Crafting strategy: HPC’s strategic intent 2012 to 2015

I remember reading from the economist JK Galbraith’s writings about economic regulators, in which he observed: ‘...regulatory bodies, like the people who comprise them, have a marked life cycle. In youth they are vigorous, aggressive, evangelistic, and even intolerant. Later they mellow, and in old age - after a matter of ten or fifteen years - they become, with some exceptions, either an arm of the industry they are regulating or senile.’(1)

HPC celebrates its 10th anniversary this year, hardly a lifetime, but long enough to look back and ask – have we remained true to our central objective - to protect the public? One of the ways we address this question is to reflect on our strategic intent document on a regular basis. This document, above all others, should articulate that central objective. It should set out clearly who we are, what we do and how we do it.

The strategic conversations that we have on the Council range from conversations that aim to make sense of new policies and changes in health and social care from a regulatory perspective, to those that focus on organisational priorities and outcomes. Creating strategy is not a science; it is a craft, one part of an organisation’s way of responding to internal and external influences whilst maintaining a clear focus on what it is there to do. This ‘crafting’ is inextricably linked to the organisational culture and the quality of working relationships which allow the conversations to flow into actions.

The revised strategic intent document that you will find on our web pages is, therefore, our current statement on how we think we should deliver public protection in health and social care. It describes our values – the underlying principles and ethical basis for what we do, our vision – how we would like to be seen in the future, and our key objectives. We aim to deliver efficient and effective regulation, maintaining our ‘can do’ culture of continuous quality improvement, tackling difficult decisions in an informed way, collaborating, anticipating and being proactive in our approach. The ways in which we deliver this must change as we do. As we grow in size and complexity, working with new groups and new stakeholders, we must maintain clarity of purpose and fidelity to our values and vision. This is the strongest defence against Galbraith’s sound and salutary observations. Complacency is surely the enemy of excellence, and the seedbed of senility.

Anna van der Gaag
Chair
HPC

Ref:

(1) Galbraith, John Kenneth (1954). The Great Crash, 1929.

Have you had the conversation yet?

In November 2011, we published a research report exploring what professionalism meant to students and educators in three different professions. Whilst, perhaps unsurprisingly, the research found that there was no one definition of professionalism, participants generally saw professional behaviour as a ‘situational judgement’ – knowing what to do, and what not to do, in a given situation – and it was defined in contrast to behaviour which was considered ‘unprofessional’. The skill of ‘knowing what to do’ included the importance of identifying poor practice and taking appropriate action.

The professionalism of health and care staff certainly seems to be in question in recent, unfortunately repeated, reports about failures in standards of care in hospitals and care homes. These examples will not be repeated here, but, quite rightly, they have led commentators to question not only the role of the regulators involved in monitoring standards, but the responsibility of individual professionals and other staff in speaking-up about poor practice. Last week, the Commission on Dignity in Care for Older People published a draft report for public consultation suggesting ways to ensure that older people are treated with compassion and dignity and receive the services they need. The Commission proposes a number of recommendations to improve the care provided to older people, and of central importance is the concept of responsibility, not just at board and managerial level, but throughout hospitals and care homes. All staff have ‘personal responsibility’ for patient care and ‘should be required to challenge practices they believe are not in the best interests of the people in their care’. These are certainly requirements that are familiar to HPC registrants. They are included in the HPC’s standards of conduct, performance and ethics and we have also published additional information on our website about raising and escalating concerns.

However, I strongly believe it is important in this debate not to focus too much on the negative - the minority who appear before our fitness to practise panels and whose unprofessional behaviour damages public trust. We should not be complacent about poor conduct or poor practice but this means that we need to focus on the majority and our shared responsibility to identify and challenge unprofessional behaviour when it occurs. As one recent report clearly argues, this is important territory. The recently published report (enclosure 08) of a working group established by the Chief Nursing Officer in Scotland to look at professionalism across the nursing, midwifery and allied health professions emphasises the need for professionalism to be clearly articulated throughout the NHS in Scotland in a way which can support all staff to display the behaviours, attitudes and values at the heart of what it is to be a professional. Professionalism is intimately linked with the trust service users place in practitioners and, crucially, with high quality services.

