Mrs Lyndsey J McConnell

: Speech and language therapist

: SL01609

Interim Order: Imposed on 02 Dec 2011

: Review Hearing

Date and Time of hearing:10:00 28/07/2017 End: 17:00 28/07/2017

: Clayton Hotel Cardiff, St Mary Street, Cardiff, CF10 1GD

: Conduct and Competence Committee
: Struck off

Allegation

During the course of your practise as a Speech & Language Therapist at the West Wales General Hospital, you:

 

1. Failed to complete assessments adequately in that you:

a) Not Proved.

b) Failed to pick up on relevant information provided by parents, teaching staff and assistants and failed to explore these more fully.

c) Failed to prepare patients for their assessments.

d) Not Proved.

e) Not Proved.

f) Failed to demonstrate an analysis of the assessments you carried out.

g) On 4 April 2011, failed to follow a systematic approach when gathering information from the school, resulting in missing a vital piece of information regarding a patient.

h) Failed to fully explore Individual Education Programs (IEPs) and did not mention the need to add targets from your assessments into the IEPs.

i) Were unable to provide a diagnosis of a child’s articulation, after seeing the patient on four occasions.

j) Failed to re-evaluate any progress the patients have made since they were last seen.

 

2. Failed to communicate effectively:

a) You did not provide clear and concise explanations to patients, parents and teachers, in that you did not adequately explain to clients the assessment activity that they were to undergo.

b) You did not reassure patients’ parents where they had significant concerns.

c) Not Proved.

 

3. Failed to maintain adequate notes in that:

a) Your notes did not include sufficient explanation of clinical decision making.

b) Your notes did not include any rationale for assessments or a full analysis of the assessments used.

c) Your notes were written in a disorganised manner.

d) Not Proved.

 

4. Failed to manage your time effectively in that:

a) You took over two and half hours to complete case notes for two patients.

b) You were unable to manage a full case load.

c) You were unable to structure your assessments and patients sessions.

d) Not Proved.

e) Not proved.

 

5. Not Proved.

 

6. Not Proved.

 

7. Demonstrated poor clinical decision making, in that:

a) Not Proved.

b) Not Proved.

c) Not Proved.

d) Failed to give a coherent plan of action for patients.

 

8. Demonstrated poor management planning:

a) You failed to liaise with the classroom assistants and teachers, when making decisions in that you:

i) Did not ask their opinion on what you could do to help patients overcome difficulties.

ii) Did not ask them about the difficulties experienced in the classroom by the child.

iii) Did not explain to them the areas that you identified as being problematic.

 

9. Demonstrated a lack of clinical reasoning in that:

a) Not Proved.

b) Not Proved.

c) You relied too much on the previous therapist’s programme, without questioning the suitability of the objectives.

d) You were unable to provide a rationale for your choice of assessment.

e) You were unable to analyse assessment results to form clinical decisions.

f) You were unable to apply theoretical information to clinical practise.

 

10. Demonstrated a lack of judgment in that:

a) Not Proved.

b) You are unable to judge your own performance and that of others.

c) You failed to identify the learning needs of classroom assistants.

d) Not Proved.

e) You did not ascertain whether the staff you worked with had the basic skills to be able to carry out the programme being given to them.

f) Not Proved.

 

11. You did not demonstrate reflective practise.

 

12. The matters set out in paragraphs 1-11 amount to lack of competence.

 

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

Finding

Preliminary Matters

1. Mrs McConnell has not attended the hearing but is represented by Ms Cook. Ms Cook explained that she had been in contact with the HCPC and that in the light of what she had been told Mrs McConnell had decided not to attend. At the invitation of the Panel Ms Cook made further enquires and informed the Panel that Mrs McConnell was unable to attend due to work commitments.

2. Ms Cook informed the Panel that she had full instructions and that it was unlikely that Mrs McConnell would be able to add anything to the information she had already provided.

3. Ms Cook agreed that the hearing could proceed and she accepted that all sanctions would be available including a striking off order.

4. Accordingly, the Panel decided to proceed with the hearing.

Background

5. The Registrant was employed by the Hywel Dda Health Board (the Health Board) as a Band 7 Highly Specialist Speech and Language Therapist. She worked with a Speech and Language Therapy Department based at Glangwili Hospital in Carmarthen and Prince Phillip Hospital Llanelli. In July 2006, the Head Teacher of one of the schools at which the Registrant worked raised concerns about the Registrant’s practice.

