Miss Stephanie P Howes

: Physiotherapist

: PH73902

: Final Hearing

Date and Time of hearing:10:00 02/12/2016 End: 17:00 02/12/2016

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

: Conduct and Competence Committee
: Suspended

Allegation

(as amended at the Final Hearing):

1. Whilst registered as a Physiotherapist, on 08 March 2016 at Worthing & Chichester Magistrates’ Court, you were convicted of the following offence(s);

a) Between 02/02/2015 and 14/05/2015 committed fraud in that you dishonestly made a false representation, namely intending to make a gain, namely you submitted 5 separate weekly timesheets to Piers Meadow Recruitment Limited which included 7 days that you had not worked, for yourself;

b) Between 02/02/2015 and 14/05/2015 made a false instrument, namely 14 authorised timesheets, with the intention that you or another should use the same to induce Piers Meadow Recruitment Limited to accept it as genuine and by reason of so accepting it to do or not to do some act to his own or another person’s prejudice.

2. By reason of your convictions as set out at paragraphs 1, your fitness to practise as a Physiotherapist is impaired

 

Finding

Preliminary Matters:

Proof of Service

1. The Panel was provided with a signed certificate as proof that the Notice of Hearing had been sent in a letter, dated 24 August 2016, by First Class post, to the address shown for the Registrant on the HCPC register.  The Notice of Hearing was also sent to the Registrant’s email address on the same date. The Panel was satisfied that Notice had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date, time and venue) of the Conduct & Competence Committee Rules 2003 (as amended).

 Proceeding in Absence

2. Having determined that service of the Notice of Hearing had been properly effected, the Panel went on to consider whether to proceed in the Registrant’s absence, as permitted by Rule 11 of the Conduct & Competence Rules 2003 (as amended). The Panel was advised by the Legal Assessor and followed that advice. The Panel also took into account the guidance as set out in the HCPC Practice Note “Proceeding in the Absence of the Registrant”.

3. The Panel determined that it was reasonable and in the public interest to proceed with the hearing for the following reasons:
 
i) The Registrant in a letter dated, 20 October 2016, informed the HCPC that she did not intend to attend the hearing due to prior work commitments. Furthermore, in the Response Proforma, the Registrant stated ‘No’ to the question ‘Do you intend to appear in person at the hearing?’ and ‘No’ to the question ‘Do you intend to be represented at the hearing?’. In these circumstances the Panel took the view that it was fair and reasonable to conclude that the Registrant’s absence was deliberate and demonstrated that she had voluntarily waived her right to be present.
 
ii) There has been no express or implied request for an adjournment. Therefore there is no indication that the Registrant would attend on any future date and therefore re-listing this case would serve no useful purpose.
 
iii) The Panel was satisfied that given the serious nature of the allegation there is a strong public interest in ensuring that this Final Hearing commences and proceeds expeditiously.

Amendment to the allegation

4. At the outset of the hearing Ms Bennett on behalf of the HCPC made an application for the allegation to be amended by making the word ‘offence’ plural. The Panel was satisfied that this was a minor typographical alteration and would therefore cause no injustice. The Panel therefore determined that the application to amend should be granted.

Background

5. On 29 March 2016 the Registrant notified the HCPC by letter, dated 19 March 2016, that she had pleaded guilty on 8 March 2016 to two offences involving fraud. The case was heard by Worthing and Chichester Magistrates’ Court.

6. The sentence imposed was an 18 week prison sentence suspended for 12 months and an unpaid work requirement of 150 hours to be completed within 12 months.

7. The fraudulent activity was investigated by the NHS Counter Fraud team who prepared an investigation report dated March 2016. The report details how the fraudulent activity was identified. The report estimates the cost of the fraud as overpayments made to the Registrant totalling £1,954.20.

Decision on Facts

Panel’s Approach

8. The Panel was aware that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the particular of the Allegation could only be found proved, if the Panel was satisfied, on the balance of probabilities.

9. In reaching its decision the Panel took into account the NHS Counter Fraud investigation and the Certificate of Conviction. The Panel could not go behind the conviction and was required to accept the certification from Worthing and Chichester Magistrates’ Court as conclusive proof of the conviction itself and the underlying facts.

