1 April 2017 to 31 March 2018 - hcpc-uk.org · for the period 1 April 2017 to 31 March 2018. This...

Protecting the publicPromoting professionalismFitness to practise annual report 2018

1 April 2017 to 31 March 2018

2Health and Care Professions Council Fitness to practise annual report 2018

Contents

Executive summary 3

Section 1: Fitness to practise key information 6 Section 1.1: Protecting the public 6Section 1.2: Developments and key statistics 7

Section 2: Concerns raised with us 16

Section 3: How we manage our cases 21Section 3.1: Case assessment 21Section 3.2: Investigating Committee panels 21Section 3.3: Interim orders 29Section 3.4: Public hearings 30

Section 4: Learning from fitness to practise cases 36

Section 5: Continuous improvement 70


Executive summary

Welcome to our Fitness to practise annual reportfor the period 1 April 2017 to 31 March 2018.

This report provides statistical information aboutour work and explains how this work protects thepublic and ensures our registrants meet ourstandards1. We have included a learning resourcethat looks at the outcomes of concluded fitnessto practise cases, to help current and futureregistrants to practise safely and effectively.

We have seen a 1.9 per cent increase in thenumber of new fitness to practise concerns wereceived. The number of individuals on ourRegister increased by 3.1 per cent. Theproportion of registrants who had concerns raisedabout their fitness to practise remained relativelylow, at 0.64 per cent, and only 0.09 per cent weresubject to a sanction imposed at a final hearing.

A large proportion (42 per cent) of the concernswe received this year were raised by members of

the public, which is consistent with previousyears. Registrants’ employers continue to be thesecond largest source of concerns, raising 26 percent. Registrants have an obligation to tell usabout events that might raise a concern abouttheir fitness to practise2 and this year, 410registrants notified us of such concerns, whichconstituted 18 per cent of concerns. This is adecrease compared with 20 per cent of theconcerns received through registrants’ self-referrals in the previous year.

Of the cases we progressed through the fitness topractise process in 2017–18:

− we closed 1,234 as they did not meet ourStandard of Acceptance3;

− Investigating Committee panels concluded 475cases;

− 432 cases were concluded at final hearings;and

− 250 cases were concluded at review hearings.

Increased hearings activity, including final andreview hearings, continued this year and amountedto 2,337 days in total. This is similar to 2016–17.

This year saw the launch of the Health and CareProfessions Tribunal Service (HCPTS). TheHCPTS began operating in April 2017 and furtherenhances the independence of the adjudicationfunction. This provides reassurance to thoseinvolved in fitness to practise cases that decisionsare made by independent panels that are at arm’slength from the organisation that has investigatedthe cases. We have also set up a TribunalAdvisory Committee (TAC)4. We have recruited anumber of panel chairs, registrant and lay panelmembers, and legal assessors. This ensures weare able to continue to hold hearings at all stagesof the process, meeting our requirements.

1 Standard of conduct, ethics and performance and Standards of proficiency2 Standard of conduct, ethics and performance, paragraph 9.53 The Standard of Acceptance is the threshold a concern about a registrant must meet before we will investigate it as a fitness to practise allegation.4 TAC is a non-statutory committee and it provides advice to the HCPC and the HCPTS on the development of its hearings function (http://www.hcpc-uk.org/aboutus/committees/tac/)


Executive summary

We have continued to develop our processes andpolicies, including providing support to thoseinvolved in fitness to practise cases. This year wehave taken forward the following initiatives.

− Established a Tribunal Advisory Committee tosupport the adjudication function.

− Initiated a review of the indicative sanctionsguidance.

− Reviewed our printing services to help ensurehearing bundles are available as quickly aspossible to allow hearing participants more timeto prepare.

− Improved the operation of the InvestigatingCommittee panel process to ensure panels areequipped to make high quality decisions.

− Reviewed the information we provide toregistrants at the point they are sent allegationsabout their fitness to practise.

− Reviewed the use of registrant assessors.− Continued to explore conducting hearings in

written form, where appropriate, to increaseefficiency and timeliness.

− Continued to explore the use of electronicbundles.

− Contributed to research to understand whyfitness to practise cases are frequent inparamedics and social workers, developing an

action plan in response to its recommendations.− Revised induction material and training for both

panel members and employees.− Reviewed how we obtain feedback from

stakeholders involved in the process, and usedthe feedback obtained to identify areas forimprovement.

The Professional Standards Authority (PSA)Performance Review of the HCPC 2016–17identified some areas where our performance didnot meet the PSA’s standards of good regulation.In response we have created a fitness to practiseimprovement plan identifying operational andstrategic changes to our process. Theprogramme of work will continue throughout2018–19 and aims to improve both the qualityand timeliness of our fitness to practise work.

We have continued to work with our keystakeholders, including the Care QualityCommission (CQC), other regulators, the NHSand social care organisations. This year we haveagreed a Memorandum of Understanding with theHealth Inspectorate Wales and worked closelywith the CQC and other regulators to develop aprotocol for the early identification and escalationof serious concerns. We have also continued to

work with our registrants and their representativeorganisations through our fitness to practisepartnership forum.

Our key priority for 2018–19 is to improve ourperformance to achieve the PSA’s standards ofgood regulation, by delivering and evaluating thefitness to practise improvement project. Keyimprovement activities include:

− a review of the resources needed to progressour work to the quality and timeliness required;

− review and development of the threshold for thereceipt and investigation of fitness to practiseconcerns;

− development of our approach to theidentification and investigation of concernsabout registrants’ health;

− development and implementation of a caseprogression plan; and

− review of our approaches to concluding casesby consent and decisions to discontinueallegation.

We will also continue to support the delivery of anaction plan developed as a result of research. Wewere commissioned by the University of Surrey, tounderstand why fitness to practise cases are


Executive summary

prevalent in paramedics and social workers inEngland. We will also be preparing to supportplans to transfer the regulation of social workersto Social Work England.

I hope you find this report of interest. If you haveany feedback, please contact our Assurance andDevelopment team at [email protected].

John BarwickExecutive Director of Regulation


Section 1: Fitness to practise key information

Section 1.1: Protecting the public

We are the Health and Care Professions Council(HCPC), a regulator set up to protect the publicby:

− setting standards for the professions weregulate;

− publishing and maintaining a Register 5 of healthand care professionals who meet thesestandards;

− approving and monitoring education andtraining programmes so that when someonesuccessfully completes a programme they areeligible to apply to the Register; and

− acting if someone on our Register falls belowour standards.

In the year 1 April 2017 to 31 March 2018 weregulated 16 professions.

− Arts therapists− Biomedical scientists− Chiropodists / podiatrists− Clinical scientists− Dietitians− Hearing aid dispensers− Occupational therapists

− Operating department practitioners− Orthoptists− Paramedics− Physiotherapists− Practitioner psychologists− Prosthetists / orthotists− Radiographers− Social workers in England− Speech and language therapists

What is fitness to practise? All our registrants must follow our standards ofconduct, performance and ethics and standardsof proficiency in order to be registered andmaintain their registration. The standards areavailable on our website www.hcpc-uk.org/publications/standards

When we say that a registrant is ‘fit to practise’we mean that they have the skills, knowledge andcharacter to practise their profession safely andeffectively. Being fit to practise is about more thanbeing a competent health and care professional.The need for registrants to keep their knowledgeand skills up to date, to act competently andremain within the bounds of their competence areall important aspects of fitness to practise.Maintaining fitness to practise also requires

registrants to treat service users with dignity andrespect, to collaborate and communicateeffectively, to act with honesty and integrity and tomanage any risk posed by their own health. Moreinformation about our approach to fitness topractise can be found in the HCPC’s Approach toFitness to Practise document on our websitewww.hcpc-uk.org/publications

What is the purpose of the fitness topractise (FTP) process? Its purpose is to identify registrants who are not fitto practise and, where necessary, take steps torestrict their ability to practise. This providesprotection for the public, and maintainingconfidence in the professions that we regulateand in us as a regulator.

Most health and care professionals adhere to thestandards without any intervention by us. Only asmall minority of registrants will ever face anallegation that their fitness to practise is impaired.

Sometimes professionals make mistakes or haveone-off instances of relatively minor unprofessional

5 http://www.hcpc-uk.org/aboutregistration/theregister/



conduct or behaviour, which are unlikely to berepeated. In such circumstances, it is unlikely thatthe registrant’s fitness to practise will be found tobe impaired. We are, therefore, unlikely to pursueevery isolated or minor mistake. However, if aprofessional is found to fall below our standards,we will consider the appropriate action to take.

Section 1.2: Developments and keystatistics

Concerns receivedOver the last six years we have seen a steadyincrease in the volume of registrants on ourRegister and in the volume of concerns. Withinthe last six years the number of registrants on ourRegister has increased by 16 per cent, to361,061 in 2017–18. The number of concerns wehave received has increased by 39 per cent, to2,302 in 2017–18. It is important to note,however, that during 2017–18 only 0.64 per centof registrants had an allegation made againstthem; the same as the year before (see Figure 1).

This year has seen an increase of 1.9 per cent inthe number of concerns received compared tothe previous year. At the same time, the numberof professionals registered increased by three percent.

Figure 1

Proportion of registrants subject to concern

Year

2012–132013–142014–152015–162016–172017–18

Total number ofregistrants

310,942322,021330,887341,745350,330361,061

% of registrantssubject to a

concern

0.520.640.660.620.640.64

Number ofconcerns

1,6532,0692,1702,1272,2592,302



The proportion of registrants who have had aconcern raised about them has remained thesame at 0.64 per cent. This means that only onein 157 registrants were the subject of a newconcern about their fitness to practise. Pleasenote that in a small number of instances aregistrant would be the subject of more than oneconcern.

Figure 2 shows where the concerns came from.The category ‘Other’ includes solicitors acting onbehalf of complainants, hospitals / clinics (whennot acting in the capacity of employer), colleagueswho are not registrants and the Disclosure andBarring Service, who notify us of individuals whohave been barred from working with vulnerableadults and / or children. Other types ofcomplainants may all fall within this category.

Members of the public continue to raise thelargest proportion of concerns, over 42 per centof the new concerns raised. While employerscontinue to be the second largest source ofconcerns, comprising 26 per cent of the total. Theproportion of cases which were the result of aself-referral by the registrant has remained thethird most common source of concern, howeverthe percentage has gone down to 18 per cent thisyear from 20 per cent in the previous year.

Figure 2

Where concerns come from

Article 22(6) / anon (69)

Employer (611)

Other (116)

Other registrant / professional (76)

Professional body (12)

Police (25)

Public (983)

Self-referral (410)

26%

42%

18%

3%

3%

1%

5%

1%



Where a concern does not meet the Standard ofAcceptance, even after we have sought furtherinformation, the case is closed. In 2017–18, 1,234cases were closed as they did not meet theStandard of Acceptance. Within the same period707 cases, 57 per cent, that were closed in thisway came from members of the public. Thiscompares to 59 per cent in 2015–16 and 26 percent in 2016–17.

Decisions by Investigating CommitteepanelsInvestigating Committee panels (ICPs) considerthe information about concerns and decidewhether there is a case to answer in relation tothe allegations. ICPs considered 534 cases in2017–18, which was 18 per cent less than in theprevious year. In 59 out of 534 cases consideredthis year, the Panel requested that we obtainfurther information before they could make adecision. The Panel decided there was a case toanswer or no case to answer in 475 cases thisyear. In 79 per cent of those cases, the decisionwas that there was a case to answer and thematter was referred for a hearing. A detailedbreakdown of those decisions, information aboutwhere the concerns originated and how theycame to be considered is set out in Figure 3.