What all these reports indicate is the need for professionals to engage in debates about professionalism. In her February bulletin, Karen Middleton, Chief Health Professions Officer at the Department of Health in England, has recently invited allied health professionals (‘AHPs’) to engage in a ‘big conversation’ about professionalism, but her call to action is surely relevant to all the professions on the HPC Register, in all the various contexts in which they work. The aim is to create an ‘environment where unprofessional behaviour is challenged immediately and constructively on an individual basis’ and we are encouraged to start talking to each other about professionalism and professional behaviour, ‘whenever and wherever’.

So, what do you think is professional or unprofessional behaviour? When is the last time your team had a conversation about professionalism? If you witnessed behaviour that you thought was unprofessional, what would you do?

Have YOU had the conversation yet?

Anna van der Gaag
Chair of the Health Professions Council

Student fitness to practise and registration – consultation ends 2 March 2012

Q. What risks do students training to be health and care professionals pose to the service users they come into contact with?

Q. How effectively do education providers deal with cases of poor conduct by students?

Q. How can we best make sure that students understand the responsibilities of them as future registrants?

Q. Should social work students (in England) continue to be registered?

These questions and more are discussed in our on-going consultation looking at student fitness to practise and registration.

We are seeking the views of all of our stakeholders on the most effective way of assuring the fitness to practise of students, including the registration of social work students in England. The consultation is being held partly because we will become responsible for regulating social workers in England from 1 August this year. Social work students are required to register with the General Social Care Council (GSCC) but the HPC does not currently register students.

Alongside the consultation, we also asked some researchers to undertake a review of the published literature in this area. This was so that we could build an increased understanding of the levels of risk from students in each of the 15 professions we regulate, and in social work, and benefit from any evidence about the best ways in which that risk might be managed. We will consider the research alongside the responses to the consultation.

The launch of the consultation prompted a renewed debate amongst the professions about the best way of managing student fitness to practise. In the social work field, Community Care reported on the potential costs if social work students continued to be registered. The General Social Care Council (GSCC) argued that registration of student social workers was crucial, in order to ‘uphold standards’ and because of the ‘unique risks associated with practice placements’.

In the consultation we have not made any specific proposals – for example, we have not proposed that social work students should or should not be registered. Instead, we wanted to stimulate discussion amongst all the professions on this topic, to help us reach an informed view on the best approach to take. So it is encouraging to see that in the professional press, in the conversations I have had with a wide range of stakeholders since we launched the consultation, and in the responses to the consultation we have received so far, we are hearing a wide range of different perspectives on this issue.

The consultation closes on 2 March 2012 and I would encourage anyone with an interest in this area to let us know what they think here.

Michael Guthrie
Director of Policy and Standards
Health Professions Council

Professionalism in healthcare professionals

What is professionalism?

There has been renewed interest over the last few months in the ‘professionalism’ of health care workers. One YouGov poll reported 41% of those surveyed thought that nurses were ‘less professional than they had ever been’. Whilst today’s wave of interest may be focused on nurses, it is in all our interests to reflect on why health and care workers are currently perceived in this way. The issues which have been a cause for concern – treating patients and service users with respect, communicating clearly, involving people in decisions about their own care, keeping accurate records of treatments and interventions – are all fundamental to good professional practise for all health and care professionals, and they are clearly articulated in the HPC’s standards.

One of the questions worth exploring in this complex arena is: what do professionals themselves think ‘professionalism’ means? As part of our commitment to building the evidence base of regulation, we commissioned researchers at Durham University to take a qualitative look at perceptions of ‘professionalism’. Specifically, we asked them to explore what the concept meant to students and educators in three professions; occupational therapists, paramedics and chiropodists / podiatrists. One hundred and fifteen students and educators participated in twenty focus groups.

What emerged from the research was that ‘professionalism’ was seen not so much as a competency but a judgement, a set of behaviours influenced by context, rather than a fixed, defined characteristic. These behaviours were strongly influenced by the particular care group, peer group, and knowledge and skills of an individual. How peers behaved, for example, could strongly influence how an individual viewed ‘professional’ behaviour, and what was appropriate in one context might not be in another. The use of humour, calling a patient by their first name, and dress codes, were all examples of behaviours which needed to be adapted depending on the context, and the skill of professionalism was in knowing when to do what. The report gives illuminating examples of unprofessional behaviour and why it was judged to be so. Standards and codes were seen as an important, if more remote, influence on behaviour – a baseline level of professionalism that would not be breached.

