Miss Tracy Hands

: Social worker

: SW07094

Interim Order: Imposed on 15 Jun 2016

: Final Hearing

Date and Time of hearing:10:00 05/06/2017 End: 17:00 07/06/2017

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

: Conduct and Competence Committee
: Suspended

Allegation

(as amended at the Final Hearing)

Whilst employed as a Social Worker by Staffordshire County Council between 12 October 2015 and 15 March 2016:

1. In relation to Service User A:

a) Between 24 December 2015 and 11 March 2016 you did not undertake and/or record any contact with the police;

b) Between 7 January 2016 and 11 March 2016 you did not undertake and/or record any visits to Service User A;

c) Between 24 December 2015 and 11 March 2016 you did not undertake and/or record an enquiry report;

2. In relation to Service User B:

a) Between 26 February 2016 and 11 March 2016 you did not complete and/or record your completion of a Mental Capacity Assessment of Service User B;

b) Between 26 February 2016 and 11 March 2016 you did not complete and/or record your completion of a referral to advocacy for Service User B;

c) Between 26 February 2016 and 11 March 2016 you did not contact Service User B to obtain her views;

d) Between 26 February 2016 and 11 March 2016 you did not liaise with community nurses and/or carers regarding Service User B;

e) Between 26 February 2016 and 11 March 2016 you did not ensure that protective measures were in place for Service User B;

3. In relation to Service User C:

a) Between 26 October 2015 and 11 March 2016 you did not adequately communicate with other professionals and/or the adoptive parent in relation to Service User C;

b) You did not complete an adequate FACE Overview Assessment of Service User C;

c) Between 10 November 2015 and 2 February 2016, you did not maintain adequate contact with Service User C;

d) Your actions at 3a, 3b and/or 3c caused a delay to Service User C’s discharge from hospital;

4. In relation to Service User D:

a) Between October 2015 and 11 March 2016 you did not fully complete your FACE Overview Assessment of Service User D;

b) You did not provide your FACE Overview Assessment of Service User D to the Continuing Health Care Funding Panel arranged for 9 March 2016 in a timely manner;

c) Your actions at 4a and/or 4b caused a delay to Service User D’s discharge from hospital;

5. Your actions described at particulars 1 to 4 constitute misconduct and/or lack of competence;

6. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary Matters

1. The Panel noted that the Registrant was unrepresented and throughout the hearing it had regard to the HCPTS Practice Note on “Unrepresented Registrants”.

Application to amend the allegation

2. At the outset of the hearing, Ms Thompson applied to amend the allegation in accordance with the proposed amendments set out in a letter to the Registrant dated 27 February 2017. Ms Thompson submitted that the proposed amendments were minor in nature, more accurately reflected the evidence, and, if allowed, would not heighten the case against the Registrant and would not cause her prejudice. The Registrant did not oppose the application.

3. The Panel accepted the advice of the Legal Assessor and decided to allow the application on the basis that the amendments are minor and serve to clarify the allegation and will not cause prejudice to the Registrant.

4. The Registrant informed the Panel that she only wished to attend in person on Day 1 (5 June 2017), and did not want to attend the subsequent two days for which this hearing was listed. She applied to give evidence and make submissions by telephone. Ms Thompson did not object to this course of action. The Panel accepted the advice of the Legal Assessor and decided that it would be fair to allow the Registrant to give evidence by telephone when she was not present at the hearing in person.

Background

5. The Registrant, a registered Social Worker, commenced employment with Staffordshire County Council for Stafford and South Staffs Independent Futures, Adult Learning Disability Team, on 12 October 2015.

6. Due to concerns about her practice, an informal Performance Improvement Plan was commenced on 19 February 2016. It is alleged that this did not proceed well. Concerns continued with regard to the Registrant’s inability to complete work and to make records in relation to her caseload. The Registrant eventually resigned from her position in March 2016.

Decision on Facts

7. The Panel heard live evidence from TD, the Registrant’s line manager at the relevant time, and also took into account the documentary evidence.

8. The Panel found TD to be a credible, measured and reliable witness. Her credibility was enhanced during her oral evidence by her willingness to admit when she did not remember events and to admit when she had been mistaken.

9. The Panel drew no adverse inference from the Registrant’s decision not to give evidence at this stage. The Panel was aware that it needed to apply the civil standard of proof, namely the balance of probabilities, and accepted the advice of the Legal Assessor.

10. The Registrant accepted that she was employed as a Social Worker by Staffordshire County Council between 12 October 2015 and 15 March 2016.

