Jannette May Ryan

: Social worker

: SW66036

: Final Hearing

Date and Time of hearing:10:00 06/10/2017 End: 17:00 09/11/2017

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

: Conduct and Competence Committee
: Suspended

Allegation

1. Received a referral on or around 19 June 2015, in relation to Service User A, which raised safeguarding concerns and you did not:
a) Record what action was taken and by whom in response to the concerns;
b) Have and/or record discussions with Service User A in respect of her views;
c) Have and/or record a discussion with senior management;
d) Initiate a MASH referral;
e) Discuss with and/or offer Service User A alternative accommodation;
f) Conduct and/or record a Mental Capacity Assessment of Service User A.
2. Did not complete and/or record the Section 42 enquiry in respect of Service User A.
3. Received a referral from the police on 4 August 2015, namely a Person A had been arrested for making threats to kill Service User A, and you:
a) Did not conduct a capacity assessment of Service User A;
b) Closed the case with no further action on 13 August 2015 without having and/or recording a discussion with a manager.
4. Received a referral from the police on 11 August 2015, namely that Service User A had been the victim of an assault by Person A, and you closed the case on 13 August 2015 and did not:
a) Visit Service User A;
b) Discuss and/or record a discussion with a manager.
5. Did not adequately complete a Safeguarding Investigating Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
a) The views and wishes of Service User A;
b) What action had been taken at that point to protect Service User A;
c) Consideration of advocacy for Service User A;
d) Consideration of capacity of Service User A;
e) Risk to Service User A;
f) Consultation with Service User A’s GP in relation to medication.
6. You completed and generated an ACM3D and an Individual Placement Agreement, prior to obtaining agreement from Service User C’s family in relation to the payment of the top up fee.
7. Following your meeting with the family of Service User C on 3 February 2015, you did not cancel the Individual Placement Agreement when you learnt that there was no agreement to pay the top up fee.
8. The matters set out in paragraphs in 1-7 constitute misconduct and/or lack of competence.
9. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary Matters

Proof of Service

1.On 30 August 2017, the HCPC sent Notice of this hearing by first class post to the registered address of the Registrant (Mrs Jannette Ryan). A copy of the Notice was also sent on the same date by email. The Notice contained the required particulars, including time, date and venue.

2. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied, on the documentary evidence provided, that the Registrant had been given appropriate Notice of this hearing in accordance with the Rules.

Proceeding in absence of the Registrant
3. Mr Ferson, Counsel appearing on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor, who advised that the discretion to proceed in a Registrant's absence should only be exercised with the utmost care and caution.

4. The Panel had regard to the chronology of events. On 2 December 2015, the Registrant had self-referred the matter to the HCPC. On 20 July 2016, a Panel of the Investigating Committee found that there was a case to answer. On 7 October 2016, the Registrant contacted the HCPC’s solicitors at Kingsley Napley and indicated that she did not feel emotionally strong enough to deal with the allegations. The representative at Kingsley Napley explained the process, and provided the contact details of the legal assistant for the case. No communications were received from the Registrant in response.

5. In January, April, May, June and August 2017, further correspondence was sent by the HCPC to the Registrant. On 18 September 2017 the hearing bundles were sent to her and on 5 October 2017, the full witness statement of TG was sent to the Registrant, it having been identified that TG’s statement had been initially sent out in the hearing bundle with pages missing.

6. No communications have been received from the Registrant since her contact in October 2016.

7. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve Notice on the Registrant in accordance with the Rules.

8. The allegation dates back to 2015, when the Registrant was working as a Social Worker at Stoke-on-Trent Council. The Panel was aware that there is one witness present to give evidence on the first day (6 November 2017), and who has travelled down from Stoke-on-Trent to do so.

9. In light of the above, the Panel was satisfied that the Registrant had been provided with the means of knowledge as to when and where her hearing was to take place. The Panel concluded that the Registrant had voluntarily waived her right to attend and there was no evidence that she would attend an adjourned hearing. The Panel also considered that it was in the public interest for the hearing to take place.

Application to amend the Allegation

10.At the close of the HCPC case, Mr Ferson applied to amend the stem of particular 1 and sub-particulars 1(a), 1(b) and 1(c). In relation to the stem of particular 1, he applied to change the date from “17 June 2015” to “on or around 19 June 2015”, as this was the date on which the referral had been allocated to the Registrant, albeit it had been received within the Council on 17 June 2015. In relation to sub-particulars 1(a), 1(b) and 1(c), he submitted that the application to amend them was to reflect the evidence which had emerged from TG. He submitted that TG’s evidence was that discussions appeared to have been recorded by the Registrant, but the detail recorded was inadequate. He submitted that there would be no prejudice to the Registrant as the amendments would leave less serious particulars and that her defence, had she attended, would have been unlikely to be any different.

11. The Panel heard and accepted the advice of the Legal Assessor. She advised that there was no bar in law to amending an allegation at a late stage in the proceedings, such as at the close of the HCPC’s case, provided that it could be done without unfairness to the Registrant.

12. In relation to the proposed amendment of the date in the stem of particular 1, the Panel was satisfied that this amendment could be made without causing unfairness to the Registrant. It was apparent on the face of the papers that although the referral had come in to the Council on 17 June 2015, it was not allocated to the Registrant until 19 June 2015. The Panel was satisfied that the amendment to correct the date did not materially change the particular.

13. The Panel was mindful of its role in regulatory proceedings, which includes having regard to the public interest, as well as, at all times, ensuring that proceedings are fair in respect of a registrant.

14. In relation to the public interest considerations, the Panel recognised that it was important to have the full circumstances of the case reflected in the particulars alleged, and that, when having regard to potential public protection issues, a registrant should not be acquitted ‘on a technicality’. However, the Panel was of the view that if the amendments were not permitted, there would, nevertheless, remain a number of factual particulars, leaving a viable allegation for it to consider. The Panel was also satisfied that this was not a case where the allegation, as originally framed, represented an ‘undercharging’ of the anticipated evidence which would have meant that the proposed amendments should be allowed, and the Registrant afforded time, as appropriate, to meet the amended allegation.

