Poppy Sprague

Background

1. The Registrant is registered with the HCPC as a Practitioner Psychologist and at all material times practised in that capacity on a self- employed basis.

2. Between August 2020 and March 2021, the Registrant engaged in inappropriate and/or unprofessional conduct via social media by sharing and/or posting content via a public Facebook Profile which identified her as a Practitioner Psychologist registered with the HCPC.

3. The relevant posts expressed the Registrant’s views about the Covid-19 pandemic and the government’s response to it.

4. Concerns about the content of the Registrant’s posts on social media were reported by a member of the public to the HCPC, resulting in an investigation culminating in these proceedings.

5. The Substantive panel made the following finding with regard to the Registrant’s misconduct;

• the Registrant acknowledged that she was not a qualified expert on public health matters, or the transmission or prevention of diseases. She nevertheless purported to give advice in her Facebook messages in her capacity as a Practitioner Psychologist on public health matters in which she had no expertise;

• the Registrant’s posts on social media were “inappropriate and unprofessional” as alleged in the stem to Particular 1 of the Allegation and were in breach of the following standards of the HCPC Standards of Conduct, Performance and Ethics (2016), namely:

2.7 You must use all forms of communication appropriately and responsibly, including social media and networking websites.

9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

6. The Substantive panel made the following findings with regard to the impairment for the Registrant’s fitness to practise. The Substantive panel dealt first with the personal component:

• the Registrant’s fitness to practise was and remains impaired having regard to the “personal” component;

• the Registrant maintained that she saw it as her duty to provide members of the public with the fruits of her research. She demonstrated no insight into the possibility that the content of her postings on social media might have been wrong or that her opinions and advice, if adopted by others, had the potential to cause them significant harm;

• she had little, if any, awareness that her postings could cause damage to the reputation of her profession;

• she did not provide any evidence of changes that she had made;

• it did not appear to occur to her that it was inappropriate for her to make pronouncements on medical issues in which she had no relevant expertise;

• she said that she would continue to post material on her Facebook account, under the banner of the HCPC, which identified her as a Practitioner Psychologist and on matters relevant to “informed consent”. She asserted that it would be unprofessional not to express her views in matters where she could assist others in achieving informed consent; and

• she stated her “inalienable right of freedom of speech” and that she followed, in effect, her own guidelines.

7. With regard to the “public” component of impairment, the panel considered that:

• There is a real risk that the Registrant will continue to post potentially harmful material on her Facebook account which identifies her as a Practitioner Psychologist registered with the HCPC. It follows that a finding of current impairment is necessary to protect the public.

• In addition, the panel was mindful of the need to maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour. The panel considered that the Registrant’s misconduct represented a serious departure from the standards to be expected of a member of her profession. In the panel’s judgement, public confidence in the profession and in the HCPC as its Regulator would be undermined if there were no finding of impairment.

8. Accordingly, the panel found he Registrant’s fitness to practise to be impaired having regard to both the personal and public components.

9. With regard to sanction, the Substantive panel decided to impose a Suspension Order for a period of 12 months. This should allow the Registrant sufficient time and opportunity to reflect on the panel’s findings and address any outstanding concerns.

10. The panel considered whether to impose a Striking Off Order but decided that to do so would be disproportionate at this time.

11. The Substantive panel gave the following guidance to the Registrant. At the review of this order, the reviewing Panel is likely to be assisted by:

• a reflective statement by the Registrant demonstrating what she has learned from the Panel’s findings concerning her misconduct and impairment of fitness to practise, the potential harm to members of the public caused by her misconduct and the damage to the reputation of her profession;

• evidence that she has reflected on and adopted the HCPC Standards of Conduct, Performance and Ethics in relation to the use of social media and undertaken training on how to communicate appropriately and responsibly on social media in her capacity as a registered HCPC practitioner; and

• her attendance at the review hearing.

This review hearing on 31 July 2024

Evidence and submissions

12. At this hearing the Panel had regard to the following documents:

• The HCPC bundle containing the decision of the Substantive panel (24 pages).

• The Registrant’s bundle, including a reflective piece and testimonials (55 pages).

13. Ms Khorassani outlined the background set out above and submitted that the HCPC were neutral on the question of whether Ms Sprague’s fitness to practise remains impaired.

14. The Registrant adopted her reflective statement and supporting documentation as her evidence and answered questions.

15. The Registrant was asked whether since the hearing in 2023 she has completed training specifically on how to communicate appropriately and responsibly on social media as a professional. The Registrant said she had not.

16. The Panel noted the content of her reflective piece in relation to work she had undertaken.

17. The Registrant was asked how the content she had posted on social media was harmful to people and the profession and she replied that it could have been divisive because everyone had views and what she wrote could confuse. When asked about the impact of her posts on the profession of psychologists she said she had not been mindful that her profile page was linked to the HCPC, but could see now that it could be harmful and would not have reflected well on anyone who had said the things she did.

18. The Registrant acknowledged that the language she had used was unwarranted, unprofessional and inappropriate. She concluded that “none of that is needed from a professional.” The Registrant said that she had not been claiming any specialist medical knowledge. She was just publishing links to medical research and told the Panel that she would not act that way again. She had done so at the time because she was “isolated and traumatized by what was happening to me”.

