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.