Mr Alexander Fawcett

: Physiotherapist

: PH105798

: Final Hearing

Date and Time of hearing:10:00 01/11/2016 End: 17:00 04/11/2016

: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Suspended

Allegation

Allegations (as amended)

During the course of your employment as a Physiotherapist at Medway NHS Foundation Trust between 21 January 2015 and 14 September 2015, you:

1. Did not complete your probationary period during which there were concerns regarding:

a. your note keeping, in that you;

i. completed patient notes with illegible handwriting on at least four occasions between March 2015 and May 2015

ii. completed patient notes with spelling errors on at least three occasions between March 2015 and May 2015

iii. did not structure your patient records according to the ‘whole systems’ approach on more than one occasion between March 2015 and May 2015

iv. did not include the patient’s subjective history in the patient’s records on more than one occasion between March 2015 and May 2015

v. failed to demonstrate adequate clinical reasoning in the patient records on more than one occasion between March 2015 and May 2015

vi. problem lists consistently lacked sufficient detail

b. your assessment skills, in that you:

i. during your probation period frequently did not complete comprehensive whole systems assessments;

ii. on at least two occasions in or around April 2015, stated that two unidentified patients chests were clear, yet on assessment both patients had significant loads of sputum

iii. did not link patient history and then adapt your assessment skills accordingly.

iv. on 19 and 20 May 2015 failed to auscultate the lower zones of the lungs of Patient 1 on two occasions and Patient 2 on one occasion.  

c. your use of monitoring during treatment sessions, in that you:

i. on an unknown date in April 2015, removed monitoring equipment from an unidentified patient and instructed the unknown patient to sit at the side of the bed.

ii. on an unknown date and in relation to an unidentified patient, took a blood pressure despite the patient being stable for several days;

iii. on an unknown date and in relation to an unidentified patient, did not reconnect an HDU patient back to the ECG monitoring equipment.

d. your identification of patient problems, in that you;

i. on 19 May 2015, failed to identify the circumstances of when a troponin blood test is required in relation to Patient 1

ii. on 19 May 2015, failed to identify that Patient 1 had metabolic alkalosis

e. your clinical reasoning, in that on 20 May 2015 you used technical terms incorrectly

f. your treatment selection, in that you;

i. on one or more occasion in or around April and May 2015 did not alter treatment plans according to the patient’s needs

ii. did not prepare bed space adequately

iii. did not sufficiently frequently provide patients with exercises for their trunk;

iv.  on 21 April 2015 did not return a patient’s table within reach of an unidentified HDU patient

v. on 21 April 2015 left Oxygen cylinders by an unidentified HDU patient’s bed

vi. on or around May 2015  needed to be prompted regarding the safe placement of a catheter when treating an unknown patient

vii. on 19 May 2015 selected an inappropriate treatment for Patient 1

g. your communication skills, in that you:

i. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient age;

ii. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient needs;

iii. on more than one occasion between March 2015 and May 2015 raised your voice unnecessarily to patients;

iv. on more than one occasion between March 2015 and May 2015 inappropriately tapped patients on their leg.

2. The matters set out in paragraph 1 constitute lack of competence.

3. By reason of your lack of competence your fitness to practise is impaired.

Finding

Preliminary matters:

Service

1. The Panel was satisfied that the Notice of Hearing had been properly served on the Registrant at his registered address, in good time.

Proceeding in Absence

2. Ms Chaker on behalf of the HCPC submitted that matters should proceed in the absence of the Registrant.  The Panel was told that the Registrant had communicated with the HCPC via an email of 17 October 2016, and indicated that:
“I feel it is best that I do not attend as even with support I still feel that it   would be detrimental to myself.  So I will not attend the final hearing.”
Further, in a letter of 30 September 2016, the Registrant had provided submissions for the Panel to consider.

3. Ms Chaker invited the Panel to proceed in the absence of the Registrant who she submitted had voluntarily absented himself.

4. The Panel exercised its discretion regarding proceeding in the absence of the Registrant with the utmost care and caution.  It had regard to the submissions of the HCPC and the correspondence from the Registrant and it accepted the advice of the Legal Assessor, including reference to case law and was guided by the HCPC’s revised practice note on Proceeding in the Absence of the Registrant. In the absence of any request by the Registrant for an adjournment, and without any indication that an adjournment would secure his future attendance, the Panel was satisfied that this was a voluntary and deliberate absence and that the hearing could proceed. Care would be taken to ensure that the hearing was fair, taking into account the Registrant’s submissions, and making no adverse inference from the Registrant’s absence. 

Amending allegation

5. Ms Chaker applied to make amendments to the Allegation, some of which had been notified to the Registrant and some of which had not.

