Miss Sarah Neita

Preliminary Matters:

Proceeding in private

1. An unopposed application was made by Ms Simpson for those parts of the hearing which dealt with the Registrant’s health to be heard in private.  Having heard and accepted the advice of the Legal Assessor this application was granted.

Background:

2. The Registrant was employed as an Occupational Therapist at the Lewisham Healthcare NHS Trust (the Trust) from November 2009. The Registrant was primarily responsible for working with children with co- ordination difficulties in mainstream schools and with children with severe learning and movement disorders within Special Schools. The Registrant’s role was to meet patients and their families on both a one-to- one and group basis, assess patients, and set goals and targets for the development of their coordination.

3. There were some concerns within the Trust about the Registrant’s performance which led to a Performance Management Plan being instituted, which was satisfactorily completed in May 2011. By then, in April 2011, the Registrant had been promoted to a Band 6 role which required, on her part, more complex clinical reasoning and assessment. It also needed her to work at an increased pace.

4. In November 2010, Child 6 had been allocated to the Registrant and she carried out an Initial Assessment in November 2010. By October 2011, the Registrant had still not written a report on this child.

5. The Registrant demonstrated further poor record-keeping by a failure to complete relevant paperwork following her assessment of three other children. There were other examples of poor record-keeping and failure to complete records within required timescales in June 2010, March 2011, October 2011 and January 2012. All these matters were found by the panel of the Substantive Hearing in February 2017 to amount to examples of lack of competence.

6. Particular 2 alleged that the Registrant had not demonstrated satisfactory clinical practice in that, in a particular case, she had failed to follow up on her recommendation for a weighted hand-splint. In the view of the Substantive Hearing panel, this allegation, which was found proved, was linked to the failures of record-keeping and amounted to another example of lack of competence. That panel determined that there had been a pattern of failure on the Registrant’s part to take required action on cases in a timely manner. Although, in that panel’s stated view, health reasons had contributed to the level of the Registrant’s ability to meet the required standards, she was unable sufficiently or consistently to improve the standard of her work.

7. In March 2012, the Registrant submitted her resignation to the Trust. She took with her, on leaving, a number of documents which contained confidential information about children who had been allocated to her and their families. These papers included supervision forms, case load forms, reports, and notes of action plans. The Substantive Hearing panel determined that there was no justification for removing these documents and that the decision of the Registrant to do so amounted to disrespect of the confidentiality of service users; as such, this amounted to misconduct.

Early Review Hearing

8. The Registrant made an application for an early review which was heard on 27 October 2017. She had completed a Data Protection training course on 24 October 2017 and submitted a Reflective Learning piece that she had written for the course, dated October 2017.

9. The Registrant was employed as a Functional Analyst, but was on long- term sick leave. She argued that she was at risk of losing her job. She therefore wanted her case reviewed as she argued that the conditions were “harsh” and that it was inappropriate for her practice to be subjected to any restrictions at all. In her oral evidence, the Registrant said that having a Conditions of Practice Order and a health condition would prevent her from obtaining employment as an Occupational Therapist. She argued that the Substantive Hearing in February 2017 related to events which had taken place between 2010 and 2012, and that no service user had ever complained about her conduct or competence. She did, nevertheless, accept that she had made errors, albeit she attributed some of these to her health and what she considered was a general lack of support from the Trust. She added that she had learnt from her errors and had taken steps to ensure that she had addressed the issues. The panel noted that since the Substantive Hearing, the Registrant had not applied for a post as an Occupational Therapist but had continued to be employed as a Functional Analyst.

10. The panel found that the Registrant’s fitness to practise remained impaired. At the conclusion of the hearing the panel found that conditions 1 and 2 of the Order should no longer be applied because the Registrant had successfully completed the Data Protection Course and shown insight.

11. However, in relation to the other issues the panel found that both statutory grounds applied, namely public protection and the public interest. The panel considered that the Registrant was remorseful and had developed some further insight, but that she had not fully remediated them and the panel considered that without evidence of remediation and full insight, there was a risk of repetition if restrictions were not placed upon her practice. The panel therefore extended the Conditions of Practice Order in relation to the other six conditions, adapting condition 4.

The review hearing on 21 February 2019

12. The Conditions of Practice order was reviewed on 21 February 2019. The Registrant was present and represented herself. The Registrant made representations and produced documents. The reviewing panel in their determination summarised the representations and the material that it had received in the following terms:

The Registrant made submissions and produced a number of documents, including evidence that she is still employed as a Functional Analyst. She stated that she has been on long-term sick leave because of her health. She stated that she will need to update her training, which is intense and thorough, before she can go back to this role, which requires her to conduct assessments and to write reports within specific timescales. The Registrant acknowledged and apologised for the failings in her record- keeping between 2010 and 2012, but pointed out that she had learnt from these and had been in employment since 2012, with no further complaints. She stated that she would like to return to work as an OT at some stage in the future. She told the Panel that she had applied for a job as a Band 5 OT in Housing but did not pursue this when she realised driving was essential, something she is currently unable to do.  She stated that she would ideally like to work in housing or in health and that her own circumstances will not only be better suited to such an environment, but also, she will be able to use her personal experience to help others who have difficulties. She believes that the combination of her experience as an OT and her health provide her with a good basis for such work. She stated that she is a motivated person, keen to learn new skills and to practise as an OT again one day. She has considered applying for Occupational Therapy Technical Instructor (OTTI) or Occupational Therapy Assistant (OTA) roles and working her way up.