Figure 3

Cases to answer and who raised the concerns

Complainant

Article 22(6) / anon 6

EmployerOtherOther registrant / professionalPoliceProfessional bodyPublicSelf-referral

Total

Number of nocase-to-answer

decisions

2504020

1329

100

Number ofcases-to-answer

decisions

622618480

2291

375

Total

8276224

100

35120

475

% case toanswer

758282

100800

6375

79

6 Under Article 22(6) of the Health and Social Work Professions Order 2001, if an allegation is not made in a normal way,we can take the matter forward if it appears that a fitness to practise allegation should be made. This means that even ifsomeone who has referred a matter to us wants to withdraw from the process, we may still take the matter forward.



The largest group of complainants for casesconsidered was employers, and panels decidedthere was a case to answer in a significantproportion of these (82 per cent). Cases that werereferred to us anonymously or under article 22(6)allows us to investigate a matter even where aconcern has not been raised in the usual way.They had a high proportion where there wasa case to answer (75 per cent). In the casesreferred by the public, ICPs found there was acase to answer in 63 per cent. This represents anincrease compared to the previous year where theproportion was 47 per cent. ICPs found that therewas a case to answer in 75 per cent of cases thatwere self-referred by registrants, compared to 66per cent previously.

Figure 4 shows the percentage of case-to-answerdecisions each year from 2012–13 to 2016–17.Seventy-nine per cent of cases reached thisconclusion in 2017–18, an increase of eight percent from the previous year.

Figure 4

Percentage of allegations where there was a case-to-answer decision

% o

f ca

ses

with

cas

e to

ans

wer

Year

20

35

10

0

40

50

60

70

80

2013–142012–13 2014–15 2015–16 2016–17 2017–18



Decisions by hearing panelsConduct and Competence Committee panelsand Health Committee panels consider all theevidence put before them. They make decisionsat final hearings about whether restrictions shouldbe placed on a registrant’s practice. This is inorder to protect the public. ICPs can make a finaldecision that the individual should be removedfrom the Register. Or, that the Register should beamended on cases where there is an incorrect orfraudulent entry allegation. In 2017–18, 432 finalhearing cases were concluded. However, only alimited number of these resulted in a sanctionbeing imposed.

Figure 5 illustrates the number of public hearingsthat were held from 2012–13 to 2017–18. Itdetails the number of hearings heard aboutinterim orders, final hearings and reviews ofsubstantive decisions. Some cases will have beenconsidered at more than one hearing in the sameyear. For example, if a case was part heard and anew date had to be arranged. Further informationabout different types of hearings is included inSection 3: How we manage our cases.

Figure 5

Number of concluded public hearings

Year

2012–132013–142014–152015–162016–172017-18

Total

565689929846

1,1351,194

Article 30(7)hearing

110100

Restorationhearing

115887

Reviewhearing

141155236171216250

Finalhearing

228267351320445432

Interimorder and

review

194265337346466505

Decisions from all public hearings where fitness to practise is foundto be impaired are published on our website at www.hcpc-uk.org (orwww.hcpts-uk.org). Details of cases that are considered to be notwell founded are not published on the HCPC website unlessspecifically requested by the registrant concerned.



Figure 6 is a summary of the outcomes of hearings that concluded in 2017–18. It does not include cases that were adjourned or part heard.

Analysis of the impact of outcomes on registrants shows that:

− 51 per cent had a sanction that prevented them from practising (strike-offorder, including removal by consent and suspension);

− twelve per cent had a sanction that restricted their practice (conditions ofpractice);

− twelve per cent had a caution entry on the Register; and− 24 per cent of the cases considered at the final hearings were not well

founded or resulted in no further action.

Figure 6

Outcomes reached by each committee

Committee

Conduct and Competence CommitteeHealth CommitteeInvestigating Committee (fraudulent and incorrect entry)

Total

Total

414171

432

Suspension

8780

95

Removed byconsent

3410

35

No furtheraction

1300

13

Caution

5300

53

Struck off

9101

92

Not wellfounded /

discontinued

8850

93

Conditionsof practice

4830

51

Well-founded

000

0



Days of hearing activity Investigating Committee, Conduct andCompetence Committee and Health Committeepanels met on 2,337 days in 2017–18, across therange of public and private decision-makingactivities. This indicates the increasing trend inhearings activity compared to the last couple ofyears. Figure 7 sets out the types of hearing daysactivity in 2017–18. It shows that 1,768 hearingdays were held to consider final hearing cases.This includes days where more than one hearingtakes place and cases that were part heard oradjourned, as well as seven restoration hearings.

While we have held more hearing days this year,the number of hearings that have concludedwithin the allocated timeframe (without the needto adjourn) has increased. This year approximately15 per cent of hearings were adjournedcompared to almost 20 per cent in the previousyear. This positive development can be linked tobetter preparation of cases before hearings. Thisis by specialised teams in the realigned Fitness toPractise Department and our improvement workfollowing feedback from all the hearingstakeholders.

Figure 7

Breakdown of public and private hearing activity in 2017–18

Private meetings Public hearings

Activity Activity

Investigating Committee Final hearingsPreliminary meetings Review of substantive sanctions

Interim orders

Total

Number ofdays

1,768164246

2,178

Number ofdays

10752

159



ICPs only hear final hearing cases aboutfraudulent or incorrect entry to the Register. Onlyone case fell into this category this year.

Panels may hear more than one case on somedays to make the best use of the time available.Of the 432 final hearing cases that concluded in2017–18, it took an average of 3.5 days toconclude cases. We have improved ourprocesses to carefully analyse the circumstancesof the cases before scheduling them for hearing.We have, also, increased communication beforethe hearing with case presenters. This helped toimprove the accuracy of the hearing length of timeand to provide better support to witnesses orunrepresented registrants who may needassistance during the hearing process.

Length of time to progress casesWe continue to try and ensure that cases areprogressed in a timely manner. Reducing the timetaken to conclude cases is in all parties’ interests,subject to the overriding need to ensure a fairprocess. The length of time for a hearing toconclude can be extended for a number ofreasons. These include complex investigations,legal arguments, vulnerability or availability of theparties and requests for adjournments, which can

Figure 8

Length of time to close all cases at all stages

0 to 2 months3 to 4 months5 to 7 months8 to 12 months13 to 15 months16 to 20 months21 to 24 months> 24 months

Total

Cumulativenumber of

cases

660892

111412661351151715941787

Number ofcases

66023222215285

16677

193

1787

% of cases

37%13%12%9%5%9%4%

11%

100

Cumulative % of cases

37%50%62%71%76%85%89%

100%



all delay proceedings. Where criminalinvestigations have begun, we will usually wait forthe conclusion of any related court proceedings.Criminal cases are often lengthy and can extendthe time it takes for a case to reach a hearing.

Figure 8 sets out the total length of time to closeall cases, from the point the concern wasreceived to case closure at different points in theFTP process. This includes cases which did notmeet the Standard of Acceptance, those whereno case to answer was found and thoseconcluded at final hearings. In 2017–18, the totallength of time for this combined group was amean of ten months and a median of fourmonths. This was comparable with the previousyear. In the previous year the mean was ninemonths and a median five months.

Figure 9 presents the length of time statistics forthe FTP cases between 2013–14 and 2017–18.Within this five-year period, the length of time ittakes to close a case has increased. This wasreflected in the Professional Standards Authority’s(PSA) last annual performance report and is beingaddressed as part of our fitness to practiseimprovement plan.

Figure 9

Length of time to conclude cases at ICP and final hearings

Leng

th o

f tim

e (m

ont

hs)

Year

10

15

5

0

20

25

30

2013–14 2014–15 2015–16 2016–17 2017–18

Length of time to progress case from receipt to final hearing

Mean Median

Length of time to progress case from receipt to ICP

Mean Median


Section 2: Concerns raised with us

Anyone can contact us and raise a concern abouta registered professional. This includes membersof the public, employers, the police and otherprofessionals.

Further information about how to tell us about afitness to practise (FTP) concern is in ourbrochure How to raise a concern, which isavailable on our website at www.hcpc-uk.org/publications/brochures

Self-ReferralsArticle 22(6) of the Health and Social WorkProfessions Order 2001 is important in ‘self-referral’ cases. Article 22(6) allows us toinvestigate a matter even where a concern hasnot been raised with us in the normal way. Forexample, in response to a media report or whereinformation has been provided by someone whodoes not want to raise a concern formally. This isan important way we can use our legal powers toprotect the public.

We encourage all professionals on our Register toself-refer any issue which may affect their fitnessto practise. Standard 9 of our standards ofconduct, performance and ethics states that “Youmust tell us as soon as possible if:

− you accept a caution from the police or if youhave been charged with, or found guilty of, acriminal offence;

− another organisation responsible for regulating ahealth or social care profession has taken actionor made a finding against you; or

− you have had any restriction placed on yourpractice, or been suspended or dismissed byan employer, because of concerns about yourconduct or competence.”

We assess all self-referrals to determine if theinformation provided suggests that the registrant’sfitness to practise may be impaired and whether itmay be appropriate for us to investigate thematter further using the Article 22(6) provision.Following the Surrey Research Action Plan, weare working towards providing further guidance tothe registrants about when it is appropriate toself-refer to us. Figure 10 provides a breakdownof concerns raised by profession, together withdetails of who raised the concern.

%

010.55.31.31.3

02.63.9

018.47.9

11.80

3.932.9

0

100

Professionalbody

0000000001300080

12



Figure 10

Concerns by profession and complainant type

Profession

Arts therapistsBiomedical scientistsChiropodists / podiatristsClinical scientistsDietitiansHearing aid dispensersOccupational therapistsOperating department practitionersOrthoptistsParamedicsPhysiotherapistsPractitioner psychologistsProsthetists / orthotistsRadiographersSocial workers in EnglandSpeech and language therapists

Total

%

0.73.21.70.70.2

16.84.9

036.36.32.4

05.9

28.81

100

%

0.50.13.70.11.10.93.30.2

06

7.111.4

01.2

63.21.2

100

%

000000000

8.325000

66.70

100

%

008004480

1616804

320

100

%

03.42.60.9

03.43.4

60.98.6

15.57.8

01.7

44.80.9

100

%

05.21.30.20.7

18.24.30.29.58.32.50.25.6

51.71.3

100

%

00

5.8000

4.35.8

033.32.94.3

02.9

37.72.9

100

Self-referral

3137314

28200

14926100

24118

4

410

Public

51

361

119

3220

5970

1120

1262112

983

Police

0020011204420180

25

Otherregistrant

084110230

146903

250

76

Other

043104471

1018902

521

116

Employer

0328146

50261

5851151

34316

8

611

Article 22(6)/ anon

004000340

232302

262

69

Total

858647

1724

120642

318180160

178

1,17427

2,302



Figure 11 provides information on the breakdownof cases received by profession and gives acomparison to the Register as a whole. Similar tothe previous year, the largest proportion ofconcerns we received were raised about socialworkers (51 per cent) and paramedics (13.8 percent). The majority (over 50 per cent) of theconcerns raised about social workers came frommembers of the public. The majority (47 per cent)of concerns about the paramedics came throughself-referral.

Figure 11

Cases by profession and percentage of the Register

Profession


Total

% ofregistrantssubject toconcerns

0.190.260.490.120.180.830.310.470.141.250.330.690.100.241.220.17

0.64

Number ofregistrants

4,32222,39513,1155,8189,5852,908

38,18313,6391,440

25,46555,13223,1041,051

32,47596,49715,932

361,061

Number ofcases

858647

1724

120642

318180160

178

117427

2,302

% of totalcases

0.352.522.780.300.741.045.212.780.09

13.817.826.950.043.39

511.17

100

% of theRegister

1.206.203.631.612.650.81

10.583.780.407.05

15.276.400.298.99

26.734.41

100



Nature of concerns: what types of cases wecan consider The standards of conduct, performance andethics are the standards we set for allprofessionals on our Register to follow. These setout, in broad terms, our expectations of theirbehaviour and conduct.

