Social workers more likely to face fitness to practise cases and removal than health staff, says study

Research finds health regulators more likely to take into account practitioners' remorse or insight with greater emphasis on seriousness of allegation in social work cases

Research results post-it note on mouse
Photo: Artur/Adobe Stock

Social workers appear more likely to face fitness to practise (FTP) proceedings and tougher sanctions as a result of them than doctors or nurses, research has found.

Men are also more likely to face fitness to practise proceedings than women across all three professions, found the study, published recently in the British Journal of Social Workers.

The study drew on a literature review and a year’s worth of hearings, in 2018, across doctors’ regulator the General Medical Council (GMC), the Nursing & Midwifery Council (NMC), for nurses, the Health and Care Professions Council (HCPC), which then oversaw social work in England, and the social work regulators in the other three countries: the Scottish Social Services Council (SSSC), Social Care Wales and Northern Ireland Social Care Council.

More referrals but less representation for social workers

The literature review identified that social workers were much more likely to be referred for fitness to practise concerns than the other two professions with the 2019 annual FTP report by the HCPC showing that 1.42% of social workers were referred, compared with 0.02% of GMC-registered doctors and 0.08% of NMC registrants, most of whom are nurses.

The analysis of the hearings found that social workers were far less likely to attend their hearings or be legally represented than the other two professions, where this data was provided, with 71% of doctors attending and 58% represented, 46% of nurses attending and 41% represented but just 7% of social workers in England attending and 6% represented.

And while social workers in England (25%) were less likely than doctors (38%) or nurses (34%)to be suspended as a result of a hearing, they were more likely to be removed, with 32% of practitioners in England being struck off and 57% of those in the other three countries facing the same fate, compared with 24% of doctors and 29% of nurses.

Where a rationale was provided for the outcome, the most prominent theme for social workers was the seriousness of the allegation, which was the case in 32% of HCPC cases and 46% of those in the other three countries. However, for doctors, this was the case in 15% of cases and for nurses 17%. Instead the primary theme for doctors was the registrant demonstrating remediation, insight or remorse (32%), whereas for nurses it was giving the professional time for remediation or insight.

Greater emphasis on public protection

The study reported: “Based on the findings, it could be argued that social work decisions were more concerned with what had occurred, whereas GMC and NMC decisions tended to acknowledge a registrant’s ability to learn from their mistakes and make amends. Across the three professions, therefore, social work regulatory activity may place more emphasis upon public protection, whilst the GMC and NMC may be more willing to consider a registrant as a public asset, who can change their ways.”

Lead author Aidan Worsley, professor of social work at the University of Central Lancashire, said: “Our research raises some significant concerns for the profession, namely that there are clearly problems regarding social workers both not attending their hearings, and rarely having the benefit of legal representation. As a profession, social workers appear to be more likely than doctors or nurses to be taken into fitness to practise proceedings – and more likely to be removed from the register than those other professionals.”

Jon Dillon, executive director, fitness to practise at Social Work England, said: “While the data was collected prior to us becoming the regulator for social work, we are aware of the concerns raised and further work is required to understand and address these concerns. We are committed to gaining a stronger understanding of the findings of the report, alongside studying our own evidence base which continues to develop through our own regulatory activities.”

‘Firm conclusions cannot be drawn’

However, the Professional Standards Authority, which oversees the work of GMC, NMC and Social Work England, warned against over-interpreting the findings.

A PSA spokesperson said: “This is a complex area fraught with variables, not least of which are ten separate legislative frameworks. Whilst studies of this nature are interesting and helpful in posing questions, the limitations of publicly available data and the variables involved in each individual case means that firm conclusions cannot be drawn.

The spokesperson referred to a 2019 scoping review commissioned by the PSA into assessing consistency of outcomes of fitness to practise outcomes, which found limited evidence investigating consistency across regulators in health and social care.

It proposed a mixed-methods programme of research looking into the consistency in fitness to practise outcomes and decision-making, and the causal factors behind this. Its recommendations were presented to the Department of Health and Social Care.

The PSA spokesperson added: “In our view and that of DHSC, the optimal way forward would be to work with the sector to reform these processes so that they are designed to minimise disparity of outcomes between professions and between demographic groups. This is an objective of the ongoing regulatory reform programme.”

Over-representation of men

The study also found that men were over-represented in hearings, across all three professions. While men accounted for 17% of UK-registered social workers, they made up 45% of those taken to hearing in 2018 by the HCPC and half of those involved in hearings held by the other three regulators. In nursing, men accounted for 11% of NMS registrants but 30% of those facing hearings, and for the GMC, 88% of hearings involved men, who accounted for 54% of registrants.

Worsley, who co-authored the study with colleague Sarah Shorrock and Manchester Metropolitan University’s Ken McLaughlin, said: “More broadly, across all those three professions, there appears to be quite a significant increase in risk of fitness to practise if you are male. We were unable to determine whether race had an impact – but, with all these issues, we hope that the different regulatory bodies – and the PSA can look at their data and reflect on the issues we raise.”

In a recent interview with Community Care, Dillon said that social workers from Black and ethnic minority groups were over-represented in fitness to practise referrals to the regulator, though it did not have evidence as yet about whether they were treated differently within the system than white counterparts.

In response to the latest study, he added:In relation to overrepresentation in fitness to practise, we are exploring two key questions. Firstly, why are certain people more likely to be referred to the regulator as a result of common practice and culture within the sector? We continue to work closely with employers, practitioners and members of the public to understand the challenges that may lead to this. Secondly, when a referral is made, are certain people treated differently within the process as a result of personal characteristics? Our quality assurance and decision review frameworks have been set up to enable us to continuously review, quality assure and learn from our interactions within the process and the decisions we produce.”