Why is this research important?

It is the first study of its kind into professions regulated by HPC. There has been a great deal of research on professionalism, but most of it in relation to doctors and nurses, very little specifically looks at the professions we regulate. The findings reveal more similarities than differences between students and educators from the three professions. We hope it will provoke further thinking about the centrality of behaviour, ethics and conduct in delivering good care.

There is a lot of discussion about whether or not support workers and assistants should be registered – mainly arising from reports about poor conduct, abusive relationships, and dishonest dealings with vulnerable people. There seems to be a renewed interest in defining and securing professional behaviours in our health and social care workforce, whether EA trained doctors, healthcare assistants, or paramedics. As a UK-wide regulator, we have an interest in promoting professionalism, stimulating debate and discussion about what part we play, and how this overlaps with the role played by others – systems regulators, employers, peers, patients and carers. I hope that many of you will see this report as an opportunity for debate and discussion about what professionalism means for you, in your context, and how it can be enhanced across the whole workforce. It is through debate and discussion that our individual and collective understanding of this important aspect of practise can develop still further.

Anna van der Gaag
HPC Chair

The research is available to download from the HPC website

Standards of proficiency for social workers in England: Reflecting the complexity of social work practice

As you may be aware, next year the regulation of social workers in England is due to transfer from the General Social Care Council (GSCC) to the Health Professions Council. We are also due to be renamed the Health and Care Professions Council to reflect our new role. As part of getting ready for the transfer, we are currently consulting on standards of proficiency for social workers in England.

Each profession regulated by the HPC has their own specific standards of proficiency and this is a legal requirement. The standards of proficiency will set out what a social worker needs to know about, understand and be able to do when they become registered for the first time.

We will use these standards when we approve undergraduate degree and masters degree programmes in social work to make sure that someone who successfully completes their degree has met the standards they need to practise safely and effectively as a social worker.

We know that once a social worker becomes registered their practise might develop in lots of different ways – for example, they might work in different settings, specialise in a particular area of practise or become involved in training social work students. Because of this, once a social worker is registered with us we will expect them to continue to meet the standards of proficiency, but only those that continue to apply to their particular scope of practice.

The draft standards of proficiency include standards about ethics, communication skills, team working and safeguarding vulnerable people. Some examples of these standards are listed below:

• knowing the limits of practice and seeking advice or referring to another professional where appropriate
• recognising workload and resources
• understanding the importance of maintaining their own health and wellbeing
• Being aware of the characteristics and consequences of verbal and non-verbal communication and how this can be affected by disability, culture, age, ethnicity, gender, religious beliefs and socio-economic status.
• Being able to contribute effectively to work undertaken as part of a multi-disciplinary team.

These are just a few examples. We set up a working group involving key stakeholders from social work to help us to put together the draft for consultation

The standards play a specific and important role in how we regulate but very much complement other standards such as the Professional Capabilities Framework (PCF). We have written a short statement with the Social Work Reform Board setting out the role of the standards of proficiency and the PCF
http://www.hpc-uk.org/mediaandevents/statements/hpcandswrbjointstatement/

Currently social workers have to meet the GSCC’s code of practice for social care workers and our standards of conduct, performance and ethics (SCPE) will replace this code. These standards describe how the public and professionals alike expect someone who is registered with us to behave. They include standards such as the need to act in the best interests of service users, protect confidentiality and behave with integrity and honesty. The standards apply to all of the 15 professions we currently regulate and once social workers in England join the HPC register they will also have to meet these. Next year, we plan to review these standards so there will be an opportunity for social workers to help us shape these standards for the future.

We are really keen to hear what social workers and others think about the draft standards. It provides a great opportunity for individual social workers to get involved and to help us to make sure the standards are fit for purpose and reflect the values and context of social work.

The consultation closes on 18 November 2011. Please do respond and help us in shaping these important standards for social workers.

Link to the consultation:

http://www.hpc-uk.org/aboutus/consultations/

Link to our standards of conduct, performance and ethics
http://www.hpc-uk.org/aboutregistration/standards/standardsofconductperformanceandethics/


By Michael Guthrie
HPC's Director of Policy and Standards

HPC builds an iPhone App

Modern mobile devices like the iPhone are changing the way people access and share information. There is already an expectation that organisations should make their services available online, but now more than ever people expect those services to be fully functional from their mobile device.

