Miss Heidi Mulrain

: Speech and language therapist

: SL28001

: Final Hearing

Date and Time of hearing:10:00 31/05/2017 End: 17:00 31/05/2017

: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Voluntary Removal agreed


(as amended at the final hearing on 13 – 17 January 2014)

During the course of your employment as a Speech and Language Therapist with University Hospital Birmingham NHS Foundation Trust between April 2010 and October 2011 you:

1. You failed to reach a satisfactory level in competencies for a Band 5 Speech and Language Therapist, in areas such as:

(a) Your assessment of dysphagia and/or dysphasia patients, which included:

(i) On or around 20 October 2010, you did not fully assess Patient C before recommending therapeutic intervention for treatment of his dysphasia;

(ii) On or around 29 November 2010 you inappropriately commenced an assessment of Patient D without first communicating with the patient’s community nurse.

(b) Your treatment planning in respect of people with dysphagia and/or dysphasia.

(c) Your treatment plans in respect of people with dysphagia and/or dysphasia, which included:

(i) On or around 23 December 2010 you inappropriately recommended that Patient S be trialled on a soft moist diet;

(ii) On or around 23 December 2010 you inappropriately recommended that Patient E be trialled on fluids.

2. You were unable to work independently and autonomously in that you required input from colleagues.

3. On or around 7 July 2010 you inappropriately suggested that Patient A, who had a severe neurological injury, be discharged as you believed the patient’s language skills were intact.

4. On or around 30 July 2010, you inappropriately attempted to carry out a Speech and Language Therapy assessment on Patient B who was in a severely compromised respiratory status.

5. The matters set out in 1 to 4 amount to a lack of competence.

6. By reason of that lack of competence, your fitness to practise is impaired.

Facts Proved: 2, 3 and 4

Facts Not Proved: 1(a)(i), 1(a)(ii), 1(b), 1(c)(i) and 1(c)(ii)


Preliminary Matters

1. The Panel has been convened to consider an application made jointly by the Registrant, Ms Mulrain, and the HCPC that the former should be permitted to remove her name from the HCPC Register.

2. The Registrant has not attended the hearing of the application.   The Panel is satisfied that the letter dated 15 March 2017 sent to her informing her of the date, time and location of the hearing constituted good service.  As to proceeding with the hearing in the Registrant’s absence, the present application is one where it would not ordinarily be expected that a registrant would attend as their position is made clear by the documentation put before the panel hearing the application and there is little, if anything, that can be added by personal attendance on the part of the registrant seeking removal from the register. Furthermore, in the case of this particular Registrant, she made clear by a letter dated 2 May 2017 that she was unable to attend.  In all the circumstances the Panel was satisfied that the hearing should proceed in the absence of the Registrant.   Such a direction is not only in the public interest but also in the interests of the Registrant herself.


3. On 22 August 2012 a Panel of the Investigating Committee determined that there was a case for the Registrant to answer in relation to an allegation that her fitness to practise was impaired by reason of her lack of competence.

4. The final hearing of that allegation was held over the five days in the week commencing 13 January 2014.   The final hearing panel determined that the facts alleged by particulars 2, 3 and 4 were proven, that those facts demonstrated a lack of competence, and that the lack of competence was impairing the Registrant’s fitness to practise at the time of the hearing.
5. The background to the allegation made by the HCPC against the Registrant was as follows:

• The  Registrant  commenced  employment  with  the  University Hospital  Birmingham  NHS  Trust  (“the  Trust”)  as  a  Band  5 Speech and Language Therapist on 1 September 2009.   She was based at the Queen Elizabeth Hospital and Selly Oak Hospital.

• Concerns were first raised about the Registrant’s practice  in about April 2010 by her then line manager, and they were discussed informally in June 2010.  At that stage it was agreed that colleagues would informally supervise the Registrant.

