal Assessor reminded the Panel should have regard to both the personal and public components and keep in mind the wider public interest. The Legal Assessor referred the Panel to the HCPTS Practice Note ‘Fitness to Practise Impairment’ dated August 2025. The Panel was referred to the cases of, CHRE v (1) NMC & (2) Grant [2011] EWHC 927 (Admin), Cohen v GMC [2008] EWHC 581 (Admin), and GMC and Armstrong [2021] EWHC 1658 (Admin).

Decision

145. The Panel considered the Registrant’s current fitness to practise firstly from the personal component and then from the wider public component. In considering its decision on impairment, the Panel made an assessment of seriousness based on its findings in relation to facts and misconduct.

146. The Panel considered that the findings in this case are serious for a number of reasons. The requirement to have the relevant standard of proficiency in English language is so intrinsic to safe and effective practice that by not having it, the Registrant placed herself in a position whereby she departed from expected professional conduct and standards of proficiency to a significant extent.

147. The Registrant’s deliberate, dishonest conduct in deceiving the HCPC, placed patients at risk of harm. It also placed colleagues at risk as they should be able to rely on the conduct and competence of the Registrant, but they were unable to do so. The concerns about the Registrant’s lack of proficiency with the English language were so great that she was unable to practice independently. This had an adverse effect on SP and PB, as well as other colleagues in the Hospital, who had to directly oversee the Registrant’s work at all times, thus impacting on the delivery of care and safe practise. The dishonest conduct resulted in the Registrant bypassing declaring her IELTS results and thus essentially deceiving her regulator. The HCPC’s overarching objective is to protect the public, including the wider public interest, and the Registrant’s dishonest actions undermined this, as she bypassed the system which is in place to ensure public safety.

148. The Registrant continued in practice at the Hospital from February 2023 to June 2023, even though she knew that she did not have the required standard of English and knowing that this was therefore directly impacting on her ability to communicate.

149. Having considered the evidence in the case and the context as found, the Panel was unable to find any mitigating features. There was nothing to suggest that any of this conduct occurred other than for the Registrant’s own personal and financial gain.

150. In relation to the personal component, in accordance with the HCPTS Practice Note (Impairment), the Panel considered whether the conduct in this case is easily remediable, whether it has been remedied and whether it was highly unlikely to be repeated.

151. The Panel considered that a shortcoming in English language proficiency is remediable. However, the Panel kept in mind that concerns that raise questions of character such as the dishonesty in this case, may be harder to remediate. The Panel had regard to its findings that the Registrant’s conduct was premediated and deliberate. Having falsely declared English as her first language, thus securing HCPC registration, the Registrant had then started her role at the Hospital knowing that she did not have the required standard of English. The Registrant continued to work during this four-month period, despite the significant communication issues. The Registrant received extensive support from the Hospital, but she did not acknowledge or accept, save for on a very superficial level in discussion with PB, that she was not able to meet the standards and was thereby placing patients and colleagues at risk of harm. The Panel considered that the apparent disregard for the impact on patients and colleagues, to ensure her own personal and financial gain, suggested an attitudinal issue.

152. The Panel next had regard to whether the Registrant’s misconduct has been remedied. The Panel had no evidence before it to indicate that the Registrant has any insight into her misconduct. The bundle included a reflection document produced by the Registrant in May 2023, in relation to her mobilising a patient. The Panel considered the Registrant’s reflection to be of poor quality. It was superficial and did not analyse the issue which had occurred or set out how a recurrence could be prevented, save to say, ‘communicate more efficiently’. The Panel noted that there has been no reflective document provided to the HCPC in relation to the Allegation. In finding a lack of insight, the Panel also factored in the Registrant’s failure to engage with the regulatory process, in that she had failed to attend the hearing and there had been only limited correspondence from her which simply detailed that she would not be attending the hearing.

153. In relation to remorse, the Panel had no evidence that the Registrant has expressed any remorse for her actions, save for on a very superficial level during her probation meeting. The Registrant’s responses to the Hospital about the concerns raised are based on her belief that she had learned from her previous mistakes and is improving. The responses are centred on the impact that the issues are having on her, not the risk her actions pose to patients and colleagues.

154. The Panel had no evidence of any remediation. The Registrant has not provided any evidence of whether she is currently working in paid or unpaid employment. It appears from her correspondence with the HCPC in 2024, that she has left the UK and does not intend to return. Although the Registrant did receive a positive reference from her SRM College, this dates back to September 2022 and relates to the Registrant’s application to join the HCPC Register. The reference was written before these proceedings were commenced and therefore does not comment on the Registrant’s misconduct or fitness to practise. The Panel therefore placed no weight on this reference.

