Mr John F Skelton

: Prosthetist / orthotist

: PO00623

: Final Hearing

Date and Time of hearing:10:00 23/01/2017 End: 17:00 26/01/2017

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

: Conduct and Competence Committee
: Suspended

Allegation

During the course of your employment as an Orthotist at University Hospitals Bristol NHS Foundation Trust from around March 2014 until around March 2015 you:

 

1. In relation to Service User A:

 

a) On or around 8 August 2014 you:

i. Did not consistently use professional communication

ii. You did not appropriately accommodate Service User A’s wishes

 

2. In relation to Service User B, Service User A’s son who has cerebral palsy:

 

a) On or around 8 August 2014 you:

i. Said “you don’t have a disability”, or words to that effect

ii. Said Colleague A was “talking a load nonsense”, or words to that effect

iii. Said that “there is nothing wrong with your feet”, or words to that effect

iv. Did not adequately accommodate Service User B’s wishes in prescribing care

 

3. In relation to Service User C:

 

a) On or around 15 August 2014 you:

i. Used unprofessional language including “if you were my private patient, you would not be having splints”, or words to that effect

ii. Said “you don’t need splints” or words to that effect

iii. Did not appear to accommodate the wishes of Service User D, Service User C’s mother, in providing treatment to Service User C

 

4. In relation to Service User E:

 

a) On unknown dates before 26 February 2015 you:

i. Repeatedly spoke to Service User E in a condescending tone

ii. Attempted to put Service User E’s foot into a splint that was not appropriate

iii. Said her pain “was psychosomatic”, or words to that effect

iv. Said “why don’t you cut your leg off”, or words to that effect

 

b) On or around 26 February 2015 you:

i. Repeatedly called her by her last name, despite historically using her first name

ii. Said “I am calling you by your last name, as you refused to be seen by me”, or words to that effect

iii. Accompanied a photographer into the consultation room to take photographs of Service User E

 

5. In relation to Service User F, on an unknown date, you said that her baby “looks like a golliwog”, or words to that effect.

 

6. In relation to Colleague B

 

a) On an unknown date:

i. You called Colleague B “petunia”

ii. The comment referred to in 5(a)(i) was said in front of Service Users

iii. The comment referred to in 5(a)(i) was homophobic

 

7. On unknown dates at the workplace, without reasonable excuse, you used racist terminology:

 

a) “P***”

b) “Chocolate Tart”

c) “N****r”

d) “Cha Chi Cha”

 

8. The matters described in paragraphs 1 - 7 constitute misconduct

 

9. By reason of that misconduct your fitness to practise is impaired.

Finding

Preliminary matters:


Amendment of Allegation

1.Ms Sheridan, on behalf of the HCPC, applied to amend the Allegation.  She submitted that the amendments more accurately reflected the evidence and could be made without injustice to the Registrant. She indicated that they do not materially change the Allegation towards the Registrant and further, Mr Skelton had been put on notice that this application would be made.  Mr Skelton raised no objection to the proposed amendment.  The Panel accepted the advice of the Legal Assessor, who had advised that it was open to the Panel to amend the allegation, provided no injustice would be caused by the amendment.  The Panel considered that the amendments sought were minor and did not change the substance of the allegation. The amendment largely served to clarify the Allegation and was beneficial to the Registrant. The Panel therefore allowed the amendment to be made. The amended Allegation is as set out above.


Application for private hearing

2.Ms Sheridan on behalf of the HCPC, applied for those parts of the hearing to be held in private that relate to the evidence of health or medical conditions relating to witnesses and immediate members of their family.  The HCPC Practice Note on Conducting Hearings in Private was commended to the Panel dealing as it did with the limited exceptions to the need for hearings to be held in public.  Exceptions cover where it is in the interests of justice to do so, or where it is done in order to protect the private life of a party, either the person who is the subject of the allegation, the complainant; a witness giving evidence or a service user.  Mr Skelton had no objections to such parts of the hearing being in private. The Panel determined to decide to sit in private for those parts of the hearing that related to personal health of witnesses.  This was to enable appropriate evidence to be given while respecting the privacy of individuals.


Background:

3.The Registrant, Mr Skelton was employed as an Orthotist by University Hospitals Bristol NHS Foundation Trust (“the Trust”) from around September 2013, for a one year fixed term contract which was extended by six months to the end of March 2015.   However, Mr Skelton offered to tend his resignation and he left the Trust before 31st March 2015. During his period working at the Trust, complaints were made about him by patients he saw.  Further colleagues interviewed reported inappropriate language being used by him.

4. The Panel heard evidence via video link from the following witnesses called by the HCPC:

- Service User E, who had made a complaint about the Registrant’s attitude and behaviour.


- Service User A (who is the mother of Service User B) also complained about the Registrant’s behaviour.


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


- Service User D (who is the mother of Service User C), who had also made a complaint about the Registrant.


- CE, the investigative officer who looked into these complaints, on behalf of the Trust.

