Mrs Elizabeth Louise Caine
Whilst registered as a Social Worker and employed by CLIC Sargent, you:
1) On or around 29 June 2015, breached professional boundaries, in that you sent emails of an inappropriate nature to Mr B, Child B’s father, in relation to safeguarding concerns which had been raised.
2) On or around 7 July 2015, in relation to a safeguarding concern about Child C, spoke to the mother of Child C about the safeguarding concern:
a) without previously discussing the matter with a nurse who was directly involved;
b) without the authority of and/or discussion with your Line Manager.
3) The matters described at particulars 1 to 2 above constitute misconduct and/lack of competence.
4) By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
Proof of Service
1. The Registrant, Mrs Elizabeth Caine, has neither attended this hearing nor been represented at it.
2. The Panel first considered whether the Registrant had been sent a valid notice of hearing. The conclusion of the Panel was that the communications sent on the 14 August 2017 satisfied this requirement.
Proceeding in absence
3. It followed from the finding that there had been a valid notice of hearing sent to the Registrant and that the Panel had jurisdiction to entertain the HCPC’s application that the hearing should proceed in the absence of the Registrant. In reaching its decision on this issue, the Panel accepted the advice of the Legal Assessor and had regard to the guidance contained in the HCPTS Practice Note on the issue. The conclusion of the Panel was that the hearing should proceed in the absence of the Registrant. The reasons for this decision were as follows:
• The Panel was satisfied that the Registrant had knowledge of the date of the hearing. In addition to the notice of hearing sent on 14 August 2017 there had been other communications informing her of that fact, including a “Response Proforma: Service of Papers” document sent to the Registrant on 3 October 2017 and returned by her on 15 October 2017. Furthermore, the Registrant sent an email to the HCPC on 28 August 2017 in which she acknowledged the date on which the hearing was scheduled to commence.
• In the email dated 28 August 2017 to which reference has just been made, the Registrant stated that she would not be attending the hearing.
• By an email sent by a member of the HCPTS’s Scheduling Team on 29 August 2017, the Registrant was informed how she could apply for a postponement or adjournment of the hearing, as well as the fact that teleconferencing facilities could be made available.
• The Registrant did not apply for the hearing to be postponed or adjourned, and she did not request that she should be able to participate by telephone.
• For these reasons the Panel was unable to conclude that there was any significant likelihood that the Registrant would attend a hearing on a future occasion if it did not proceed as scheduled.
• The HCPC’s allegations concern events that occurred more than two years ago, and the Panel concluded that further delay was undesirable.
• At the commencement of the hearing one of the two witnesses the HCPC proposed to call to give evidence was already in attendance, and the other witness was due to attend at midday on the same day.
• Finally, by a letter dated 14 October 2017 the Registrant had stated her case in relation to the allegations. The Panel was satisfied that the disadvantage to the Registrant arising from her absence from the hearing was thereby partially mitigated.
• For all these reasons, the Panel was satisfied that the clear public interest in the hearing continuing outweighed the absence of the Registrant, necessitating the decision that the hearing should proceed in her absence.
4. The HCPC’s allegations against the Registrant concern events that occurred in June and July 2015 when she was employed as a Social Worker with CLIC Sargent Services North Region (“the Charity”). The Charity provides support to children diagnosed with cancer, and to the families of those children. In 2015 the Registrant was working as a Social Worker based at the Royal Manchester Children’s Hospital (“RMCH”), but she had previously worked for the Charity as a Youth Development Worker and as a Social Work Assistant. The matters relied upon by the HCPC will be described when the Panel explains its decisions on the facts. It should, however, be stated that the circumstances relating to particular 1 had been discovered by managers at the Charity, and were being managed by them, when the discussion relevant to particular 2 occurred. The Registrant left her employment on 31 March 2016, having resigned in January 2016 before the completion of the Charity’s internal disciplinary process.
Decision on Facts:
5. The HCPC called two witnesses to give evidence before the Panel. They were:
• AD, a Social Worker employed by the Charity as a Team Leader, who line managed the Registrant.
• PG, also a Social Worker, the Assistant Director of Services with the Charity, who was also the Charity’s Designated Lead for Safeguarding.
The Panel found them both to be credible witnesses who gave consistent evidence that could safely be relied upon.
6. In addition to the oral evidence of AD and PG, the Panel was also provided with their written witness statements and a bundle of documentary exhibits. Included in the exhibits were relevant email exchanges and case records, as well as the records of interviews carried out for the purposes of the Charity’s internal disciplinary process.
