Shirley A Munro

Background

5.The Registrant is a Speech and Language Therapist.

6.At the material time, the Registrant was a Clinical Specialist and Service Lead for school age children with Developmental Language Disorder (DLD), working as part of the Speech and Language Therapy Community Children’s Team at South Eastern Health and Social Care Trust, herein after “the Trust” where she had worked for 27 years, commencing the most recent role in April 2016 at a Band 8a level.

7.On 1 July 2016, the HCPC received a referral from the Registrant’s employer. They notified the HCPC that the Registrant was being reviewed under the Trust’s capability procedure due to ongoing concerns about her performance.

8.In 2016 there had been some concerns raised in relation to the Registrant’s clinical practice which resulted to her being subject to a capability action plan. The action plan was signed off on 21 December 2016, citing significant progress.

9.In addition to this, it was alleged that in March 2017 and April 2017, the Registrant had failed to carry out her clinical duties in relation to three children in particular, which had resulted in complaints from the children’s parents.

10.Furthermore, the Trust was concerned that the Registrant was failing to provide appropriate care for a high proportion of children on her caseload and this constituted a risk.

11.Concerns were also raised about the Registrant inappropriately storing a large number of children’s files at her home. The Trust conducted a review of the Registrant’s files which brought to light the concerns that were put before the Panel.

12.The Registrant’s case was the subject of a hearing before a panel of the Conduct and Competence Committee. (“the substantive hearing panel”). The Hearing concluded on 13 August 2021.

13.Following the fact finding hearing, the Substantive Order Panel found the following facts found proved:

1 (In relation to SU 1, 2, 4, 5, 6, 7 & 8,)
2 (In relation to SU 11, 13, 14, 15 & 19).
3 (In relation to SU 1, 2, 8, 22),
4 (In relation to SU 26, 6, 50, 20, 27, 28, 5, 29, 7, 9, 30, 16, 31, 32),
6 (In relation to SU 38, 40 32, 41,9 &22),
7 (In relation to SU 6, 40, 3, 1, 43)
8 (In relation to SU 44, 45, 42)
9 (In relation to SU 46, 9, 30, 53 &31)
10 (In relation to SU 3, 12, 11, 47, 51)

14. The Panel found the following facts not proved:

1 (In relation to SU 9 & 39,)
2 (In relation to SU 12, 16,17,18),
5 (In relation to 52, 20, 21, 23, 24, 25),
6 (In relation to SU 8),
3 (In relation to SU 33, 34, 35, 36, 37, 38),
4 (In relation to SU 10),
11 (In relation to SU 49)
12 (In relation to SU 32)
13 (In relation to SU 13, 19, 32, 48)

15.The Panel found misconduct and lack of competence in relation to the facts found proved and determined that the Registrant was impaired on both the personal and public component. The Panel imposed a 3 year Conditions of Practice Order. It gave the following reasons in its written determination in relation to impairment:

