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

BLOG update: Stop kissing the carpet

Panorama programmes have a reputation for shocking audiences. Last nights’s programme, ‘Undercover care’ was no exception. It told the story of systematic abuse in a residential care home for people with learning disabilities through graphic, disturbing footage, secretly filmed. Restraint of the ‘patients’ included a routine called ‘kissing the carpet’, in which vulnerable young disabled adults were pinned to the floor, sometimes under a chair, with their hands pinned under the feet of a support worker. The programme reported weeks when 24 such restraints took place – when one would have been shocking enough on its own. Professor Jim Mansell, one of the UK’s authorities on caring for people with learning disabilities and author of numerous reports and studies, was interviewed on the programme. He described the pattern of abuse as one he recognised - in which a senior long serving unqualified member of staff creates the model for others to follow, and no-one dares to challenge or report such abuse to the outside world.

I found this programme particularly shocking in part because I worked as a speech and language therapist with people with learning disabilities in the 1980s. At that time, institutional care was still common and stories of abuse were also widely reported in the press – although without the benefit of clever hidden cameras. I vigorously supported the campaign to close these long stay hospitals, many of which I had visited as part of a three year research study. Thankfully, almost all these large institutions had gone by the mid 1990s, replaced by smaller, more home-like residential facilities, closer to communities and families, more accessible to visitors, more transparent in their management.

But still the abuse continues. The Panorama programme has already led to a series of apologies, suspensions and soul searching. For me, it highlights yet again the importance of regulating individuals as well as institutions. On the spot inspections of care homes will only go so far in uncovering systematic abuse, because it can only ever be periodic inspection, whether unannounced or not. Castlebeck’s home had been inspected three times in the previous 2 years and there was ‘no evidence of systematic abuse’. We need to have regulation of all those employed in the care of vulnerable people, not just those whose qualifications give them more responsibility. We need a system which makes raising concerns about colleagues clear, simple and decisive and acceptable. We do not have a mandatory system of regulation for support workers in England. I look forward to the time when we do.


Anna van der Gaag
Chair
HPC

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

Many people will be aware that the Government has proposed to transfer responsibility for the regulation of social workers in England to the HPC. As part of the preparations for this transfer, we established a working group (known as a Professional Liaison Group) of experts in the field of social work to assist us with the drafting of new standards of proficiency for social workers in England. This group met for the last time this week, having met four times since November.

The purpose of the standards of proficiency is to establish threshold standards necessary for safe and effective practice. They must reflect existing requirements and training provision, and must be flexible enough to apply to the different environments in which social workers practise. Each profession regulated by HPC has developed standards, written as part of the overarching standards which apply to all. This is a legal requirement, and the standards are specified in the legislation, which is why they had to be developed in addition to existing frameworks and standards, such the Professional Capabilities Framework or the National Occupational Standards. The HPC standards of proficiency serve a particular purpose – they are threshold standards for safe and effective practise for social workers in England – and although they do relate to the existing frameworks they have to be created for each profession regulated by HPC.

The key challenge is to ensure that the standards reflect the values of social work, the complexity of practice and diversity of contexts and settings in which social workers find themselves.

The process of drafting standards requires individuals who are able to focus on the nuances of the meaning of a sentence whilst holding the big picture of what lies at the heart of social work practice. Over the years I have taken part in many PLG meetings at HPC. I have rarely seen a group work so well together so quickly on what is ahugely challenging task. The representatives from the social work community included social work managers, employers, academics, professional body, regulatory body and union representatives. The group was well chaired by Professor Jeff Lucas, a lay member of the HPC Council and included three Members of the HPC Council. The feedback from members on the process and the way it was conducted by the HPC Executive was positive and constructive.

The next step is to ensure that the standards are thoroughly reviewed by a wide range of stakeholders before being approved by the HPC’s Education and Training Committee and Council. Once published, the standards will be subject to ongoing reviews and updates to ensure that they continue to develop and change with the profession. There is more work to be done in ensuring that the standards are clearly situated within existing standards and frameworks for social workers in England, and that the relationships between these different standards and their particular purpose is clearly understood. I have no doubt that the collaborative spirit in which this first stage has been conducted will continue to influence the process as it unfolds, and I am grateful to all those who have taken the draft standards thus far. The beginning is always the hardest part.

Anna van der Gaag
Chair
HPC

BLOG update: Counsellors and psychotherapists working group meets for the last time

Last week, the tenth and final meeting of the HPC professional liaison group on counsellors and psychotherapists took place before a packed public gallery of observers.

Since the meeting in December last year, the counsellor and psychotherapy members of the group have held meetings to undertake further reviews of the draft standards of proficiency.

There were three substantive items on the agenda – consideration of a new draft set of standards for psychotherapists working with children and young people, the draft standards of education and training, and the revised draft standards of proficiency for counsellors and psychotherapists, aligned with the new version of the generic standards of proficiency.

The Group had already made an in principle decision that the profession specific standards of proficiency should be drafted for counsellors at Level 5 and Level 7, and Level 7 for psychotherapists, effectively creating two level of entry points for counsellors, and one for psychotherapists. This meeting provided an opportunity for the whole group to review these draft standards with a view to making recommendations to the HPC Council in due course.

As ever there was a wide ranging discussion on almost all of these issues, and at several points the group felt it was important to take an indicative vote amongst those from the counselling and psychotherapy professions around the table. The outcome of this voting was as follows
• There was agreement (one abstention) that the first entry point for counsellors should be set at Level 5.
• There was agreement (one abstention) that there should be different entry points for counsellors – one at Level 5 and the other at level 7

These outcomes represent significant progress in the work to describe different levels of practise.

On the other two substantive points, - creating a separate set of standards of proficiency for child psychotherapists and holding two separate sets of standards of proficiency for counsellors and psychotherapists at Level 7 - the group did not reach a consensus. . These matters were therefore referred to the HPC Council for further deliberation.

There were passionate views round the table, not least over the importance of the language of the standards, and a clear feeling that there were differences in identity, philosophy and semantics between counsellors and psychotherapists. There were also differences in practise, which some felt could be more clearly articulated in the draft standards at Level 7. However, the opposite view was that that differentiation at entry level 7 was not supported by evidence from the field – there were currently counsellors and psychotherapists who use the title interchangeably, applying theory and practise from both fields, depending on the context.

The disparity continues to centre around describing differentiation – and specifically how and what differentiates a counsellor and a psychotherapist trained to Level 7 when they qualify from a training programme. For me, the debate is a philosophical and ideological one – tied up closely with identity. I did not hear anyone say that there was no difference between the two – only disparate views on how and what distinguishes them at the point of entry to practise.

Since the outset of the work of the PLG, references have been made to the ‘building blocks’ of regulation – standards, levels of entry to the Register and the structure of the Register being examples of these. It struck me after the meeting that the standards could also be described using the analogy of a climbing wall. The standards are something like the footholds and hand-grips on a climbing wall. If the wall is ‘professional practise’, and the climbers are practitioners – there are an almost unlimited number of ways that the wall can be climbed. For counsellors and psychotherapists, we may not yet have agreement on where the foothold and hand grips should be placed on the wall, but we are significantly closer now than we were a year ago.

This debate will therefore continue well beyond the ending of the PLG. I very much believe that this further work will bring us to a pragmatic solution that is acceptable to the majority. Members of the PLG have been tenacious in their commitment to this work, and have created new milestones, new agreements, new clarity. Without clear standards, there can be no robust regulation. On behalf of the Council, I would like to thank them for their personal investment and considered contribution to this important work.



Anna van der Gaag
Chair
HPC