6. An oral application was made on behalf of the HCPC for Service User A to give evidence via video link.  This was because she had undergone a serious operation and could not travel.  Ms Skelton indicated that the witness had said that she was unable to come to the hearing in London at present, but was able attend a nearby video-conferencing facility.  The Registrant had no objections to Service User A giving her evidence in this way. Regard was had to the legal framework. Rule 10A(1) of the HCPC (Conduct and Competence Committee) Rules 2003, as amended, allows, “In proceedings before the Committee, the following may, if the quality of their evidence is likely to be adversely affected as a result, be treated as vulnerable witnesses… any witness with physical disabilities who requires assistance to give evidence.” Rule 10A(2) allows certain special measures to be adopted in these circumstances: “Subject to any representations from the parties and the advice of the Legal Assessor, the Committee may adopt such measures as it considers desirable to enable it to receive evidence from a vulnerable witness.” Rule 10(3) allows that a measure may include the use of a video link.  The Panel decided that using a video-link was the most suitable way of getting the best evidence available, and allowed Service User A to give evidence that was relevant to this case remotely.

7. The Registrant also gave evidence under oath.  The Panel was advised that he was of good character and gave him good credit for this.  In addition to hearing from witnesses and the Registrant, the Panel also received reports and letters that pertained to the internal Trust investigation, including those resulting from interviews with the Registrant, and with Trust employees who had contributed to an internal investigation but who did not appear before it. 

8. The decision that the proceeding should proceed in private was revisited after the Panel heard evidence from the first witness. This was because it had proved difficult to keep separate the medical condition of Service User A, and her treatment, from the Allegation which the Registrant faced. The Panel heard from the Legal Assessor, who advised that the decision to sit in private may relate to all or part of a hearing.  Given that conducting proceedings in private is regarded as the exception, Panels should always consider whether it would be feasible to conduct only part of the proceedings in private before deciding to conduct all of the proceedings in private.  Due to the fact that the issues of medical treatment and the Allegation would be inextricably linked, the Panel decided that the whole of Service User’s A, D and E’s evidence was heard in private.

9. The Panel considered carefully the credibility and reliability of every person who gave evidence.

- Service User E was a forthright individual who gave a strong and lucid account of events that had occurred involving her.  The Panel noted no sign of cognitive impairment, (as intimated by the Registrant) and found Service User E to be clear in her recollection and adamant under cross examination.  She came across as a reliable and credible witness who, despite her anger at how the Registrant had treated her, wanted to tell her story.

- Service User A was reliable and credible in relating her own experiences to the Panel.  She gave the impression of clearly being able to remember events and would not be swayed under cross examination.  In relation to giving evidence on behalf of her son, it was less possible to evaluate how accurately different conversations between Service User B and the Registrant, had been reported to her, and how much may have been the impressions she had gained.


- Service User D was found to be a credible and sincere witness.  The Panel found her to be not only honest but direct and made efforts to give scrupulous evidence. She maintained a great deal of composure in face of some difficult questions.  The Panel did not consider her to be overly emotional as suggested by the Registrant but that she gave frank and sincere answers.


- CE strove to give a careful and accurate account of events that had occurred throughout his investigation.  Although not always appearing comfortable giving evidence, he appeared to be honest and reflective in the answers he provided.  His evidence covered both fact and opinion and the Panel found him to be reliable and credible.

- The Registrant, by comparison, did not appear to have taken seriously the disciplinary process and seemed similarly relaxed about the regulatory process.  His responses were not beyond obfuscation. He repeatedly appeared to deflect important questions and minimise the role he had played in events.  He did not seem  able to consider other peoples’ perspectives or exhibit empathy. While there was no evidence of aggression in his demeanour and he was calm in his presentation, the Panel was not confident that he was always completely truthful. An example of this was the explanation he gave for using Witness E’s surname rather than her Christian name; he said that he preferred formality and took him a long time to adapt to using first names. However, Witness E was very clear in her evidence about his prior use of her Christian name and the Panel accepted her evidence, which was supported by proceedings before the Panel; the Registrant addressed several individuals at the hearing by their first names despite never having met them before, until this was brought to his attention.  He also referred to CE, as “C” – despite not having had day to day contact with him, only having met him during the Trust investigation.


Decision on Facts

10. The Panel applied the principles that the burden of proving the facts is on the Health and Care Professions Council, that the Registrant does not have to prove anything and that the case is only to be decided on the evidence before it.  It was mindful that it had heard from several separate people who individually came across as honest, and who all give evidence in a similar vein. All of them tell a similar tale of the Registrant being dismissive and making them feel bad.


