01 April 2016

Focus on Standard eight: Be open when things go wrong

Michael Guthrie, HCPC’s Director of Policy and Standards talks about a new standard which requires registrants to be open and honest when things go wrong.

What does the new standard say?

Standard eight says that registrants need to be open and honest when something has gone wrong with the care, treatment or other services that they provide. This includes letting service users and carers know; apologising; and taking action to put matters right if they can. The standard also says that registrants need to support service users and carers to raise concerns and be helpful and honest in their responses to complaints.

Why a new standard and why is it important?

The reports of inquiries into failings in health and social care services in recent years have emphasised the importance of organisations and individuals being open and honest when service users are harmed or could have been harmed, as a result of errors or mistakes in the care or treatment they have received. This is sometimes referred to as a ‘duty of candour’. In England, there is now a statutory duty of candour which some organisations in health and social care have to meet, and similar requirements are being introduced in the other UK countries.

The previous version of the Standards already required registrants to be honest and to protect service users from harm. The new standard builds on this to set out clearer and more specific expectations. We do not use the term ‘candour’ because of feedback that this term was not always understood.

The other UK wide regulators of health and care professionals either have or are introducing a similar standard for their registrants. We all want to make a small, but important, contribution to creating a culture that supports professionals being open and honest with service users and carers about mistakes and errors and one which is open to, and acts on, feedback – both positive and negative.

What does this mean for registrants?

We are asking registrants to be transparent in their work and to act appropriately to make sure that service users and carers are not kept in the dark when something goes wrong.

The work that health and care professionals do is very often highly pressured and rarely risk free. The standard isn’t about penalising registrants when inevitably mistakes happen or where outcomes are not as beneficial as they had hoped. But it is about expecting registrants to act appropriately when they identify that something has gone wrong. This includes letting the service user know but also, for example, making sure that any records are completed accurately. For registrants who are employed, this includes making sure that they use their employer’s incident reporting arrangements where appropriate.

The Standard includes an expectation that registrants will apologise when something goes wrong. Service users and carers have fed back to us about the power of apologies – that though simple and easy to give, they make a huge difference to the service user, and to their relationship with the professional, even where the person apologising had not made the mistake. We know that sometimes professionals can be reluctant to apologise for fear of the consequences. We are very clear that an apology is a positive thing and not an admission of liability or wrongdoing.

As with any of our standards, we expect registrants to use their professional judgement. For example, some registrants will work in teams where it might be more appropriate for another professional to inform a service user or to make an apology. We expect registrants to adhere to the principles of these standards and that they are able to justify their decisions and actions if asked to.

Further information about the Standards of conduct, performance and ethics is available here.

For more information about Standard eight, or to address any queries you may have, join in our tweetchat on Thursday 21 April at 6.00pm using the hashtag #my_standards

27 January 2016

Why are our Standards of conduct, performance and ethics important for service users?

Steve McNeice was a service user member of the Professional Liaison Group involved in revising our Standards of conduct, performance and ethics. Here, he reveals what these standards mean for service users and why they’re so important.

In March 2003 I contracted Group ‘A’ Streptococcus, which, after mutating a number of times, ultimately became Meningococcal Septicaemia. This resulted in the amputation of both my legs above the knee, the loss of the muscles in my right forearm, the loss of all my fingertips and the amputation of my little finger on my right hand. I also have significant lung capacity reduction, deafness in one ear and reduced hearing loss in the other.

As a consequence of managing these lifelong and complex conditions, I continue to experience and benefit from the services of a wide variety of allied health professionals (AHPs), including paramedics, prosthetists, orthotists, physiotherapists, occupational therapists and radiographers.

Reviewing the Standards

This previous and on-going patient experience as a long-term service user led to my involvement in reviewing and revising the HCPC’s Standards of conduct, performance and ethics (SCPE) as part of a Professional Liaison Group (PLG). These are Standards for the 16 professions regulated by the HCPC, setting out in broad and easily understandable terms the behaviours expected of its registered health and care professionals. My role within the PLG entailed making suggestions about how these standards could be made more accessible, practical and useable, particularly for service users.

