Elizabeth Israel

Preliminary Matters

Privacy application

1. Ms Khan, appearing on behalf of the HCPC, submitted that the parts of the hearing relating to the Registrant’s private family life should be conducted in private, under Rule 10(1)(a) of the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (hereafter ‘the Rules’) but submitted that the remainder of the proceedings should be heard in public.

2. The Registrant agreed with the HCPC application that parts of the hearing should be conducted in private.

3. The Panel accepted the Legal Assessor’s advice, which had drawn the Panel’s attention to Rule 10(1)(a) and the HCPTS Practice Note on ‘Conducting Hearings in Private’.

4. The Panel determined, given the nature of the Registrant’s submissions to previous panels and having regard to the material before it regarding the Registrant’s private life, that there was a need for requisite parts of the evidence pertaining to the Registrant’s private life, to be heard in private, pursuant to Rule 10(1)(a) of the 2003 Rules. The Panel considered that the Registrant would suffer disproportionate damage if it did not do so. In making its decision, the Panel also determined that it would be feasible to move between public and private session.

Background

5. In May 2021, the Registrant registered with PSL Recruitment Services Limited (‘PSL Recruitment’), an agency which recruits physiotherapists for both the NHS and private providers. Mr AT, the managing director of PSL Recruitment and the Registrant had a phone conversation, and arrangements were made for the Registrant to attend for an interview. This was originally scheduled for 20 May 2021, and was postponed by a day, so took place on 21 May 2021. According to Mr AT, the Registrant had said she wished to start work as soon as possible as she needed money.

6. Part of the compliance process undertaken by PSL Recruitment was to obtain at least two references for candidates, covering their last three years of employment. The Registrant provided PSL Recruitment with contact details for three referees: KD at Homerton University Hospital; JP at Excellent Health Physiotherapy; and KC at TRP Physio.

7. PSL Recruitment received an ‘out of office’ from KD’s email in response to attempted contact on 21 May 2021. When PSL Recruitment were able to speak to her on 24 May, she advised that the request should be sent to the Human Resources department. No response was received to that request.

8. The second referee, Mr JP, could not be contacted on the business email provided by the Registrant. Mr AT therefore spent some time on 21 May 2021 attempting to locate him through online searches. The closest match he found was ‘Excellence Physiotherapy and Osteopathy London’. He called the practice and was informed that no-one by the name of Mr JP worked there. When Mr AT asked about the Registrant, he says he was told by the Practice Manager that the Registrant had worked at the clinic for about a month. Mr AT noted that according to the Registrant’s CV, she had worked there considerably longer.

9. Later, on 21 May 2021, PSL Recruitment received an email purporting to be from Mr JP, to say that the Registrant had informed him that PSL Recruitment were trying to get in touch with him. A reference request form was sent to the outlook email address that Mr JP had used to contact PSL Recruitment. The reference was returned on 24 May 2021.

10. The third referee was Mr KC of TRP Physio. According to Mr AT, emails sent to the address the Registrant had provided kept bouncing back. On 25 May 2021 PSL Recruitment received an email purporting to be from Mr KC, sent from a G-mail address. The email said that he had been informed that PSL Recruitment were attempting to contact him for a reference in relation to the Registrant. He asked for the reference request to be sent to the G-mail address. Later the same day, an email was received from Mr KC’s G-mail account attaching a reference for the Registrant.

11. On 25 May 2021, Mr AT called KC in order to verify the reference. Mr KC informed Mr AP that his physiotherapy practice had closed down around a year previously, and that KC, at that time, ran a cake shop. Mr KC subsequently confirmed that he did not write the reference that PSL Recruitment had been sent in his name, for the Registrant.

12. Mr AT then suspected that the Registrant was writing the references herself. During a call later on 25 May 2021 between Mr AT and the Registrant, she admitted she had done so, after Mr AT said that he would need to report the matter to the police. There was then a discussion about notifying the HCPC, and the Registrant said she needed time to think things through. She called Mr AT back and informed him that she would self-refer to the HCPC.

