IN THE MATTER OF THE CARE STANDARDS ACT 2000
IN THE MATTER OF THE TRIBUNAL PROCEDURE (FIRST-TIER TRIBUNAL)
(HEALTH, EDUCATION AND SOCIAL CHAMBER) RULES 2008
IN THE MATTER OF THE FIRST-TIER TRIBUNAL – SOCIAL CARE CHAMBER
IN THE MATTER OF THE GENERAL SOCIAL CARE COUNCIL [GSCC] CONDUCT COMMITTEE
IN THE MATTER OF MR ABRAHAM AGBODO
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ABRAHAM AGBODO
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Applicant |
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and
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GENERAL SOCIAL CARE COUNCIL
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Respondent |
JUDGMENT
BEFORE: MISS GILLIAN IRVING QC
MR PAUL THOMPSON
MRS CLAIRE TRENCHER
REPRESENTATION: The Appellant was unrepresented.
GSCC was represented by Ms L Griffin (C) instructed by Field Fisher Waterhouse LLP.
1. On the 16th day of February 2011 the Appellant issued his application to appeal the decision of the General Social Care Council – hereinafter referred to as the GSCC – who, on the 10th February 2011, removed his name from the Register to Practice as a Social Worker. The Appeal is made pursuant to Section 68(1) Care Standards Act, 2000.
2. On the 13th April 2011 Tribunal Judge Brayne directed that the Appeal be by way of rehearing rather than review. We heard evidence over a period of 5 days, commencing 4th July 2011. We are grateful to both parties for the measured and helpful way in which they conducted the proceedings in particular Ms Griffin. Her Case Summary was of particular assistance.
3. The Law
3.1 We reminded ourselves at all stages that the legal burden of proving the allegations levied against the Appellant remained with the GSCC. It was not for the Appellant to “disprove” the facts asserted.
The standard of proof applicable was the civil standard, ie on a balance of probability, or put in another way, was it more likely than not.
3.2 When considering the issue of “misconduct” and subsequently the issue of sanction. We took into account the guidance to be found in the Code of Practice for Social Care Workers 2004, the Indicative Sanctions Guidance of 2008 and the definition of “misconduct” to be found in Rule 2 of the General Social Care Council (Conduct) Rules 2008.
We proceeded on the basis that save in exceptional circumstances the Guidance should be followed as drafted.
4. Backcloth to Appeal
4.1 The Appellant is now 63 years of age. He qualified as a Social Worker in 1998 having formerly worked in Whitehall for many years as a Civil Servant. In 2001 he joined Hertfordshire County Council. Between 2006 and November 2009 when he was suspended, he worked at Chase Farm Hospital, Enfield in Middlesex.
4.2 At the time of his suspension he was a Level III Social Worker. His role was to assess and arrange packages of care as well as residential and nursing placements. Although he would often deal with the more complex of care packages there was an expectation given the size of the team in which he worked, that he would also assist in the assessment and arrangement of more straightforward cases as required. He would interview the patient, assess their needs and arrange appropriate care to facilitate their discharge from hospital.
4.3 The team at the time of the allegations ie May – July 2009, consisted of a manager Fiona Davis, Deputy Manager Duc Tran, and 7 others including the Appellant. There were three Social Workers, two at level 3 and one newly qualified and three Social Care Workers. Additionally there was an office administrator. The office at Chase Farm was physically small an d the managers worked upstairs from the office in which the Appellant and his colleagues were accommodated.
4.4 In addition to covering Chase Farm Hospital “the team” also covered Barnet Hospital and St Albans Hospital as required.
4.5 Undoubtedly there was pressure on the team and the uncertainty of discharge meant that the level of demand for Services could be difficult to predict. With the introduction of the Community Care (Delayed Discharges) Act 2003 which came into force in January 2004, a Social Services Department could be fined about £120 for each patient whose discharge was delayed due to the absence of a care package. The pressure on the Department was consequently increased.
4.6 In evidence we heard that the hospital ward would notify the Social Services Department when a patient was ready for discharge. A written notice would be served. A Section 2 notice meant that a patient would be ready for discharge in 72 hours; a Section 5 notice meant that the patient needed urgent assessment as he/she would be leaving hospital within 24 hours.
