Social worker acted ‘outside scope of practice’ with intervention – HCPC

The HCPC said the intervention a social worker recommended was not done with a proper risk assessment, and the social worker was not properly managed

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A social worker who recommended an intervention “outside the scope of practice” has been suspended by the HCPC.

The social worker, who worked in Child and Adolescent Mental health Services (CAMHS), proposed an intervention where a girl would only self-harm on set days and times, with her mother attending to wounds without comment.

The social worker was qualified and trained to use the systemic practice technique, however a conduct panel found it was “outside the scope of social work”. His failure to conduct a proper risk assessment or discuss the approach with other professionals before proposing the approach amounted to misconduct, it added.

Supervision and management failings

The panel found the social worker had not been properly managed or supervised for a “significant period of time”. This had left him working “with little or no constraints” on his practice which contributed to his “serious error”.

“The panel recognised that there is a place for innovative and creative interventions in social care, however, such interventions must be carefully thought through and must be based on proper risk assessment and good communication with professional colleagues,” the conduct committee said.

Although the specific intervention the social worker recommended was not an approach advocated by CAMHS, the panel accepted that his use of systemic techniques was approved by CAMHS and his local authority employer and to that extent “he was not acting improperly”.

However, it found he had performed a risk assessment “on the hoof” and “in his head”. These actions were “foolhardy in the extreme” as the girl was in the highest category of risk.

‘Avoid the fuss’

The social worker told the panel he would act differently in future, but this would only be “to avoid the ‘fuss’ that had been created by his actions, not because he acknowledged that he made any error of judgement”.

He disputed that his actions were in the course of his ‘practice’ as a social worker when he was utilising his systemic practitioner skills.

The panel concluded that he had shown no insight into his failings, and this created a risk of him repeating them. It said there was “no doubt that the registrant’s intervention was motivated by a desire to do his best” for the service user, but his practice was impaired. As a result, he was suspended for six months.

The social worker was also found to have used his personal mobile phone to have taken a photo of scarring on another service user’s harm. The panel said this made the girl identifiable but found the social worker had acted in out of a “desire to secure an appointment for her, with a psychiatrist, as soon as possible” and this was not misconduct.

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29 Responses to Social worker acted ‘outside scope of practice’ with intervention – HCPC

  1. David Steare September 6, 2016 at 12:09 pm #

    Interestingly, some important details have been omitted from the above report:
    – The intervention happened in February 2013. It has taken three and a half years so far to get to this stage. It also took four different allegations to find one that the HCPC proceeded with.
    – The FTP hearing took 8 days at a cost of up to £80,000 for the HCPC’s legal and panel fees that are paid for out of registrants fees.
    – I have been retired for two years and I am collecting my state pension.
    – I asked that my registration be allowed to lapse two years ago. I had/have no desire to work as a social worker again.
    – The HCPC and its panel is not authorised by statute or professionally qualified to make findings about systemic practice which lies outside the scope of social work and health care.
    – My intervention was supported in writing by a delegated member of the Association for Family Therapy’s ethics committee and also by an author of over 60 books, chapters and papers on family therapy.
    – The taking of photographs for clinical reasons was/is permitted by NHS Trust policy.

    I have set up a Facebook page called ‘Social Workers with HCPC proceedings’ if anyone would like to view my posts / contact me for support.

    • Susan September 7, 2016 at 6:50 pm #

      I just think what a waste of money, time and energy if you had already decided not to practice Social Work any more what is the point of a sanction. I personally feel the HCPC go beyond their purpose of protecting the public by this naming and shaming procedure. I can’t comment on your actions as I’m not qualified to do so but I do recognise that the majority of Social Worker do try their best for the Service Users

    • Interesting and helpful reminder of the need to consider diversity of children affected in CSE cases. I have also noticed in my work that children involved and exposed to sexually harmful behaviour get into the trappings and lured into being victims or pe September 8, 2016 at 2:57 pm #

      This goes to show how organisations can become oppressive to certain practitioners and the good will of the workers goes to such a waste. There are many decisions senior managers with Hcpc Reg. Failing to protect of practice anti discriminatory management and support that goes ignored and thus given exemption merely due to status and the hiarchy.

    • September 8, 2016 at 11:43 pm #

      how can we contact you

  2. Andrew Foster September 6, 2016 at 1:01 pm #

    You can call it a systemic practice technique or dress it up in the mysterious language of CAHMS to imply that the approach is valid, contemporary and on occasions ‘effective’. There were certainly cases involving the ‘ducking stool’ which certainly did for some of our witches. Is it any wonder that our profession seems to be invariably on the backfoot? And a six month suspension is not vaguely commensurate with the transgression which is quite probably illegal in relation to ‘duty of care’ and ‘safeguarding’ responsibilities etc. This worker could even be …….I will stop there. Dismissal must surely be the only viable option.

