Miss Stephanie P Howes

: Physiotherapist

: PH73902

: Final Hearing

Date and Time of hearing:12:30 30/11/2017 End: 17:00 30/11/2017

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

: Conduct and Competence Committee
: Struck off

Allegation

1. Whilst registered as a Physiotherapist, on 08 March 2016 at Worthing & Chichester Magistrates’ Court, you were convicted of the following offence(s);

a) Between 02/02/2015 and 14/05/2015 committed fraud in that you dishonestly made a false representation, namely intending to make a gain, namely you submitted 5 separate weekly timesheets to Piers Meadow Recruitment Limited which included 7 days that you had not worked, for yourself;

b) Between 02/02/2015 and 14/05/2015 made a false instrument, namely 14 authorised timesheets, with the intention that you or another should use the same to induce Piers Meadow Recruitment Limited to accept it as genuine and by reason of so accepting it to do or not to do some act to his own or another person’s prejudice.

2. By reason of your convictions as set out at paragraphs 1, your fitness to practise as a Physiotherapist is impaired.

Finding

Proof of Service

1. The Panel was aware that written notice of these proceedings was posted by first class post to the Registrant at her registered address on 30 October 2017. Notice was also effected by email.  The Panel was shown documents which established service of the notice and the identity of the Registrant’s registered and email address.  In these circumstances the Panel accepted that service of the notice had been effected in accordance with the rules.
 
Proceeding in the absence of the Registrant

2. Ms Brezezina on behalf of the HCPC submitted that the Panel should consider the case in the absence of the Registrant. She informed the Panel that there had been no engagement by the Registrant with the HCPC since the substantive hearing in December 2016.

3. The Panel heard and accepted the advice of the Legal Assessor.

4. The Panel was aware that a decision to proceed in the absence of the Registrant was one to be taken with great caution. However the Panel has decided to proceed in the absence of the Registrant. The reasons are as follows:
• Service of notice of this hearing has been effected in accordance with the rules;
• The Registrant has not applied for an adjournment;
• The Panel has taken account of the HCPTS Practice Note on proceeding in the absence of the Registrant;

There is no reason to suppose that an adjournment would result in the future attendance of the Registrant;
• There is a public interest in proceeding;
• The Suspension Order expires on 30 December 2017;
• In all the circumstances the absence of the Registrant should be treated as voluntary.

Background:

5. On 29 March 2016 the Registrant notified the HCPC by letter, dated 19 March 2016, that she had pleaded guilty on 8 March 2016 to two offences involving fraud. The case was heard by Worthing and Chichester Magistrates’ Court.
 
6. The sentence imposed was an 18 week prison sentence suspended for 12 months and an unpaid work requirement of 150 hours to be completed within 12 months.

7. The fraudulent activity was investigated by the NHS Counter Fraud team who prepared an investigation report dated March 2016. The report details how the fraudulent activity was identified. The report estimates the cost of the fraud as overpayments made to the Registrant totalling £1,954.20.

Hearing on 02 December 2016

8. At the substantive hearing on 02 December 2016, the Panel found all the factual particulars in the allegation proved. It determined that by reason of her convictions, the Registrant’s fitness to practise was impaired. The Panel held that the convictions were proved by the Certificate of Conviction which it had seen.

9. The Panel determined that the Registrant’s fitness to practise was  impaired.   That conclusion was based on both “the personal and public policy grounds. In summary its reasons were as follows:

In respect of the personal ground, the Panel stated its conclusion as follows;

“The Registrant forged signatures on 14 timesheets and fraudulently claimed for 66 hours on 7 dates on 5 different timesheet claims when she was not at work but off sick. The Registrant’s dishonest actions resulted in an overpayment by the Trust. The Panel took the view that this conduct and behaviour breached a fundamental tenet of the profession and brought the profession into disrepute. The Panel considered the HCPC Standards of Conduct and Ethics and was satisfied that the Registrant’s actions represented a significant departure from the following standards which state:

 3 – ‘You must keep high standards of personal conduct’

13 - ‘You must behave with honesty and integrity and make sure your behaviour does not damage the public’s confidence in you or your profession.’

