Title: Improving patient, family and colleague witnesses’ experiences of Fitness to Practise proceedings: A mixed methods study
Funder: Department of Health and Social Care

Abstract: Why we are doing this research:_x000D_ _x000D_ If professionals fail to meet their regulator’s standards, they may face a Fitness to Practise (FtP) investigation and hearing (tribunal) to find out if there was misconduct, and whether sanctions should be imposed to protect the public. This is rare compared to the number of professionals and the number of complaints made about professionals._x000D_ _x000D_ Witnesses to misconduct can be called to give evidence to the regulator’s investigators and then to take part as a witness and be cross examined if the case goes to a hearing. A proportion of these cases will include patients, service users and colleagues who may have been significantly harmed by the registrant’s behaviour. _x000D_ _x000D_ It can be a long and costly process. Regulators’ research has mainly focused on the impact of this process for professionals. We do not know what the impact is for patients and service users, family and colleague witnesses, what support they receive from the regulator and what support they would like. This is important because having to remember traumatic events can be deeply distressing. James Titcombe, a father whose wife was a witness in a FtP hearing for the midwife involved in the care of their baby who died after birth has said, “I can honestly say that the process felt like the worst kind of mental torture imaginable.” _x000D_ _x000D_ We know from the research on victims who go to court in cases of sexual harm that some people find the retelling and questioning of being a witness to be a harrowing experience. We do not know if this is the case in hearings involving professional misconduct. This is the first independently funded multi-regulator research into the experience of public witnesses in professional misconduct hearings. _x000D_ _x000D_ What we plan to do:_x000D_ _x000D_ We aim to undertake research with several regulators to better understand and improve the experiences of witnesses involved in FtP hearings. We focus on cases of misconduct where the witness was harmed by the registrant’s practice or behaviour including sexual abuse, harassment and bullying, theft and fraud, and involving lasting physical or psychological harm. We will:_x000D_ 1. Look closely at all the documents produced for witnesses and the support provided by regulators on their journey from making the complaint through to the FtP hearing to improve the experience for witnesses, to see how readable they are and how well they explain what people want to know._x000D_ 2. Use surveys for around 105 people, focus groups and interviews with around 23 people, to find out how to improve the support provided by regulators and employers for their staff who may become witnesses in relation to colleagues’ behaviour. _x000D_ 3. Examine the paperwork of 35 finished cases up to 3 years ago including the hearing transcripts and written evidence, and interview those involved, to identify what could have been done differently to reduce trauma. _x000D_ 4. Follow 7 different cases where witnesses may have been harmed by the registrant’s conduct. This will involve attending the hearings and interviewing about 36 relevant people (witnesses, witness support officers, lawyers and hearing panel members) after the hearing. _x000D_ 5. Up to 17 witnesses who have experienced a FtP hearing in the last 3 years will be asked to film their story._x000D_ _x000D_ How we plan to have impact from our research:_x000D_ _x000D_ This mix of research will give us rich insight into the experiences of witnesses and regulators’ staff with whom they come into contact. We will have input throughout the project from 3 Advisory Groups. Our public and patient involvement collaborator will chair an advisory group of patient advocacy groups and people with lived experience of being involved as witnesses in FtP proceedings. A second advisory group with the Professional Standards Authority (PSA) and all 13 of the UK’s Health and social care regulators are advisers on the project. A third advisory group includes lawyers involved in cross examining witnesses in FtP, and employers and professional organisations who refer to and employ staff who could be involved in FtP proceedings. These advisers will be invited to contribute to the research and to its findings and the outputs._x000D_ _x000D_ The results will be analysed and brought together to produce new resources and guidelines for these processes. We will work with a mix of members of the public in workshops to decide the best ways to produce these resources. Workshops with professionals will look at how employers can better support their staff and patients/service users, and how regulators can improve their ways of working and training of staff and the people who take part in hearings, and the support provided to witnesses. We will use different methods in these workshops including drawing, film and storytelling._x000D_ _x000D_ We will co-produce a range of outputs for the public, regulators, professionals, training bodies and employers which will be available free online at healthtalk.org, socialcaretalk.org and the Open University OpenLearn platform. We will work with the PSA and the 13 bodies, public and employers, to ensure our project outputs are used effectively and compassionately.