15. The Panel considered that the exhibits bundle, served on 18 September 2017, indicated that the Registrant had recorded entries within the electronic case notes. It was therefore of the view that this information should have been apparent to the HCPC on the face of the papers, and that the particulars drafted accordingly. The Panel did note that the case had been to a Panel of the Investigating Committee.

16. In relation to whether it would be unfair to the Registrant to allow the proposed amendments, the Panel was concerned at the very late stage that they were sought in the proceedings. It had regard to the importance of a registrant knowing in advance what she is accused of. The Panel therefore considered whether it should accept the amendments and call an adjournment. However, the Panel was mindful that the Registrant has not attended this substantive hearing, and any amendment would be unlikely to affect her engagement in the regulatory process; however, this equally meant that she was unaware of the proposed revisions.

17. The Panel was concerned with the impact that allowing the proposed amendments to sub-particulars 1(a), 1(b) and 1(c) would have on the fairness of proceedings to the Registrant. It considered that it would have an adverse effect on the principle of justice not only being done, but being seen to be done. The Panel was of the view that allowing the proposed amendments at this late stage in proceedings would give the appearance of taking advantage of identifying the weaknesses in the evidence to adjust the particulars to fit the evidence in light of the Panel’s questions, so that they were more likely to be found proved. The proposed amendments to sub-particulars 1(a), 1(b) and 1(c) were material, and may have a potential impact on the possible outcome for the Registrant. The Panel concluded that allowing the proposed amendments to particulars 1(a), 1(b) and 1(c) could be viewed as manifestly unfair, potentially to the detriment of the reputation of the Regulator.

18. In all the circumstances, the Panel decided it would be unfair to allow the amendments, save for the change of date from 17 to 19 June 2015 in the stem of particular 1.

Background

19. The Registrant is a Social Worker registered at the HCPC. At the relevant time, the Registrant was employed as a Social Worker at Stoke-on-Trent Council (the Council).

20. The Registrant started working as a Social Worker at the Council in January 2005. On 11 June 2015, she joined the ‘Tunstall Team’ as a Level 10 Social Worker. In that role she was involved in the assessment and management of complex cases, including cases which involved the safeguarding of adults aged 18 and over. Despite a reorganisation, there was considerable continuity between the Registrant’s previous work and her work on the newly-created team.

21. The Council used an electronic case management system for storing records. This system was called Care First. The expectation was that Care First should be updated promptly and each time a worker had a discussion with anyone related to the case. There were a number of components to the Care First electronic system, which included forms to complete, as well as observation logs.

22. Service User A had a learning disability, was unable to manage her finances, needed support with taking her medication and required small amounts of prompting with managing her personal care. Service User A lived with her husband, Person A, who also had learning difficulties, as well as other issues. Both service users were well-known to the Council and to the police.

23. On 17 June 2015, a new referral in respect of Service User A came into the Council. It was made by HM, a member of staff at an independent service provider agency, which provided support to service users in a number of areas including housing, financial assistance and debt management. Her referral detailed issues that Service User A was said to be nervous whilst in her property and allegations of exploitation by a neighbour, Person C.

24. On 19 June 2015, the case was allocated to the Registrant, who had previous dealings with Service User A, according to Service User A’s notes. She visited Service User A’s property on that day with a support worker. She accessed the First Contact form within the Care First system on that day, and made entries within it.

25. On 4 August 2015, a second referral was received in respect of Service User A. This second referral was made to the Council by the police, following an allegation made by Service User A that her husband (Person A) had threatened to kill her.

26. On 11 August 2015, a third referral was received in respect of Service User A. This third referral was made to the Council by the police and was as a result of Person A being arrested and charged with assaulting Service User A.

27. On 20 August 2015, a safeguarding meeting was held in respect of Service User A.

28. The allegations against the Registrant in respect of Service User A are that:

• After the first referral on or around 19 June 2017, she did not take and/or record various safeguarding actions;

• After the second referral on 4 August 2015, she did not conduct a capacity assessment of Service User A, and closed the referral without having and/or recording a discussion with a manager;

• After the third referral on 11 August 2015, she did not visit Service User A, and closed the referral without discussing and/or recording a discussion with a manager; and

• She did not adequately complete a Safeguarding Investigation Worker Report prepared for the Enquiry Meeting of 20 August 2015, in that it did not address various safeguarding issues;

29. Service User C was a lady in her 70s who lived in a residential nursing placement. She went into residential care after she left hospital. When the Registrant was allocated the case, Service User C was already in residential care and had been self-funding her residential care for a long time. A referral was made by Service User C’s family to the Council, to state that her funds had dropped below the threshold set by Local Government. The Registrant was therefore allocated to the case to determine whether the Council would pick up the funding.

30. The allegations against the Registrant in respect of Service User C are that the Registrant:

• Completed and generated forms which could trigger payment before obtaining agreement from Service User C’s family in relation to a top-up fee; and

• Following a meeting with the family of Service User C in February 2015, did not cancel the placement agreement once she learnt that there was no agreement to pay the top-up fee.

31. On 26 August 2015, TG, the then-manager of the Longton Wellbeing Team at the Council, was appointed as the Investigating Officer. As part of that investigation, she interviewed a number of managers, including MN, the Registrant’s line manager, DH, and CF, Senior Social Workers. She reviewed the Care First electronic case files of Service User A and Service User C. She also conducted investigatory interviews with the Registrant on 10 September 2015 and 6 October 2015, as well as interviewing a number of other relevant social work staff.

Decision on Facts


32. On behalf of the HCPC, the Panel heard evidence from TG, the Investigating Officer. The Panel was also provided with a documentary exhibits bundle, which included:

• TG’s Investigation Report and relevant accompanying appendices;

• Summaries of the investigative interviews with the Registrant, and managers MN, DH and CF;

• Copies of the Care First electronic case files for Service User A and Service User C;

• Training and supervision records for the Registrant.

