Dr Simon Redpath
Allegation as amended:
During the course of your employment as a Psychologist with Abertawe Bro Morgannwg University Health Board, you:
1. In respect of Patient A:
(a) made inappropriate comments to family members;
(b) did not appropriately assess mental capacity;
(c) did not recognise and/or address the risks posed within the discharge plan;
(d) did not work collaboratively and/or take colleague opinion into consideration;
(e) prepared an inaccurate report on or around 10 January 2012;
(f) demonstrated inconsistent clinical reasoning in respect of the patient’s capacity and/or discharge;
(g) undertook inappropriate and/or indiscriminate testing;
(h) did not interpret test results correctly;
(i) did not obtain appropriate consent to record the patient.
2. In respect of patient B:
(a) did not maintain appropriate and/or professional boundaries;
(b) did not maintain patient confidentiality;
(c) did not appropriately assess mental capacity;
(d) did not work collaboratively and/or take colleague expert opinion into consideration;
(e) carried out inappropriate anxiety management;
(f) did not maintain accurate and/or appropriate records;
(g) undertook inappropriate and/or indiscriminate testing;
(h) provided an inaccurate list of test results;
(i) acted beyond your remit as a practitioner psychologist in that you walked the patient.
3. In respect of Patient C:
(a) did not work collaboratively and/or take colleague expert opinion into consideration;
(b) acted beyond your remit as a practitioner psychologist in that you took the patient on a home visit before the risk assessment was conducted.
4. In respect of Patient D:
(a) did not work collaboratively and/or take colleague opinion into consideration;
(b) did not provide an adequate and/or appropriate assessment and/or care package.
5. In respect of Patient E, did not identify and/or know how to carry out appropriate assessment.
6. In respect of Patient F, made inappropriate comments of family members.
7. In respect of Patient G, made inappropriate comments to family members.
8. In respect of Patient H, did not work collaboratively and/or take colleague expert opinion into consideration.
11. In respect of patient K:
(a) did not adequately consider the impact of testing upon the patient;
(b) undertook inappropriate and/or indiscriminate testing;
(c) misinterpreted test results.
12. In respect of Patient L:
(a) did not maintain accurate and/or appropriate records;
(b) undertook inappropriate testing.
13. As identified in an audit during May 2012:
(a) In 8 out of 12 cases you did not refer to treatment goals and/or plans;
(b) did not make references to multidisciplinary team assessments and/or goals in 11 out of 12 cases.
14. The matters described in paragraphs 1 to 13 constitute misconduct and/or lack of competence.
15. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.
1. The Registrant, Dr Simon Redpath, has attended this hearing at which he has represented himself.
2. The final hearing of the HCPC’s allegations against Dr Redpath commenced on Monday, 17 July 2017. At an early stage it was agreed that the complexity and detail of the case made it appropriate and fair for the Panel to reach its decisions on the facts, and announce those findings, before proceeding to consider any other stages of the case that might arise. All of the evidence relating to the factual issues was given and introduced between Monday, 17 July 2017 and Friday, 28 July 2017 when the Panel adjourned the hearing with directions for the parties to make sequential written submissions on the facts.
3. The parties having complied with the directions to make written submissions, the Panel met in private for five days commencing on Monday, 9 October 2017, to reach its determination on the facts.
4. At the commencement of the hearing on 18 October 2017, the Panel handed down the decision on the facts, and subsequently received submissions from the Presenting Officer and the Registrant on the issues of the statutory grounds and current impairment of fitness to practise. After the Panel announced its decision on those issues, on 19 October 2017, the Panel received submissions on sanction. The case concluded on 19 October 2017 after the Panel had announced its decision on sanction and dealt with the issue of an interim order. No part of the hearing over 18 and 19 October 2017 was conducted in private.
5. At the commencement of the July 2017 hearing, the Panel dealt with a number of applications made by the HCPC. They related to:
• amendment of the factual particulars to the allegations;
• the introduction of expert evidence; and,
• the introduction of the evidence of one of the witnesses by way of a written witness statement without the witness being called.
6. Amendment. The factual particulars to the allegations as originally referred to the Conduct and Competence Committee by the Investigating Committee had already been amended by the direction of a Panel sitting at a Preliminary Hearing on 13 January 2017. At the hearing in July 2017, the present Panel was requested to direct that particulars 9 and 10 should be deleted. The application was therefore, in effect, for the discontinuation of part of the case. The Registrant did not object to the removal of the particulars. The Panel approached this application on the basis that it was not required to permit the removal of these particulars simply because the HCPC considered that it was not appropriate to advance them, but that it was necessary for the Panel to be satisfied that their removal was appropriate having regard to the evidence that was available to the HCPC. Having considered the matter, the Panel concluded that it was appropriate for particulars 9 and 10 to be deleted from those requiring a decision. Subsequently, the Panel agreed to an amendment of the stem to the allegations that had previously alleged that the Registrant had worked at a physical location that was not accurate for the entirety of the period being considered. There being no objection by the Registrant to the proposed amendment, the Panel agreed that it was appropriate to substitute for the physical location, the identity of the employing Health Board.
7. Expert evidence. It had long been the intention of the HCPC to rely upon the expert evidence of Ms Julianne Kinch, a Consultant Clinical Neuropsychologist. Reliance on the evidence of Ms Kinch had been an issue raised at the Preliminary Hearing held on 17 January 2017, although for reasons it is not necessary to explain in this decision, no concluded decision was made as to reliance on her evidence on that occasion. It followed that it was necessary for the Presenting Officer to apply for permission to rely on her evidence at the commencement of the hearing. An unusual feature of the case was that Ms Kinch had been involved in the Health Board’s internal disciplinary proceedings against the Registrant. The Panel was of the clear view that if that earlier involvement compromised Ms Kinch’s impartiality, it would not be appropriate for her to be relied upon by the HCPC as an expert witness in the present case. Having carefully considered the matter, and having considered the entirety of what Mr DM (whose involvement in the matter will be subsequently explained) said about Ms Kinch’s involvement in the Health Board’s process, the Panel concluded that there were no grounds on which Ms Kinch’s impartiality could be doubted such as to make it inappropriate for her to be treated as an expert witness, particularly in view of the terms of the declaration and statement of truth signed by her. Being satisfied that the substance of her evidence was relevant to the issues being considered, and also being satisfied that the complexity of those issues made it appropriate for expert evidence to be received, the Panel agreed to the HCPC’s application.
8. Evidence by way of written witness statement. The HCPC sought to rely on the evidence of Ms ER, a Speech and Language Therapist, and her witness statement was included in the bundles sent to the Registrant and Panel in advance of the hearing. In this public document the Panel will not explain the reason why Ms ER could not attend the hearing, but the Panel was satisfied that the reason for her absence was a good reason. The Panel balanced against any unfairness to the Registrant arising from the introduction of evidence he would not be able to challenge directly, the public interest of all available evidence being introduced. The conclusion of the Panel was that there would be little unfairness to the Registrant arising from the introduction of the evidence, not least because Ms ER was not the sole witness to the issues to which her evidence related, and in assessing the weight that might properly be attributed to her evidence, the Panel would take into account the fact that it had not been possible for the Registrant to challenge it.
9. It was acknowledged at an early stage that during the course of the hearing it would be necessary for the Panel to direct that some of the evidence should be given in private. One reason why such a direction was necessary was that there would be specific elements of the evidence relating to some of the patients that would create a risk that their identities might be understood by members of the public. The other reason was that an element of the Registrant’s defence involved him raising matters relating to his private life. The Panel has considered the entirety of the evidence in reaching its decisions, but, as this document is a public determination, no detail of the evidence given in private will be referred to in it.