At the HPC we are seeing the number of people accessing our services from mobile devices increasing. As an organisation looking to extend our reach to the public and our stakeholders to raise awareness of our regulatory role, it is a communications channel that we simply cannot ignore.

Mobile apps allow organisations to tailor information and services specifically for mobile devices, not only to ensure that the information is fully accessible from a smaller device, but also to utilise the specific strengths of these devices, such as GPS technology, social media integration and multimedia capabilities.

For me the key to building a successful mobile app is to focus it around a specific audience, and not to attempt to do too many things for too many people. The best apps that I have used tend to focus on a specific utility and perform it very well.

With the public as our primary audience, our focus was getting across our key messages, namely, who we are, what we do and how to raise a concern about a health and care professional.

However our strongest message is to encourage people to check that their professional is currently registered, ensuring that they are practising legally, safely and effectively, and they are entitled to use a protected title.

When we recently redesigned our online Register (accessed through our microsite hpcheck.org), we built new infrastructure which allows us to integrate this utility through other channels, and our new mobile app was perfectly placed to make full use of this.

The challenge for us was to design a mobile interface that made searching the Register easy, clear and accessible, and I would like to think that we've achieved that.

We were also able to integrate our RSS feeds giving users access to the latest news and media releases from the HPC. There is also the added benefit of users being able to save any relevant news items, as well as share items with friends and colleagues.

We have also managed to make use of the iPhones’ multimedia capabilities by including our ‘raising a concern’ brochure for download, and our video on 'understanding fitness to practise hearings' which can be viewed directly from the app.

We feel the new app uniquely extends the reach of the HPC Register, as well as providing another communications channel for our stakeholders.

We do not, however, see this as a finished product, and we are already looking at ways in which we can improve and extend the app in the future. You can download it free from the iPhone App Store now, and please tell us what you think by emailing us at: app@hpc-uk.org


Tony Glazier
Web Manager, Health Professions Council

Making regulation more accessible

‘Accessible’ is a word that most people associate with physical access to buildings or buses. People with disabilities campaigned for decades to afford the right to equal access in public places, and as a result, society has become more ‘accessible’ to many more people, whether through markings on pavements for people with visual impairments, or ramps outside public buildings for people who use wheelchairs. Communication ‘access’ is a less familiar term, and still less understood by the majority of people, despite the fact that there are an estimated 2.5 million people in the UK with communication difficulties of some kind or another. In broad terms, ‘communication access’ refers to the right to information – to have information in formats that make sense – whether in a different language, or in pictures or symbols.

Governments in the UK have been promoting this kind of access, albeit less visibly than others. More than ten years ago, the Scottish government published an important document called ‘Same as You’, a policy statement on the future of services for people with learning disabilities. It represented a new step towards a more inclusive and accessible future. It made an important reference to the role of communication and information;

‘Better information, communication and advocacy are central to making any changes and putting principles into practice. If we are to include people with learning disabilities and autistic spectrum disorders more fully, they need to have accurate information so that they can make informed choices and decisions’ (Same as You, 2000, p42).

The following year, a very similar policy statement was published by the Department of Health in England in ‘Valuing People’ (2001). Both of these were heavily influenced by the All Wales Strategy for people with learning disabilities, also groundbreaking policy which set the scene for many of the reforms of services for people with learning disabilities in the 1990s and beyond.

One of the key initiatives which grew out of this reform agenda, - became known as ‘Easy Read’ – ensuring that public services provided information that was accessible to people who, for whatever reason, found written English difficult to understand. My colleagues within speech and language therapy have been instrumental in promoting this over many years. Today there are a large number of organisations, many employing people with disabilities, who provide help and guidance on making information more accessible. Last year, HPC commissioned Inspired Services Ltd, to produce an Easy Read version of the HPC’s public information leaflet. This was developed with and by service users in collaboration with members of the HPC Fitness to practise team. Making information about how to complain ‘accessible’ was a challenging task for all those involved. HPC has made a clear commitment in its strategic objectives to make information about its processes more accessible, so that people know how to complain, and where to complain. It is essential for a regulator to take steps to ensure that information on how to complain is as ‘accessible’ as possible. I am delighted to see that the easy read version is now available on line and my thanks to all those who made it happen.


Anna van der Gaag
Chair
HPC