About the research

The study, Protecting the Public? An Analysis of Professional Regulation – Comparing Outcomes in Fitness to Practice Proceedings for Social Workers, Nurses and Doctors was published in The British Journal of Social Workers 2020 (0).

It used data from six regulators: UK medical regulator the General Medical Council, the Nursing & Midwifery Council, for UK nurses, the Health and Care Professions Council, which then regulated social workers in England, and the social work regulators for Scotland (the Scottish Social Services Council), Wales (Social Care Wales) and Northern Ireland (the Northern Ireland Social Care Council).

Researchers analysed 348 cases from hearings carried out in 2018, 46% of which related to doctors, 29% to nurses, 21% to social workers in England and 4% to social workers in the rest of the UK.

They then recorded the gender of the registrant, whether they attended the hearing, whether they were represented, the outcomes of hearings and rationale for those, where provided.

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14 Responses to Social workers more likely to face fitness to practise cases and removal than health staff, says study

  1. Joe September 25, 2020 at 6:41 pm #

    Is anyone surprised by this? Registration should have remained voluntary and CPD should have been left to managers who actually oversee their workers work! We pay fees so someone can sit in an office in London who absolutely do not bring anything to the profession. No wonder social work colleagues are leaving in droves and they can’t recruit to the vacancies

    • Maria September 28, 2020 at 12:06 pm #

      There is a massive problem with the recruitment & retention of experienced SW’s in LA work, if they treated SW’s better & with more compassion, respect & dignity then they wouldnt have this problem!

    • Kirsten October 2, 2020 at 10:36 am #

      Voluntary registration? You’re not serious, surely?

  2. john stephenson September 25, 2020 at 7:07 pm #

    They are so many inequalities re fitness to practice,namely an over representation of ethnic minorities,when I put in a f.o.i request for the breakdown of ethnic minorities involved in hearings I was informed they do not record these details,why oh why are they not being investigated re this.

    • Maria September 28, 2020 at 12:02 pm #

      Because they are trying to cover up their failings re institutional racism in the whole system!

  3. The Watcher September 25, 2020 at 7:29 pm #

    Social workers are the most oppressed professionals in England, including oppression from their own regulatory body! ?

    • Maria September 28, 2020 at 12:04 pm #

      Sadly oppression, discrimination & victimisation of SW’s is rife in the whole system & no one is doing anything about it!

  4. Andrea September 26, 2020 at 8:23 am #

    I am sure the rigorous CPD process will take SWE to the heights of knowledge that will allow them to deal with our competence much more diligently.

  5. Jason M September 28, 2020 at 10:14 am #

    I have experience of FTP myself and my first thought was – steady on everyone! Have you seen the number of cases this actually related to? It was 14. Not the basis for anyone to go jumping to conclusions. And a complex area fraught with variables it certainly is. SWE want to look harder at the factors – good.

    When it comes to men and people of colour, there is perhaps potential for ethnic majority complainants’ prejudices, and those about men in caring roles, to be part of their reasons for making the complaint. These can’t be filtered out without some investigation and as long as it sounds serious then the regulator must investigate in order to exonerate. And I wonder if a less clear idea of what Social Workers do and should do makes it harder for others to see when we have been wrong? This would mean things get REALLY bad before a complaint is made, leading to more serious outcomes proportionally. I am not sure. I think no-one else should be too sure either. Unfairness in stats may not mean an unfair process.

  6. Paul September 28, 2020 at 1:46 pm #

    According to the statistics provided in this article Social Workers are 18 times more likely to be referred to their professional body than nurses. Did the researchers break down the reasons for these referrals. If there are 80000 registered Social Workers that means close to 1200 people were under investigation in that year. Not surprised the fees keep going up.Those figures are so disproportionate when compared against other professions that you can’t help but question why.

  7. jules September 28, 2020 at 1:55 pm #

    I strongly believe that our role is just to support another layer of bureaucracy, rather than to work with the people in our localities. Practice managers and their supervisors; the operation managers, are in the best position to assess fitness to practice. I resent the cost of ‘membership’ and have no idea to what use the monies are put.

  8. Deborah Jane Jarman September 28, 2020 at 4:50 pm #

    I am sadden that yet again social care are faced with yet another round of ‘getting to know’ a new regularity body. Who are already hot on the heals of CPD – your payment – with no reference to C19 – or the pressures of high case loads and poor middle management support (supervision) and even weaker infrastructures that can be found all over the country within LA’s.

    The article has made me think of – how can a regulatory body effectively make an analysis on the quality of training, opportunities for training, funding available in such current economical misery. There is not a capacity to challenge via ‘our regulatory body’ to be able to take these issues on board – there never has been because no one has ever asked what was needed by the people funding the very service being used to monitor their ‘practice’ and should be based on many factors due to social care dealing with a range of ‘human issues’ within local communities.

    The quality of practice is only as good as the training on offer, the values and investment in staff by the LA or organisation, alongside a personal professional responsibility by every individual – if we are to be judged on CPD around our capacity to practice – surely social demographics and resources should also be being monitored and referred to in any process that looks at fitness to practice as they impact on us every day, week, month and year,

  9. Andrew October 2, 2020 at 5:22 pm #

    While I agree that SWE is an irrelevance and just a wallpaper of platitudes, it’s a bit strong to claim they are ;oppressing” social workers. The bureaucrats don’t have the imagination.

  10. JasonM October 12, 2020 at 9:50 am #

    The worst thing about being investigated. From SWE website:
    “Investigations usually take about six months. The process may take longer…”
    That is hard to deal with.