There has been only limited engagement from the Registrant during these proceedings. Although the Registrant submitted a letter in which she expressed remorse, regret and a commitment to self-reflection, the Panel was unable to assess whether the Registrant had developed meaningful insight. There was no evidence before the Panel that the Registrant fully appreciated the consequences of her actions on her former employer or that the Registrant had properly reflected on the impact of her behaviour on her profession, which legitimately expects high standards of integrity and honesty at all times. The Registrant indicated in her letter that she has learnt from the experience, but provided no detail as to what she has learnt and what steps she has taken to ensure that such dishonest conduct would not be repeated in the future. Furthermore, there was no explanation in the Registrant’s letter as to why she behaved in this manner.

The Panel recognised that demonstrating remediation following a conviction involving dishonesty is particularly difficult, as probity issues are reliant on attitude, which can often only be inferred from conduct. However, in the absence of meaningful reflection and a commitment to remediation the Panel concluded that there was a risk of repetition.
The Panel concluded that for these reasons the Registrant’s fitness to practise is currently impaired based on the personal component.”

• In respect of the public policy ground; the Panel stated its conclusion as follows:

“In considering the public component the Panel had regard to the important public policy issues which include the need to protect the public, maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour.
The Registrant’s conduct fell far below the standard expected of a registered practitioner and the Panel takes the opportunity to declare that it is wholly unacceptable for a physiotherapist to defraud an employer for financial gain. The Panel concluded that public confidence would be undermined if a finding of fitness to practise was not made, given the seriousness of the Registrant’s dishonest conduct and behaviour.”

11. 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 only appropriate and proportionate Order. It explained its reasons as follows;

“The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s repeated misconduct and dishonest behaviour, and in the absence of exceptional circumstances, it would be wholly inappropriate to take no action. Furthermore it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.


The Panel then considered a Caution Order. The Panel noted paragraph 22 of the ISP which states:

“A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate action. A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate. A caution order is unlikely to be appropriate in cases where the registrant lacks insight.”

In view of the Panel’s findings that the Registrant has demonstrated limited insight into her misconduct and provided no evidence of remediation, a risk of repetition remains. The Panel concluded that a Caution Order would be inappropriate and insufficient to meet the public interest.

The Panel went on to consider a Conditions of Practice Order. The Panel noted that the ISP states:

‘Conditions of practice are unlikely to be suitable in situations where problems cannot be overcome, such as serious overall failings, lack of insight, denial or matters involving dishonesty...”.

The Panel concluded that the dishonest submission of timesheets, which involved forging a signature on numerous occasions, is not amenable to conditions as the basis for this type of misconduct is an attitudinal failing. In these circumstances the Panel was unable to formulate conditions which would be workable, measurable or proportionate. Furthermore, conditions would not adequately address the serious nature of the misconduct and so would undermine public confidence in the profession and the need to uphold standards of conduct and behaviour.

The Panel next considered a Suspension Order. A Suspension Order would send a signal to the Registrant, the profession and the public re-affirming the standards expected of a registered physiotherapist. The Registrant has not fully engaged with these proceedings. However, in her letter dated 20 October 2016, she has demonstrated some insight into her wrongdoings and appears to be capable of developing an appropriate level of insight and taking purposeful steps towards remediation. The Panel further noted that the Registrant’s expressions of regret and remorse were insufficient as evidence of insight.

Although the Registrant has not worked as a Physiotherapist since her conviction, she appears to remain committed to her profession, as evidenced by her letter dated 20 October 2016 in which she states:

‘I truly value my time spent working in the NHS and the amazing training and teaching I received over the course of my career. I hope in the future that I will be able to redeem myself and contribute to the service once again as a Physiotherapist.’

In the Panel’s view the Registrant should be given the opportunity to demonstrate that she can ‘redeem’ herself and noted that paragraph 34 of the Indicative Sanctions Guidance states:

‘If the evidence suggests that the registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option. However, where there are no psychological or other difficulties preventing the registrant from understanding and seeking to remedy the failings then suspension may be appropriate.’

The Panel considered that the above paragraph might apply to the Registrant and that she should be given an opportunity to consider carefully the decision of this Panel and reflect on her previous conduct and behaviour.