Health and care professionals must adhere to SCPE as a condition of their continuing HCPC registration. The Standards are important because they outline a minimum quality of service that the public can, or should, expect from their health and care professional. This means that they are equipped with a better understanding upon which to base their expectations for any intervention or service being provided.

Reflecting service user expectations

In terms of my own expectations, I believe that AHPs should work ‘with’ service users. Communication should be appropriate in language and manner, allowing me to make an informed choice (albeit in conjunction with the professional). I would also expect them to work within their own knowledge and skill set, recognising any limitations whilst acting at all times in my best interest.

The revised Standards of conduct, performance and ethics absolutely reflect my expectations. Like most service users with lifelong and often complex conditions, I have changing needs. I therefore feel privileged that I’m able to benefit from the skills, expertise and knowledge afforded to me by my caring AHPs.

Building the relationship between professionals and service users

Importantly, the revised SCPE include a new standard about registrants being open and honest when things go wrong. I would add that this should be a two-way process: if I do something wrong, I would be the first to apologise. This trust and mutual respect is crucial for service users who have to build long-term relationships in order to work constructively with AHPs. Indeed, it can directly impact meeting any goals or on-going needs.

Registrants are also required to report and escalate any concerns they might have about the safety and wellbeing of service users. Clearly, this is essential. News reports often highlight the lessons to be learnt from whatever incident may have occurred, but I believe that prevention is generally better than cure.

Standards of conduct, performance and ethics are, of course, directly relevant to health and care professionals regulated by the HCPC, as well as those aspiring to join the Register. However, they are also of particular interest and importance to service users, carers and the general public. I know and understand, from my own personal experience, the benefit to patients of a skilled and professional workforce. So it is particularly pleasing to have been part of the revision of a set of standards that seeks to support, maintain and encourage that workforce.

More information about the HCPC’s Standards of conduct, performance and ethics is available here.

26 January 2016

SCPE and me

HCPC registrant, Council Chair and educator, Elaine Buckley, explains the process involved in revising our Standards of Conduct, Performance and Ethics, and highlights their importance to health and care professionals.

On 26 January 2016, we published our revised Standards of conduct, performance and ethics. These Standards have always served to set out what is expected of me as an HCPC registrant. They have provided guidance as I’ve progressed in my career as a physiotherapist, and have assisted me as an educator in articulating these expectations to students as they embark on qualifying in their chosen profession. The Standards are equally as important to the HCPC as a regulator. They help us to determine suitability of character for individuals who apply to our Register, and in cases where concerns are raised about a registrant’s fitness to practise.

As Chair of the working group - called a Professional Liaison Group (PLG) - which assisted with the revision of the Standards, I have been impressed with the thoroughness of the process: particularly in terms of the gathering of evidence to inform any changes and the level of stakeholder engagement. The PLG comprised a variety of stakeholders, including service users and carers, professional bodies, employers and registrants.

The journey to revise the Standards began with a number of commissioned projects capturing the views of a wide range of stakeholders. This included workshops with different groups of service users and carers; focus groups and interviews with registrants and employers; and discussion with Fitness to Practise (FtP) Panel Chairs.

The PLG then reviewed the evidence gathered, debated issues and suggested changes to the previous Standards. This resulted in the development of a robust set of draft Standards, which went out for public consultation UK-wide. The consultation elicited 217 responses from stakeholders including individual health and care professionals, professional bodies, employers and educators. In addition, we benefited enormously from the views of service users and carers at a series of UK-wide events we held during the consultation period. Further changes were made to the Standards in light of the consultation.

The key changes from the previous version of the Standards include a standard about reporting and escalating concerns about the safety and wellbeing of service users. There is also a standard about being open and honest when things go wrong: individuals are expected to tell service users and carers when they become aware that something has gone wrong with the care, treatment or other services that they provide and to take action to put matters right wherever possible. They are also required to consider making an apology and to make sure that the service user receives an explanation of what happened.