155. The Panel considered whether the misconduct was likely to be repeated by the Registrant. The Panel took into account all it had read and heard about the misconduct. Given its finding that the Registrant has shown no insight and has not remediated the Panel concluded that the risk of repetition remains high.

156. The Panel decided that on the personal component the Registrant’s fitness to practise is currently impaired on the grounds of her misconduct.

157. The Panel next considered whether a finding of current impairment was necessary in the public interest. The Panel was mindful that the public interest encompassed not only public protection but also the declaring and upholding of proper standards of behaviour as well as the maintenance of public confidence in the profession. It took into account the guidance in the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin) at paragraph 74:- ‘In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.’

158. The Panel had regard to the factors identified by Dame Janet Smith in her 5th Shipman Report and cited in CHRE v (1) NMC and (2) Grant. The Panel considered whether:

a- The Registrant has in the past and/or is liable in the future to place service users at unwarranted risk of harm.

b- The Registrant has in the past brought and/or is liable in the future to bring the profession into disrepute.

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

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

159. In relation to a), the Panel determined that the Registrant had placed patients and colleagues at unwarranted risk of harm. Such was the level of risk related to her lack of proficiency with the English language that she was not permitted by the Hospital to practise independently.

160. In relation to b), that is the question of whether the Registrant has in the past brought the profession into disrepute, the Panel determined she had. A significant aspect of public interest is upholding proper standards of conduct and behaviour so as not to bring the profession into disrepute. The role of the HCPC Standards is to set out in general terms how registrants are expected to behave and outline what the public should expect from their health and care professional. In breaching such a significant amount of the HCPC Standards, as already set out within this decision, the Registrant has brought the profession into disrepute.

161. The Panel then considered c), being whether the Registrant had breached fundamental tenets of the profession. The Panel took into account that it is essential to the effective delivery of the service that the public can trust Occupational Therapists to be honest and to comply with the Standards which are fundamentally in place to ensure patient and colleague safety. In acting as she did, in dishonestly declaring that English was her first language, and thereafter being unable to communicate to the required level, the Registrant completely undermined the regulator and the safety of the public for her own gain. The Panel considered that the conduct, as described, demonstrated a serious breach of the fundamental tenets of the profession.

162. The Panel then considered d), being whether the Registrant had acted dishonestly. The Panel found that she had behaved dishonestly, in making the pre-meditated and deliberate decision to declare that English was her first language, when she knew this was not the case.

163. The Panel asked itself, given the nature of the Allegation and the facts found proved, would public confidence in the profession and how it is regulated be undermined if there were to be no finding of impairment?

164. Based on its findings in relation to the unwarranted risk of harm, the bringing the profession into disrepute, the breaching of the fundamental tenets of the profession, and the dishonesty, the Panel concluded that public confidence would be undermined if there were to be no finding of impairment. The Panel considered that not to make a finding of current impairment of fitness to practise in relation to the misconduct would seriously undermine public trust and confidence in the profession and would fail to uphold and declare proper standards.

165. The Panel therefore decided on the public component of impairment that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction

Submissions

166. Mr Schofield addressed the Panel on the approach it should take in relation to its decision on sanction, with reference to the HCPC Sanctions Policy (March 2019) (‘the Policy’).

167. Mr Schofield submitted that based on the evidence and the Panel’s findings to date, there are no mitigating factors for the Panel to take into account.

168. In relation to aggravating features of the case, Mr Schofield submitted that there was a pattern of behaviour as the Registrant’s inability to communicate to a proficient standard of English impacted her clinical practice at the Hospital. Mr Schofield submitted that the Registrant had no insight and had not remediated and there remains a risk of repetition of her conduct. He submitted that there is very little evidence that she has taken a step back and reflected on her practice.

169. Mr Schofield submitted that there had been a risk of patient harm caused by the Registrant’s misconduct. He submitted that the lack of proficiency in the English language is at the heart of everything within the Standards and therefore there was an associated risk to patients as a result.

170. Mr Schofield referred the Panel to the sections within the Policy which refer to serious cases. He submitted that the Registrant’s conduct could be seen as a breach of trust given the negative impact it had on her Hospital colleagues. In relation to the dishonesty, he submitted that whilst it was a sole act of dishonesty, its effect was ongoing and prolonged. Furthermore, the Registrant did not admit to her conduct, knowing the natural consequences that would follow. Her dishonesty was a premeditated, positive and deliberate action. He submitted that the Panel should consider this to be at the higher end of the spectrum of dishonesty.