33. The Panel heard and accepted the advice of the Legal Assessor. In respect of the facts, the Panel understood that the burden of proving each individual fact is on the HCPC and that the HCPC will only be able to prove a particular fact if it satisfies the required standard of proof: namely the civil standard, whereby it is more likely than not that the alleged incident occurred.

34. The Panel recognised that TG, as the Investigating Officer, did not have first-hand knowledge of the matters alleged and her evidence derived from the Care First records and relevant documents in respect of Service User A and Service User C, and interviews with other members of staff. The Panel found TG to be honest and credible, although the Panel did identify a few discrepancies between her account and the documentary evidence. The Panel had the benefit of having copies of that source documentary evidence and was able to evaluate it in order to make its findings on the facts.

35. The Registrant did not attend, but the Panel did not hold her non-attendance against her. It had regard to her recorded responses in the investigatory interviews and the disciplinary hearing. Although the Panel was mindful that these responses had not been given on Oath, or tested by questioning, the Panel noted that her responses included answers which were detrimental to her.

36. In light of the Panel’s decision not to allow the proposed amendments to particulars 1(a), 1(b) and 1(c), Mr Ferson offered no evidence on them, and the Panel accordingly finds 1(a), 1(b) and 1(c) not proved.

Particular 1(d) – Proved
1. Received a referral on or around 19 June 2015, in relation to Service User A, which raised concerns and you did not:
d) Initiate a MASH referral;
37. The Panel finds particular 1(d) proved.

38. MASH is the Multi-Agency Safeguarding Hub. Its role is to ensure that information from the system is presented to the police, who conduct lateral checks of any alleged source of risk. Its purpose is to ensure the safety of both the Social Worker and the service user.

39. The Panel was satisfied that there was no evidence that the Registrant had initiated a MASH referral, and in her investigatory interview of 10 September 2015, she accepted that she did not refer the police to MASH. The Panel was therefore satisfied that the Registrant did not initiate a MASH referral.

Particular 1(e) – Not Proved
1. Received a referral on or around 19 June 2015, in relation to Service User A, which raised concerns and you did not:
e) Discuss with and/or offer Service User A alternative accommodation;

40. The Panel finds particular 1(e) not proved.

41. The Panel had regard to an email, dated 19 July 2015, from the Registrant sent to Housing Advice Services, requesting consideration for Service User A and her husband to be placed on the housing list. Within that email she attached a letter in support from a Police Inspector, dated 9 July 2015. The Police Inspector, in that letter, recommended that Service User A and Person A be “moved to alternative accommodation in an area which has been assessed as risk appropriate”.

42. From this, in order to make the request for alternative accommodation and for police support for that application, the Panel inferred that the Registrant must have had discussions with Service User A about alternative accommodation.

Particular 1(f) – Proved
1. Received a referral on or around 19 June 2015, in relation to Service User A, which raised concerns and you did not:
f) Conduct and/or record a Mental Capacity Assessment of Service User A.

43. The Panel finds particular 1(f) proved.

44. The Panel had regard to the First Contact Assessment Form completed following the first referral. In the section about whether there are ‘any concerns about the person’s decision making or perceptions about their situation’, it is recorded that Service User A has a learning difficulty. In the same section it is recorded: “…although I have not completed [a] Mental capacity assessment I assume she has capacity”. The Registrant, in her investigatory interview of 10 September 2015, accepted that she did not complete a capacity assessment, as there was nothing to suggest that Service User A did not have capacity. The Panel was therefore satisfied that the Registrant did not conduct a Mental Capacity Assessment of Service User A.

Particular 2 – Proved
2. Did not complete and/or record the Section 42 enquiry in respect of Service User A.
45. The Panel finds particular 2 proved.

46. A Section 42 enquiry is an investigation involving a number of agencies to obtain investigatory evidence when safeguarding concerns are raised in respect of a service user. It enables a strategy meeting to be held with the various professionals involved, and ensures that the correct professional with the requisite knowledge is conducting the investigation.

47. The Panel had regard to the Section 42 enquiry form, which the Registrant had started to complete on 26 June 2015. She had completed Service User A’s details. However, the rest of the form was blank. In light of this, the Panel was satisfied that the Registrant did not complete or record a Section 42 enquiry in respect of Service User A.

Particular 3(a) – Proved
3. Received a referral from the police on 4th August 2015, namely that Person A had been arrested for making threats to kill Service User A, and you:
a) Did not conduct a capacity assessment of Service User A;

48. The Panel finds particular 3(a) proved.

49. The Panel had regard to the First Contact Assessment Form completed following the second referral. In the section about whether there are ‘any concerns about the person’s decision making or perceptions about their situation’, it is recorded that Service User A “is aware and understands the consequences of the alleged abuse”. Whilst the Panel acknowledged that this was a conclusion about Service User A’s decision-making, there was no rationale within the records of the reasons for reaching that conclusion.

50. In the Registrant’s investigatory interview on 10 September 2015, in answer to the question of whether she had re-visited her earlier decision in respect of capacity, she said “No. All through this I had no reason to think that Service User A did not have capacity”.

51. From the First Contact Assessment Form and the Registrant’s response in interview, the Panel inferred that it was more likely than not that the Registrant did not conduct a capacity assessment of Service User A after the second referral.

Particular 3(b) – Proved
3. Received a referral from the police on 4th August 2015, namely that Person A had been arrested for making threats to kill Service User A, and you:
b) Closed the case with no further action on 13th August 2015 without having and/or recording a discussion with a manager;

52. The Panel finds particular 3(b) proved to the extent that she did not record a discussion.

53. The Panel had regard to TG’s oral evidence essentially clarifying that the terminology of ‘closing a case’ in fact meant closing or completing a specific referral with management agreement on the next steps to be taken in the case as a whole. It is in this context that the Panel considered this sub-particular. The Panel had regard to the First Contact Assessment Form for the second referral, which demonstrates that the Registrant closed the form on 13 August 2015.