“At the resumed hearing the Registrant attended and was given time overnight to prepare written submissions to address the Panel on impairment. The Registrant provided her submissions and answered the Panel’s questions. The Panel also heard submissions from Miss Woolfson on behalf of the HCPC.
Having determined that the Registrant's actions amounted to misconduct in respect of the facts found proved, the Panel went on to consider whether her fitness to practise was currently impaired as a consequence of misconduct.
The Panel heard and accepted the advice of the Legal Assessor. It had regard to the HCPC's Practice Note on impairment, and in particular the two aspects of impairment, namely the ‘personal component’ and the ‘public component’, based on the case of Cohen v GMC [2008] EWHC 581 (Admin). The Panel was aware that what has to be determined is current impairment, that is looking forward from today.
The Panel also had regard to the criteria that were set out by Dame Janet Smith in the Fifth Shipman Report, namely whether our findings of fact in respect of the Registrant’s misconduct show that her fitness to practise is impaired in the sense that she has put service users at risk, or is liable to do so in the future, whether she has brought her profession into disrepute or may do so in the future, and whether she has breached the fundamental tenets of her profession or may do so in the future. There was no need to consider whether she has acted dishonestly because this is not such a case.
In relation to remediation, the Panel firstly considered whether the Registrant’s misconduct was capable of remediation. The Panel considered in particular that her misconduct related to administrative functions and a failure to manage her workload but not her clinical decision making. In particular, relating to timely record keeping, making prompt onward referrals, liaising with professionals and parents, inappropriate storage of files and failing to manage her workload. The Panel considered that the misconduct was capable of remediation.
The Panel next considered whether the Registrant had taken remedial action to address her misconduct. It noted that she has not been working since she left the Trust in 2017. It took into account the difficulties caused by the Pandemic for attendance at in person training or conferences. The Panel took account of the fact that the Registrant told it that she had been keeping up to date with clinical developments. But the Registrant had not provided details of any training courses she had identified or undertaken that would address the concerns raised such as time management and GDPR training.
The Registrant placed weight on the fact that it was the circumstances she found herself in that contributed to the misconduct but noted that the Registrant’s solution was to avoid working for the NHS and work in private practice so that she was in charge of her own workload and could manage the pressures of work herself. The Panel found that this lacked such detail so as to be unrealistic. The Registrant has not given the Panel any workable solutions for how she would recognise when pressures arose or what she would do if she found herself in a similarly pressured environment to avoid the situation reoccurring.
The Panel found that the Registrant lacked insight as to the effect of her actions on other professionals or service users. She rather sought to place the blame for it on the situation she was in. The Panel did take into account the fact that the Registrant had no other fitness to practise proceedings during her career.
In these circumstances the Panel was not satisfied that she demonstrated an ability to recognise or respond to issues that might arise with her practice. The Panel concluded that it did not have evidence to demonstrate that the Registrant had remediated her misconduct.
The Panel further noted that there would be no oversight of the Registrant in her proposed working environment. She had not provided the Panel with any workable measures to show how her practice would be managed. In the absence of fully developed insight and remediation, the Panel concluded that there remained a high risk of repetition, which in turn exposed patients to a risk of harm. Those risks could be significant given the fact that the Registrant proposes to work with children who are developing quickly and any delay can impact their ability to access education and function in society.
The Panel acknowledged that the Registrant had not set out to cause harm, but the failings occurred over a period of almost 12 months and affected a number of service users who were vulnerable by reason not just of their age but by the complexity of their needs.
In all the circumstances, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the personal component.
In relation to the public component, the Panel was of the view that members of the public need to have confidence that Paediatric Speech and Language Therapists are able to act in a timely manner to seek the appropriate treatment for young children. The Public would also expect that sensitive confidential information about young service users and their family would be stored in a secure manner. The Panel concluded that public confidence in the profession would be undermined if no finding of current impairment were made in the particular circumstances of this case.
Accordingly, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the public component.”

16.The Panel proceeded to deal with Sanction and noted the following in relation to Sanction:

“Having determined that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on her registration. The Panel took account of the submissions of Miss Woolfson on behalf of the HCPC. It also had regard to all the evidence it had heard, and all of the material previously before it.
The Panel heard and accepted the advice of the Legal Assessor and it exercised its independent judgement. It bore in mind the Sanctions Policy (the Policy) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to punish but to protect members of the public and to safeguard the public interest, which includes upholding professional standards within the profession, together with maintaining public confidence in the profession. It therefore understood that it must impose the least restrictive sanction to address those risks which it had identified.
The Panel took into account the following mitigating circumstances that the Registrant has had a long career of safe and successful practice. The Registrant was suffering from ill health at the time but she has recovered. The Panel also considered the following aggravating factors that the Registrant had limited evidence as to insight and no evidence of remediation.
In light of the Panel’s conclusions that there was a risk of repetition, which in turn posed a potential risk of harm to patients, the Panel did not consider that the options of taking no further action or mediation were appropriate to protect the public or to safeguard the wider public interest. The Panel bore in mind that neither option would restrict the Registrant’s practice, and so neither option was sufficient to protect against the risk of repetition identified or to maintain public confidence in the profession.

