The fitness of the fitness to practise process

The most recent annual 'fitness to practise' report from the Health and Care Professions Council (HCPC) makes interesting reading. In 2013–14, there were 18 allegations about practitioner psychologists that reached the stage of having a 'case to answer' and were therefore considered to be put forward to a hearing. Five were discontinued through lack of evidence and three led to suspensions of registrants on health grounds. Five complaints were found to be 'not well founded'. One registrant was suspended for rude and insulting behaviour and one was suspended for inadequate clinical skills. Therefore, only two were sanctioned for incompetence, suggesting that this method of regulation cannot possibly be an efficient means of ensuring that professional standards are upheld.

According to Barlow (2010), 5–10 per cent of therapists leave their clients in a worse off state than when they first entered therapy. In two of the 18 allegations, it was claimed that the registrant's relationship with a client was inappropriate. In a total of 19,919 registrants this represents 0.01 per cent. This figure is either highly laudable or gives an inaccurate estimate of the actual state of affairs.

The norms governing a violation of boundaries in psychotherapy are highly contested and instances are probably best decided on a case-by-case basis by supervisors or a board of independent professional peers. The HCPC's quasi-judicial system is not fit for this purpose. It is also expensive: HCPC receives £1.5 million annually from practitioner psychologists' pockets.

Richard Hallam
Visiting Professor of Psychology
University of Greenwich

Reference
Barlow, D.H. (2010). Negative effects from psychological treatments. American Psychologist, 65, 13–19.

In response to Richard Hallam, we are writing to address some of the points raised in relation to our fitness to practise (FtP) process.

The Health and Care Professions Council's (HCPC) FtP proceedings are designed to protect the public from those whose fitness to practise is impaired. It is not a process for resolving general complaints, and it is not designed to resolve disputes between registrants and service users, or to punish registrants for past or 'one-off' minor mistakes that are unlikely to be repeated.

So how exactly does our FtP process work? Any concerns are initially assessed to determine whether they meet our Standard of Acceptance, which sets out a modest and proportionate threshold that allegations must normally meet before they will be investigated by the HCPC. We recognise that employers and managers must deal with circumstances of staff misconduct, lack of competence and ill health, and that this can include situations with our registrants. In many cases, this can be effectively resolved by the employer at the local level. As such, it is unlikely that there will be evidence to suggest that the registrant's fitness to practise is impaired, and therefore if it is referred to us we would normally close the case without taking any further action. So for example, issues relating to professional boundaries can often be managed through clinical supervision, and would therefore not need to be referred to us. Of course we would take action if the issue raised public protection concerns, such as improper relationships with service users.

The number of FtP cases that the HCPC manages should be viewed in context. In 2013–14, we received 157 cases relating to practitioner psychologists. This equates to 0.79 per cent of practitioner psychologist registrants being subject to an FtP concern. Practitioner psychologist cases also have a higher rate of case closure on the basis that they did not meet the Standard of Acceptance when compared with some of our regulated professions with greater registrant numbers, including physiotherapists, radiographers and occupational therapists. Of the cases referred to our Investigating Committee panel, approximately half record a decision of 'no case to answer' and do not reach final hearing stage.

267 final hearings across all professions concluded in 2013–14 – a small total in comparison to the 322,021 professionals on our Register – and only 0.06 per cent of registrants were subject to a sanction imposed at a final hearing. This small number of cases that reached final hearing stage reflects the fact that the FtP process focuses on those registrants where there is strong evidence to suggest that their fitness to practise is impaired.

It is also important to recognise that registrant fees are not only used to finance the fitness to practise process, but also to fund all our statutory functions including, for example, our registrations and approvals processes. However, we are very mindful of the cost and emotional impact on those involved in an FtP hearing. For that reason our processes are designed to ensure that only those cases that really need to go to a final hearing, do. We also have provision to dispose of certain cases by consent, whereby the HCPC and the registrant can seek to conclude a case without the need (and cost) of a contested hearing by entering into either a voluntary removal, conditions of practice or caution agreement. Cases can only be disposed of in this manner with the authorisation of a Panel of a Practice Committee.

The HCPC is committed to working with employers and others, as well as the professions themselves, to ensure that they understand our FtP proceedings, including what should be referred and when they should refer it. Along with producing more detailed guidance, we are constantly looking at ways of quality assuring the work that we do, as well as reducing the length of time and cost attached to the FtP process.

John Barwick
Director of Fitness to Practise
Health and Care Professions Council