Mr Simon White
During the course of your employment as a Physiotherapist with Bristol Community Health, between August 2012 and January 2015;
1. In relation to Patient A you:
(a) Required prompting to ensure all the brakes on the commode were engaged prior to transferring Patient A to the commode;
(b) Did not plan for and/or show evidence of planning for Patient A’s discharge;
(c) Did not fully complete the notes of your session with Patient A on 23 June 2014;
(d) Did not develop exercise programmes for Patient A which were patient-specific and/or goal focused.
2. On the 13 August 2014, whilst completing an initial physiotherapy assessment with an amputee patient, Patient B you:
(a) Did not ensure that the surrounding area was safe and unobstructed prior to requesting Patient B to wheel themselves to the parallel bars;
(b) Did not move and/or prompt the patient to move the foot plate on the patient’s wheelchair before he stood up;
(c) Did not remove the stump plate before allowing Patient B to transfer from the wheelchair to the parallel bars;
(d) Did not remove the stump plate before allowing Patient B to sit back down.
3. On the 19 August 2014, whilst conducting a manual handling assessment and an initial assessment with Patient C who had a revision of a total hip replacement, you:
(a) Did not notice that the chair available to Patient C was too low which increased the risk of Patient C’s hip dislocating;
(b) Positioned Patient C at the edge of the bed thereby increasing the risk of falling;
(c) Did not obtain full details regarding Patient C’s Multiple Sclerosis;
(d) Conducted limited objective assessments of Patient C and did not record the clinical reasoning as to why this was the case.
4. On the 20 August 2014, whilst assessing Patient D who was recovering from a fractured hip, you:
(a) Did not adequately observe Patient D undertaking a hip extension exercise thereby:
(i) allowing her to perform the exercise incorrectly;
(ii) leaving her at risk of hitting her head on the wall;
(b) Did not seek and/or record information regarding Patient D’s previous falls;
(c) Did not and/or had to be prompted to carry out a cognitive assessment of Patient D;
(d) Did not carry out a balance assessment;
(e) Did not plan and/or record planned treatment in relation to Patient D;
(f) Did not show evidence of clinical reasoning in relation to the patient’s risk of falling;
(g) Did not, without assistance, notice and/or record that Patient D’s left leg caused them the most difficulty with mobility;
(h) Did not, without assistance, record and/or analyse Patient D’s comorbidities;
(i) Did not complete clear and/or comprehensive patient records regarding the range of motion in both of Patient D’s legs.
5. Assessed Patient E’s outdoor mobility on 30 October 2014, and you:
(a) did not discuss the assessment with the patient and/or provide her with instructions prior to commencing the assessment;
(b) did not prompt the patient to check for oncoming traffic before commencing a road crossing, which led to a colleague standing in the middle of the road to slow oncoming traffic;
(c) did not record the incident referred to above in the patient notes;
6. On 03 November 2014, whilst attempting to carry out a sliding board transfer from a bed to a wheelchair in relation to Patient F you did not:
(a) place the sliding board in the correct position underneath the patient in order to complete the transfer from the bed to the wheelchair;
(b) react appropriately when Patient F became fatigued and/or moved too close to the end of the bed thereby increasing the risk of falling;
(c) provide instructions to the rehabilitation worker assisting you with the transfer.
7. The matters set out in paragraphs 1 – 6 constitute lack of competence.
8. By reason of your lack of competence your fitness to practise is impaired.
1. The Panel was informed by the hearings officer that notice of this hearing was sent to the Registrant’s registered address by letter dated 26 July 2016 and by email on the same date. The Panel was satisfied that notice had been properly served as required by the Rules.
Proceeding in absence:
2. Ms Eales applied for the hearing to proceed in the Registrant’s absence. Ms Eales referred the panel to the contents of an email sent by the Registrant to HCPC dated 18 October 2016 in which he informed the HCPC that he longer practised as a Physiotherapist. He also stated that he was not engaging with this process and would likely not respond to further queries. The Panel received and accepted the advice of the Legal Assessor who advised that the Panel’s discretion to proceed in the Registrant’s absence should only be exercised with the utmost care and caution.
3. The Panel had regard to the contents of the Registrant’s email to the HCPC dated 18 October 2016 and concluded that the Registrant had voluntarily absented himself. The Panel also considered that the Registrant had indicated he would not attend an adjourned hearing and that no purpose would be served by an adjournment. The Panel also had regard to the fact that four witnesses were due to be called by the HCPC and considered that it was in the public interest and in the Registrant’s interests that the substantive hearing should take place expeditiously. Accordingly, the Panel decided to proceed in the Registrant’s absence.
