Regulatory reform: streamlining fitness to practise

I had the privilege of contributing to the Westminster Health Forum policy conference on the reform to professional healthcare regulation in the UK. It provoked some interesting conversations, so I thought I would share my thoughts with you via this blog.

The burden of current fitness to practise process

There has been broad acknowledgement for some time that the framework for the regulation of healthcare professionals in the UK is no longer fit for purpose. The current arrangements are prescriptive, rigid and inconsistent with a multitude of regulators each operating to different legislation and rules. This results in a complicated, overly adversarial and punitive fitness to practise process that is often stressful and lacking in humanity.

It is also costly, accounting for the majority of the fees charged to professionals for concerns about a tiny proportion of our professionals (0.66% for HCPC). To me, this appears to be a regulatory regime that attaches insufficient value to supporting professionals.

By way of illustration, under the HCPC’s current legislation, if a registrant has been convicted of a serious criminal offence, even though they may have been sentenced and could be in prison, we still have to continue through each stage of the fitness to practise process, including gathering evidence, giving the registrant the right to reply and having a final hearing. It may be 15 months before we’re able to conclude the case. This takes up resource which could be focused elsewhere, frustratingly for what is an automatic strike off offence.

Similarly, the flexibility of our Investigating Committee Panels is very limited. The ICP can make either a case to answer or no case to answer decision. There is little opportunity to reflect learning points to improve a registrant’s future practice, or to put in place proportionate remedial measures to support the registrant so that they can practice safe and effectively, whilst ensuring public protection.

What could be improved

Fitness to Practise has been rightly identified by the Government as one of the priority areas requiring legislative reform. We want to create a process which supports professionals to address concerns about their practice and help create an environment of openness where there can be honest discussions when things go wrong. We are working closely with the Department of Health & Social Care and other regulators to introduce a series of measures to support this.

The first is to ensure regulators have a level playing field of powers to handle fitness to practise cases and the flexibility to set and adjust their operational procedures through rules without the requirement for Privy Council approval. This will enable regulators to be more responsive and adaptable to developments in healthcare.

The challenge will be ensuring how best practice is embedded in the operational procedures of each regulator, and that the flexibility that may be afforded, does not result in unnecessary divergence in approach between regulators. In my second blog Regulatory reform – the opportunities, I explore the importance of regulators working together.

Second, under the new proposals regulators will have a full range of case disposal options which includes the ability to resolve fitness to practise cases without the need for a full panel hearing (where it is appropriate to do so).  

The opportunity to have case examiners to consider complaints and determine whether an individual’s fitness to practise is impaired and, where appropriate, resolve the case by consent, coupled with the automatic removal of registrants who have been convicted of a very serious criminal offence will have a significant positive impact.

Third, regulators will have the scope to apply a range of consistent measures to registrants whose fitness to practise is found to be impaired. There will also be the potential to offer formal advise to registrants whose conduct has fallen short of our standards but their fitness to practise has not been found to be impaired.

This level of regulatory autonomy will provide greater flexibility and ensure fair, efficient disposal of cases whilst ensuring effective public protection. Crucially, it will make a significant difference to the timeliness of the fitness to practise process and the costs involved.

Next steps

We will continue to work with the Department and other regulators to secure the right type of legislation, and to quickly adapt to it for the benefits of service-users and registrants who have a concern raised against them.

But, we do this also for all registrants, and for the public interest. These changes will release funds to further invest in supporting professionals’ practise and upstream regulatory activity to help people not end up in the fitness to practise process. This has to be in everyone’s best interests.