1 Recommendations to regulators and the government
This section allows you to think about what you would recommend to regulators and the government in order to improve experiences of people who raise concerns.
Activity: reflection point
Based on your understanding of the findings from Sessions 1 to 4 what recommendations would you propose to the government? Also, what should regulators do to provide independent support to public referrers?
If you did not complete Sessions 1 to 4 you may want to think about what you would expect from a regulator if you wanted to raise a concern.
If you’d like to, make some notes in the text box below. Your notes will only be visible to you.
Discussion
You will most likely agree that additional support is needed for members of the public and professionals wishing to raise a concern. This should include confidential advice and clearer signposting for those considering raising a concern; support in articulating the concern, advocacy support; and support as the concern is progressed, including for witnesses at Fitness to Practise hearings. This key recommendation is also part of Tackling Support Locally (Department of Health, 2009, p. 50). Similarly, we argue that regulators and employers should signpost public referrers to sources of independent advocacy and advice across the various processes including inquests, civil proceedings, NHS complaints, social services complaints and criminal cases.
Based on our research findings we feel that all these recommendations should support to improve the Fitness to Practise process for all. The following video provides some regulator comments about our findings and recommendations.
Watch Film 1 at the following link: Improving patient, family and colleague witnesses’ experiences of Fitness to Practise proceedings: A mixed methods study [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]
We are also suggesting that employers and health and social care regulators should review and extend informational, wellbeing and emotional support offered to members of the public, registrants and colleague witnesses involved in Fitness to Practise processes. In addition to this, based on our findings, we recommend that regulators recognise the public’s key role when they raise concerns in the Fitness to Practise process. Also, they need to understand how Fitness to Practise processes can be experienced by the public, their motivations for raising a concern in the first place, the impact of the unfamiliarity of these processes, and the work and personal costs involved for the public. They should recognise the harm caused by unintentionally disrespectful or overtly legalistic communications. We make these recommendations to all regulators of the UK’s health and social care workforce.
Activity: reflection point
Consider what recommendations you would make to regulators on information provision. Make some notes in the text box below.
Discussion
We identified four recommendations to provide information effectively:
- Support members of the public to understand Fitness to Practise processes and decision-making steps, answer their questions and keep them regularly updated.
- Provide clearer public-facing information co-produced with members of the public about the steps that can be taken to support people in raising concerns and to provide evidence as a witness throughout the process and at a hearing.
- Public-facing information should be designed to be understood by the the large majority of the UK adult population by:
- being compliant with UK government accessibility requirements
- being worded to be easily understood by those with limited literacy and support for people to understand more complex topics
- being available in different formats including audio and video
- covering each of the main stages of Fitness to Practise and the support available.
- Regulators should consider providing a liaison function to employers, where this does not already exist, to improve the selection and management of cases and to identify issues which may fall on the employer to support the witnesses.
Communication is critical in supporting public referrers. We strongly believe that instead of one-way communication based on transmission of information regulators should focus on a two-way dialogue to allow public referrers to feel valued and heard in the Fitness to Practise process. There are several ways they may accomplish this, and in the following activity you will learn how regulators might strengthen their communication with public referrers.
Activity: reflection point
Watch the following animation.
Transcript
SPEAKER 1: We have called this meeting to hear more about your experiences as witnesses in the fitness to practise process and to present our recommendations for how fitness to practise can be improved based on the findings in our research.
SPEAKER 2: For me, I was really scared to talk about it all publicly. I was worried I could lose my licence. But the whole thing was being treated as a box-ticking exercise. They need to show more compassion. These issues really affect people.
SPEAKER 1: Yes, in general, we recommend regulators show much more compassion and integrity when dealing with these complaints. There was a lack of humanity, which really needs addressing.
SPEAKER 3: It was really difficult to work out where to begin. There are all these regulatory bodies I had to sift through, and the website wasn’t worded accessibly.
SPEAKER 1: This is a common problem. There needs to be greater clarity about where, when, and how to report concerns.
SPEAKER 4: I thought I’d get regular updates about the case, but I heard nothing. Meanwhile, they were writing reports that were just wrong, totally wrong, and I wasn’t privy to any of it.
SPEAKER 1: We recommend greater inclusion for witnesses in the fitness to practise process to avoid this common experience. There needs to be improved access to information about the investigation and preparation before hearings too. We also recommend offering independent advocates who can work with individuals to guide and support them through the process.
SPEAKER 5: The amount of time it took them to deal with the case was really frustrating. They were waiting for the professional that raised the concern about to send them information. It took a year to receive it, and I’d kind of given up by then.
SPEAKER 1: Thank you all for providing your vital insights into your experiences as witnesses in the fitness to practise process. Your comments and our own research has brought to us a number of recommendations. These are just some of them.
Firstly, there needs to be more compassion, integrity, and humanity when dealing with complaints, minimising the number of times people need to retell their distressing story. There needs to be greater clarity around where, when, and how to report concerns. The fitness to practise process needs to be more inclusive with better access to information, preparation, and other sources of support. We recommend offering independent advocates who can work with individuals to guide and support them across the process.
People want others to know about the lasting impact of the harm they have experienced from the professional. People need more realistic preparation for what to expect when cross-examined in a hearing and what they and the panel chair can do to make it less adversarial. People should be offered support after the hearing to understand the outcome and how to get support. Panel members and lawyers should be trained in cross-examination to minimise distress and harm.
All of these statements are recommendations based on our research findings. Reflect on these recommendations and consider whether you feel they would support improve Fitness to Practise. Write your response in the box next to the statement.
| Statement | Agree/Not sure/Disagree? |
|---|---|
| Clearly explaining the function and purpose of the process, and for each case explain why aspects of a case might not be included, or a referral may be closed. | |
| Actively listening to and, as far as possible, addressing people’s concerns about the process. | |
| Recording a statement of their concerns and the impact of these concerns available to regulator staff throughout the case. | |
| Keep people affected by the case regularly updated on progress. In the event of unavoidable delays explain as clearly as possible why this has happened and what will happen next. | |
| Establish the means of communication, amount of information and timings of communications with the public who raised concerns and others affected by the case and make this available to regulator staff throughout the case. | |
| Decisions should be communicated by appropriate staff members who are able to answer questions. | |
| Review terminology and provide staff training in respectful and empathetic engagement and communication. |
Comment
Based on our research findings we feel that all these recommendations should support to improve the Fitness to Practise process for all.