13. The Registrant emailed the HCPC using the ‘registration’ email address at 5.29pm on 25 May 2021. She wrote:

“I am contacting you regarding my registration as a physiotherapist. My name is Elizabeth Israel (PH105956).
I have been under immense stress in regards to finding work and proving food and money for my family.
As a result I created an email address and provided a reference for myself. I understand the implications and unlawfulness in doing so and I would like to offer my sincere deepest apologies. It has been brought to my attention by a previous employer and I believe that it is the best decision to contact you to let you know. I acted outside of my character and I am very remorseful.
I value my professional title as a physiotherapist which I have worked so hard to maintain and understand the implications in doing so.Please let me know how this can be resolved. I look forward to hearing from you soon”

14. On 26 May 2021, PSL Recruitment also submitted a referral to the HCPC. That referral included reference to the HCPC address to which the Registrant’s self-referral had been made and stated that it appeared to have been sent to the incorrect place.

15. A substantive hearing was held between 19 and 23 June 2023. At the outset of the hearing, the Registrant admitted Particulars 1 and 2 of the Allegation. The substantive hearing panel found the facts proved and that the Registrant’s fitness to practise was impaired by reason of her misconduct in respect of both the personal and public components of impairment. The Substantive Hearing panel found that the Registrant’s apology and expressions of remorse were genuine and noted that, since the incident in May 2021, the Registrant had obtained and worked in three locum roles, and there had been no repetition of her misconduct.

16. The Substantive Hearing panel, however, was also of the view that the Registrant had not demonstrated full insight and that much of what she had told the panel was unsupported by independent evidence. The panel stated that:

“She had not been able to give specific or concrete examples, either of courses she had undertaken, conversations she had had with her GP mentor, or the learning she had gained from the preparatory reading for her planned studies commencing in September 2023. Despite requests from the Panel, the Registrant had not provided any evidence of the development and reflection she said she had undertaken. She had not provided evidence of CPD, or extracts from the reflective diary she had referred to in her evidence. The Panel would have been assisted by such material, as well as character references. The Panel noted that the Registrant had referred to a range of people from whom she has received support, including people at her church, and in the care home where she had undertaken voluntary work. She had referred to conversations with her GP mentor and clinical educators in her professional role. Yet none of these had attested to her character”.

17. The Substantive Hearing panel also concluded that there was a risk of repetition of the Registrant’s dishonest conduct if she were under pressure to achieve a particular outcome. With regard to sanction, the Substantive Hearing panel decided to impose a Suspension Order for a period of 10 months. It considered that this would give the Registrant time to reflect further on the impact of her actions on the profession and the public and give her the opportunity to address the outstanding concerns. The Substantive Hearing panel advised the Registrant that a reviewing panel was likely to be assisted by:

• a reflective statement from the Registrant, dealing with the impact of her dishonesty on the public and the profession;

• evidence of CPD demonstrating learning in relation to the importance of professional standards specifically relating to Standard 9 of the HCPC Standards of Conduct, Performance and Ethics; and

• testimonials or references as to her character from paid or voluntary work.

18. On 24 April 2024, the first reviewing panel determined that the Registrant had not discharged the persuasive burden that she had sufficiently demonstrated that she had addressed the outstanding concerns of the Substantive Hearing panel for the following reasons:

• the Registrant’s written reflections were of a generic nature: they did not address the particular facts of her case; the lessons she had learned and why she would not repeat such dishonest conduct in the future;

• the Registrant had not yet provided any references or testimonials relating to her employment pre-dating the substantive hearing in June 2023. The Panel did not accept her explanation that she could not provide such references or testimonials because “people move on”. There was no evidence before the Panel that she had applied for such references;

• the Registrant could have provided the Panel with a copy of her application to Kings College Hospital for the Band 4 physiotherapy assistant job to demonstrate that she had disclosed that she was currently subject to a Suspension Order. That could have provided the Panel with evidence demonstrating her integrity and transparency. She did not do so;

• the Registrant could have provided the Panel with a testimonial as to her integrity and good standing from her university for the purpose of today’s review, she did not do so;

• the Registrant could have provided evidence of her completion of CPD courses but did not do so. The Panel did not accept her explanation that she could not do so because she did not have a printer; and

• the Panel noted that the Registrant relied on her assertion that she had been undergoing very difficult and stressful circumstances in her personal life. She provided no independent evidence of this.