It was essential that we refreshed the Standards in such a way that ensured they remained relevant for all 16 professional groups that we regulate. Our registrants work across a range of settings: in the private sector, NHS and in local authorities, to name but a few. This meant that the PLG’s discussions focused as much on format, as on content.

As such, we have made changes to the structure of the Standards to improve their accessibility. We hope that the new concise layout will ensure ease of understanding, not only for our registrants, but also for service users and carers. Despite the new ‘look’ of the Standards, registrants should be assured that the content remains consistent.   

I hope that you will find our revised Standards clear and easy to engage with, and that they will continue to guide your practise as you progress through your career.

The Standards of conduct, performance and ethics are now available to download here. The HCPC will be producing a range of communications to highlight what the revised Standards mean for registrants, including regular articles within our In Focus newsletter, blog pieces, live forums and social media messaging.

For more information visit www.hcpc-uk.org/aboutregistration/standards/standardsofconductperformanceandethics

22 January 2016

Reviewing the Standards of proficiency for social workers in England

Chair of our Education and Training Committee, Joy Tweed, highlights discussions from our recent event which contributed to our current review of the Standards of proficiency for social workers in England. 

On Thursday 21 January I had the privilege to chair an event at the HCPC which brought together a broad range of stakeholders from within the social work community, including educators, managers, learning and development professionals and newly qualified social workers.

The reason for our meeting? To discuss the Standards of proficiency for social workers in England. These standards, which set out the threshold entry level to the Register, are essential to regulation. They articulate our expectations of the skills and knowledge required for safe and effective practise and we use them across our regulatory processes specifically in education, fitness to practise and registration.

The review is part of our ongoing commitment to ensuring our Standards are relevant, up-to-date and fit for purpose. The review is particularly timely now that we have completed our three year programme of approval of social work education programmes. We can also take into account changes in the sectors since the standards were last published – for example, the Knowledge and Skills statements published by the Chief Social Workers for Children and Adults.

Our event was part of a broader programme of work to engage with the sector. We plan to consult on proposed revised standards and publish them later this year. 

As part of the review, we have already benefited from the feedback of educators, HCPC visitors and registration assessors, practice placement educators, service users and carers and others including principal social workers and managers.

The feedback from this work and our event is remarkably similar. Some stakeholders want us to better articulate the relationship between our standards and other frameworks like the Professional Capabilities Framework (PCF) and the Knowledge and Skills Statements. Others were keen for us to ensure that the standards were more explicit about social work values. At the event, we discussed the need to include specific references on leadership and strengthen our wording on supervision and reflection as well as emotional resilience. We told participants about the findings of a piece of work that Shaping our lives did on our behalf, speaking with service users and carers about their experiences and perspectives on the Standards. Service users and carers emphasised the importance of good communication to developing an effective relationship between social worker and client, one that ensured partnership in decision making.

Overall, however, the overwhelming majority of individuals we have spoken to so far agreed that the existing Standards of proficiency are clear and relevant to social workers in England and that few changes are required. This is very encouraging as we see these Standards playing a key role in generating the next generation of professionals.

What struck me about our event was the breadth of involvement across the sector and the engagement by very busy people who were all committed, passionate and enthusiastic about helping us to make these very important Standards relate to the work of social workers every day.

This is just the start of the process. There will be an opportunity for the wider social work community to provide their feedback when we consult on the revised draft standards later in the year.

In the meantime, I would like to thank everyone involved so far for taking time out of their busy lives and so readily sharing their skills and knowledge.

Joy Tweed
Chair, Education and Training Committee   

02 December 2015

An overview of our fitness to practise activity undertaken in 2014-15

John Barwick, Acting Director of Fitness to Practise at HCPC, highlights the findings presented in our Fitness to practise annual report 2015 and discusses key areas of work and activities undertaken this last year.

This month we published our Fitness to practise (FtP) annual report, covering the period 1 April 2014 to 31 March 2015. The report provides information about the work we do in considering allegations about the fitness to practise of our registrants.

