Mr Alexander David Gabr Tennant

: Social worker

: SW35684

: Review Hearing

Date and Time of hearing:10:00 16/08/2017 End: 12:30 16/08/2017

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

: Conduct and Competence Committee
: Conditions of Practice

Allegation

During the course of your employment as a Social Worker at Knowsley Council between January 2011 and 04 February 2014, you:

 

1. Created Review Forms, which contained duplicated, inaccurate and/or no information on a number of Service Users’ records, including:

 

a. Creating duplicate Review Forms on the record of Service User A, for reviews that had not taken place, in particular:

 

i. On 13 November 2012 you created a Form 7, the written report section of which was an exact copy of the review which had taken place on 24 October 2012.

 

ii. On 29 January 2013 you created a Form 8M, a form to be completed by a consultant psychiatrist only, which was an exact copy of the information entered by the consultant from the cancelled review of 22 November 2012.

 

iii. On 6 February 2013 you created a Form 7, which was an exact copy of the review which had taken place on 24 October 2012.

 

iv. On 26 June 2013 you created a Form 7, which was an exact copy of the review which had taken place on 24 October 2012.

 

v. On 26 July 2013 you created a Form 8M, a form to be completed by a consultant psychiatrist only, which was an exact copy of the information entered by the consultant from the cancelled review of 3 July 2013.

 

vi. On 26 July 2013 you created a Form 7, which was an exact copy of the review which had taken place on 24 October 2012.

 

b. On 9 July 2012 you created a Form 7 on the record of Service User B, which did not contain sufficient information about the review, thereby incorrectly indicating that a review had taken place.

 

c. On 23 July 2012 you completed a Form 7 on the record of Service User B, which was not an accurate reflection of what was discussed at that review, because it was almost an exact duplication of the Form 7 created on 9 July 2012 (as at 1.b.above).

 

d. On 28 March 2013 you created a Form 7 on the record of Service User B, which did not contain the date of the review.

 

e. Creating duplicate Review Forms on the record of Service User B, for reviews that had not taken place, in particular:

 

i. On 28 May 2013 you created a Form 8M, a form to be completed by a consultant psychiatrist only, which is an exact copy of the review which had taken place on 23 July 2012.

 

ii. On 20 June 2013 you created a Form 8M, a form to be completed by a consultant psychiatrist only, which is an exact copy of one previously completed by the consultant.

 

iii. On 20 June 2013 you created a Form 7, which is an exact copy of the Form 7 created on 28 March 2013 (as at 1.d. above).

 

f. On 25 October 2012 you completed a Form 7 on the record of Service User C, which was not an accurate reflection of what happened in respect of that review, in that it did not state the non-attendance of the Service User or the re-scheduled date.

 

g. You duplicated Review Forms on the record of Service User C, for reviews that had not taken place, in particular:

 

i. On 23 November 2012 you created a Form 8M, a form to be completed by a consultant psychiatrist only, which is an exact copy of the review form completed by the consultant for the review which did not take place on 25 October 2012.

 

ii. On 23 November 2012 you created a Form 7, which was an exact copy of the review which you had created on 25 October 2012 (as at 1.f. above).

 

iii. On 6 February 2013 you created a Form 7, which was an exact copy of the review which you had created on 25 October 2012 (as at 1.f. and 1.g.ii.).

 

iv. On 25 June 2013 you created a Form 7, which was not an accurate reflection of that review, because it was a duplication of the Form 7 created on 25 October 2012 (as at 1.f. above).

 

v. On 9 July 2013 you created a Form 7, which was an exact copy of the review which you had created on 25 October 2012 (as at 1.f., 1.g.ii. and 1.g.iii. above).

 

2. Your actions in 1 above created incorrect work records.

 

3. Your actions at 1 and 2 above were dishonest.

 

4. The matter described in paragraphs 1 and/or 2 and/or 3 constitute misconduct.

 

5. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Applications

Service

1.     The Panel was informed that an original notice of hearing was sent to the Registrants address, as it appears on the HCPC Register, on 14 July 2017. The Panel was satisfied that good service had been effected in accordance with Rules 3 and 5 of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (‘the Rules) and it was satisfied that all reasonable steps had been taken by the HCPC to inform the Registrant of todays proceedings.