19. As a consequence, the first reviewing panel determined to impose a further period of suspension for three months to allow the Registrant a further opportunity to address the outstanding concerns. The first reviewing panel also advised the Registrant that a future reviewing panel was likely to be assisted by:

a. a more focused reflective statement from the Registrant, addressing her understanding of the impact of her dishonesty on the public and the profession, together with evidence of how her practice had since changed, e.g. by providing a copy of her application to Kings College Hospital for the Band 4 position in October 2023;

b. evidence of CPD completed during the last two years;

c. testimonials or references in respect of her employment and character prior to and since June 2023; and

d. a reference or testimonial as to her character from Brunel University.

20. The previous reviewing panel also highlighted to the Registrant that if she failed to address the outstanding concerns, there was a risk that a future reviewing panel may consider imposing a Striking Off Order.

Registrant’s evidence

21. The Registrant gave oral evidence to the Panel; outlined below is a summary of the Registrant’s oral evidence to the Panel and is not a verbatim account of it. During the course of her oral evidence, the Registrant stated the following:

i. in regards to the HCPC communication, she was originally sent an email, on 03 July 2024, from Ms Khan. However, usual process would be that she would receive an email from the HCPC, a short time before the listed hearing and that email would request documentation from her. When she received that email, on this occasion and for the purposes of this hearing, she responded to this correspondence from the HCPC, from 09 July 2024 onwards;

ii. the Panel will see from the correspondence before it that she sent the information and evidence on 12 July 2024, but the information ended up in her “drafts folder” in her email inbox. She became aware of this situation on Monday 15 July 2024, and promptly sent the information to the HCPC on this date;

iii. she has communicated with the HCPC throughout;

iv. when the HCPC questioned the authenticity of the references provided, and the nature Mr JA’s business, she sent an email to her employer questioning the nature of the business because it was listed as “food” on the Companies House website and they are a “wellness clinic”. Consequently, she asked Mr JA to provide evidence of the reference directly to the HCPC;

v. her employer (Mr JA), informed her that the error on the Companies House website was an “accounting error” and one which he was previously unaware of;

vi. she had downloaded and saved all of the reference / character documents to her computer as she had wanted to compile a single email to send the documents together to the HCPC. This is the reason the word documents presented show her, in the information section of the document, as the “creator” of the document;

vii. she is employed by the person who provided the reference (Mr JA);

viii. you can see from the email provided on the morning of the email, from Mr JA, that he agrees that there is an error on the Companies’ House website as to the listed nature of the business;

ix. Mr JA would be content to appear before the HCPC to verify the reference provided;

x. she had been unemployed for a year;

xi. she was asked to provide the Kings College Hospital application by the previous reviewing panel (in April 2024) as that panel questioned whether she had been honest about her suspension during her application process with Kings College and she had stated that she had;

xii. any CPD list provided is relevant to her Physiotherapy practice as it develops her profession and that is why she attended the courses listed;

xiii. there are no guidelines as to what constitutes CPD. Meaning that you don’t always get a certificate to verify attendance on a course. CPD can also come from a number of sources, such as journal reading;

xiv. she has tried to provide evidence to allay the HCPC’s suspicion(s) that the documents, provided for today’s hearing, have been fabricated;

xv. she has provided the information that she was asked to submit;

xvi. she has been unemployed for a period of time and therefore unable to pay for or undertake paid for CPD;

xvii. her reflection has developed since the last review panel and outlines her personal growth and reflection “is subjective” so it is disheartening for Ms Khan to suggest that her reflective piece is lacking in some way;

xviii. she has secured employment, with Mr JA , which is voluntary;

xix. she was not asked to provide evidence that she attended Brunel University, she was asked to provide a character reference from Brunel University. She was unable to obtain this because a number of her lectures were online and therefore, she did not meet with her tutor so was unable to obtain a reference from her tutor; and

xx. telephone interviews do take place, she gets telephone calls from recruitment firms, such as ‘Indeed Recruitment’, all the time.

