Vivian M Oppon-Osei

: Social worker

: SW56479

: Final Hearing

Date and Time of hearing:10:00 19/06/2017 End: 17:00 22/06/2017

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

: Conduct and Competence Committee
: Struck off

Allegation

Allegation (as amended at Substantive Hearing):

Whilst employed as a Locum Social Worker at North East London NHS Trust:

1.     On or around 12 October 2015, regarding your visit to Service User A, you:

a)     Did not complete an appropriate risk assessment in respect of Service User A after he disclosed to you that he wanted to commit suicide;

b)     Did not complete a Needs Assessment Form in respect of Service User A following Service User A’s disclosure described in particular 1a);

c)     Did not tell your manager/s about Service User A’s disclosure described in particular 1a) until approximately 15 October 2015;

d)     Did not immediately notify the relevant healthcare professionals and/or agencies that Service User A had made the disclosure described in particular 1a).

2.     The matters described in paragraph 1 constitute misconduct and/or lack of competence.

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

 

Finding

Preliminary Matters


Application to amend the Allegation


1. Miss Mitchell-Dunn applied to amend the Particulars, in the form sent to the Registrant on 6 December 2016. Ms Hurd indicated that the proposed amendments were agreed. The Panel considered the submissions of Miss Mitchell-Dunn and the advice of the Legal Assessor. The Panel was satisfied that the amendments were necessary to better reflect the evidence in the case and did not alter the nature of the allegations.  The Panel was therefore satisfied that the amendments could be made without causing any prejudice to the Registrant and agreed to grant the application.


Background


2. The Registrant worked as a locum social worker in the Integrated Care Management Team within Waltham Forrest Council from 17 August 2015 until 23 October 2015. On 12 October 2015, the Registrant visited Service User A. During the course of the visit, Service User A informed the Registrant repeatedly that he was having suicidal ideations. Following the visit, the Registrant recorded a case note on 13 October 2015 which included that she had talked with Service User A regarding the issues which were concerning him. However, the Registrant did not report the incident to her managers or to any other professionals at the time. In the early hours of 13 October 2015, Service User A made a suicide attempt and was taken to hospital. The Registrant did not inform her line manager until 15 October 2015, having received a Police report of the attempted suicide during the early hours of 13 October 2015.

Decision on Facts


3. In relation to the HCPC’s case, the Panel heard oral evidence from witness 1 (BS), Senior Social Worker, who at the relevant time was the Registrant’s line manager. The Panel also heard oral evidence from witness 2 (JC), the Community Matron in the Integrated Care Management (ICM) team. The Panel read the agreed witness statement of witness 3 (AC), Team Manager of the ICM team. The Panel was provided with a Final Hearing Bundle which included the witness statements of witnesses 1, 2 and 3 and an Exhibits bundle which included all of the exhibits referred to by the witnesses.


4. In relation to the Registrant’s case, the Panel heard oral evidence from the Registrant and was provided with a documentary bundle titled “Registrant’s Representations”, which included emails between the Registrant and the HCPC and a witness statement dealing with the Registrant’s account of what happened and details of material which she had read since the incident.


5. The Panel considered that Witness 1 gave careful, measured evidence and was credible. The Panel considered that Witness 2, whilst an honest witness, relied partly on assumptions rather than facts and that her recollection of her conversation with the Registrant on 13 October 2015 may not have been totally accurate.


6. The Panel found that whilst the Registrant made full and frank admissions and expressed remorse, she was unable to answer questions directed as to why, in relation to Service User A, she had not completed a risk assessment and had not immediately informed her managers or relevant healthcare professionals of Service User A’s suicidal ideations. The Panel, whilst not finding that the Registrant was being deliberately evasive, was not assisted by her inability to answer these questions. However, the Registrant, in her evidence to the Panel, accepted that she had seriously breached professional standards in respect of her dealings with Service User A.


7. The Panel noted that the facts in relation to Particulars 1a), 1b), 1c) and 1d) are not in dispute and were admitted by the Registrant. The Panel further considered that witness 1 gave clear evidence that the Registrant ought to have completed a Needs Assessment Form in respect of Service User A by 13 October 2015. The Panel also had regard to the Person Case Notes in relation to Service User A. The Panel considered that Service User A was clearly at an immediate risk on 12 October 2015 and that the Registrant ought to have taken the action set out in the Particulars.
8. Accordingly, the Panel found each of Particulars 1a) – 1d) proved.

Decision on Grounds


9. The Panel considered that the Registrant owed a duty of care to Service User A, who at the time when he was seen by the Registrant on 12 October 2015, was extremely vulnerable and at risk of causing himself harm.  The Panel was satisfied that by failing to complete an appropriate assessment, and by not immediately informing her managers or other health professionals as to his suicidal ideations, the Registrant failed to promote and protect the interests of service users, which amounted to a serious falling short of Standards 1, 6 and 7 and 10 of the HCPC Standards of conduct, performance and ethics as follows:


1 – You must act in the best interests of service users.
6 – You must act within the limits of your knowledge, skills and experience and, if necessary, refer the matter to another practitioner.
7- You must communicate properly and effectively with service users and other practitioners.
10 – You must keep accurate records.


10.  The Panel also considered that the Registrant’s conduct breached the Standards of Proficiency for Social Workers in the following respects:


1 - Be able to practise safely and effectively within their scope of practice.
2.3 - understand the need to promote the best interests of service users and       carers at all times.
2.4 - understand the need to address practices which present a risk to or from service users and carers, or others.
4 - Be able to practise as an autonomous professional, exercising their own professional judgement.
4.1 - be able to assess a situation, determine its nature and severity and call upon the required knowledge and experience to deal with it.
4.2 - be able to initiate resolution of issues and be able to exercise personal initiative.
4.3 - recognise that they are personally responsible for, and must be able to justify, their decisions and recommendations.
4.4 - be able to make informed judgements on complex issues using the information available.


11. The Panel was satisfied that the Registrant was aware of the required standards and that she had not met them. The Panel considered these to be serious breaches which amounted to misconduct and did not amount to lack of competence.

Decision on Impairment


12. In considering whether the Registrant’s fitness to practise is currently impaired, the Panel had regard to its findings of misconduct and to the Health and Care Professions Tribunal Service Practice Note, “Finding that Fitness to Practise is impaired”.

13. The Practice Note contains the guidance that Panels are “concerned with the issue of whether in the light of any misconduct proved, the fitness of the registrant to practise has been impaired taking account of the critically important public policy issues”.

14. Those “critically important public policy issues” which must be taken into account by Panels were described by the court in the case of Cohen v GMC [2008] as: “the need to protect  service users and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect… and that public interest includes amongst other things the protection of [service users] and maintenance of public confidence in the profession”.

15. Thus, in determining whether fitness to practise is impaired, Panels must take account of a range of issues which, in essence, comprise two components (i) the ‘personal’ component, i.e. the current competence, behaviour etc. of the individual registrant; and (ii) the ‘public’ component, i.e. the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

16. In relation to the personal component, the Panel was satisfied that the Registrant’s misconduct had resulted in actual harm being caused to Service User A. She had made assumptions about Service User A and had not been probing in relation to his suicidal ideations. She did not realise the need to do a risk assessment during her visit with Service User A on 12 October 2015 and did not question him appropriately. The Registrant failed to notice obvious alarm bells such as Service User A drinking wine throughout the visit, which she attributed to a lifestyle choice, and seeming to be happy and content, notwithstanding his suicidal ideation. In addition, rather than escalate to the relevant agencies the obvious risks, the Registrant sought to de-escalate them by urging Service User A to focus on she what described as “the positives”. On leaving Service User A’s home, the Registrant did not reassess his risk of suicide.

17. In considering the risk of repetition, the Panel took into account the Registrant’s current insight. Although the Registrant was remorseful and reassured the Panel that she would take the appropriate steps if faced with a similar situation in the future, the Registrant was unable to explain why it did not occur to her to assess his risk of suicide or immediately notify the relevant healthcare professionals and/or agencies. The Panel concluded that the Registrant had failed to demonstrate sufficient insight into her failings.

18. The Panel noted the Registrant’s evidence as to her remediation since the incident, in particular her assertion that she had undertaken relevant reading. The Panel was however concerned that, notwithstanding that the Registrant had identified a year ago an urgent need to undertake risk assessment training in relation to dealing with service users with mental health issues, she had failed to undertake any training, education or work, paid or otherwise in this field. Whilst the Registrant gave evidence that she had worked for two boroughs since leaving her employment with Waltham Forrest Council, she provided no references regarding any paid or unpaid work nor evidence of applied learning. The Panel concluded that the Registrant had failed to demonstrate that she had remedied her misconduct.

19. Taking all matters into consideration, the Panel determined that there remains a significant risk of repetition.

20. In relation to the public component, the Panel was also satisfied that the Registrant had brought her profession into disrepute and had breached a fundamental tenet of her profession, given that the primary duty of a Social Worker is to safeguard service users from harm.

21. For all these reasons, the Panel found that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, on both the personal and public components of impairment.

22. Accordingly, the Panel finds the Allegation is well founded.

Decision on Sanction


23. The Panel considered the submissions made by Miss Mitchell-Dunn on behalf of the HCPC and Ms Hurd on the Registrant’s behalf. The Panel received and accepted the advice of the Legal Assessor.

24. The Panel was mindful that the purpose of any sanction was not to punish the Registrant but to protect the public and maintain public confidence in the profession and the HCPC as its regulator, by the maintenance of proper standards of conduct and behaviour.

25. The Panel had regard to the Indicative Sanctions Policy dated 22 March 2017 [“the ISP”]. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of seriousness.

26. In deciding whether to impose any sanction, the Panel had regard to paragraph 13 of the Indicative Sanctions Policy which states:

 "There is a significant difference between insight and remorse. The degree of insight displayed by a registrant is central to a proper determination of whether fitness to practise is impaired and, if so, what sanction (if any) is required. The issues which the Panel need to consider include whether the registrant: 
• has admitted or recognised any wrongdoing;
• has genuinely recognised his or her failings;
• has taken or is taking any appropriate remedial action;
• is likely to repeat or compound that wrongdoing.”

