OT further suspended for failing to maintain adequate records or demonstrate clinical reasoning

HCPC Panel further suspends occupational therapist for six months

Published on 24th April 2019

An occupational therapist remains suspended from the Health and Care Professions Council register for not demonstrating adequate clinical reasoning, failing to follow up actions and failing to maintain adequate records.

Miss Ruth E Yorkston was suspended for 12 months in April 2017 and had her suspension extended by a further 12 months in April 2018 by a reviewing panel. At a review this month, Miss Yorkston was suspended for a further six months after a HCPC Tribunal Service Panel found her fitness to practise remains impaired.

Qualifying in 1992, Miss Yorkston worked as an occupational therapist for Tees, Esk and Wear Valleys NHS Foundation Trust from 2001 until 2012. In 2008, concerns arose relating to her ability to perform her job adequately and these concerns persisted throughout 2008 and into 2009.

Around November 2009 the Trust received an occupational health report, which outlined that Miss Yorkston suffered from a health condition and it was decided to redeploy her to the South Durham Psychosis Team, based at the Goodall Centre on 1 April 2010.

On 27 July 2010, it was reported that there were continuing concerns about Miss Yorkston's competence, and she was removed from clinical practice on 5 August 2010 and placed within the inpatient Occupational Therapy Team to complete project work not involving patient contact. An investigation was initiated into her clinical practice.

In July 2011 the Professional Head of Allied Health Professionals with the Trust produced an action plan to support Miss Yorkston's clinical reasoning, practice, and record-keeping, with a view to returning her to supervised practice. The plan contained 12 objectives.

Miss Yorkston was to be based in the Darlington Psychosis Team in October 2011 for three months to receive support and build up her caseload. Other objectives were for her to provide clear evidence of understanding and applying Occupational Therapy processes and to use the Mayers Lifestyle Questionnaire (MLQ) tool and Model of Human Occupational Screening Tool (MOHOST). Her placement was supervised by a Specialist Occupational Therapist and she was restricted to working on 5 or 6 cases, with formal weekly supervision, and informal daily supervision.

The action plan was formally reviewed in both November and December 2011 but on 12 December, Miss Yorkston's placement with the Darlington team was terminated owing to concerns about her practice and service user safety. The concerns were collectively referred to a disciplinary hearing, which took place on 03 April 2012. Miss Yorkston referred herself to the HCPC in June 2012.

At the hearing, the panel found all the facts proved except for 1(c) (i) - (iii) and concluded that Miss Yorkston's fitness to practise was impaired by reason of her lack of competence. That panel’s decision noted her lack of insight and remediation and suspended Miss Yorkston for 12 months and offered suggestions as to information that a reviewing panel would find helpful.

At the first review of the Suspension Order on 10 April 2018 the reviewing panel decided that Miss Yorkston's fitness to practise remained impaired and decided to impose a further Suspension Order for 12 months. While some progress had been made, there remained a risk to service users. That panel suggested that the next reviewing panel would be assisted by:-

•A testimonial from any OT mentor the Registrant may find to assist her address her shortcomings.

•Details of how the Registrant has kept her skills and knowledge up to date during the period that she has not been working as an Occupational Therapist, including proof of any CPD activity.

•Any further evidence to demonstrate that the Registrant has continued to develop appropriate coping strategies to deal with work related stress that may impact on her health condition.

At the review hearing last month, Miss Yorkston took oath and said she had made enquires about courses but had not been able to get on any. A mentor would have cost £500 and she could not afford that. She went on to say that Teesside University did not provide mentoring.

As to Occupational Therapist Assistant roles, Miss Yorkston said she was concerned that such a role would prejudice her NHS pension. She had sought a carer’s role and had completed a course for carers last year. She was presently unemployed and due to family commitments she had not been able to get an Occupational Therapist Assistant job and she was concerned that such a role was not relevant to the role of an Occupational Therapist.

Miss Yorkston told the Panel that she recognised she did not do a perfect job as an Occupational Therapist but said she felt she could not have done anything else at the time, having failed to get on the MOHT course. She said that she did not want to leave the profession and asked that should her fitness to practise remain impaired, if the HCPC could give her a clear indication of what she was expected to do.

The Panel noted that Miss Yorkston has not worked as an occupational therapist since 2012. The Panel also appreciated and took account of the evidence that she has faced some personal difficulties over the last year, including financial constraints.

The Panel noted that Miss Yorkston has sought to undertake courses to remediate, and it considered that she is genuinely seeking to remediate her practise. She did not peruse the Return to Practise course that she said had identified. Despite the suggestions made by the previous Reviewing panel, Miss Yorkston has not yet addressed the identified issues with her practice such as record keeping and clinical reasoning. As a result the remediation undertaken by the Registrant in the last 12 months has been very limited, and she has not addressed the particular failings identified.

Miss Yorkston's failings are remediable but they have not yet been remedied. She has genuinely seeking to remediate her practise, but has faced some difficulties in the last year and has made limited progress.

The Panel considered that a further period of six months suspension would be appropriate and proportionate. It would protect the public, and the public interest, and would provide Miss Yorkston with a further period in which to undertake relevant learning and focus on the remediation of her practise.

The Panel told Miss Yorkston that a future reviewing Panel would be assisted by relevant testimonials from paid or unpaid work from those who have recent experience of working with her, details of how she has kept her knowledge and skills up to date, any further evidence of CPD activity and reflection on that activity particularly how it relates to the competency issue found and any further evidence to demonstrate that she has appropriate coping strategies in place to deal with return to work related stressors.

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