7. As has already been mentioned, although the Registrant did not participate in the hearing, the Panel had her letter dated 14 October 2017 in which she explained her case in relation to the allegations. Furthermore, the Panel had regard to the records of explanations she gave not only at the time of the relevant events, but also when interviewed for the purposes of the Charity’s investigation into those events.
8. The Panel accepted the advice it received as to the manner in which it should approach its findings on the facts, in particular that the burden of proof rested on the HCPC to prove matters on the balance of probabilities.
9. Child B was a child allocated to the Registrant. He was receiving treatment for cancer as an outpatient at RMCH. Child B’s mother had a serious illness and was in hospital.
10. On 29 June 2015 Child B’s father sent an email to the Registrant in which he wrote the following:
“[Mother B] in her delirious state …has made some accusations against me regarding herself and the boys – beggars belief! … and accused me of abuse and neglect of the boys! I’ve got social services coming tomorrow …. as if we haven’t got enough to contend with. ….” (redacted to protect the confidentiality of the family)
Approximately 20 minutes after the father of Child B sent this email, the Registrant replied in the following terms:
“That is terrible, social services will soon see once they do there assessment that it was [Mother B’s] deterioration of her illness that has caused her to make those allegations. They will just have to act on it as it’s a concern in their eyes, so be patient you know it’s not true and the truth will prevail.”
11. The HCPC’s case in relation to the Registrant’s emailed reply is that it represented a breach of professional boundaries because it went beyond supporting the father of Child B by inappropriately agreeing with the father that the contentions were groundless.
12. The documentary exhibits provided to the Panel included the email exchange just referred to, and accordingly, the Panel was satisfied that the Registrant wrote in the terms alleged. As to the appropriateness of writing to the father in those terms, the Panel is satisfied that the Registrant breached proper professional boundaries in writing as she did. Her actions breached the requirements of the Charity’s Safeguarding Children and Adults At Risk Policy in that she jumped to a conclusion about alleged behaviour without checking the facts. In the judgement of the Panel it was not necessary for the Registrant to accept the father’s contentions in order to support him, and that in responding as she did the Registrant breached proper professional boundaries.
13. It follows that particular 1 is proved.
Particulars 2(a) 2(b).
14. The HCPC’s case in relation to particular 2 is that when in hospital being attended by a Health Care Assistant, Child C bent back his fingers and stated that that was what his father did to him. The Health Care Assistant then reported the incident to a nurse, JP.
15. On 7 July 2015, JP telephoned the Registrant to discuss the case. JP asked whether the Registrant would be making the referral to social care. The Registrant responded by saying that the referral would need to “come from health as they were the ones it was first reported to.”
16. Later the same day, the Registrant had a conversation with the mother of Child C. The Registrant recorded her conversation with the mother of Child C in the following terms:
“Asked [Mother C] whether [JP] had been and discussed what [Child C] had said. Mother looked very confused and asked what had been said. I informed that when the Health Care Assistant had seen [Child C] that he pulled fingers back and said that this is what dad does to me. [Mother C] was shocked and said that she had not heard that before and that [Child C] had not said anything to her as they discuss everything…… I explained that now it has been said it is a safeguarding issue and that it needs to be reported for them to investigate further.”
17. The HCPC’s case is that, given the Registrant’s response to JP that she (the Registrant) would not be reporting the safeguarding concern, it was not appropriate for to have the conversation with the mother without first discussing the matter with JP and/or without the authority of her Line Manager, AD.
18. The Panel is satisfied from the contemporaneous documentary records and the Registrant’s own accounts of the incident (including her letter dated 14 October 2017) that she stated that she would leave it to the health care professionals to report the matter, that she had the conversation with the mother in circumstances in which the mother was not aware of the matter, and did so without first discussing the matter with Ms JP or her line manager.
19. Accordingly, the Panel finds particular 2 proved.
Decision on Grounds
20. In the judgement of the Panel, the Registrant’s actions were serious. With regard to particular 1, the crossing of proper professional boundaries had potential to harm both Child B and, indirectly, child B’s father. In circumstances where she should have had the safety of Child B as her paramount concern, she expressed an acceptance that the safeguarding concerns raised were groundless. Furthermore, her expressed acceptance of the father’s account when she had no grounds for doing so apart from his account, failed to provide him with the constructive support he was entitled to receive from her. Particular 2 was a more serious breach. Not only did it occur after the Charity was managing its concerns relating to particular 1, but even taken in isolation, the Registrant’s actions had the potential to compromise any safeguarding investigations and measures. It gave rise to the risk of collusion between Child C’s mother and father, as well as exposing the child to criticism or recrimination for making the disclosure.