Particular 1a) – Proved

11. The Registrant admitted both elements of this Particular. The Panel also took into account the evidence of TD, supported by the documents provided, which substantiated this Particular. The Panel therefore found this Particular proved.

Particular 1b) – Proved

12. The Registrant admitted both elements of this Particular. The Panel also took into account the evidence of TD, supported by the documents provided, which substantiated this Particular. The Panel therefore found this Particular proved.

Particular 1c) – Proved

13. The Registrant admitted both elements of this Particular. The Panel also took into account the evidence of TD, supported by the documents provided, which substantiated this Particular. The Panel therefore found this Particular proved.

Particular 2a) – Proved

14. The Registrant admitted both elements of this Particular. The Panel also took into account the evidence of TD, supported by the documents provided, which substantiated this Particular. The Panel therefore found this Particular proved.

Particular 2b) – Proved

15. The Registrant admitted both elements of this Particular. The Panel also took into account the evidence of TD, supported by the documents provided, which substantiated this Particular. The Panel therefore found this Particular proved.

Particular 2c) – Proved

16. The Registrant admitted this Particular. The Panel also took into account the evidence of TD, supported by the documents provided, which substantiated this Particular. The Panel therefore found this Particular proved.

Particular 2d) – Proved (in relation to community nurses)

17. The Registrant denied this Particular in relation to carers, but admitted it in relation to community nurses.

18. The Panel considered the evidence of TD, which was that Service User B was allocated to the Registrant on 25 February 2016 by an email from TD to the Registrant. The Registrant was required to undertake a safeguarding enquiry. TD, in her oral evidence, said that she set up a meeting with carers which the Registrant attended. The Panel noted that the Registrant had recorded in Service User B’s case notes that she attended an initial meeting at the carer’s home address on 26 February 2016. TD stated in her oral evidence that although the Registrant identified further steps which needed to be taken, after this initial meeting she did not further liaise with carers.

19. The Panel found that the date of the meeting, namely 26 February 2016, fell within the range of dates set out in the Particular, and therefore it found this element of the allegation not proved. However, taking into account the Registrant’s admission as well as TD’s evidence, the Panel found that the Registrant did not liaise with community nurses during the period set out in the Particular.

Particular 2e) – Proved

20. The Registrant denied this Particular.

21. TD’s evidence was that protective measures were needed as a result of safeguarding concerns raised in respect of Service User B. These concerns revolved around whether she had the ability to manage her finances, in light of the risk that she was vulnerable to financial exploitation. There were further concerns that Service User B was sending intimate photographs of herself to another and whether she had the capacity to consent. In Service User B’s records, the Registrant herself had recommended that a mental capacity assessment regarding finances be completed with a referral for advocacy, which TD agreed were appropriate measures in this case, but her evidence was that she was unable to find evidence on Service User B’s file that such measures were put in place. On the balance of probabilities, the Panel found this Particular proved.

Particular 3a) – Proved

22. The Registrant denied both elements of this Particular.

23. The Panel took into account the evidence of TD that at the time the case was allocated to the Registrant, Service User C was in hospital, having been diagnosed with a terminal illness. In order to assist with his discharge from hospital, the Registrant was required, according to TD, to communicate “with hospital staff, the community learning disability nurse, the police and the service user’s adoptive mother in order to put a plan of care in place for Service User C to receive treatment in the community as an outpatient”. TD’s evidence was that while initially the Registrant’s communication with hospital staff regarding Service User C was good, it did not continue to be adequate, with TD and her manager receiving several calls a week from hospital staff because they were unable to contact the Registrant. The Panel took into account evidence in Service User C’s records that hospital staff were repeatedly attempting to contact the Registrant and she was not responding to or returning their calls.

24. TD’s evidence was that on or around 9 November 2015, the Registrant visited Service User C to gather information and was part of a safeguarding meeting which TD had chaired. The records show that there was a meeting on 9 November 2015 at which the Registrant, the learning disability nurse and Service User C’s adoptive mother were present. TD’s evidence was that there was very little evidence in the case notes to show that the Registrant had adequate communication with the relevant parties after this date. Further, TD’s evidence was that Service User C’s adoptive mother also contacted Staffordshire County Council with concerns about the lack of contact with the Registrant.