Here, we provide an overview of the statistics in terms of the cases progressed through our FtP process in 2014-15, as well as highlighting key activities undertaken to continually review and improve our procedures.

In 2014-15, the number of individuals on our Register increased by 2.7 per cent. The number of new concerns we received also increased from 2,069 to 2,170, a percentage rise of 4.8 from the year before. However, despite this increase, the proportion of the Register affected still remains low, with only 0.66 per cent of registrants (or 1 in 166) being subject to a new concern in 2014-15.

In 2014-15:

  • 1,042 cases were closed before being considered by an Investigating Committee Panel (ICP) as they did not meet our Standard of acceptance.  
  • 849 cases were considered by an ICP.
  • 351 final hearings were concluded. Of these, 15 cases were discontinued, 76 were not well-founded, seven resulted in no further action, and one was removed. Imposed sanctions included 52 cautions, 39 conditions of practise orders, 69 suspensions and 62 strike-offs. 30 cases resulted in voluntary removal.
  • 236 review hearings were held.

The number of cases considered by an ICP and the number of final hearings concluded increased significantly from 2013-14. We had anticipated these increases due to the high number of concerns we received in 2013-14 and the time it takes for those concerns to progress through the process.

Given the further increases in concerns received in 2014-15, we have planned our resources in 2015-16 to allow for additional ICP and hearing days if required. 

Key areas of work and activities undertaken in 2014-15

  • Improving the experience individuals have when they’re involved in the FtP process, be it a complainant, registrant, employer or witness. This included reviewing the tone of our correspondence.
  • New initiatives have included proactively seeking feedback from complainants and registrants at the conclusion of a case, and using the Patients Association peer review model to assess how we handle FtP concerns.
  • Enhancing the information sources available to employers. Ongoing engagement with this group is important to ensure they understand what concerns to refer to us, at what time, and what information to provide.
  • As part of our commitment to building an evidence base for the field of professional regulation, we published Preventing small problems from becoming big problems in health and care. This report provides an insight into the triggers of disengagement and explores ways in which preventative action might be implemented.
  • We signed new Memoranda of Understanding with the Care Quality Commission and the Disclosure and Barring Service. These agreements set out how we will work together to achieve our separate statutory functions but also our joint objective of safeguarding the health and well-being of the public.

Future work

  • We will continue to look at cost efficiency in our FtP process
  • We have reviewed our Standard of acceptance policy to ensure it remains fit for purpose. This has involved taking into account the changing nature of the cases we receive, feedback from those involved, and feedback from our audit and complaints data.
  • We will start work to further separate our investigation and adjudication functions to ensure enhanced independence in our FtP process.

The Fitness to practise annual report 2015 is available to download here.

16 November 2015

What happens at a fitness to practise hearing?

Your six-point guide to the Health and Care Professions Council’s (HCPC) hearing process.

1. The panel

The three-strong panel considering the case will be led by a Chair. The Chair may be a lay person or from one of our professions. They will be joined by a lay person, who is not registered with us, plus a registrant from the same profession as the person being investigated.

Panels of the Conduct and Competence Committee consider allegations that a registrant’s fitness to practise is impaired by reason of misconduct, lack of competence, or a conviction or caution for a criminal offence. Panels of the Health Committee consider allegations that registrants’ fitness to practise is impaired by reason of their physical and/or mental health.

2. Public or private?

Hearings are usually held in public. This means that members of the public (including the press) can attend. Hearings may sometimes be held or part-held in private if there is confidential information involved. For example, if the panel thinks they need to protect service user confidentiality, the registrant’s private life or that of any witnesses.

Even if a hearing is held in private, any decisions the panel makes and the reasons for them, still need to be publically available.