10. The Panel drew no adverse inferences from the Registrant’s absence.

Particular 1(a) and 1(b) – Found Proved
‘While registered as Physiotherapist, on 8 March 2016 at Worthing and Chichester Magistrates’ Court, you were convicted of the following offence(s); 

a) Between 02/02/2015 and 14/05/2015 committed fraud in that you dishonestly made a false representation, namely intending to make a gain, namely you submitted 5 separate weekly timesheets to Piers Meadow Recruitment Limited which included 7 days that you had not worked, for yourself;

b) Between 02/02/2015 and 14/05/2015 made a false instrument, namely 14 authorised timesheets, with the intention that you or another should use the same to induce Piers Meadow Recruitment Limited to accept it as genuine and by reason of so accepting it to do or not to do some act to his own or another person’s prejudice.

11. The Panel accepted the Certificate of Conviction as conclusive evidence that the Registrant was convicted of offences under the Fraud Act 2006 and the Forgery and Counterfeiting Act 1981. The Panel noted that the Registrant accepted that she had been convicted following her guilty pleas at Worthing and Chichester Magistrates’ Court on 8 March 2016.

12. The Panel was therefore satisfied that the facts and grounds have been proved.

Decision on Impairment

Panel’s Approach

13. The Panel went on to consider whether the Registrant’s fitness to practise is currently impaired. The Panel took into account the submissions of Ms Bennett on behalf of the HCPC and the contents of the Registrant’s letter dated 20 October 2016. The Panel also took into account the HCPC Practice Note: ‘Finding that Fitness to Practise is Impaired’ and accepted the advice of the Legal Assessor.

14. In determining current impairment the Panel had regard to the following aspects of the public interest:
 
• The ‘personal’ component: the current behaviour of the individual registrant; and

• The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.
 
Panel’s Decision
 
15. The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective.

16. The Registrant forged signatures on 14 timesheets and fraudulently claimed for 66 hours on 7 dates on 5 different timesheet claims when she was not at work but off sick. The Registrant’s dishonest actions resulted in an overpayment by the Trust. The Panel took the view that this conduct and behaviour breached a fundamental tenet of the profession and brought the profession into disrepute. The Panel considered the HCPC Standards of Conduct and Ethics and was satisfied that the Registrant’s actions represented a significant departure from the following standards which state:

• 3 – ‘You must keep high standards of personal conduct’

• 13 - ‘You must behave with honesty and integrity and make sure your behaviour does not damage the public’s confidence in you or your profession.’

17. There has been only limited engagement from the Registrant during these proceedings. Although the Registrant submitted a letter in which she expressed remorse, regret and a commitment to self-reflection, the Panel was unable to assess whether the Registrant had developed meaningful insight. There was no evidence before the Panel that the Registrant fully appreciated the consequences of her actions on her former employer or that the Registrant had properly reflected on the impact of her behaviour on her profession, which legitimately expects high standards of integrity and honesty at all times. The Registrant indicated in her letter that she has learnt from the experience, but provided no detail as to what she has learnt and what steps she has taken to ensure that such dishonest conduct would not be repeated in the future. Furthermore, there was no explanation in the Registrant’s letter as to why she behaved in this manner.

18. The Panel recognised that demonstrating remediation following a conviction involving dishonesty is particularly difficult, as probity issues are reliant on attitude, which can often only be inferred from conduct. However, in the absence of meaningful reflection and a commitment to remediation the Panel concluded that there was a risk of repetition.

19. The Panel concluded that for these reasons the Registrant’s fitness to practise is currently impaired based on the personal component.

20. In considering the public component the Panel had regard to the important public policy issues which include the need to protect the public, maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour.

21. The Registrant’s conduct fell far below the standard expected of a registered practitioner and the Panel takes the opportunity to declare that it is wholly unacceptable for a physiotherapist to defraud an employer for financial gain. The Panel concluded that public confidence would be undermined if a finding of fitness to practise was not made, given the seriousness of the Registrant’s dishonest conduct and behaviour.

22. The Panel concluded that the Registrant’s current fitness to practise is impaired on the basis of both the personal component and the wider public interest and therefore the HCPC’s case is well-founded.

Decision on Sanction

Panel’s Approach

23. The Panel accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of any sanction is not to punish the Registrant, but to protect the public and the wider public interest. The public interest includes maintaining public confidence in the profession and the HCPC as its regulator and upholding proper standards of conduct and behaviour. 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.

24. The Panel had regard to the Indicative Sanctions Policy (ISP) and took into account the submissions made by Ms Bennett, on behalf of the HCPC, and the representations made by the Registrant in her letter dated 20 October 2016.

