04 October 2017

Understanding complaints about paramedics and social workers in England

Michael Guthrie, Director of Policy and Standards, discusses recently published research looking at fitness to practise concerns about paramedics and social workers in England.

In 2015-16, social workers made up 27 per cent of the HCPC Register but 55 per cent of all fitness to practise cases we received. Paramedics made up 6 per cent of the Register and 11 per cent of cases.

In 2016, we commissioned a team at the University of Surrey to understand better, why we appear to receive disproportionately more fitness to practise concerns about these professions than for other professions we regulate, and what we might be able to do about this trend.  Amongst the different regulators of health and social care professions in the UK there is an increasing recognition that we need to try to rebalance our energies, away from reactively dealing with instances of poor practice and conduct, towards an approach that focuses more on prevention.

The research included a review of the published literature; interviews and focus groups with paramedics, social workers, employers and service users; and a review of 10 per cent of fitness to practise cases in these professions over two years. Our thanks go to all those who participated.

Overall, the research found a number of common themes, which appear to be behind complaints including changing public and societal expectations; challenging practice; pressurised work environments; and the evolving nature of both professions. The case review found that a cohort of concerns we consider about social workers are from members of the public raising issues that at their heart are about disagreements with decisions and a desire to see them changed. Many of these cases concerned disputes between family members over place of residence and contact with children. For paramedics, the case review found that the rate of self-referral (where a registrant reports a potential fitness to practise matter about them to us) was much higher than for other professions and that some of these self-referrals may be unnecessary. The Standards of conduct, performance and ethics says that registrants must let us know if, for example, they are convicted, receive a police caution or are dismissed by their employers.

The above can only be an incomplete discussion of the research. We are at a very early stage of thinking about how we might respond to and take forward the findings. Some initial actions are likely to include using the insights from the research to engage further with the public, employers and registrants on when to refer and self-refer a fitness to practise concern.  We will also want to consider how we might use fitness to practise case studies developed as part of the research to develop teaching and learning materials for educators.


The research is an interesting read and is now available on our website. It’s important that we (professionals, employers and regulators alike) constantly strive to learn from the concerns we receive and use the learning positively to improve. However, whenever we talk about this area we always need to remind ourselves that although the fitness to practise process is an important part of our work, it affects only a minority of registrants in any one year (in the last financial year 1.23% of paramedics and 1.33% of social workers). The vast majority of health and care professionals are hardworking, dedicated professionals doing their best day-in-day out for service users.

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