  3. Andrew Foster September 6, 2016 at 5:58 pm #

    I was going to leave things there. However, as the alleged practitioner has commented, I am bound to make some further observations about this so-called technique. The intervention, as manifest in this example, has absolutely no proven validity whatsoever. None! Parallels might reasonably be drawn with the practice of trepanning.

    The author and delegated member of the association for Family Therapy’s Ethics Committee may indeed have supported the practitioner but that is absolutely no justification for a technique which in this instance is closer to constituting a criminal act. The decision it seems was taken without reference to the internal moderation and advice of what is sometimes known as a ‘line manager’. The practitioner proceeded to act in isolation from his employer. I also fail to see how the taking of a photograph on a mobile phone can be justified by the asssertion that it was for ‘clinical reasons’…….simply absurd. I for one am pleased that the practitioner has left the social care arena and has no intention to practice again. I hope that the young and vulnerable client survived her personal trauma and this so called technique.

    • Daisy September 7, 2016 at 8:42 pm #

      It sounds like you are desk bound management who thinks in black and white whilst most social workers operate in the murky area in between.

  4. David Steare September 7, 2016 at 2:03 pm #

    So, Andrew, you do not agree with the National Institute for Clinical Excellence’s guidelines that recommend harm reduction/minimisation techniques for self-harm? Presumably, you accept that NICE can recommend techniques with “absolutely no proven validity whatsoever”?

    And do you believe that to allow a young person to self-harm whenever she feels like it with no follow up care is preferable to negotating with a young person to constrain her self-harm and to receive after care, and asking her to choose those limits?

    Are you so superior to me? What has led you to appear so judgemental? I wonder if you are a social worker?

  5. Richard September 7, 2016 at 3:43 pm #

    Hi David,

    Well done you on your insightful & wise intervention which I’m sure will have helped your client. A registered 55 year old social worker with a Masters in Advanced Social Work with Adults.

  6. Andrew Foster September 7, 2016 at 5:55 pm #

    So David, let me say that I do agree with NICE guidelines that recommend harm reduction/minimisation techniques for self-harm. As for the technique that you employed, no, I do not agree with its use. NICE or any ‘body’ for that matter can make whatever recommendations it likes, whenever it likes and however it likes. However, you apear to have overlooked the fact that I have a basic human and democratic right to make my own decisions and choices as to whether or not I am in accord with any recommendation that is made.

    Regarding the ‘permission to self harm’ issue, those are my words, I reject your paradigm which offers up just two options.

    Lastly, I am not superior to anyone. As for appearing to be judgemental, I disagree. I simply have views which you do not share. And no, I am not a social worker. I can conclude only that you ‘just do not get it’.

    As for Richard’s response, it is beyond me that he is ‘sure the intervention will have helped your client’, not to mention that your use of the technique had been ‘insightful and wise’, in his view. I really do not understand the basis for that assertion. As for being a registered 55 year old social worker with a Masters in Advanced Social Work with Adults, I am not quite sure either just how relevant that is to this debate. I have a certificate for swimming 25 yards, which I attained over 50 years ago. However, I am still a rubbish swimmer to this day.

    • Daisy September 7, 2016 at 8:48 pm #

      Andrew Foster admitting ‘I am not a social worker’ That says it all really.

      • Andrew Foster September 8, 2016 at 11:15 am #

        Daisy, I am not a social worker. However, I was a social worker for 30 years. Your post was clearly made with indecent haste. I hope your assessments are somewhat more rigorous and evidence-based.

    • Clare September 8, 2016 at 12:47 pm #

      I think you are missing the point, this relates to misconduct. Whether you agree with the techniques or not, he hasn’t actually engaged in misconduct. I have sometimes had to use my personal mobile due to the poor quality work phone. That is not misconduct. So what is the point of the actions of the HCPC.

      Whilst you are entitled to have your views, I struggle to see how you can back the HCPC actions regarding misconduct when basically they are saying there is none but we don’t quite like this so we’ll suspend you for 6 months.

    • Liz Oyewole September 9, 2016 at 7:43 am #

      I am reading all this as I am away however as an advanced social work practitioner all I want to say to Andrew is you are most likely to be in management.
      *Micro manage
      *Strong part of the culture of blame
      *Have no clue what social work is about and has become
      * No clue about social work today and the issues
      *Have all these unrealistic ideas in your head quick to judge as you do not work with people and do not have the ability nor experience to.