22. In response to questions from Ms Khan, the Registrant stated:

i. she obtained her current role, with her current employer, via a contact known to her and she volunteered to work with them. There was no formal application process;

ii. the role was not advertised as “they are known in the local health community”. The therapy provided by her employer is “more Holistic”;

iii. her role requires her to: attend events; promote the company; assisting and deliver presentations; demonstrate the medical equipment to patients; undertake postural assessments; develop the website; and assist the owner of the business, which encompasses a number of different things;

iv. the owner (Mr JA ) sees approximately ten patients daily, but her role is flexible to fit in with her own childcare so she sees about five patients with him, a week;

v. she is not paid for the role, she does it for “career development” and there is no rigid time frame;

vi. she did not get the references in an email, one of them was via Whatsapp via PDF, she had to download it and save it, “as previously explained”. She has good relationships with the referees and so it was “quite casual” as to how she obtained the references from them;

vii. she did not just forward the PDF to the HCPC, rather she downloaded it and converted it to ‘word’, as she wanted to send all of the information in one email;

viii. on the screenshots sent to her by the HCPC, the word documents show as ‘created and modified’ on 15 July 2024, and she cannot explain why it does not show that it was ‘created’ on 12 July 2024 as per her explanation that this is when she originally sent the email to the HCPC and it went into her “drafts folder” (prior to her realising and sending it to the HCPC on Monday 15 July 2024);

ix. she realised that the document had not been sent on the Monday 15 July 2024 and so she sent it when she realised;

x. she had chosen not to defer her course at Brunel University, but this was an option still open to her and there were “personal reasons” for this decision;

xi. in respect of her CPD: she attended a “hands-on workshop” in February 2024, it was provided by a “social media influencer” – by the name of “JMB” and it related to “an online transformation course”; and

xii. she wishes to practise as a physiotherapist because it is something that she has always wanted to do. [Redacted], she realised that is what she wanted to do and she has good relationships and communications with clients. It’s a role that makes her happy and she is passionate about it.

23. In response to questions from the Panel, the Registrant stated the following:

i. she commenced her course with Brunel University in September 2023. She did not undertake her exams as they have been deferred until August 2024;

ii. she last attended Brunel in “around March” but she could not be specific as to when exactly;

iii. in respect of the name of her personal tutor, she would “have to check”. After checking her computer, she confirmed the names as “GC”, “TM”. She also confirmed that TM was the course lead;

iv. the course she had been undertaking was an LLB Law and this was the name of the course;

v. she was a at “gradue entry” but she had was in her final year next year;

vi. she had paid fees to undertake the LLB Law course;

vii. she would attend the University campus sometimes once or twice a week for seminars, but most of the lectures were “recorded”;

viii. she had extenuating circumstances which the University had authorized, meaning that she was permitted to “do some of the exams in August 2024”;

ix. at the last review hearing (in April 2024) she informed that reviewing panel that her course was “going well”, because at the time it was, but since that time she has “decided not to continue with the course [Redacted] ”;

x. in respect of the reference from Ms SK: she first met Ms SK during 2016, post university. They met when they were preparing for a BUPA running event. She is a character reference, she is not a “friend”, but provides a character reference as she has known her for a long time;

xi. she disputes that the reference provided by Ms SK is not dated. Her document, from Ms SK, shows that the reference was dated 05 May 2024 and she is unsure why the Panel does not have that version before it;

xii. she asked Ms SK to provide the reference for the purposes of these proceedings;

xiii. in respect of Ms MT's reference, it is dated 12 June 2024. She knows Ms MT through earlier studies and when Ms MT worked as a carer and they kept in contact. Ms MT was asked to provide a character reference;

xiv. in respect of Page 21 of the HCPC bundle, and the reference from Mr JA, this is the version of the document that was downloaded to her computer;

xv. the reference from Mr JA should have been labelled both “professional and character reference” and she did “raise this with him” when he provided it to her and she noted that it just stated ‘Character reference’;

xvi. the reference from Mr JA states ‘employment’ within the body of the document. She does “lots of things as outlined previously to the Panel, but she is voluntary employed”;

xvii. the address for the business is listed on Mr JA ’s reference, but there is no formal “office”;

xviii. despite Mr JA listing himself as a ‘clinical manager’ on the reference – this is just his “wording”, he is not a clinician;

xix. the reference from Mr JA in the addendum bundle and the email are “the same document”, just one has been downloaded to her computer and the other has not. In respect of spelling differences, noted by the Panel between in the two documents (‘Cast and Castt’) – the correct spelling is “double tt” and the difference “is a copying or grammatical error” and “double tt is how it appears on Companies house”. She also could not comment on the discrepancies in the spelling of Mr JA’s name on the documents provided, but, in her view, this also amounted to a “grammatical error” and this does not make the document “less authentic” and Mr JA, told her “over the telephone” that he had spelt his own name incorrectly; and

xx. in the addendum bundle, at page 21 of the PDF, she did not correct or amend the document to change the spelling of the company name (Cast to Castt), but Mr JA may have “changed this along with the spelling of his own name”.