4.7 Before a patient was discharged from hospital, it was up to the discharge nurse on the Ward to check that a care package was in place.
4.8 Sadly we were told that there were occasions when a patient was discharged without any inquiry having been made as to whether a package of care was available. Further, there was a demand for beds and there were occasions when attempts were made to discharge patients prematurely.
4.9 It follows that there were occasions when the nursing and Social Care staff were in conflict as to the appropriateness of discharge for a patient.
4.10 There was no “duty” system in operation in the team largely because of the unpredictability of the number of patients fit for discharge at any particular time. Fiona Davis managed the Social Workers and Duc Tran the Social Care Assistants, however both managers could allocate work to any individual.
4.11 Supervisions, ie meetings between the worker and relevant manager were designed to take place monthly. Here the case load of each would be discussed together with any other relevant professional issues.
4.12 An Appraisal of each member of the team took place annually.
5. In addition to his Social Work duties, the Appellant was also a representative for UNISON. In February 2009 he became the Branch Equalities Officer. His Union duties involved representation of others as well as attending meetings and advising on grievances. There was no formal agreement in place between the Appellant and management in relation to time spent on Union duties during working hours.
6. Between 29th May 2009 and 5th November 2009 the Appellant was involved in five separate “incidents” which ultimately became the counts of alleged misconduct investigated by the Conduct Committee of the GSCC. They are set out in detail together with our findings in paragraph 8 of this Judgment.
6.1 Prior to the referral to the GSCC, the Appellant’s employers commissioned an investigation into the allegations. The first investigation was undertaken in-house by Mr David Price. In November 2009 following a complaint by the Appellant as to the lack of independence of the inquiry, Hertfordshire County Council commissioned a further investigation by a member of the East of England Regional Assembly, namely Georgina Chaney. She did not review the entirety of the allegations, just that which was alleged to have occurred in November 2009.
6.2 A disciplinary hearing took place on 24th and 25th February 2010 and the Appellant was dismissed from his employment. He had no legal representation at that hearing. His subsequent application to an Employment Tribunal where he again was without legal representation was also unsuccessful.
6.3 He did not attend the hearing before the Conduct Committee.
7. Lack of representation and delay
7.1 It is highly regrettable that the Appellant was unable to secure assistance with legal representation before this Tribunal and before as outlined. Having been dismissed from his employment and subsequently removed from the register the Appellant was without funds and public funding is not available to him for this litigation. Given the effect of the GSCC decision such is highly unfortunate.
We record our thanks to Ms Katrina Jamieson member of the Bar Pro Bono Unit who provided detailed and careful written submissions on behalf of the Appellant.
7.2 A year elapsed between the disciplinary hearing in February 2010 and the hearing before the Conduct Committee in February 2011. We know not the date of the referral to the GSCC was made nevertheless, by the time it got to hearing, for the majority of witnesses some 20 months or so had elapsed from the precipitating event in which they were involved. Given the absence of statements made by the key protagonists themselves and their reliance upon the notes of others of interviews conducted with them – same not seen or signed until 4 months after the alleged incident, this was undesirable.
The cogency of an individual’s evidence, the accuracy and power of recollection is clearly impeded by delay and can result in unfairness to all.
8. Our Findings Regarding the Allegations
8.1 Allegation 1
· The first allegation we were asked to determine related to the alleged conduct of the Appellant on the 29th May 2009 on Canberra Ward, an infection control ward at Chase Farm Hospital. It was alleged that he:
(a) Refused to wear precautionary gloves and/or apron;
(i) when asked to do so by Staff Nurse Lorna Dennison; and
(ii) contrary to the hospital policy;
(b) in relation to patient Mrs F, for when he was the allocated Social Worker, he failed to:
(i) assess her needs; and
(ii) arrange any appropriate discharge care package;
(c) raised his voice to Staff Nurse Lorna Dennison and/or lent on her desk.
· The Panel heard evidence from Staff Nurse Dennison who attended before us at short notice and to whom we are grateful. We also heard from the Junior Matron Eleina Chiew who although not a witness to the incident itself saw the impact of the incident on Staff Nurse Dennison and others working on the Ward. In respect of the latter we had before us signed notes of interviews conducted by Fiona Davis with Maria Guerra, Kwabena Marfo, and Elizabeth Ashu-O’Shea.