25. On the basis of the evidence, the Panel found this Particular proved.

Particular 3b) – Proved

26. The Registrant denied this Particular.

27. TD’s evidence was that the FACE Overview Assessment was not adequate. In her oral evidence she withdrew her opinion that the risk assessment element of it was not adequate, and she accepted that it was difficult to produce a perfect document. She did not change her view that its inadequacy lay in the fact that much of it consisted of copied and pasted emails, and it was not holistic or analytical in its approach. TD also told the Panel that the box in the FACE Overview Assessment regarding support relating to a skin condition was completed with “no support required” but that, in light of Service User C’s skin cancer, this was not appropriate. There was no reference to breathing difficulties resulting from his tumours or the fact that he was terminally ill and his health was unfortunately only going to deteriorate. The assessment did not make clear that due to his illness, Service User C’s capabilities and subsequent needs could fluctuate on a daily basis. Overall, the assessment did not provide sufficient analysis of need to determine the support Service User C needed. In addition, a number of boxes were left blank.

28. On the basis of the above, the Panel found that the assessment was not completed adequately and therefore found this Particular proved.

Particular 3c) – Proved

29. The Registrant denied this Particular.

30. TD’s evidence was that on 2 February 2016, Service User C’s previous Social Worker asked the Registrant to contact Service User C. Service User C said he had not seen or heard from the Registrant and he was becoming distressed. TD stated that due to the circumstances, she would have expected visits to take place at least once a week in order for a true assessment of need to be produced and a robust discharge plan put in place for Service User C. TD’s evidence was that apart from the initial meeting with Service User C on or around 9 November 2015, there are no records to show that the Registrant contacted him, despite the fact that the need to contact and/or visit him was communicated to the Registrant by email and during supervision.

31. The Panel therefore found this Particular proved.

Particular 3d) – Proved

32. The Registrant denied this Particular.

33. TD’s evidence was that the Registrant’s omissions in respect of Service User C caused a delay in his discharge of some weeks. The Panel determined that a combination of each of the omissions as set out in this Particular contributed to this delay. The Panel therefore found this particular proved.

Particular 4a) – Proved

34. The Registrant admitted this Particular. The Panel took into account TD’s evidence that there were blank sections in the FACE Overview Assessment of Service User B which should have been completed by the Registrant. The Panel therefore found this particular proved.

Particular 4b) – Proved

35. The Registrant admitted this Particular. The Panel took into account TD’s evidence that the FACE Overview Assessment was only provided to the Continuing Health Care Funding Panel (CHCFP) approximately five to ten minutes before it met on 9 March 2016 and that it should have been submitted a few days before. The Panel therefore found this Particular proved.

Particular 4c) – Proved (in relation to Particular 4b))

36. The Registrant denied this Particular.

37. TD’s evidence was that an incomplete FACE Overview Assessment form would not have prevented the CHCFP from considering it. However, the fact that it was submitted a few minutes before the hearing was due to take place meant that the CHCFP did not consider it, and that it would have to be put before a CHCFP at a later date. TD’s evidence was that this caused a delay in respect of a potential future placement and caused Service User D to remain in hospital longer than necessary. TD told the Panel that this delay was a matter of weeks.

38. On the basis of the evidence, the Panel found this Particular not proved in relation to the actions at Particular 4a), but proved in respect of the actions at Particular 4b).

Decision on Grounds

39. The Panel then considered whether the facts found proved amount to misconduct and/or lack of competence. The Panel bore in mind this issue is a matter for its own professional judgment, and there is no burden of proof on either party.

40. The Panel took into account the submissions of Ms Thompson and of the Registrant, who made submissions by telephone and accepted that the facts found proved fell below the standard expected. The Panel accepted the advice of the Legal Assessor who referred to the case of Roylance v GMC (No. 2) [2000] 1 AC 311.

41. The Panel first considered whether the facts found proved amounted to a lack of competence and concluded that they did not. There was not before the Panel a fair sample of the Registrant’s work in order to make an assessment as to her lack of competence. Nevertheless, the Registrant is an experienced social worker and there is no suggestion from the evidence in this case that she lacked the knowledge or competence to carry out her work.

42. The Panel considered that the matters found proved fell short of the following standards:

Standards of Conduct, Performance and Ethics (2008-2016)

1 You must act in the best interests of service users

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

10 You must keep accurate records

Standards of Conduct, Performance and Ethics (2016-present)

1 Promote and protect the interests of service users and carers

2 Communicate appropriately and effectively

6 Manage risk

10 Keep records of your work

Standards of Proficiency for Social Workers (2012-2017)

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

2 be able to practise within the legal and ethical boundaries of their profession

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

8 be able to communicate effectively

9 be able to work appropriately with others

10 be able to maintain records appropriately

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

43. The Panel bore in mind that the breach of a professional rule or standard did not necessarily mean that a finding of misconduct will follow.