Particular 1 is found proven in its entirety

11. The Registrant denied particular 1.  There was evidence that in August 2014, the Registrant did not consistently use professional communication, nor appropriately accommodate Service User A's wishes. Service User A gave evidence that the Registrant was not listening to her and presented as knowing better than her what colour of boots she would find acceptable.  Service User A gave evidence of two appointments with the Registrant.  The first when she chose the style and colour of boot to be made for her and secondly, when she attended for an appointment to receive the boots and checked that they fitted.  Service User A’s evidence was that at the first appointment the Registrant had persistently insisted that she should have orange boots when she was clear that she would never have orange boots but wanted a brown pair as they would be “unobtrusive.” She was very unhappy about his manner at that appointment but understood that brown boots had been ordered.  She gave evidence on attending for the second appointment, the boots were in fact orange and she again made it clear that she did not want orange boots but that the Registrant had insisted that she should have them; and that he called in a member of reception staff to support him, although in the event the member of staff was equally clear she would not have chosen orange boots.  The Registrant’s evidence was to suggest that he was not the Orthotist at the first appointment but accepted that he was at the second appointment.  Service User A was clear in her evidence that he had been at the first appointment and the Panel preferred her evidence in this regard.  The Registrant went on to give evidence that he did believe the orange boots to be “trendy” and suited Service User A.  He accepted that he had called in a member of staff to “check my judgement that they were trendy” but went on to say that he was concerned the Service User was simply changing her mind and about the cost of changing the boots.  The Panel’s conclusion preferring the evidence of Service User A was that he had tried to impose his choice of colour at both the first and second appointments that it had been inappropriate to bring in a member of staff in the way that he did; and even had the facts been as he described his handling of the situation was inappropriate and unnecessarily confrontational.  Accordingly, the Panel found that this particular was proved in its entirety.


Particular 2 is found proved in part.

Particular 2a)i) is found proved.

12. In relation to Service User B, who has cerebral palsy: on or around 8 August 2014 the Registrant said "you don't have a disability," or words to this effect. The Registrant admitted that words to this effect were used.  Service User A, the mother of Service User B was not at the relevant appointment.  She gave evidence of what the Registrant was reported to have said relying on an account given by Service User B when he arrived home upset after the appointment and she had then written the letter of complaint.  It appears to the Panel that the Registrant has been consistent in expounding a philosophy that people, “should not be defined by their disability”; bearing in mind the burden and standard of proof, the Panel could not discount that this message had “lost something in translation” when reported to his mother, who wrote a letter and gave evidence.  His mother, Service User A also gave evidence that her son, does not see himself as having a disability. Accordingly, the Panel is not confident that it knows the context of the comment.   While this matter is found proved, to the extent that the Registrant spoke the words no misconduct will be based upon this fact given that the Panel cannot be confident of the context.

Particular 2a)ii) is found proved.

13. While the Registrant did not admit that he said Colleague A was "talking a load of nonsense", or words to that effect, he did agree that a) he did not agree with Colleague A’s opinion, b) said as much during the appointment with Service Users B and A and c) admitted that “nonsense” may have come into what he said. Service User A’s complaint written in a letter the following week refers to the Registrant’s dismissiveness of Colleague A’s views, that this was expressed in a disparaging way and noted the use of the word “nonsense.” The impression of his superior attitude was confirmed in his evidence to the Panel when he referred to a subsequent consultant who had taken a different approach to that of Colleague A.   

Particular 2a)iii) is not found proved.

14. The Registrant is adamant that he did not say to Service User B that, "there is nothing wrong with your feet", or words to that effect.  He gave evidence that there was no denying Service B’s condition, and it appeared to the Panel that this particular is related to the conversation about a person not being defined by a disability.  Accordingly, the Panel finds that the context in which any such conversation took place is all important, and does not find this particular proved.

Particular 2a)iv is not found proved.

15. It is alleged that the Registrant did not adequately accommodate Service User B's wishes.  The Registrant gave evidence that he did not have a letter from the clinician with whom Service User B had had a recent appointment and that as an autonomous practitioner he wanted to undertake progress that was in the best interests of Service User B. If the Registrant considered that it was important for Service User B to see his colleague, or to have a conversation with her himself, he should have simply apologised and indicated that the appointment could not proceed that day.  While the Panel does not consider this particular found proved, it was concerned that the Registrant felt it necessary to reference Service User B’s agitation, and took this as another example of deflection. The Panel considered the mood Service User B was in to be irrelevant; it was for the Registrant to manage this situation in which a patient presents for an appointment in a professional manner.

Particular 3 is found proven in its entirety

16. The Registrant has made partial admissions to particular 3(a)(i-iii). In relation to Service User C, he agreed that he said:
i. "if you were my private patient, I would not be treating you,” - or words to that effect
His explanation was that he thought that he had a better solution for her treatment and meant that he would not advocate splints for someone with the condition that Service User C had.

This is also his explanation for saying:

ii. "you don't need splints," - or words to that effect. His view which conflicted with that of the previous clinician to see Service User C, should have been raised with other members of a multi-disciplinary team.  It was both unprofessional and inappropriate to undermine another clinician in that way, and would be liable to confuse patients.  Service User D indicated she had left the appointment with her daughter, Service User C feeling confused.

The Registrant also admitted that he had said:

iii. "she will want to wear heels and by fitting her with splints you are not allowing her to do that", or words to that effect.

17. His explanation was that he considered splints to be unnecessary and detrimental to the child’s development but he failed to consider that in criticising the mother in front of her child that he could be causing damage to their relationship. Service User D gave evidence that she was angry and that the remark had caused “untold damage” given that she had spent years telling her daughter who would have loved to wear heels, that this was not possible.  Had the Registrant believed that the treatment necessary was different from the assessment from the referring clinician, the appropriate course of action would have been for him to engage with the other clinician and then together with the mother and child in a constructive and positive approach.  As it is, the Panel found that his bombastic approach caused significant upset as described by Service User D. 

18. In relation to particular 3(b) the Panel finds proved that the Registrant did not appear to accommodate the wishes of Service User D, Service User C's mother, in providing treatment to Service User C. Both Service User D and the Registrant gave evidence that the Registrant attempted to use foam blocks to gain an impression of Service User C’s foot before appreciating that her muscle tone meant that this was not practical and taking a cast.  Service User D had clearly advised him that in the past foam moulds had not worked and that he disregarded her input.  He admitted to ultimately doing, “as I was told,” and “feeling under pressure to do this,” although he did not agree with the treatment regime.  It was clear from the Registrants own evidence that despite significant time passing he took no action to engage with the other clinicians to discuss with them differences of professional opinion.  The Registrant did not appear to appreciate that in not respecting another professional’s view nor resolving them appropriately he could have been causing untold harm to the patient, and to her confidence in and opinion of the clinicians treating her.

Particular 4 is found proven in its entirety

19. Credible and robust evidence was given by Service User E of the manner in which the Registrant acted towards her.

20. In relation to particular 4.i) she said that the Registrant did not listen to her, and that when she gave him measurements and a diagram of what she thought would suit her best, he crumpled up this piece of paper and threw it into a wastepaper bin. The Registrant recalled the piece of paper but gave evidence he could not recall what had happened to it.   He restated that he was an autonomous practitioner who had a obligation to treat his patients as he thought best.

21. In relation to particular 4.ii) that he attempted to put Service User E's foot into a splint that was not appropriate on more than one occasion, the Registrant responded by saying that fittings were necessary and that pain was necessary prior to modifying and shaping the splint to provide the best possible fit.  Service User E who had had previous orthotics, said that the Registrant had not been gentle but had caused actual pain in a way that she had not experienced with other clinicians.

22. In relation to particular 4.iii) where it is alleged that the Registrant said Service User E’s pain "was psychosomatic", or words to that effect, the Registrant originally denied ever saying words to that effect.  The Panel and the Registrant heard to the vehemence with which Service User E recounted hearing the word “psychosomatic” and knowing it was, “not a nice word by the way it was said,”; although unaware of its meaning, she described going home and looking it up in the dictionary.  On discovering it meant “imaginary” – she was indignant, because she said her pain was not imagined but very real.  She said it was another example of the Registrant not listening to her.  The Registrant conceded on hearing this evidence that the word may have been mentioned but not in the context suggested.  The Panel preferred the evidence of Service User E to the Registrant, given her confidence and evidence, and his uncertainty.

23. In relation to particular 4.iv) that the Registrant said "why don't you cut your leg off”, or words to that effect, the Registrant gave evidence that this was partly banter from Service User E’s next of kin who was present but also a clinical option that had been canvassed with Service User E by her orthopaedic surgeon if surgery and orthotics did not work.  While Service User E acknowledged that amputation had been canvassed as a clinical option outside her appointment with the Registrant, she was adamant that this had been said by the Registrant.  “He definitely made the comment.  I was shocked.  It is not for him to make a comment like that; that would be for the surgeons.  They had decided that amputation would not be the first option, a splint was.  It was sarcastic, he suggested I was causing trouble.  It is not his prerogative.” She found it to be distressing, demeaning and humiliating.  She indicated that she could not take much more after that and on being seen in distress, indicated that she did not want to see the Registrant again.  The Panel preferred the evidence of Service User E. 

24. In relation to particular 4.b), that on or around 26 February 2015 the Registrant:

i. Repeatedly called her by her last name


ii. Said "I am calling you by your last name, as you refused to be seen by me,” or words to that effect

25. The Registrant has made admissions.  This conversation took place with the service user as she was sitting with another clinician who was treating her.  The Panel had available to it a formal statement written the next day by that clinician recording the events in a way that support the evidence of the Service User.  The Registrant has suggested that his behaviour was prompted by politeness and formality given that he had been advised she, the service user no longer wanted to see him.  The Panel does not consider that the Registrant was motivated by either politeness or formality.  Rather, it finds that he was using her surname to make a point, when she had specifically, and by his own admission, repeatedly, reminded him at previous appointments to call her by her Christian name.  Service User E gave evidence that he had done so up to that point. In admitting that he used her last name, because she refused to be seen by him, he reveals his motive the Panel finds.  He was unhappy that she had told his colleagues that, “she did not want to see him” – and wanted her to know this.  Further, despite apparently being willing to upset Service User E and purporting to have interpreted her ‘not wanting to see him’ as being confined to being for a clinical reason to suit his own purposes, he nonetheless approached her. The Registrant walked into Service User E’s appointment with another clinician, who made a contemporaneous note of events which supports Service User E’s version. The Panel places significant weight on this.  Relying on Service User E’s evidence as supported by that note the Panel finds that the Registrant’s explanation lacks credibility. 


Particular 5 is found proved.