54. The Panel had regard to an entry by MN, the Registrant’s line manager, in the observation logs of a case work supervision on 10 August 2015, recording a discussion about Service User A. It appeared from TG’s evidence that she had not taken account of this documentary evidence. MN had recorded details of the discussion of the case, including that “[the Registrant] will speak to Housing to see whether [SUA] could be considered for sheltered accommodation given her vulnerabilities. [The Registrant] will arrange an enquiry review meeting to try and agree a way forward”. In light of this entry, the Panel concluded that the Registrant had discussed the case with a manager, although the Panel does not know the full extent of that discussion.

55.  However, the Panel found no evidence that the Registrant had herself recorded this discussion, and so this particular is proved.

Particular 4(a) – Proved
4. Received a referral from the police on 11th August 2015, namely that Service User A had been the victim of an assault by Person A, and you closed the case on 13th August 2015 and did not:
a) Visit Service User A;

56. The Panel finds particular 4(a) proved.

57. The Panel had regard to the screen shot of the assessment completion for the third referral, showing that it was closed in the same sense as for particular 3, namely that the initial work on the referral and a plan for the next steps had been completed on 13 August 2015.

58. From the observations records in Care First, the Panel noted that information regarding Service User A being assaulted by her husband had come into the Council before the police referral on 11 August 2015. The chronology from Care First recorded the alleged assault as occurring on 8 August 2015 and the Registrant as telephoning Service User A on 10 August 2015, during which call Service User A described the alleged assault. There is no entry in Care First to indicate that the Registrant visited Service User A before she closed the referral. In the absence of a record to evidence a visit to Service User A, the Panel was satisfied that that it was more likely than not that the Registrant had not visited Service User A following receipt of the referral and before closing the case.

Particular 4(b) – Proved
4. Received a referral from the police on 11th August 2015, namely that Service User A had been the victim of an assault by Person A, and you closed the case on 13th August 2015 and did not:
b) Discuss and/or record a discussion with a manager.

59. The Panel finds particular 4(b) proved, to the extent that the Registrant did not record a discussion.

60. The Panel was satisfied from the screen shot of the assessment completion for the third referral that the Registrant had closed the case in the same sense as for particular 3, namely that it was completed on 13 August 2015. A note has been entered in the reasons section of “no ongoing safeguarding concerns”.

61. The Panel had regard to the entry by MN, the Registrant’s line manager, in the observation logs of a case work supervision on 10 August 2015. Although this entry pre-dated the formal third referral of 11 August 2015, it was clear to the Panel that it alluded to the information which was provided in the third referral. The observation recorded for Service User A contains an entry by the Emergency Duty Team (EDT) on 8 August 2015 recording the alleged physical assault by Service User A’s husband on her on 8 August 2015, which resulted in the third referral. An entry by the EDT on 9 August 2015 recorded that the husband has been bailed to stay away from the home address and had been detained under the Mental Health Act.

62. The Panel was satisfied that there was no documentary record within the Care First system entered by the Registrant of a discussion with a manager regarding closing the third referral. However, MN had recorded in the observation record of Service User A details of the discussion of the case, including that: Service User A’s husband “has since been admitted to Ward 2 at [a mental health hospital]”, which was then followed by the next steps which were discussed. In light of this entry, the Panel concluded that the Registrant had discussed the subject matter of the third referral with her line manager, MN, in supervision, although the Panel does not know the full extent of that discussion.

63.  However, the Panel found no evidence that the Registrant had herself recorded this discussion, and so this particular is proved.

Particular 5
5. Did not adequately complete a Safeguarding Investigation Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
64. The Panel had regard to the wording of the stem of particular 5, namely use of the phrases “adequately complete” and “address”. It agreed with Mr Ferson’s submissions that the use of the term “address” in respect of an issue was not the same as “recording” an issue. A dictionary definition of “address” is “to give attention to deal with a matter or problem”. The Panel’s approach, therefore, was that even if an issue was referenced in the report by being recorded within it, the Panel needed to consider whether the issue had been clarified and evaluated, and not merely referred to, in order to be considered adequately completed.

Particular 5(a) – Proved
5. Did not adequately complete a Safeguarding Investigation Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
a) The views and wishes of Service User A;

65. The Panel finds particular 5(a) proved.

66. The Panel had regard to the Safeguarding Investigation Worker Report (the Report), which the Registrant had completed. In the section headed ‘Please detail the Adult at risk’s views/opinions and desired outcomes’, the Registrant had entered “Currently [SUA] wishes to be supported to find alternative accommodation away from current area and neighbours”.

67. The Panel found that this was a minimal amount of information to record about Service User A’s views and wishes, given the ongoing history of the case. The Panel accepted the evidence of TG that the report should have addressed the views and wishes of Service User A in respect of each referral individually. The Panel was therefore satisfied that the views and wishes of Service User A were not addressed.

Particular 5(b) – Proved
5. Did not adequately complete a Safeguarding Investigation Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
b) What action had been taken at that point to protect Service User A;

68. The Panel finds particular 5(b) proved.

69. The Panel had regard to the Report as a whole and was of the view that much of the form had ‘cut and pasted’ extracts from other electronic records, without clarifying which, if any, actions had been taken by that time, specifically to protect Service User A. In the absence of such clarity, the Panel was satisfied that the Registrant had not addressed what action had been taken to protect Service User A.

Particular 5(c) – Proved
5. Did not adequately complete a Safeguarding Investigation Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
c) Consideration of advocacy for Service User A;

70. The Panel finds particular 5(c) proved.

71. Having regard to the Report as a whole, the Panel was satisfied that there were no entries to indicate that there had been consideration of appointing an advocate on Service User A’s behalf. In particular, the section entitled ‘name of Advocate/Carer’ was left blank. The Panel was satisfied that the Registrant had not addressed the consideration of an advocate.

Particular 5(d) – Proved
5. Did not adequately complete a Safeguarding Investigation Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
d) Consideration of capacity of Service User A;

72. The Panel finds particular 5(d) proved.

73. The Panel had regard to the Report and the section headed ‘Please comment on the Adult’s ability to participate in the Enquiry process (including any Mental Capacity issues)’. In this section the Registrant had recorded “[SUA] is able to articulate her needs well”.