10. At the time relevant to the allegations, the Registrant was employed as a Highly Specialist Clinical Neuropsychologist working at Band 8a. He had commenced his employment with the Health Board (“the Board”) in 2008, at which time the Neuro Rehabilitation Unit (“NRU”) had been located at Morriston Hospital. In 2010 the NRU was relocated to the Neath Port Talbot Hospital. It was a sub-acute regional unit with 13 beds. The patients were adults with acquired brain injuries arising from a variety of causes, including trauma, hypoxia, stroke and tumour. The patients typically had complex rehabilitation needs requiring a multidisciplinary team approach.
11. From the time of his employment in 2008 until March 2011, the Registrant had been line managed by Dr RW, at the time the Lead Consultant Clinical Neuropsychologist. The Panel received no direct evidence from Dr RW. From March 2011 to November 2011 the Registrant reported to Ms TH, Directorate General Manager. In November 2011 Dr TE took up the position of Lead Consultant Clinical Neuropsychologist, and upon doing so, she became the Registrant’s line manager.
12. It is the HCPC’s case that at a very early stage after she took up her post, Dr TE became aware of complaints that had been made about the Registrant. In early February 2012 the Registrant commenced a period of sick leave and that was followed by a period of suspension that commenced in April 2012. In the event, the Registrant never returned to his post.
Decision on Facts
13. In reaching its decisions on the facts, the Panel has reminded itself throughout that the burden of proof rests on the HCPC to prove matters against the Registrant. The standard of that burden is the balance of probabilities.
14. The HCPC called four witnesses to give oral evidence before the Panel. The witnesses called to give evidence before the Panel were:
• Mr DM, at the relevant time the Assistant Director, Therapies, Health Science and Psychology at the Board. Mr DM is not himself a Psychologist, being registered in another part of the HCPC Register, and his involvement relevant to the case was that he undertook an investigation on behalf of the Board. The fact that Mr DM is not a Psychologist and had no direct personal knowledge of the relevant events necessarily limited the extent to which his evidence was relevant. However, to the extent that evidence (including the accounts of witnesses who were not called to give evidence before the Panel) produced by him was relied upon, the Panel was satisfied that his investigation was objective and independent.
• Dr TE’s role as the incoming Lead Consultant Clinical Neuropsychologist has already been explained. The Panel is satisfied that Dr TE believed that her evidence was accurate and that she did not intend to mislead the Panel. However, there are two factors that must be recorded with regard to the evidence of Dr TE. One of them is that she had limited contact with the Registrant. Their working coincided only for the few months between Dr TE taking up her post in November 2011 and the Registrant ceasing clinical activities in early February 2012. During that short period their contact was limited, not least because they worked at different locations. Another factor is that the Panel found that the evidence she gave was coloured by the view she had of the Registrant. At an early stage she received negative formation about the Registrant from a number of people with whom he worked, and this unquestionably affected her own view. In giving her evidence she was reluctant to concede matters when it would have been appropriate to do so, and at times she was defensive about her role in dealings she had with the Registrant. These reservations have not resulted in the Panel entirely discounting her evidence, but it has had the consequence that the Panel has treated her evidence with caution and has attempted to look for external corroboration before accepting it.
• Ms AB-D (at the time, Ms AH), an Occupational Therapist working on the NRU. The Panel accepted that although she developed a negative view of the Registrant, Ms AB-D gave her evidence as she saw it, did her best to assist the Panel and was open when she could not remember matters.
• Ms Julianne Kinch, the expert witness to whom reference has already been made. The Panel was satisfied that she was appropriately qualified to give the opinions contained in her evidence. In assessing the evidence of Ms Kinch, the Panel remembered her involvement in the Board process and assessed whether the evidence she gave in the present case was given defensively, justifying evidence given in the earlier proceedings. However, whilst the Panel was satisfied that Ms Kinch gave her evidence truthfully and was unaffected by her earlier involvement, being on occasions prepared to concede matters when she gave evidence at the hearing, the Panel noted that her involvement was limited to examination of the paperwork.
15. In addition to the witnesses who attended to give evidence at the hearing, the Panel received the evidence of Ms ER, the Speech and Language Therapist, to whom reference has already been made.
16. The HCPC produced in excess of 5,200 pages of documentary exhibits. These included patient notes as well as the fruits of Mr DM’s investigation, including the written accounts of people interviewed by him.
17. The Registrant gave evidence and called three witnesses to give evidence on his behalf. The Panel’s assessment of the evidence of the Registrant and the witnesses called by him to give evidence is as follows:
• So far as the Registrant, Dr Redpath, was concerned, the Panel acknowledges the difficulty any unrepresented registrant has, that they have the task of being both witness and advocate. In this particular case, the Registrant’s difficulties were added to by the number of factual particulars advanced against him and by the enormous volume of documentation it was necessary for him to deal with. The Panel found that he conducted himself very well, but at the same time the Panel found that on occasions he did not answer questions put to him fully. Furthermore, on occasions, his responses were implausible. These reservations had the consequence that the Panel did not feel able to accept the entirety of his evidence.
• Dr DA, a Consultant in Rehabilitative Medicine. The Panel found that although he was called to give evidence on behalf of the Registrant, he was not someone who was selective in his evidence on that account. The Panel found his evidence to be consistent and measured and that he did his best to assist the Panel.
• Ms FC, at the relevant time the Ward Manager on the NRU. The Panel found that there were a number of respects in which the evidence she gave was tailored to support the case of the Registrant, having on occasions selective recall of events. This finding had the consequence that the Panel did not feel able to accept the entirety of her evidence.
• Ms SM, an assistant secretary working for a trades union whose office was located very near the NRU. The Panel found her evidence to be straightforward and credible. Although her evidence did not relate to clinical matters, the Panel found that it was helpful in understanding the atmosphere and relationships on the NRU.
18. As has already been mentioned, the Panel spent five full days deliberating on the facts. In undertaking this task the Panel had not only all the case papers (including the written witness statements and all the exhibits and all the documentary exhibits), but also the notes of the evidence made by each Panel member at the hearing and the transcripts of that evidence. In considering each particular, the Panel also had regard to the written submissions produced, respectively by the Presenting Officer and the Registrant.
19. The Panel should make clear the extent to which it has had recourse to the documentary exhibits. In reaching its decisions, the Panel has made frequent reference to the exhibits, including the patient notes. The exhibits have been considered not only when the other evidence being considered by the Panel has made explicit reference to exhibits or to matters contained in the exhibits, but also on other occasions in order to assess the evidence being considered. However, it is necessary to make clear that the Panel has not undertaken a root and branch review of the entirety of the documentary exhibits. It would neither be practicable to do so, nor appropriate as such an exercise might result in a case being considered by the Panel that had not been addressed by the parties.
20. Before turning to explain its decisions on the facts, there are two further matters that should be mentioned:
• The NRU was a small unit in a defined geographical area treating patients with specific difficulties. To minimise the risk of patient identification, the Panel has not summarised the specific circumstances of the relevant patients save that it is necessary to do so in order to explain its decisions.
• As has been stated more than once, this is a case involving considerable detail. In order to keep the decision to a manageable length, the Panel will not refer to all the evidence it has considered in reaching its decisions, but will summarise the decision while ensuring that there is sufficient detail for it to be understood why the decision has been reached.
Particular 1(a) – not proved.
21. It is important to record the evidence the Panel has received concerning the allegation that the Registrant made inappropriate comments to family members. The Panel was provided with an email dated 27 June 2011 written by Patient A’s daughter in which she made complaints about the Registrant. The Panel is of the opinion that if the Registrant said the things he is alleged to have said, the comments would have been inappropriate, a proposition with which the Registrant agrees. However, the Registrant disputed that he said them, and accordingly, as acknowledged in the HCPC’s written submissions, the issue is whether they have been proved on the basis of disputed hearsay evidence. In the judgement of the Panel it would be necessary to explore the evidence of the patient’s daughter for it to be accepted as correct, and accordingly the Panel has concluded that the HCPC has not discharged the burden of proving particular 1(a) which is therefore not proved.
Particular 1(b) – proved.
22. The Registrant undertook three mental capacity assessments (MCA), one on 28 June 2011 and two on 20 July 2011. In relation to the MCA undertaken on 20 July 2011 addressing the issue, “What level of support [Patient A] will require upon discharge”, the Registrant determined that the patient did not have the capacity to decide that issue at that time. However, in the other MCA undertaken on the same day and at the same time addressing the issue, “[Patient A’s] capacity to decide which of two community based options to live upon discharge as home is not currently an option”, the Registrant determined that the patient had capacity to make that decision. The Registrant has admitted this particular. The Panel accepts the evidence of Ms Kinch that if a patient does not have the capacity to decide what level of support he or she will require, the patient cannot have capacity to determine the discharge environment. It follows that the Registrant did not appropriately assess Patient A’s mental capacity and particular 1(b) is proved.
Particular 1(c) – proved.
23. The Panel has approached its decision on this particular by construing the words “discharge plan” to mean, not a specific document created at a specific time, but rather the contributions made from time to time, all of which were geared towards the eventual discharge of the patient. The Panel accepts the evidence of Ms Kinch that having conducted assessments of Patient A which found that scores on a memory test fell below the 0.1st percentile, and that Patient A had difficulty with sequencing, response initiation, flexibility of thought, shifting thought and divided attention, the Registrant’s contribution towards the discharge plan did not recognise the risks those limitations would inevitably give rise to. Particular 1(c) is proved.
Particular 1(d) – proved.
24. Reliance is placed by the HCPC on two areas. One is an email written by the Registrant on 21 July 2011 in which he questioned the ability of a Social Worker to undertake a MCA, and, in particular, the terms in which that email was written. The other area is his attitude towards the contributions of Ms AB-D, the Occupational Therapist. As to the former, the Registrant admitted to being embarrassed by the terms in which he questioned the Social Worker’s ability to undertake a MCA. As to the latter, by paragraph 21 of his written submissions, he has sought to justify why he might regard the contribution of the Occupational Therapist as being of limited value. The Panel finds that both aspects of the HCPC’s case demonstrate that he was not working collaboratively and taking colleague opinion into account, and it rejects the suggestion by the Registrant that the Occupational Therapy input would be of limited value until the local resources provided by the local authority for the area to which a patient would be discharged could be known. In the judgement of the Panel the contribution of the Occupational Therapist was relevant to the needs of the patient upon discharge, and that in turn would impact on what an appropriate discharge accommodation would be. Particular 1(d) is proved.
Particular 1(e) – not proved.
25. Contained in the report written by the Registrant on 10 January 2012 was the sentence, “On one occasion after a period of built up frustration he managed to catch a bus from the front of the hospital any by a variety of means make his way safely to his sister’s house in [location omitted by Panel for reasons of confidentiality].” The case was originally advanced against the Registrant on the basis that far from the patient making his way safely to his sister, he had been picked up on a motorway slip road. As acknowledged by the Presenting Officer in his written submissions, there is a lack of clarity about the date when any incident concerning a slip road occurred. It was the Registrant’s evidence that the first he heard of a motorway slip road was when he read, long after the event, witness statements prepared for the Board’s investigation. The Panel considers it material that in a report prepared by Ms AB-D on 3 January 2012 (a week before the report prepared by the Registrant) she wrote, “Whilst in hospital [Patient A] frequently complains of being bored. He has, on one occasion absconded from the ward and found his way to his sister’s house in [same location redacted] because he is “fed up” with hospital.” The conclusion arrived at by the Panel is that the HCPC has not produced sufficiently cogent evidence upon which it would be possible to conclude that the Registrant’s report was inaccurate in the respect complained of. The consequence is that particular 1(e) is not proved.
Particular 1(f) – proved.
26. For the reasons advanced in finding particular 1(b) proved, namely, that if a patient does not have the capacity to decide what level of support he or she will require, the patient cannot have capacity to determine the discharge environment, particular 1(f) is also proved.
Particular 1(g) – proved.
27. The Panel noted that the criticisms advanced by Ms Kinch were, in part, based upon an assumption as to the order in which the Registrant undertook the various assessments. It was the Registrant’s evidence, which the Panel accepted, that he started the assessments undertaken with regard to Patient A by undertaking the Western Aphasia Battery (WAB). Given the evidence relating to the chronology, the Panel finds that it is not appropriate to reach a finding against the Registrant based upon an assumption as to the order in which assessments were undertaken. However, the Panel accepts the evidence of Ms Kinch that as a Psychologist with specific training in neuropsychology, the Registrant should have made an appropriate selection of tests and not administered a fixed test battery which did not take into account the specific patient deficits. For example, the Pyramids and Palm Trees assessment was not required as it is a tool designed to assess semantic knowledge, and there was no reason to suspect the patient was suffering from aphasia or agnosia. Accordingly, particular 1(g) is proved.
Particular 1(h) – proved.
28. In paragraph 27 of his written submissions, the Registrant refers to there being an error, one that would have been appreciated by suitably qualified clinicians to be a simple failure to remove from the template, by referring to Trails A and Trails B under the heading DKEFS. This, however, is not the basis on which the HCPC advanced the case against the Registrant, and it is not the basis on which the Panel has made its finding. The HCPC’s criticism concerns the passage in the Opinion section of the report prepared by the Registrant on 12 July 2011 that, “His behaviour on, and off, the ward and his performance on tests of discrete cognitive functioning indicate that [Patient A] could cope well if he returned home with the appropriate social support.” The Panel accepts the evidence of Ms Kinch that this opinion is inconsistent with the test results relating to the patient’s impaired ability, especially with regard to memory and executive functioning. Particular 1(h) is proved.
Particular 1(i) – not proved.
29. With regard to the tape recording that it was intended should be played to family members, the Panel accepts that the Registrant appreciated the need for the patient to consent, sought that consent and that the patient gave, or at least purported to give, his consent to it. The HCPC’s case does not question any of these elements, but is confined to the issue of whether the patient had capacity to give consent. The Panel accepts that the Registrant considered the issue of Patient A’s capacity to give consent. There being no requirement that the assessment of that capacity should be recorded in writing, the Panel has concluded that the HCPC has not discharged the burden of proving against the Registrant either that the Registrant did not assess the patient’s capacity to give consent, or that the patient’s ability to retain information was so limited that he was unable to retain the information relevant to the giving of consent for long enough to be able to give consent. Accordingly, particular 1(i) is not proved.
Particular 2(a) – proved.
30. The HCPC’s allegation concerns an occasion when at the weekend events led to the Registrant calling at the home of Patient B. The Panel accepts that the Registrant had not set out to visit the patient, but that when travelling near the patient’s home he saw an emergency vehicle travelling in the direction of it, he decided to follow to see if an emergency had arisen with regard to the patient. Had the reason for the emergency vehicle approaching the patient’s home been that it was in fact visiting him, then the Panel would not criticise the Registrant for becoming involved. However, the evidence is that the emergency vehicle passed beyond the patient’s home, but seeing a carer near the home, and stopping to speak to that carer, the Registrant entered the property and spoke to the patient. In doing so, the Panel finds that the Registrant did not maintain an appropriate professional boundary. If it had been necessary to have any exchange with the carer after realising that the emergency did not involve the patient, the Registrant should have politely declined any further involvement. Particular 2(a) is proved.
Particular 2(b) – not proved.
31. The evidence produced to the Panel disclosed that two sisters of Patient B worked in a shop in the Registrant’s home area. In the judgement of the Panel, the Registrant cannot be criticised for shopping in his local shop, and cannot reasonably be expected to have avoided using it on the grounds that family members of a patient or ex-patient worked there. The evidence also suggests that the sisters were in the habit of speaking about their brother to people whom they knew had been involved in his care. Common sense and good manners would require a person in the position of the Registrant to acknowledge the conversation of the sisters. What, of course, a professional could not properly do under any circumstances would be to divulge confidential information about the patient or ex-patient. The HCPC has not produced evidence that persuades the Panel that the Registrant divulged confidential information about Patient B. It follows that particular 2(b) is not proved.
Particular 2(c) – proved.
32. On 16 June 2011 the Registrant undertook a MCA where the issue was described as, “Where [Patient B] would like to be discharged to with the appropriate support.” The Registrant assessed him as having capacity to make that decision at that time. In his written submissions, the Registrant accepts that the MCA was not appropriate to assess the patient’s capacity to understand his needs upon discharge, and therefore to have capacity to decide where he should be discharged to. The Panel accepts this acknowledgment on the part of the Registrant, and on the basis of it, together with the opinion of Ms Kinch, finds particular 2(c) proved.
Particular 2(d) – proved.
33. The HCPC’s case against the Registrant arises out of his response to a home visit made by Patient B in the company of Mr RP, a Physiotherapist, and Ms GL, an Occupational Therapist. That home visit was made on 27 June 2011 and the two professionals who accompanied the patient recorded him as having significant difficulties. Three days later another home visit was made, on this occasion the patient being accompanied by Ms GL and the Registrant, and this visit was considered to be successful. Given that the Registrant was accompanied by the same Occupational Therapist who had attended the earlier home visit, the Panel does not consider that it can be said that the Registrant was not working collaboratively. However, in making the recommendations he did in reliance on the successful home visit he attended and omitting reference to the unsuccessful visit three days earlier, the Panel has concluded that the Registrant fell into error. By omitting reference to the earlier visit he did not convey a full picture of the patient’s potential difficulties. To that extent, the Panel finds that particular 2(d) is proved on the basis that he did not take colleague opinion into account.
Particular 2(e) – not proved.
34. Particular 2(e). This particular is advanced by the HCPC against the Registrant in reliance on two aspects of the Registrant’s involvement with Patient B. One aspect was the provision of a script of a relaxation recording that was made in an attempt to address the patient’s anxiety. So far as the script of the relaxation material is concerned, it was accepted that it would have been too complicated for the patient to absorb, and accordingly it would have been inappropriate to have provided it to him. However, as the Presenting Officer acknowledges in his written submissions, there is no evidence to gainsay the Registrant’s account that the script was provided for the nurses, not for the patient. For the avoidance of doubt, the Panel does not consider that the recorded version of the relaxation material was inappropriate. The other aspect alleged by the HCPC relates to the provision of oxygen. In the patient’s notes on 11 June 2011 the Registrant wrote, “Will make CD of relaxation script to assist [Patient B] to manage anxiety. Encourage slow deep breathing in ++ severe episodes may benefit from brief use of O2 to redress O2, CO2 balance.” The HCPC’s case is that the provision of oxygen to the patient was not something the Registrant should have been suggesting, and would in any event have been entirely inappropriate. The Panel agrees with both of those submissions. However, the allegation is that the Registrant carried out inappropriate anxiety management, and in circumstances where he neither administered oxygen nor directed another person to do so, the Panel does not feel able to construe what is clearly a suggestion to be considered to be carrying it out. For these reasons particular 2(e) is not proved.
Particular 2(f) – not proved.
35. This particular appears to have been based upon two broad complaints. In paragraph 112 of her report Ms Kinch refers to at least 11 entries in Patient B’s handwritten medical notes where it is recorded that the Registrant walked the patient. The paragraph then continues, “If Dr Redpath’s signature was not contained in the notes then it is more likely than not that someone reading these notes would attribute the entries to a Physiotherapist, rather than a Psychologist, as they reflect physiotherapy treatment not psychological interventions.” Upon examining the exhibited patient notes of Patient B, the Panel is unable to find any entry made by the Registrant, whether made in relation to walking with the patient or any other matter, in relation to which he has not both signed his name and clearly written his status as a Clinical Neuropsychologist. Therefore, if it was the intention of Ms Kinch to assert that the Registrant did not sign his name, or otherwise made an entry that could have been understood as having been made by a Physiotherapist, the Panel finds that the contention is not supported by the documentary evidence presented to it. The other aspect of the HCPC’s complaint is that on 8 July 2011, the Registrant commenced to write an entry in the patient’s notes and then crossed out what he had written in such a way that it is impossible, or at least extremely difficult, to read what had been written. This, it is contended, was inappropriate as a deletion should have been made in such a way to enable what had been originally written to be read. The Panel accepts as likely that the Registrant commenced writing an entry in Patient B’s notes that related to another patient. Having realised his mistake he crossed out the incorrect entry and initialled the alteration. The Panel also accepts that good practice would have been for him to have deleted the entry leaving it capable of being read. However, the Panel is of the view that a single lapse from best practice cannot in all fairness be said to amount not “maintain[ing] accurate and/or appropriate records”, and accordingly particular 2(f) is not proved.
Particular 2(g) – proved.
36. Two broad areas are relied upon by the HCPC in advancing this particular. One concerns the issue of an MRI scan raised by the Registrant. The patient underwent a CT scan on 4 March 2011 and on 12 May 2011, the Registrant wrote a letter to Dr DA in which the following passage appears, “To aid formulation, understanding and treatment it would be more helpful to get more information regarding his neuropathology. I was wondering if it would be possible to request an MRI scan for a neuroradiologist opinion on [specific issues identified]”. It is the HCPC’s case that an MRI scan would have been inappropriate for this patient, particularly given his high levels of anxiety. In circumstances where the issue of MRI scan was nothing more than a suggestion for an appropriately qualified medical practitioner to consider, the Panel is of the clear view that it cannot be said that the Registrant “undertook” anything in relation to a MRI scan. The other aspect of the HCPC’s case concerns the assessment tests undertaken by the Registrant himself. Originally, it was contended that the Balloons test was inappropriate, but in evidence before the Panel, Ms Kinch conceded that Psychologists working at the Registrant’s level might consider it appropriate to administer that test, and for that reason the Panel does not accept the criticism so far as it concerns the Balloons test. However, with regard to the Western Aphasia test and the Pyramids and Palm Trees test, the Panel does find that they were inappropriately undertaken as there was no indication of language difficulties, and the other tests that the Registrant was including in those he either had already, or intended to, administer, namely the WAIS-IV and RBANS tests, would have informed him of the necessity to undertake the Western Aphasia and Pyramids and Palm Trees tests. Accordingly, particular 2(g) is proved on the basis of the use of these tests.