Submissions

The submissions outlined below are a summary of the parties’ submissions to the Panel and are not a verbatim account of the submissions made.

HCPC

24. Ms Khan outlined the background of the case to the Panel. She also submitted that the Registrant’s fitness to practise remains impaired on both the personal and public components and that the HCPC was inviting the Panel to either extend the Suspension Order or Strike the Registrant from the HCPC Register.

25. Ms Khan further submitted:

i. on 09 July 2024, the Registrant contacted the HCPC to state that she will provide evidence for the HCPC after contacting the HCPTS;

ii. the evidence was only sent on 15 July 2024, although the Registrant said that she had sent the evidence on Friday 12 July 2024;

iii. the Registrant has provided a reflective piece, testimonials and states that she has completed CPD;

iv. a strike-off order may be appropriate as the Registrant had not engaged “well” with the HCPC;

v. the Registrant was aware of what documentation needed to be provided to the Panel, at the conclusion of the last review hearing on 24 April 2024 and some of this has been provided very late;

vi. there is not yet sufficient evidence to demonstrate a sustained and maintained change, or that the original findings have been addressed;

vii. the Registrant has not provided sufficient evidence of remediation;

viii. the reflective piece does not go far enough, it remains descriptive. There is no comment about how the Registrant would prevent similar conduct from recurring in the future;

ix. the list of CPD provided is brief, old and not relevant. There are also no certificates or emails provided by the Registrant to support the list of courses completed;

x. the Registrant states that she has left her law degree at Brunel University and is no longer on the course [Redacted];

xi. Brunel University would have been able to provide evidence that the Registrant was enrolled on the course, as informed to the previous reviewing panel, and that this evidence has not been provided;

xii. in respect of the lack of evidence of the Band 4 application, the Registrant, when challenged, states that the application was a telephone interview and evidence is not able to support it;

xiii. the HCPC has been unable to verify the authenticity or the authors of the references provided to theHCPC;

xiv. the reference documents when checked by the HCPC note that they were ‘created’, by the Registrant in a word document;

xv. given the lateness of the documents provided to the HCPC (late on the evening on 15 July 2024 – the day before today’s review hearing). Consequently, the HCPC have unable to verify the testimonials;

xvi. one of the emails provided by the Registrant, seems to show that the referee sent the email after midnight on 15 July 2024;

xvii. when the HCPC searched the website for one of the references, the HCPC noted that the website could not be found;

xviii. the HCPC submit that there has not been a sustained and maintained change and the Registrant has not discharged the persuasive burden;

xix. the Registrant has engaged at the last minute and has provided limited reflections;

xx. there is insufficient evidence demonstrating learning of the HCPC standards;

xxi. without sufficient and verifiable information to the contrary, the HCPC submits that the Registrant’s fitness to practise remains impaired;

xxii. the Registrant has had twelve months to demonstrate remediation and she has failed to do so;

xxiii. the Registrant has not provided the required information sought by the previous reviewing panel;

xxiv. the HCPC invite the Panel to strike the Registrant from the Register. However, if the Panel are not minded to strike the Registrant from the Register, the HCPC submits that the Panel should suspend the Registrant for a short further period of one month, to enable her to properly engage with the HCPC and provide the required evidence to demonstrate that her fitness to practise is no longer impaired.

Registrant

26. The Registrant made the following closing submissions:

i. there was only one of the CPD activities she referenced related to a “social media influencer”;

ii. the document from Ms SK was sent directly to the HCPC and was not downloaded via word;

iii. she is an ‘assistant’, and is in this position; and

iv. Mr JA has provided a character reference.

Decision

27. The Panel took into account the documents furnished to it by the HCPC and the Registrant. It also had regard to the evidence before it and the parties’ submissions.