74. The Panel accepted the evidence of TG that ‘capacity’ in this context means the mental capacity to understand risk. The Panel was of the view that the entry was insufficient to demonstrate that the Registrant had considered whether Service User A, given her learning difficulties, had understood the potential risks she faced. The Panel was satisfied that the Registrant had not addressed the consideration of capacity.

Particular 5(e) – Proved
5. Did not adequately complete a Safeguarding Investigation Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
e) Risk to Service User A;

75. The Panel finds particular 5(e) proved.

76. The Panel had regard to the Report and the section headed ‘Please detail the ongoing risk to the Adult…’ The Panel noted that in this section the Registrant refers to physical and financial abuse, and, obliquely, to the risk posed by the neighbours. These risks are not explained, amplified or assessed, and other relevant risks are not mentioned, although they are alluded to as background elsewhere in the Report. The Panel was satisfied that the Registrant had not addressed the Risk to Service User A.

Particular 5(f) – Proved
5. Did not adequately complete a Safeguarding Investigation Worker Report, in preparation for the Enquiry Meeting, in that it did not address:
f) Consultation with Service User A’s GP in relation to medication;

77. The Panel finds particular 5(f) proved.

78. TG said that she understood that the Registrant did consult with Service User A’s GP in relation to her medication. However, this was not recorded in the Report. Having regard to the whole of the Report, the Panel found no reference within it to a consultation with Service User A’s GP, and so was satisfied that the Registrant had not addressed the consultation with the GP within the Report.

Particular 6 – Proved
6. You completed and generated an ACM3D and an Individual Placement Agreement, prior to obtaining agreement from Service User C’s family to the payment of the top up fee.
79. The Panel finds particular 6 proved.

80. The Council had a contract with the residential placement provider to provide residential nursing care for a fee. If the fee of the residential placement is higher than the Council are willing to pay, the Council can ask whether there is anyone who can cover the additional cost. This is called the ‘top-up fee’ and the person paying it is the ‘sponsor’. An ACM3D form is the form that is completed when there is to be a top-up fee and after it has been agreed by the sponsor how much it will be and who is to pay it. The ACM3D, once authorised by a manager, then generates an Individual Placement Agreement for the residential care.

81. The Panel had regard to both the ACM3D and Individual Placement Agreement (IPA) forms. The ACM3D has been completed by the Registrant and names Service User C’s daughter as the sponsor. It is dated 13 January 2015. The IPA is signed by a representative of the Council (AG) and the Home Manager on 26 January 2015 and by the sponsor, Service User C’s daughter, on 2 February 2015. The daughter has annotated the form to the effect that the topping up payment – payable by the sponsor – is “to be negotiated”. She has signed that annotation.

82. The Panel was satisfied that the Registrant had completed the ACM3D form on 13 January 2015, before the level of the top-up fee had been agreed. This, in turn, generated the IPA form on the system for the Registrant to populate.

Particular 7 – Proved
7. Following your meeting with the family of Service User C on 3rd February 2015, you did not cancel the Individual Placement Agreement when you learnt there was no agreement to pay the top up fee.
83. The Panel finds particular 7 proved.

84. The Panel noted that there was some ambiguity within the documents as to the date on which the meeting between the Registrant and Family C had taken place. TG, in her witness statement, referenced it as 3 February 2015, as did the Registrant in her red book diary, whereas the record in the observation reports, entered on 3 February 2015, refers to the meeting as taking place on 2 February 2015. The Panel was satisfied that such a meeting took place on either 2 or 3 February 2015, and the Registrant would have been aware of which meeting is referred to, given her diary entry and investigatory interview. Therefore, the Panel interpreted the date as being ‘on or around 3 February’, as this would cause no unfairness to the Registrant.

85. The papers indicated to the Panel that the Registrant may have been working on the basis that the top-up fee was agreed in principle, although the level was not agreed, and that she perhaps hoped that the level of the top-up would be agreed. However, the Panel was satisfied that at the time of the meeting, on or around 3 February 2015, the Registrant was aware that the top-up fee had not been agreed by Family C. The papers indicated that the residential placement for Service User C continued after 3 February 2015 for a further three weeks before she was transferred to another care home that was more appropriate to her needs. The Panel was therefore satisfied that, factually, the Registrant did not cancel the IPA.


Statutory Ground and Impairment


86. The Panel next considered whether the matters found proved as set out above amounted to misconduct and/or lack of competence, and if so, whether by reason thereof, the Registrant's fitness to practise is currently impaired.

87. The Panel heard and accepted the advice of the Legal Assessor. The Panel was aware that any findings of lack of competence and/or misconduct and impairment were matters for the independent judgement of the Panel. The Panel was aware that consideration of impairment only arises in the event that the Panel judges that the facts found proved do amount to misconduct and/or lack of competence and that what has to be determined is current impairment; that is, looking forward from today.

Decision on Grounds

88. The Panel considered that the Registrant was an experienced Social Worker. She had worked as a Social Worker at the Council since 2005. The facts found proved represent two service users for whom she was responsible in that time. The Panel did not consider that this represented a fair sample of the Registrant’s practice, such as to demonstrate a lack of competence on the Registrant’s part. The Panel, therefore, considered the statutory ground of misconduct in respect of each particular found proved.

89. In relation to particular 1(d), TG, in her evidence, stated that the decision by a Social Worker of whether or not to make a MASH referral in any given case was for the professional judgment of a Social Worker. TG said that in her own professional judgement, the Registrant should have initiated a MASH referral in respect of Service User A. She described a MASH referral as essentially a protocol for sharing information between professional agencies. TG acknowledged that either the assistant who had received the referral on 17 June 2015 or DH, the manager who completed the initial work on the case, could also have initiated a MASH referral. However, once the case had been allocated to the Registrant by 19 June 2015, the Registrant should have initiated a MASH referral soon after allocation.

90. The Panel accepted TG’s opinion on this. The case notes of Service User A show extensive police involvement with her before the referral on 17 June 2015, including previous MASH involvement in December 2014 by the police. As Service User A’s allocated Social Worker, the Registrant should have known of the difficult history and should have understood the need to share this latest issue and its risks with the MASH. As an experienced Social Worker with the Council by this point, the Registrant knew or ought to have known what to do following the referral, namely to initiate a MASH referral.