19. The Registrant was asked how she would behave if she disagreed with a government policy in the future, such as a vaccination policy. She acknowledged that it was difficult to predict the future, but her approach would be to “reflect on how I deal with conflict”. She was asked about how she would deal with issues arising from the pandemic if she could go back in time. She said she would reflect on how to deal with differences of opinion.

20. With regard to the testimonials that she had provided, she told the Panel that she had asked those who followed her online to reply if they found what she was doing was helpful. She had not specifically referred to the allegations that had been proved against her or her subsequent suspension, although she was confident that the majority of those following her knew what had gone on.

21. She said she could reassure the Panel that there would be no repetition because the behaviour happened four years ago and there had been no repetition.

22. Ms Khorassani made no further submissions to the Panel. The Registrant thanked the Panel for the time they had taken and explained that she was sincere and grateful for the questions they had asked.

The Panel’s approach

23. The Panel received the advice of the Legal Assessor, which it accepted and followed in the decision set out below.

24. First, it reminded itself of its powers under Article 30(1) of the Health Professions Order 2001 to extend the period for which the Order has effect or to impose any order the first Panel could have imposed.

25. It reminded itself of the importance of a review hearing, described by the Supreme Court in Khan v GPhC [2016] UKSC 64 as “the ‘teeth’ behind the sanctions other than erasure and should focus the doctor’s mind on the need to undertake any necessary remediation”.

26. It followed the ordered sequence of decision making set out by Blake J in Abrahaem v General Medical Council 2008 EWHC 183:

i. Address whether the fitness to practice is impaired before considering conditions.

ii. Whether all the concerns raised in the original finding of impairment have been sufficiently addressed to the Panel's satisfaction.

iii. In practical terms there is a persuasive burden on the practitioner at a review to demonstrate that he or she has fully acknowledged why past professional performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.

27. It bore in mind the guidance given to Panels by the Supreme Court in Khan (above) to focus on the Registrant’s current fitness to practice:

“The guidance therefore makes clear that the focus of a review is upon the current fitness of the Registrant to resume practice, judged in the light of what he has, or has not, achieved since the date of the suspension. The review committee will note the particular concerns articulated by the original committee and seek to discern what steps, if any, the Registrant has taken to allay them during the period of his suspension.”

28. The Panel had regard to the over-arching objective of protecting the public, which involves the pursuit of the following objectives:

• to protect, promote and maintain the health, safety and well-being of the public;

• to promote and maintain public confidence in the professions regulated under the Order; and

• to promote and maintain proper professional standards of conduct for members of those professions.

29. It also bore in mind that in deciding whether the Registrant’s fitness to practise is still impaired, it should follow the approach of Dame Janet Smith endorsed by the High Court in CHRE v NMC and P Grant [2011] EWHC 927 (Admin):

"Do our findings of fact in respect of the (Registrant’s) misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

• has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

• has in the past brought and/or is liable in the future to bring the …..profession into disrepute; and/or

• has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the … profession; and/or

• has in the past acted dishonestly and/or is liable to act dishonestly in the future”.

30. The Panel also had regard to the HCPTS Practice Note of November 2023 which directs panels to look at both the personal and public components of impairment of fitness to practise. The “personal” component relates to the Registrant’s own practice as a Practitioner Psychologist, including any evidence of insight and remorse and efforts towards remediation. The “public” component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.

31. Accordingly, the Panel looked at the personal component first and reminded itself of the key questions which need to be answered:

• Are the acts or omissions which led to the allegation remediable?

• Has the Registrant taken remedial action?

• Are those acts or omissions likely to be repeated?

32. The Panel bore in mind that an important factor will be the Registrant’s insight into those acts or omissions, the extent to which the Registrant:

• understands how and why it occurred and its consequences for those affected; and

• can demonstrate they have taken action to address that failure in a manner which remedies any past harm (where that is possible) and avoids any future repetition.

33. The Panel also bore in mind the public component of impairment which encompasses the second and third limbs of the overarching objective, namely promoting and maintaining public confidence in the profession and promoting and maintaining proper professional standards of conduct for the profession.

The Panel’s decision

Impairment

34. The Panel first considered whether the Registrant’s fitness to practise remains impaired. It bore in mind that there had already been a finding of impairment and asked itself whether the Registrant had demonstrated that she had taken sufficient steps to allay the concerns of the previous panels.

35. The Panel accepted that the Registrant has engaged with the HCPC and has complied with her suspension.

36. The Panel looked at the questions set out in the case of Grant above and noted that the substantive Panel had found that the Registrant had put members of the public at unwarranted risk of harm and brought the profession into disrepute.

37. The Panel then went on to consider whether the Registrant had satisfied the Panel that she had sufficiently addressed the concerns of the substantive Panel that there was no longer a significant risk of repetition.

38. The Panel had regard first to the Registrant’s level of insight and asked whether that had improved to a point that reassured the Panel. The Panel noted that she understood in general terms that her language had been unprofessional and inappropriate and brought the profession into disrepute.

