Witness to harm, holding to account: Improving patient, family and colleague witnesses’ experiences of fitness to practise proceedings

What is the project?

In this project, researchers carried out a mixed-methods study with the UK’s health and care regulators about the public’s experience as witnesses in professional health and care regulatory proceedings.

There are two million health and social care professionals in the UK who are legally required to be registered by a regulator. If their behaviour falls below standard, they may be investigated.

In some of the most serious cases, this might include a public hearing where a decision will be made about whether they can continue to practise.

This process is known as fitness to practise.

This project focused on people who had been harmed by the registered person, because the researchers wanted to know if going through the fitness to practise process affected how they felt, for better or worse.

Why was the work carried out?

Witnesses to misconduct can be called to give written or oral evidence in fitness to practise proceedings. These might include patients, service users and colleagues who give evidence in relation to significant harm that they or someone else has suffered, such as in cases involving sexual abuse, violence, harassment, theft or lasting clinical harm.

We know from the research on victims who give evidence in criminal courts in cases of sexual harm that for some the re-telling and questioning involved can be a harrowing experience.

However, less is known about how taking part in fitness to practise proceedings impacts on patients and service users, family and colleague witnesses, how they experience support from the regulator, what they find helpful, and where support could be improved.

This support is important, because having to recall traumatic events in these hearings could be distressing.

Where and when did the work take place?

This work focused on the whole of the UK and was completed in February 2024.

Who was involved?

The project was a collaboration between The Open University, Manchester Metropolitan University, the University of Glasgow, the University of Edinburgh and the University of Leicester.

It was funded by a National Institute of Health and Care Research (NIHR) grant.

Social Care Wales was a member of the Regulators Advisory Group . Social Care Wales also took part in a review of social care regulators’ witness vulnerability policies and legal frameworks, and in events to communicate the work.

You can read more about Social Care Wales’s involvement in a blog by Hywel Dafydd, our Assistant Director of Regulation.

What have they learned from the work?

The team found that most of the regulators’ websites presented too much or too little information, at too high a level of complexity, in inaccessible formats, and made the process of navigating the website to submit a concern about a professional difficult.

The public who’d been harmed and who raised a complaint, and then took part in investigations and hearings, mainly found the process to be onerous, protracted, distressing and disappointing.

The work produced 20 recommendations, many of which are about improving how regulators conduct their processes and communicate with the public to avoid distress and potential retraumatisation. They also aimed to maintain trust in regulation and the health and social care professions.

The work led to the creation of a free OpenLearn course on ‘Improving patient, family and colleague witnesses’ experiences of fitness to practise proceedings’. A series of animations about ‘Understanding fitness to practise’ has also been produced. There are also videos of people’s stories about taking part in these proceedings.