The circumstances surrounding the allocation of Mrs F to the Appellant and his demeanour when he returned to his office from the Ward are set out in the interview notes of Edith O‘Kecha, Kathy Wogan, Marie Vince and Ann McNeill all of whom gave evidence to the Panel. Understandably given the passage of time their recollection of events on that particular day had diminished but we were able to form a clear view of the demeanour and attitude of the Appellant assisted in large part by his admissions to us and his presentation during cross-examination by Ms Griffin.
· We have no hesitation in accepting the evidence of Staff Nurse Dennison. She was fair and temperate in her account, the incident had clearly upset her and she had felt embarrassed and humiliated by it. She had not performed her particular role for long and the incident made her question her ability to do so. She had felt intimated by the Appellant, the tone and pitch of his voice and his opposition to her requests. The Appellant did not deny he refused to wear the apron and gloves and did not fundamentally deny the discussion surrounding his request to have Mrs F moved from her room so he could assess her. We have no doubt that he was loud and overbearing on the Ward and caused other members of staff to stop what they were doing to look and listen to what was happening.
His conduct was inappropriate and had Staff Nurse Dennison not insisted that the patient remain in her room and the Appellant follow infection control procedures, both he, the patient and others could have been put at real risk of harm from infection.
Even accepting the evidence of the Appellant that he had not previously been asked to assess a patient on an infection control ward and had received no training in respect of Clostridium Difficile, he should not have conducted himself in the way that he did. Had he had any doubts about procedures he should have contacted his manager or service colleagues in the office. His failure to respect and acknowledge the expertise of Staff Nurse Dennison is most unfortunate. His inability to recognise the deficiencies in his conduct – as evidenced by the correspondence after the event – was troubling. However, by the time he gave evidence before us, the Appellant was more, but not completely, insightful into his behaviour. He suggested that he may have been annoyed before he had gone to the Ward due to the allocation of the case of Mrs F to him. We see from the evidence of Edith O’Kecha that Mrs F was her client, Mrs F was reallocated to the Appellant by Duc Tran on 27.5.2009, whilst Ms O’Kecha was on leave. On 28.5.2009 a Section 5 notice had been served.
Whether or not the Appellant went to the Ward in the wrong frame of mind and whether or not he was right to be concerned about the discharge of patients direct from an infection control ward, his behaviour cannot be excused.
We accept the evidence that the Appellant later that day avoided receipt of some telephone calls from Canberra Ward and consequently as he accepted, the Appellant did fail on the 29th May to assess Mrs F for a discharge package. We accept that distressed her and caused inconvenience to her friend and neighbour who had taken time from work to attend with the patient. Ultimately that assessment was completed by Ms Davis same days later.
· Although expressing remorse at his behaviour and the impact it had on the nurse and Mrs F, we observed a degree of hesitation and reluctance to do so on behalf of the Appellant. We were conscious throughout of his lack of legal advice and representation and whether such hesitation could be attributed to a mistaken belief that to admit wrongdoing would aggravate rather than ameliorate his position, we can only speculate. Nonetheless when considering the issue of sanction we took this into account.
· There is no doubt in our minds that the behaviour of the Appellant of 29th May fell within the definition of “misconduct” as defined in Rule 2(i) of the 2008 Rules. However, mindful of the guidance distilled from the Discipline Policy operated by Hertfordshire County Council such behaviour although serious did not, in our view, amount to gross misconduct.
8.2 Allegation 2
· It is alleged that on 16th June 2009 the Appellant:
(a) failed to assess the needs of patient Mr T and arrange any appropriate discharge package for him; and
(b) that on the 18th June 2009 the Appellant behaved inappropriately and threw paperwork relating to Mr T at Mr Duc Tran, the Assistant Manager.
· We heard direct evidence from Ms O’Kecha, Duc Tran, Marie Vince, Fiona Davis, Anne McNeill as well as the Appellant in relation to the events of the 16th-18th June. We also had the benefit of the notes of the interviews between Ms Davis and Yvonne Wilson and Sharon Coleman who were present in the office with Mr Tran in the 18th June.
· We say at the outset that we are satisfied that all who appeared before us used their best endeavours to provide an honest account of events some two years of age. Hence where there were inconsistencies with evidence previously given by them we reminded ourselves of the delay incurred between the giving of evidence to us and the events in issue.
