Conclusions and recommendations |
Time taken to conclude Fitness to Practise hearings
1. The PSA have reported to us that in 2012-13 the HCPC met all its standards of good regulation. It also stated that "the HCPC has maintained its efficient and effective performance across all areas of responsibility." The PSA consider that the HCPC's performance in 2012-13 is particularly notable as it has completed the transfer of social workers during this period, increasing the volume of allegations it is handling, and expanding its scope.
2. The PSA has highlighted the specific issue of routine health checks for registrants who are convicted of drink or drug related offences. The HCPC has argued that rather than introducing a blanket policy of health checks, a case-by-case approach is more proportionate. We will revisit this issue next year.
3. Evidence we received from organisations representing professions registered by the HCPC also raised some specific concerns about the HCPC's fitness to practise processes. We recommend that the HCPC consider the individual points raised in written evidence by these organisations, and provide a response to those organisations, to ensure that their feedback is used, where necessary, to improve processes.
4. We asked the HCPC to provide us with further information on the length of time it takes to conclude fitness to practise cases. The HCPC reported to us that in 2012-13 the average total length of time to close all cases was 9 months; the average length of time to conclude cases that went through to a final hearing was 16 months. However, reporting 'average' timescales can conceal wide variations and certain cases taking an unacceptably long time to resolve-indeed the HCPC report that in 2012-13, 27 cases took in excess of 24 months to conclude. We urge the HCPC to commit itself to a clear "start to end" target setting out the maximum length of time it takes to conclude its Fitness to Practise processes, and in our view the maximum time should be 12 months. Such a target represents a commitment from the HCPC to the patients and service users it aims to protect, and to its registrants, and should be clearly communicated on its website.
Revalidation or 'continuing fitness to practise'
5. The HCPC told us that there is no one-size-fits all solution to securing patient input into their continuing fitness to practise processes. In our view this should constitute an important part of any revalidation system, and we urge the HCPC to continue their efforts to include such feedback on a regular and consistent basis.
The Francis report
6. The Francis report has thrown a spotlight on the role of health and care regulators in ensuring public protection, as healthcare professionals have an unambiguous professional duty to raise with the relevant authorities any concerns which they have about the safety and quality of care being delivered to patients. For the effective regulation of clinical and caring professions, regulators need to be visible and accessible to registrants, and also to patients and members of the public who wish to raise concerns about patient safety. Regulatory bodies must also collaborate effectively between themselves. We recommend that the HCPC continues to monitor its own profile both with patients and service users, with professionals, and with other relevant organisations, and we will seek further evidence of the progress the HCPC and other professional regulators have made in implementing the recommendations of the Francis report at our next accountability hearings in the autumn.
Regulation of social care workers
7. The issue of ensuring standards for social care workers is crucial to delivering safe, high quality care for patients. The HCPC have told us they are opposed to running a voluntary register for social care workers, and have argued instead for the establishment of a 'negative register' for social care workers. In their view, although this would have cost implications, it would offer far greater public protection than a voluntary register, and they argue that it would supplement rather than duplicate the existing Disclosure and Barring Service, which in the HCPC's view has too high a threshold.
8. The Committee is concerned by the most recent in a series of reports of abuse by social care workers. In 2011 the Government proposed a voluntary register, but no progress has been made since then and we agree with the HCPC that in any event voluntary registration would not be effective. We recommend that, as a first step to improve regulation in this sector, the Government should publish plans for the implementation of the HCPC's proposals for a negative register. The legislation that would be required to enable the establishment of such a negative register is contained in the Law Commission's draft Bill on the regulation of health and social care professions. Beyond the establishment of a negative register, we recommend that the Government, working with the PSA and the HCPC, develop further proposals for more effective regulation to provide proper safeguards in this area.
9. We ask the Department of Health to set out in response to this report what changes it proposes to make to the powers of regulatory bodies by secondary legislation during this session of Parliament, and when it anticipates that they will be brought forward.
Statutory regulation of other new groups
10. The HCPC has a record of assimilating new professional groups onto its register, and most recently the Government has suggested that herbal medicine practitioners and non-medical public health specialists should be added. Members of 'aspirant' groups such as these may experience frustration owing to delays and uncertainty, as the HCPC has reported to us that it is unable to commit resources to developing its approach to potential new groups until the Government has introduced legislation. The UK Public Health Register has raised a number of concerns relating to the proposed regulation of non-medical public health specialists. We recommend that the HCPC engages directly with the UK Public Health Register to ensure its concerns are registered.
11. In addition to this, since 2003, the HCPC has recommended to Government that statutory regulation be extended to eleven other professions. Of these, the only group to receive statutory regulation to date are operating department practitioners and practitioner psychologists. Statutory regulation gives professions, in the words of the HCPC, "a huge badge of respectability, professionalism and endorsement." Decisions about whether to extend statutory regulation to different professions need to be informed both by considerations of issues of patient safety, and consideration of the evidence base for that profession. We do not seek to make judgements on either of these factors for individual professions, and, although as the HCPC has pointed out that health and care regulation is not currently "a very logical landscape", at this stage we are not seeking to make recommendations for change simply to address inconsistencies. However, if there are unregulated groups which need to be regulated on the grounds of patient safety, this should be dealt with swiftly.
12. We received written evidence from the Registration Council of Clinical Physiologists arguing strongly that Clinical Physiologists should be subject to statutory regulation, a position that the HCPC agreed with. We recommend that, in responding to this report, the HCPC lists any professional groups for which they feel there is a compelling patient safety case for statutory regulation so that we can take this further with the Department of Health as a matter of urgency. We are concerned at the length of time it can take for professional groups to gain statutory regulation. As we understand that new groups can be added to the HCPC's register by means of secondary legislation we see no reason why there should be undue delay in extending statutory regulation to professional groups where there is a compelling patient safety case for doing so.