1 Why do people raise a concern?

Protecting the public is the primary goal of health and social care regulators. By doing so, they aim to maintain public trust. It is one of the criteria used to determine if a registrant – who registers with a regulatory body – no longer poses a risk to the public. Our findings show that people who use services raise concerns about practitioners to guarantee that the lesson is learned and that practitioners do not repeat the mistakes that endanger the public. Along with this, Fitness to Practise procedures that are supportive and responsive to the needs of the public boost public trust in health and social care institutions.  

The role of health and social care regulators is to protect the public by ensuring those on the register are competent and upholding the profession’s standards. To accomplish this, regulators must provide accessible and readable information, so that the public understands how to report a concern. It should also include how they will be supported throughout the Fitness to Practise process. Our findings suggest that when content relevant to Fitness to Practise is easily understandable by most adults, people feel more comfortable raising concerns and going through the procedure. 

We found that raising concerns and going through the Fitness to Practice procedure caused significant further trauma for some people, which should be largely avoidable. Trauma-informed practice, which refers to services based on the knowledge that trauma can harm people and their ability to build trustworthy connections with social and healthcare providers, is possible. This type of approach would give referrers the assistance they need, freeing regulators to fulfill their primary duty of safeguarding the public while concurrently advancing and maintaining their safety and wellbeing. 

People were motivated to go through the Fitness to Practise process to stop anyone else from going through what they did. One participant stated: ‘I did not want another individual to go through the same distress and trauma that I suffered.’ Similarly, another participant highlighted:

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The quote reads: ‘...my thoughts were, there’s nothing that can be done for me, but I wouldn’t want anyone else to go through this. So, it was all about preventing harm to others in future.’

Some participants felt Fitness to Practise is about enabling practitioners to reflect on their conduct and change their practice.

Some participants described being unsatisfied with the outcome of their referral, but they wanted to ensure that people are aware of their concerns. According to an interview participant:

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The quote reads: ‘… He won’t go to court or he won’t go to jail or anything … Can you believe that? Now, I don’t care because to me it’s more like well I want the public to know. You know, that’s what I want at this stage …’

Hopefully this has given you an insight into why some people raise concerns to regulators. This discussion was centered on the general population rather than health and social care professionals. So, the question is, can professionals report concerns to regulators?

The answer is that yes, they can, and indeed they are required to since practitioners’ values include protecting people’s safety and wellbeing while providing quality services. Although it can be difficult for them, we found that practitioners do raise concerns about their fellow colleagues. 

Although whistleblowing procedures are put in place to protect practitioners who raise concerns about their colleagues, in our research we found that some practitioners still found it difficult due to power differential and the working culture. Whistleblowing is in the public interest because it legally protects people to raise concerns that affect the public or workers in an organisation. Raising concerns through appropriate routes is seen as important in protecting the public and people working in health and social care (General Medical Council, 2014; General Dental Council, 2015).

According to a junior doctor in training who was concerned about the conduct of a senior colleague:

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The text reads: ‘… there was an incident which I was very unhappy about with a senior doctor when I was in training. And at the time I wanted to tell someone. And I realised that if I did, my undertanding was that if I did it would make everything worse. So instead I challenged him directly. And it helped me to understand that I didn’t think I could ask anyone for help. Because he was very entitled to behave like this, he felt very entitled to behave as he did and I could see that he was very well supported in that feeling of entitlement.’

The same practitioner also highlighted reasons they thought misconduct and malpractice existed in their workplace:

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The quote reads: ‘So partly I was very isolated. So I was a doctor in training and we go from place to place. And so my training programme director was in another city. I was living in the local area with my family but I didn’t have any friends, I didn’t have any colleagues who I knew well. The work environment was very brutal. I would often see colleagues crying in a corridor somewhere; the senior doctors screaming at each other if they had a difference of opinion. And so there was a sense that people were putting up with terrible things and nobody seemed to want that to change. And so when I challenged the person about his bad behaviour, his approach was well, why shouldn’t I? And I could see that that was right, it seemed to be, yes, why shouldn’t he, who was going to stop him.’

Furthermore, when a practitioner raises a concern about their colleagues, they do not always receive support from their employer. One research participant commented:

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The quote reads: ‘… I wrote everything down what she told me and I wrote down anything what I could see on the texts, which were quite rude some of them. And anywayI didn’t get no support from head office, from [employer name]. They never rang me and said are you OK with this? All I got was, this is when you go, this is the date you go and this is what it involves and how to get there and this and that. But there was no support, like do you feel OK about this or anything like that …’