· It was an unequivocal fact that on or about the 16th June 2009, the Social Care Department received a Section 5 Notice for patient Mr T. The patient had previously been allocated to Ms O’Kecha who had gone on annual leave on 15th June. In her absence Mr Tran sought to allocate the case to the Appellant. There was no dispute between Mr Tran and the Appellant that the former had taken the file to him and had sought to reallocate it. It was the Appellant’s case that he had informed Mr Tran he could not accommodate the case due to the pressure of other work and his Union commitments. He, however, offered to help him out by making some preliminary inquiries. The Appellant did not regard the files as formerly allocated to him whereas, it would appear, Mr Tran did. The Appellant effectively triaged the case and spoke to the patient’s next of kin and to the Occupational Therapist. There had been no OT assessment and there was no report. Following his initial inquiry he returned the file to Mr Tran with a note raising the spectre of a 6 week residential respite placement. Support for the Appellant’s understanding that this was an informal allocation can be found in the notes of interview between Anne McNeill and Fiona Davis of 30th June 2009.
· At some point, Mr Tran returned the papers to the Appellant. We have a handwritten undated note from Mr Tran which says “…I have a copy of the OT access visit as discussed. I have discussed the concerns with Fiona and we think you should do as much as you can to get this cracking”.
Careful perusal of e-mail exchanges between the Appellant and Mr Tran suggests that Mr Tran reluctantly on the 16th accepted that the Appellant couldn’t take the case on and it wasn’t until the OT report was received on the 18.6.2009 that it was re-allocated to the Appellant. (e-mail of 18.6.2009 13:49)
However, the facts are ambiguous as despite the e-mails, the evidence of Mr Tran was to the effect that he regarded the case as formally allocated on the 16th and that he instructed Ms McNeill to formally allocate the case to the Appellant on the IRIS system on the 17th June; Mr Tran asserts that he personally returned the paperwork to the Appellant’s desk on the 17th.
The e-mail exchanges we have seen between 16.6.2009, 12.39 and 18.6.09 prior to 13.49 from Mr Tran to the Appellant do not include any formal request for the Appellant to continue with the case (as is suggested in the interview notes of 30.6.09). In her evidence Ann McNeill described how she felt the file was going backwards and forwards and on the 17th June she had been asked to return it to the Appellant and formally allocate it to him on the computer system. We accept her evidence that the Appellant declined to accept the file. It was undoubtedly in the Appellant’s possession when on the 18.6 it is alleged he threw the file at Mr Tran over his computer.
· We find on the evidence that there was ambiguity about the initial allocation of the Appellant. The e-mails and notes suggest an ongoing debate about whether the Appellant’s workload may have lacked capacity to absorb the new referral up until the morning of the 18th when the OT report was known to be on its way.
The e-mails don’t sit neatly with the evidence of Mr Tran and Ann McNeill and the fact the file was formally allocated to the Appellant on the IRIS system on the 17th.
He certainly refused to accept the file and he did not work upon it between the 17th July and the time of his supervision on 19th July.
The supervision notes of Friday 19th July confirmed in evidence by Ms Davis, suggest that Ms Davis accepted that the Appellant may lack the capacity to do the work and agreed that the case should go back to Ms O’Kecha upon her return to the office the following week. Only if she was “not around” or “not available” would the Appellant “follow up”.
This agreement between Ms Davis and the Appellant was never communicated to Mr Tran.
On Tuesday the 23rd June 2009 Mr T was discharged home – there was no care package in place. No-one from the Ward, discharge nurse or otherwise, had checked whether a plan was in place. Ms O’Kecha had returned to work on the 22nd June but we accept the evidence of Ms McNeill that she had declined to take the file back from the Appellant. No-one in a managerial capacity appears to have checked who was doing what, Mr Tran was still unaware of Ms Davis’ decision.
Fortunately no harm was suffered by the patient but undoubtedly the family were caused unnecessary anxiety and distress.
We find that between the 17th June and the period of supervision on 19th June 2009, the Appellant would not accept the allocation of the case and that he did not work on it during that period. Arguably until the OT assessment was complete – which was not until 18th June, he could have done little more than he had done on the 16th June. Thereafter on the afternoon of the 18th June he was out of the office on Union business and on the 19th June his Team Manager acceded to his request that the case return to the original Social Care Worker.