Particular 2(h) – proved.
37. The Registrant accepted that there was an error in the listing of test results in the Appendix to the Neuropsychological Test Results in the report dated 11 April 2011 prepared by him. The presentation of the test results suggests that Trails A and Trails B are sub-tests of the DKEFS, whereas this was inaccurate. The Panel finds particular 2(h) proved in this respect.
Particular 2(i) – not proved.
38. The thrust of the HCPC’s criticism of the Registrant with regard to this particular is that he was undertaking the activities of a Physiotherapist when he was not qualified to undertake them. The Panel has made a number of findings of fact relating to the context in which the Registrant’s activities occurred. Patient B experienced high levels of anxiety. The evidence suggests that the difficulties Patient B experienced with regard to walking were aspects of his anxiety as opposed to having a physical cause. It is the evidence of the Registrant that the patient did not seem to be progressing with the physiotherapy interventions he was receiving. It was against this background that the Registrant undertook walking with the patient. It is important to record a contemporaneous record in the patient’s notes made by Dr DA after Mr RP, a Physiotherapist, raised concerns about the Registrant’s actions. Dr DA arranged a meeting held on 12 August 2011 at which he (Dr DA), Mr RP and the Registrant were present. Dr DA’s note of the meeting is in these terms, “[Mr RP] had raised concerns about [the Registrant] walking [Patient B] without his rollator frame. On discussion we agreed that [the Registrant’s] input in terms of mobilising [Patient B] was safe and improving his confidence, and he felt that his memory was getting better. PLAN to continue mobilisation with nursing staff while [Mr RP] continues his physio input and all input geared at getting [Patient B] independently mobile in the long run but approaching it from different angles.” Another important piece of evidence is what was said by another Physiotherapist, Mr TH, when he was interviewed on 28 September 2012 by Mr DM for the purposes of the Board investigation. Mr TH, was a senior Physiotherapist who worked on the NRU. When dealing with the issue of the Registrant walking with the patient, the note of what he said is in the following terms: “The patients anxiety was high; it was how best to bring him down and practice walking. [The Registrant] walked the patient to reduce his anxiety. I didn’t think that that was really inappropriate and would have said if I thought the patient was at risk. I only thought that without [the Registrant] there, he wasn’t functioning so was the work relevant? My concern was around how productive was this? To my knowledge this only happened with [Patient B].” When asked the question, “So this walking of the patient is that something that is common for a psychologist to do?”, Mr TH is recorded as having said, “I have worked with psychologists who have worked with anxiety management and yes, at the end of the day, it is his risk assessment as to what he does with the patient. I can’t make those for him. If I would have felt it was unsafe, I would have stepped in at the time.” If the evidence presented to the Panel had persuaded it that the Registrant was undertaking physiotherapy, or, even if it was not physiotherapy, what he was doing could be categorised as unsafe, then the Panel would unhesitatingly find the Registrant had acted beyond his remit as a Psychologist. However, the evidence does not enable the Panel to reach either of those conclusions for the reasons explained, and, accordingly, although it must be acknowledged that it is unusual for a Psychologist to undertake walking with a patient, in the very unusual circumstances in which the Registrant’s activities with the patient occurred, the Panel finds that the HCPC has not discharged the burden of proving that the Registrant acted beyond his remit as a Psychologist. Accordingly, particular 2(i) is not proved.
Particular 3(a) – not proved.
39. In advancing this particular, the HCPC relies upon two separate complaints. One originated with Ms ER, the Speech and Language Therapist whose evidence was introduced in the hearing by way of a hearsay written witness statement. She complained that the Registrant did not work collaboratively, and contended that, notwithstanding the fact that she worked with Patient C, she was not involved in a DST meeting. Without being specific as to date, she contended that the Registrant and Ms FC decided that a DST meeting would be held, but that other professionals and the family were not informed. The Registrant accepts that he had an informal conversation with Ms FC with a view to arranging a DST. On reviewing the patient’s notes, it is apparent that a DST took place on 24 November 2011 and that a report was prepared by Ms AB-D, the Occupational Therapist, for the purposes of that meeting and that a family member attended. Although Ms ER alleges in her witness statement that the Registrant and Ms FC, “did not request any information from us to guide the discharge planning process”, that statement is not consistent with the fact that an Occupational Therapy report was prepared. In circumstances where it was not possible for the evidence of Ms ER to be challenged or explored, the Panel is not able to accept her account in relation to the arrangements for this DST meeting if that is the meeting to which she was referring, and, if it was not that meeting, there is insufficient information on which the Panel could base a decision that the Registrant had not acted collaboratively. The other aspect of the evidence relied upon by the HCPC in relation to this particular, is the evidence of Ms AB-D in relation to a DST meeting which she claims took place on 10 November 2011. The notes do not support the contention that a DST meeting took place on that day, and in the judgement of the Panel it is unlikely to have been held given the documented DST held two weeks later on 24 November 2011, and for the purposes of which Ms AB-D prepared a report. For all these reasons the Panel finds that particular 3(a) is not proved.
Particular 3(b) – not proved.
40. The HCPC’s complaint against the Registrant is that he took Patient C on a home visit on 16 December 2011 without undertaking a risk assessment. The patient’s notes disclose that in two separate entries made by Ms AB-D on 15 December 2011, the day before the visit, it was understood that the Registrant would be accompanying Patient C on a home visit, and it is apparent from the notes made on the day of the visit that it was made with the knowledge of the nursing staff. On the basis of the available evidence the Panel is not persuaded that the HCPC has provided an evidential foundation for the proposition that the Registrant was required to undertake a risk assessment. Accordingly particular 3(b) is not proved.
Particular 4(a) – proved.
41. To preserve Patient D’s confidentiality it is necessary that the Panel should not identify the name of the premises to which she was discharged. In this determination it will be referred to as “the discharge destination”. The aspect of this particular that alleges that the Registrant did not take colleague opinion into consideration relates to the concerns raised by Ms AB-D that the discharge of Patient D to her discharge destination was premature. That Ms AB-D held this view is clear, not only from entries made contemporaneously in the patient’s notes, but also in a report she subsequently made to Dr TE and her witness statement made for the present proceedings. However, the decision to discharge the patient was made by Dr EC, at that time a Locum Consultant in Rehabilitative Medicine. It was a decision made by Dr EC on 6 December 2011 following a MDT held the previous day. The Registrant was one member of the team contributing to the decision which was ultimately to be made by Dr EC. The Registrant made his contribution, as did Ms AB-D. The note of the MDT held on 5 December 2011 includes the following, “OT: Functional able to be independent Limited by fatigue”, which accords with the views expressed by Ms AB-D. The Panel’s view is, therefore, that the Occupational Therapist’s view was considered by Dr EC in the process that resulted in the discharge of the patient, and that it was not required of the Registrant that he should have considered that view himself, although he did recognise that there were issues relating to the patient’s fatigue in his report written on 4 November 2011. Accordingly, the Panel does not accept this aspect of the HCPC’s case in relation to this particular. The Panel does accept the evidence of Ms AB-D that during a ward round the Registrant referred to the “structured day” element of the notes prepared by her, as “rubbish”, and threw them down in front of a colleague, Dr EC. The evidence of Ms AB-D is corroborated by the accounts of Dr EC given in an account she sent to Dr TE on 3 February 2012 and in her interview with Mr DM on 8 May 2013. On the basis of the acceptance of this evidence, the Panel has concluded that the Registrant was not working collaboratively. Particular 4(a) is proved to that extent.