The Panel next considered a Caution Order, and bore in mind that such an Order would not restrict the Registrant’s practice and so would not protect the public or the wider public interest. In addition, the Panel had regard to paragraph 101 of the Sanctions Policy and did not consider that any of the factors which might indicate that a Caution Order was appropriate were applicable in this case. In particular, the Panel considered that the misconduct was serious and wide-ranging with a consequent risk of harm to patients; there was a risk of repetition; the Registrant had not shown a ‘good level of insight’; and she had not provided evidence of appropriate remediation.
The Panel next considered whether the imposition of a Conditions of Practice Order was the appropriate and proportionate response in this case. The Panel noted its earlier observations that the misconduct was potentially remediable. The misconduct found did not relate to the Registrant’s clinical decision making. There are no persistent or general failures which would prevent the registrant from remediating the issues and, in the Panel’s view, realistic, appropriate conditions can be formulated.
The Registrant attended today and has notified the Panel that she is not currently in practice. She confirmed to the Panel that she will complete any courses or conditions that are put in place and the Panel is satisfied that she will comply with them.
The Panel is satisfied that the Registrant does not pose a risk of harm by being restricted in practice as it has identified the failings do not relate to her clinical decision making, they relate to her administrative management of patients.
The Panel next considered whether a Suspension Order was the appropriate and proportionate response. It noted that a suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. It also noted that the Sanctions Policy identified that a Suspension Order was likely to be appropriate where there were serious concerns which could not reasonably be addressed by a Conditions of Practice Order.
As the Panel determined that Conditions of Practice were appropriate, and the concerns were met by such an order. It determined that the suspension was too disproportionality high a sanction”

17.The Panel imposed the following Conditions of Practice Order for 3 years:

“1. Before undertaking any type of Speech and Language Therapy work you must:

a. satisfactorily complete a period of refresher training that complies with the HCPC return to practice requirements, such training to include courses on:

i. GDPR/confidentiality;
ii. Record keeping; and
b. forward a copy of your results/certificates of completion to the HCPC.

2. You must inform the following parties that your registration is subject to these conditions:

1.any organisation employing or contracting with you to undertake professional work;
2. any agency you are registered with or apply to be registered with (at the time of application); and
3. any prospective employer (at the time of your application).

1. You must promptly inform the HCPC if you take up any employment as a Speech and Language Therapist including setting up in private practice and/or any voluntary work.

2. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
3. Upon return to practice you should obtain a professional mentor who should be a Registered speech and language therapist. You should arrange to meet or speak with your mentor on a monthly basis and to review your case load with particular reference to its administrative management (i.e., referrals, transfer, discharge, record keeping, reviews, liaising with parents and professionals). After six months it is within the discretion of the Mentor to reduce to bimonthly mentoring sessions if no concerns had been identified.
4. You must maintain appropriate records of all contact with service users for whom you have a duty of care and make those records available for inspection at all reasonable times by any person authorised to act on behalf of the HCPC.”

Submissions

18. Ms Khorassani, on behalf of the HCPC referred the Panel to the substantive review hearing bundle which sets out the background to this matter.

19. Ms Khorassani reminded the Panel of the powers pursuant to Article 30 of the Health Professions Order 2001. She also referred the Panel to the HCPTS Practice Note: Review of Article 30 Sanction Orders. Ms Khorassani submitted that the HCPC will be requesting a Suspension Order.

20. The HCPTS Practice Note on Review of Article 30 Sanction Orders highlights that the factors to consider include:

• the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decision;

• the degree of insight shown and whether this has changed;

• the steps which the Registrant has taken to maintain or improve his or her professional knowledge and skills;

• whether any other fitness to practise issue have arisen;

• whether the Registrant has complied with the existing order and, if it is a COP order, has practised safely and effectively within the terms of that order.