“Registrants must:

− promote and protect the interests of serviceusers and carers;

− communicate appropriately and effectively;− work within the limits of their knowledge and skills;− delegate appropriately;− respect confidentiality;− manage risk;− report concerns about safety;− be open when things go wrong;− be honest and trustworthy; and− keep records of their work.”

The standards are important as they help us todecide whether we should take action if someoneraises a concern about a registrant’s practice.More information about all of our standards canbe found on our website at https://www.hcpc-uk.org/standards/

We consider every case individually. However, aregistrant’s fitness to practise is likely to beimpaired if it appears that they have breached ourstandards by:

− being dishonest, committing fraud or abusingsomeone’s trust;

− exploiting a vulnerable person;− failing to respect service users’ rights to make

choices about their own care; − not managing health problems appropriately,

affecting the safety of service users; − hiding mistakes or trying to block our

investigation;− having an improper relationship with a service

user;− carrying out reckless or deliberately harmful acts;− seriously or persistently failing to meet

standards;− being involved in sexual misconduct or

indecency (including any involvement in childpornography);

− having a substance abuse or misuse problem; − have been violent or displayed threatening

behaviour; or− carrying out other equally serious activities

which affect public confidence in the profession.

We can also consider concerns about fraudulentor incorrect entry to the Register. For example, theperson may have provided false information whenthey applied to be registered. Or, otherinformation may have come to light since whichmeans that they were not eligible for registration.

What we cannot do We are not able to: − consider cases about professionals who are not

registered with us;− consider cases about organisations (we only

deal with cases about individual registrants); − get involved in clinical or social care

arrangements;− reverse decisions of other organisations or bodies;− deal with customer service issues;− get involved in matters which should be

decided upon by a court;− get a professional or organisation to change the

content of a report;− arrange refunds or compensation;− fine a professional;− give legal advice; or− make a professional apologise.



Further information about the types of concernswe considered and action taken is included inSection 4: Learning from fitness to practise cases.

What to expect Case managers keep everyone involved in thecase up to date with progress, informed of theprocess being followed and decisions beingmade. Case managers are neutral and do nottake the side of either the registrant or the personwho has made us aware of the concerns. Toensure decisions are made independently, HCPCemployees or Council members are not involvedin the decision-making process. This ensures thatwe balance the rights of the registrant against theneed to protect the public.

How to raise a concern If you would like to raise a concern about aprofessional registered with us, please write to usat the following address.

Fitness to Practise DepartmentHealth and Care Professions CouncilPark House184–186 Kennington Park RoadLondon SE11 4BU

If you need advice, or feel your concerns shouldbe dealt with over the telephone, you can contacta member of the Fitness to Practise Departmentby:

Tel +44 (0)20 7840 9814Freephone 0800 328 4218 (UK only)Fax +44 (0)20 7582 4874

For more information, including reporting aconcern visit http://www.hcpc-uk.org/complaints/raiseaconcern


Section 3: How we manage our cases

Section 3.1: Case assessment

We take a proportionate and risk-based approachwhen considering a registrant’s fitness to practise.

New concerns about a registrant’s fitness topractise that are raised with us are considered bythe Case Reception and Triage team. Theconcerns are assessed against our Standard ofAcceptance. For further information, please seeThe Standard of Acceptance for allegations policyand our Standard of acceptance explainedfactsheet on our website at www.hcpc-uk.org/publications/policy.

The policy also recognises that, while concernsare raised about only a small minority ofregistrants, investigating them takes a great dealof time and effort. It is important that ourresources are used effectively to protect thepublic and are not diverted into investigatingmatters which do not give cause for concern. Ifthe Standard of Acceptance is not met, even afterwe have sought further information, the case willbe closed. Where cases are closed we will,wherever we can, signpost complainants to otherorganisations that may be able to help with theissues they have raised.

Section 3.2: Investigating Committee panels Following our initial enquiries, if the Standard ofAcceptance is met, the case will be allocated to acase manager in our Investigations team. Theteam will gather evidence to make a fullassessment of the allegation. We will, as far as itis lawful to do so, share the evidence we haveobtained with the registrant under investigationand will ask for their observations. The casemanager will manage the case through to theInvestigating Committee Panel (ICP). The ICP willconsider the case and determine whether thecase should be closed at that stage. Or whetherthere is a case to answer and the case should bereferred for a hearing.

An ICP can decide that:

− more information is needed;− there is a case to answer (which means the

matter will proceed to a final hearing); or− there is no case to answer (which means that

the case does not meet the ‘realistic prospect’test).

ICPs meet in private to conduct a paper-basedconsideration of the allegation. Neither theregistrant nor the complainant appears before theICP whilst it decides whether or not there is acase to answer based on the documents beforeit. In considering whether there is a case toanswer, the burden of proof is upon us. The ICPapplies a ‘realistic prospect’ test. This makes surethat they are satisfied that there is a realisticpossibility that they will be able to prove thealleged facts. Based on those facts, the panelconsidering the case at a final hearing wouldmake one of the following conclusions.

− Those facts amount to the statutory ground (iemisconduct, lack of competence, physical ormental health, caution or conviction or adecision made by another regulator responsiblefor health and social care).

− The registrant’s fitness to practise is impaired byreason of the statutory ground.

Only in cases where the ‘realistic prospect’ test issatisfied in respect of all three relevant elements(facts, statutory ground(s) and impairment) canthe matter be referred to a final hearing. Panelsmust consider the allegation as whole.



Examples of case-to-answer and no case-to-answer decisions can be found in the sectionbelow.

In some cases there may be a realistic prospectof proving the facts. However, the panel mayconsider there is no realistic prospect of thosefacts amounting to the ground(s) of the allegation.Similarly, a panel may consider that there issufficient information to provide a realisticprospect of proving the facts and establishing theground(s) of the allegation but there is no realisticprospect of establishing that the registrant’sfitness to practise is impaired. This could be for anumber of reasons. For example, because theallegation concerns a minor and isolated lapsethat is unlikely to recur. Or there is evidence toshow the registrant has taken action to correctthe behaviour that led to the allegation beingmade, so there is no risk of repetition. Such casesmight result in a no case to-answer decision, andmight therefore not proceed to a final hearing. Weare required to assess these issues carefully on acase-by-case basis.

In no case-to-answer decisions, if matters arisewhich the panel want to bring to the attention ofthe registrant, the decision may include a learning

point. Learning points are general in nature andare for guidance only. They allow ICPs toacknowledge that a registrant’s conduct orcompetence is not to the standard expected.Learning points provide ICPs the opportunities togive advice on how the registrants can learn fromthe events.

Decisions by Investigating Committeepanels Each case will be considered on its own merit.Panel decisions will vary, depending on factorsincluding the factual circumstances of the case,behaviours demonstrated by the registrant andthe risk to the public. The following examplesdescribe the allegation and a brief rationale of thepanel’s decision.



Panel decision

Type of concern

Profession

Standard

No case to answer

Failure to provide adequate careA practitioner psychologist was alleged not to have correctly identified specific psychological issuesas a core component of a service user’s presenting problems. In consequence, they did notformulate a suitable treatment plan. It was also alleged that the registrant had neither informed theservice user’s GP that they were unable to treat these specific issues nor referred the service user toother appropriate professionals.

Practitioner psychologist

Standard of conduct, performance and ethicsStandard 1. Promote and protect interests of service users and carersStandard 2. Communicated appropriately and effectivelyStandard 3. Work within the limits of your knowledge and skillsStandard 6. Manage risk: Identify and minimise risk

Examples of decisions by the Investigating Committee Panel

Case study 1



Registrant’s response

Case study

Registrant responded and denied the allegations

As well as the registrant’s written response to the allegation, the Panel had the benefit of otherinformation gathered during the investigation. This included copies of GP referral letters, apsychiatrist’s report and correspondence between the professionals involved in the service user’streatment. As well as, together, with the registrant’s notes of their sessions with the service user anda report commissioned from a registrant assessor. Registrant assessors are experienced members ofthe registrant’s own profession. They are instructed by us to provide expert and independent adviceto ICPs where the matters being investigated are particularly complex.

The Panel noted that the registrant had denied the allegation, however considered other informationavailable to it. It was satisfied there was a realistic prospect of establishing the following. theregistrant had not identified the specific psychological issues as a core component of the serviceuser’s presenting problems. It was also satisfied that they had not maintained the required level ofcontact with the service user’s GP or with other professionals involved in the service user’s care. Insummary, the Panel concluded was that the case met the realistic prospect test in relation to thefacts of the allegation.

The Panel went on to consider the second strand of the test. Namely, whether there was a realisticprospect of the alleged facts being found to amount to the statutory ground, in this case ofmisconduct. In this regard the Panel considered the referral letters from the service user’s GP. Itnoted that the first referral letter, from a locum GP, had not been acknowledged by the registrant. Itscontent was not, subsequently, referenced by any of the other professionals involved in the serviceuser’s care. The second referral letter, which made no reference to the specific psychological issuesin dispute, was acknowledged by the registrant. The registrant denied receiving the first letter.



Case study (continued) The Panel noted that the registrant’s first appointment with the service user had been scheduled verypromptly after the second referral. In the Panel’s view, this gave weight to the conclusion that theregistrant had not received the first referral letter. They, therefore, would have been unaware of itscontent.

The Panel further noted that the registrant’s notes of the initial session with the service userconcentrated on a range of presenting psychological issues. They made only brief reference to thespecific issues set out in the allegation. The service user had four sessions with the registrant over asix-month period. During this time, the service user was seen by a psychiatrist. They, also, did notidentify the specific issues forming a central component of the service user’s presenting problems.

In considering the independent Registrant assessor’s report, the Panel found that this reached nofirm conclusion on whether the service user’s specific psychological issues were a centralcomponent of their presenting problems. The Panel took into account all of the available informationto make its decision. There was no information to suggest that the registrant ought to have identifiedthat the specific issues were a core component of their presenting problems. Accordingly, there wasa realistic prospect of establishing the alleged facts. However, there was no realistic prospect offinding that these facts amounted to misconduct.



Panel decision

Type of concern

Registrant’s response

Profession

Case to answer

Failure to provide adequate careA paramedic was alleged to have conducted incomplete assessments and provided inadequatetreatment to several service users over a twelve-month period. The alleged shortcomings in theregistrant’s practice ranged over a number of paramedic interventions. This included an inability tocannulate a service user and a failure to provide the same service user with oxygen, and notrecording a clear rationale where a decision had been taken not to take a service user to hospital.

Registrant responded and accepted some limited responsibility for inadequate standards of careprovided to these service users. However, they strongly denied most of the alleged facts. Where thefacts were admitted, the registrant denied that these were evidence of either misconduct or a lack ofcompetence.

Paramedic

Case study 2



Standard

Case study

Standard of conduct, performance and ethicsStandard 1. Promote and protect interests of service users and carersStandard 2. Communicated appropriately and effectivelyStandard 3. Work within the limits of your knowledge and skillsStandard 6. Manage risk: Identify and minimise risk

Standards of proficiency for paramedicsStandard 1. Be able to practise safely and effectively within their scope of practice Standard 4. Be able to practise as an autonomous professional exercising their professional judgement Standard 10. Be able to maintain records appropriatelyStandard 14. Be able to draw on appropriate knowledge and skills to inform practice

In their written response to the allegation, the registrant accepted limited responsibility for inadequatestandards of care provided to these service users. However, they strongly denied most of the allegedfacts. Where the facts were admitted, the registrant denied that these were evidence of eithermisconduct or a lack of competence.

