101109 Fitness to practise and complaints

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					Fitness to practise and complaints

Douglas Bilton
Research and Knowledge Manager
Outline of this session
• To discuss some of the information that CHRE holds about cases that
  go to a fitness to practise hearing and discuss with you whether you
  find this information of interest
• To discuss CHRE’s interest in complaints more widely
• To discuss ways that CHRE could help in future
• To talk about possible future developments and to seek your views
How big are the registers? (end March 2010)
Pharmaceutical Society of Northern      2,060
General Chiropractic Council            2,607

General Osteopathic Council             4,250

General Optical Council                 24,295

Royal Pharmaceutical Society of Great   58,664
Britain (now General Pharmaceutical
General Dental Council                  94,023

Health Professions Council              205,311

General Medical Council                 231,232

Nursing and Midwifery Council           665,599
Fitness to practise issues
• Adverse health alcohol breach of confidentiality child porn conviction
  data protection violations dishonesty regarding qualifications and
  memberships dishonesty fraud theft drugs fail to comply with conditions
  fail to follow health and safety infection control fail to follow regulatory
  body advice or procedures fail to maintain professional boundaries fail
  to refer inconclusive post mortem fail to visit examine diagnose or
  follow up inappropriate anaesthesia inappropriate prescribing or
  medication admin inappropriate dispensing manslaughter misleading
  advertising police caution poor performance or lack of competence poor
  records or history taking poor storage of drugs poor working
  relationships poor or lack of communication practising unregistered
  rough handling of patients sexual misconduct substandard treatment
  trating without consent verbal abuse violent behaviour
Some statistics from our database (28/08/10)
                 No of final   Not impaired   Caution     Conditions   Suspension   Erasure

General          69            13 (19%)       19 (28 %)   14 (20%)     9 (13%)      6 (9%)

General Dental   480           51 (11%)       45 (9%)     63 (13%)     87 (18%)     91 (19%)

Nursing and      2521          305 (12%)      484 (19%)   151 (6%)     361 (14%)    1057 (42%)
What is CHRE’s wider interest in complaints?
• Referrals to regulatory bodies fitness to practise departments are
• The reasons are unclear; probably a combination of factors
• Proposals for advocacy services are changing for NHS complaints in
  England: Liberating the NHS: Local democratic legitimacy in health
• Proposed that local authorities commission advocacy services through
  local or national HealthWatch
• HealthWatch proposed to become a “citizens advice bureau” for health
  and social care
• We said: learn from ICAS – local authorities will need quality assurance
• Boost the level of service provided: help with recording a complaint,
  forwarding to relevant authority, support and advocacy throughout
Three principles
• Three things are in everyone’s interest:
• First, that if there are problems with a health professional’s conduct or
  performance they should be dealt with as soon as possible and in the
  right way (Papadakis: “Unprofessional behaviour in medical school is
  associated with subsequent disciplinary action by a state medical
  board” 2004 – University of California graduates)
• Second, that where people have concerns they are able to find the right
  place to take those concerns as soon as possible
• Third, that having got to the right place, they have the help, support,
  information and advice they need
• What can and should CHRE do to make this happen?
Draft guidance on raising a concern
• Tested an early draft at CHRE’s public meetings earlier in the year
• An English version currently being tested on our website
• Complaints map felt to be too complex for most, but some valued being
  able to see the complexity that they might be getting into
• We have redrafted the guidance so that you choose a statement that
  describes your situation most closely, and that takes you to the relevant
  guidance on what to do
• The flowchart is still available but secondary to written guidance
So what next?
• CHRE wants to look at other options for assisting people in getting the
  right issues to the right place as soon as possible
• This could include looking at, for example, a ‘portal’ for referring cases
  to the regulators – but what would that mean: a staffed service? Would
  it include advocacy and support, or would it be better for CHRE (?) to
  focus on navigation, and for the regulatory bodies to work to boost their
  information and support for the public – for example the GMC online
  hearing room?
• Could there be a role for CHRE in helping those ‘within the system’ eg
  those working for HealthWatch to spot what cases might be suitable for
  referral to a regulatory body
• Will the CHRE stamp on guidance about things where we have no
  powers or limited powers confuse, or is it better that advice is coming
  from as many different places as possible where people may end up?

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