Application for the Hearing to be Held in Private

2.     The Panel determined that it would hear those parts of the case in which reference was made to the health and private life of the Registrant in private, under Rule 10 (1)(a) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (‘the Rules’).  In making this decision the Panel acknowledged that there is a presumption that hearings will be held in public. The decision is to protect the private life of the Registrant which the Panel considers outweighs the public interest in this instance.

Proceeding in Absence/Applicant for the Registrant to Appear via Teleconference

 

3.     Mr Doyle, on behalf of the HCPC, applied for the hearing to proceed in the absence of the Registrant pursuant to Rule 11 of the Rules.  He referred the Panel to the fact that the Registrant wished to engage in the hearing by telephone and did not apply for an adjournment.

 

4.     The Panel accepted the advice of the Legal Assessor, that the decision to proceed in the absence of the Registrant is a decision to be taken with the utmost care and caution.  The Panel had regard to the relevant Practice Note including the criteria set out in R v Jones [2002] UKHL 5 and the guidance in General Medical Council v Adeogba/ Visvardis [2016] EWCA Civ 162. In particular the Panel noted that it must consider whether to proceed by reference to all the circumstances of which it is aware, with fairness to the practitioner being of prime importance, but fairness to the regulator and the public interest also being taken into account.

 

5.     The Panel noted that the Registrant had not sought an adjournment and had submitted that he was unable to attend the hearing in person due to financial constraints and his working pattern. There is a statutory requirement to review this order before 15 September 2017. The Panel was satisfied that whilst the Registrant would not be physically present during the hearing he would nevertheless be present by telephone during all parts of the review hearing.

 

6.     The Panel therefore determined that there would be no useful purpose in adjourning the matter and concluded that, in all the circumstances, it was in the public interest for this matter to proceed expeditiously today.  There would be no prejudice to the Registrant who was able to fully engage by telephone and the Panel therefore determined to proceed in the absence of the Registrant today but to permit his participation by telephone as requested.

 

Background

7.     At the relevant time the Registrant was a registered Social Worker.  Between January 2011 and January 2014 he was employed as a level 3 Adult Mental Health Social Worker by Knowsley Metropolitan Borough Council (the Council).  He was initially based in the Community Mental Health Team and, following a reorganisation in December 2012, he was moved to the recovery team. 

8.     One of the Registrant’s duties was to arrange regular reviews of the mental health assessments of the service users to consider, amongst other things, whether any changes to medication or other services were required.  Such reviews would typically take place every three months on average but could be set with a greater or lesser frequency.  Reviews would be attended by any professionals involved in caring for the service user.

9.     Following an internal investigation by the Council the Registrant was dismissed from his employment in February 2014 and reported to the HCPC.

10.   All parts of the Allegation (except particular 3 in relation to 1(b) and 1(d)) were proved against the Registrant at a hearing which took place between 15 – 18 August 2016. In summary, it was found that the Registrant had dishonestly created work records in respect of the reviews of three service users during the relevant period.  Some records were duplicates, all were inaccurate and gave the impression that work had been done by the Registrant when it had not or that the service user had been seen, when they had not. The Registrant created these documents to give his managers the false impression that he was up to date with his record keeping.

11.   The Panel found that the ground of misconduct was made out (it appeared that a mis-managed health condition had contributed to the failings identified) and determined that the Registrant’s fitness to practise was impaired at that time.

12.   In making it’s determination, the Panel considered that the Registrant:

deliberately and systematically concealed his failures to perform to the required standard by falsifying documents.  This conduct was in his own personal interest….. Vulnerable service users were put at serious risk of harm and some were actually harmed by significant delays to the reviews of their circumstances and the handling of their cases..’

13.   The Panel recognised that the Registrant suffered from some underlying health problems and he had taken some steps to address them, although no up to date information was available to it at the time the sanction was imposed.  It also noted that the Registrant had identified, if not yet undertaken, an action plan to remediate shortcomings in his practice, such as organisation, time management and use of supervision.

14.   A Suspension Order for a period of 12 months was imposed on 18 August 2016.

Decision

15.   This is a review of the substantive Supervision Order imposed on 18 August 2016, which came into effect on 15 September 2016 upon expiry of the appeal period. This order will therefore expire on 15 September 2017.

16.   The Panel heard representations on behalf of the HCPC and from the Registrant. It accepted the advice of the Legal Assessor.  It also considered two bundles of documentation, one from the HCPC comprising 36 pages and one from the Registrant comprising 39 pages.

17.   In undertaking it’s task today, the Panel is not undertaking a rehearing of the matters which were brought against the Registrant, nor going behind previous findings. The Panel reminded itself that the decision as to what is the appropriate and proportionate disposal at this review hearing is a matter for its judgment alone. The Panel recognised that, at a review, it has to consider whether the concerns raised in the finding of impairment through misconduct have been sufficiently addressed to its satisfaction.  In practical terms this means that there is a persuasive burden on the practitioner at a review to demonstrate that he has acknowledged past failings, and has sufficiently addressed past impairment. The Panel also noted the requirements which might assist the review hearing which were indicated to the Registrant on 18 August 2016.

Impairment

18.   The Panel accepted the advice of the Legal Assessor, had regard to the HCPC Practice Note “Finding that Fitness to Practise is Impaired”, dated July 2013 and noted the guidance in the case of Meadows v GMC [2007]1 All ER 1, and Council for Healthcare Regulatory Excellence (CHRE) v NMC and Grant [2011] EWHC 927.

19.   The Panel noted that the Registrant has secured work placements for two social care agencies since the final hearing, positions in which he has employed many of the skills required of a social worker. Specifically he has worked at the Harbour Psychiatric Hospital as a health care worker since April 2017 and at an approved hostel for the National Probation Service since June 2016. The Registrant also submitted the following documentation for consideration:

·          A medical report and evidence of steps, treatment and counselling taken to address his health condition;

·          Certificates of online training undertaken for his role as a healthcare assistant in the NHS courses;

·          A reference from Service Care Solutions confirming there have been no issues reported to them in respect of the Registrant’s work at Harbour Psychiatric Hospital;

·          A performance Appraisal form in relation to the Registrant’s role as a Support Worker at the hospital dated 18 July 2017.

20.   The Panel considered that the Registrant has been open, honest and transparent in the way he gave his evidence. He acknowledged the failings identified at the final hearing and described the wrongdoing as ‘errors’ which were ‘serious, inexcusable and wrong’.  He accepted that the Suspension Order had been necessary and acknowledged the consequences of his actions to service users and his profession. He provided an update of the actions he has taken to address the failings identified at the Final Hearing.

21.   The Registrant has taken proactive steps since the order to address and manage the health condition which contributed to his misconduct.  This included a stress management course, ongoing medical treatment and a course of counselling undertaken from January to March 2017.  These steps have provided the Registrant with the opportunity to reflect on his misconduct, in particular his dishonesty.  He has considered and analysed the underlying causes of the factors which compromised his work and his ability to practice safely, and he asserted that he has developed strategies to ensure there is no repetition of the situation which led to the Allegation.  The Registrant was able to articulate strategies he would employ to avoid finding himself in a similar situation and as to how he would now react if he did find himself in such a situation in order to minimise the risks to service users. He also stated that he has developed a better understanding of the importance of prioritising his workload and maintaining accurate records and recognises the associated risks of failings in these areas to both service users and the profession.

22.   The Registrant has sought to keep up to date with training in order to enhance his practice.  He has successfully completed training for his role as a health care assistant in order to commence work in the Harbour Psychiatric Hospital. He was also subject to an in-depth interview by a Mental Health nurse before commencing work in this capacity. He works directly with psychiatric patients at the Harbour Hospital and, amongst other things, he undertakes observations, risk assessments and creates professional records and maintains clinical notes. The Panel noted the reference provided in respect of his work there and that no issues had been raised about the Registrant’s practice, however there was no specific mention of his record keeping or honesty. Before he registered with the Social Care Solutions agency in October 2016 the Panel heard that the Registrant passed numerous compliance assessments before he could start work.  He provided details of 19 completed training courses, most of which have direct relevance to social work practice.

23.   The Registrant also gave details of the shift work he undertakes at a hostel for the National Probation Service.  Whilst his current roles do not require his registration as a Social Worker, the Panel, nevertheless noted that both of the roles have required him to utilise many of the skills required of a social worker.