26. While the Registrant denied this particular, the words that are alleged were admitted in his oral evidence to have been said by the Registrant.  He gave evidence that he saw Service User F in the reception area, with a “pretty baby” and the features that the baby had prompted him to say on his return to an administrative area, that he had seen, “a pretty baby, that looks like a golliwog", or words to that effect. The Registrant maintained that it was the unusual features and appearance of the baby that had prompted this remark, rather than the race to which the baby belonged, and that he had not said this to the mother, whom he did not know.  The Registrant said the word “g******g" was in his vocabulary and referenced to Noddy, a child’s toy and the Robertson’s Jam mascot; no malice was intended by the remark. The Panel find this particular proved.

Particular 6 is not found proved.

27. The allegation that the Registrant called Colleague B "petunia" in front of Service Users is denied by the Registrant. At the time of the Trust’s investigation, the Registrant gave an explanation for what had been said at the relevant time, and this was a reference to “Patchouli” the strong aromatic which Colleague B wore.  The Registrant said that he had spoken to his colleague about not wearing a fragrance with such a strong aroma, because it disturbed other colleagues and service users.  The Registrant said that this had not gone down well because his colleague indicated that he needed to wear it because he cycled into work.  While CE gave evidence that the wearing of a strong smelling fragrance, could be a management issue, he indicated that how it was dealt with was important.  The Registrant gave evidence that his approach to the problem once a quiet word had not worked, was to say to service users in the reception area, when Colleague B was present, “What do you think of our new air freshener?,” referencing how his colleague smelt.  He said that the patchouli oil “stank”.  The only evidence in support of this allegation comes from a record of an interview with another member of staff taken during the disciplinary investigation.  This is hearsay evidence that has not been fully tested and with limited detail as to time and context.  Accordingly, whilst the Panel accepts the Registrant’s evidence as to how he spoke, and takes the view that this is additional evidence of a bombastic approach, it does not find proved that he called Colleague B “Petunia.” 


Particular 7 is found proved in part. Particular a)-c) is found proved; particular 7 d) is not found proved.

28. The Registrant gave evidence that he had said the words listed at a)-c), namely “P***”, “Chocolate Tart” and “N****r”; he denied saying the phrase, “Cha Chi Cha” however. He denied the words “P****” and “Chocolate Tart” were racist or inappropriate, albeit he acknowledged that the word “N****r” was not a word that he should have used in the workplace. 

29. In relation to particular 7.a), the Registrant said he used the word “P***” meaning a corner shop.  This reference to a small convenience store was something that he had grown up with in the 1960s during his childhood in Kent.  The Registrant originally gave evidence that he would not use the word in connection with a person, but only with a shop, and that it referenced the establishments run by people with a strong work ethic, given the long hours they were open.  Following questions from the Panel, the Registrant expanded that, “Not all corner shops are P***; not every one is run by Indians or Pakistanis,” revealing that it was the physical characteristics of certain nationalities that were being referenced.  In his disciplinary interview and confirmed in his oral evidence, the Registrant advised that the term “P***” was in his vocabulary.  He gave evidence that whilst it was not a word he used daily, it was a word he would use for example when saying he was “going to the P***” by which he meant shops.  This continued even up until recent times following the events with which this case is concerned since when he has spoken with peers who have told him that this was wrong.
 
30. In relation to particular 7.b) and using the words “Chocolate Tart" to a colleague, the Registrant gave evidence that this arose in connection with a Christmas meal that was being planned when they were discussing menus.  The Registrant said his reference to “Chocolate Tart” and his colleague was about the description of the dish, and his colleague.  The Registrant explained, “I had said, ‘You would be that Chocolate Tart,’ not that, ‘You are a Chocolate Tart,’ and that it was the description of “Dark, sensuous, tasty, whatever…” that he was referencing.  On questioning from the Panel, he acknowledged that the colleague to whom he said this was non-white and was of part Iranian heritage. He had been surprised that she had been reminded of bullying at school because of this and surprised that she had been offended.
 
31. In relation to particular 7c) and using the word, "N****r" – the Registrant explained in his oral evidence that this had happened after he had worked very long hours and was exhausted. He described returning to the staff room and saying words to the effect “I feel like I have been working like a n****r.” He said that he was regretful that he used the word and acknowledged that, “it was totally inappropriate to use it.” The Registrant indicated that he does, “recognise strong language which not inappropriate.”  He said that it had just slipped out and had been said thoughtlessly rather than being intended to cause offence.

32. In relation to particular 7.d) and allegedly saying, "Cha Chi Cha" – the Registrant indicated that he had, “No idea where that came from. Never heard it. Never said it.” The Panel took into account that the Registrant had admitted all the other derogatory terms and the Registrant’s denial in this regard.  Given that this allegation forms part of a single reference, with very limited evidence without context or occasion being specified the Panel does not find this particular proved.

33. In relation to the words used being inappropriate and racist, the Panel does not accept that the Registrant is unclear that these are words that should not to be used and have negative connotations. In the second decade of 21st century, the Panel does not find it credible that anyone could be ignorant of the offensive and racist connotations of such words, particularly with a man who has worked for extended periods within the NHS.

