Mr Simon White
The following allegation was considered by a Panel of the CCC at the substantive hearing on 16 November 2016.
During the course of your employment as a Physiotherapist with Bristol Community Health, between August 2012 and 23 January 2015;
1. In relation to Patient A you:
(a) Required prompting to ensure all the brakes on the commode were engaged prior to transferring Patient A to the commode;
(b) Did not plan for and/or show evidence of planning for Patient A’s discharge;
(c) Did not fully complete the notes of your session with Patient A on 23 June 2014;
(d) Did not develop exercise programmes for Patient A which were patient-specific and/or goal focused.
2. On 13 August 2014, whilst completing an initial physiotherapy assessment with an amputee patient, Patient B, you:
(a) Did not ensure that the surrounding area was safe and unobstructed prior to requesting Patient B to wheel themselves to the parallel bars.
(b) Did not move and/or prompt the patient to move the foot plate on the patient’s wheelchair before he stood up.
(c) Did not move the stump plate before allowing Patient B to transfer from the wheelchair to the parallel bars.
(d) Did not move the stump plate before allowing Patient B to sit back down.
3. On the 19 August 2014, whilst conducting a manual handling assessment and an initial assessment with Patient C who had a revision of a total hip replacement you;
(a) Did not notice that the chair available to Patient C was too low which increased the risk of Patient C’s hip dislocating.
(b) Positioned Patient C at the edge of the bed thereby increasing the risk of falling.
(c) Did not obtain full details regarding Patient C’s multiple sclerosis.
(d) Conducted limited objective assessments of Patient C and did not record the clinical reasoning as why this was the case.
4. On 20 August 2014 whilst assessing Patient D who was recovering from a fractured hip, you:
(a) Did not adequately observe Patient D undertaking a hip extension exercise thereby:
(i) Allowing her to perform the exercise incorrectly;
(ii) Leaving her at risk of hitting her head on the wall;
(b) Did not seek and/or record information regarding Patient D’s previous falls;
(c) Did not and/or had to be prompted to carry out a cognitive assessment of Patient D;
(d) Did not carry out a balance assessment;
(e) Did not plan and/or record planned treatment in relation to Patient D;
(f) Did not show evidence of clinical reasoning in relation to the patient’s risk of falling;
(g) Did not, without assistance, notice and/or record that Patient D’s left leg caused them the most difficulty with mobility;
(h) Did not, without assistance, record and/or analyse Patient D’s co-morbidities;
(i) Did not complete clear and/or comprehensive patient records regarding the range of motion in both of Patient D’s legs.
5. Assessed Patient E’s outdoor mobility on 30 October 2014, and you:
(a) Did not discuss the assessment with the patient and/or provide her with instructions prior to commencing the assessment;
(b) Did not prompt the patient to check for oncoming traffic before commencing a road crossing, which led to a colleague standing in the middle of the road to slow oncoming traffic;
(c) Did not record the incident referred to above in the patient notes.
6. On 3 November 2014, whilst attempting to carry out a sliding board transfer from a bed to a wheelchair in relation to Patient F you did not:
(a) Place the sliding board in the correct position underneath the patient in order to complete the transfer from the bed to wheelchair;
(b) React appropriately when Patient F became fatigued and/or moved too close to the end of the bed thereby increasing the risk of falling;
(c) Provide instructions to the rehabilitation worker assisting you with the transfer.
7. The matters set out in paragraphs 1-6 constitutes lack of competence.
8. By reason of your lack of competence your fitness to practise is impaired.
Participation by telephone
1. The Registrant by an email dated 15 November 2017 stated that whilst he was unable to attend this hearing in person he was available to participate by telephone. Having heard the submissions of Mr Pandya and the advice of the Legal Assessor, the Panel determined to allow the Registrant to participate by telephone, which he did.
2. At the relevant times the Registrant was a registered Physiotherapist employed as a Band 5 Physiotherapist at Bristol Community Health (BCH). He was on six monthly rotations as part of the Band 5 rotation programme. The Registrant was responsible for treating and assessing patients in the community, outpatients or those who were staying at the centre and was also required to plan for the discharge of patients. The registrant joined the North Bristol Rehabilitation Centre (the North Centre) on 31 March 2014 where he worked for approximately six months before joining the South Community Rehabilitation Team.
3. Concerns were raised about the Registrant’s performance particularly in relation to his goal planning, treatment reviews, prioritisation and time management. Notwithstanding additional supervision over an extended period of time, across multiple teams, an action plan and a capability assessment, the Registrant’s performance did not improve and a referral was then made by BCH to the HCPC.
Hearing on 14-16 November 2016.