24.   However, the Panel did note that in his submissions, the Registrant, to his credit, recognised the fact that he is not yet ready to return to a social work position without supervision.  The Panel considered that, notwithstanding the encouraging steps taken by the Registrant to address his failings, he nevertheless still lacks the resilience required to return to unrestricted practice.  In particular, the Registrant submitted that when he returns to social work (which he hopes to do in a phased manner), he would require direct supervision and support regarding workload, record keeping and stress/time management, ‘so as to avoid errors in the future’.

25.   In all of these circumstances, whilst the Panel is satisfied that the Registrant has remedied the issues and developed his insight as far as he is able to, he  has also been insightful enough to recognise that his failings are not yet fully remedied to the point that he could return to unrestricted practice.  Accordingly, there remains a risk that he could be overwhelmed by his workload in the future which may lead to a repetition of the misconduct identified. Accordingly, the Panel finds that the Registrant’s current fitness to practise remains impaired.

Sanction

 

26.   The Panel is aware that the purpose of any sanction is not to be punitive, though it may have a punitive effect. The Panel has borne in mind that its primary function at this stage is to protect the public, while reaching a proportionate sanction, taking into account the wider public interest and those of the Registrant. In so doing, the Panel has taken account of the Indicative Sanctions Guidance, applying it to the Registrant’s case on its own facts and circumstances.

27.   In determining the appropriate and proportionate sanction, the Panel had regard to the seriousness of the Registrant’s misconduct and also bore in mind the evidence he has provided of the steps taken to address the failings identified at the final hearing.

28.   The Panel first considered taking no action and allowing the order to expire on 15 September 2017, however it concluded that this would be inappropriate and would not be sufficient to protect service users, given the risk of repetition identified.  The Panel considered that this was not an appropriate case for mediation and that a Caution Order would be insufficient.

29.   The Panel next considered a Conditions of Practice Order. It noted that the Registrant has been working in roles which require many of the skills of a social worker without complaint since the final hearing.  Given the shortcomings identified by the misconduct and the continued risk of repetition, the Panel was satisfied that a Conditions of Practice Order for 18 months is the appropriate and proportionate sanction in this case.  This will allow the Registrant to return to supervised practice and provide him with a route back into safe and unrestricted practice in due course.  The order will give the Registrant a framework of support within which he can demonstrate his resilience within a social work role such that he can evidence full remediation of the failings identified in the fullness of time.

30.   The Panel considered whether to extend the current Suspension Order or to impose a Striking Off  Order and considered these would be disproportionate and unnecessarily punitive orders given the steps taken by the Registrant since the Suspension Order was imposed, to address the issues identified.  It was satisfied that a Conditions of Practice Order for 18 months would adequately protect the public and the wider public interest.

Order

Order: The Registrar is directed to annotate the HCPC Register for a period of eighteen months, from the date of expiry of the Suspension Order with a Conditions of Practice Order in the following terms:


1. You must inform the HCPC within 28 days if you take up any employment or other engagement as a Social Worker.

2. When undertaking employment or any other engagement which requires your registration as a Social Worker, you must place yourself and remain under the supervision of  a workplace supervisor, registered  by the HCPC and supply details of your supervisor to the HCPC within 14 days of taking up that work. You must attend upon that supervisor as required and follow their advice and recommendations.

3. You must work with your supervisor to formulate a Personal Development Plan designed to support the following areas of your practice:

• Stress management
• Time management
• Record Keeping
• Prioritisation of workload

4. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

5. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.


6. At least 28 days before any review hearing you must forward to the HCPC:

• a copy of your Personal Development Plan;
• a report from your supervisor detailing your progress under your Personal Development Plan;
• Up to date references that attest to your skills and abilities in respect of record keeping, time management and stress management.


7. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer or by any agency or other organisation or person, if employed or engaged as a social worker.

8. 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 social 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. You will be responsible for meeting any and all costs associated with complying with these conditions.

10. Any condition requiring you to provide any information to the HCPC is to be met by you, sending the information to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management

Notes

No notes available

Hearing history

History of Hearings for Mr Alexander David Gabr Tennant

Date Panel Hearing type Outcomes / Status
16/08/2017 Conduct and Competence Committee Review Hearing Conditions of Practice
15/08/2016 Conduct and Competence Committee Final Hearing Suspended