34. The word, “P***” is both racist and inappropriate.  It should not be used in a professional setting.  It is not acceptable and would not be used by people at large, of all ages, races and genders in UK today because it would cause offence.  It is clear that the word would cause offense, not least of all to a racial group. 

35. He used the words “Chocolate Tart” in referring to a non-white female colleague with whom he worked.  He admitted it was in part it was because the confectionary was described as “Dark,” and that the colleague had a complexion that was darker than his own, “a healthy tan”. It would not have been said had she been white; accordingly if he did not know that it could be racist, he should have done.

36. The word “N****r” is one that is deeply offensive, and wholly inappropriate. He should not have used it.

37. The Registrant explained in his oral evidence his understanding of language was based on a 1960s upbringing, and 1970s television, (he specifically referred to Alf Garnett).  The Panel finds that this is not a credible justification for using these words decades later when society has moved on so significantly. This is symptomatic of his bombastic manner, whereby he has a much greater regard for himself than anyone else.

38. The Panel was of the view that his Human Resources colleague has aptly described the Registrant in saying that he is an “Old school racist – who says ‘paki’ and ‘nigger’; [who] did not seem to know or care about the offence he was causing.”


Decision on Grounds:

Misconduct

39.The Panel considered the submissions made, the legal advice, and guidance that exists on misconduct.  Ms Sheridan submitted that the Registrant’s actions clearly amount to misconduct in terms of some act or omission which falls short of what would be proper in the circumstances.  It was submitted that the standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner and reference was made to both the Standards of Proficiency for Orthotists and the HCPC Standards of Conduct, Performance and Ethics.

40.The Panel found that the Registrant has breached the HCPC Standards of Conduct, Performance and Ethics, particularly:

1.You must act in the best interests of service users;

3.You must keep high standards of personal conduct;

7.You must communicate properly and effectively with service users and other practitioners;

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

41.Further, that the Registrant has also breached the following Standards of Proficiency for Orthotists:

2.4 Registrant prosthetists / orthotists must recognise that relationships with service users should be based on mutual respect and trust, and be able to maintain high standards of care even in situations of personal incompatibility;


8 Registrant prosthetists / orthotists must:
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;
8.5 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;
8.6 understand the need to provide service users or people acting on their behalf with the information necessary to enable them to make informed         decisions;
8.8 recognise the need to use interpersonal skills to encourage the active participation of service users;


9.Registrant prosthetists / orthotists must:
9.1 be able to work, where appropriate, in partnership with service  users, other professionals, support staff and others;
9.2 understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a     team;
9.3 understand the need to engage service users and carers in planning and evaluating diagnostics, treatments and interventions to meet their needs     and goals;
9.4 be able to contribute effectively to work undertaken as part of a multi-disciplinary team.


42.In considering statutory grounds, the Panel considered whether the behaviour of the Registrant was deliberate.  It was the view of the Panel that the Registrant had chosen to behave in ways that he considered acceptable, despite attempts from colleagues to educate him, and complaints from patients. His behaviour has impacted adversely on a number of services users and a number of colleagues.  He has caused upset and confusion; undermined colleagues; and in one instance has caused actual pain when fitting a splint; and he has used language that should have never been used and which has caused significant offence. 

43.The Registrant has admitted misconduct in respect of those parts of the Allegation which he admitted.  The Panel has considered the remaining particulars within the Allegation and found the majority of them proved against him and amount to misconduct save for allegation 2a i).  While there may be beliefs and attitudes which the Registrant holds that he has sought to suggest go some way to providing an explanation for his conduct, such as his background, personality in enjoying banter, and a desire to do the best for his patients, these are not sufficient to exonerate the Registrant.

44.The Panel is satisfied that his behaviour is serious and that his behaviour falls below the standards expected. Accordingly, the Panel finds that there is misconduct. 

Decision on Impairment 

45. Ms Sheridan submitted that the Panel may consider that there is little before the Panel to show that the Registrant understood any wrongdoing or that he had remedied his behaviour, aside from some admissions, many of which were qualified.  She asked the Panel to consider whether they felt that the Registrant was evasive during his evidence, and whether he tried to downplay his behaviour.  If so, she submitted that the Panel may question how much insight he really has about his actions or wrongdoing, and if there are concerns about his level of insight, suggested there is a risk of repetition.

46.The Registrant submitted that the evidence was capable of interpretation. While he acknowledged that the process had allowed him to have his say and explain context, he said it has been enlightening also. He submitted that the allegations against him had highlighted a gap between his understanding and what patients were feeling. He had since consulted with others and now said that his vocabulary could be interpreted as being racist by others, and reminded the Panel that his evidence was that it was not intended in that way. He said that he did accept that he needed to be more aware of how he interacts with people and that he considered it appropriate to attend a communication course, an awareness course, and possibly a conflict resolution course that addresses conflict between professionals. He thanked the Panel and let them know that he had benefitted from this process.

47.In considering impairment, the Panel has taken into account that the purpose of these procedures is not to punish the Registrant for past wrongs 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 behaved in a manner that meant patients did not feel respected or listened to.  He dismissed the views of patients and fellow clinical professionals, and used language that was both inappropriate and racist to colleagues.