44. The facts found proved relate to fundamental duties of a social worker, namely to carry out visits with service users, to communicate with other professionals, to complete assessments, to make records and to ensure that protective measures are put in place to safeguard vulnerable service users. Service Users A, B, C and D were vulnerable. Service Users A and B were the subjects of safeguarding concerns, and were at a real risk of harm. Service Users C and D were vulnerable because they were reliant on the Registrant to assist in their discharge from hospital. Service User C had been diagnosed with a terminal illness and, on hospital staff assessing him as fit for discharge, it was particularly important that there were no delays in the Registrant assisting to secure his discharge. In the event, the discharge from hospital of Service Users C and D was delayed by the Registrant’s omissions.

45. A social worker’s intervention cannot properly occur without effective liaison with others, and without adequate assessments and visits with service users. The Registrant did not carry out these basic duties adequately or at all, and this led to delays in the care and protection given to these vulnerable service users. The Panel found that each of the particulars found proved was serious.

46. The Registrant told the Panel in mitigation that she experienced a lack of support from management and had had to travel long distances to see some service users. However, the Panel accepted TD’s evidence that the Registrant was asked to do no more travelling than other team members. The Panel noted in any event that, in relation to Service User C, who was in hospital approximately one hour’s drive from the Registrant’s office base, she only visited him once.

47. In the Panel’s view, the Registrant was given significant support by her line manager, TD. For example, the Registrant had regular supervisions with and guidance from TD, and further steps were identified as necessary in those supervisions for the Registrant to manage her caseload. Further support was afforded to the Registrant in the form of a reduced caseload of 13 cases rather than the 30-40 cases held by other social workers in the Adult Learning Disability Team. TD told the Panel that this was initially because the Registrant was newly employed and still in her probationary period. TD intervened in a number of the Registrant’s cases and attended meetings with her, which she told the Panel she would not normally do. An informal Performance Improvement Plan was put in place which was to be monitored by fortnightly supervision sessions. In addition, TD offered the Registrant the option to work from home.

48. In all the circumstances, the Panel concluded that the Registrant fell seriously short of the standards expected of a registered social worker. This impacted adversely upon the support given to vulnerable service users and hindered the promotion of their welfare.

49. The Panel therefore concluded that each of the particulars found proved constituted misconduct.

Decision on Impairment

50. The Panel bore in mind that the issue of whether or not the Registrant’s fitness to practise is currently impaired is a matter for its own professional judgment, and there is no burden of proof on either party.

51. The Panel took into account the submissions of Ms Thompson and of the Registrant, who made submissions by telephone. While the Registrant accepted previous impairment in respect of the facts found proved, her position was that she is not currently impaired. The Panel took into account the Practice Note of the HCPTS entitled “Finding that Fitness to Practise is ‘Impaired’”, a copy of which was given to the Registrant at the conclusion of the first day of the hearing. The Panel accepted the advice of the Legal Assessor, who referred to the case of CHRE v NMC and Grant [2011] EWHC 927.

52. The Panel took into account the engagement by the Registrant in the hearing and the admissions made by her. The Panel concluded that her admissions were indicative of a degree of insight into the concerns regarding her practice while employed by Staffordshire County Council.

53. In her submissions, the Registrant told the Panel that she had had two short placements though an agency in two separate local authorities as a social worker following her resignation from Staffordshire County Council. However, the Panel has had little evidence about this work. The testimonials submitted by the Registrant are positive about her work, and are written in the knowledge of these HCPTS proceedings. However, they relate to the Registrant’s work prior to her employment at Staffordshire County Council.

54. The Panel has not had any evidence of reflection or any real insight from the Registrant about how her omissions impacted upon the service users in question, or upon public confidence in the profession and how she would do things differently in the future. There was no evidence presented to it of any attempts by the Registrant to remediate her failings or undertake training which would assist in guarding against such failings recurring in the future. The Registrant told the Panel of her further studies in coaching, but there was no indication as to how this has contributed to her development as a social worker.

55. The Panel considered the questions posed by Dame Janet Smith in the Fifth Shipman Report as set out in the case of Grant. The Panel concluded that the Registrant had in the past put service users at unwarranted risk of harm, had brought the profession into disrepute and had breached fundamental tenets of the profession. In the absence of evidence of sufficient insight into her failings, reflection upon them, an indication of how she would act differently in the future in similar circumstances, or remediation, the Panel concluded that she was likely to act in these ways in the future.