39. Nevertheless, the Panel noted that, even a year after the Substantive Panel’s decision and more than three years after the Registrant’s misconduct, she did not demonstrate any detailed understanding of why she had behaved as she did (apart from a general reference to trauma) and her understanding of the effect on the profession and those who read her posts remained superficial.

40. The Panel concluded that, probably because of her superficial insight, the Registrant had not undertaken remediation and training focused on the issues in this case. The Panel has read the Registrant’s reflection on the webinar she attended and the reference from Associate Professor SF  and is satisfied that the webinar was focused on assisting those who had suffered trauma, not on how to use social media in a professional manner that does not bring the profession into disrepute.

41. The Panel found this particularly troubling because the Substantive Panel gave the Registrant clear guidance and also notes that the HCPC has issued registrants with guidance on “using social media wisely”, which should have informed the Registrant’s approach.

42. The Panel has examined the testimonials provided by the Registrant and acknowledges that these demonstrate that there are many who hold her in high esteem. However, the Registrant accepted that these are not from people who know the details of the misconduct proved against her and can assist the Panel with the likelihood or otherwise of repetition.

43. The Panel has read the Registrant’s reflections but does not find in these any reassurance that she has yet developed sufficient insight to direct her remediation and reduce the risk of repetition if there is a crisis in future. The Panel accepts that the Registrant has not repeated her misconduct but, in light of the views she expressed, the extent to which her posts were inevitably associated with the HCPC and the language she used in her posts, that reassurance is not sufficient.

44. The Panel also found that it would be failing to uphold proper standards for the profession and maintain public confidence in the profession if it allowed the Registrant to return to unrestricted practice before the risk of repetition had been resolved.

45. The Panel concluded that, with the personal and public interest components in mind, the Registrant's fitness to practise is currently impaired; that is to say that the Panel found that there was still a significant risk of harm to the public and the wider public interest if the Panel did not make a finding of impairment.

Sanction

46. Having found that the Registrant’s fitness to practise remains impaired, the Panel went on to consider what sanction if any it should impose.

47. The Panel accepted the advice of the Legal Assessor and had regard to the HCPC’s Sanctions Policy (2019) and accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of a sanction is not to punish the Registrant but to protect the public and the wider public interest in upholding proper standards and maintaining public confidence in the profession and the regulatory process. The Panel applied the principle of proportionality, balancing the interests of the Registrant with those of the public and considered the available sanctions in ascending order.

48. The Panel noted the following matters which mitigated the sanction in this case:

• the Registrant has no previous findings against her nor have there been any findings of misconduct since the misconduct recorded in this case;

• the Registrant has expressed regret for her actions and developed some limited insight into the effect of her misconduct; and

• the Registrant has provided a significant number of testimonials from persons who have followed her online and who say they have benefited from her communication.

49. The Panel also noted the following matters which aggravate the sanction in this case:

• the Registrant’s postings on social media put at risk a number of vulnerable people who held her and her opinions in high regard; and

• the Registrant’s insight has been slow to develop and her remediation has been very limited.

50. The Panel then considered each of the available sanctions in turn. The Panel was satisfied, for the same reasons as the substantive panel that:

• The case is too serious for the Panel to take no further action.

• A Caution Order would not reflect the seriousness of the Registrant’s misconduct or provide any protection to members of the public. There remains a risk of repetition, and the Registrant has shown insufficient insight or remediation.

• A Conditions of Practice Order would not be appropriate because the misconduct does not relate to the Registrant’s practice as a clinician and the Panel could not formulate any conditions which would address the underlying concerns regarding the Registrant’s use of social media.

51. The Panel then considered whether the Suspension Order remains sufficient to protect the public and the wider public interest. The Panel considered with care whether the time had arrived when it would be necessary to impose a striking off order. The Panel concluded that the time has not yet arrived because:

• the Registrant has engaged with the HCPC and attended this hearing;

• the Registrant has developed some insight and undertaken some, although unfocused remediation; and

• there is just sufficient material before the Panel to persuade it that a further period of suspension may be capable of serving the wider public interest in returning a practitioner to unrestricted practice, if the Registrant takes the opportunity given to her to demonstrate sufficient insight and remediation.

52. The Panel then considered how long a period of suspension should be and concluded that 12 months was the appropriate period because the Registrant had demonstrated that she needed a significant time to develop insight and undertake properly focused remediation.

53. The Panel cannot bind a future reviewing Panel but notes that a reviewing Panel is likely to be assisted by the same things which the substantive Panel suggested, namely:

• A reflective statement by the Registrant demonstrating what she has learned from the Panel’s findings concerning her misconduct and impairment of fitness to practise, the potential harm to members of the public caused by her misconduct and the damage to the reputation of her profession.

• Evidence that she has reflected on and adopted the HCPC Standards of Conduct, Performance and Ethics in relation to the use of social media and undertaken focused training on how to communicate appropriately and responsibly on social media in her capacity as a registered HCPC practitioner.

ORDER: The Registrar is directed to suspend the registration of Miss Poppy Sprague for a further period of 12 months on the expiry of the existing order.

No notes available

History of Hearings for Poppy Sprague