Particular 4(b) – not proved.
42. The Panel is not persuaded that the Registrant’s assessments of Patient D were either inadequate or inappropriate, and there are no grounds for believing that the Registrant had an obligation to provide a care package. The Registrant’s obligation was to provide appropriate input to the decision to be made by the discharging clinician (here Dr EC) as to whether the circumstances (which would include the available care package) justified discharge. This particular is not proved.
Particular 5 – not proved.
43. This particular is advanced by the HCPC on the basis that a Clinical Psychologist, Dr MF, suggested that a functional analysis should be carried out and reported that the Registrant appeared to be unsure how this should be undertaken. It should be noted that the Panel did not receive any direct evidence from Dr MF. She was not called as a witness to give evidence before the Panel, and she did not make a witness statement for the present proceedings. Her evidence was contained in a document she sent to Dr TE on 21 March 2012 and in a record of her interview with Mr DM on 10 July 2012. Both of these accounts were given approximately two years after the incident occurred. Having heard the Registrant’s evidence given in the present case, the Panel accepts that after Dr MF suggested that a functional analysis should be undertaken, he merely telephoned her to confirm that her suggestion of functional analysis was what he would have described as behavioural analysis or an ABC chart. Such an analysis was subsequently carried out. The Panel finds that the communication does not demonstrate anything beyond the Registrant wishing to confirm an issue of terminology. The Panel does not accept the HCPC’s case that the exchange between the Registrant and Dr MF arose because he was unable to identify or know how to carry out an appropriate assessment in this regard. Accordingly, particular 5 is not proved.
Particular 6 – not proved.
44. The evidence made available to the Panel in relation to the allegation that the Registrant made inappropriate comments to a member of Patient F’s family is hearsay upon hearsay in that it is based upon an account of a conversation Ms HB, an Occupational Therapist, is said to have had with the family member. Ms HB was not called as a witness in the present proceedings and did not make a witness statement for the present proceedings. Her account is contained in the record of her interview with Mr DM for the purposes of the Board’s disciplinary process. In circumstances where the conversation is denied, the Panel does not feel able to accept this evidence as it has not been possible for the Registrant to challenge it or for the Panel to assess it. Accordingly, particular 6 is not proved.
Particular 7 – not proved.
45. This particular is also advanced on the basis of hearsay evidence, in this instance by the exhibiting of a letter of complaint dated 14 September 2012 written by the family member to the Chief Executive of the Board. For the same reasons that applied to the preceding particular, the Panel finds that the HCPC has not discharged the burden of proving this particular. Particular 7 is not proved.
Particular 8 – proved.
46. The HCPC’s case in relation to particular 8 concerns events on 18 and 19 January 2012 relating to Patient H. It was alleged by Ms AB-D that on 18 January 2012 the Registrant unilaterally told the patient he could leave the NRU, and announced the fact that the patient would be leaving to other professionals on the ward. The Panel does not accept that contention. The finding made by the Panel is that when the Registrant was told by Ms KJ, the Deputy Ward Manager, that the patient had expressed an intention of leaving, at her request, the Registrant spoke with the patient in an attempt to persuade him to stay. Being unsuccessful in attempting to persuade the patient to stay, the Registrant asked Ms KJ to inform Dr EC. So far as the events of 18 January 2012 are concerned, for the reasons just explained, the Panel does not accept that the Registrant failed to work collaboratively, and it also finds that there were no colleague opinions for him to take into account. However, the Panel has reached a different conclusion in relation to the events of the following day, 19 January 2012. The Registrant was aggressive towards Dr EC when she expressed concern that a patient under her care had returned home without her knowledge, and he told Ms KJ to “butt out” when she sought to intervene. The Panel accepts the hearsay accounts of Dr EC and Ms KJ as they are consistent with one another and also because of the Registrant’s acceptance in evidence before the Panel that there was a heated discussion after Dr EC spoke to him in terms that suggested that she believed that the previous day he had told the patient that he could leave. He also accepted that he told Ms KJ to butt out. In behaving in this manner, the Panel is satisfied that the Registrant was not working collaboratively. Furthermore, in failing to attend the MDT meeting that was held on 19 January 2012 without communicating to those attending the meeting why he was not attending it, the Panel has also concluded that the Registrant was acting in a manner that did not take colleague opinion into account. For these reasons the Panel finds particular 8 proved on the basis of the events of 19 January 2012.
Particular 11(a) – not proved.
47. The Panel has understood the basis upon which this particular is advanced as being that it is alleged by the HCPC that, because of Patient K’s distressed condition, the Registrant should not have considered undertaking any assessments, whether or not they were appropriate. The Panel finds that when a visual test was undertaken on 26 April 2011 the patient was tearful, and as the patient remained tearful, the Registrant did not resume any testing that day. On 27 April 2011 the Registrant introduced a test of effort that the patient failed, whereupon the Registrant recorded, “At this stage have no further plans to assess unless he indicates a wish to”. On 27 April 2011 a meeting took place between the Registrant, Dr SJ (a Consultant in Rehabilitative Medicine) and the patient’s family, when it was agreed that cognitive assessment would be carried out the following day. In circumstances where the professionals who had direct knowledge of the patient decided that assessments would be carried out, the Panel does not accept the premise upon which this particular is advanced. Accordingly, particular 11(a) is not proved.
Particular 11(b) – proved.
48. The Panel accepted the evidence of Ms Kinch that the Registrant undertook inappropriate and indiscriminate testing of Patient K. The assessments were undertaken at a very early stage after the patient’s accident and were numerous. In particular, the Panel finds that the test of effort and three separate visual inattention tests were inappropriate. Particular 11(b) is proved.
Particular 11(c) – proved.
49. As to the calculation of the raw score sheet resulting from the TOMMS test administered on 28 April 2011, the Panel accepts that Ms Kinch calculated the totals correctly. It finds that the Registrant made an error in the calculation of the scores, but as the error was one of arithmetic and not one that changed the overall conclusion to be drawn from the score results, the Panel does not consider that it would be appropriate to find that the Registrant misinterpreted the test results on that basis. However, the Panel accepts Ms Kinch’s evidence that the Registrant misinterpreted Patient K’s score of 12/15 in the Rey 15 Item Memory Test as a fail, whereas in fact it should have been considered a pass. Particular 11(c) is proved on the basis of the misinterpretation of the Rey 15 Item Memory Test.
Particular 12(a) – proved.
50. In approaching its decision on this particular, which is based on the expert evidence of Ms Kinch, the Panel noted the Registrant’s evidence that a significant portion of Patient L’s notes had not been provided to Ms Kinch. The Panel accepts that she may well not have received all of the patient’s notes. It follows that fairness to the Registrant demands that the issue should be decided accepting that Ms Kinch was forming her view on incomplete notes. However, even on this basis, the Panel is persuaded by Ms Kinch’s evidence that the HCPC’s criticism is proved. The records reviewed by Ms Kinch were not accurate as there were omissions, and they were not full, as there was an absence of a full narrative that provided the evidence for clinical reasoning and decision-making. Particular 12(a) is proved.
Particular 12(b) – proved.
51. Patient L had sustained severe physical injuries including a serious brain injury. As a result of her brain injury, she was in a state of post-traumatic amnesia (PTA) for a significant period of time. It is apparent from the records of assessments undertaken that the Registrant administered a test battery approximately a fortnight after Patient L emerged from PTA. Despite the fact that the Registrant selected tests he believed would be appropriate for this patient at this time, the Panel accepts the evidence of Ms Kinch that this was at too early a stage for the patient to be considered sufficiently psychologically robust to undergo the formal psychometric testing administered. It follows that particular 12(b) is proved.