56. The Panel was of the view that the wider public interest was engaged in this case. The Registrant was responsible for vulnerable service users with learning disabilities, two of whom had safeguarding concerns raised about them, and two of whom were in hospital, and whose discharge from hospital was delayed by the Registrant’s omissions. The Registrant’s misconduct spanned a significant period of time in relation to a number of omissions in her work. In the circumstances, the Panel came to the conclusion that the need to maintain public confidence in the profession and to uphold proper professional standards would be undermined if a finding of impairment were not made.

57. The Panel therefore found that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction

58. The Panel took into account the submissions of Ms Thompson and of the Registrant, who made submissions by telephone. The Registrant expressed her desire to continue to work as a social worker and suggested that a Caution Order was appropriate in her case. The Panel had regard to the HCPC Indicative Sanctions Policy, a copy of which had been given to the Registrant before the sanction stage of the hearing. The Panel accepted the advice of the Legal Assessor. The Panel was aware that the purpose of sanction is not to be punitive, although it may have that effect.

59. The Panel found the following to be mitigating factors:

• admissions of some of the particulars of the allegation;

• engagement with the proceedings;

• no previous fitness to practise concerns;

• experience in the profession;

• the misconduct occurred during the probationary period of new employment;

• two supportive testimonials.

60. The Panel found the following to be aggravating factors:

• actual delay to the support given to service users was caused by the Registrant;

• insufficient insight from the Registrant into the effect of her misconduct on the service users;

• the misconduct related to wide-ranging and fundamental areas of a social worker’s practice;

• vulnerable service users were involved;

• extensive support in the workplace was given to the Registrant which she did not respond to in order to remedy her deficiencies.

61. The Panel first considered taking no further action and decided that this was inappropriate. The omissions of the Registrant were significant in respect of vulnerable service users. The Panel has already determined that there is a real risk that service users will be put at unwarranted risk of harm in the future. The Panel’s view is that taking no further action will not safeguard against this risk. In addition, the misconduct in this case is too serious and taking no further action would undermine public confidence in the profession and in the regulator.

62. The Panel next considered a Caution Order. It decided that this was not appropriate in the light of the serious omissions and real risk of harm to the public in the future, which a caution would not safeguard against because it would not restrict the Registrant’s practice. In addition, the misconduct in this case is too serious and taking no further action would undermine public confidence in the profession and in the Regulator.

63. The Panel next considered a Conditions of Practice Order and decided that this would not be workable. Although the misconduct is in principle remediable, during the time of the allegation the Registrant had the benefit of good supervision from a supportive line manager, which was insufficient to prevent her omissions from occurring and continuing. The Panel was therefore unable to formulate conditions which, in its view, would be sufficient to address the public protection concerns. In light of the previous failure of supervision to protect service users, any conditions that the Panel might consider would need to be so extensive to meet the concerns in this case that they would, in the Panel’s view, effectively amount to a suspension.

64. The Panel therefore decided that a Suspension Order for a period of 9 months would be appropriate and proportionate. This will protect the public, maintain public confidence in the profession and will uphold proper professional standards. At the same time it will allow the Registrant time in which to develop her insight into her misconduct and reflect on its impact upon the service users and upon public confidence in the profession. A period of 9 months was chosen as this would, in the Panel’s view, be the minimum required for the Registrant to demonstrate that she had remediated her failings.

65. The Panel was of the view that a Panel reviewing this sanction in due course might be assisted by the following:

• a written reflective piece from the Registrant on the reasons for her deficiencies, their effect on the service users, and changes she would make to ensure that they did not occur in the future;

• evidence of work done to improve communication skills, time management, record keeping and report writing;

• testimonials or references from any current or recent employment, whether paid or unpaid;

• evidence of training to address the Registrant’s deficiencies.

66. The Panel took into account proportionality and the fact that a suspension will prevent the Registrant from practising. However, the Panel carefully balanced this with the public interest, including public protection, and concluded that the need for public protection weighed heaviest in the balance.

67. The Panel did go on to consider a Striking Off Order, but decided that this would be disproportionate to the omissions at this stage, the fact that they are remediable, and in the light of no previous fitness to practise concerns.

68. The Panel therefore decided to impose a suspension order for a period of 9 months.

Order

That the Registrar is directed to suspend the registration of Miss Tracy Hands for a period of 9 months from the date this order comes into effect.

Notes

The order imposed today will apply from 5 July 2017 (the operative date).

This order will be reviewed again before its expiry on 5 April 2018.

Hearing history

History of Hearings for Miss Tracy Hands

Date Panel Hearing type Outcomes / Status
05/06/2017 Conduct and Competence Committee Final Hearing Suspended