6. In September 2009 a senior Speech and Language Therapist at the Health Board was asked to undertake an internal investigation in relation to concerns about the working practices of the Registrant. As part of the investigation he conducted interviews with teachers at four different schools where the Registrant worked as a Speech and Language Therapist. He then produced a report. Additionally, another Speech and Language Therapist conducted an audit in April 2010 of the Registrant’s case notes.

7. In November 2010 the Head of the Speech and Language Therapy Service in Ceredigion was appointed to supervise the Registrant on one day a week for a period of six weeks. The Head of the Speech and Language Therapy Service prepared a report of her findings at the end of this period in February 2011. The Registrant then completed a further four week period of supervised practice in a different setting. After a third period of supervised practice the Registrant’s employment was terminated on 30 September 2011.

8. A panel considered the allegation at a final hearing between the 20 and 22 August 2012. It made a number of findings of fact relating to the Registrant’s competence as a Speech and Language Therapist. They related principally to inadequate completion of assessments, failure to communicate effectively, failing to maintain adequate notes, failing effectively to manage her professional time, poor clinical decision making, poor management planning, demonstrating a lack of clinical reasoning, an absence of professional judgement and a failure to demonstrate reflective practice.

9. The panel went on to consider whether the facts found proved amounted to misconduct and/or lack of competence. It concluded that the findings amounted to a lack of competence but not misconduct. The panel identified a number of breaches of the Council’s Standards of Proficiency for Speech and Language Therapists as well as breaches of the Council’s Standards of Conduct Performance and Ethics. It took the view that the Registrant had not been able to satisfactorily address what were ‘persistent and significant failures in key areas of professional competence, in particular those of communication and the application of clinical skills and judgement’.

10. The panel then considered the question of sanction. It found that whilst no Service Users came to any harm there was ‘a significant potential of such harm had the supervisor not been present to intervene and assist as necessary.’ It recognised that the Registrant had a good level of knowledge in many areas but had reasons to doubt that such knowledge could be ‘consistently applied to her practice’ to achieve a satisfactory standard of work. The panel acknowledged the genuineness of the Registrant’s insight but considered that it had been insufficient to effectively address her shortcomings. Careful consideration was given as to whether to impose a Conditions of Practice Order but the panel concluded that no conditions of practice could be formulated unless there was such close supervision as to make the Conditions of Practice Order unrealistic, unworkable and tantamount to suspension. The panel therefore concluded that only a Suspension Order would be adequate to protect the public and was necessary and proportionate.

11. That Order was considered by a review panel on 29 August 2013. That panel took account of the considerable amount of effort made by the Registrant in the intervening period which had provided her with a degree of experience which was beginning to address the deficiencies identified in her case. It was however, in that panel’s judgement, insufficient to adequately remediate the shortcomings in her practice. In that panel’s opinion, although the Registrant was to be commended for the positive progress she had clearly made, she was still not in a position to be able to work as an autonomous professional and would need such close supervision that nothing less than an extension of the Suspension Order was appropriate. It therefore extended the Suspension Order for a period of 12 months.

12. That Order was reviewed on 21 August 2014. That reviewing panel heard evidence from the Registrant. It formed the view that she had demonstrated successful progress in many of the areas of concern that had been previously identified. The panel was however not satisfied that all of the previous areas of concern had been adequately dealt with. The panel concluded that the Registrant’s fitness to practise remained impaired. It considered that given the insight of the Registrant and her progress over the previous two years, a continuing order of suspension would be disproportionate and that the remaining level of risk could be properly dealt with by a Conditions of Practice Order. The panel imposed a Conditions of Practice Order of 18 months.

13. That Order was reviewed on 2 February 2016 and that panel heard evidence from the Registrant and received a number of documents both by way of witness statements, testimonials and reports. In the Registrant’s evidence, she told the panel of her efforts of remediation and the work that she had done in order to correct the identified deficiencies in her practice. At the hearing in 2016 the panel was provided with a report from a Principal Speech and Language Therapist at the Abertawe Bro Morgannwg University Health Board who had supervised the Registrant on 15 days between 23 September 2015 and 13 January 2016. Her summary in the report was:

‘Mrs McConnell has been committed to developing her skills during this placement. She has attempted to respond to all the feedback that she has been given and has attempted every task that she has been given. She has made some progress, most noticeably in her ability to reflect on her actions and in her awareness of office etiquette.

Her progress in other areas such as report writing has been more limited and she will continue to require significant support with assessment, intervention, and report writing in future placements / employments.

Mrs McConnell was strongly dependant on my supervision/instruction throughout the placement. I would consider this level of supervision not to be needed by a qualified speech and language therapist.

I am aware of the longevity of concerns about Mrs McConnell’s practice as a speech and language therapist and understand that a number of steps to support her to improve her practice have been taken prior to her placement with me.

I therefore believe that the persistence of concerns about her practice, in the areas identified by the HCPC, is therefore significant.’

14. That panel concluded that the Registrant’s fitness to practise was still impaired on the grounds of lack of competence and it considered that because of the efforts made by the Registrant she should be given a further opportunity to satisfy the conditions imposed by a Conditions of Practice Order. The panel considered that the Order should be made for a period of 18 months in order to give adequate time for completion. In order for her to complete the matters referred to in condition 10 it was the panel’s view that she would need at least 12 further months to complete the Speech and Language Competency Framework.

15. The panel in 2016 stated:

“The Panel does, however, note that in this case concerns were initially raised in 2006. There have already been two Orders of Suspension, each of 12 months and one Conditions of Practice Order of 18 months. The Registrant should understand and be aware that a Conditions of Practice Order cannot be continued indefinitely. A Reviewing Panel may therefore take a different view to this Panel.”

Decision

16. In making its decision, the Panel considered all of the information put before it including the submissions of Mr Thompson, on behalf of the HCPC, and those by Ms Cook on behalf of the Registrant. It accepted the advice of the Legal Assessor.

17. In a statement provided to the Panel the Registrant explained that she had applied to four different Health Boards for a job as a Speech and Language Therapist but she has been unsuccessful in obtaining a job.

18. The Registrant had also applied for a job as a Speech and Language Therapist with the RNIB who employ her as a Transitions Officer. Although she was not offered the job at the RNIB she was offered the opportunity of some supervised practice but for various reasons this did not materialise.

19. As the Registrant has not done any work as a Speech and Language Therapist since the last hearing she has not addressed any of the many deficiencies identified in her practice and she has not complied with the Conditions of Practice Order.

20. Accordingly, the Panel has determined that her fitness to practise is still impaired.

21. The Panel considers there remains a potential risk to the public and it would therefore not be appropriate to arrange mediation, to conclude the case without taking any action or to impose a caution order.

22. The Panel then considered whether to extend the current Conditions of Practice Order. The reality is that the Registrant has been subject to a Conditions of Practice Order for nearly three years and she has come nowhere near addressing the deficiencies in her practice. It was submitted on her behalf that she is committed to remediating her practice but the Panel has seen little evidence of this, for instance although she has been unsuccessful in securing paid employment as a Speech and Language Therapist there is no evidence before the Panel that she has made significant efforts to seek voluntary work.

23. The Registrant has been working for the RNIB and she could have provided examples or reflections of how the work she was doing was relevant to work as a Speech and Language Therapist but she has not.

24. In all the circumstances, the Panel has concluded that it is not sufficient or proportionate to extend the Conditions of Practice Order.

25. Clearly, a Suspension Order would serve no useful purpose as if the Registrant has not addressed her failings whilst subject to a Conditions of Practice Order she is not going to whilst suspended.

26. Accordingly, the Panel has concluded that the only proportionate order is a striking off order.

Order

The Registrar is directed to strike the name of Lyndsey McConnell from the register on the date this order comes into effect.

Notes

The order imposed today will apply from 21 August 2017.

Hearing history

History of Hearings for Mrs Lyndsey J McConnell

Date Panel Hearing type Outcomes / Status
28/07/2017 Conduct and Competence Committee Review Hearing Struck off
02/02/2016 Conduct and Competence Committee Review Hearing Conditions of Practice
21/08/2014 Conduct and Competence Committee Review Hearing Conditions of Practice