48.The Registrant acknowledged that his behaviour at times fell below acceptable standards of behaviour for Registrant Orthotists and those registered with the HCPC. The Panel noted that he shows some remorse but the Panel is concerned that this focuses more upon his current situation than the harm he has caused others.  The Registrant’s avowed focus has been on the best interest of patients, and the banter he enjoyed with patients and colleagues, but has limited recognition that his failings are responsible for the complaints that have been made and the way in which he behaved in failing to respect others, rather than simply having the best clinical opinion. His pattern of behaviour demonstrates a lack of respect for staff, other clinical professionals, and patients; it has shown a degree of arrogance; this was repeated over an extended period of time.
 
49. The Panel took into account the registrant’s evidence.  He has said that he was told that Service User A was a “constant complainer” – and suggested that Service User E had, “had words put in her mouth”; he describes a colleague he offended as someone who had to be “carefully stepped around” – and said that he had to, “keep an eye on” another Orthotic colleague.  The Panel does not accept that the Registrant’s behaviours can be adequately be explained by reference to other people’s behaviours. There were multiple failings by the Registrant in terms of different inter-personal relationships, so that despite some positive submissions now being made, the Panel is not confident that the Registrant truly comprehends how grave his failings were, nor can it be confident that these would not be repeated in the future.

50. The Registrant’s failings were multiple in that he caused unnecessary harm, in the fitting of some devices, he had difficult professional relationships with colleagues and he exhibited a disregard for the feelings of his service users.  The Panel find that there is a risk of harm, in failing to work collaboratively with other clinicians and his patients.  He confused and upset patients and gave little thought about how to manage a difference of professional opinion when this arose.

51.The Panel was concerned that the issues surrounding behaviour and language exist, given that the norms of social engagement, require this learning and norms to be assimilated for effective interaction and collaborative working in multi-disciplinary teams.  Whilst it is positive that the Registrant is now considering attending courses to address this, the Panel remains concerned that he has shown such significant short comings in his understanding of his own behaviours.  Further, the Registrant has not been able to evidence any such learning in the two years since he left the Trust beyond talking with others about the appropriateness of language.

52.The Panel is of the view that the behaviour is remediable but the process of remediation has not yet started in any meaningful way despite the time that has passed.  The Panel cannot say that he has remediated his failings. The Panel is satisfied that the risk of repetition, were the Registrant to find himself in similar circumstances, does exist. Further there remains concern that other lapses may occur, particularly because the Registrant professes himself unable to judge which words are acceptable in the modern world, nor fully comprehend the manner in which professional differences of opinion should be tackled and resolved so as not to impact patients negatively. This means that the Panel cannot be satisfied that there is no such future risk.  In these circumstances the Panel finds that there are current concerns relating to the Registrant’s fitness to practise.
  
53.Having regard to the critically important public policy issues, the Panel’s assessment is that the Registrant’s current fitness to practise remains impaired. Confidence in the profession of Orthotists will be undermined as members of the public would be concerned about the failure to behave in a caring way and which takes into account what patients say.  Patients who are afraid of being physically hurt because someone is too rough and will not acknowledge their pain, or who disregard clinical advice, because of confusion about conflicting views would suffer harm. This is particularly so for the services users seen by Orthotists who require long term, often life-long care.  The public is entitled to expect practitioners to behave in a professional, courteous and respectful manner that respects patient dignity.  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.

54.Accordingly the Council’s case is well founded.


Decision on Sanction:

55.In considering what sanction, if any, to impose, the Panel has taken account of the submissions made by Ms Sheridan and the Registrant, as well as the advice of the Legal Assessor.  It has also considered the HCPC Indicative Sanctions Policy.

56.Ms Sheridan has said that the decision on what sanction, if any, to be imposed, is a matter for the Panel.  She submitted that a short term suspension may be the most suitable disposal of this matter.  She said that the Panel may feel that no lesser sanction would have the necessary of the deterrent value to the Registrant. 

57.The Registrant submitted that he had not been employed for the last two years.  Ending work after a disciplinary investigation, had meant he had felt unable to work during the two intervening years, initially because of the way his job had ended and thereafter because he did not feel able to commit to an employer, with the HCPC process hanging over him. The Registrant said that he had declined work offered to him, in a locum capacity. This was because it was not his ideal way of being a clinician. He could have maintained a professional input into profession but he first wanted this process to conclude.

58.The Registrant indicated that he would like to work again within a clinical environment in an NHS post.  He did not want to be a sole autonomous Orthotist trying to take forward a service during a time of change, as he had been in Bristol. He accepted that he had acted bombastically and “bulldozed” through a lot.  Hs said that he not totally empathised with people around him but that he had had many successes within the 30 years he had spent within this profession. The Registrant was proud of his knowledge and experience.  He said that had, “a lot to give,” and, “would like to impart my knowledge to a new generation of young people and be involved in their training.”