• Further concerns were identified in mid and late July 2010, as a consequence  of  which  the  Trust’s  Head   of   Speech   and Language Therapy became involved and the Registrant was placed  under  formal  supervision.    Subsequently,  the  Trust’s Poor Performance Management process was started.

• Between   July   2010   and   January   2011,   the   Registrant’s supervisors set various performance objectives for her to meet during supervision sessions, and reviewed her practice which was largely directly supervised.  As a result of an improvement in the   Registrant’s   performance,   from   January   2011   the Registrant worked independently, but had to review cases with more senior colleagues.  In March 2011, following feedback from colleagues, Stage 1 of the Formal Performance Management process commenced.

• Stage 2 of  the  Formal  Performance  process  began  in  June 2011. The  following  month  a  Poor  Performance  Summary Report was produced for the purposes of a Stage 2 Review meeting.  The report concluded that the Registrant continued to be unable to provide autonomous, safe, no-harm interventions as required of a Band 5 Speech and Language Therapist. The report recommended that the Registrant be issued with a Stage 3 – Final Written Warning in respect of her performance.  At the same time a referral was made to the HCPC.

• Stage 3 of  the  Trust’s  Formal  Performance  Management process   started   in   approximately   August   2011   and   the Registrant returned to undertake some clinical work under observed practice.    However, on 18 October 2011, the Registrant resigned from her post.

6. It  was  found  that  the  established  facts  demonstrated  a  lack  of competence, as they represented a fair sample of  the Registrant’s work, and demonstrated performance to an unacceptably low standard.

7. When the final hearing panel considered the issue of impairment of fitness to practise as at the date of the hearing they were conducting, it was acknowledged that the deficiencies identified by particular 4 had been largely addressed, although there were still concerns about her ability to deal safely and effectively with dysphagic patients.  That panel also recognised that the Registrant had attended a course about dysphagic patients, but there was no evidence any learning that had been gained by attendance on that course had resulted in an improvement in patient management because the Registrant had not practised independently since October 2011.  The conclusion of the panel was that in January 2014 the Registrant still posed a risk to patient safety, and that finding necessitated a finding of impairment of fitness to practise at that time.

8. The sanction imposed by the final hearing panel was a Conditions of Practice Order for a period of 12 months, such an order being necessary and proportionate. The conditions were as follows:

(1) You must notify the HCPC promptly of any professional appointment you accept for which registration with the HCPC  is  required  and  provide  contact  details  of  your employer.

(2) You  must  not  work  with  or  manage  swallowing  or potential swallowing disorders in adults or children unless directly supervised by a Speech and Language Therapist of at least Band 6 or equivalent.

(3) You must maintain a record of every case where you have undertaken work identified in condition 2 above which must be signed by your supervisor who must also comment on the standard of your performance.

(4) You must provide a copy of these records to the HCP Con a three-monthly basis.   The first report must be provided within three months of the Conditions of Practice Order taking effect or confirm that there have been no such cases during that period.

(5) Should you apply to work as a Speech and Language Therapist you must inform the following parties that your registration is subject to these conditions:

a.  any organisation or person employing or contracting with you to undertake professional work;

b.  any agency you are registered with or apply to be registered with (at the time of application); and,

c.  any prospective employer  (at the time of your application).

9. The review of the Conditions of Practice Order imposed by the final hearing panel took place on 13 January 2015.  The Registrant attended the hearing but was not represented.  Before the hearing of that review the Registrant had contacted the HCPC, stating that she was working as a Communication Support Coordinator with the Stroke Association,
and she confirmed that she had not been employed in a capacity that required her HCPC registration and that she had not undertaken any work with swallowing patients.  The conclusion of the reviewing Panel was that the Registrant’s fitness to practise remained impaired as at January 2015 as there was no evidence that the failings had been remedied.   The reviewing panel determined that the appropriate sanction to be imposed on the review was a renewal of the conditions of practice that had been ordered by the final hearing panel for a period of 2 years.