4. After a substantive hearing held between 14 and 16 November 2016, the Panel found all the factual particulars in the allegation proved and determined that a finding of lack of competence was “applicable”. It stated its reasons as follows;
“The Panel noted that the facts found proved, cover a six month period and involve six different patients, representing a fair sample of the Registrant’s work. The Panel also considered that the matters found proved concerned basic aspects of practise for a registered Band 5 Physiotherapist which displayed a lack of concern or appreciation for patient safety. The Registrant was unable to work autonomously or to meet the requirements of his job description. At the material times, the Registrant had been a qualified Physiotherapist for two years. Notwithstanding being provided with extensive support by his employer, the Registrant’s performance remained inadequate and unsafe.”
5. The Panel also found that the Registrant had failed to meet a number of the standards of proficiency for registered Physiotherapists, displaying a performance which fell short of the standards required of a Band 5 Physiotherapist.
6. The Panel determined that the Registrant’s fitness to practise was impaired. Its reasons were stated as follows;
“The Panel took into account that each of the incidents set out in the Particulars of the Allegation involved patients who were vulnerable as a result of serious health conditions and disabilities. Patient A suffered from Parkinson’s disease, a heart condition and weakness to his knee. Patient B was reliant on a wheelchair for mobility. Patient C had a total hip replacement and suffered from Multiple Sclerosis. Patient D had suffered a hip fracture and required a proper balance and gait assessment. Patient E had limited mobility and required proper care and assistance and Patient F needed to be moved from bed to wheelchair by proper use of a sliding board.
The Panel considered that the Registrant’s lack of competence had the potential to cause harm to the Patients A - F and undermine public confidence in the physiotherapy profession. The Panel further considered that in doing so, the Registrant had breached fundamental tenets of his profession by not acting in the best interests of service users and by failing to maintain their safety.
Whilst the Panel considered that the Registrant’s lack of competence was potentially remediable, it was not assisted by any evidence of remediation, insight or remorse and was not provided with any information as to the Registrant’s current circumstances. Accordingly, the Panel considered that the risk of repetition was high.
For these reasons, the Panel concluded that the Registrant’s fitness to practise is currently impaired.”
7. Having decided that the Registrant’s fitness to practise was impaired, the Panel proceeded to consider the appropriate sanction. It reviewed all the options available to it and decided that a Suspension Order for a period of 12 months was the appropriate and proportionate Order. It explained its reasons as follows:
“In determining the appropriate and proportionate sanction, the Panel had regard to its findings in relation to lack of competence involving repeated failures in the care of multiple patients and a disregard for their safety.
The Panel identified the following aggravating factors:
• The Registrant’s lack of competence was persistent over a prolonged period, notwithstanding supervision and support being provided to him.
• The Registrant’s lack of competence gave rise to serious patient safety issues for which the Registrant has provided no evidence of insight or remorse.
• The Registrant’s lack of competence potentially caused harm to patients who were extremely vulnerable people with physical disabilities.
In light of the Registrant’s failure to engage, the only mitigating factor which the Panel was able to identify was the lack of any previous disciplinary action against the Registrant.
The Panel first considered taking no action, however it concluded that this would be inappropriate and would not be sufficient to protect service users or the reputation of the profession. The Panel considered that this was not an appropriate case for mediation and that a caution order would be insufficient given the seriousness and totality of the Registrant’s lack of competence which was not an isolated incident.
The Panel next considered a conditions of practise order. The Panel was mindful that notwithstanding extensive support being provided to the Registrant by his employers, he was unable to improve his practice. The Registrant seemed oblivious to the safety needs of his service users. The Panel considered that his lack of competence arose due to attitudinal problems which could not be adequately addressed by conditions. The Panel also had regard to the Registrant’s non-engagement and the lack of information as to his current circumstances. For all these reasons, the Panel determined a conditions of practice order would be inappropriate and would not adequately protect the public or the public interest.
The Panel next considered a suspension order. The Panel noted that such an order is usually appropriate where remediation is foreseeable and there is some insight and it is necessary to prevent a Registrant from practising. The Panel was presented with no evidence of any insight or that the Registrant was willing to take any steps to remedy his lack of competence. In the Panel’s view, it is necessary to prevent the Registrant from practising. However, the Panel had regard to the fact that a striking off order cannot be imposed where the only Statutory Ground is lack of competence. Accordingly, the Panel concluded that a suspension order for 12 months was the only appropriate and proportionate sanction”.
Decision of this Panel
8. Mr Pandya made submissions to this Panel. In summary, he said as follows: that on the evidence now available this Panel could properly conclude that the Registrant had developed some insight but that there were still concerns about the Registrant’s ability to practise safely. He submitted that the Registrant’s fitness to practise was still impaired. He invited the Panel to consider whether there were conditions that could properly be formulated in order to address the identified risks but submitted that any such conditions should not be so restrictive as to amount to Suspension. He reminded the Panel that a Striking Off order was not presently available to it.
9. The Registrant gave evidence by telephone. He also relied on his written statement attached to his email dated 15 November 2017. In summary his evidence was as follows:
• He said that he has been working at Chantry Day Hospital as a Band 4 Support Practitioner since November 2015. He described the nature of his role. He works as part of the Memory Assessment Service with older adults with dementia. He says that his short term goal was to restore his confidence and build a positive reputation for himself within the department. He stated that that he had been well supported by his managers.
• He said that he would like to resume his professional career as a Physiotherapist and “ideally I would be seeking a post that offers both supportive supervision and a mentor who can guide my progress in the areas of concern in my practice”.
• He accepted that the facts as found proved by the Panel in November 2016 make “for grim reading and reflected an unacceptably low standard of care for my patients”.
• He acknowledged that he had not worked as a physiotherapist since January 2015 and that he had not done any training or relevant remediation work since that date. He accepted that if the decision of the Panel did enable him to resume his professional practice he would have to undertake training as indicated by his then employers.
• He said that he had learnt from what had happened and that in the future, he would be much more proactive in seeking both advice and support.
• He expressed the hope that if the Panel was minded to allow him to practise, albeit subject to supervision, the precise nature and duration of that supervision could be left to his line managers. He recognised that in returning to work as a physiotherapist he would have to “take one step at a time”.
10. The Panel saw a number of documents that were submitted on behalf of the Registrant; they included the following:
• A written statement from the Registrant which was attached to the email from the Registrant dated 15 November 2017.
• A testimonial dated 14 November 2017 from Sonia Cox a Day Hospital Manager at Chantry Day Hospital.
• A testimonial dated 15 November 2017 from Jon White an Operational Service Manager; East Mendip Integrated Team.
11. Both testimonials were very supportive of the Registrant, describing the work that he was presently doing. In substance the authors of the two testimonials said that the Registrant was professional, worked both well and independently within the team and also that he was a valuable and well regarded member of that team.
12. The Panel considered the submissions that it had received and the evidence that it had heard. The Panel also heard and accepted the advice of the Legal Assessor.
13. The Panel is aware that it has all the powers that are set out in Article 30  of the Health and Social Work Professions Order 2001 [The Order] and which are summarised in the letter dated 10 November 2017 addressed to the Registrant and giving notice of this hearing.
14. The Panel is aware that the process under Article 30  of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise is still impaired and if so whether the Suspension Order under review remains the appropriate and proportionate means of public protection or should be varied or replaced by some other order.
Decision on Impairment
15. The Panel has concluded that the Registrant’s fitness to practise is still impaired in that there was a risk of repetition and therefore a restriction on the Registrant’s ability to practise was necessary in order to protect members of the public. The Panel also concluded that public confidence in the profession, and the HCPC as its regulator and the need to maintain proper standards within the profession, would all be undermined if a finding of current impairment was not made. In coming to the above conclusions, the Panel noted that the Registrant had not worked as a Physiotherapist since January 2015 and had not undertaken any remedial action or training. The Panel also noted that the Registrant himself accepted that if he was able to resume his career as a Physiotherapist he would have to undergo training, supervision and mentoring. The Panel considered that whilst the Registrant had developed some insight, that insight, and have recently started to reengage with the HCPC his insight was not complete and did not sufficiently address the impact that his failings might have had on his patients.
Decision on Sanction
16. Having concluded that the Registrant’s fitness to practice is still impaired, the Panel proceeded to consider what order is appropriate, proportionate, sufficient and necessary to protect the public and to safeguard the public interest.
17. The Panel took into account the principles of proportionality balancing the interests of the Registrant with the public interest.
18. The Panel has had regard to the contents of the Indicative Sanctions Policy published by the HCPTS and is aware that sanctions should be considered in ascending order of severity. The Panel is aware that the purpose of sanctions is not punitive but to protect members of the public and to safeguard the public interest. The latter objective includes maintaining standards within the profession, together with public confidence in the profession and in its regulatory processes.
19. The Panel has concluded that to take no action, thus allowing the present order to lapse, making a mediation order or imposing a caution order would be inappropriate having regard to the nature and gravity of the matters found proved. Such outcomes would not sufficiently protect the public or the public interest. In coming to this conclusion the Panel took into account the seriousness of the Registrant’s lack of competence and the fact that this lack of competence was extensive both in its nature and duration.
20. The Panel gave careful consideration to making a Conditions of Practice Order. However it concluded that the only conditions that it could properly formulate in order to address the identified risks and to safeguard the public interest would be so restrictive as to amount to suspension. Accordingly it concluded that the appropriate order was a Suspension Order for a period of 6 months.
Review by another Panel.
21. This order will be reviewed by another Panel before it expires. That reviewing Panel might be assisted by the following;
• Participation by the Registrant, preferably in person at the hearing itself.
• A reflective piece from the Registrant addressing what he had learnt from each of the particulars of the allegation and his understanding of the impact of his failings on each of the patients concerned.
• Evidence of the steps that he had taken by way of training, CPD and other relevant courses, to address the failings that were identified at the substantive hearing, as well as updating his knowledge and skills
• Testimonials from current employers.