21. The Panel considered whether the Registrant’s actions breached HCPC imposed standards. The conclusion it reached is that the following standards of the HCPC’s Standards of conduct, performance and ethics (2012) were breached:
Standard 1, “You must act in the best interests of service users.”
Standard 2, “You must respect the confidentiality of service users.”
Standard 7, “You must communicate properly and effectively with service users and other practitioners.”
Standard 13, “You must ……. make sure that your behaviour does not damage the public’s confidence in you or your profession.”
Furthermore, the circumstances of the two events demonstrate that the Registrant did not practise in a manner which accorded with the standards of performance required by the HCPC’s Standards of Proficiency for Social Workers in England.
22. The Panel considered whether the Registrant acted as she did because she did not have the knowledge and skills required to be able to practise safely and effectively. However, the conclusion of the Panel was the issues of the maintenance of proper professional boundaries and the observing of confidentiality are matters so basic and fundamental to Social Work practice that the Registrant as a practitioner qualified for some years must have had knowledge of them. For this reason the Panel found that there was no lack of competence.
23. With regard to misconduct, the Panel was satisfied that the Registrant’s actions were sufficiently serious to be categorised as misconduct.
Decision on Impairment
24. The Panel began its consideration of the issue of current impairment of fitness to practice by considering the factors relevant to that issue identified by Dame Janet Smith in the Fifth Shipman Inquiry Report:
Do our findings of fact in respect of the doctor's misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his fitness to practise is impaired in the sense that he:
1. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm;
2. has in the past brought and/or is liable in the future to bring the medical profession into disrepute;
3. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession;
4. has in the past acted dishonestly and/or is liable to act dishonestly in the future.
25. The conclusions of the Panel were as follows:
• For the reasons already identified by the Panel when it explained its decision on the statutory grounds, the Registrant’s actions put service users at risk of harm in the past.
• Such evidence as the Panel has of the Registrant’s insight is that it is incomplete. In her letter written as recently as 14 October 2017 there is evidence that the Registrant has avoided taking full responsibility for her actions, and there is a lack of recognition of the risks to which the service users were exposed. Furthermore, there is an absence of evidence of remediation. These findings lead the Panel to conclude that there is a risk that the Registrant would expose service users to the risk of harm in the future if she was permitted to return to unrestricted practice.
• The lack of professionalism demonstrated by the circumstances of the two incidents inevitably leads to the conclusion that in the past the Registrant has brought her profession into disrepute by breaching professional boundaries, failing to observe confidentiality and not following procedural guidelines.
• The incomplete insight and lack of evidence of remediation leads the Panel to conclude that there is a risk that the Registrant would bring her profession into disrepute in the future.
• The breaching of the Standards of conduct, performance and ethics already identified means that fundamental tenets of the profession were breached.
• For the reasons identified in relation to risk of harm and bringing the profession into disrepute, there is risk that fundamental tenets of the profession would be breached in the future.
• The Panel did not go on to consider the issue of dishonesty included in Dame Janet’s guidance because there is no dishonesty alleged in this case.
26. In addition to these matters, the Panel is satisfied that public confidence in the Social Work profession would be diminished if findings of this seriousness did not result in a finding of current impairment of fitness to practise.
27. The consequence of all these findings is that the Panel finds the Registrant’s fitness to practise to be impaired upon both the personal and public components relevant to that issue.
28. The finding that the Registrant’s fitness to practise is impaired by reason of her misconduct is well founded, means that the Panel must proceed to consider the issue of sanction.
Decision on Sanction
29. After the Panel announced its decision on the Allegation, the Panel received submissions from the Presenting Officer on the issue of sanction. He reminded the Panel of the proper purpose of a sanction and urged the Panel to have regard to the HCPC’s Indicative Sanctions Policy. The Presenting Officer did not, however, submit that the Panel should impose any particular sanction.
30. The Registrant’s absence from the hearing meant that there were no submissions from her made to the Panel on the issue of sanction. The Panel did, however, have regard to the Registrant’s letter dated 14 October 2017 when making its decision.