28. The Panel considered the relevant Practice Notes issued by the HCPTS, ‘Fitness to Practise Impairment’ and ‘Review of Article 30 Sanction Orders’, together with the HCPC’s Standards of Conduct, Performance and Ethics.

29. The Panel accepted the advice of the Legal Assessor who had reminded it that the purpose of the review is to consider the issue of current impairment of the Registrant. The Legal Assessor also reminded the Panel of the following:

i. the Panel could have regard to a number of factors when reviewing the Order. Namely, the previous panel’s findings, the extent to which the Registrant has engaged with the regulatory process, the scope and level of insight and the risk of repetition;

ii. the Panel could take account of a range of issues, when considering current impairment, which in essence comprises the two components:

a) the ‘personal’ component: the current competence and behaviour of the Registrant; and

b) the ‘public’ component: the need the protect the public, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

iii. it is only if the Panel determines that the Registrant’s fitness to practise remains impaired, that the Panel should go on to consider sanction by applying the guidance as set out in the HCPC ‘Sanctions Policy’;

iv. the Registrant bears the “persuasive burden” of demonstrating that she has fully acknowledged the deficiencies which led to the original findings and has addressed her impairment sufficiently through ‘insight, application, education, supervision or other achievement’ Abrahaem v GMC [2008] EWHC 183; and

v. the principle of proportionality required the Panel to consider the Registrant’s interests to be balanced against the interests of the public.

30. In making its decision, the Panel had regard to both the personal and public elements of impairment.

31. The Panel noted that the Registrant’s misconduct in this case related to a finding that she had fraudulently fabricated two references, which she went on to provide to a prospective employer, and that she admitted, before the Substantive Hearing panel, that she had acted dishonestly when doing so.

32. The Panel noted the previous reviewing panel’s decision (April 2024), which it was not bound by, but noted in particular that the previous review panel stated:

‘30. The Panel was not fully satisfied that the Registrant had sufficiently demonstrated that she had addressed the outstanding concerns of the panel of the substantive hearing for the following reasons:

• the Registrant’s written reflections were of a generic nature: they did not address the particular facts of her case; the lessons she had learned and why she would not repeat such dishonest conduct in the future;

• the Registrant had not yet provided any references or testimonials relating to her employment pre-dating the substantive hearing in June 2023. The Panel did not accept her explanation that she could not provide such references or testimonials because “people move on”. There was no evidence before the Panel that she had applied for such references;

• the Registrant could have provided the Panel with a copy of her application to Kings College Hospital for the Band 4 physiotherapy assistant job to demonstrate that she had disclosed that she was currently subject to a Suspension Order. That could have provided the Panel with evidence demonstrating her integrity and transparency. She did not do so;

• the Registrant could have provided the Panel with a testimonial as to her integrity and good standing from her university for the purpose of today’s review. She did not do so;

• the Registrant could have provided evidence of her completion of CPD courses but did not do so. The Panel did not accept her explanation that she could not do so because she did not have a printer;

• the Panel noted that the Registrant relied on her assertion that she had been undergoing very difficult and stressful circumstances in her personal life. She provided no independent evidence of this.’

33. The Panel also had regard to the previous review panel’s determination at paragraph 37, where that panel set out what might assist today’s Panel. The Panel noted that this included the following:

• ‘a more focused reflective statement from the Registrant, addressing her understanding of the impact of her dishonesty on the public and the profession, together with evidence of how her practice had since changed. E.g. by providing a copy of her application to Kings College Hospital for the Band 4 position in October 2023;

• evidence of CPD completed during the last two years;

• testimonials or references in respect of her employment and character prior to and since June 2023;

• a reference of testimonial as to her character from Brunel University.’

34. The Panel considered the documentation provided to it by the parties and it noted that it had been provided with the following:

i. main bundle – 40 pages;

ii. an addendum bundle – 27 pages; and

iii. an email exchange between the Registrant and the HCPC – 4 pages.

35. The Panel considered the reflective statement provided by the Registrant for the purposes of today’s hearing. Having done so, the Panel determined that notwithstanding the very clear guidance provided by the previous reviewing panel as to what the reflective statement should contain, the Registrant’s document did not address, to the Panel’s satisfaction, the Registrant’s understanding of the impact of her dishonesty on the public or the profession. Further, the Panel also considered that it also did not outline how she would prevent such conduct from being repeated in the future. The Panel considered, much like the previous panel had with the Registrant’s earlier reflective statement, that the Registrant’s written reflections were of a generic nature and failed to demonstrate any meaningful insight into her admitted conduct and dishonesty.