The Panel noted that the registrant had made partial admissions to several of the alleged facts. ThePanel also gave due weight to documents provided by the ambulance service that employed theregistrant paramedic. This documentation included Patient Clinical Records (PCRs), completed bythe registrant, the outcome of a Training Needs Analysis and the report into the incidents, producedby the investigating officer appointed by the ambulance service.

The Panel weighed up the information provided by the ambulance service and the registrant’sresponse to the allegation. The Panel was satisfied that there was no realistic prospect of proving the



Case study (continued) alleged facts in respect of the allegation relating to one of the service users. It was clear from thedocumentation that responsibility for these shortcomings lay with another paramedic and not withthe registrant who was the subject of the allegation.

In relation to the greater part of the allegation, however, the Panel was able to conclude that therewas a realistic prospect of proving the facts. This was based on the registrant’s partial admission ofresponsibility, together with all the other information gathered during the investigation, that there wasa realistic prospect of proving the facts.

As it is required to do by law, the Panel then moved on to consider whether there was a realisticprospect that these facts would amount to one of the statutory grounds – in this case eithermisconduct or lack of competence. The Panel noted that the allegations related to several serviceusers and involved a number of serious clinical failings over a relatively short period of time. ThePanel recognised that these failings, if proved, could have put service users at serious risk of harm.Because of this, it determined that there was a realistic prospect that the alleged facts would amountto misconduct or lack of competence.

The Panel was next required to apply the same realistic prospect test. It questioned if the registrant’sfitness to practise was impaired (ie negatively affected) by a final hearing panel. Either by reason ofthe alleged misconduct or lack of competence. The Panel took into account the potentially seriousimpact the registrant’s alleged lack of competence or misconduct could have had on the serviceusers affected. It considered the allegation as a whole (ie the alleged facts, the statutory ground andthe question of impairment). Consequently, it concluded that there was a realistic prospect ofestablishing current fitness to practise impairment.



Section 3.3: Interim orders

In certain circumstances, panels of our PracticeCommittees may impose an interim suspensionorder or an interim conditions of practice order onregistrants who are subject to a fitness to practise(FTP) investigation. These interim orders preventthe registrant from practising, or places limits ontheir practice, while the investigation is ongoing.This power is used when it is necessary to protectthe public. For example, because if a registrantcontinued to practise they would pose a risk tothe public, or to him or herself. Panels will onlyimpose an interim order if they are satisfied thatthe public or the registrant involved requireimmediate protection. Panels will also considerthe potential impact on public confidence in theregularly process. They will determine whether aregistrant should be allowed to continue topractise without restriction whilst they are subjectto an allegation. An interim order may then beimposed in the public interest.

An interim order takes effect immediately and willremain until the case is heard or the order is liftedon review. The duration of an interim order is setby the panel, however it cannot last for more than18 months. If a case has not concluded before

the interim order expires, we must apply to therelevant court to have the order extended. In2017–18 we applied to the High Court to extendan interim order in 37 cases.

A Practice Committee panel may make an interimorder to take effect either before a final decision ismade about an allegation, or pending an appealagainst the decision.

In 2017–18, 164 applications were made forinterim orders, accounting for over 7 per cent ofthe cases received. The majority (141 cases, 86per cent) of those applications were granted and23 (14 per cent) were not. In 2016–17, a similarnumber of applications was made and 90 percent were granted (see Figure 12). Social workersin England and paramedics had the highestnumber of applications.

Our governing legislation says that we have toreview an interim order six months after it is firstimposed and every three months thereafter. Theregular review mechanism is particularly important.This is because an interim order will restrict orprevent a registrant from practising pending a finalhearing decision. Applications for interim orders areusually made at the initial stage of the investigation.

However, a registrant may ask for an order to bereviewed at any time if, for example, theircircumstances change or new evidence becomesavailable. An interim suspension order may bereplaced with an interim conditions of practice orderif the panel consider this will adequately protect thepublic. Equally, an interim conditions of practiceorder may be replaced with an interim suspensionorder. This is if the panel considers it to benecessary to protect the public, or an interim orderof either type may be revoked. In 2017–18 therewere seven cases where an interim order wasrevoked by a review panel.

We assess the risk of all concerns on receipt tohelp determine whether to apply for an interimorder. In 2017–18, the median time it took for apanel to consider whether an interim order wasnecessary was 14 weeks, from receipt of thecomplaint.

Not all interim order applications are madeimmediately on receipt of the complaint. It may bethat we receive insufficient information with theinitial complaint, or that during the course of theinvestigation the circumstances of the casechange. We assess the risk of new material as itis received throughout the lifetime of a case, to



decide if it indicates that an interim orderapplication is necessary.

In 2017–18, in cases where information appearedto pose a risk, the median time between receivingthe information and hearing an interim orderapplication by a panel was 20 days.

Figure 12 shows the number of interim orders byprofession and the number of cases where aninterim order has been granted, reviewed orrevoked. These interim orders are those soughtby us during the management of the case. It doesnot include interim orders that are imposed at finalhearings to cover the registrant’s appeal period.

Section 3.4: Public hearings

Cases where the Investigating Committee decidedthat there was a case to answer are referred to apanel of the Conduct and Competence Committeeor the Health Committee for consideration,depending on the nature of the allegation.

Most hearings are held in public, as required byour governing legislation, the Health and SocialWork Professions Order 2001. Occasionally ahearing, or part of it, may be heard in private in

Figure 12

Number of interim orders by profession

Profession


Total

Ordersrevoked on

review

0000000001200040

7

Ordersreviewed

05

11052

12220

465892

25142

0

340

Applicationsnot granted

00100010035002

101

23

Applicationsgranted

065033660

2713605

592

141

Applicationsconsidered

066033760

3018607

693

164



certain circumstances. If a registrant is registered orlives in the UK, we are obliged to hold hearings inthe UK country concerned. The majority ofhearings take place in London at our Health andCare Professions Tribunal Service offices. Whereappropriate, proceedings are held in locationsother than capitals or regional centres, for example,to accommodate attendees with restricted mobility.

Conduct and Competence Committee panelsConduct and Competence Committee panelsconsider allegations that a registrant’s fitness topractise is impaired by reason of misconduct, lackof competence, a conviction or caution for acriminal offence, or a determination by anotherregulator responsible for health or social care. Someallegations contain a combination of these reasons.

Misconduct The majority of cases heard at a final hearingrelate to allegations that the registrant’s fitness topractise was impaired by reason of theirmisconduct. Some of these cases relate toallegations about a lack of competence or aconviction. Some of the misconduct allegationsthat were considered included:

− failure to provide adequate service user care oraccurate assessment;

− failure to maintain accurate records;− failure to complete adequate reports; − dishonesty (eg falsifying records, fraud or false

claim of sick leave);− bringing profession into disrepute;− breach of confidentiality through inappropriate

use or misuse of patient information;− breach of professional boundaries with

colleagues, service users or service user familymembers;

− assault or abuse;− bullying and harassment of colleagues;− failure to report incidents;− driving under the influence of drink;− misrepresentation of qualifications and / or

previous employment;− failure to communicate properly and effectively

with service users and / or colleagues;− posting inappropriate comments on social media;− acting outside scope of practice; and− unsafe clinical practice.

Lack of competence In 2017–18, lack of competence allegations weremost frequently cited as the reason for aregistrant’s fitness to practise being impaired afterallegations of misconduct. This is consistent withprevious years.

Some of the lack of competence allegations weconsidered included:

− a failure to provide adequate service user care;− inadequate professional knowledge; and− poor record-keeping.

Convictions / cautionsCriminal convictions or cautions were the thirdmost frequent grounds of allegation consideredby panels of the Conduct and CompetenceCommittee in 2017–18. These allegations eitherrelated solely to the registrants’ conviction(s) orcaution(s) or were “composite” allegations, in thatthey also covered other matters amounting toanother statutory ground, for example,misconduct.

Some of the criminal offences considered included:

− theft;− fraud;− shoplifting;− possession of drugs and / or possession of

drugs with the intent to supply;− receiving a restraining order and breach of a

restraining order;− driving under the influence of alcohol;− failure to provide a specimen;



− assault (common or by beating);− possession of pornographic images; and− sexual offences.

More details about the decisions made by theConduct and Competence Committee can befound at www.hcpts-uk.org. Case studies,including examples of how some of the aboveconcerns, were considered at the hearing and thesanction that resulted, can be found in Section 4:Learning from fitness to practise cases.

Health Committee panelsPanels of the Health Committee considerallegations that registrants’ fitness to practise isimpaired by reason of their physical and / ormental health. Many registrants manage a healthcondition effectively and work within anylimitations their condition may present. However,we can take action when the health of a registrantis considered to be affecting their ability topractise safely and effectively.

Our presenting officer at a Health Committeehearing will often make an application forproceedings to be heard in private. Sensitivematters regarding registrants’ ill-health are often

discussed and it may not be appropriate for thatinformation to be discussed in a public session.

The Health Committee considered 17 cases in2017–18. This is slightly more than the 13 casesin 2016–17. For further information aboutoutcomes please refer to Figure 6.

Preliminary hearingsPanels have the power to hold preliminaryhearings in private with the parties involved for thepurpose of case management. Such hearingsallow for substantive evidential or proceduralissues to be resolved (by a panel direction) prior tothe final hearing taking place. For example todecide on the use of expert evidence or theneeds of a vulnerable witness. This helps finalhearings to take place as planned. In 2017–18,59 preliminary hearings were held, compared to89 in 2016–17. This represents a decrease, giventhat there were a similar number of final hearings.

AdjournmentsIn certain circumstances hearings can beadjourned in advance of the event. Other than inexceptional circumstances, applications shouldbe made no later than 14 days before the hearing.

Hearings that commence but do not conclude inthe time allocated are classed as part heard.

The powers panels have and how decisionsare madePanels carefully consider the individualcircumstances of each case and take intoaccount what has been said by all parties involvedbefore making any decision.

Panels must first consider whether the facts ofany allegations against a registrant are proven.They then have to decide whether, based uponthe proven facts, the statutory ‘ground’ set out inthe allegation has been established. For example,if misconduct or lack of competence has beenestablished. And, if, as a result, the registrant’sfitness to practise is currently impaired.

If the panel is satisfied that an allegation against aregistrant is well founded, it has the power to referthe matter to meditation. This is the processwhere an independent person helps the registrantand the other people involved to agree on asolution to issues. It can also decide, instead, thatit is not appropriate to take any further action.



In cases which are not appropriate for mediation,but require further action, the panel then has aduty to:

− caution the registrant (place a warning on theirregistration details for between one to five years);

− impose conditions on a registrant’s practice;− suspend the registrant from practising; or− strike the registrant’s name from the Register,

which means they cannot practise.

In some exceptional cases there is a singlestatutory ground, either of health or lack ofcompetence referred to in the allegation. In thosecases, the panel does not have the option to makea striking-off order in the first instance. This isbecause it is recognised that in cases where illhealth has impaired fitness to practise, or wherecompetence has fallen below expected standards,it may be possible for the registrant to remedy thesituation over time. The registrant may be given theopportunity to seek treatment or training.Consequently, they may be able to return topractice if a panel is satisfied that it is a safe option.

Making decisions – Health and CareProfessions Tribunal Service (HCPTS)Independent panel members of our PracticeCommittees7 make decisions about our cases.