171. In relation to Conditions of Practice, Mr Schofield submitted that these are less likely to be appropriate in dishonesty cases.

172. In relation to a Suspension Order, Mr Schofield submitted that the concerns do represent a serious breach of the Standards, but that the Registrant has no insight, is likely to repeat the misconduct, and is unlikely to be able to resolve or remedy her failings.

173. Mr Schofield submitted that this case relates to serious dishonesty and the sanction imposed should ensure it reflects the maintenance of the public interest, including confidence in the profession and upholding of standards. Mr Schofield submitted that public trust would be errored if a registrant could subvert the registration process and not be sufficiently sanctioned.

Legal Advice

174. The Panel heard and accepted the advice of the Legal Assessor, who referred it to the Policy, which states that any sanction must be proportionate, is not intended to be punitive and should be no more than is necessary to meet the legitimate purposes of providing adequate protection to the public, to protect the reputation of the profession, maintain confidence in the regulatory system and declare and uphold proper professional standards.

175. The Legal Assessor reminded the Panel that its primary function at this stage is to protect the public, while deciding what, if any, sanction is proportionate, taking into account the wider public interest and the interests of the Registrant. In respect of the Panel’s findings at grounds and impairment, the Legal Assessor drew the Panel’s attention to the paragraphs on seriousness, including dishonesty, which starts on page 16 of the Policy.

Decision

176. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity. The Panel considered the mitigating and aggravating factors in determining what sanction, if any, to impose.

177. Taking into account its earlier findings, the Panel could not identify any mitigating factors, which might indicate a reduced ongoing risk to patient safety.

178. Taking into account its earlier findings, the Panel identified the following aggravating factors:

• The Registrant’s dishonest conduct was premeditated and was a positive deliberate action to circumvent the HCPC requesting her IELTS results, as she knew that she had not achieved the required pass marks for registration. This resulted in her obtaining personal and financial gain.

• Whilst the dishonesty in the HCPC application was a single event, the consequences of that dishonesty were such that the Registrant was able to secure access to the HCPC Register, and therefore a role as an Occupational Therapist at the Hospital. Her inability to communicate in the English language led to a risk of harm to patients and colleagues. Despite the significant issues caused by her dishonesty, the Registrant did not take the opportunity to admit that she did not have the required standard of English language proficiency to be registered on the HCPC Register.

• The Registrant breached the trust placed in her as a registered Occupational Therapist by her colleagues and patients. The Registrant worked at the Hospital as a HCPC registered Occupational Therapist whilst knowing that she did not have the required level of English language proficiency to be registered and had made a false declaration on her HCPC application. Her dishonest conduct and lack of proficiency in the English language meant that she was not working in partnership with her colleagues. Her misconduct had an adverse effect on her colleagues in the Hospital, who had to directly oversee her work at all times, thus impacting on the delivery of care and safe practise.

• The Registrant’s dishonest conduct placed vulnerable service users and colleagues at risk of harm. This harm was only mitigated because the Registrant was not allowed to practise autonomously. Even with direct oversight, the Registrant placed a vulnerable service user at risk by mobilising them despite repeated instructions not to.

• The Registrant has not provided any evidence of insight, remorse or apology.

• There is a lack of remediation, and the Registrant has failed to engage with these proceedings.

179. The Panel started by considering the least restrictive sanction first, working upwards only where necessary. It took into account that the final sanction should be a proportionate approach and will therefore be the minimum action required to protect the public.

180. Due to the serious nature of the misconduct found in this case, which includes dishonesty, the Panel considered that neither mediation nor taking no further action would not be appropriate.

181. The Panel next considered whether a Caution Order would be appropriate. The Panel considered that a Caution Order would not be in accordance with the Policy which states: ‘A caution order is likely to be an appropriate sanction for cases in which: the issue is isolated, limited, or relatively minor in nature.’ The Registrant’s misconduct was not isolated, it was not limited, nor was it relatively minor in nature. It involved premediated and deliberate dishonest conduct, which led to her gaining employment as a registered Occupational Therapist at the Hospital. Within that role she continued to conceal her dishonesty and was not able to communicate in English to the required standard, which led to multiple issues and placed patients and colleagues at risk of harm.