6. The Panel accepted the advice of the Legal Assessor and took account of the need to consider fairness to both parties.  The Panel was mindful that the Registrant was aware of the majority of the changes that the HCPC wanted to make and had not raised any objection.  Where the changes suggested today did not change the case materially as regards substance, the Panel permitted the amendments.

7. The Panel made it clear that all the amendments requested were permitted except for one additional stem which would have introduced a new element that the Registrant had not been made aware of.

8. The Panel further amended the wording of the stem of allegation 1 of its own volition to more accurately reflect the Registrant’s situation at the Trust.

Background

9. The Registrant commenced employment as a newly qualified Band 5 Physiotherapist at Medway NHS Foundation Trust (“the Trust”) on 21 January 2015.  There was both a formal and informal training programme in place for him.  This included regular one-to-one supervisions, weekly training sessions, plus additional ‘on-call’ training.  His informal training included a ‘running commentary’ at the patient’s bedside where he was asked to talk through his assessment and treatment as he was completing it.  He was also given a ‘rotation workbook’ to complete, to record his progress, and signed a Probationary document outlining expectations over a six month period.

10. Early in the Registrant’s probation period, various concerns were raised by staff in relation to his lack of progress.  Most concerns about the Registrant’s performance were raised with his line manager, Witness 1, by colleagues, in the course of face-to-face conversations. Some she learned from the notes of his supervision sessions.  As a result, the Registrant was invited to a meeting with Witness 1 on 7 April 2015, in which a range of concerns were raised in the areas of:

a.         Clinical reasoning/assessment skills/treatment skills

b.         Clinical notes

c.         Communication

d.         Teaching and learning opportunities

e.         Poor perceived attitude.
 
11. Following this informal meeting, and acting on the advice of Human Resources, Witness 1 decided to implement the Trust’s probationary policy procedure for performance management.  This was to identify objectives and provide appropriate support to ensure that the Registrant completed his probationary period and could be confirmed in post.  This was communicated to the Registrant on 14 April 2015.

12. Regular meetings regarding these objectives were held with the Registrant.  Such was the concern at these objectives not being met in a timely manner, that the Registrant was removed from the on call rota, due to his inability to practise safely without supervision. 

13. On 25 May 2015, the Registrant informed Witness 1 about some health problems he was experiencing which meant that he was unable to work. She advised him to contact his GP, occupational health, his union representative, and peers.  At the end of the discussion, the Registrant decided he was not well enough to work and went home. Initially, the Registrant was signed off work by his GP until 3 June 2015. On 4 June 2015, he was referred to Occupational Health which he attended on 16 June; a phased return to work plan was recommended.

14. The Registrant was due to return to work on 1 July 2015; he did not do so and was signed off sick until 21 July. From his return to work at the Trust on 22 July, until his resignation on 14 September, the Registrant worked for a total of 4 days.  The Registrant was due to attend a final probationary meeting on that date, but submitted his resignation shortly before the meeting.

15. As a result of the concerns which had not been remedied in the course of his probationary period, the Trust referred the Registrant to the HCPC.  The Registrant has engaged with the regulatory process.  On 6 March 2016, the Registrant returned to the HCPC a signed Notice to Admit Facts, and thereafter has been in correspondence with the HCPC.

Facts

16. The Panel accepted the advice of the Legal Assessor. The Panel applied the principles that the burden of proving the facts is on the HCPC, that the Registrant does not have to prove anything and that the case is only to be decided on the evidence before it.

17. The Panel heard live evidence from the following witnesses called by the HCPC:

a. Witness 1, who was responsible for the performance management process

b. Witness 2, who supervised the Registrant on 19 and 20 May 2015.

18. The Panel found both witnesses to be experienced practitioners who gave credible evidence and said when they were unable to remember certain events.

19. On behalf of the HCPC, the Panel was also presented with witness statements for both witnesses that were called, as well as exhibits including contemporaneous notes made by the Registrant’s mentors, team leader, Witness 1, and Witness 2, as well as other staff.  Also included in the exhibits were examples of the Registrant’s handwritten clinical notes and electronic patient records.

20. On behalf of the Registrant, testimonials from the Registrant’s current employer and his fiancée, and certificates that attest to completion of courses in dementia care and medication were provided, along with written representations.

HCPC Submissions
21. Ms Chaker submitted that the facts were proved by:

i. the statement and oral evidence of Witness 1 who was responsible for the performance management process;

ii. the statement and oral evidence of Witness 2 who supervised the Registrant on 19 and 20 May 2015;

iii. contemporaneous notes made by the Registrant’s mentors, team leader, Witness 1, and Witness 2;

iv. the Registrant’s admissions;

v. copies of patients’ notes made by the Registrant.