Particular 13(a) – proved.
52. The criticism advanced by the HCPC by this particular is based upon an audit undertaken by Dr TE. The Panel noted the Registrant’s concerns as to how the audit was undertaken, namely as to the selection of the cases reviewed, the acceptance by Dr TE that she had not reviewed the electronic MDT notes or nursing notes, as well as the fact that the audit was undertaken at a time when the Registrant was suspended from his employment. In addition to these reservations, the Panel has reviewed the evidence of Dr TE in the light of its already expressed reservations about her evidence. However, despite all these matters, the Panel has concluded that the evidence of Dr TE was factual, as opposed to an opinion, and that her evidence could safely be relied upon. The consequence is that particular 13(a) is proved.
Particular 13(b) – not proved.
53. This particular should be read as alleging that there was an absence of references to multidisciplinary team assessments and/or goals in the eleven cases despite the fact that such references were required. The Panel does not doubt the accuracy of Dr TE’s evidence that such references were not included in the notes. The Panel accepts that the Registrant had an obligation to liaise with other professionals (not least because it was specifically mentioned in his job description), and it also accepts that he should have referred to the assessments of other professionals and/or goals set by them if such references were necessary for the purposes of his own work. However, with regard to this particular, the Panel finds that the HCPC has not discharged the burden of proving that the Registrant had such a duty to make these references in the specific eleven cases alleged. It follows that particular 13(b) is not proved.
54. It follows that the Panel must proceed to consider the issues of the statutory grounds and current impairment of fitness to practise in relation to those facts the Panel has found proved.
Decision on Grounds
55. Having announced its findings on the facts, the Panel received submissions from both the Presenting Officer and the Registrant on the issues of the statutory grounds and current impairment of fitness to practise.
56. The Presenting Officer submitted that it was not the HCPC’s case that the Registrant wilfully disregarded the welfare of his patients, and also made clear that the HCPC did not suggest that the Panel’s findings demonstrated moral opprobrium on the part of the Registrant. While accepting that the issue was one for the Panel’s judgement, he submitted that the factual findings suggested that a finding of lack of competence was appropriate, rather than one of misconduct.
57. The Registrant began his submissions to the Panel by explicitly accepting the Panel’s findings. He acknowledged shortcomings in relation to the assessments of mental capacity and recognised that he needed further training in relation to this area. As to administering tests, he stated that he had re-visited the material from the specialist course he had completed. He reminded the Panel of the evidence given in private at the hearing in July 2017 as to the difficulties he was facing during the relevant period. These difficulties not only arose from a challenging working environment, recognised as toxic, but also from two separate major issues impacting on his personal life, issues that are now largely resolved.
58. At the commencement of its discussions on the facts the Panel considered whether it was possible, and, if possible, appropriate to categorise the findings made in relation to the 18 proved particulars. The Panel concluded that it was both possible and appropriate. The categories, and the proved particulars assigned to them, are as follows:
• Assessments of mental capacity and discharge – particulars 1(b), 1(c), 1(f) and 2(c).
• Collaborative working ¬– 1(d) and 2(d)
• Communication – 4(a) and 8
• Testing – 1(g), 1(h), 2(g), 2(h), 11(b), 11(c) and 12(b).
• Record keeping – 12(a) and 13(a).
• Boundaries – 2(a).
59. Having grouped the findings in this way, the Panel accepted that the HCPC’s submission that its findings more appropriately suggested a lack of competence was correct, particularly as the Panel agreed with the HCPC’s submission that none of the matters being considered arose from a wilful disregard for the welfare of the patients. Given the detail already included in its decision on the facts, the Panel does not consider that it is necessary to detail each of its findings in order to demonstrate why it came to this conclusion, believing that examples will suffice. The references to standards in the remainder of this paragraph are references to the HCPC’s Standards of Proficiency for Practitioner Psychologists in force at the time.
• The deficiencies in relation to assessments of mental capacity arose because the Registrant failed properly to appreciate how to conduct the such an assessment, and apply his findings to issues pertaining to discharge. With regard to those assessments the Panel finds that he did not discharge the obligations imposed on him by standards 2a.2 (“be able to select and use appropriate assessment techniques”) and 2a.4 (“be able to analyse and critically evaluate the information collected”).
• With regard to collaborative working, the Panel found that the Registrant did not refer to the unsuccessful home visit made by others in the multi-disciplinary team shortly before his own successful visit, sent an inappropriate email to a colleague and did not work collaboratively with the Occupational Therapist. The Panel therefore finds that the Registrant did not discharge: standards 1b.1 (“be able to work, where appropriate, in partnership with other professionals ….”); 1b.2 (“be able to contribute effectively to work undertaken as part of a multi-disciplinary team”); and, 1b.3 (“be able to demonstrate effective and appropriate skills in communicating information, advice, instruction and professional opinion to colleagues ….”).
• The identified shortcomings with relation to testing arose from standards: 2a.1 (“be able to gather appropriate information”); 2a.2 (“be able to select and use appropriate assessment techniques”), and, 2a.4 (“be able to analyse and critically evaluate the information collected”).
• The record keeping findings breached standard 2b.5 (“be able to maintain records appropriately”).
60. The Panel is satisfied that the boundary issue arose not because of a deliberate intention on the part of the Registrant to flout a requirement of which he was conscious at the time, but rather because he failed to consider the appropriateness of becoming involved once he knew that the emergency vehicle was not going to the assistance of the service user. The Panel views this issue as an error of judgement made on the spur of the moment in unusual circumstances, and is not of a nature that requires the Panel to consider it further in relation to either misconduct or lack of competence.
61. The one category of findings that the Panel is clear could not sensibly be said to arise from a lack of competence is that which has been described above as “communication”. The Panel will return to consider these particulars after explaining its concluded decision in relation to lack of competence. Before concluding that the findings of fact with the exception of those described as “communication” do in fact demonstrate a lack of competence, the Panel considered whether they represented a sufficiently wide sample of the Registrant’s work for that conclusion to be reached. The Panel was satisfied that they did. They represented deficiencies in a number of different areas, over a period of some months and they related to a number of different patients. The Panel therefore found that a lack of competence is made out.
62. So far as the communication findings are concerned (namely, particulars 4(a) and 8), the Panel carefully considered whether those particulars should lead to a finding of misconduct additionally being made. The Panel was of the clear view that the behaviour these particulars represented was reprehensible, and despite the circumstances in which they arose (for example, the behaviour represented by particular 8 arose when the Registrant inappropriately responded to the incorrect contention that he had permitted the patient to go home), the Registrant should not have acted as he did. However, when the Panel asked itself the question whether the behaviour represented by those particulars either individually or collectively reached the threshold fairly to be described as misconduct, the conclusion was that it did not. Although fellow practitioners would be disapproving, the Panel did not believe that they would describe it as deplorable.
63. The result of these findings is that the Panel makes a finding of lack of competence. Misconduct is not found.
Decision on Impairment
64. The Panel accepts that the Registrant has reflected not only on his behaviour, but also on the Panel’s reasons for its findings on the facts. The Panel also accepts that in relation to his behaviour towards former colleagues that he is regretful and embarrassed.