Panel members are drawn from a wide variety ofbackgrounds, including professional practice,education and management. Each panel has atleast one lay member and one registrant member.Lay panel members are individuals who are not,and have never been, eligible to be on the HCPCRegister. The registrant panel member will be fromthe relevant profession. This ensures that we haveappropriate public and professional input in thedecision-making process.

A legal assessor will be present at everysubstantive hearing before a Conduct andCompetence Committee panel or a HealthCommittee panel. They do not take part in thedecision-making process, but will give the paneland the others involved, advice on law and legalprocedure. They ensure that all parties are treatedfairly. Any advice given to panels is stated in thepublic element of the hearing.

Disposal of cases by consent Our consent process is a means by which we,and the registrant concerned, may seek toconclude a case without the need for a contestedhearing. In such cases, both parties consent toconclude the case by agreeing an order. Theorder is of a type that the panel would have beenlikely to make had the matter proceeded to a fully

contested hearing. Both parties may also agree toenter into a Voluntary Removal Agreement. ByVoluntary Removal Agreement, we allow theregistrant to remove themselves from theRegister. This is on the basis that they no longerwish to practise their profession and admit thesubstance of the allegation that has been madeagainst them. Voluntary Removal Agreements aremade on similar terms to those that apply when aregistrant is struck off the Register.

Cases can only be disposed of in this mannerwith the authorisation of a panel of a PracticeCommittee.

In order to ensure that we fulfil our obligation toprotect the public, neither us nor a panel wouldagree to resolve a case by consent unless wewere satisfied that:

− public protection was being secured properlyand effectively; and

− there was no detrimental effect on the widerpublic interest.

7 Information about Practice Committees can be found inthe Health and Social Work Professions Order 2001 athttps://www.hcpc-uk.org/resources/legislation/orders/consolidated-health-and-social-work-professions-order-2001/



To ensure a panel can decide this, evidence ispresented to demonstrate that the registrantunderstands the impact on their registration if theyagree to a sanction. We will only considerresolving a case by consent:

− after an ICP finds that there is a case to answer,so that a proper assessment has been made ofthe nature, extent and viability of the allegation;

− where the registrant is willing to admit thesubstance of the allegation (a registrant’s insightinto, and willingness to address failings are keyelements in the FTP process and it would beinappropriate to dispose of a case by consentwhere the registrant denies liability); and

− where any remedial action agreed between theregistrant and us is consistent with theexpected outcome if the case was to proceedto a contested hearing.

The process of disposal by consent may also beused when existing conditions of practice ordersor suspension orders are reviewed. This enablesorders to be varied, replaced or revoked withoutthe need for a contested hearing.

In 2017–18, 37 cases were concluded via ourconsent arrangements at final hearing. This is thesame number as in the last two years.

Further information on the process can be foundin the practice note Disposal of cases by consentat www.hcpts-uk.org

Discontinuance Following the referral of a case for hearing by theInvestigating Committee, it may becomenecessary for us to apply to a panel todiscontinue all or part of the case. This may occurwhen new evidence becomes available. Or,because of emerging concerns about the qualityor viability of the evidence that was considered bythe Investigating Committee. We provide thepanel with a summary of what has changedduring the course of the investigation. This meansthat the case is no longer as we originallyunderstood, or how new or additional evidencehas emerged.

In 2017–18, allegations were discontinued in full innine cases. This is a decrease from 32 in 2016–17.

Attendance at hearing All registrants have the right to attend their final hearing. Some attend and representthemselves, whilst others bring a union orprofessional body representative or haveprofessional representation, for example a solicitor or counsel.

Some registrants choose not to attend, but theycan submit written representations for the panelto consider in their absence.

We encourage registrants to participate in theirhearings where possible. We make informationabout hearings and our procedures accessibleand transparent. This is to maximise participationand to ensure that any issues that may affect theorganisation, timing or adjustments can beidentified as early as possible. Ourcorrespondence sets out the relevant parts of ourprocess and includes guidance. We also producepractice notes, which are available online,detailing the process and how panels makedecisions. This allows all parties to understandwhat is possible at each stage of the process.

Panels may proceed in a registrant’s absence ifthey are satisfied that we have properly servednotice of the hearing and that it is just to do so.

Panels must not draw any improper inferencefrom the fact that a registrant has failed to attendthe hearing. In particular, they must not treat theregistrant’s absence as an admission that thecase against them is well founded. Panels willreceive independent legal advice from the legalassessor when choosing whether or not to



proceed in the absence of the registrant. Thepanel must be satisfied that in all circumstances itwould be appropriate to proceed in theregistrant’s absence. The practice noteProceeding in the absence of the registrantprovides further information and is available atwww.hcpts-uk.org

Suspension and conditions of practicereview hearingsAll suspension and conditions of practice ordersmust be reviewed by a panel before they expire. Areview may also take place at any time, at therequest of the registrant concerned or by us.

Registrants may request reviews if, for example,they are experiencing difficulties complying withconditions imposed or if new evidence relating tothe original order comes to light.

We can also request a review of an order if, forexample, we have evidence that the registrantconcerned has breached any condition imposedby a panel.

In reviewing a suspension order, the panel willconsider evidence and decide whether the issuesleading to the original order have been addressed.If the panel feels satisfied that they have been, it

will consider whether the overriding objective ofpublic protection can be met without the order.

If a review panel is not satisfied that the registrantconcerned is fit to practise, it may:

− extend the existing order; or− replace it with another order.

In 2017–18 we held 272 review hearings.

Restoration hearingsA person who has been struck off our Registerand wishes to be restored, can apply forrestoration under Article 33(1) of the Health andSocial Work Professions Order 2001.

A restoration application cannot be made until fiveyears have elapsed since the striking-off ordercame into force. In addition, if a restorationapplication is refused, a person may not makemore than one application for restoration in anytwelve-month period.

In applying for restoration, the burden of proof isupon the applicant. This means that the applicantneeds to prove that he or she should be restoredto the Register, but we do not need to prove thecontrary. The procedure is generally the same as

other FTP proceedings. However, in accordancewith the relevant procedural rules, the applicantpresents their case first, after which, ourpresenting officer makes submissions.

If a panel grants an application for restoration, itmay do so unconditionally or subject to theapplicant:

− meeting our ‘return to practice’ requirements; or− complying with a conditions of practice order

imposed by the panel.

In 2017–18, seven applications for restorationwere heard. Of these, four were restored – oneparamedic, one chiropodist and one socialworker. Three applicants were not restored – onesocial worker and two physiotherapists.

More information about the HCPTS can be foundon our website www.hcpts-uk.org.


Section 4: Learning from fitness to practise cases

Through our fitness to practise (FTP) process wecapture and analyse data to identify trends,forecast levels of activity at various stages orgather intelligence. It gives us, and ourstakeholders, an opportunity to learn andimprove.

Cases closed without consideration by anInvestigating Committee panel (ICP)Figure 13 shows patterns of referral, acrossprofessions for cases that are closed withoutconsideration by an ICP. For instance, socialworkers are the largest profession on the Registerand have the most concerns raised about them.This profession also had the largest number ofcases that are raised by members of the public(63 per cent). Equally, however, it had the largestnumber of cases that were closed because theconcerns did not meet the Standard ofAcceptance.

Physiotherapists are the second largestprofession, yet have a much lower rate ofconcerns raised than paramedics, or socialworkers in England. They also have a lower rateof closure as a result of the Standard ofAcceptance not being met.

Figure 13

Cases closed by profession before consideration at ICP

Profession

Arts therapistsBiomedical scientistsChiropodists / podiatristsClinical scientistsDietitiansHearing aid dispensersOccupational therapistsOperating department PractitionersOrthoptistsParamedicsPhysiotherapistsPractitioner psychologistsProsthetists / orthotistsRadiographersSocial workers in EnglandSpeech and language therapists

Total

% of total cases2016–17

0.30.92.50.20.7

13.21.70.1

11.57.77.40.12.7

58.71.2

100

Number ofcases

2016–17

617474

131960311

214142137

150

1,08923

1,854

Number ofcases

2017–18

718382

161048231

17087

1040

3167318

1,246

% of total cases 2017–18

0.61.43.00.21.30.83.91.80.1

13.67.08.3

02.5

54.01.4

100



Paramedics have the second largest number ofconcerns raised and are the fifth largestprofession overall. This group also has the secondhighest number of cases closed because of afailure to meet the Standard of Acceptance.

ICP decisions and how registrants wererepresentedFigure 14 provides information on case-to-answerand no case-to-answer decisions andrepresentations received in response toallegations. In 2017–18, there was an increase inrepresentations being made to the ICP by eitherthe registrant or their representative.Representations were made in 76 per cent of thecases considered compared to 74 per cent in2016–17.

A total of 100 cases considered by ICPs resultedin a no case-to-answer decision. In 98 per cent ofthose cases, representations were made either bythe registrant or the representative.

Figure 14

Response to allegations provided to ICP

40

60

20

0

80

100

120

140

160

180

200

Registrant Representative None

Case to answer No case to answer



ICP case-to-answer decisions bycomplainant Figure 15 shows the number of case-to-answerdecisions by complainant type. There continuesto be differences in the case-to-answer rate,depending on the source of the complaint.

Like the previous year, out of cases concluded atICP, the largest complainant group was made upof employers. A case-to-answer decision wasmade in a significant proportion of those cases(82 per cent, compared to 78 per cent in theprevious year). The case-to-answer rate for thesecond largest complainant group (members ofthe public) has gone up to 63 per cent from 47per cent in 2016–17.

Final hearing outcome by professionFigure 16 shows the full range of decisions madeat final hearings in relation to the differentprofessions we regulate. In some cases, therewere more than one allegation against the sameregistrant. The table sets out the sanctionsimposed per case, rather than by registrant. Thesanctions of ‘consent – removed’ and ‘consent –conditions of practice’ are those where theregistrant consented to the sanction.

Figure 15

ICP decisions by complainant

Complainant

Article 22(6) / AnonEmployerOtherOther registrant / ProfessionalPoliceProfessional bodyPublicSelf-referral

Total

% case toanswer

2016–17

837862368850476671

7

% case toanswer

2017–18

758282

100800

6376

79

Total 2017–18

8276224

100

35120

475

Number ofno case to

answer2017–18

2504020

1329

100

Number ofcase toanswer

2017–18

622618480

2291

375

Figure 16

Sanctions imposed by profession



Profession


Total

Total

01713259

20201

6024131

18222

7

432

Consent -suspension

0000000000000000

0

Consent –conditions

0000000000000010

1

Consent –caution

0000000000000010

1

Consent –removed

01001152061102

123

35

Suspended

04302355174107

530

95

Struck off

063102090

107312

480

92

Not wellfounded

042001610

195202

501

93

No furtheraction

0010011003300040

13

Conditionsof practice

01201131053301

263

50

Caution

012110020

101304

270

52



Final hearing outcome and how registrantswere representedIn 2017–18, 19 per cent of registrantsrepresented themselves. A further 35 per centchose to be represented by a professional, aslight decrease from 37 per cent from 2016–17.Of those who were represented by a professional,most attended with that representative. We meetwith the various registrant representative bodiesand share this data with them. This is to help toprovide more insight. We also encourage theregistrants to seek representation early in theprocess. This is part of our regular communicationabout the investigation and to schedule a hearing.

Registrants did not attend and were notrepresented in 47 per cent of final hearings. Thiscompares to 49 per cent in 2016–17 (see Figure17). It is positive when more registrants areengaging in the FTP process.

Figure 18 details outcomes of final hearings andwhether the registrant attended alone, with arepresentative, or was absent from proceedings.Sanctions that prevent the registrant from workingare imposed less often in cases where a registrantattends or is represented, than in other cases.