22. She further submitted that if the Panel finds the facts proved, it should also find the Registrant’s fitness to practise impaired by reason of lack of competence. 

Registrant’s Submissions

23. The Registrant’s submissions had been provided in documentary form.  He made a number of admissions but indicated that he was newly qualified and had never completed a respiratory placement. He indicated that he struggled within the team, and was under pressure from having been put on probation policy performance measures. He said that he was unable to complete his objectives due to his illness.

Panel Determination on Facts

1 Did not complete your probationary period during which there were concerns regarding:

1 (a) your note keeping, in that you;

1 (a) (i) completed patient notes with illegible handwriting on at least four occasions between March 2015 and May 2015

24. The Panel heard from Witness 1 that other team members had concerns about the Registrant’s handwriting.  The Panel was taken to notes recording these concerns.

• The Band 7, day to day team leader had written: “Alex to continue to write clearly + bigger and to ensure…his notes are accurate as his clinical notes are not currently meeting legal requirements.”

• An assigned mentor to the Registrant had noted that his: “handwiting still needs work”. 

25. The Panel considered samples of the Registrant’s handwritten notes for the following dates: 21 and 25 April and 6, 12, 18, 19 and 20 May. In many places, the Panel struggled to read the notes in their entirety.  In the Notice to Admit Facts which he completed on 6 March 2016, the Registrant has admitted that his patient records were consistently illegible.

Found proved.

1 (a) (ii) completed patient notes with spelling errors on at least three occasions between March 2015 and May 2015

26. The Panel heard from Witness 1 that the Registrant was given the formal objective of “Reduced typing errors.”  The Panel was taken to the Registrant’s typed notes in which there were a number of words that were not spelt accurately.  It appeared that these were uncorrected typographical errors; Witness 1 confirmed that no automatic spell-check facility was available on this electronic patient note system.  The Registrant has admitted that his patient records frequently included spelling errors.

Found proved.

1 (a) (iii) did not structure your patient records according to the ‘whole systems’ approach on more than one occasion between March 2015 and May 2015

27. The Panel heard from Witness 1 that the ‘whole systems’ approach is one that is used at the Trust. It involves a holistic approach to patient assessment whereby all body systems and aspects of a patients wellbeing and health are considered.  Witness 1 explained to the Panel in her oral evidence that where the Registrant did indicate a body system in his record, for example “MSK” for musculo-skeletal issues in one patient’s notes, he did not record a comprehensive assessment of this body system which should include range of movement, muscle power, pain and mobility. The Registrant consistently failed to consider all body systems in his records, examples of this were witnessed by the Panel in all the presented patient notes. The Registrant submitted that he was confused because he had been given a variety of different structures to follow. The Panel accepted the evidence of Witness 1 that numerous attempts were made to support the Registrant in respect of this without any improvement.

Found proved.

1 (a) (iv) did not include the patient’s subjective history in the patient’s records on more than one occasion between March 2015 and May 2015

28. In her witness statement Witness 1 indicated that team members were concerned about the lack of subjective history in the Registrant’s notes.  In her oral evidence Witness 1 confirmed that the subjective history would involve the patient’s own perception of how they felt and what had happened.  The Registrant’s notes on 21 April and on 12 May were seen by the Panel; they did not include the patient’s subjective history in either case. The Registrant has admitted this particular.

Found Proved.

1 (a) (v) failed to demonstrate adequate clinical reasoning in the patient records on more than one occasion between March 2015 and May 2015

29. Witness 1 indicated both in her witness statement and in her oral evidence that the Registrant did not demonstrate adequate clinical reasoning. The Panel was shown patient notes completed by the Registrant on 21 April 2015 where he identified decreased air entry and decreased mobility, but failed to identify what should be done or why there was a problem with the patient’s mobility. The Registrant has admitted that his patient notes consistently did not include clinical reasoning.

Found proved.

1 (a) (vi) problem lists consistently lacked sufficient detail.

30. Witness 1 indicated that the Registrant’s patient notes did not include sufficient detail in problem lists.  In relation to these, Witness 1 said that, “the treatment and problems do not fully collaborate, for example he has taught leg exercises but his problem list does not mention any concerns with lower limb strength.” The Panel was shown these patient notes completed by the Registrant on 12 May 2015. The Panel was also shown other patient notes he completed which did not contain any problem lists.  The Registrant has admitted this particular.

Found proved.

1 (b) Your assessment skills, in that you:

1 (b) (i) during your probation period frequently did not complete comprehensive whole system assessments

31. The Panel noted that the evidence in relation to this particular was the same as for particular 1 (a) (iii) above. The Panel heard from Witness 1 that if assessments are not recorded they are deemed not to have been carried out. The Registrant has admitted this particular.

Found proved.