31. A sanction is not to be imposed to punish a registrant against whom a finding has been made. Rather, a sanction is only to be imposed to the extent that it is required to offer a proper degree of protection for the public and to maintain a proper degree of confidence in the registered profession and in the regulatory process. To ensure that these principles are applied, it is necessary for a Panel to consider whether any sanction is required at all. If it is, the Panel must approach the available sanctions in an ascending order of seriousness until one that satisfies the public interest is reached.
32. The Panel confirms that it has applied the approach just outlined above, and in doing so has had regard to the HCPC’s Indicative Sanctions Policy.
33. In the judgement of the Panel the aggravating factors of the case are that the Registrant’s misconduct put service users at risk of harm and she is liable to repeat that behaviour. Furthermore, her actions were likely to increase the anguish of parents of acutely ill children. It is also an aggravating factor that the Registrant has demonstrated limited insight. A mitigating factor is that the Registrant has expressed some acceptance of shortcomings with regard to the two incidents.
34. In the judgement of the Panel the findings in this case are too serious to result in no sanction being imposed. Furthermore, it is not a case in which mediation is appropriate as there are no outstanding issues that remain to be resolved between the Registrant and another party.
35. The Panel next considered whether the imposition of a Caution Order would be appropriate. As a Caution Order would not restrict the Registrant’s ability to practise as a Social Worker, it would not protect service users from the risk of future identified by the Panel. For this reason a caution order would not maintain an appropriate degree of public confidence. Accordingly, the Panel rejected the making of a caution order as an appropriate disposal.
36. Having considered but rejected the making of a Caution Order, the Panel next considered whether a Conditions of Practice Order should be imposed. The conclusion of the Panel was that for the following reasons the making of a conditions of practice order would not be appropriate in this case:
• The terms in which the Registrant wrote her letter dated 14 October 2017 does not encourage the Panel to believe that she recognises the true nature of her misconduct. That being the case, the Panel does not consider that it could be confident that the risk of harm would be avoided by only restricting aspects of her work.
• The limited engagement demonstrated by the Registrant in the HCPC fitness to practise process has the consequence that the Panel does not think that the imposition of conditions is appropriate as it would be a sanction that would require the Panel to be satisfied that there would be acceptance and compliance on the part of the Registrant.
• Although in the same letter the Registrant states that she has transferred her social work skills and values into a new profession, she has not identified the nature of that new work. This has the consequence that the Panel would not, in any event, be able to formulate appropriate conditions.
37. The rejection of Conditions of Practice as an appropriate sanction had the consequence that the Panel next considered the making of a Suspension Order. The Panel concluded that a suspension order is the appropriate sanction in this case as it will protect the public from the risk of harm, it will maintain a proper degree of public confidence, yet will give the Registrant an opportunity to demonstrate that she has developed insight and remediated her misconduct. In view of the steps the Panel will suggest the Registrant might consider before the review of the suspension order, it has determined that the appropriate length of the period of suspension is 9 months.
38. The Panel tested its tentative view that the making of a Suspension Order is the appropriate sanction in this case by considering whether a Striking-Off Order should be made. In the judgement of the Panel it is not necessary, and would therefore be disproportionate, to make such an order in a case involving misconduct which is capable of remediation, and where the Registrant may wish to avail herself of the opportunity to demonstrate full insight and remediation.
39. In common with all Suspension Orders, the order made in the present case will be reviewed before it expires. When the review takes place the sanction options available to the reviewing panel will be the sanction range that was available to the present Panel, including the making of a striking-off order. The decision to be made on the review will be one for the reviewing panel to make, but it may be helpful for the present Panel to suggest to the Registrant some matters that could assist her if she is of the view that she would wish to return to work as a Social Worker. The suggestions are:
• She is strongly encouraged to attend the review hearing.
• That she write a reflective piece addressing the misconduct identified by the present Panel.
• That she provide evidence of remediation, including any training and online courses undertaken, particularly with regard to the following issues:
o Maintaining professional boundaries.
o Adherence to confidentiality requirements.
o Risk analysis.
• That she provide evidence that she has kept her Social Work skills and knowledge up-to-date.
• That she provide up-to-date references.
Any information the Registrant wishes to submit for the purposes of the review of the order should be made available to the HCPTS no later than 14 days before the date scheduled for the review.
No notes available
History of Hearings for Mrs Elizabeth Louise Caine
|Date||Panel||Hearing type||Outcomes / Status|
|21/11/2017||Conduct and Competence Committee||Final Hearing||Suspended|