Figure 17

Representation at final hearings

50

75

25

0

100

2016–17 2017–18

Registrant Registrant attended and had a representative

None Registrant did not attend but had a representative

Year

%



Figure 18

Sanctions imposed by panels and representation at final hearings

2016–17 2017–18

CautionConditionsNo Further ActionWell founded Not well foundedRegister entry amended – removedStruck offSuspendedConsent – removedConsent – cautionConsent – suspensionConsent – conditions

Total

Representedself

17920

2706

162000

79

Registrantattended and had

a representative

262974

501

10160001

144

Registrant did notattend but had a

representative

320000112000

9

Norepresentation

61000

160

746231100

200

Total

525094

931

919535101

432

Representedself

9431

2206

181000

64

Registrantattended and had

a representative

222631

630

14200100

150

Registrant did notattend but had a

representative

120040213001

14

Norepresentation

3621

280

707627301

217

Total

353883

1170

9211531402

445



Figure 19 shows the number of registrants fromeach profession who were represented at hearings in2017–18. This is broken down to those who either:

− represented themselves, with no representativeattending;

− those who attended the hearing with arepresentative; or

− the representative attending on the registrants’behalf.

Paramedics and social workers in England had thehighest number of cases that went to a hearing.Forty-nine per cent of social workers and 70 percent of paramedics represented themselves, camewith a representative or a representative acted ontheir behalf. Twenty-seven per cent of socialworkers in England and 50 per cent of paramedicshad a representative attend the hearing on theirbehalf (either with or without the registrant).

Final hearing outcome by source of complaintSimilar to the previous year, employers were thecomplainant in 63 per cent of the cases heard.Members of the public were the complainant ineight per cent. The most commonly imposedsanction was a suspension order (in 95 matters)and employers were the complainant in 73 per centof those cases.

Figure 19

Representation at final hearings by profession

Profession

Arts therapistsBiomedical scientistsChiropodists / podiatristsClinical scientistsDietitiansHearing aid dispensersOccupational therapistsOperating department PractitionersOrthoptistsParamedicsPhysiotherapistsPractitioner psychologistsProsthetists / orthotistsRadiographersSocial workers in EnglandSpeech and language therapists

Total

Registrantattended

and had arepresentative

057222950

29111003

563

144

Representedself

021001230

121207

471

79

Registrant didnot attend but had a

representative

0000101001000150

9

Norepresentation

01050268

121

1812117

1143

200

Total

01713259

20201

6024131

18222

7

432



Figure 20

Sanctions imposed by who the complainant was

Outcome

CautionConditions of practiceNo Further ActionNot Well Founded / DiscontinuedRemovedRemoved by ConsentConsent – cautionConsent – conditions of practiceStruck offSuspensionWell-foundedNot impaired

Total

Total

52508

931

3511

919541

432

Self-referral

1981

130900

152011

87

Public

152803004400

27

Professionalbody

201100001100

6

Police

20020000

10000

14

Otherregistrant

110200000000

4

Other

110410005000

12

Employer

25344

610

2311

537030

275

Article22(6)/Anon

110200003000

7

Fifty per cent of the matters self-referred by registrantsresulted in a sanction being imposed that preventedthem from practising. This was the case in 53 per centof cases involving concerns raised by employers and in40 per cent of matters involving concerns received frommembers of the public (see Figure 20).



Cases not well founded at hearingsThe panel may decide that the allegations are ‘notwell founded’, in which case there will be norestrictions imposed on the registrant’s practice.This will happen, for example, in cases where, atthe hearing, the panel does not think that thefacts have been proved to the required standard.Or the panel concludes that, even if the facts areproved, they do not amount to the statutoryground (eg misconduct) or show that fitness topractise is impaired. In that event, the hearingconcludes and no further action is taken. In2017–18 the panel concluded that 93 cases werenot well founded at the final hearing.

We continue to monitor these cases to ensurethat we maintain a high standard of quality forallegations and investigations. ICP membersreceive regular refresher training on the case-to-answer stage. The training helps to ensure thatonly cases meeting the realistic prospect test, asoutlined in Section 3.2, are referred to a finalhearing. Figure 21 sets out the number of casesthat were not well founded between 2012–13 and2017–18.

In 31 of the 93 cases (33 per cent) which werenot well founded, registrants demonstrated that

Figure 21

Cases not well founded at hearings

Year

2012–132013–142014–152015–162016–172017–18

Number of notwell founded and

discontinued infull cases

54607584

11793

Total number ofconcluded cases

228269351320445432

% of cases notwell founded

23.722.321.426.326.321.5



their fitness to practise was not impaired. The testfor panels to apply is that current fitness topractise is impaired. It is based on a registrant’scircumstances at the time of the hearing. Ifregistrants are able to demonstrate insight andcan show that any shortcomings have beenremedied, panels may not find current fitness topractise impaired.

In some cases, even though the facts may bejudged to amount to the statutory ground in theallegation (eg misconduct or lack of competence),a panel may not be persuaded that misconduct,or lack of competence, as the case may be, hasled to any current impairment of the registrant’sfitness to practise. For example, this may happenif an allegation was minor or concerns an isolatedincident that is unlikely to reoccur. In 40 of thecases (43 per cent) which were not well founded,the panel concluded that the statutory grounds (ofmisconduct, lack of competence or health) werenot met.

In other cases, the facts of an allegation may notbe proved to the required standard (ie on thebalance of probabilities). In 2017–18, seven caseswere not well founded because the facts were not

proved. The remainder of these not well-foundedcases were either discontinued in full or wesubmitted at the hearing that there was no caseto answer. We review any cases that are not wellfounded on facts to explore if an alternative formof disposal would have been appropriate. Wecontinue to monitor the levels of not well-foundedcases. This is to ensure that we are utilising ourresources appropriately, and that we minimise theimpact of public hearings on the parties involved.This work has resulted in a lower proportion ofcases not well founded at hearings this yearcompared to the previous years.

Nature of concerns We develop our tools for capturing information,which may provide useful learning points aboutthe nature of concerns. We are currentlydeveloping a case classification policy to enableus to capture information about the nature ofconcerns more consistently and at the key pointsin the life cycle of cases.

The most frequent concerns considered at finalhearings are listed in Section 3.4: Public hearings,and some example case studies below. The casestudies cover different professions and reference

our standards of conduct performance and ethicsand standards of proficiency. They showexamples of behaviour that fell below ourstandards and the measures panels took toprotect the public. We hope these are useful forregistrants to understand the type of conduct thatcould lead to proceedings and for the public tounderstand the types of concerns that progressto a hearing.



Type of concern

Profession

Standard

Case study

Bringing profession into disrepute / inappropriate comments on social media

Paramedic

Standards of conduct, performance and ethics (updated in August 2012)Standard 3. You must keep high standards of personal conductStandard 13. You must behave with honesty and integrity and make sure that your behaviour doesnot damage the public’s confidence in your profession

A paramedic self-referred after he posted inappropriate comments on social media, which causedhis employer to suspend him. A Conduct and Competence Committee panel considered theallegation against the registrant, who attended the hearing and was represented. The registrantadmitted all of the facts of the allegation.

The Panel found some of the facts proved amounted to misconduct. The posts were on a publicsocial media page and the registrant had included details of his employer. They felt the inflammatoryand offensive posts on social media could damage the public’s perception of the profession. ThePanel found that the registrant demonstrated insight, remorse and remediation. The Panel felt that

Examples of the most frequent concerns and sanctions at final hearings

Case study 1



Case study (continued)

Measures we put in place to protect the public

there was a low risk of the incident being repeated. However, in considering the public interest thePanel felt that a finding of impairment was necessary to maintain confidence in the profession andthe regulator.

The Panel wanted to send a clear message to the public and other health professionals that offensiveand inflammatory language towards others would not be tolerated. The Panel then went on toconsider sanctions. They decided that, because of the strong mitigating factors in this case, theimposition of a caution order was proportionate. The Panel struck a proper balance between theneed to mark the gravity of the registrant’s actions, whilst recognising the long and unblemishedcareer, and personal, exceptional mitigation.

The Conduct and Competence Committee Panel imposed a twelve-month caution order.



Type of concern

Profession

Standard

Failure to provide adequate care

Paramedic

Standards of conduct, performance and ethics (updated in January 2016)Standard 3. Work within the limits of your knowledge and skillsStandard 6. Manage riskStandard 10. Keep records of your work

Standards of proficiency for paramedics (updated in August 2014)Standard 1. Be able to practise safely and effectively within their scope of practiceStandard 2. Be able to practise within the legal and ethical boundaries of their profession Standard 3. Be able to maintain fitness to practiseStandard 4. Be able to practise as an autonomous professional exercising their own professionaljudgement Standard 8. Being able to communicate effectivelyStandard 10. Being able to maintain records appropriatelyStandard 14. Being able to draw on appropriate knowledge and skills to inform practiceStandard 15. Understand the need to establish and maintain a safe practice environment

Case study 2



Case study


A paramedic self-referred with an allegation that he carried out inadequate assessments. He failed tomeet Clinical Performance Indicators, and failed to take a patient to the hospital who was complainingof chest pains. The registrant had not recorded the reason why he left the patient at home. Followinganother call to emergency services, the registrant attended with a second crew who found the patientunconscious. The patient subsequently passed away.

The Panel found that these actions amounted to misconduct. The Panel took into account that, whilstthis was an isolated incident, it was a serious issue. The Panel was of the opinion that the registrant hadbreached core tenets of the profession and had put the patient at ‘unwarranted harm’. Whilst theregistrant had provided submissions at the ICP stage expressing some remorse for what hadhappened to the patient, he had stopped engaging with the fitness to practise process from thenonwards.

The registrant was an experienced paramedic and formerly a team leader. In his earlier submissions, heexplained that he was no longer working in the profession and expressed a desire to retire frompractice. Therefore, the Panel had no up-to-date information to demonstrate whether the registrant hadshown insight, or that they were capable of remedying the failures. The Panel was not confident as towhether the registrant was currently in employment. In addition, the registrant was previously subject toFTP proceedings in 2014.

The Panel found that the registrant had not learnt from that experience and that his intention to retirefrom practice demonstrated an unwillingness to resolve any deficiencies in his practice. The Panel tookinto account the seriousness of the incident. It also considered the effect on public confidence in theprofession, and the regulatory body, when making its decision to strike the registrant from the Register.

The Conduct and Competence Committee Panel imposed a striking-off order.



Type of concern

Profession

Standard

Breach of confidentiality

Social worker

Standards of conduct performance and ethics (updated in January 2016)Standard 1. Promote and protect the interests of service users and carersStandard 1.1. You must treat service users and carers as individuals, respecting their privacy anddignityStandard 5. Respect confidentialityStandard 5.1. You must treat information about service users as confidentialStandard 9. Be honest and trustworthyStandard 9.1. You must make sure that your conduct justifies the public’s trust and confidence in youand your professionStandard 10. Keep records of your workStandard 10.3. You must keep records secure by protecting them from loss, damage orinappropriate access

Case study 3



Case study


A social worker’s employer raised concerns with us after the registrant left a notepad containingconfidential information, pertaining to a number of service users, at the home address of a serviceuser. Despite being aware that the notepad contained confidential information, the registrant did notrecover the notepad in a timely manner.

The registrant represented himself at the hearing and attended via telephone. The Panel found thatbecause the registrant did not recover the notebook on the same day he realised he had left it, hehad compromised the confidentiality of the information in the notebook. It also breached the right toprivacy of service users and their families. This included highly sensitive contact and personal detailsof vulnerable families and an adoption placement.