4. At the relevant times the Registrant was a registered Physiotherapist employed as a Band 5 Physiotherapist at Bristol Community Health (BCH). He was on six monthly rotations as part of the Band 5 rotation programme. The Registrant was responsible for treating and assessing patients in the community, outpatients or those who were staying at the centre and was also required to plan for the discharge of patients. The registrant joined the North Bristol Rehabilitation Centre (the North Centre) on 31 March 2014 where he worked for approximately six months before joining the South Community Rehabilitation Team.
5. Concerns were raised about the Registrant’s performance particularly in relation to his goal planning, treatment reviews, prioritisation and time management. Notwithstanding additional supervision over an extended period of time, across multiple teams, an action plan and a capability assessment, the Registrant’s performance did not improve and a referral was then made by BCH to the HCPC.
Decision on Facts
6. The Panel heard oral evidence from four witnesses called on behalf of the HCPC. Two of the witnesses were Band 6 Physiotherapists, one a Band 6 Occupational Therapist and one an Advanced Practitioner (Band 7 Physiotherapist), who all worked for BCH at the same time as the Registrant. The witnesses comprised the Registrant’s line manager (AR), Band 6 supervisor (AW), Band 6 team leader (AH) and the Lead Therapist (GB).
7. The Panel considered that all the witnesses gave credible and balanced evidence. The Registrant’s line manager was new to management and obviously found her relationship with the Registrant difficult to manage, however she was prepared to seek support from senior colleagues when questioning her own judgment. The Panel found that the Registrant’s supervisor was very professional and was firm but fair. She acknowledged the weaknesses in management processes but was clear about the standards expected of a Band 5 Physiotherapist. The Panel found the Registrant’s team leader and the lead therapist to be credible, calm and considered. Both dealt with the capability proceedings well.
8. The Panel drew no adverse inference from the Registrant’s absence. However, the Panel was not provided with any evidence on the Registrant’s behalf which challenged any of the HCPC evidence.
9. The Panel had regard to all of the documentary evidence comprising of a main bundle including the witness statements and a bundle of exhibits. The Panel heard submissions from Ms Eales and received and accepted the advice of the Legal Assessor. The Panel made the following findings of fact:
Particulars 1a) – 1d) – Proved
10. The Panel accepted the oral evidence of the Registrant’s then line manager AR, which was also consistent with her witness statement. The Panel also found her evidence was supported by the entries in the supervision notes contained within the bundle of exhibits.
Particulars 2a) – 2d) – Proved
11. The Panel accepted the clear oral evidence of AR, supported by the contents of her witness statement.
Particulars 3a) – 3d) – Proved
12. As above, the Panel accepted the clear oral evidence of AR, supported by the contents of her witness statement.
Particulars 4a) – 4i) – Proved
13. The Panel accepted the unchallenged evidence of GB who assisted AR and shared her concerns regarding the Registrant’s poor performance.
Particulars 5a) – 5c) – Proved
14. The Panel considered that AW gave compelling evidence of the incident involving Patient E.
Particulars 6a) – 6c) – Proved
15. The Panel received convincing evidence from AH in relation to the sliding board incident involving Patient F. The Panel considered that Ms H gave credible telephone evidence from the Philippines.
Decision on Statutory Ground
16. The Panel noted that the facts found proved, cover a six month period and involve six different patients, representing a fair sample of the Registrant’s work. The Panel also considered that the matters found proved concerned basic aspects of practise for a registered Band 5 Physiotherapist which displayed a lack of concern or appreciation for patient safety. The Registrant was unable to work autonomously or to meet the requirements of his job description. At the material times, the Registrant had been a qualified Physiotherapist for two years. Notwithstanding being provided with extensive support by his employer, the Registrant’s performance remained inadequate and unsafe.
17. The Panel was satisfied that the Registrant had failed to meet the following standards of proficiency for registered Physiotherapists, displaying performance which fell short of the standards required of a Band 5 Physiotherapist:
"1.2 recognise the need to manage their own workload and resources effectively and be able to practise accordingly”,
“2.1 understand the need to act in the best interests of service users at all times”,
“3.3 understand both the need to keep skills and knowledge up to date and the importance of career-long learning”,
“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”,
“8.1 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”,
“8.4 be able to select, move between and use appropriate forms of verbal and non-verbal communication with service users and others”,
“9.1 be able to work, where appropriate, in partnership with service users, other professionals, support staff and 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”,
“9.5 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”,
“11.1 understand the value of reflection on practice and the need to record the outcome of such reflection”,
“12.1 be able to engage in evidence-based practice, evaluate practice systematically, and participate in audit procedures”,
“15.1 understand the need to maintain the safety of both service users and those involved in their care”,
“15.2 know and be able to apply appropriate moving and handling techniques”,
“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”.
