Fit to practise

Gail Adams (centre) and the PSU team. Image: Marcus Rose

At least 250,000 UNISON members are required to maintain a professional registration as a condition of employment. There’s a common joke that the only time they hear from the regulator is either to pay the registration fee, or if their fitness to practise is being called into question.

Neither of those is very funny. But while the first may be a headache, the second could, career-wise, be a matter of life and death.

That’s where UNISON’s Professional Services Unit comes in. Based at UNISON Centre, the unit (pictured above) will handle someone’s case from beginning to end. No other union does this. And it has an incredible record in protecting our members.

Demetrios Matheou: How would you sum up the purpose and the work of PSU?

Gail Adams: Our unit provides highly specialist advice, representation and support to – primarily – health and social care staff who are being investigated by their professional regulator, for their fitness to practise. So, for example, a paramedic being investigated by the Health and Care Professions Council [HCPC], a nurse or a midwife by the Nursing and Midwifery Council [NMC], a care worker in Scotland by the Scottish Social Services Council [SSSC].

The case officer who’s allocated manages the entire process, from the minute we receive it, until whatever point it’s closed. The member gets to develop a relationship with them, so they understand why we’re asking for specific things – documents and information, evidence that we can gather – with the objective of getting their case closed with the best possible, achievable outcome for them.

And who can use your service?

Anyone whose membership predates the allegation by four weeks. I can only stress that if anyone ever hears from their regulator, the first thing they must do is contact their branch or UNISON Direct. Straight away. Don’t ignore it. Don’t put it on the kitchen table. Don’t think it will go away, because it won’t. The sooner they contact us, the sooner we can put help and support in place.

How many regulators are there?

There are nine UK-wide statutory regulators and a number of others in the devolved nations that we also cover, because health and social care regulation is a devolved matter. But care workers in England are not regulated. Social workers are regulated separately in the four countries. And we also cover the Education Workforce Council in Wales.

How common are complaints?

Across the regulators, between 0.5 to 1.25% of registered people will be subject to fitness to practise proceedings at some point in their professional career.

That sounds small.

It sounds small, but there are over a million health and social care staff regulated across the UK, so overall it’s a lot. Our unit has about 800 live cases at the moment.

And health and social care represents the largest number of cases?

Yes, whether it’s a UK regulator or a devolved nation regulator, the overwhelming majority work in health and social care. So they’re looking after the most vulnerable in society – from newborns to end of life, and literally everyone in between. It can be a member working in a care home, in an ambulance, in a hospital setting, in a person’s own home, and many other places.

Can you explain what’s meant by fitness to practise?

That’s the exam question, if you like: are you capable of safe and effective practice? The premise of most of the regulators is around three principles: public protection – someone’s harmed or could have harmed a member of the public; public interest – the allegation is so serious that a member of the public would be worried if somebody continued to practise without there being some form of regulatory action; and the registrant’s own interest – is there a health matter that is impacting their ability to practise safely and effectively?

So, what kind of complaints would be taken to a regulatory body?

There can be issues involving clinical practice: a member can be accused of care failings, medication errors, problems with risk assessments, which are quite significant in mental health care. There can be complaints about the way that people are spoken to. There can be vexatious complaints: a very good example would be social work, where I’d say that the majority of referrals are by family members of children who are subject to court proceedings. It’s a vast range.

And the people making those complaints?

In the majority of cases it’s either an employer, or somebody who has received care, or a family member who has complained as a result of what their loved one has experienced.

Why not make a complaint direct to an employer?

Sometimes people do both.

And why would an employer go to a regulator rather than take some kind of disciplinary procedure themselves?

Again, they can do both. If somebody has gone through a disciplinary procedure with the employer and mistakes are still happening, the risk measures that they put in place are obviously not working, and that may then be a reason to report them to the regulator; or if a matter was so serious that somebody’s been dismissed.

Equally, some employers will just go straight to the regulator, needlessly, so that they don’t have to manage the situation themselves. We feel this is a particular issue in social care.

What are the options open to a regulator when considering a complaint?

There are a range of outcomes, from there being absolutely no case to answer and the matter being closed – this is the majority of outcomes that we achieve at UNISON – to what are called regulatory sanctions. This could be a caution, a warning, ultimately, with the more serious allegations, you can be removed from the register.

And therefore, you can’t work?

You can’t work, you can’t practise. Your livelihood is taken away. There is damage to your reputation. Many of our members experience difficulty in obtaining work even while the investigation is taking place.

How about care workers in England, who are not regulated?

They can be referred to the Disclosure and Barring Service, which can prevent them from providing any kind of care to an adult or to a child, and also impacts on them working voluntarily.

It must be a terrible shock when someone receives that letter from the regulator.

It is. This can have a profound effect on people’s state of mind and wellbeing. I’ve yet to meet anyone who deliberately goes to work to perpetrate harm.

Some people may have been subject to a local investigation, so they will understand that there’s a concern. But they’re still scared when they hear from their regulator. They’re extremely worried that they’re going to lose their job and registration, they’re worried about their future and the impact it could have – the overwhelming majority of our members have got children, or care responsibilities.

And they fear what other people will think of them. So, they come to us very vulnerable.

                                      Gail Adams. Image: Marcus Rose

Why is your team so successful?

Because of the time and energy that we put into the case. And because the relationship is developed with the member, who nine times out of 10 will follow our advice, we are able to put before a regulator sufficient evidence to either argue that the cause for complaint didn’t happen, or mitigating factors, or to demonstrate that lessons have been learned and the member’s practice has improved.

We will write the actual submissions to the regulator ourselves, though nothing goes to the regulator without the member seeing and approving it. Often, we ask members to update their training, provide a written reflection on the event, and character references.

Considering some complaints can involve patient safety, are some cases more urgent than others?

Yes. If something’s referred to a regulator that is very serious, then they have to immediately conduct a risk assessment – to determine, in effect, if it’s safe for this person to continue to practise while they investigate, without any restrictions.

There is very little time for those kinds of hearings – we get less than seven days. So, when I said that this unit is highly specialised, that’s what I mean. They’re capable of taking those very serious, complex cases, and dealing with somebody who’s going to be panicking and highly vulnerable, and turning representation around very quickly.

According to the regulators, almost 50% of registrants are not represented in fitness to practise investigations as they are not in a union. They are more likely to receive worse outcomes, as it’s not easy to advocate for yourself. That’s why it’s so important to be in UNISON and receive this help as part of your membership.

Tell me about the team.

I’ve now got 15 case officers, who have a wide variety of advocacy experience, and two admin. I think they’re extraordinary. I couldn’t be prouder of them. All our team does is fitness to practise. They know it like the back of their hands. They know the rules, they know the regulators, they know the processes. They work really hard, have really good values, and they believe that people deserve help and representation.

Even if somebody’s made a mistake, we don’t judge them. That’s not our job. Our job is to represent members and to get the best possible outcome for them.