1 (b) (ii) on at least two occasions in or around April 2015, stated that two unidentified patients chests were clear, yet on assessment both patients had significant loads of sputum

32. Witness 1 gave evidence that the Registrant listened to both patients chests and said that they were clear. She said that when she then checked the patients, she heard that both their chests were not clear. The Registrant has made admissions in this regard.

Found proved.

1 (b) (iii) did not link patient history and then adapt your assessment skills accordingly.

33. Witness 1 gave evidence that often, the Registrant did not even take or acknowledge the patient history. He did not adapt his assessment according to specific patients, nor link this with individual histories.  She said that he treated people the same whether they were “40 or 80” and asked the same questions of each patient. The Panel saw examples of the Registrant’s patient notes from 21 April and 12 May 2015 that were missing a patient history. The Registrant submitted that “where I noticed in the patient’s history something that could impact on my assessment, sought advice from doctors to gain a full history of the patient’s condition to determine what assessment was appropriate to carry out”. The Panel considered that this example did not address this particular, being only one example of the Registrant gathering further medical information. He does not go on to say how he then adapted his assessment.

Found proved.

1 (b) (iv) on 19 and 20 May 2015 failed to auscultate the lower zones of the lungs of Patient 1 on two occasions and Patient 2 on one occasion.

34. Witness 2 gave evidence that on 19 May, she asked the Registrant to auscultate Patient 1. This is the examination of a patient’s lungs with a stethoscope, listening to each area of the lungs. She saw that he did not check the lower area of the chest and said to him that she did not think he had checked the bases of the lungs. He replied that he had listened to all the areas he needed to. Witness 2 said she then showed him how to do a correct auscultation, but the next day he again failed to listen to the bases of Patient 1’s lungs. She said that she again prompted him to do so. However approximately two hours later, he failed to listen to the bases of Patient 2’s lungs until prompted.

Found proved.

1 (c)  your use of monitoring during treatment sessions, in that you:

1 (c) (i) on an unknown date in April 2015, removed monitoring equipment from an unidentified patient and instructed the unknown patient to sit at the side of the bed.

35. Witness 1 in her evidence explained that this High Dependency Unit (HDU) patient was being asked to sit up on the bed for the first time. He had been unwell and any exercise would increase the body’s oxygen requirement and therefore close monitoring was required. The Registrant should have seen this from reading the patient notes.  Witness 1 said that she did “jump in quick” when the monitoring equipment was removed because “it should not have been done.”  The Registrant in his written submissions disputed that he had done anything wrong because he had watched other physiotherapists remove monitoring equipment briefly in getting other patients to a sitting position from a reclining position and had intended to reattach it immediately but did not get the chance. Witness 1 indicated that each patient should be assessed individually and treatment adjusted to meet their need. The fact that this had been done with others did not mean it was suitable for all patients. This reflects the Registrant’s lack of awareness of appropriate monitoring.

Found proved.

1 (c) (ii) on an unknown date and in relation to an unidentified patient, took a blood pressure despite the patient being stable for several days;

36. Witness 1 explained that the patient had been stable and there was nothing to suggest that they needed increased monitoring, but the Registrant still took their blood pressure. She said that this could, “increase their concerns”. The Registrant has admitted this particular.

Found proved.

1 (c) (iii) on an unknown date and in relation to an unidentified patient, did not reconnect an HDU patient back to the ECG monitoring equipment.

37. Witness 1 explained that the Registrant had appropriately disconnected the monitoring equipment during treatment, but then did not reconnect the patient back to the ECG monitoring equipment afterwards. This happened in her presence. The Registrant has admitted this particular.

Found proved.

1 (d) your identification of patient problems, in that you;

1 (d) (i) on 19 May 2015, failed to identify the circumstances of when a troponin blood test is required in relation to Patient 1

38. Witness 2 gave evidence that the Registrant told her that a troponin blood test is required, as a matter of, “routine, if there had been chronic cardiac failure.” He did not appear to appreciate that the test would be done, “if a specific coronary event had been suspected.” She said that it was important to understand this, as if the test indicated a recent cardiac event, the patient would be left in bed and not asked to do anything strenuous. The Registrant has admitted that there were concerns regarding his identification of patient problems.

Found proved.

1 (d) (ii) on 19 May 2015, failed to identify that Patient 1 had metabolic alkalosis

39. Witness 2 told the Panel that the Registrant, when looking at the patient results, had initially simply repeated the diagnosis he had been told on nursing handover. On being asked to consider the data, he was able to then correctly identify the condition that the patient had.