36. The Panel next noted that the Registrant had also failed to provide a copy of her application to King’s College Hospital for the Band 4 position which she claimed that she had applied for in October 2023. The Panel was also cognisant of the fact, that when questioned about her King’s College application during the course of today’s hearing, the Registrant gave oral evidence to the Panel that it had been a ‘telephone interview’ and she was unable to provide such evidence to it. The Panel considered that this change of position by the Registrant demonstrated an inconsistency between the accounts provided to the previous panel and the Panel today. The Panel rejected the Registrant’s suggestion to it, as part of her oral evidence, that she would not be able to provide any evidence of a telephone interview with King’s College in some form and the Panel considered this amounted to a further lack of transparency on the Registrant’s part.

37. Additionally, the Panel acknowledged that the previous reviewing panel had also suggested that the Registrant provide ‘evidence of CPD completed during the last two years’. The Panel considered the documentation provided by the Registrant and noted that this amounted to a single document in which the Registrant had listed the names of CPD which she claimed to have undertaken during the last two years. The Panel noted, with dismay, that the Registrant had not provided any evidence by way of certificates, emails, or other correspondence to support her contention that any of the courses listed by her, had in fact been satisfactorily completed.

38. The Panel next had regard to the testimonials provided by the Registrant. The Panel noted that two of the testimonials provided (Ms SK and Ms MT) did not have any contact details contained within them, by which the references could be verified. Further, the Panel also noted that it was only when asked, during her oral evidence, that the Registrant provided the date for Ms SK’s testimonial and that this was not outlined on the document before the Panel.

39. Additionally, the Panel was very concerned by the highlighted inconsistencies and errors throughout the two versions of the testimonial allegedly provided by Mr JA, which the Panel noted that the Registrant claimed, again during her oral evidence, to be exactly the same document. The Panel noted that the inconsistencies were numerous and included: spelling differences in Mr JA’s own name; the spelling of the name of his business; the nature and type of his business listed on Companies House; and whether the nature and/or capacity in which the Registrant worked (employed or voluntary).

40. The Panel also noted that there was a question raised before it, by the HCPC, as to when one of the testimonials had been ‘created’ (on the information tab /section within the document itself) and when it had been modified and that when the Registrant was questioned over why the document listed itself as having been ‘created’ on the 15 July 2024 despite the Registrant claiming to have attempted to send it three days earlier, on 12 July 2024, that the Registrant was unable, in the Panel’s view, to provide a credible account for this further discrepancy.

41. The Panel also noted, that the documentation provided by the Registrant had been furnished to the HCPC and HCPTS at very short notice prior to the review hearing and, that again, notwithstanding this being flagged by a previous panel, this resulted in the HCPC being unable to check or verify the nature and/or veracity of the testimonials provided and in view of the aforementioned discrepancies identified by the Panel, this caused further concern for the Panel as to the Registrant’s conduct and transparency.

42. Additionally, the Panel also noted that the Registrant had failed to provide a reference or testimonial as to her character from Brunel University, as suggested by the previous reviewing panel.

43. The Panel next considered the Registrant’s oral evidence to it and determined that it could place no weight on the evidence provided by the Registrant. In the Panel’s view, the Registrant was, during the course of her oral evidence to it, frequently vague and inconsistent with the answers she provided. For example, when she was asked about her attendance on the LLB Law course at Brunel University, the Registrant indicated that she had decided to leave the course in March 2024 (a fact which she claimed to verify from looking at her computer during her oral evidence), however, the Panel noted that this was not mentioned to the previous reviewing panel when it convened to review her case, in April 2024 (one month after she claimed to have made the decision to leave the course).

44. Further, the Panel also found that the Registrant’s oral evidence to it lacked credibility and it was unable to place any weight on her evidence in respect of her answers provided on the discrepancies in Mr JA’s testimonial in relation to when it was sought and/or provided to her, when it was ‘created’, and/or why she had needed to ‘modify’ the document at all, instead of simply forwarding the correspondence directly onto the HCPC, or asking the referee to provide it directly himself to the HCPC.

45. In view of the underlying dishonesty finding in this case, and in particular that the dishonesty related to fabrication of references, the Panel was left concluding, in view of all of the aforementioned, that the Registrant had not taken sufficient steps to demonstrate that she had insight into her failings or that she had taken any steps to remedy them. The Panel also considered that the Registrant had failed to provide relevant and/or appropriate evidence that she had taken steps to address her failings through CPD or other achievements and the Panel therefore could not be satisfied that her conduct would not be repeated in the future.

46. For these reasons, the Panel therefore concluded, in light of the above and taking the previous panel’s findings into account, that the Registrant had not discharged the persuasive burden of satisfying it that her fitness to practise did not remain impaired on the personal component.

47. The Panel then went on to consider the public component of impairment. The Panel reminded itself that part of its role was to maintain professional standards and uphold confidence in the Physiotherapy profession. The Panel considered that there remained a risk of potential harm due to the Registrant’s conduct and as identified by the Substantive Hearing panel. The Panel was satisfied that a member of the public, appraised of all of the circumstances of this case, would have their confidence in the profession, and the regulator, undermined if a finding of current impairment was not made on public interest grounds. The Panel therefore determined that the Registrant is also impaired on the public interest component.

48. Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the personal and public components.

49. Having determined that the Registrant’s fitness to practise remains impaired, the Panel considered what sanction to impose. The Panel bore in mind that sanction is a matter for its own independent judgment and that the purpose of a sanction is not to punish the Registrant but to protect the public. Further, that any sanction must be proportionate, so that any order must be the least restrictive order that would protect the public interest, including public protection. The Panel had regard to the HCPC guidance titled ‘Sanctions Policy’.

50. The Panel considered the options of taking no action or imposing a caution order and determined, like the previous reviewing panel, that the concerns in respect of the Registrant’s conduct were too serious for the imposition of either of these sanctions as neither would provide adequate public protection.

51. The Panel next considered the option of replacing the existing Suspension Order with a conditions of practice order. The Panel had regard to paragraph 108 of the ‘Sanctions Policy’ and noted that it stated that Conditions of Practice were likely to be inappropriate in more serious cases, such as dishonesty. The Panel shared this view and it also considered that there were no proportionate, appropriate or workable conditions of practice which could be devised to address the conduct which the Panel considered to be attitudinal in nature.

52. The Panel next considered, very carefully, extending the current Suspension Order versus a Striking-off Order. The Panel noted the Registrant’s engagement and that she had attended the Substantive Hearing and the subsequent review hearings. However, notwithstanding this, the Panel also noted that the Registrant had been the subject of a Suspension Order for over 12 months, since the Order was first imposed (23 June 2023 to 17 July 2024) and in that time, she had, in the Panel’s view, failed to: demonstrate appropriate insight into her dishonest failings; appropriately remediate her conduct; and/or provide any evidence of her ongoing CPD or learning; and/or provide appropriate references/testimonials. In this regard, the Panel considered that the Registrant, despite very clear guidance from previous panels, had demonstrated an unwillingness to acknowledge or resolve matters and/or an unwillingness to demonstrate that her conduct would not be repeated in the future. The Panel therefore considered that a further suspension order would serve no purpose.

53. Consequently, taking into account the serious on-going potential risk that the Registrant poses to the public, the Panel was of the view that, notwithstanding a striking-off order being an order of last resort, in this case, it was the only sanction which was appropriate to safeguard members of the public from the risk posed by the Registrant’s dishonest conduct. Further, the Panel was of the view that any lesser sanction would be insufficient to protect the public, public confidence in the profession and public confidence in the regulatory process.

 

 

ORDER: The Registrar is directed to strike the name of Ms Elizabeth Israel from the HCPC Register with immediate effect.

The Order imposed today will apply from 17 July 2024.

No notes available

History of Hearings for Elizabeth Israel

Date	Panel	Hearing type	Outcomes / Status
17/07/2024	Conduct and Competence Committee	Review Hearing	Struck off
24/04/2024	Conduct and Competence Committee	Review Hearing	Suspended
19/06/2023	Conduct and Competence Committee	Final Hearing	Suspended