The HCPC, or Health and Care Professions Council, is the UK’s second largest health and social care regulator and regulates 350,000 individuals from 16 different professions. Just 6% of HCPC registrants are paramedics and 27% are social workers. However, during 2014/15 10.65% of all HCPC fitness to practise (“FtP”) cases related to paramedics and 57.65% related to social workers. Why are these professions so over-represented in FtP matters?
I’ve been asked this question many times, most recently when speaking at the College of Paramedics’ conference last year. My theory, based solely on empirical experience, has always been that the over-representation is complex but attributable mainly to a) the nature of patients and service users encountered by paramedics and social workers (often people in great distress), b) the work that has been done by many organisations and regulators to make the public more aware of what they should expect from health and social care professionals and how to complain about those professionals and c) an employer-led focus on HCPC referral rather than local resolution of complaints.
In conjunction with the HCPC, a team of researchers (including the HCPC’s former Chair, Anna van der Gaag) has now published a detailed study entitled ‘People Like Us? Understanding Complaints About Paramedics And Social Workers‘ which aims to improve understanding of the reasons behind the over-representation of paramedics and social workers in FtP processes. The study is a significant piece of work and was conducted via a literature review, Delphi consultation with international experts, interviews and focus groups with experts/service users/carers and a review of a random sample of HCPC FtP cases over a two-year period.
Does the study support my theory? Yes, but the study’s conclusions are also of course far more comprehensive and nuanced. I recommend it to anyone involved with professional regulation.
The study cites the following as some key reasons behind paramedic FtP over-representation:
- Rapid expansion in the scope and autonomy of the profession, with paramedics now working in general practice, custody and a wide variety of other settings
- Significant increases in the pressures on paramedics, particularly with regard to volume and range of services required (paramedics now deliver a highly variable, complex mix of responses through a wide variety of channels)
- Change in societal expectations from healthcare providers
- Poor relationships between management and front line staff, with a lack of mutual trust and effective communication
- A tendency within the profession towards under-reporting of errors and a blame-focussed working environment
- Low scores on health and well-being indices for both psychological stress and physical illnesses amongst paramedics
- A disproportionately high number of self-referrals from paramedics.
Turning to social workers, the study identifies the following as key causes of FtP over-representation:
- The challenging and contradictory nature of social workers’ roles (encompassing both care and control)
- Societal ambivalence towards social workers’ work with vulnerable and/or dangerous people
- Social workers’ position at the heart of a welfare system that is under immense strain
- Employers possibly referring concerns to the HCPC as a way of protecting the organisation and apportioning any blame to an individual alone
- Poor workplace conditions, with high levels of stress possibly contributing to poor judgement, unethical or incompetent practice
- Inadequate supportive supervision.
The study’s authors conclude by making some interesting recommendations, which I fully support. They note that few of the reviewed FtP cases involved any deliberate acts of malice or incompetence but “a disproportionate number of referrals to the regulator did not meet the threshold for further investigation”. They recommend the adoption of a more nuanced set of regulatory tools, with much greater emphasis on local, employer-led interventions rather than HCPC referral. One of their final comments is that, whilst there will always be a very small number of professionals who deliberately cause harm and must be held to account, “there are many more professionals who, with appropriate local support and intervention, would, and arguably should, never have been referred to the regulator in the first place”.
Let’s hope that the HCPC also finds the study to be of interest and carefully considers the work it could do to reduce unnecessary and distressing HCPC referrals amongst the two professions.
My team and I specialise in defending professionals before the HCPC. Our experience includes acting for the College of Paramedics, British Association of Social Workers and their paramedic and social worker members. If you are facing a fitness to practise investigation and need assistance, please don’t hesitate to get in touch.