21. Ms Khorassani submitted that the HCPC note that the current Conditions of Practice Order could be extended, however, it does not appear that the Registrant has adhered to any of the previous conditions or engaged with the HCPC process since the Order was imposed.

22. In those circumstances, the HCPC submitted that the Order should be amended to a Suspension Order. Ms Khorassani reminded the Panel that a Strike Off Order is also available and may be the best option, particularly given the Registrant’s current circumstances.

23. Ms Khorassani addressed the Panel in relation to whether the Registrant’s fitness to practice remains impaired and referred the Panel to the relevant standards which Registrant’s should adhere to. Ms Khorassani also referred the Panel to the test set out in the case of Grant [2011] EWHC 927 (Admin).

24. Ms Khorassani submitted that the Registrant has not engaged since the hearing concluded on 13 August 2021, she has not complied with conditions and addressed the areas of concern and on that basis her fitness to practice remains impaired.

25. Mr Munro made submissions to the Panel on behalf of the Registrant. He submitted that since the Registrant was dismissed in 2018, following a lengthy dispute with her employer, she decided that she would no longer practice as she was approaching retirement age. He submitted that prior to this time she had an unblemished career for over 30 years. He submitted that the Registrant had not undertaken any courses to improve her skill set as she did not intend to return to work as a Speech and Language Therapist.

26. He stated that the Registrant is 65 years old and she has no intention of returning to work. Mr Munro submitted that the Registrant is opposed to a Strike Off Order being imposed on the basis that there is a stigma attached to such an Order. He submitted that the Registrant is keen to explore the option of Voluntary Removal. He stated that this would be a more satisfactory outcome to end a lengthy career.

27. Mr Munro submitted that the Registrant recognises that she has limited computer skills, and is not technically minded, therefore she struggled with the rapid advances in IT.

28. In response to Panel questions in relation to whether the Registrant’s fitness to practise remains impaired, Mr Munro submitted that the Registrants fitness does remain impaired. He stated that the Registrant has not been in employment as a Speech and Language Therapist for approximately 6 years and she has not maintained her skill set as a result.

29. In response to further Panel questions regarding the nature of the proposed Order, Mr Munro stated that there was no merit in an extension of the Conditions of Practice Order on the basis that the Registrant cannot comply with the conditions. He submitted that although a Suspension Order appeared harsh, this may be the only available option to the Panel and would allow time for the Registrant to explore the option of Voluntary Removal.

30. In closing submissions, Ms Khorassani submitted that although it is a possibility that disposal by consent can be explored, it is not clear if this is a disposal available to the Registrant and that a Striking Off Order remains an option available to the Panel.

Decision

31. The Panel received and accepted the advice of the Legal Assessor.

32. The Panel was mindful of its powers upon a review of a Suspension Order under Article 30(1) of the Health Professions Order 2001 and had regard to the guidance contained in the HCPTS Practice Note: Review of Article 30 Sanctions Orders, the HCPTS Practice Note: Impairment and the HCPC Sanctions Policy

33. The Panel noted that its task is to conduct a comprehensive review of the current order on the basis of the information available today. It must not seek to go behind the findings of the previous panels.

34. The Panel must first decide whether it finds the Registrant’s fitness to practise to be currently impaired by reason of her misconduct.

35. The Panel noted that in accordance with the guidance in the case of Abrahaem v General Medical Council [2008] EWHC 183 (Admin), the persuasive burden to satisfy the Panel of fitness to practise at a review hearing is upon the Registrant.

36. The Panel further noted that if it found the Registrant’s fitness to practise to be currently impaired, then it should consider what steps to take in respect of the current order in accordance with its powers under Article 30(1) of the Health Professions Order.