13. The reviewing panel determined that the Registrant’s fitness to practise remained impaired. It expressed its reasons in the following terms.

The Panel found that the Registrant was open and honest and that she has recently begun to take active steps to return to work. She has clearly suffered from significant health issues and the Panel were impressed by her commitment, determination and insight.

The Panel have considered the HCPC Practice Note “Finding that Fitness to Practise is ‘Impaired’”, the documentary evidence and the submissions from both parties. The Panel finds that, despite the Registrant’s efforts, her fitness to practise remains impaired. Both statutory grounds continue to apply, namely public protection and the public interest. The Panel accepts that the Registrant is genuinely remorseful and that she has insight, but acknowledges that her opportunities to remediate her failings have been significantly limited due to her extended sick leave. The Panel welcomes the fact that the Registrant is determined to return to work but considers that, without evidence of her report-writing and note taking, there is a risk of repetition if restrictions are not placed upon her practice.

14. Having determined that the Registrant’s fitness to practise remained impaired the Panel imposed a further Conditions of Practice Order for a further period of 12 months. The Panel explained its reasons in the following terms:

The Panel considered what, if any, sanction to impose and referred to the HCPC Indicative Sanction Policy.

The Panel first considered taking No Further Action, mediation or a Caution Order. It concluded that these were not appropriate due to the nature of the findings because such sanctions would not restrict the Registrant’s practice and therefore would not protect the public.

The Panel decided that a Conditions of Practice Order for a period of 12 months remained appropriate and proportionate, in that it would strike a balance between the interests of the Registrant and those of the public. The Panel determined that the existing Conditions of Practice remain the most practicable and workable conditions.

15. The Conditions of Practice Order was in the following terms;

The Registrar is directed to extend the Conditions of Practice Order against the registration of Miss Sarah Neita for a further period of 12 months on the expiry of the existing Order. The Registrar is directed to annotate the HCPC Register to show that for a period of 12 months, you must comply with the following conditions of practice:

1) If you engage in professional work as an Occupational Therapist you must place yourself and remain under the supervision of a supervisor and supply details of your supervisor to the HCPC within fourteen days of commencing such work.

2) If you engage in professional work as an Occupational Therapist you must:

a) Work with your supervisor to formulate a Personal Development Plan designed to address the following areas of your practice:

(i) Completing written assessments within the required timeframe;
(ii) Completing  clinical records within the required timeframe;
(iii) Progressing cases by following up on recommendations for intervention.

b) Within three months of commencing work as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

c) Following the submission of your Personal Development Plan in accordance with (b) above, you must then provide, every three months, an updated Progress Report on your Personal Development to the HCPC, to be endorsed by your supervisor.

3) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

4) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

5) You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you 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)

6) You will be responsible for meeting any and all costs associated with complying with these conditions.

16. The panel gave guidance as to what might assist a reviewing panel. The guidance was in the following terms:

This Order will be reviewed in 12 months. The Panel notes that a future reviewing panel may be assisted by:

• Testimonials from any current or recent employers, either in Occupational Therapy or otherwise (e.g. OTTI/OTA or any paid or voluntary work).
• Evidence that the Registrant has kept up-to-date with the profession, for example, a Continuing Professional Development (CPD) portfolio of evidence.

Decision of this Panel:

17. The function of the Panel in a mandatory review under Article 30 of the Health and Social Work Professions Order 2001 is to review whether the Registrant’s fitness to practise remains impaired and, if so, what the appropriate and proportionate sanction or outcome should be, so as to protect the public and safeguard the public interest.

18. Ms Simpson outlined the relevant facts and said that she would make her substantive submissions after she had heard the evidence of the Registrant. Having heard the evidence of the Registrant [which is summarised below], Ms Simpson acknowledged that the Registrant had done some work to address the deficiencies that had been established but had not done so completely. She recognised that the Registrant had demonstrated some but not complete insight. However, Ms Simpson submitted that the Registrant’s fitness to practise was still impaired. In support of this submission, Ms Simpson submitted that the essential facts remained the same as they were at the time of the previous hearings. The Registrant had not worked in any paid employment since May 2016 and had not worked as an Occupational Therapist since November 2014. As a consequence, the Registrant had not complied with the Conditions of Practice Order imposed by previous panels. Ms Simpson further submitted that Conditions of Practice were no longer an appropriate Order. The Registrant had not complied with the Conditions of Practice Orders which had been in place for three years. She submitted that a Suspension Order would serve no purpose and that in all the circumstances a Striking Off Order was the appropriate Order to make. It was the only effective Order that would protect the public and sustain the confidence of the public and was in all the circumstances proportionate.