91. In the Panel’s judgement, the Registrant’s failure to initiate a MASH referral fell far below the standards to be expected of a Social Worker and amounted to misconduct. There were a range of professionals involved in the care of Service User A who needed to be made aware of this latest development set out in the referral of 17 June 2015, so as to understand the potential safeguarding implications for Service User A.

92. In relation to particular 1(f), the Panel had regard to the Registrant’s responses in the investigatory interview of 10 September 2015. She highlighted that she had ‘assumed’ capacity. The Panel acknowledged that the Mental Capacity Act requires that mental capacity is to be assumed, but that is in circumstances where there is no reason to consider it. The Registrant was Service User A’s allocated Social Worker, and knew that Service User A had a learning disability and could not read or write. In the Panel’s judgement, these factors should have triggered a capacity assessment. The Panel considered that a capacity assessment would have been key to ascertain whether Service User A understood the potential risks she was facing from her neighbours at that time.

93. The Panel had regard to the Staffordshire and Stoke-on-Trent Adult Safeguarding Enquiry Procedures document. This document identifies how safeguarding relates to other processes and it highlights that mental capacity is a key consideration in this area when co-ordinating information and sharing facts. The Panel acknowledged that it was not possible for it to know whether or not Service User A had capacity to understand the potential risks she faced. However, by failing to undertake a Mental Capacity Assessment at that time, to confirm whether or not Service User A had capacity, there was the potential for this failing to increase the risk to Service User A. In the Panel’s judgement, the Registrant’s failure to conduct a Mental Capacity Assessment fell far below the standards to be expected of a Social Worker and amounted to misconduct.

94. In relation to particular 2, the Panel had regard to the Staffordshire and Stoke-on-Trent Adult Safeguarding Enquiry Procedures document. The Panel considered that the document was clear in its guidance on this, setting out the objectives of a Section 42 Safeguarding Enquiry as being to: establish facts; ascertain the adult’s views and wishes; assess the needs of the adult for protection, support and redress and how they might be met; protect from the abuse and neglect in accordance with the wishes of the adult; make decisions as to what follow up action should be taken with regard to the person or organisation responsible for the abuse or neglect; and enable the adult to achieve resolution and recovery.

95. The Panel acknowledged that the Care First records confirm that the Registrant visited Service User A on 19 June 2015, the day she was allocated the case. The Panel was of the view that the information in the referral, together with the information gathered on this visit, provided the Registrant with sufficient material to complete a Section 42 Enquiry report. The Registrant then received further concerns from Service User A’s Learning Disability nurse, which, in the Panel’s view, underlined the need for a Section 42 Enquiry. By starting to fill in the form with Service User A’s details on 26 June 2015, the Panel was satisfied that the Registrant understood that a Section 42 Enquiry may be necessary.

96. In the Panel’s view, by not completing the Section 42 Enquiry, the opportunity to generate a multi-agency coordinated plan in respect of safeguarding Service User A was delayed, potentially exposing her to risk. In the judgement of the Panel, this fell far below the standards to be expected of a Social Worker and amounted to misconduct.

97. In relation to particular 3(a), the Panel had regard to the evidence of TG to the effect that at the time of the second referral, raising additional concerns about the risks faced by Service User A, the Registrant needed to re-visit her initial conclusion in relation to Service User A’s mental capacity.

98. In the Panel’s view, the same considerations which applied at the time of the first referral remained, namely Service User A’s learning disability, coupled with her being unable to read and write, applied at the time of the second referral. The source of potential risk from Service User A’s neighbours, identified in the first referral, had now been added to by the potential risk from Service User A’s husband, who had been arrested for threats to kill. This could have affected her emotional state and so made the need for a Mental Capacity Assessment even more essential given the new risks she faced. In the Panel’s view, the failure not to conduct a Mental Capacity Assessment following the second referral fell far below the standard expected of a Social Worker and amounted to misconduct.

99. In relation to particular 3(b), the Panel had regard to the observation records of Service User A. Whilst the Panel had found that the Registrant had not recorded the discussion that she had with her manager on 10 August 2015 about Service User A, it was apparent to the Panel that there had been a discussion with MN, as her manager had recorded the details of that discussion in the observation record. The Panel concluded that TG had been wrong in her evidence when she said there was not a case file record of any discussion with a manager. MN was the Registrant’s line manager, and he had recorded the discussion in the observation record, which covers the information about Service User A’s husband relating to his arrest for threats to kill, the fact that he had been admitted onto a mental hospital ward, consideration of sheltered accommodation for Service User A and that the Registrant will arrange an enquiry review meeting to try and agree a way forward. The Panel concluded that the entry made by MN, within Service User A’s case file in the observation record section, meant that a professional subsequently accessing Service User A’s records would have the details of the discussion and be able to ascertain the safeguarding concerns. In the Panel’s judgment, the absence by the Registrant of an entry about that discussion did not amount to misconduct.

100. In relation to particular 4(a), the Panel had regard to the chronology of the escalation of risk as identified in the observation records for Service User A. Following the first referral on 17 June 2015, there were two further referrals which increased the range of risks that Service User A was facing. The Registrant did speak to Service User A on the phone on 10 August 2015. However, given the way the situation was escalating, she should have visited her. This fell far below the standards expected of a social worker and amounted to misconduct.

101. In relation to particular 4(b), the Panel found that the Registrant should have made a record of her discussion with the manager and this was a shortcoming, especially as the manager’s record is extremely limited. However, this is not a serious shortfall and does not amount to misconduct.

102. In relation to particular 5, the Panel considered the deficiencies of the report, itemised in sub-particulars 5(a) to 5(f) and found proved, together. The Panel was of the view that each deficiency found essentially represented an objective for a Safeguarding Enquiry, as set out in the Staffordshire and Stoke-on-Trent Adult Safeguarding Enquiry Procedures document.