      I know people like you we have them all around who love to glorify themselves on their resume I went in changed this, did that, critiqued that, shook a few, referred a few to HCPC due to innovative practice and lack of risk assessments.

  7. Meg September 7, 2016 at 6:23 pm #

    What worries me more is that the HCPC is judging people on their use of techniques in which they have trained and are qualified, but which are not specifically within the scope of social work practice. Many social workers working in integrated mental health teams may find themselves in this position.
    It also concerns me that the HCPC thinks we work in an environment that allows us to sit and write out a formal risk assessment prior to an intervention. When I am working with somebody at risk, I often find myself doing a quick risk assessment ‘on the hoof, in my head’ and then choosing an appropriate intervention based on that. The realities of social work practice means this is the norm for many workers.
    It just demonstrates to me how out of touch the HCPC appears to be from normal social work practice. 🙁

  8. Issy September 8, 2016 at 10:44 am #

    Thank you David for your clarifications and responses – and it is clear from Andrew’s statements that he is not a practising social worker (from his comments it appears he was a colleague of David’s with a managerial position?)

    I agree with other comments that the HCPC have spent considerable resources achieving very little – ‘suspending’ someone who has retired is clearly pointless so the value must be in providing direction and guidance to all those who continue to practice social work.

    For me as a practising children and families social worker my biggest concern with the HCPC position as described in this article, is that their conclusion fails to clarify what is expected of us. Their ruling seems to rest on the statement ‘outside the scope of social work’.
    But where is ‘the scope of social work’ delineated? How do we know when we have transgressed beyond undefined boundaries?

    As registered social workers, our duty of care is clear. This social worker was working within a clinical setting and following the National Institute for Clinical Excellence’s guidelines. So is the HCPCs notion of a ‘risk assessment’ in this context, in practice a directive to each of us to do less? Is it sufficient for social workers to simply record clients lives and give them (judgemental) directives to change without supporting the often lengthy and limping journey that usually accompanies any fundamental shifts from habitual, harmful behaviours to unfamiliar, new, less damaging ways of being?

    Andrew refers to David’s approach as giving the client ‘permission to do harm’ but I fail to see how any discussion with the vulnerable client and her mother about the dangers of self harm – and therefore the need to significantly reduce the risks of her self harming behaviours – can have led to the client believing it is of no consequence if she continues to self harm – i.e. that David was ‘giving her permission’ to continue to behave as before? I assume that within a systemic family therapy intervention there will also have been considerable attention paid to those factors which may have contributed to the client adopting in these behaviours as ‘solutions’ to her emotional pain.

    Blame culture tends to be overly concerned with the ‘risks’ that staff pose to the institution – with concern for the client being tagged on as a justification – and we are increasingly managed by people who have not themselves practised social work in a context of diminishing resources. Experienced social workers are leaving the field in their thousands. That is not a symptom of a healthy, well functioning system.

  9. Where's the list? September 8, 2016 at 11:03 am #

    The HCPC should just cut to the chase and just give us a list of approved interventions, assessments and scripts for when we have to talk to families about physical, emotional, sexual abuse and/or neglect.

    If they could tell me what time I can close my curtains at home and how many sheets of toilet roll I can use (and whether that total is just for me, or the household) as well as how long I can spend in the bathroom. Oh, if they could publish guidelines on when and where I can make eye contact with anyone outside of work safely too, that would be much appreciated.

  10. Lisa hewitt September 8, 2016 at 11:31 am #

    It’s actually terrifying that any of us could be up in front of Hcpc at any time for trying our best with little resources or support. Hcpc are a farce they employ a solicitor to throw you to the lions ie Hcpc and if you wish to have representation you have to pay a barrister at least £8000 or get basw to represent you. They try their best but are not solicitors. So basically you may as well just leave and give it up and avoid the humiliation of basically being in a court environment and on trial for trying your best in a profession that the public and media slate. Why do we do it because we are passionate about helping people. I bet if you looked at every social workers practice with a fine tooth comb we would all be at fault and risk Hcpc wrath.

    • Martin Weinbren September 8, 2016 at 2:12 pm #

      Lisa, I run an affordable representation service. I’m a former employee of BASW, as you may be aware. I think in the case described he was lucky not to be struck off, but he may be if within 2 years he can’t prove his practice is ‘remediated’. HCPC has social workers on its panels, but doesn’t tend to publish results where no sanction is issued. In my experience, being represented makes a huge difference to the outcome. If anyone wants to know more about what I do, message me on Facebook.

