Former NHS Shetland children’s physiotherapist in misconduct battle

An experienced children’s physio­therapist is battling to avoid being suspended or struck off by her professional body in the wake of her sacking last year by NHS Shetland.

Kay Leask, 47, from Lerwick, is up before the Health Professions Council (HPC) accused of being unfit to practise as a result of alleged misconduct and incompetence over several years.

Ms Leask, a physiotherapist in Shetland for 26 years, is intent on refuting the allegations during an eight-day hearing at The Shetland Hotel. She says she was the victim of systematic bullying and isolation by colleagues in the physiotherapy and occupational health units at the Gilbert Bain Hospital.

The public hearing results from her dismissal and failed appeal in April 2009 which led automatically to her being reported to the HPC, an independent body which regulates 15 non-medical professions in the UK including chiropodists, speech therapists, paramedics and hearing aid dispensers. It has the power to strike a member off its register, preventing them working in their field in the UK for up to five years.

Ms Leask faces a string of 16 broad allegations, none of which might be regarded as particularly serious in its own right but taken together paint a picture of poor per­formance and attitude. They include the alleged failure to assess some patients in the proper way or keep adequate notes, treating colleagues’ patients without informing them, publicly criticising and undermining other therapists and failing to co-operate as a team member.

She is further accused of failing to seek or accept supervisors’ input to tackle her performance problems, being unable to manage stress and anger at work and having poor timekeeping and management.

There is no allegation that her actual clinical treatment of physio­therapy patients was sub-standard.

Ms Leask, who is dyslexic, has been representing herself at the hearing while London barrister Sarah Harris presents the case against her on the HPC’s behalf before the three-person panel, chaired by Raymond Pattison. Ms Leask told The Shetland Times her London-based lawyer had let her down, leaving her with no choice but to act on her own behalf. She is due to present her side of the story next week.

The hearing has over 1,000 pages of evidence before it and will hear from at least a dozen witnesses and some character referees for Ms Leask.

The HPC has flown up a nine-strong team from London to conduct the hearing with members accommodated in the Shetland and Lerwick hotels for up to 11 nights.

It is the latest public spectacle for NHS Shetland involving its physiotherapists. In 2005 Australian physiotherapist Patrick Guest was suspended for six months by the HPC after a hearing in London due to his poor record-keeping during a spell in Shetland the previous year.

Before that, in 1996, Shetland NHS was forced to offer physiotherapist Karen Hetherington her job back at the Gilbert Bain Hospital and give full financial compensation after she won her case for being unfairly dismissed the previous year.

The main feature of the first two days of Ms Leask’s hearing was extensive questioning of the HPC’s first witness, Fiona Smith, who is head of physiotherapy for NHS Shetland.

The evidence on Monday and Tuesday exposed some of the professional rivalries and personal insecurities among staff members in physiotherapy, where 12 people work, and in occupational therapy, contrasting with the mundane systems and tight procedures that healthcare professionals have to operate under.

Quickly revealed was a clash of styles and personalities between Ms Leask and her boss, who she believed tended to side with colleagues who complained about her. Others she was at odds with were Katie Hatfield, Margaret Gear, Mandy Thomson, Lianne Campbell and occupational therapist Mark Beswick, leading to what both sides in the dispute agreed was her growing isolation in the department, made worse by her work being mainly part-time.

In her support Ms Leask will be bringing in other former colleagues and the parents of child patients as witnesses or to submit statements in her support next week. She qualified in 1984 and worked for NHS Shetland until last year, except for spells off on maternity leave and sick leave.

Ms Smith qualified two years prior to her and became her line manager initially in 1999.

Early in the hearing Ms Harris told the panel that Ms Leask felt colleagues were in some way out to get her or were conspiring against her. Elaborating on that herself, Ms Leask said “the start of all my problems” had been in 2002 when she felt colleagues blamed her for an unspecified incident affecting a workmate in paediatrics, Elaine Lloyd, which apparently prompted the woman to leave. However, Ms Smith said Ms Leask was mistaken in her belief. The impression she had gleaned was that nobody blamed her.

She told the hearing she had noticed changes in Ms Leask’s behaviour at work from around 2002 which had been “quite subtle” to begin with, including ceasing to attend all the monthly team meetings and becoming withdrawn from her colleagues. She got her mail sent through to the children’s unit instead of coming into the main physiotherapy unit to pick it up herself and commune with workmates.