65. So far as the Panel’s findings in relation to the competence issues, it is the Panel’s judgement not only that the shortcomings are of a nature that are capable of being remedied, but it is also of the view that the Registrant has the ability to remedy them. It has already been stated that the Registrant accepted the Panel’s findings. The Panel accepts that view as one genuinely expressed, and it therefore accepts that the Registrant has started to develop insight into those matters. However, there is a difference between the commencement of the development of insight, and the conclusion of that process. Furthermore, the fact that the professional work as a Practitioner Psychologist undertaken by the Registrant since he ceased clinical work for the Board in February 2012 has been limited, means that the Panel cannot be satisfied that the Registrant has remedied the shortcomings that were demonstrated in the period that has been considered by the Panel. This in turn means that there remains a risk of repetition. It follows that a finding of current impairment of fitness to practise is required upon consideration of the personal component relevant to that issue.
66. The Panel is also satisfied that a fully informed and fair minded member of the public would expect that the Registrant should not be permitted to return to unrestricted practice unless and until there can be confidence that the shortcomings identified by the Panel’s findings have been satisfactorily addressed. For this reason a finding of current impairment of fitness to practise is additionally required to satisfy the public component relevant to the issue.
67. As the Panel has found that there was a lack of competence currently impairing the Registrant’s fitness to practise, that allegation is well founded with the consequence that the Panel must proceed to consider the issue of sanction.
Decision on Sanction
68. After the Panel announced its decisions on the statutory grounds and current impairment of fitness to practise, the Presenting Officer and the Registrant made submissions on the issue of sanction.
69. The Presenting Officer urged the Panel to have regard to the Indicative Sanctions Policy and to ensure that any sanction determined by the Panel represented a proportionate response to the findings made. He submitted that the risk of repetition already identified by the Panel might make the taking of no further action or the imposition of a caution order inappropriate. The Presenting Officer also acknowledged that the Panel might take the view that suspending the registration of the Registrant might be considered to be disproportionate in the light of the Panel’s findings that the shortcomings are of a nature that are capable of being remedied, that the Registrant acknowledges the Panel’s findings and has expressed a desire to address matters.
70. The Registrant told the Panel that he wishes to practise as a Practitioner Psychologist, but doing work at weekends and evenings, rather than by seeking full-time employment. He stated that he does not have any work in the pipeline, but, if permitted by the Panel’s decision on sanction, would take the steps necessary to permit him to work as he wishes. These steps would include re-registering with professional bodies and seeking a supervisor. He also informed the Panel that in undertaking professional development he would focus on the areas of deficiency identified by the Panel.
71. The Panel has approached the decision it is required to make on the basis that a sanction is not to be imposed to punish the Registrant. Rather, it is required any sanction should be proportionate to the findings made and should be the least restrictive order consistent with the need to protect the public and to maintain a proper degree of confidence in the profession of Practitioner Psychologist and in the regulation of that profession. The Panel has throughout had regard to the HCPC’s Indicative Sanctions Policy.
72. The Panel first considered whether no further action could be taken. The conclusion of the Panel was that the finding of lack of competence in this particular case was inconsistent with permitting the Registrant to return to unrestricted practice. For the same reason, the Panel rejected the option of directing that mediation should be undertaken.
73. The Panel next considered the making of a caution order. The Panel concluded that such an outcome would not be appropriate in the present case. The lack of competence found by the Panel did not arise from an isolated lapse, the deficiencies were neither limited nor minor in nature, and there was an identified risk of repetition.
74. The Panel then considered whether a conditions of practice order would be appropriate. In this regard, the Panel has also stated that it is satisfied that the identified shortcomings are of a nature that are capable of being remedied and that the Registrant is an individual who has the ability to remedy them. In addition to being able to remedy them, the Panel is also satisfied that he will be willing to do so. He has fully engaged in the HCPC regulatory process, and has not only stated that he accepts the Panel’s findings, but also that he has a desire to address matters. The Panel assessed whether the making of a conditions of practice order was appropriate by considering whether a suspension order should be made. In the judgement of the Panel a suspension order would be a disproportionate outcome given the ability and willingness of the Registrant to remedy the matters and his desire to return to practice. In the judgement of the Panel, the practical consequence of the imposition of a suspension order would be that the Registrant would be prevented from demonstrating remediation of the shortcomings the Panel has identified.
75. The conditions of practice that the Panel has identified as being required are set out in the Order below. They are not exhaustively repeated here. The Panel is satisfied that the appointment of an appropriately qualified supervisor before any professional work is undertaken, and the work the Registrant will be required to undertaken in conjunction with that supervisor towards addressing the deficiencies identified by the Panel will afford a necessary, but sufficient, level of monitoring to achieve protection of the public and to maintain public confidence. The Panel is satisfied that the appropriate length of the Order is 12 months, acknowledging that it may be some time before the Registrant appoints a supervisor and commences any professional work.
76. The Panel reminds the Registrant that this Order will be reviewed before it expires. The conditions require the Registrant to supply certain information related to his Personal Development Plan, but he should understand that he is at liberty to supply any information he considers to be relevant to the review that will be undertaken by the reviewing panel of his fitness to practise as at the date of the review.
77. Finally, it should be made clear that in requiring the Registrant to address certain areas by way of a Personal Development Plan, the Panel has confined the conditions to those areas that are relevant to its finding that his current fitness to practise is impaired. Any wider issues of de-skilling arising from the fact that the Registrant has been away from full-time practice for some time will be covered by the general obligations binding on all HCPC registrants relating to returning to practice requirements.
The Registrar is directed to annotate the Register to show that, for 12 months from the date that this Order comes into effect, you, Dr Simon Redpath, must comply with the following conditions of practice:
1. Within 14 days of taking up any employment, or holding yourself out as being prepared to undertake any professional activities, for which your HCPC registration is required, you must inform the HCPC of the details of the employment you have taken up or work you are prepared to undertake.
2. Before undertaking any work as a Practitioner Psychologist you must place yourself under the supervision of a supervisor registered by the HCPC as a Practitioner Psychologist, Clinical Psychologist, and supply details of your supervisor to the HCPC within 14 days of their engagement. In selecting a supervisor you should ensure before he or she is prepared to provide the reports required by these conditions.
3. You must work with your supervisor to formulate a Personal Development Plan to address the deficiencies in the following areas of your practice:
• Mental Capacity Act assessments.
• Selection of appropriate assessment tools.
• Collaboration with other professionals.
• Record keeping.
4. Within 2 months of the appointment of your supervisor you must forward a copy of your Personal Development Plan to the HCPC.
5. You must discuss with your supervisor your progress towards addressing the aims set out in your Personal Development Plan on a monthly basis. These discussions may, but need not, take place in face-to-face meetings.
6. 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.
7. You must request your supervisor to provide a report detailing your progress towards achieving the aims set out in your Personal Development Plan:
(a) within six months of the appointment of that supervisor, and send that report to the HCPC at that stage;
(b) not less than 28 days before the date of the review of this Order, an up-to-date report.
8. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer or complaints made about your professional practice.
9. You must inform the following parties that your registration is subject to these conditions:
a. any organisation or person employing you or contracting with you (including individual clients you see on a private basis) to undertake professional 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).
10. You will be responsible for meeting any and all costs associated with complying with these conditions.
11. 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
History of Hearings for Dr Simon Redpath
|Date||Panel||Hearing type||Outcomes / Status|
|18/10/2017||Conduct and Competence Committee||Final Hearing||Conditions of Practice|
|17/07/2017||Conduct and Competence Committee||Final Hearing||Hearing has not yet been held|