Whether the Appellant was acting reasonably when asserting he could not accommodate the case we know not. We cannot say that he declined the file only because he thought it was beneath him and did not require his skill and expertise. That could never be a good or adequate reason for refusal.
· We detected having heard from Ms O’Kecha and the Appellant, a degree of petulance on behalf of both. There was a lack of client focus. There was also a history between the Appellant and Mr Tran, formerly friends, which involved the recruitment and promotion of Mr Tran to a post desired by the Appellant and which had been advertised, we were told, at short notice – whilst the Appellant was away on leave. No-one in the office had apparently been interviewed for the post. Certainly, the Appellant felt let down by the process.
The evidence available suggests that the Appellant had little respect for Mr Tran and his ability to perform the role he had acquired.
Against this backcloth we find that there was an unsatisfactory incident on the morning of the 18.6.09 when the Appellant admits he “lobbed” the file across Mr Tran’s desk at him. In evidence he admitted his behaviour was unsatisfactory and inappropriate. Despite maintaining that the file was thrown at him, Mr Tran opined that the act was not done maliciously. There was a “watering down” of the event as it had initially been described.
· We would certainly have expected the Appellant to have received a warning as to his future conduct. We do not, on the facts however, consider that it falls into the definition of serious misconduct.
We remain equivocal about his response and attitude to the assessment of Mr T. Given the undercurrent of political issues and the poverty of communication between managers and managers and staff, we do not consider we can, mindful of the burden and standard of proof, conclude that there was serious misconduct in relation to that matter.
The failure to secure a clear working agreement in relation to the Appellant’s Union duties was surprising.
8.3 Allegations 3 and 4
It is alleged that on the 30th July 2009 the Appellant:
· behaved inappropriately in that in the presence of a patient’s relative he made a telephone call to Mrs Batson, Discharge Co-ordinator at Chase Farm Hospital and:
(i) demanded she speak to the patient’s relative;
(ii) twice said to the patient’s relative that she was refusing to speak to them; and
(iii) said words to the effect that he would not lie for her.
It is alleged that on the 31st July 2009, that the Appellant behaved inappropriately in that he shouted at Mrs Batson during a telephone call and was loud and abrupt with her.
· We heard evidence from Mrs Batson who sought to assist us but was clearly struggling to recollect events in detail. We did not gain the impression that she sought either to obfuscate or exaggerate. There was a measure of agreement between the Appellant and the witness as to the events of the 30th June. The telephone inquiry he made related to a patient that had recently been reallocated to him. Mrs Batson had been in post but a few weeks and was the only one in the office. She accepted that the Appellant had asked to speak to a Mr Fonseca but in his absence she had offered to assist. The patient’s relative was on the Ward and had expressed concern about a cancelled meeting and discharge planning.
There was no statement from the relative or any of the nursing staff present.
Mrs Batson informed us that she had tried to find the file relating to the patient but was unable to do so and informed the Appellant of this. He did ask Mrs Batson to speak to the relative but denied alleging that Mrs Batson was refusing to do so. He accepted that he said he would not lie for her but this he avers was in relation to the missing file.
It is clearly possible that confusion/a misunderstanding arose during the telephone conversation about what was being said by the Appellant to the relative. It was not ideal that the relative was present whilst the call took place but there is nothing to suggest that the Appellant was trying to be other than helpful. It is important that the public have trust and confidence in the health and social care system and it was unnecessary for the anxiety of the relative to be raised – as no doubt it was – by disclosure that the file was unavailable.
In relation to the allegation of 31st July 2009, the Appellant accepted that he may have raised his voice to Mrs Batson. He would not accept her interpretation of events but we do. During the hearing it was evident that as the Appellant became animated either for positive or negative reasons, his voice became louder and the tone more acute; he spoke more quickly and his diction was less clear. Having heard from him and given the events of the day before, we think it highly probable that he was irritated by Mrs Batson’s request for information and was defensive/obstructive as a consequence.
· We remind ourselves that by this time the Appellant had notice of 2 complaints lodged against him, namely that of Sister Chiew dated 29th May 2009 and that of Mr Tran dated 25th June 2009.