182. The Policy also states that a Caution Order is likely to be an appropriate sanction for cases in which there is: ‘a low risk of repetition; the registrant has shown good insight, and the registrant has undertaken appropriate remediation’. The Panel considered its earlier decision on impairment and kept in mind it had not found a low risk of repetition, it had not found the Registrant to have good insight, nor did it find that she had remediated. In the circumstances the Panel considered that the Registrant’s misconduct was too serious for a Caution Order, and such a disposal would be contrary to the Policy.

183. The Panel next considered whether to impose a Conditions of Practice Order. The Panel took into account the Policy which states that:

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

Conditions are also less likely to be appropriate in more serious cases, for example those involving:

Dishonesty

Failure to work in partnership’

184. The Panel found that the Registrant has not shown insight and that she has not engaged in the fitness to practice hearing process. Further, she has had serious misconduct findings made against her by the Panel, which include dishonest conduct which led to her inappropriately obtaining HCPC registration. The Panel found that the Registrant’s conduct was not minor, rather that it was serious. The dishonest conduct had serious implications as it allowed her to gain employment at the Hospital as an Occupational Therapist when she did not have the requisite proficiency in English language to meet the necessary professional Standards. This led to risk of harm for colleagues and patients.

185. The Panel kept in mind its decision on impairment, and that it had found that there is a risk that dishonest misconduct, which appears attitudinal in nature, will be repeated given the lack of insight and remediation. The Panel considered that a Conditions of Practice Order would not be sufficient to address and safeguard members of the public from the risks of the Registrant’s misconduct.

186. Taking all the above factors into account the Panel concluded that a Conditions of Practice Order would not be appropriate.

187. The Panel next considered a Suspension Order. The HCPC Sanctions Policy states:

‘A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register.’

188. The Panel was mindful that it had found that the facts proved represent a serious breach of multiple sections of the HCPC Standards. It had found no insight from the Registrant in relation to her misconduct and had found that there is a high risk of repetition of the dishonest conduct.

189. The Panel had regard to whether it had any evidence before it to suggest that the Registrant is likely to be able to resolve or remedy their failings. The Panel took into account its earlier finding that due to the apparent attitudinal issues, it would be extremely difficult for the Registrant to adequately remediate the misconduct. The Registrant has not undertaken remediation nor has she evidenced any insight. The Panel considered that all these factors together indicate that the Registrant is unlikely to be able to resolve or remedy her attitudinal failings.

190. The Panel reminded itself, as per paragraphs 56-59 of the Policy, that:

‘Dishonesty undermines public confidence in the profession and can, in some cases, impact the public’s safety.

Dishonesty, both in and outside the workplace, can have a significant impact on the trust placed in those who have been dishonest, and potentially on public safety. It is likely to lead to more serious sanctions.’

191. In this case, the Panel considered the Registrant’s dishonesty to be at the higher end of the spectrum. The dishonesty was premediated and deliberate. By dishonestly declaring that English was her first language, the Registrant deprived the HCPC of an opportunity to consider her IELTS results which would have shown that she had not met the required standard, and thus her registration would have been unsuccessful. The Registrant’s actions prevented the HCPC from ensuring public protection in accordance with the overarching objective, and the HCPC relied on the Registrant’s declaration. Dishonesty of this nature towards her own regulator, erodes public trust in the profession and the HCPC. The dishonesty was further compounded because as a result of being a HCPC registered Occupational Therapist the Registrant was employed by the Hospital and she thereby placed patients and colleagues at risk as she was not able to communicate in the English language to the standard required.

192. The Panel took into account that Occupational Therapists hold positions of trust, and a key aspect of their role is communication. The role often requires them to engage with vulnerable patients as well as communicate with multi agency professional healthcare colleagues. The misconduct found in this case, risks seriously undermining the public trust and confidence in Occupational Therapists. Within healthcare, honesty and integrity are vital for the health and safety of patients. The Registrant’s actions were completely contrary to this.

193. The Panel considered that the misconduct in this case was of such a serious nature that the requirements of public protection and the wider public interest would not be adequately served by imposing a Suspension Order.

194. The Panel, having decided a Suspension Order did not protect the public nor meet the wider public interest, decided that the proportionate order was a Striking Off Order.

195. The Panel took into account the Policy and noted that a Striking Off Order is a sanction of last resort and should be reserved for those categories of cases where there is no other means of protecting the public and the wider public interest. The Panel decided that the Registrant’s case falls into this category because of the serious, and deliberate nature of the dishonest conduct towards the regulator and the associated risk which that created with her inability to communicate to the required standard of English in her role at the Hospital. The Registrant showed a disregard for the impact on patients and colleagues, placing her own personal gain over the health and safety of patients and colleagues. These factors combined with the Registrant’s lack of insight, the high risk of repetition and the apparent unwillingness to resolve matters led the Panel to conclude that any lesser sanction would undermine public trust and confidence in the profession and would be insufficient to protect the public. The Panel also considered that a Striking Off Order in this case would act as a deterrent to others, making clear that dishonesty to the regulator, whose role it is to ensure public safety, will not be tolerated.