Found proved in as much as the Registrant failed to independently identify that Patient 1 had metabolic alkalosis without prompting

1 (e) your clinical reasoning, in that on 20 May 2015 you used technical terms incorrectly

40. Witness 2 told the Panel that the Registrant did not appear to be able to use technical terms correctly, for example, when asked what the consequence may be of mobilising a patient with bradycardia, he said “heart failure”, when what he meant was “collapse”. Heart failure is a recognised chronic illness and is not the same as collapse. Confusing technical medical terminology could mislead other healthcare and medical professionals. Witness 2 said that there were other similar examples throughout the day.

Found proved.

1 (f) your treatment selection, in that you;

1 (f) (i) on one or more occasion in or around April and May 2015 did not alter treatment plans according to the patient’s needs;

41. Witness 1 told the Panel that the Registrant tended to “just walk patients”. He failed to consider other treatment options determined by the patient presentation. The Registrant has admitted that he did not reflect patient needs in his treatment plans.

Found proved.

1 (f) (ii) did not prepare bed space adequately

42. The examples given by the HCPC in support of this particular are the same as those given below in relation to 1 (f) (iv) and 1 (f) (v). Accordingly this particular is found proved for the same reasons.

Found proved.

1 (f) (iii) did not sufficiently frequently provide patients with exercises for their trunk;

43. Witness 1 told the Panel that when a patient has been in hospital a long time with minimal movement, their trunk gets weak. It is important for a physiotherapist to focus on helping the patient strengthen their trunk before providing other treatment. Witness 1 said that the Registrant did not include any treatment for the trunk when seeing patients. She said that even when prompted he struggled to think of suitable exercises. The Registrant has admitted this particular.

Found proved.

1 (f ) (iv) on 21 April 2015 did not return a patient’s table within reach of an unidentified HDU patient;

44. Witness 1 said that she was with the Registrant when he moved a patient’s table out of reach whilst treating them but did not return it to its former position.  The Registrant said in his written submissions that he had been asked by a nurse to leave it where it was as she needed to “get to the patient and would return the table”.  Witness 1 said that she was in the bed space at the time and did not see such an exchange.  She agreed that it could have occurred elsewhere, although she said it was unlikely that the nurse would have asked this away from the bed space. In any event, it is clear that the Registrant did not return the table within the reach of the patient.

Found proved

1 (f) (v) on 21 April 2015 left Oxygen cylinders by an unidentified HDU patient’s bed;

45. Witness 1 in her witness statement recounts an episode in which the Registrant failed to return oxygen cylinders to their rack after he had used them with the patient. She said this was an obvious safety hazard. The Registrant in his written submissions said that this was not intentional. In any event, it is clear that the Registrant left the oxygen cylinders by the patient’s bed.
Found proved.

1 (f) (vi) on or around May 2015 needed to be prompted regarding the safe placement of a catheter when treating an unknown patient

46. Witness 1 explained to the Panel that it is important that a catheter is placed safely lower than the patient so that gravity enables urine to drain away properly, and output can be monitored. She said that on two occasions she had had to prompt the Registrant to put a patient’s catheter back safely. The Registrant has admitted this particular, although he states in his written submissions that this was a genuine mistake that he did not repeat.

Found proved.

1 (f) (vii) on 19 May 2014 selected an inappropriate treatment for Patient 1

47. Witness 2 in her witness statement set out that Patient 1 had reduced lung volumes, possibly due to a sputum load. The Registrant suggested hyperinflation as a suitable treatment.  Witness 2 stated that this was an inappropriate treatment to suggest as it is impractical to use on a non-ventilated patient such as Patient 1.

Found proved.

1 (g) your communication skills, in that you:

1 (g) (i) on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient age;

48. Witness 1 gave evidence that the Registrant did not adapt his style, and made no distinction between patients who were “40 or 80”, asking the same questions of them all. This particular is disputed by the Registrant, but he did not provide any examples of how he adapted his communication style to the age of the patient.

Found proved.

1 (g) (ii) on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient needs;

49. Witness 1 gave evidence that the Registrant really struggled to communicate with patients who were cognitively impaired. She said that a number of colleagues had given similar feedback, including a Band 7 physiotherapist who stated that he “struggles to adapt his communication from patient to patient”. The Registrant has disputed this particular but has not provided any examples of how he adapted his communication style to patient needs.

Found proved

1 (g) (iii) on more than one occasion between March 2015 and May 2015 raised your voice unnecessarily to patients;

50. Witness 1 recounted how the Registrant had panicked and shouted at a patient who was cognitively impaired. The Registrant in his written submissions acknowledged that on occasions he had raised his voice to patients, as a result of the pressure he was under, or because a patient raised their voice to him. The Panel does not accept that it was necessary for the Registrant to raise his voice in these circumstances.

Found proved.

1 (g) (iv) on more than one occasion between March 2015 and May 2015 inappropriately tapped patients on their leg.