19. The Registrant gave evidence, she produced a number of documents and responded to questions. In brief summary her evidence and representations were as follows;

• She stated that in her opinion her fitness to practise was no longer impaired.
• She recognised a number of her failings and as best she could had sought to rectify them.
• She had worked out methods of addressing the failures which, she hoped, would prevent the previously found concerns arising again.
• She gave a detailed description as to what she would do to improve her record keeping and to ensure a better handling of the demands of her profession.  She believed that her confidence had greatly improved and that she would be able to handle stressful situations and demanding management.
• She believed that the existence of the Conditions of Practice Order had prevented her from obtaining employment as an Occupational Therapist, albeit she acknowledged, that she did receive a conditional offer of employment as an Occupational Therapist in June 2019 and that the withdrawal of that offer, was not due in full to the existence of the Order but also because she was unable to provide any evidence of how she had been performing in her current role.
• She confirmed that she was employed by Company A as a Functional Analyst and had been so employed since November 2014. However, since May 2016 she was on long term sick leave due to her health.
• She had done voluntary work that did not exceed approximately 6 hours a month.
• She confirmed that she would like to return to the therapeutic work involved in the practice of Occupational Therapy. In particular, she was interested in working with elderly service users and those with health issues. In recent weeks her health has improved and she is now ready to return to work as an Occupational Therapist.

20. The Panel found that the Registrant was open and honest and that she has recently begun to take active steps to return to work. She has clearly experienced significant health issues and the Panel were impressed by her commitment, determination and developing insight.

21. The Panel have considered the HCPC Practice Note “Finding that Fitness to Practise is ‘Impaired’, the documentary evidence and the submissions from both parties. The Panel finds that, despite the Registrant’s efforts, her fitness to practise remains impaired. Both statutory grounds continue to apply, namely public protection and the public interest. In coming to this conclusion the Panel considered that the essential facts remained unchanged since those that existed in February 2017, October 2017 and February 2019. The Registrant had not complied with a Conditions of Practice Order which had been in place for three years. The Registrant is developing insight but her essential failings had not been remediated. In particular, there was no evidence before the Panel that she has remediated in relation to her report writing, note taking, completion and submission of records in a timely manner and follow-up work. In all the circumstances there was a risk of repetition. The Panel did not believe that unrestricted the Registrant was capable of safe and effective practice. Moreover public confidence in the profession of Occupational Therapist and in the HCPC as its regulator would be undermined by a finding that the Registrant’s fitness to practice was no longer impaired.

22. The Panel then considered what, if any, sanction to impose. It took into account the HCPC’s Sanction Policy published in March 2019. The Panel applied the principle of proportionality. It was aware that all the relevant orders were available to it.

23. The Panel first considered taking no further action, mediation or a caution order. It concluded that these were not appropriate due to the nature of the findings. Such sanctions would not restrict the Registrant’s practice and therefore would not protect the public.

24. The Panel decided that the existing Conditions of Practice Order for a period of 12 months remained appropriate and proportionate and would strike a proper balance between the interests of the Registrant and those of the public. In coming to this conclusion the Panel; noted the recent improvement to the Registrant’s health, her determination to address her failings and also her desire to return to the therapeutic work of an Occupational Therapist. The Panel also considered that the Conditions of Practice presently in place were workable and were indeed compatible with her present employment as a Functional Analyst with Company A.

25. This Order will be reviewed in 12 months. The Panel notes that a future reviewing panel may be assisted by:

• Testimonials from any current or recent employers, either in Occupational Therapy or otherwise (e.g. OTTI/OTA or any paid or voluntary work).
• Evidence that the Registrant has kept up-to-date with the profession, for example, a Continuing Professional Development (CPD) portfolio of evidence.

The Registrar is directed to extend the Conditions of Practice Order against the registration of Miss Sarah Neita for a further period of 12 months on the expiry of the existing Order. The Registrar is directed to annotate the HCPC Register to show that for a period of 12 months, you must comply with the following conditions of practice:

1) If you engage in professional work as an Occupational Therapist you must place yourself and remain under the supervision of a supervisor and supply details of your supervisor to the HCPC within fourteen days of commencing such work.

2) If you engage in professional work as an Occupational Therapist you must:

(a) Work with your supervisor to formulate a Personal Development Plan designed to address the following areas of your practice:

(i) Completing written assessments within the required timeframe;
(ii) Completing  clinical  records  within the  required timeframe;
(iii) Progressing cases by following up on recommendations for intervention.

(b) Within three months of commencing work as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

(c) Following the submission of your Personal Development Plan in accordance with (b) above, you must then provide, every three months, an updated Progress Report on your Personal Development to the HCPC, to be endorsed by your supervisor.

3) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

4) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

5) You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you 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)

6) You will be responsible for meeting any and all costs associated with complying with these conditions. 

The order imposed today will apply from 28 March 2020.

This order will be reviewed again before its expiry

History of Hearings for Miss Sarah Neita