103. In the Panel’s view, the Registrant had failed to produce a report that addressed the relevant issues pertaining to Service User A. The report was also not produced in good time for the Enquiry Meeting of 20 August 2015. Within the Registrant’s red book diary, the Panel noted that there were additional details of relevance to a number of the safeguarding issues which had not been transferred onto the Care First case records for Service User A. These should have been transferred and should subsequently have been included and addressed in the Report, but were not.

104. In the Panel’s judgement, the consequences of the Registrant’s failure to produce a Report that adequately addressed all the issues were that the participants at the meeting did not have the full information they required. They did not have the issues sufficiently analysed or presented in the Report so as to enable fully informed decisions in respect of safeguarding Service User A to be made. This failure had the potential to delay appropriate decisions from being reached and, in turn, could have increased the risk to Service User A. The Panel concluded that the Registrant’s failures in respect of producing the Report fell far below the standards expected of a Social Worker and amounted to misconduct.

105. In relation to particulars 6 and 7, the Panel was of the view that these were so closely linked, in relation to the procedures to follow for Council funded residential care home fees, that they should be considered together. As found in the findings of fact, the Panel acknowledged that the Registrant had thought that a top-up fee had been agreed in principle, albeit the level had still to be negotiated. The Panel considers that the Registrant hoped and perhaps believed that the family would have been able to negotiate and pay a top-up amount agreeable to all parties. However, in the Panel’s view, this does not excuse the Registrant’s actions, which were to complete the forms as if agreement had been reached, and placed the family of Service User C at financial risk of fees which they potentially could not afford, given that there were already substantial arrears accrued from when Service User C was self-funding her care.

106. The Panel noted that the case files indicate that there were discussions underway at the end of February 2015 about transferring Service User C to a more appropriate care home, better able to meet her needs. In light of this, the Panel recognised that it is possible that the Registrant was optimistic that for the short time that Service User C was likely to remain in the home, agreement could be reached on top-up payments. However, once the Registrant was aware from the meeting on or around 3 February 2015 that agreement on top-up fees had not been reached, there was a responsibility upon her to act so as not to expose the Council or the family of Service User C to risk of financial cost.

107. The Panel makes clear that it accepts that the Registrant had nothing to gain from her actions. It was, however, clearly inaccurate to record that the daughter had agreed to pay the top-up fee on the form when she had not. In relation to the observation records in respect of Service User C, in relation to the meeting on or around 3 February 2015 (recorded in the observation records as taking place on 2 February 2015), the Registrant’s entry about the meeting is that the family were looking to negotiate the top-up fee. The Registrant recorded that the family had signed the contracts, but she failed to record that the daughter had annotated the contract in a way that may invalidate it, by writing that the top-up was to be negotiated. The Panel was of the view that the Registrant, aware of the position of the family, did not take action over a period of several weeks to correct the inaccurate impression that she had created. In the Panel’s judgment, the Registrant’s actions in respect of the funding for Service User C fell far below the standards expected of a Social Worker and amounted to misconduct.

108. The Panel found that the following HCPC Standards of Conduct, Performance and Ethics had been breached by the Registrant;

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.

9 – You must get informed consent to provide care or services (so far as possible).

10 – You must keep accurate records.

109. The Panel, having determined that the facts found proved amounted to misconduct, went on to consider the context in which that misconduct occurred. It was of the view that the role of the managers had not been particularly supportive of the Registrant, nor had the oversight of her been particularly rigorous, particularly in relation to the complex and developing case of Service User A. For example, in the supervision with MN on 10 August 2015, he does not appear to have asked questions of the Registrant focussing on the need to conduct a Mental Capacity Assessment, appoint an advocate or the urgency of re-housing Service User A immediately. There appears to be some recognition in the record of the Council’s disciplinary proceedings that the Registrant was not given as much managerial support as she might have been.

110. The Panel was mindful that other professionals with responsibility for Service User A’s care had made similar omissions as the Registrant. For example, after Service User A had been transferred to a different Social Worker, there is no evidence within the papers that a full Mental Capacity Assessment was undertaken in respect of Service User A. Equally, the Panel could find no record of a Mental Capacity Assessment before the case was allocated to the Registrant on 19 June 2015, or after the Enquiry Meeting on 20 August 2015.

111. The Panel considered that the electronic forms themselves used by the Council as part of the Care First case management system were not designed in such a way as to assist with a logical and structured approach in thinking.

112. Notwithstanding this context, the Panel considered that the Registrant’s failings were serious. She had not sought adequate management support, as was her responsibility. Many of the Registrant’s failings related to safeguarding which, in the Panel’s view, is a fundamental aspect of Social Work. The Registrant had demonstrated a lack of urgency when dealing with the changing and escalating risks faced by Service User A, and this led to a prolonged period of time in which she was exposed to the risks.

Decision on Impairment

113. The Panel had regard to the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’” and in particular the two elements of impairment, namely the ‘personal component’ and the ‘public component’; as advised by the Legal Assessor.

114.  The Panel first considered the ‘personal component’.

115. The Panel was of the view that there were some indications within the papers that the Registrant had some insight into her failures within her practice. There were her admissions to her employer during the investigatory and disciplinary process, and she is recorded as saying that she wanted to learn from her mistakes. Although she was unable to explain herself and the particular failures in the disciplinary proceedings, she did say that it was not the way she normally worked. In the documentation, the Registrant repeatedly refers to feeling “overwhelmed”, despite the Council saying that her caseload was light, at 18, with only 3 ‘ongoing’ cases, compared to 20-22 overall cases for most of her colleagues. She had apologised and demonstrated remorse during the disciplinary proceedings, and TG had told the Panel that it was clear to her that the Registrant was distressed by the process. The Panel notes that the Registrant had a 30-year unblemished record with the Council, the final 10 years of which had been as a Social Worker.

116. However, the difficulty for the Panel at this substantive hearing is that the Registrant has not engaged with the process. The reality is that the Panel has no up-to-date position as to whether the Registrant has fully developed insight into her failings, such that she is able to explain how she came to make the failures, so as to be able to identify how to avoid making similar errors in future. For example, she could gain insight into her failures through reflection. The Panel noted that it was suggested in the Council’s disciplinary hearing that with more guidance from management she would be unlikely to find herself in a similar situation again, but the Panel has no current information before it to assist it in ascertaining whether this would be the case.