His colleagues were undoubtedly aware of the investigations because Ms Davis had begun to interview them as the dates of the interviews reflect.
It would be surprising if the Appellant did not feel threatened by the process and it must have been a difficult environment in which to work. If one adds to this our knowledge that the Appellant had prior to moving to this team in 2006 suffered a period of ill-health and absence due to work-related matters it suggests a fragility we should bear in mind when judging his behaviour.
· We did not consider that the events of the 30th and 31st June amounted to “misconduct” and were not satisfied on the totality of the evidence available to us that it was indicative of a pattern or course of conduct of the Appellant’s behaviour.
8.4 Allegation 5
The Appellant accepted allegation 5, namely that on the 5th November 12009 he tried to discuss his disciplinary case with Ms McNeill contrary to the written instructions contained in the letters dated 20.7.09 and 2.8.09 sent to him by Adrian Smith, Commissioning Officer and David Price.
There was no dispute of substance between Ms McNeill and the Appellant on this point. However, his breach must be set in context.
As we have already described this was a small office with a small team. On the 30th October 2009 David Price, one of the investigating officers, had called the Appellant from his office and handed to him the bundle of evidence which was to be relied upon against him at the disciplinary hearing then scheduled for 16th November. That bundle contained the interviews with his colleagues conducted by Ms Davis. Having read those documents we accept the Appellant’s evidence that he was upset and distressed by what he had read.
This had been anticipated by Ms Davis who had requested/recommended that whilst the investigation was taking place and pending the decision of the Disciplinary Hearing, the Appellant should be suspended on full pay – more commonly described as “garden leave”. Unfortunately such request was not heeded.
The Appellant described the atmosphere as “toxic” prior to the Disciplinary Hearing. To expect him to do nothing or say nothing at all once appraised of the content of the bundle was unrealistic and in our view harsh. Having heard from both the Appellant and Ms McNeill such exchange as occurred was extremely short. Ms McNeill told us she was not distressed, she had been told by Ms Davis to leave the room if the Appellant sought to engage her in discussion.
It was not Ms McNeill who rang Ms Davis to complain on 5.11.09. We accept the Appellant’s evidence that he did not set out to intimidate or upset Ms McNeill, he was himself upset by what he had read.
We do not regard this incident as evidence of misconduct on the part of the Appellant.
9. From the Panel’s perspective clearly the incident on the 29th May was the most serious. Despite the skilful and persuasive attempts of Ms Griffin to encourage us to view the Appellant’s behaviour as evidence of a course or pattern of conduct we do not consider it appropriate to do so.
Unlike the GSCC we had the benefit of his last 2 annual appraisals. They were extremely positive. There was no evidence or suggestion of him being a dysfunctional element affecting the efficacy of the team at the hospital.
Despite the content of the investigation reports, Ms Davis described what she called “niggling complaints” in the team and nothing more.
We are not investigating any allegations made by any service user against the Appellant.
The evidence of the team manager was that he had many positive qualities as a Social Worker. He does not, however, take criticism well.
We formed the impression from those witnesses who worked with the Appellant that they never expected that he would be removed from the Practice Register.
10. Since February 2011 the Appellant has been unable to secure any employment and has been in receipt of benefits. He is in financial difficulty. Prior to the decision of the GSCC he had managed to obtain some employment with Walthamstow Council at Whipps Cross Hospital. It was a short term contract with a prospect of extension.
11. Sanction
Bearing in mind the guidance and the findings we have made, we have determined that the decision to remove the Appellant’s name from the Register should be revoked. This means he is immediately able to re-apply for registration. We are of the view that a period of “suspension” was the appropriate sanction. Mindful that the Appellant already been unable to work as a Social Worker for a period of 5 months we do not consider that any further period of suspension would be appropriate.
In arriving at this decision we are alert to the limits of the Appellant’s insight in to his conduct on 29th May 2009 and subsequently in his response to the complaint.
We are satisfied that a period of suspension shall indicate to the Appellant that his behaviour was unacceptable. The incident on 29.5.09 was serious but the Appellant has demonstrated some if not complete insight into his failings. With further training we are satisfied that it is unlikely that such behaviour shall be repeated.
Judge Gillian Irving
25 July 2011