The Panel had no doubt that the registrant’s actions demonstrated a failing so serious as toconstitute misconduct. The Panel heard the registrant’s account of changes he made in his practice.This ensures that matters of the kind found proved would not be repeated. The Panel recognisedthat the event was an isolated incident in a 30-year career. However, maintaining confidentiality is afundamental requirement for social workers. Therefore, the Panel felt that members of the publicwould be concerned to learn of this breach of confidentiality by an experienced social worker.

Accordingly, the Panel concluded that public confidence in the profession would be undermined if afinding of impairment was not made. The Panel decided that although they felt the risk of repetitionwas low, the seriousness of the misconduct needed to be marked by an appropriate sanction. Thiswas to send a clear message to social workers and the public that such conduct is unacceptableand must not be repeated. The Panel decided to impose a twelve-month caution order.

The Conduct and Competence Committee imposed a twelve-month caution order.



Type of concern

Profession

Standard

Failure to maintain adequate records

Occupational therapist

Standards of conduct, performance and ethics (updated in August 2012)Standard 1. You must act in the best interests of service users. (…) You are responsible for yourprofessional conduct, any care or advice you provide, and any failure to act. (…) You must protectservice users if you believe that any situation puts them in dangerStandard 7. You must communicate properly and effectively with service users and otherpractitionersStandard 10. You must keep accurate records

Standards of proficiency for occupational therapists (updated in March 2013)Standard 2.8. Be able to exercise a professional duty of careStandard 4.2. Be able to make reasoned decisions to initiate, continue, modify or cease treatment orthe use of techniques or procedures, and record the decisions and reasoning appropriatelyStandard 4.4. Recognise that they are personally responsible for and must be able to justify theirdecisionsStandard 4.5. Be able to make and receive appropriate referralsStandard 9.10. Be able to work in appropriate partnership with service users in order to evaluate theeffectiveness of occupational therapy intervention

Case study 4



Case study An occupational therapist’s employer raised concerns relating to their clinical practice and conduct,following a number of incidents relating to nine different cases. The concerns included a failure tomaintain adequate case files; not completing case notes about contacts with service users,assessment reports and care plans.

The registrant was not present at the hearing nor was represented. The Panel found that theregistrant had breached significant parts of the standards. In addition, incidents involved in theallegation related to vulnerable service users in complex and / or urgent cases. The Panel concludedthat the proven facts did not amount to a lack of competence, as it was not satisfied that theallegation represented a fair sample of the registrant’s work. It also found that the registrantcompetently dealt with other cases. However, having proven some of the facts the Panel determinedthat the matters constituted misconduct.

The Panel felt that the registrant was aware of the risks and the impact on vulnerable services usersof not recording her actions and decisions. They agreed that the registrant displayed a recklessdisregard for the risk in failing to record her actions and decisions about service users. The Panelfound that the registrant’s failings were remediable, but had no evidence of any steps the registranthad taken to address the failings. The Panel reached the view that the registrant had notdemonstrated insight or remorse, and posed a risk of repetition. The Panel considered that a findingof impairment was necessary in order to protect members of the public, to uphold proper standardsand to protect the reputation of the profession and the regulator.

The Panel then went on to consider which sanction to impose to protect the public. It identifiedaggravating and mitigating factors, and considered the sanctions available to them in ascendingorder. It noted that there was nothing that may have prevented the registrant from remedying theirfailings and concluded a suspension order was appropriate in this case. The Panel was of the viewthat a period of six months would be appropriate and proportionate to protect the public, to satisfy





the wider public interest and to allow the registrant an opportunity to demonstrate full insight andremediate her failings.

The Conduct and Competence Committee imposed a twelve-month caution order.



Type of concern

Profession

Standard

Failure to provide adequate care

Social worker

Standards of conduct, performance and ethics (updated in August 2012)Standard 1. You must act in the best interests of service usersStandard 6. You must act within the limits of your knowledge, skills and experience and, if necessary,refer the matter to another practitioner

Standards of proficiency – social workers in England (updated in January 2017)Standard 1. Be able to practise safely and effectively within their scope of practiceStandard 1.1. Know the limits of their practice and when to seek advice or refer to anotherprofessionalStandard 1.3. Be able to undertake assessments of risk, need and capacity and respondappropriatelyStandard 2. Be able to practise within the legal and ethical boundaries of their professionStandard 2.2. Understand the need to promote the best interests of service users and carers at alltimesStandard 2.3. Understand the need to protect, safeguard and promote the wellbeing of children,young people and vulnerable adults

Case study 5



Case study


A social worker’s employer raised a concern that the registrant acted beyond his scope of practice.The registrant did not record or undertake an assessment about the impact of legal proceedings onthe service user’s physical or mental wellbeing. This was whilst he was the service user’s designatedcare coordinator.

The registrant attended the hearing and was represented. The Panel found that the registrant’sconduct fell short of the standards expected of a social worker. His proactive engagement in theservice user’s legal proceedings gave the service user false hope, despite being aware that a legalrepresentative had advised them on a number of occasions that their claim had no realistic prospectof success. As a consequence, the Panel felt the registrant put the service user at risk of financialloss as they were made subject to an order for costs.

The registrant’s use of company letter-headed paper to correspond on behalf of the service usergave the impression that he was acting on behalf of the service user in his capacity as a socialworker, making his employer susceptible to reputational damage. The Panel also found that by notconducting a sufficiently analytical and comprehensive mental health assessment of the vulnerableservice user, the registrant was in breach of our standards.

The Panel felt that although misconduct of this nature could be remedied, the registrant was lackinginsight and unable to demonstrate effective remediation. The Panel also felt that the public wouldexpect a registered social worker to follow accepted practices. The Panel felt they should act onlywithin the scope of their practice. The Panel decided that a suspension order was sufficient andnecessary to protect the public in the view of the registrant’s lack of insight and remediation.

The Conduct and Competence Committee imposed a twelve-month suspension order.



Type of concern

Profession

Standard

Case study

Inappropriate relationship with patient

Psychologist

Standards of conduct, performance and ethics (updated in August 2012)Standard 1. You must act in the best interest of service usersStandard 3. You must keep high standards of personal conductStandard 13. You must behave with honesty and integrity and make sure your behaviour does notdamage the public’s confidence in you or the profession

A psychologist’s employer raised concerns that the registrant had taken a service user on a tripinvolving an overnight stay in a shared hotel room, bought the service user alcohol and appeared tobe under the influence of alcohol in the presence of the service user.

The registrant was present and represented at the final hearing. The Panel was in no doubt that therewas an intimate relationship between the registrant and the service user. The Panel was, also, in nodoubt that the boundaries of the personal and professional relationship were blurred between theregistrant and service user. The Panel found that the failure of the registrant to maintain appropriateboundaries was serious and amounted to misconduct. During the registrant’s evidence, the Panel feltthat the registrant still did not fully understand the extent of the risks and danger that her actions

Case study 6





caused to the service user and the risks other members of the public were exposed to. Therefore,the registrant had not demonstrated full insight.

The Panel felt that the public, knowing the facts and findings in this case, would have great concern.Their confidence in the profession would be undermined if they did not find that the registrant’s fitnessto practise was impaired. The Panel decided that the issues identified were capable of correction.There was no persistent or general failure which would prevent the registrant from doing so. Therefore,the Panel felt a conditions of practice order to be a proportionate and appropriate response to therisks identified. The Panel felt that this would provide sufficient protection to the public.

The Conduct and Competence Committee imposed a twelve-month conditions of practice order.



Type of concern

Profession

Standard

Case study

Failure to maintain adequate records

Dietician

Standards of proficiency for dietitians (updated in March 2013)Standard 1. Be able to practise safely and effectively within their scope of practiceStandard 8. Be able to communicate effectivelyStandard 10. Be able to maintain records appropriatelyStandard 11. Be able to reflect on and review practiceStandard 12. Be able to assure the quality of their practiceStandard 14. Be able to draw on appropriate knowledge and skills to inform practice

A dietitian’s employer raised concerns about their clinical practice and conduct, following a numberof incidents relating to six different service users. This included a failure to record sufficient details ofdietetic assessments, failure to address the needs of a service user adequately and failure to makethe necessary referrals within a reasonable timeframe.

The registrant was not present at the hearing nor was represented. The Panel considered that theshortcomings occurred during a period when additional supervision and support for the registranthad been put in place. The evidence given suggested that the registrant’s failure to perform tasks

Case study 7





was not wilful or deliberate. However, the Panel agreed that the shortcomings were serious becausethey had the potential to result in harm to the service users concerned. The Panel determined thatthe matters constituted a lack of competence and found that the registrant’s fitness to practise wasimpaired.

The Panel agreed that the registrant’s failings had not been remediated. Moreover, the Panel found itnecessary to reassure members of the public. Otherwise, they would lose confidence in theprofession and the regulatory process if a practitioner whom had not remediated their shortcomingswere permitted to return to practise unrestricted. The Panel then went on to consider which sanctionto impose to protect the public. It decided that a twelve-month suspension order would prevent theregistrant from practicing until they were able to demonstrate safe and effective practice.

The Conduct and Competence Committee imposed a twelve-month suspension order.



Type of concern

Profession

Standard

Case study


Driving under the influence of alcohol

Chiropodist / podiatrist

Standards of conduct, performance and ethics (updated in August 2012)Standard 3. You must keep high standards of personal conduct

A podiatrist self-referred following a conviction for driving under the influence of alcohol. The Conductand Competence Committee Panel considered the allegation. The registrant did not attend thehearing but had provided his own account of the incident. He expressed his sorrow and a wish toresume his career in podiatry. When considering current impairment, the Panel determined theregistrant’s conviction for the offence and damaged public confidence in the profession. It felt thatthere was some risk of repetition and a lack of engagement. It, therefore, found the registrant’sfitness to practise to be impaired by reason of the conviction.

The Panel concluded that the registrant’s conduct in committing the offence was remediable. Thiswas by, for example, attending an appropriate rehabilitative course and by re-engaging with hisprofession. It felt a six-month suspension order would maintain public confidence in the profession.This would allow the registrant to develop further insight and reflect on the gravity of the offence.

The Conduct and Competence Committee imposed a six-month suspension order.

Case study 8



Type of concern

Profession

Standard

Case study

Dishonesty by falsifying time sheet and travel expense claims

Physiotherapist

Standards of conduct, performance and ethics (updated in August 2012)Standard 3. You must keep high standards of personal conductStandard 13. You must behave with honesty and integrity and make sure that your behaviour doesnot damage the public’s confidence in you or your profession

Standards of proficiency for physiotherapists (updated in August 2013)Standard 3. Be able to maintain fitness to practiseStandard 3.1. Understand the need to maintain high standards of personal and professional conduct

The NHS Counter Fraud Unit of the local NHS Trust raised concerns about a physiotherapist. Onnumerous occasions, the registrant submitted timesheets and claimed payments for hours they didnot work. They, also, submitted timesheets purporting to be signed by a colleague when they hadnot been and claimed travel expenses which they were not entitled to and after they were no longeremployed.

Case study 9





A Conduct and Competence Committee panel considered the allegation against the registrant, whodid not attend the hearing. Having found most of the facts proved, the Panel determined that theregistrant’s actions were dishonest and that they would have known they were. The Panel decidedthat such behaviour fell far below the standards expected of a registrant and amounted tomisconduct.