Ms Smith said because of Ms Leask’s “reading problems” her colleagues used to help her finalise reports and tackle her computer-related equipment but later she became unwilling to accept help.

She also stopped seeking colleagues’ professional opinions, Ms Smith said, becoming aggressively defensive and unreceptive to their views and critical about the abilities of some. She had a particularly dysfunctional relationship with fellow paediatric physio Katie Hatfield, Ms Smith said. She thought the two “felt a bit threatened by each other”.

One of the ways that manifested itself was by Ms Leask instantly changing a course of treatment that her rival had just begun for a patient, Ms Smith told the hearing. She was also said to have been publicly critical of her rival’s work, which reached the ears of parents.

In 2006 Ms Smith instigated so-called informal capability proceedings in relation to Ms Leask, who was then working part-time. The process was mounted after what she said were several “unfruitful” meetings between the two to try to address what she felt was Ms Leask’s failure to work properly as a team member and her frequent lateness for tutorials and supervision meetings.

Ms Leask denied that she missed team meetings, except one where she had to treat a child urgently. She said her perceived lateness had never been raised formally as an issue.

As an example of her teamwork she said she had trained Ms Hatfield in paediatric physiotherapy techniques. She also disputed the claim that she had deliberately cut herself off, explaining that she was busy and the child outpatient unit, which opened in 2002, was at the opposite end of the building to the main physio unit. However, she did not like the reception she got when she did go into the main base.

Faced with the capability proceedings against her Ms Leask retaliated by lodging a Dignity at Work complaint against Ms Smith, alleging that she was being bullied by her. The matter took eight months to complete and her complaint and an appeal were not upheld. Mediation was later carried out to try to soothe tensions between the two women.

Ms Leask had previously written to Ms Smith alleging that she was being bullied and harassed by other colleagues but she accused Ms Smith of not exploring the matter. Ms Smith said she had not been able to deal with it because no specific allegations had been made.

Asked about her general claim of bullying and harassment, Ms Smith said: “No. There were people who felt bullied and harassed by Kay. A lot of people went out of their way to try to support Kay and it just didn’t work.”

When Lesley Bruce of NHS Fife was asked to do a review of the paediatric physiotherapy service Ms Leask’s approach and working practices were criticised in her findings.

Concerns were also raised by the physiotherapists who took on Ms Leask’s more urgent paediatric work during her absence for the Dignity at Work investigation. They found that some of her notes were what Ms Smith described as “muddled, disorganised” and “a bit rambling” with opinions mixed in with what should have been purely factual information.

In some cases it was not clear from the notes why a patient was coming for physiotherapy, she said. Some had been coming longer than required and other notes contained a lack of goals to be achieved by treatment. Exercise plans for children, intended to be read by parents or carers, contained no guidance, she said, or listed “excessive” numbers of exercises – perhaps a dozen or more – for a child who had previously refused to do even one.

Despite all the criticisms, Ms Smith told the panel that Ms Leask “absolutely had the patients’ best interests at heart” in her work but did not seem to understand when she was being unprofessional. “I wouldn’t dispute that her heart was in the right place,” she told the panel.

After a period off work Ms Leask was assigned in May 2008 to do clinical work, supervised by Mandy Thomson. At that time Ms Smith said she found Ms Leask to be “very stressed, very anxious” and angry. She also had problems recollecting information.

Further criticism of Ms Leask’s performance led to Ms Smith beginning a formal capability process, which Ms Leask would not accept. The matter lay unresolved from November 2008 despite two meetings during which Ms Smith said Ms Leask was angry and upset, partly about Ms Smith being involved in the process, which she saw as a conflict of interest.

With Ms Leask on sick leave, Ms Smith said she made another six failed attempts to get a meeting before writing to her in February 2009 regarding a disciplinary meeting. She was then sacked in her absence. Her appeal failed in April last year.

The case against Ms Leask was expected to take five days to present to the panel. However, progress on Monday and Tuesday was slow and the hearing may over-run its scheduled completion time of next Wednesday. If that happens it will be adjourned, probably for three or four months until a slot could be found for it to continue.

The HPC usually meets in London or, if the business is Scottish-related, in Edinburgh. But the difficulties of requiring Ms Leask and all the Shetland-based NHS witnesses to travel south for such a long period led to the decision to hold the hearing in Lerwick. The HPC is funded by its members themselves through an annual levy of £76.