The Panel decided that the appropriate and proportionate order is a Suspension Order. A Striking Off order would be disproportionate and punitive. The Panel determined that the Suspension Order should be imposed for a period of 12 months. The Panel was satisfied that this period would be sufficient for the

Registrant to demonstrate an appropriate level of insight into her failings. If she is unable to demonstrate insight within that time frame it is highly unlikely that she will ever be able to do so.


Review

12. The Panel gave guidance as to what might help a reviewing Panel. That guidance was in the following terms;

“This Order will be reviewed shortly before expiry. Although this Panel cannot bind a future reviewing panel, that panel is likely to be assisted by the following:

(a) The Registrant’s attendance in person;

(b) A full and substantive reflective statement from the Registrant identifying the reasons for her actions, what she has learnt from the experience and the actions she has taken to avoid repetition;

(c) Details of how the Registrant has kept her physiotherapy skills and knowledge up to date;

(d) Current character references including reference(s) from recent employer(s).”

Decision of this Panel
 
13. Ms Brezezina made submissions to this Panel. In summary she said as follows; that there had been no engagement by the Registrant with the HCPC since the last hearing and there was no change in the relevant facts, from those that had existed at that time. She submitted that the Registrant’s fitness to practise was still impaired, the reasons being precisely the same as those determined in December 2016.  She said that there was no evidence of insight or remediation or any evidence that the Registrant had sought to respond to the suggestions made by the Panel in December 2016, as to what would assist a reviewing Panel. She submitted that the appropriate order was either a Suspension Order or a Striking Off Order.

14. The Panel considered the submissions that it had received on behalf of the HCPC. There were no submissions, representations or other material received from the Registrant. The Panel also heard and accepted the advice of the Legal Assessor.

15. The Panel is aware that it has all the powers that are set out in Article 30 [1] of the Health and Social Work Professions Order 2001 [The Order] and which are summarised in the letter dated 30 October 2017 addressed to the Registrant and giving notice of this hearing .

16. The Panel is aware that the process under Article 30 [1] 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

17. 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 ability to practise was necessary in order to protect members of the public.  The Panel also concluded that public confidence in the profession,in the HCPC as its regulator and the need to maintain proper standards within the profession, would all be undermined if a finding of present impairment was not made. In coming to the above conclusions, the Panel noted that the Registrant had not complied with any of the suggestions made by the Panel in December 2016 as to what would assist a reviewing Panel. The Registrant had not produced a reflective statement or details as to how she had maintained her professional skills, or any references from recent employers. There was no evidence of remediation or insight.

Decision on Sanction

18. 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.

19. The Panel took into account the principles of proportionality balancing the interests of the Registrant with the public interest.

20. 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.

21. 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 considerations set out in paragraph 14 above.

22. The Panel gave careful consideration to making a Conditions of Practice Order. It concluded that there were no conditions that would adequately address the risks identified above.  Moreover the Registrant had not addressed any of the suggestions made by the Panel in December 2016 as to what she could do, to assist a reviewing Panel. Accordingly there were serious doubts as to whether the Registrant would comply with a Conditions of Practice Order.

23. The Panel then considered a Suspension Order. It noted that the last Panel had stated, when making the Suspension order for 12 months, that such a period would be sufficient to demonstrate an appropriate level of insight into her failings and that if she was unable to do so, within that time frame, it was highly unlikely that she would ever be able to do so. This Panel agrees with that conclusion and is reinforced in that view by the Registrant’s failure to engage with the HCPC since the last hearing and by the fact that she has not sought to comply with any of the suggestions made by the Panel in December 2016 as to what would assist a reviewing Panel. Accordingly, the Panel did not consider that a further Suspension order was appropriate. The Panel has determined that only a Striking Off Order is sufficient and appropriate in order to protect the public and to sustain public confidence.

 

 

Order

ORDER: That the Registrar is directed to strike the name of Miss Stephanie P Howes from the Register when the current Suspension Order expires on 30 December 2017.

Notes

No notes available

Hearing history

History of Hearings for Miss Stephanie P Howes

Date Panel Hearing type Outcomes / Status
30/11/2017 Conduct and Competence Committee Final Hearing Struck off
02/12/2016 Conduct and Competence Committee Final Hearing Suspended