Lay abstract: Aim:_x000D_ We focus on cases of serious misconduct by health and social care professionals before a professional regulator involving serious harm to the person who experienced the misconduct. We aim to improve understanding of their expectations and experiences, and to recommend improved processes for witnesses involved in Fitness to Practise (FtP) proceedings. _x000D_ _x000D_ Background_x000D_ There are 2 million health and social care registrants in the UK and thousands of 'concerns' about their practice are referred to regulators, with less than 1% investigated further. If their behaviour is evidenced to fall below the professional standards, they may face a Fitness to Practise (FtP) hearing or tribunal. In 2019/20 2,783 FtP hearings took place across the 10 regulators under the Professional Standards Authority (PSA) to determine if there was misconduct, and whether sanctions should be imposed to protect the public. There are three further social care regulators for Wales, Scotland and Northern Ireland concerned with the standards of practise of a wide range of social care professionals. All these regulators share a common legal purpose of ensuring registrants practise safely and act appropriately. _x000D_ _x000D_ Witnesses to misconduct can be called to give evidence in a FtP investigation and hearing. A proportion of these will include patients, service users and colleagues who may have been significantly harmed by the registrant’s behaviour. Such cases may include behaviours associated with sexual abuse, harassment and bullying, theft and fraud, abuse of rights and lasting clinical harm. We know from the research in the criminal justice system that there is potential for additional trauma caused by the experience of being a witness. To our knowledge, no academic research on witness experience in the context of professional regulation has been conducted in the UK or elsewhere. This is the first independently funded multi-regulator research on fitness to practise. We will collect and consider evidence about whether and how the conduct of FtP processes may adversely impact on witnesses and evaluate regulators' interventions designed to mitigate these secondary harms. _x000D_ _x000D_ Objectives:_x000D_ 1. Examine the experiences of witnesses throughout the FtP journey from initial engagement, investigation, to the hearing and its outcome._x000D_ 2. Conduct a systematic analysis of the content and user experience of the existing FtP information, resources and interventions for witnesses._x000D_ 3. Identify where and how these could be improved to benefit witnesses and improve confidence in and efficiency of regulation._x000D_ 4. Co-develop and co-produce ‘good practice’ guidance and resources for a range of stakeholders; the public, regulators, health and social care employers and regulated practitioners._x000D_ _x000D_ Methods: _x000D_ We are investigating the experience of witnesses in cases managed by several of the UK’s regulators. Sequential mixed methods will be used to understand the experience of witnesses in the FtP journey and in the co-design of guidance and resources. These methods include: 1). Surveys of witnesses (n=105); 2). Interviews with a) members of regulators‘ public engagement groups (n=6), b) witnesses who have used regulators‘ support services (n=6), c) health and social care employers regarding how they support colleagues who have been harmed by a registrant co-worker (n=11). 3). Document analysis to assess the readability and content of regulators' FtP witness support materials. 4) Case studies of cases completed in the past 3 years involving harm (n=35) including a) content analysis of case materials and then for a subset of these cases b) further (n=33-45) interviews including witnesses, regulator staff and adjudicators. These retrospective interviews will use memory reconstruction techniques and event mapping to identify key areas for improvement. To complement these retrospective case studies, 5) ethnographic study of 7 new FtP hearings will be gathered to extend insight into witnesses’ experiences, as well as additional perspectives from regulator staff and lawyers, and researchers’ direct observations of the hearing. 6) Film reflective narratives of up to 14 people’s experiences of FtP hearings, including their needs for and use of witness support services, legal, complaints, health and care services. 7) Results will be analysed and synthesised in three iterative workshops. _x000D_ _x000D_ Advisors: _x000D_ Regulators, public and patient advocacy bodies, employers and professional bodies have all informed and support this proposed project. Our public and patient involvement collaborator will chair an advisory group of patient advocacy groups and people with lived experience of being involved as witnesses in FtP proceedings. A second advisory group with the PSA and all 13 of the UK’s Health and social care regulators are advisers on the project. A third advisory group includes lawyers involved in cross examining witnesses in FtP, and employers and professional organisations who refer to and employ staff who could be involved in FtP proceedings. These advisers will be invited to contribute to the research and to its findings and the outputs. We will have an independent Study Steering Committee of research, regulatory and public experts._x000D_ _x000D_ Outputs:_x000D_ As this is a new focus of academic research, we anticipate there will be considerable impact from the findings. In addition to academic outputs, we will co-produce resources including guidance for regulators. We will co-produce web resources such as podcasts, and films on digital platforms Healthtalk.org and Socialcaretalk.org, that incorporate audio and filmed witness stories available free to the public. We will create an 8 hour free to access OpenLearn course for professionals to promote understanding of professional regulation and the FTP processes, the experience of being a public member witness, and the support they may benefit from.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE