Mr David John Steare

: Social worker

: SW38894

: Review Hearing

Date and Time of hearing:12:30 07/08/2017 End: 17:00 07/08/2017

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

: Conduct and Competence Committee
: Struck off

Allegation

Allegation (as found proved at final hearing)

During the course of your practice as a Social Worker employed by Staffordshire County Council you:

1. In or around February 2013 introduced and/or suggested changes to Service User A’s intervention/care plan but did not:

a) Discuss the changes to Service User A’s intervention/care plan with other professionals first;

b) Undertake any or any adequate risk assessment of these changes;

3. Your actions at paragraphs 1 and/or 2 above placed Service User A at risk of harm.

4. Introduced and/or suggested an intervention in relation to Service User A which was outside the scope of practice as a Social Worker.

5. On or around 5 November 2012, took a photograph of Service User B on your own personal phone.

6. The matters described in paragraphs 1(a), 1(b) and 3 constituted misconduct.

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

Finding

Preliminary Matters

Proof of Service

1. The Panel was provided with a signed certificate as proof that the Notice of Hearing had been posted on 7 July 2017 by first class post, to the address shown for the Registrant on the HCPC register.  The Panel was satisfied that Notice had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date, time and venue) of the Conduct and Competence Committee Rules 2003 (as amended).

Proceeding in Absence

2. Having determined that service of the Notice of Hearing had been properly effected, the Panel went on to consider whether to proceed in the Registrant’s absence. The Panel was advised by the Legal Assessor and followed that advice. The Panel also took into account the guidance as set out in the HCPC Practice Note “Proceeding in the Absence of the Registrant”.

3. The Panel determined that it was fair, reasonable and in the public interest to proceed in the Registrant’s absence for the following reasons:

a) The Registrant, in an email dated 8 July 2017, stated, ‘I received your email and letter about the review next month. I am getting tired of this continuing HCPC involvement and I have no intention of attending any further hearing.’ In these circumstances, the Panel was satisfied that it was reasonable to conclude that the Registrant has chosen not to attend the hearing. Therefore the Panel was satisfied that the Registrant’s absence demonstrated a voluntary waiver of his right to be present.

b) There has been no application to adjourn and the Registrant has clearly indicated that he would not be willing to attend ‘any further hearing’. Therefore re-listing this review hearing on an alternative date would serve no useful purpose.

c) As this is a mandatory review hearing, there is a strong public interest in ensuring that it is considered expeditiously. It is also in the Registrant’s interest that this review is considered as soon as possible.

Background

4. The relevant background for the purposes of this review is set out below.

5. The Registrant is a registered Social Worker. The Registrant worked as a senior practitioner in the Children & Adolescent Mental Health Services (CAMHS) Team of the Staffordshire Healthcare NHS Trust. He was employed by Staffordshire County Council (the Council).

6. In February 2013, concerns were raised about the care the Registrant had provided to Service User A. The intervention decided upon by the Registrant involved Service User A ‘only cutting’ herself on alternate days at set times with her mother attending to her wounds without comment. Although the intervention was not an approach advocated by CAMHS and did raise concerns in the way it was implemented with Service User A, the Substantive Hearing panel accepted the evidence that the intervention could be appropriate if implemented correctly. The Registrant had not discussed the intervention with other professionals first, and had performed a risk assessment ‘on the hoof’ and in his head during his session with Service User A and her mother in which the intervention was agreed. The panel determined that the Registrant should have undertaken a comprehensive risk assessment using the CAMHS risk assessment model.

7. Service User A was a child who, at the relevant time, had just been discharged from hospital and was in the highest category of risk. The previous panel concluded that the Registrant’s implementation of his chosen intervention had put Service User A at risk of harm, and that particulars 1(a), 1(b) and 3 individually and collectively amounted to misconduct.

8.  The substantive panel imposed a 6 month Suspension Order. This Order was reviewed on 10 February 2017 and the reviewing panel extended the Order by a further 6 months.  That  panel suggested that at  the next review, the Panel may be assisted by the following:

•   Evidence of insight, which may include written reflections upon his understanding of (a) the need to undertake assessments of risks (“Standards of Proficiency: Social workers in England” paragraph 1.3), and (b) the need to build and sustain collaborative professional relationships with colleagues as an autonomous practitioner (see “Standards of conduct, performance and ethics” paragraph 7, and “Standards of Proficiency: Social workers in England” paragraph 9.1).

•   Evidence of his keeping up to date with current practice in care planning and risk management.

HCPC Submissions

9. Ms Royer, on behalf of the HCPC, outlined the history of this case. She reminded the Panel of the information that the previous panel had suggested the Registrant provide to assist this reviewing panel. Ms Royer submitted that the Registrant had failed to take the two opportunities that have been given to him to demonstrate that his fitness to practise is no longer impaired. She invited the Panel to impose a Striking Off Order.

Registrant’s Submissions

10. The Registrant did not submit any written representations for the purposes of this review hearing. However, on 8 July 2017 he sent an email to the HCPC attaching a British Medical Journal (BMJ) paper entitled, ‘Should healthcare professionals sometimes allow harm? The case of self-injury’ and a copy of Power Point Presentation slides. He stated that the slides formed the basis of a talk he had been invited to give at a university symposium on social work regulation in March 2017. The Registrant sent a further email to the HCPC on 31 July 2017 enclosing his notes for each slide.

Panel’s Approach

11. In undertaking this review, the Panel took into account the documentary evidence and the submissions from Ms Royer, on behalf of the HCPC.

12. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt. In particular that:

• The purpose of the review is to consider the issue of impairment based on the previous panel’s findings of fact, the extent to which the Registrant has engaged with the regulatory process, the scope and level of his insight and the risk of repetition.

• In terms of whether his previous misconduct has been sufficiently and appropriately remediated, relevant factors include whether the Registrant:

(i) fully appreciates the gravity of the previous panel’s finding of impairment;

(ii) has maintained his skills and knowledge;

(iii) is likely to place service users at risk if he were to return to unrestricted practice.

• The Panel should have regard to the HCPTS Practice Note: ‘Finding that Fitness to Practise is impaired’ and must take account of a range of issues which, in essence, comprise two components:

(i) the ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and

(ii) the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

• It is only if the Panel determine that the Registrant’s fitness to practise remains impaired, that the Panel should go on to consider sanction by applying the guidance as set out in the HCPTS Indicative Sanctions Policy (ISP), and the principles of proportionality which require the Registrant’s interests to be balanced against the interests of the public.

Decision  

13. At the first review hearing, the Registrant did not provide any of the evidence the substantive hearing panel indicated would be of assistance. However, he did provide written submissions. This Panel has not had sight of those submissions but noted that they were described by the first review panel as an attempt ‘to denigrate the regulatory process in rather inflammatory language.’ Similarly, for the purposes of this review, the Registrant has not provided any of the evidence that the first review panel indicated may be of assistance. Instead, the Registrant provided the Panel with a BMJ paper and a Power Point presentation, including his accompanying notes. The Panel noted that the presentation contained disparaging remarks about the HCPC and the regulatory process. No further information was provided by the Registrant for the purposes of this review.

14. In the absence of any positive evidence of insight and remediation, the Panel was not satisfied that there has been any material change in circumstances, since the last review, with regards to the risk to service users and the consequential impact on public trust and confidence. Therefore, the Panel was led to the inevitable conclusion that, the Registrant’s fitness to practise remains impaired.  

15. Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what sanction, if any, to impose.

16. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s misconduct which remains un-remediated, to take no action on his registration would be inappropriate. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

17. The Panel went on to consider a Caution Order. As the Registrant has persistently demonstrated no insight into his misconduct, provided no evidence of remediation and whilst the risk of repetition remains, the Panel concluded that a Caution Order would be inappropriate and insufficient to protect the public and meet the wider public interest.

18. The Panel took the view that the Registrant is either unwilling or unable to provide the information and evidence that was suggested by the substantive hearing panel and the first review panel. In these circumstances, this Panel had no confidence that he would comply with a Conditions of Practice Order, even if suitable conditions could be formulated. The Panel was aware that the suggestions made by the previous panel are only indicative and do not have any binding authority, unlike conditions which require compliance. However, both involve willingness on the part of the Registrant and a determined effort. In the absence of any evidence that the Registrant is willing and able to remediate his previous misconduct, the Panel concluded that there were no conditions it could devise which would be appropriate, workable and measurable.

19. The Panel next considered extending the current Suspension Order for a further period of time. The Panel noted that a Suspension Order would prevent the Registrant from practising during the extended suspension period, which would therefore protect the public and the wider public interest. However, the Panel took into account the fact that the Registrant was warned at the substantive hearing that if he was unable to develop insight during his 6 month’s suspension, he would risk a Striking Off Order. The Registrant was given a further and ‘probably last’ opportunity at the first review to reflect on these proceedings and in the words of the substantive hearing panel, ‘open his mind to the fact that although his motives were good, his proposed intervention was introduced in a fundamentally wrong way which carried serious risks.’ For a second time, the Registrant has failed to take advantage of the opportunity that was presented to him and the Panel concluded that no useful purpose would be served by providing him with a further opportunity.

20. The Panel took into account paragraph 41 of the ISP which states, ‘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.’ The Panel concluded that this paragraph applied to the Registrant. Although the Panel noted that the Registrant’s misconduct related to a single incident within an otherwise unblemished career, was motivated by the best of intentions and no actual harm was caused, it was satisfied that he had exhausted both opportunities to demonstrate that he is fit to return to practice. The Panel was also satisfied that the Registrant’s repeated failure to acknowledge any error of judgement or the findings of the substantive hearing panel strongly indicated that he had no intention of doing so. In reaching this conclusion, the Panel took into account the tone and content of the Registrant’s email to the HCPC following the first review. The email was sent on 15 February 2017 and states; ‘I was very disappointed to read that I wasn’t struck off the register. Clearly my last correspondence wasn’t inflammatory enough.’

21. The Panel concluded that the Registrant’s repeated failure to accept the findings of the final hearing panel and address the serious concerns that have been identified is fundamentally incompatible with continued registration. The panel was satisfied that removal from the register is the only means to protect service users and the wider public interest.

22. Accordingly, the Panel concluded that the appropriate and proportionate sanction would be a Striking Off Order.

 

Order

ORDER: That the Registrar is directed to strike the name of David John Steare from the Register with immediate effect.

Notes

No notes available

Hearing history

History of Hearings for Mr David John Steare

Date Panel Hearing type Outcomes / Status
07/08/2017 Conduct and Competence Committee Review Hearing Struck off
10/02/2017 Conduct and Competence Committee Review Hearing Suspended
08/08/2016 Conduct and Competence Committee Final Hearing Suspended
18/04/2016 Conduct and Competence Committee Final Hearing Adjourned part heard