117. In the Panel’s view, the Registrant’s key failures were not following and not complying with safeguarding procedures as well not complying with procedures surrounding residential care funding. There were also record-keeping failures. The Panel was of the view that each of these areas was capable of remediation. For example, there are courses and training in respect of safeguarding which the Registrant could undertake. However, as she has not engaged with the HCPC process the Panel has no evidence before it that the Registrant has, in fact, reflected on her failures, thought about what steps she would take to ensure that she did not repeat those failures, or thought about how such failures may impact upon the confidence of the public in the profession. In the absence of information from the Registrant as to her current position, there was no evidence that she had remediated her practice.

118. In all the circumstances, given the absence of information to demonstrate that the Registrant now had good insight and had remediated her practice, the Panel could not rule out that there remained a risk of repetition of the failures by the Registrant, and therefore concluded that, in respect of the personal component, her fitness to practise was currently impaired.

119. The Panel went on to consider the ‘public component’.

120. In light of the Panel’s conclusion that these were serious failures on the part of the Registrant in respect of two service users, and that the risk of repetition could not be ruled out, it was of the view that the public would expect the Regulator to take action in order to protect members of the public. It therefore concluded that public confidence in the reputation of the profession would be undermined if a finding of impairment were not made in this case. Similarly, the Panel concluded that professional standards would be undermined if it did not make a finding of impairment. Accordingly, in respect of the ‘public component’, the Panel concluded that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction

121. Having determined that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on her registration.

122. The Panel took account of the submissions of Mr Ferson on behalf of the HCPC. It also had regard to all of the material previously before it.

123. The Panel accepted the advice of the Legal Assessor and it exercised its independent judgement. It had regard to the HCPC Indicative Sanctions Policy (the Policy) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public and to safeguard the public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

124. Before considering the individual options open to the Panel, it considered the significant aggravating and mitigating features which have previously been identified at the Misconduct and Impairment stages of this case.

125. The Panel considered the following to be the significant aggravating factors:

• The Registrant had not sought adequate management support;

• The Registrant’s failings predominantly related to safeguarding;

• The Registrant had demonstrated a lack of urgency in dealing with the changing and escalating risks faced by Service User A;

• The Registrant’s failings were not isolated but continued over several months; and

• The Registrant has not engaged with this regulatory process.

126. The Panel considered the following to be the significant mitigating factors:

• The managerial oversight of the Registrant was not particularly supportive;

• The Registrant had made admissions and demonstrated remorse during the Council’s disciplinary process;

• The Registrant had a previously unblemished career of 30 years at the Council, the last 10 years of which had been in the role of Social Worker.

127. The Panel first considered whether any sanction was necessary. Given the risk of repetition and therefore risk to service users, the Panel did not consider that this was a case where it was appropriate to take no further action. The Panel concluded that some form of sanction was necessary to protect the public as well as maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour.

128. Given that the Panel had ruled out that this was an appropriate case for no further action, it concluded that mediation was also not an appropriate outcome in this case.

129. The Panel does not consider that a Caution Order would meet the criteria as set out in paragraph 28 of the Policy, which reads “A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the Registrant has shown insight and taken appropriate remedial action”. As previously found, the Panel did not consider that the Registrant’s failures were isolated, but continued for several months. In the absence of engagement from the Registrant, the Panel had been unable to conclude other than that there remains a risk of repetition. A Caution Order, in the Panel’s view, would not afford protection to the public.

130. The Panel next considered a Condition of Practice Order. The Panel noted its earlier finding that the Registrant’s failings were capable of remediation, and so on its face, conditions might be appropriate. The Panel was of the view that it would be possible to formulate workable conditions which would both protect the public and address the wider public interest. However, the Panel had regard to paragraph 33 of the Policy, which reads “Conditions will rarely be effective unless the registrant is genuinely committed to resolving the issues they seek to address and can be trusted to make a determined effort to do so”. The Registrant’s responses during the Council’s disciplinary hearing indicated to the Panel that the Registrant may be capable of resolving her failings and willing to abide by conditions. However, in the absence of the Registrant in these proceedings, or detailed and compelling written submissions from her, the Panel could not be satisfied at this present time that the Registrant was either willing or able to abide by conditions.

131. The Panel, therefore, had to move on to consider a Suspension Order. Clearly such an Order would meet public protection needs and is certainly sufficient to assure the public and professionals that professional failures and transgressions are appropriately dealt with in the public interest. The Panel was satisfied that a Suspension was the appropriate and proportionate Order.

132. The Panel considered that the length of the Order should be for 8 months. This was with a view to allowing the Registrant the time and opportunity, firstly to feel able to engage ‘emotionally’ with the regulatory process, and secondly to demonstrate remediation and develop insight.

133. This Panel did not seek to fetter the discretion of a future reviewing panel, who will look at whether the Registrant is ready to resume work as a Social Worker, but it did consider that such a panel may be assisted by:

• The participation of the Registrant, ideally in person or, alternatively, through other means such as via telephone, with representation, or written submissions;

• A reflective piece identifying her insight into the actions that gave rise to the allegations and their impact on others;

• Evidence of training relevant to the assessment and management of risk, mental capacity assessments, structured record keeping, and any other relevant training;

• Testimonials from colleagues and managers at any recent workplace, including voluntary work.

134. Although the Panel had no information as to the Registrant’s current financial situation, it recognises that a Suspension Order would be likely to have an onerous effect upon her and could potentially affect her livelihood. However, without good engagement from the Registrant in this Regulatory process, the Panel determined that the interests of protecting the public and upholding confidence in the profession outweighed the interests of the Registrant.

Order

ORDER: That the Registrar is directed to suspend the registration of Mrs Jannette May Ryan for a period of 8 months from the date this order comes into effect.

Notes

 This Order will be reviewed again before its expiry.

Hearing history

History of Hearings for Jannette May Ryan

Date Panel Hearing type Outcomes / Status
06/10/2017 Conduct and Competence Committee Final Hearing Suspended