10. On 24 March 2016 the Registrant wrote to the HCPC.  In the letter she stated that her role with the Stroke Association had changed, but was still  non-clinical.    She  stated  that  she  had  been  unsuccessful  in obtaining work as a Speech and Language Therapist and requested that her name be removed from the HCPC Register.  The Presenting Officer informed the Panel today that this request was overlooked.  It was not a case of the request being considered, but refused, by the HCPC at that time.

11. On 6 December 2016 the HCPC sent the Registrant a notice of hearing in relation to a further review hearing that was scheduled to take place on 6 January 2017.   Having received this notice of hearing, on 15
December 2016 the Registrant again wrote to the HCPC stating that she did not intend to attend the forthcoming hearing and giving updated information about her activities (which continued to be one for which her HCPC registration was not required).   She reiterated the request she had made over eight months earlier to be sent information about voluntary removal from the HCPC Register.   There was, however, insufficient time to put in place the voluntary removal process before the scheduled further review.

12. The further review took place on 6 January 2017.  As she had indicated in her letter dated 15 December 2016, the Registrant did not attend the hearing.  The panel conducting this further review concluded that the Registrant’s fitness to practise was still impaired.   When considering
 the issue of sanction the Panel concluded that neither a conditions of practice order, nor any lesser sanction, would provide a sufficient response to that finding.  Acknowledging that the period of time the Registrant had been subject to a conditions of practice order extended to this reviewing panel the power to make a striking off order, the Panel concluded that such an order would be too punitive given the level of her engagement in the process.   The result was that this reviewing panel made a suspension order, directing that the appropriate period of such  an  order  was  six  months  as  that  would  be  sufficient  for procedures relating to the voluntary removal process to be put in place.

13. On  2  May  2017,  after  she  had  executed  the  Voluntary  Removal Agreement, the Registrant wrote to the HCPC confirming that she wished to be removed from the Register, stating that she would be unable to attend the hearing today, and that she was about to take up a new post which would not require her HCPC registration.

14. The  result  of  the  order  made  on  17  January  2017  is  that  the Registrant’s registration is currently suspended, and will remain so until 14 August 2017.


15. In  advancing  the  application  for  voluntary  removal,  the  Presenting Officer outlined the background to the case and submitted on behalf of the HCPC that the removal of the Registrant from the Register would afford a proper degree of public confidence.

16. The Panel has approached its decision on the application by deciding the following matters:

• being satisfied that the Registrant is seeking removal from the HCPC Register;

• if she is, whether the outcome would secure a proper degree of public protection;
• if  it  would,   whether   there   are   any   other   public   interest considerations that should lead to the application being refused.

17. In reaching a decision on these three elements:

• There is no doubt that the Registrant is seeking removal from the HCPC Register.  She first made the request by her letter dated 24 March 2016, renewed the request by her letter dated 15 December 2016, executed the Voluntary Removal Agreement on 20 April 2017 and reiterated her request by the letter dated 2 May 2017.  Accordingly, this is an outcome the Registrant has consistently sought for a period in excess of a year.

• Clearly, the removal of the Registrant’s name from the register would provide a proper degree of public protection as no greater protection could be provided.

• In the judgment of the Panel there are no wider public interest considerations that should lead to the application being refused. This was a case of lack of competence, not one of notorious misconduct, and in any event the issues were publically canvassed at the final hearing in January 2014.


Accordingly, the Panel agrees to the Voluntary Removal Agreement taking effect, and the Panel Chair will sign the Consent Order.



Hearing history

History of Hearings for Miss Heidi Mulrain

Date Panel Hearing type Outcomes / Status
31/05/2017 Conduct and Competence Committee Final Hearing Voluntary Removal agreed
06/01/2017 Conduct and Competence Committee Review Hearing Suspended
13/01/2015 Conduct and Competence Committee Review Hearing Conditions of Practice
13/01/2014 Conduct and Competence Committee Final Hearing Conditions of Practice