51. Neither Witness 1 nor Witness 2 said they had witnessed the Registrant inappropriately tapping patients on their leg.  Witness 1 indicated that she had been told by another member of staff that he had done this, which they felt, “could come across as patronising”.  The Registrant did indicate that he did have a natural trait of placing a hand on a person’s knee to express empathy and sympathy, and had witnessed other therapists doing this, but was careful to recognise when this would be inappropriate. He said that, “After receiving feedback that this was inappropriate I did not do this again, but then was told that I was coming across as unsupportive.” There is no direct witness evidence that the Registrant inappropriately tapped patients on their leg.

Not proved.

Statutory Grounds and impairment

HCPC Submissions

52. Ms Chaker on behalf of the HCPC submitted that if the Panel finds the fact proved, it should also find the Registrant’s fitness to practise impaired by reason of lack of competence.

53. Ms Chaker submitted that the Registrant’s inadequacies were pervasive and covered a wide range of skills, from basic skills to those that should have been easily developed over his probationary period.  His improvements were isolated and not on-going.  She said that if he had a health issue from his first day working at the Trust, he did not mention it to his managers.  She invited the Panel to consider that it was work which had overwhelmed him, having made insufficient progress with a risk of losing his job.  She said that his ill health was attributable to his failings of competence, rather than vice versa. 

54. Ms Chaker said that the necessary standards for physiotherapists at the time that the Registrant was practising the profession had not been met, and this demonstrated a lack of competence.

55. Ms Chaker submitted that should the panel find this ground made out, it is invited to go on to consider the question of whether the Registrant’s fitness to practise is impaired considering both the ‘personal component’ and the ‘public component’ as set out in the HCPC Practice Note on ‘Finding that Fitness to Practise is “Impaired”’.  She said the Registrant has provided no detail of the coping strategies that he would use in the future. She questioned whether his insight has developed since he had worked with the Trust and she highlighted a lack of evidence of any remediation of his failings.

Registrant’s Submissions

56. The Registrant’s submissions had been provided in documentary form.  He accepts that as a newly qualified Band 5 physiotherapist he made mistakes but does not accept that his fitness to practise is impaired.  The Registrant submits that he has learned from his mistakes and has tried to use the feedback he was given.  Since leaving the Trust he has worked as a healthcare assistant in a care home with people with mental illness and dementia, and more recently as a Band 3 Therapy Support Worker on hospital ITU and surgical wards.

Panel Determination on Grounds

57. The Panel accepted the advice of the Legal Assessor and was guided by the relevant HCPC practice notes. It took into account the submissions of both parties and the evidence before it. The Panel found that the facts found proved cover many different areas. The Registrant did not always keep full and legible patient notes. This meant that physiotherapists and other healthcare professionals were not able to be clear about his assessment or treatment. This may have had direct impact on the continuity of patient care and could have resulted in treatments being repeated or not progressed appropriately.

58. The Registrant did not always carry out comprehensive and accurate assessments. Again this would have impacted on patients and colleagues. His failure to properly auscultate Patient 1 and Patient 2, and his inability to identify that two other patients had significant sputum load, could have put these patients at risk. His inability to correctly monitor a number of patients could also have put them at risk.

59. The Registrant’s inability to communicate effectively with patients would have made it difficult for him to establish effective working relationships with them, and to assess and treat them appropriately.

60. The Panel finds that the Registrant has breached the following HCPC Standards of Proficiency for Physiotherapists:

1 be able to practise safely and effectively within their scope of practice

1.1 know the limits of their practice and when to seek advice or refer to another professional

3 be able to maintain fitness to practise

3.1 understand the need to maintain high standards of personal and professional conduct

3.3 understand both the need to keep skills and knowledge up to date and the importance of career-long learning

4 be able to practise as an autonomous professional, exercising their own professional judgement

4.1 be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem

4.2 be able to make reasoned decisions to initiate, continue, modify or cease techniques or procedures, and record the decisions and reasoning appropriately

4.3 be able to initiate resolution of problems and be able to exercise personal initiative

4.4 recognise that they are personally responsible for and must be able to justify their decisions

8 be able to communicate effectively

8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues and others

8.3 understand how communication skills affect assessment and engagement of service users and how the means of communication should be modified to address and take account of factors such as age, capacity, learning ability and physical ability

8.4 be able to select, move between and use appropriate forms of verbal and non-verbal communication with service users and others

8.5 be aware of the characteristics and consequences of verbal and non-verbal communication and how this can be affected by factors such as age, culture, ethnicity, gender, socio-economic status and spiritual or religious beliefs

9 be able to work appropriately with others

9.3 understand the need to engage service users and carers in planning and evaluating diagnostics, and therapeutic interventions to meet their needs and goals