196. The Panel had regard to proportionality and balanced the public interest against the Registrant’s interests. The Panel took into account the consequential personal, financial and professional impact a Striking Off Order may have upon the Registrant. These consequences are likely to be mitigated because the Registrant is no longer in the UK and has indicated that she is not going to return. In any event the potential consequences to the Registrant are significantly outweighed by the Panel’s duty to give priority to public protection and the wider public interest.

197. The Panel concluded that the appropriate and proportionate order is a Striking Off Order.

 

Order: The Registrar is directed to strike the name of Manna Reji from the Register on the date this order comes into effect.

 

Interim Order

Application

198. Mr Schofield submitted that if the Panel imposed a restrictive sanction, then it should move on to impose an Interim Order to cover the appeal period.

199. Mr Schofield submitted that the Notice of Hearing letter (26 August 2025) includes a paragraph informing the Registrant of the Panel’s powers to impose an Interim Order. Mr Schofield submitted that this is evidence that the Registrant has been afforded an opportunity of appearing before the Panel and being heard on the question of whether an Interim Order should be made.

200. Mr Schofield submitted that the Panel should proceed in the Registrant’s absence as she has waived her right to be present at the hearing and has been consistent in her correspondence with the HCPC that she would not be attending a hearing. Mr Schofield submitted that for the reasons outlined at the commencement of the hearing, the Panel should proceed in the Registrant’s absence.

201. Mr Schofield submitted that an Interim Order is necessary given the findings made by the Panel at the impairment stage. He submitted that there remains a risk to public protection and that public confidence would be undermined if an Interim Order were not in place.

202. Mr Schofield submitted that if a substantive Conditions of Practice Order is imposed then the Interim Order should be for Interim Conditions of Practice to mirror the substantive order. He submitted that if a Suspension Order or Strike Off is imposed, then the Panel should impose an Interim Suspension Order.

203. The Panel heard and accepted the advice of the Legal Assessor that it has the power to make an Interim Order if it considers it is necessary for public protection or otherwise in the public interest. The Panel was referred to the Sanctions Policy and the HCPTS Practice Note on Interim Orders. The Legal Assessor advised the Panel that as the Registrant was not present it had, in accordance with the HCPTS Practice Note, first to decide whether to proceed in the absence of the Registrant.

Panel Decision

204. Having made its decision on sanction, the Panel considered the Interim Order application. The Panel decided that it was appropriate to consider whether to make an Interim Order in the absence of the Registrant. In reaching this conclusion, the Panel took into account the contents of the Notice of Hearing sent to the Registrant, on 26 August 2025, where it is stated, ‘Please note that if the Panel finds that it is necessary to do so, it may also impose an interim order (under Article 31 of the Health Professions Order 2001) at any stage during the hearing. An interim order suspends or restricts a registrant’s right to practise with immediate effect.’ The Panel was satisfied this meant the Registrant was on notice that this was a possible outcome at this hearing.

205. The Panel remained satisfied that the Registrant had waived her right to be present at the hearing for the same reasons given for proceeding with the final hearing in her absence, as already detailed within this decision. The Panel could see no reason to adjourn the hearing in order to allow the Registrant to participate on a later date because there was no indication that she would do so on any other occasion. The Panel took into account the fact that it had identified there to be a continuing risk to the public if the Registrant were allowed to practise without restriction and decided it was clearly in the public interest to consider whether to make an Interim Order today, even if that meant it was conducted in the absence of the Registrant.

206. The Panel considered that the Interim Order is necessary in light of the risks to the public and the wider public interest identified in the substantive decision, most significantly, the ongoing risk of the dishonest misconduct. The Panel decided that an Interim Conditions of Practice Order would be sufficient to protect the public for the same reasons that it was not an appropriate sanction. The Panel therefore found that an Interim Suspension Order should be imposed. The Panel considered a duration of 18 months was appropriate and proportionate given the length of time an appeal may take to be decided by the High Court, if an appeal is made.

Interim Suspension Order

The Panel made an Interim 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.

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

History of Hearings for Manna Reji

Date	Panel	Hearing type	Outcomes / Status
12/01/2026	Conduct and Competence Committee	Final Hearing	Struck off