27. Having carefully considered all matters, the Panel concluded that given the serious nature of the Registrant’s misconduct and its findings that there is a significant risk of repetition, a sanction was required both for public protection and in the public interest.

28. The Panel considered the following as aggravating factors:

• As a result of the Registrant’s misconduct, Service User A suffered serious physical harm;
• The Registrant has shown a lack of insight into the seriousness of her misconduct;
• The Registrant’s failings involved basic elements of social work practice, in particular the need to recognise when a service user is at risk, assess that risk and safeguard them from harm;
• At the time of the incident, the Registrant had been a qualified Social Worker for nine years and was unable to practise safely.

29. In considering mitigating factors, the Panel took into account that the Registrant admitted all the allegations from the outset. The Registrant has also apologised and expressed remorse for what happened to Service User A as a result of her failings.

30. The Panel considered the available sanctions in ascending order of seriousness and concluded that taking no action or imposing a Caution Order would be not be appropriate to mark the seriousness of the matters for which the Registrant’s fitness to practise is found to be impaired. This was not an incident of a minor nature and there is a significant risk of repetition. For the same reasons, the Panel concluded this was not an appropriate case for mediation.

31. The Panel next considered conditions of practice. The Panel had regard to paragraph 30 of the ISP, “Conditions of practice will be most appropriate where a failure or deficiency is capable of being remedied and where the Panel is satisfied that allowing the registrant to remain in practice, albeit subject to conditions, poses no risk of harm or future harm”.

32. The Panel carefully considered whether workable, appropriate, realistic and verifiable conditions could be formulated. The Panel had regard to its previous findings in relation to misconduct and impairment. It considered that the case was about the Registrant’s inability to recognise risks to the service user and to   act on it. Further, the Registrant failed to demonstrate the core professional skills required in order to practise safely. The Panel was mindful of the additional guidance in paragraph 30 of the ISP that an order of conditions of practice would be regarded as confirmation that, beyond any conditions imposed, the Registrant is capable of practising safely and effectively. Even 19 months after the incident, the Registrant was still unable to say why she did not safeguard the service user, nor could she demonstrate her understanding of risk and how to respond to it.

33. In all the circumstances, the Panel was unable to formulate practicable and workable conditions which would adequately protect the public or satisfy the public interest.

34. In considering a Suspension Order, the Panel had regard to the ISP which states at paragraph 39, “Suspension should be considered where the Panel considers that a caution or conditions of practice would provide insufficient public protection or where the allegation is of a serious nature but unlikely to be repeated and, thus, striking off is not merited”.

35. The Panel had regard to its findings that, due to the Registrant’s lack of insight and lack of effective remediation, there is a significant risk of repetition. However, the Panel carefully considered whether the Registrant’s misconduct could be remedied by way of a period of suspension during which the Registrant could further reflect and undertake necessary training or appropriate voluntary work.

36. The Panel had, at the forefront of its mind, the fact that the Registrant has been qualified since 2006 and that her misconduct involved basic elements of social work practice. The Registrant was also completely unable to safeguard her service user from harm, which the Panel regarded as a social worker’s primary and paramount duty.

37. The Panel was also mindful that over 12 months ago, the Registrant acknowledged that it was crucial for her to undertake risk assessment training in mental health cases, and yet this work is still outstanding. Nor has the Registrant provided any testimonial or other evidence of recent safe practice as a Social Worker.

38. The Panel had regard to paragraph 41 of the ISP, “If the evidence suggests that the registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option. However, where there are no psychological or other difficulties preventing the registrant from understanding and seeking to remedy the failings then suspension may be appropriate”. Taking all matters into consideration, the Panel considered the Registrant is unable to remedy her misconduct, given the length of time since qualification and her failure to provide any evidence of effective remediation. Accordingly, a Suspension Order would not be sufficient to protect the public.

39. In respect of a Striking Off Order, the Panel had regard to paragraph 48 of the ISP which provides that, “Striking off should be used where there is no other way to protect the public, for example where there is a lack of insight, continuing problems or denial. A registrant’s inability or unwillingness to resolve matters will suggest that a lower sanction may not be appropriate”.

40. Having regard to all of its previous findings, including the findings set out above in relation to the appropriateness of lesser available sanctions, the Panel came to the conclusion that a Striking Off Order was the least restrictive sanction and was the only way to protect the public, given the Registrant’s inability to remedy her misconduct.

41. For all of the above reasons, the Panel determined that the least restrictive and proportionate sanction in this case is a Striking Off Order.

Order

ORDER: The Registrar is directed to strike the name of Mrs Vivian M Oppon-Osei from the Register on the date this order comes into effect (the Operative Date).

Notes

 This Order will apply from 19 July 2017

Hearing history

History of Hearings for Vivian M Oppon-Osei

Date Panel Hearing type Outcomes / Status
19/06/2017 Conduct and Competence Committee Final Hearing Struck off