      • David Steare September 8, 2016 at 4:15 pm #

        Martin claims that I was lucky not be struck off, but I say that I was unlucky. I wanted my name removed from the register and I asked for that as my ‘punishment’. I am retired so I cannot prove that my practice is ‘remediated’. I last worked as a social worker two years ago and I wanted my registration to lapse a few months later. When Martin was at BASW it was obvious to me that he represented a management position, and I suspect that all BASW ARAS come from management. I cannot recommend Martin’s services and I am unhappy to find him seemingly exploiting this conversation to advertise.

  11. Andrew Foster September 8, 2016 at 12:59 pm #

    Lisa, yes, you may as well leave the profession as you suggest. Being ‘passionate’ and ‘trying your best’ simply does not feature on the accountability map. There can be no action without accountability, no matter how passionate one is about the work. The point at issue here concerns a technique which was used inappropriately and which, in my opinion, ought not to have even been contemplated. It is nothing to do with the whiney arrogance and bleating within the profession that purports that social workers somehow ought to be given special dispensation because they are ‘trying their best’ in difficult circumstances. If you disagree with that view, perhaps you need to find a different ‘passion’?

  12. Becky September 8, 2016 at 4:09 pm #

    Wow, this is such an interesting discussion. Social workers are challenged daily to find ways to establish a meaningful and therapeutic relationship with their clients in order to try and impart change. And with all the good intentions so any times we have to create different, innovative paths to move toward effective strategies to help our clients. Having said that, it does worry me that an intervention would “support” a clients self-destructive coping mechanism of self harm? I certainly understand trying to work with her in reducing the destructive behaviour, and assume (hope) that practicing more effective coping strategies would be promoted as well?

  13. Andrew Foster September 8, 2016 at 6:29 pm #

    This really is less complicated than some posts are suggesting. It certainly is not rocket science. Anyhow, to close now,u I am able to report my learning from this chapter in my life. My reflections tell me that dinosaurs in fact still roam the earth……….that muesli knitting is still practised widely in the world of social care……and no doubt that vegan sandals continue to be de rigeur in some offices throughout the UK. Goodbye for now.

  14. Critical Duck September 8, 2016 at 8:48 pm #

    Should we all call the HCPC when we are considering an intervention – I think I might call to ensure my life story work will not lead to a sanction. I was thinking of releasing balloons in a park to celebrate the completion of it. However, there is a chance that the young person may not let go of them and hence place themselves at harm as they are floated into the air. ……Ridiculous, however, has it got to that point?

  15. Cee Bee September 8, 2016 at 10:08 pm #

    What stands out in the above article is the lack of supervision & support to the worker. I do not question HCPC findings – I question the narrow scope of the enquiry.
    Are the managers responsible for supervision being taken before the HCPC in relation to their fitness to practice?
    Are senior officials responsible for workforce performance indicators being investigated or chastised in any way?
    Was the service reported to OFSTED?

    It is always the frontline worker who takes the fall and is publicly humiliated, even though working conditions directly contribute to ability to practice.
    HCPC do not seem to support frontline workers. Reporting does not help. Who is speaking out or acting to improve working conditions or address managerial malpractice. We need a professional body that defends and promotes the profession.

  16. Donna T September 8, 2016 at 10:33 pm #

    Andrew Foster clearly has no idea about the profession. In fact, his comments are embarrassing.

    David I think it’s shocking that you were suspended for an approach which was person-centred in supporting an individual’s unique needs. We cannot prevent self harm. However, supporting someone to do this in a way which may reduce the risk of harm is essential. Thanks for sharing your comments, David.

  17. Daniel September 8, 2016 at 11:01 pm #

    The ethics of family therapy do not equivalate to that of social work practice. Social work clearly utilises expertise from multiple fields. However it is a representative of the state, can you imagine the NHS openly advising such a practice? I doubt it.

    As much as you have chosen to act, where is the accountability of the organisation you were employed by? Why isn’t the head of service being put on suspension for lack of appropriate supervision and guidance. The main area the HCPC needs to improve on is challenging institutional processes and ensuring they are accountable and take responsibility as well as practitioners.

  18. September 9, 2016 at 12:00 am #

    it is worrying that the hcpc are now delving into what interventions are approved, i worked for a voluntary agency as a social worker delivering programmes which we fitted to the individual. The programmes were not from a book, were not approved or registered and was very much a case of finding a holistic intervention which may or may not have worked. we are not mind readers, we cannot say what will and wont work, social work is about making effective change but to do so you have to be able to think outside the box. the hcpc continue to try to prove their worth but in doing so are destroying social workers lives, not only those that are being penalised but those that read these articles and think ‘that could be me’

  19. Hels September 9, 2016 at 7:04 am #

    Is the above truly what the comments section is designed for, points scoring and digs!!!! I’m very disappointed at most of the above ‘professionals’