9.4 be able to contribute effectively to work undertaken as part of a multi-disciplinary team

9.5 understand the need to agree the goals, priorities and methods of physiotherapy intervention in partnership with the service user

10 be able to maintain records appropriately

10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines

12 be able to assure the quality of their practice

12.6 be able to evaluate intervention plans using recognised outcome measures and revise the plans as necessary in conjunction with the service user

12.8 be able to evaluate intervention plans to ensure that they meet the physiotherapy needs of service users, informed by changes in circumstances and health status

13 understand the key concepts of the knowledge base relevant to their profession

13.4 understand the structure and function of the human body, together with knowledge of health, disease, disorder and dysfunction, relevant to their profession

13.5 understand the theoretical basis of, and the variety of approaches to, assessment and intervention

13.6 understand the following aspects of biological science:

– normal human anatomy and physiology, including the dynamic relationships of human structure and function as related to the neuromuscular, musculoskeletal, cardio-vascular and respiratory systems

– patterns of human growth and development across the lifespan

– factors influencing individual variations in human ability and health status

– how the application of physiotherapy can cause physiological and structural change

13.7 understand the following aspects of physical science:

– the principles and theories from physics, biomechanics, applied exercise science and ergonomics that can be applied to physiotherapy

– the means by which the physical sciences can inform the understanding and analysis of movement and function

– the principles and application of measurement techniques based on biomechanics or electrophysiology

– the application of anthropometric and ergonomic principles

13.8 understand the following aspects of clinical science:

– pathological changes and related clinical features commonly encountered in physiotherapy practice

– physiological, structural, behavioural and functional changes that can result from physiotherapy intervention and disease progression

– the specific contribution that physiotherapy can potentially make to enhancing individuals’ functional ability, together with the evidence base for this

– the different concepts and approaches that inform the development of physiotherapy intervention

13.9 understand the following aspects of behavioural science:

– psychological, social and cultural factors that influence an individual in health and illness, including their responses to the management of their health status and related physiotherapy interventions

– how psychology, sociology and cultural diversity inform an understanding of health, illness and health care in the context of physiotherapy and the incorporation of this knowledge into physiotherapy practice

– theories of communication relevant to effective interaction with service users, carers, colleagues, managers and other health and social care professionals

– theories of team working

14 be able to draw on appropriate knowledge and skills to inform practice

14.2 be able to deliver and evaluate physiotherapy programmes

14.3 be able to gather appropriate information

14.4 be able to select and use appropriate assessment techniques

14.5 be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment

14.6 be able to undertake or arrange investigations as appropriate

14.7 be able to analyse and critically evaluate the information collected

14.8 be able to form a diagnosis on the basis of physiotherapy assessment

14.9 be able to demonstrate a logical and systematic approach to problem solving

14.10 be able to use research, reasoning and problem solving skills to determine appropriate actions

14.11 be able to formulate specific and appropriate management plans including the setting of timescales

14.12 be able to apply problem solving and clinical reasoning to assessment findings to plan and prioritise appropriate physiotherapy

14.13 recognise the need to discuss, and be able to explain the rationale for, the use of physiotherapy interventions

14.14 be able to set goals and construct specific individual and group physiotherapy programmes

14.15 be able to conduct appropriate diagnostic or monitoring procedures, interventions, therapy, or other actions safely and effectively

14.16 be able to select, plan, implement and manage physiotherapy interventions aimed at the facilitation and restoration of movement and function

14.17 know how to position or immobilise service users for safe and effective interventions

14.18 be able to select and apply safe and effective physiotherapy-specific practice skills including manual therapy, exercise and movement, electrotherapeutic modalities and kindred approaches

15 understand the need to establish and maintain a safe practice environment

15.1 understand the need to maintain the safety of both service users and those involved in their care 

15.4 be able to work safely, including being able to select appropriate hazard control and risk management, reduction or elimination techniques in a safe manner and in accordance with health and safety legislation

15.6 be able to establish safe environments for practice, which minimise risks to service users, those treating them and others, including the use of hazard control and particularly infection control

61. The Panel is satisfied that the Allegation represents a fair sample of the Registrant’s work during his probation period.

62. Accordingly, the Panel finds that the facts found proved amount to a lack of competence.

Panel Determination on Impairment

63. In considering impairment, the Panel has taken into account that the purpose of these procedures is not to punish the Registrant for past misdoing but to protect the public against the acts and omissions of those who are not fit to practise. The Panel is of the view that the Registrant repeatedly failed to take on board the suggestions for improving his performance, and such improvements that were made, were not consistent nor made across all areas of practice.  Further, the Panel is mindful of the evidence from those who worked at the Trust that there were few pro-active attempts by the Registrant to use his own initiative or take opportunities to improve his performance. The Panel notes that the Registrant’s fiancée gives written testament to the fact that he spent “lots of his own time doing learning and research for work” but this did not appear to have resulted in improved performance in the workplace.