Although this allegation did not concern issues of public protection, the Panel decided that a findingof impairment was necessary. It was necessary to uphold and maintain proper standards, andmaintain confidence in the profession. As the registrant did not engage with the process, the Panelhad no evidence of remorse or insight. The Panel considered that there were no mitigating factors inthis case. The Panel agreed that any lesser sanction than a striking-off order would not meet thewider public interest. The Panel thought that any lesser sanction would not act as a deterrent toother registrants. It would, also, not uphold the reputation of the profession and maintain publicconfidence in the regulatory process.

The Conduct and Competence Committee imposed a striking-off order.



Type of concern

Profession

Standard

Case study

Dishonesty – fraud

Operating department practitioner

Standards of conduct, performance and ethics (updated January 2016)Standard 9. Be honest and trustworthyStandard 9.1. You must make sure that your conduct justifies the public’s trust and confidence in youand your profession

An employer raised concerns about an operating department practitioner’s (ODP) conviction of fraud.For this conviction, she was sentenced to 18-months imprisonment and suspended for 24 months.The registrant had withdrawn money from her stepfather’s bank accounts, whilst registered as Powerof Attorney for his property and finances. She used this money for her personal gain.

The registrant was not present at the hearing nor was represented. The Panel was satisfied that thefacts were proven, and amounted to the statutory ground of conviction. The registrant had pleadedguilty to the offence at the Crown Court. However, she had not provided any evidence todemonstrate insight, remorse or remediation. In the absence of such information, the Panel was ofthe view that there remained a risk of repetition. The Panel agreed that the case was serious.

Case study 10





The registrant had pleaded guilty to an offence of dishonesty. She had abused the position of trust inwhich she had been placed. Namely, to act as the Power of Attorney for her vulnerable stepfatherwho lacked the capacity to manage his own affairs and finances. The offence had taken place over anumber of years.

The Panel felt that the registrant’s conduct had brought the profession into disrepute. The Panel feltthat it would have a detrimental effect on the reputation of the regulator and would undermine publicconfidence in the profession if they were to find no current impairment. The Panel was also of theview that a finding of impairment was required to declare and uphold proper standards of conductand behaviour.

The Panel then went on to consider which sanction to impose to protect the public. It was clear tothe Panel that any reasonably well-informed member of the public would be profoundly concerned ifan ODP, convicted of such an offence, was not removed from the Register. Therefore, the Panelconcluded that the nature and gravity of the registrant’s offending was such that a striking-off orderwas required.




Type of concern

Profession

Standard

Failure to conduct a full / accurate assessment

Social worker

Standards of conduct, performance and ethics (updated in August 2012)Standard 1. You must act in the best interests of service usersStandard 6. You must act within the limits of your knowledge, skills and experience and, if necessary,refer the matter to another practitionerStandard 7. You must communicate properly and effectively with service users and other practitionersStandard 10. You must keep accurate records

Standards of proficiency for social workers in England (updated in August 2012)Standard 1. Be able to practise safely and effectively within their scope of practiceStandard 2.2. Understand the need to promote the best interests of service users and carers at all timesStandard 2.4. Understand the need to address practices which present a risk to or from serviceusers and carers, or othersStandard 4. Be able to practise as an autonomous professional, exercising their own professionaljudgementStandard 4.1. Be able to assess a situation, determine its nature and severity and call upon therequired knowledge and experience to deal with itStandard 4.2. Be able to initiate resolution of issues and be able to exercise personal initiative

Case study 11



Standard (continued)

Case study


Standard 4.3. Recognise that they are personally responsible for, and must be able to justify, theirdecisions and recommendationsStandard 4.4. Be able to make informed judgements on complex issues using the information available

An employer raised concerns about a social worker who did not report a service user’s suicidalthoughts to their managers or any other professionals. This was despite it happening repeatedlyand after recording a case note. Following the visit, the service user made a suicide attempt andwas taken to hospital. The registrant delayed informing her line manager about this despite havingreceived a police report.

The registrant attended the hearing and was represented. The Panel felt that the registrant owed aduty of care to the service use. At the time, the service user was extremely vulnerable and at risk ofcausing himself harm. The Panel was satisfied that by failing to complete an appropriate assessmentand by not immediately informing her managers or other health professionals, the registrant failed topromote and protect the interests of service users.

The registrant to be in serious breach of the standards, which it felt amounted to misconduct. ThePanel found that the registrant lacked insight and lacked effective remediation. The Panel alsodetermined there was a risk of repetition. It felt the registrant had brought her profession intodisrepute by breaching a fundamental tenet of the profession. This was given that the primary duty ofa social worker is to safeguard service users from harm. The Panel came to the conclusion that astriking-off order was the only way to protect the public, given the registrant’s inability to remedy hermisconduct.




Type of concern

Profession

Standard

Case study

Unsafe clinical practice

Biomedical scientist

Standards of conduct, performance and ethics (updated in August 2012)Standard 1. You must act in the best interests of service usersStandard 7. You must communicate properly and effectively with service users and otherpractitioners

Standards of proficiency for biomedical scientists (updated in November 2014)Standard 4. Be able to practise as an autonomous professional, exercising their own professionaljudgement

A biomedical scientist’s employer raised concerns following an incident where the registrant failed tofollow procedure. When processing samples, the registrant failed to prevent contamination, which ledto inaccurate results.

The registrant attended the hearing and was represented. While it was a one-off incident, the Panelfelt it was not due to a lack of understanding, knowledge or training. The Panel felt these weredeliberate acts and contrary to the standard operating procedures. It resulted in blood samples

Case study 12





having to be retaken. Additionally, there was a potential risk of harm if clinicians had acted on thecontaminated results. Therefore, the Panel felt the registrant’s conduct fell well below the standardsexpected of a biomedical scientist. The incident was sufficiently serious to constitute misconduct.The Panel felt that the misconduct was remediable. However, it felt that the registrant had notdemonstrated that it had been remedied. In addition, there was a risk of repetition, given the extremepressures of the work environment. The Panel also felt the following clear message needed to begiven to the public and to other registrants. It is not acceptable for a biomedical scientist to make adeliberate decision to not follow mandatory standard operating procedures. Therefore, the Panelfound the registrant’s fitness to practise was impaired on both the personal and public component.

The Panel then went on to consider what sanction to impose which would be sufficient to protect thepublic. The Panel felt a conditions of practice order would be sufficient. The conditions required theregistrant to undertake training and the preparation of a personal development plan to ensure theregistrant was able to manage their workload effectively, even when subject to stress, so that theregistrant wasn’t tempted by shortcuts or to take risks.

The Conduct and Competence Committee imposed a twelve-month conditions of practice order.


Section 5: Continuous improvement

The role of the Professional StandardsAuthority and High Court cases The Professional Standards Authority for Healthand Social Care (PSA) is an independent bodythat oversees the work of the nine health and careregulatory bodies in the UK. The PSA reviews ourperformance, and audits and scrutinises ourfitness to practise cases and decisions. Inresponse to the PSA’s performance review 2016–17, this year we started a major project. This wasto address the areas for improvement identified bythe authority, as listed in the Executive summaryof this report.

The PSA can refer any regulator’s final decision ina fitness to practise case to the High Court (or inScotland, the Court of Session) if it considers thatthe decision is not sufficient for public protection.This is under section 29 of the National HealthService Reform and Health Care Professions Act2002. The PSA reviews decisions to check if it issufficient to protect the public’s health, safety andwellbeing. It checks whether the decision issufficient to maintain public confidence in theprofession concerned. And, whether it is sufficientto maintain proper professional standards andconduct for members of that profession.

In 2017–18, the PSA referred one of our cases tothe High Court under section 29. However, thematter was resolved by means of a consent orderbetween us, the PSA and the registrant.

Registrants may also appeal against the panel'sdecision if they think it is wrong or unfair. Anappeal must be lodged within 28 days of thehearing. Appeals are made directly to the HighCourt in England and Wales, the High Court inNorthern Ireland or, in Scotland, the Court ofSession.

In 2017–18, eight registrants sought to appealdecisions made by the Conduct and CompetenceCommittee to the High Court. Five of theseappeals were dismissed by the High Court. Threeappeals were settled by consent, with anagreement for the matters to be remitted to a newpanel to reconsider the sanction.

The High Court received one application forjudicial review of a decision by the ICP in thereporting period. However, it refused permissionfor the application to proceed.

The status of the cases was correct at the time ofwriting this report in March 2018.

Working with stakeholdersWe aim to provide the best customer service tothose involved in the FTP process. We ask forfeedback to find out what is working and what wecan do to improve, in line with our customerservice policy 8.

In the Fitness to Practise Department we operatea feedback mechanism and engage with theindividuals who are part of the proceedings to letus know how we have done, and how we canimprove their experience of the process. Recentanalysis showed that about 70 per cent ofcomplainants and registrants who were subject toa complaint and provided feedback said that theywere satisfied with our service. The remainderwere either neutral or not satisfied. It isencouraging that positive feedback increased thisyear, particularly after we realigned the Fitness toPractise Department and set up the Health andCare Professions Tribunal Service (HCPTS).Feedback showed that these changes havecontributed to the positive experience that ourstakeholders have had.

8 www.hcpc-uk.org/aboutus/customerservice/process


Section 5: Continuous improvement

We are continuing to improve the way we gatherfeedback and would like to hear from morepeople about their experiences with us.

You can contact us with your feedback in thefollowing ways.

Service and Complaints ManagerThe Health and Care Professions Council Park House 184–186 Kennington Park Road London SE11 4BU

Tel: +44(0)20 7840 9708 Email: [email protected]

Twice a year we hold FTP forums, attended bymembers of professional bodies and tradeunions. We discuss developments in regulation,particularly those which may affect registrantsgoing through FTP proceedings. This mightinclude new or updated policies, statistics andtrends, research work, or operational approaches.Our aim is to get a better understanding of theissues faced by our stakeholders and to workwith them to achieve balanced outcomes forregistrants and the public.

Examples of improvements made based onfeedback − We reviewed our service standards. − Created a bespoke induction and training plan

for our employees. − Reviewed induction and refresher training for

our partners (including the panel members andlegal assessors) to equip them in making clearand well-reasoned written decisions aboutregistrants’ fitness to practise.

− Updated our standard template letters. − Reviewed our webpages on the FTP process. − Reviewed our practice notes and policies,

including our Fitness to practise publicationpolicy.

− Streamlined the process for preparing hearingbundles, enabling us to provide documentationto the parties involved earlier, giving them moretime to prepare.

− Developing the process for quality checking preand post hearings.

We established regular meetings, such as theDecision Review Group or AdjudicationDevelopment Group, to discuss opportunities forimprovement, after identifying learning points frompanel decisions or feedback.

Management InformationWe gather and analyse data on a monthly basis.This allows us to identify trends in our activitiesand implement appropriate actions in response.For example, we noted that the rate of finalhearing outcomes resulting in short and / orcontinued suspensions had doubled in the lasttwo years. In response, we initiated a six-monthprogramme to systematically review all sanctionsof cases open at that time. This was to allow us tounderstand them better. Also, it helped us to takeany appropriate action to support the registrantsin their preparation for the review hearings. Wedeveloped new information for registrants toincrease engagement with the proceedings beforethe review hearings. We are now presenting amore detailed chronology of events to the panelsfor these hearings. Case managers are spendingmore time ensuring registrants and theirrepresentatives are aware of our position and theimplications on their ability to work in theirprofession if they do not engage in the process.

Further information about our activities can befound on our website including information whichwe report to the Council https://www.hcpc-uk.org/news-and-events/meetings/?Categories=176

© Health and Care Professions Council 2018Publication code: 20171012F2PPUB (published November 2018)

To request this document in Welsh or an alternative format, email [email protected]

Park House184 –186 Kennington Park RoadLondon SE11 4BU

tel +44 (0)300 500 6184www.hcpc-uk.org

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