37. In reaching its decision, the Panel carefully considered all of the documents provided to it in the substantive review hearing bundle, the Registrant’s written submission, and oral submissions.

38. The Panel first considered whether the Registrant’s fitness to practise remains impaired. The Panel carefully considered the reasoning set out in the written determination of the substantive hearing panel.

39. The Panel noted that the concerns involved deficiencies in areas of her practice, which can be summarised as administrative functions and a failure to manage her workload but not her clinical decision making. In particular, relating to timely record keeping, making prompt onward referrals, liaising with professionals and parents, inappropriate storage of files and failing to manage her workload.

40. In considering the personal component the Panel noted that the Registrant accepts that she has not been working since she was dismissed by the Trust in 2018. It is the HCPC case that the Registrant has not complied with the Conditions of Practice Order and the Registrant accepts this.

41. The Registrant further accepts that she has not undertaken any further training and has not been keeping up to date with clinical developments other than for personal interests. In all the circumstances, the Panel determined that there remained a high risk of repetition.

42. When considering insight and remediation, the Panel determined that the acts which led to the allegation are remediable. The Panel had regard to the Registrant’s written and oral submissions and determined that the Registrant demonstrated limited insight in relation to the impact of her conduct on service users and the profession. The Panel concluded that on the personal component the Registrant is currently impaired.

43. The Panel next considered the public component of impairment. The Panel acknowledges the need to protect service users and concludes that due to the lack of compliance with the Order, there is a risk of repetition which places service users at risk of harm.

44. The Panel agreed with the previous panel and determined that members of the public need to have confidence that Paediatric Speech and Language Therapists are able to act in a timely manner to seek the appropriate treatment for young children. The Public would also expect that sensitive confidential information about young service users and their family would be stored in a secure manner. The Panel concluded that public confidence in the profession would be undermined if no finding of current impairment were made in the particular circumstances of this case. The Panel is therefore satisfied on the public component that the Registrant’s fitness to practise is currently impaired.

45. Having found that the Registrant’s fitness to practise remains currently impaired, the Panel next considered its powers as set out in Article 30(1) of the Health Professions Order. The Panel considered the available sanctions in ascending order of restrictiveness.

46. The Panel was satisfied that to take no action or to impose a Caution Order would not provide the necessary level of public protection. The Panel was further satisfied that neither course of action would meet the wider public interest considerations.

47. The Panel next considered whether it would be appropriate to continue the Conditions of Practice Order. The Panel decided that a Conditions of Practice Order would not be appropriate in circumstances where the Registrant has no intention of returning to work, and therefore is not in a position to comply with conditions.

48. The Panel considered whether to impose a Suspension Order and determined that a Suspension Order for 12 months would be the most appropriate and proportionate sanction in the particular circumstances of this case. Such an order will protect the public and satisfy the wider public interest. The duration of the Order will permit the Registrant to explore the option of Voluntary Removal and ascertain whether this is an option which is available.

49. The Panel considered the Sanctions Policy in relation to Striking Off Orders and does not consider the facts of this case to justify such an order and such an Order would be disproportionate at this stage.

50. The Panel concluded that the appropriate and proportionate sanction in the circumstances of this case was a 12 month Suspension Order.

51. The Panel determined that a future reviewing Panel may be assisted by the following:

• Your attendance at the review Hearing.

• The Registrant's level of engagement in pursuing Disposal by Consent (Voluntary Removal). If this is not a viable outcome, any evidence of her current circumstances.

• The Panel will also be assisted by a written reflective piece, demonstrating the Registrant’s understanding of the impact of her conduct on service users and the profession.

Order: That the Registrar is directed to annotate the register entry of Mrs A Munro with a Suspension Order for a period of 12 months from the date this Order comes into effect.

The Order imposed today will apply from 10 September 2024.

This Order will be reviewed again before its expiry on 10 September 2025.

History of Hearings for Shirley A Munro