64. The Registrant has provided the Panel with some evidence that he has insight into his lack of competence and his fiancée, who was an undergraduate with him, has written a testimonial indicating his enthusiasm for the profession of physiotherapy.  The Panel accepts that the Registrant has acknowledged that his performance fell below acceptable standards for Registrant Physiotherapists. The Panel noted that he showed some remorse but the Panel is concerned that he explains his lack of competence by reference to his inexperience. The Panel heard from Witness 1 that students on placement and physiotherapy assistants were working at a higher level than the Registrant, and that she had never known a Band 5 newly qualified physiotherapist to have his level of problems.

65. The Panel is of the view that the Registrant’s lack of competence is remediable but in light of the relatively limited information he has provided, there is no evidence that it has been remediated. The Panel is satisfied that the risk of repetition of exactly the same behaviour, were the Registrant to find himself in another Band 5 physiotherapy post, remains. In these circumstances the Panel finds that there are current concerns relating to the Registrant’s lack of competence.

66. Having regard to the critically important public policy issues, in the Panel’s assessment, the Registrant’s current fitness to practise remains impaired. Confidence in the profession of physiotherapy would be undermined if such a finding was not made.  The public is entitled to expect physiotherapists to be competent, irrespective of what is occurring in their own personal lives.

67. There is a need to maintain confidence in the profession and to declare and uphold proper standards, send a clear message to other healthcare professionals and to maintain confidence in the regulatory process.

68. The Panel did have regard to the fact that the Registrant attempted to change his performance and some improvements were noted, but these were not consistent or maintained.

69. Therefore the Panel finds that the Registrant’s fitness to practise is currently impaired.

Panel Determination on Sanction

70. The Panel heard submissions from Ms Chaker, and accepted the advice of the Legal Assessor. It had regard to the HCPC’s Indicative Sanctions Policy (ISP).

71. The Panel kept at the forefront of its thinking that the purpose of a sanction is to protect the public, not to punish the Registrant.

72. The Panel considered each sanction in turn, starting with the lowest available.

73. Having found that the Registrant’s fitness to practise is currently impaired, and that there is a risk of repetition of his poor performance, the Panel decided that it would not be appropriate to impose no sanction, or order mediation as this would not adequately protect the public. Similarly the Panel decided that a caution would not be appropriate as this would allow the Registrant to practice as a physiotherapist without restriction.

74. The Panel next considered whether to impose conditions of practice. However, in view of the findings that it has already made regarding the basic and wide ranging nature of the Registrant’s lack of competence and the risk of repetition it has identified, the Panel was of the view that workable conditions which would adequately protect the public could not be formulated. The Panel also took into account that some of the conditions that it might impose would in any case be similar to the support, training, mentoring and supervision the Registrant received at the Trust, which did not result in any sustained improvement.

75. The Panel further noted that the Trust had concerns that the Registrant was not safe to work unsupervised and so had removed him from the on-call rotas. The Panel therefore considered imposing a condition that the Registrant only works under direct supervision but it rejected this as in practise this would amount to a suspension.

76. The Panel next considered suspending the Registrant.

77. It took account of the ISP, which states “suspension should be considered where the panel considers that a caution or conditions of practice would provide insufficient public protection”.

78. The Panel was of the view that the Registrant may be able to remedy his lack of competence, and noted that he expressed a wish to practise as a physiotherapist in the future. It therefore decided that a 12 month Suspension Order was the appropriate and proportionate sanction, which would protect the public and address the public interest.

79. The Suspension Order will be reviewed before it ends. A reviewing panel may be assisted by the following information from the Registrant;

• testimonials or references relating to any recent work he has undertaken

• a reflective piece on his shortcomings that demonstrates insight

• evidence of recent training / CPD including a CPD portfolio

• evidence of remediation of his shortcomings, for example, eidence of his current communication skills with patients and evidence he is able to write legibly

• evidence of continued reading / learning specific to current physiotherapy practice.

Order

ORDER: That the Registrar is directed to suspend the registration of Mr Alexander Fawcett for a period of 12 months from the date this order comes into effect.

Notes

This order will be reviewed again before its expiry on 2 December 2017 or earlier, if new evidence which is relevant to the order becomes available after it was made.

An Interim Suspension Order was imposed to cover the appeal period.

Hearing history

History of Hearings for Mr Alexander Fawcett

Date Panel Hearing type Outcomes / Status
01/11/2016 Conduct and Competence Committee Final Hearing Suspended