3. Considered factors

In deciding whether a registrant’s fitness to practise is impaired, the panel will take into account factors including:
  • Whether they have ignored previous warnings
  • Whether they have taken action to correct their behaviour
  • Whether they have insight (understanding of the harm caused)
  • The link between their conduct and their profession
  • Whether their behaviour has undermined public confidence
  • Whether they have not met our standards of conduct, performance and ethics
  • Whether they are likely to repeat the behaviour

4. Possible sanctions

If the panel finds the case against the registrant is well-founded, there are a number of actions they may take or sanctions which can apply:
  • Take no further action or order mediation (a process where an independent person helps agree a solution to any issues)
  • Caution order (place a warning on the Register for between one to five years)
  • Conditions of practice order (setting conditions which must be met, e.g. working under supervision or further training)
  • Suspension from practice (for no longer than one year)
  • Striking-off order (registrant’s name will be struck from the Register which means they can no longer practice)

5. Timescales

The time a case takes to reach the end of the process can vary depending on the nature of the investigation, how complicated the issues are, and the availability of parties to give evidence to the panel. We understand that it can be stressful when an FtP concern is raised, and we will provide you with an idea of how long our enquiries will take at each stage of the process. 

In 2013-14 the length of time of cases referred for a hearing to conclude was an average of 17 and a median of 14 months from receipt of the allegation. Continuing to analyse the length of time cases take to conclude has enabled us to identify a number of early triggers that can be used to predict the impact on the lifetime of a single case, and the overall system.

6. Appealing a decision

Registrants can appeal against the panel’s decision if they consider it is wrong or the sanction is unfair. The appeal is heard by the High Court in England and Wales or Northern Ireland, or the Court of Session in Scotland. In 2013-14, seven registrants appealed the decisions made by the Conduct and Competence Committee. To date, two appeals were withdrawn by the registrant, three were dismissed by the court, one case had a substituted decision and one is ongoing.

For more information about fitness to practise hearings watch our YouTube video or visit www.hcpc-uk.org/complaints/hearings/atthehearing

29 October 2015

5 things you should know about the HCPC’s annual monitoring process

Education Manager, Ben Potter, highlights what education providers need to be aware of when it comes to annual monitoring this year.

Programme leaders of our approved education and training programmes should have received correspondence in October about our annual monitoring process over the 2015-16 academic year.

Annual monitoring is a retrospective documentary process to consider whether a programme continues to meet our education standards, and that individuals who successfully complete the programme are able to meet the HCPC’s relevant Standards of proficiency (SOPs), standards for prescribers or standards for approved mental health professionals.

901 programmes – more than ever before – are being considered through annual monitoring in 2015-16. Here’s 5 things education providers can do to help ensure a straightforward and effective process:

1. Submit one of two types of monitoring submission: a declaration or an audit

Depending on whether you’re in Group A or Group B, you will need to submit an audit or a declaration. A declaration asks you to confirm that the programme continues to meet our education standards, and that recent and future changes have been reported to us. An audit asks you to submit a completed form and mapping document with several key pieces of your internal quality monitoring documentation. You can check if your education provider is in Group A or B here.

2. Evidence service user and carer involvement

Education providers who have not been visited since September 2014 will need to demonstrate how they are involving service users and carers in their approved programmes. This follows the introduction of SET 3.17 in 2014 and the prescribing standard B.15 in 2015. Guidance on how to evidence service user and carer involvement can be found here.

3. Demonstrate the integration of revised SOPs

With the exception of social worker and practitioner psychologist programmes, all pre-registration education and training programmes must declare that they have integrated the revised Standards of Proficiency (SOPs) for their profession into their teaching and learning. More information on our processes for assessing the revised SOPs is detailed here.

4. Send us your submission by the specified deadline

Your submission date is detailed in the correspondence emailed to you in October. This date will usually correspond with the end of any internal quality processes. You must complete the relevant form – declaration or audit – and submit it to us, along with the requested documentation, by the deadline stated in our correspondence to you. Failure to do so may result in your programme’s ongoing approval being considered by the HCPC’s Education and Training Committee.

5. Further guidance on the HCPC website

The Education section of the HCPC website provides detailed information and guidance about the annual monitoring process. You can also read and/or download our Annual monitoring – supplementary information for education providers publication. If you require any additional advice, you can contact the HCPC’s education department on 020 7840 9812 or email annualmonitoring@hcpc-uk.org