25. The Panel identified the following aggravating factors:

• The dishonesty was repeated;

• The Registrant breached her employer’s trust;

• The absence of full insight.

28. The mitigating factors identified by the Panel were as follows:

• The Registrant fully admitted the criminal offences;

• The Registrant fully admitted the Allegation;

• No service users were put at risk as a consequence of the Registrant’s actions.

Panel’s Decision

26. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s repeated misconduct and dishonest behaviour, and in the absence of exceptional circumstances, it would be wholly inappropriate to take no action. Furthermore it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

27. The Panel then considered a Caution Order.  The Panel noted paragraph 22 of the ISP which states:

“A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate action.  A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate.  A caution order is unlikely to be appropriate in cases where the registrant lacks insight.” 

28. In view of the Panel’s findings that the Registrant has demonstrated limited insight into her misconduct and provided no evidence of remediation, a risk of repetition remains. The Panel concluded that a Caution Order would be inappropriate and insufficient to meet the public interest.

29. The Panel went on to consider a Conditions of Practice Order. The Panel noted that the ISP states:
‘Conditions of practice are unlikely to be suitable in situations where problems cannot be overcome, such as serious overall failings, lack of insight, denial or matters involving dishonesty...”.

30. The Panel concluded that the dishonest submission of timesheets, which involved forging a signature on numerous occasions, is not amenable to conditions as the basis for this type of misconduct is an attitudinal failing. In these circumstances the Panel was unable to formulate conditions which would be workable, measurable or proportionate. Furthermore, conditions would not adequately address the serious nature of the misconduct and so would undermine public confidence in the profession and the need to uphold standards of conduct and behaviour.

31. The Panel next considered a Suspension Order. A Suspension Order would send a signal to the Registrant, the profession and the public re-affirming the standards expected of a registered physiotherapist. The Registrant has not fully engaged with these proceedings. However, in her letter dated 20 October 2016, she has demonstrated some insight into her wrongdoings and appears to be capable of developing an appropriate level of insight and taking purposeful steps towards remediation. The Panel further noted that the Registrant’s expressions of regret and remorse were insufficient as evidence of insight.

32. Although the Registrant has not worked as a Physiotherapist since her conviction, she appears to remain committed to her profession, as evidenced by her letter dated 20 October 2016 in which she states:

‘I truly value my time spent working in the NHS and the amazing training and teaching I received over the course of my career. I hope in the future that I will be able to redeem myself and contribute to the service once again as a Physiotherapist.’

33. In the Panel’s view the Registrant should be given the opportunity to demonstrate that she can ‘redeem’ herself and noted that paragraph 34 of the Indicative Sanctions Guidance states:

‘If the evidence suggests that the registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option. However, where there are no psychological or other difficulties preventing the registrant from understanding and seeking to remedy the failings then suspension may be appropriate.’

34. The Panel considered that the above paragraph might apply to the Registrant and that she should be given an opportunity to consider carefully the decision of this Panel and reflect on her previous conduct and behaviour.

35. The Panel decided that the appropriate and proportionate order is a Suspension Order. A Striking Off order would be disproportionate and punitive. The Panel determined that the Suspension Order should be imposed for a period of 12 months. The Panel was satisfied that this period would be sufficient for the Registrant to demonstrate an appropriate level of insight into her failings. If she is unable to demonstrate insight within that time frame it is highly unlikely that she will ever be able to do so.

36. This Order will be reviewed shortly before expiry. Although this Panel cannot bind a future reviewing panel, that panel is likely to be assisted by the following:

(a) The Registrant’s attendance in person;

(b) A full and substantive reflective statement from the Registrant identifying the reasons for her actions, what she has learnt from the experience and the actions she has taken to avoid repetition;

(c) Details of how the Registrant has kept her physiotherapy skills and knowledge up to date;

(d) Current character references including reference(s) from recent employer(s).

Order

That the Registrar is directed to suspend the registration of Stephanie P Howes for a period of 12 months from the date this order comes into effect.

Notes

The order imposed today will apply from 30 December 2016. 

This order will be reviewed again before its expiry on 30 December 2017.

Hearing history

History of Hearings for Miss Stephanie P Howes

Date Panel Hearing type Outcomes / Status
30/11/2017 Conduct and Competence Committee Final Hearing Struck off
02/12/2016 Conduct and Competence Committee Final Hearing Suspended