59.The Registrant submitted that this regulatory process will mean that he has to look at himself and in doing so, seriously step back from the process, and consider how he has been bombastic.  He reminded the Panel that he will consider three types of course, dealing with self-awareness and confrontation. He said that he was now, “more aware” of himself, and how he, “interacts with people.” He said that he had made a note today, that he should not be so confident in his actions, in that they can impart pain, anxiety and humiliation. He said that he will not always compromise, but ultimately the support of a peer group would help him not be, “so quick on the draw.”

60.The Registrant said that the support of colleagues would be important to him, so that he can confer with peers. He submitted that he only has patient welfare at heart, although he now recognise that this has not is always been perceived to be the case.  He did not think that public have been at risk in his consultations, and considered the majority of his patients have benefitted from his efforts.  He said that he had been naïve about working in Bristol, and what he considered acceptable. He still maintains that his language was used in innocence but has taken on board what has been said and will not use those words in a professional situation again. He reiterated that he enjoys the work of an Orthotist, the learning, the problem-solving, professional colleagues, and service users who he works with.  He submitted that he hoped the Panel would consider that remedial measures can be imposed and that his personal development as an Orthotist means that the public would be assured that they would not be harmed, nor the profession and its regulation would not be undermined. 


Sanction:

61.In considering the appropriate sanction in this matter the Panel has had regard to its earlier findings. The Panel was not persuaded that he has completely learnt from his experience at the Trust, insofar as the risk of the likelihood of repetition of inappropriate behaviour in the future is concerned. This is because his interpersonal skills have been shown to be limited. 

62.In view of the seriousness of the case, to take no further action, would not be appropriate as it fails to address the serious issues raised of inappropriate, and disrespectful behaviour, including causing harm in an environment where people are vulnerable, and the public interest in respect of this fact. 

63.Mediation was discounted as this is not a process where there needs to be resolution between two parties.
 
64.Imposition of a caution order was discounted because it does not reflect sufficiently the Registrant’s breach of professional standards in multiple situations. There are concerns about inappropriate language, inappropriate patient treatment, and inappropriate behaviour concerning his professional colleagues’ expertise. The Panel considered a more serious sanction was necessary to protect the public, maintain confidence in the profession and maintain confidence in the regulatory process. 

65.The Panel went on to consider the imposition of a Conditions of Practice Order and considered the same to be inappropriate as there are no verifiable, realistic or measurable conditions of practice which could address the wide range of failings identified; such conduct would make a Conditions of Practice Order unworkable. Racist language, harming patients and being dismissive of patients’ pain and concern, and his disrespect for colleagues require marking more significantly.  Further the Registrant’s insight is in its early stages.

66.The Panel next considered a Suspension Order taking account of the Registrant’s lack of knowledge and skills of acceptable social interaction which had the potential to place vulnerable patients at risk.  The Registrant had demonstrated some insight but has not undertaken any significant remedial action in the two years since leaving the Trust. Accordingly, there is a risk of repetition of the facts found proved to occur again, should the Registrant find himself in a clinical setting as an Orthotist.

67.The Panel went on to consider whether a period of suspension would be appropriate in this case. In the light of the above considerations and the circumstances of this case, the Panel determined that a Suspension Order would suffice to protect the public and the public interest and would mark the seriousness of the failings identified. It would provide the Registrant with an opportunity to engage further with the process and to demonstrate insight into his misconduct, whilst protecting the public and the public interest.

68. The Panel did go on to consider whether a Striking off Order would be appropriate. However, taking into account the mitigating factors in this case, which involve the Registrant’s engagement with the process and insight, albeit limited at this stage, the Panel determined that it would not be a just nor proportionate sanction at this point in time. The Panel determined that the Registrant should be given the opportunity to more fully demonstrate insight and remediation of his misconduct and therefore the sanction of last resort is not at this stage appropriate.

69. The Panel determined that the order of suspension is to last 9 months.  The deep seated attitudes and behaviours which the Registrant has demonstrated will not be easily or quickly addressed.  Nine months would enable the Registrant to have the opportunity to learn, consolidate, and demonstrate new behaviours.

70. This Order will be reviewed before it expires and a future Panel reviewing this Order would be assisted by the following:
 a) A reflective piece by the Registrant, concentrating on what led to his misconduct, how his actions impacted, or could have impacted, on service users, and colleagues and how he has changed his behaviour and remediated his misconduct;
 b) Information about any employment he undertakes;
 c) An indication as to his future professional plans;
 d) Evidence of the Registrant keeping his practice up to date and remediating his misconduct by undertaking relevant courses. The reviewing panel may be particularly assisted by evidence from courses that have involved interaction with and challenge by other individuals.  He may find it         helpful to approach a professional body or academic institution;
 e) Up to date character and /or employment references from persons who are aware of these proceedings and who can report on his behaviours.

 

 

Order

That the Registrar is directed to suspend from the Register Mr John Skelton for period of 9 months on the date that this order comes into effect.

Notes

The order imposed today will apply from 23 February 2017.  This order will be reviewed again before its expiry on 23 November 2017 date. 

Hearing history

History of Hearings for Mr John F Skelton

Date Panel Hearing type Outcomes / Status
07/11/2017 Conduct and Competence Committee Review Hearing Suspended
23/01/2017 Conduct and Competence Committee Final Hearing Suspended