Policy responses and statements
- Name of organisation:
- Council for Healthcare Regulatory Excellence
- Name of policy document:
- Harmonising fitness to practise sanctions across regulators
- Deadline for response:
- 29 February 2008
Background: The Council for Healthcare Regulatory Excellence (CHRE) is a statutory overarching body, covering all of the United Kingdom and separate from Government, established from April 2003. CHRE promotes best practice and consistency in the regulation of healthcare professionals.
CHRE has been consulting on harmonising the sanctions available to the regulators of healthcare professionals under their fitness to practise procedures. The consultation was developed with the co-operation of the nine healthcare regulators: General Chiropractic Council (GCC), General Dental Council (GDC), General Medical Council (GMC), General Optical Council (GOC), General Osteopathic Council (GOsC), Health Professions Council (HPC), Nursing and Midwifery Council (NMC), Pharmaceutical Society of Northern Ireland (PSNI), and Royal Pharmaceutical Society of Great Britain (RPSGB).
The sanctions available to the nine healthcare regulators are central to their roles in protecting the public and in safeguarding the standards of the professions that they regulate. The objective of this consultation was to seek views on the principle of harmonising sanctions across all the healthcare regulatory bodies and to identify the most appropriate range of sanctions to be available to regulators.
CHRE will report on the conclusions of the consultation to the Departments of Health, the individual regulators and the public in April 2008.
COMMENTS ON
COUNCIL FOR HEALTHCARE REGULATORY EXCELLENCE
HARMONISING FITNESS TO PRACTISE SANCTIONS ACROSS REGULATORS – A CONSULTATION PAPER
The Royal College of Physicians of Edinburgh is pleased to respond to the CHRE on Harmonising fitness to practise sanctions across regulators - a consultation paper.
In general, the College agrees that harmonisation across the regulators will bring benefits of clarity for the public, but cautions against this being done at the expense of preserving the key principles of proportionality and suitability for the different professions. The scheme of sanctions should reflect the level of risk associated with each profession, and variation should be allowed where circumstances require different solutions.
Q1. Should all regulators in FTP cases have available the same set of sanctions?
In general, it would be helpful for all regulators to have access to a similar set of sanctions. However, the case for complete standardisation of sanctions is not entirely well made. The four benefits cited for standardisation (flexibility, consistency, clarity and fairness) could be achieved in other ways and should not be the sole basis on which sanctions are standardised. It is important that sanctions match need, and there may be some variability across the different groups.
Q2. Which of the following sanctions should be available to all regulators: Erasure, suspension, conditions on practice, cautions, warnings or fines?
All of these, with the exception of fines, should be retained by all regulators. The majority of health care professionals work in the public sector, and serious sanctions which restrict or prevent them earning their living already imposes a severe financial penalty if a deterrent is required. The regulatory system should be protective (of the public) rather than punitive. Financial compensation for the patient is available through other routes. See also Q20.
Q3. Are there other sanctions which should be included in the standard set?
Requiring retraining and monitored practice may provide an additional sanction/outcome that could be applied universally where the regulator considers there is room for remediation and the public would not be put at risk as a result. The financial implications of this would need careful consideration.
Q4. Should there be a common term for erasure?
This seems intuitively attractive, but the choice of term is critical. Erasure may imply a more serious sanction than removal, which could be voluntary or temporary. Whichever term is selected, there would benefit from a clear definition.
Q5. Should erasure be available to all regulators in cases in which allegations relate solely to health and or performance?
The long term removal from the register of a healthcare professional with impaired performance or health issues is feasible under indefinite suspension provisions and achieves the same effect. Unless it can be demonstrated categorically that there is no opportunity for health improvement or training, it would be harsh to erase and may be open to challenge.
Q6. Should there be a standard minimum period before restoration to the register?
The reasons for removal will vary and the regulators should have some flexibility to set “minimum tariffs”, recognising the reducing probability of a successful return with time. However, it would be reasonable to have a minimum period of 12 months before consideration of a case for restoration. For shorter periods, suspension may be a more appropriate option than removal and should have a set time period applied (which can be reviewed).
Q7. What should the minimum time period be?
A period of less than a year would seem to be inappropriate where the sanction of erasure was applied.
Q8. Should all regulators be in a position to specify the kind of evidence that would be required to apply for restoration?
Yes.
Q9. What powers/recommendations can regulators have/make when imposing and reviewing suspension orders?
The ability to require retraining and a period of supervised practice is important. The ability to impose this would be constructive, although many would appear to have this power already under “conditions”.
Q10. Should all regulators be able to review a case early if the registrant does not comply with conditions?
Yes.
Q11. Should the regulator be able to impose condition on practice on restoration to the register?
Yes.
Q12. At a hearing should all panels be able to accept written undertakings from the registrant?
Agreed, with the proviso that procedures and criteria are in place to ensure that undertakings are monitored for compliance. Undertakings signal clear insight and recognition of problems by the healthcare professionals and should be supported. The question of whether this information should be in the public domain is more complex, as it may be difficult to maintain patient and team confidence in the individual who is still permitted by the regulator to work and impede remediation. However, employers and line managers should always have access to this data - see Q18 below.
Q13. Should all regulators have a power to agree undertakings at the investigation stage as an alternative to referral to a hearing?
Yes.
Q14. Should there be a common terminology for cautions, warnings, admonishments and reprimands?
The words do not all have the same meaning, and so it would be worth considering carefully the use of more than one to signal different things. This would be an analogous to the difference between “careless”, “reckless” and “dangerous” driving.
Q15. Should the length of caution be standard?
The regulators should retain the flexibility to ensure the length of a caution reflects the circumstances of each case. However, guidance to support consistency of approach would be helpful.
Q16. Would it be helpful for FTP panels to have the power it issue cautions for different periods?
Yes – see Q15.
Q17. Should cautions be available in cases in which fitness to practice is found?
Agreed, provided it is clear why the caution is being imposed and appropriate for the level of impaired practice and circumstances rather than erasure or other sanctions.
Q18. Should all cautions appear on public registers?
This is only appropriate for more advanced sanctions, as it is important that patient confidence is not eroded unnecessarily. Confidence in the ability of the person to practice (at the level agreed) is also important. All cautions should not be disclosed to general enquirers as this could lead to practitioners being effectively stopped from practicing. If this is needed to protect the public, then a panel should restrict practice or erase.
Q20. Should financial penalties be available?
The position of healthcare regulators is different to other professional regulatory bodies in that their primary role is the protection of the public through the regulation of individuals, most of whom are employed by the state. The regulator has no role in the regulation of the organisations responsible for services to patients. Financial compensation to patients is available through other routes. See also Q2.
Q21. Should interim orders be allowed?
Yes.
Q22. Should sanctions come into force immediately and panels have the power to enforce an immediate order?
Not unless the potential consequences eg danger to patients or abrogation of the duty of care is likely to be an issue. It is important that the working of the legal system be recognised, and the regulatory process must be human rights compliant with appeals provisions.
Q23. Should registrants have a right of appeal against all decision including cautions?
Yes.
Q24. Are there other sanctions for regulators to consider?
See Q9.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[29 February 2008] |