18. For all of the above reasons, the Panel was satisfied that the statutory ground of lack of competence was applicable in this case.
Decision on Impairment
19. The Panel took into account that each of the incidents set out in the Particulars of the Allegation involved patients who were vulnerable as a result of serious health conditions and disabilities. Patient A suffered from Parkinson’s disease, a heart condition and weakness to his knee. Patient B was reliant on a wheelchair for mobility. Patient C had a total hip replacement and suffered from Multiple Sclerosis. Patient D had suffered a hip fracture and required a proper balance and gait assessment. Patient E had limited mobility and required proper care and assistance and Patient F needed to be moved from bed to wheelchair by proper use of a sliding board.
20. The Panel considered that the Registrant’s lack of competence had the potential to cause harm to the Patients A - F and undermine public confidence in the physiotherapy profession. The Panel further considered that in doing so, the Registrant had breached fundamental tenets of his profession by not acting in the best interests of service users and by failing to maintain their safety.
21. Whilst the Panel considered that the Registrant’s lack of competence was potentially remediable, it was not assisted by any evidence of remediation, insight or remorse and was not provided with any information as to the Registrant’s current circumstances. Accordingly, the Panel considered that the risk of repetition was high.
22. For these reasons, the Panel concluded that the Registrant’s fitness to practise is currently impaired.
Decision on Sanction
23. The Panel considered the submissions made by Ms Eales on behalf of the HCPC. The Panel received and accepted the advice of the Legal Assessor.
24. The Panel was mindful that the purpose of any sanction was not to punish the Registrant but to protect the public and maintain public confidence in the profession and the HCPC as its regulator, by the maintenance of proper standards of conduct and behaviour.
25. The Panel had regard to the Indicative Sanctions Policy. 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 seriousness.
26. In determining the appropriate and proportionate sanction, the Panel had regard to its findings in relation to lack of competence involving repeated failures in the care of multiple patients and a disregard for their safety.
27. The Panel identified the following aggravating factors:
• The Registrant’s lack of competence was persistent over a prolonged period, notwithstanding supervision and support being provided to him.
• The Registrant’s lack of competence gave rise to serious patient safety issues for which the Registrant has provided no evidence of insight or remorse.
• The Registrant’s lack of competence potentially caused harm to patients who were extremely vulnerable people with physical disabilities.
28. In light of the Registrant’s failure to engage, the only mitigating factor which the Panel was able to identify was the lack of any previous disciplinary action against the Registrant.
29. The Panel first considered taking no action, however it concluded that this would be inappropriate and would not be sufficient to protect service users or the reputation of the profession. The Panel considered that this was not an appropriate case for mediation and that a caution order would be insufficient given the seriousness and totality of the Registrant’s lack of competence which was not an isolated incident.
30. The Panel next considered a conditions of practise order. The Panel was mindful that notwithstanding extensive support being provided to the Registrant by his employers, he was unable to improve his practice. The Registrant seemed oblivious to the safety needs of his service users. The Panel considered that his lack of competence arose due to attitudinal problems which could not be adequately addressed by conditions. The Panel also had regard to the Registrant’s non-engagement and the lack of information as to his current circumstances. For all these reasons, the Panel determined a conditions of practice order would be inappropriate and would not adequately protect the public or the public interest.
31. The Panel next considered a suspension order. The Panel noted that such an order is usually appropriate where remediation is foreseeable and there is some insight and it is necessary to prevent a Registrant from practising. The Panel was presented with no evidence of any insight or that the Registrant was willing to take any steps to remedy his lack of competence. In the Panel’s view, it is necessary to prevent the Registrant from practising. However, the Panel had regard to the fact that a striking off order cannot be imposed where the only Statutory Ground is lack of competence. Accordingly, the Panel concluded that a suspension order for 12 months was the only appropriate and proportionate sanction.
The order imposed today will apply from 14 December 2016 (the operative date).
This order will be reviewed again before its expiry on 14 December 2017.