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Improving the experience of witnesses in health and care professional practice proceedings

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In a world first, researchers have been funded to study the experience of witnesses who give evidence in professional conduct hearings about care provided by health and social care professionals.

A particular focus will be on cases where there are allegations of harm caused. This focus should allow the identification of potential improvements to support witnesses, for consideration by regulators and employers.

The Open University (OU) and Manchester Metropolitan University, the University of Oxford, the University of Glasgow and The University of Edinburgh have been awarded just under £750,000 by the National Institute for Health Research (NIHR).

The project: Witness to harm, holding to account: Improving patient, family and colleague witnesses’ experiences of Fitness to Practise proceedings, will see researchers undertaking a mixed methods study with the UK’s health and care regulators about the experience of the public as witnesses in professional health and care regulatory proceedings.

This independently funded research will explore the experience of witnesses involved in Fitness to Practise (FtP) proceedings in six of the UK’s health and social care regulators. It aims to find out what support witnesses expect, what they receive and what they need. It will explore and identify current best practice and potential improvements to how the public engages with FtP processes, and lead to workable recommendations and supportive resources for the public, professional bodies, employers and regulators.

Over the 30 months of the project from September 2021, the team will be working with a further seven UK regulators of health and social care professionals, (in addition to the six mentioned above), people who have been witnesses in these proceedings, and employers of health and social care practitioners, to produce videos and other support materials for use by the public, regulators, regulatory lawyers and professional bodies, health and social care educators and employers.

Co-Principal Investigator from The Open University Professor Louise Wallace said: “We aim to find what the public expect and what they experience when they agree to give evidence about the care they received from a professional, particularly when it has been alleged that the care they received from the registrant caused them lasting harm. We know that “victims” in criminal court hearings can suffer harm all over again by having to relive their experience. There is no independent research on what happens when people give evidence in a professional regulatory tribunal, or whether the support offered by regulators to witnesses helps them or could be improved. Our study aims to gain unique insights, and from these findings, create resources and guidance that enables people to be better supported when they engage with fitness to practise proceedings.”

Co-Principal Investigator from Manchester Metropolitan University Professor Sara Ryan said: “Little is known about the experiences of being a witness at a Fitness to Practise hearing particularly for members of the public who have experienced harm and for whom the tribunal process can generate further distress. This comprehensive study involving researchers from five universities, family members and patient safety organisations will address this gap and produce resources to better support those involved.”

Co-Investigator from the University of Glasgow, Professor Rosalind Searle said: “It is so important to have independent research that allows those who are called to be witnesses to be asked to give their insights into processes which can deeply affect them, and more significantly unnecessarily, add to their distress. It is a privilege to work on this project adding expertise by retrospective study of a range of these cases to understand what has occurred, and more importantly how these people can be better supported and processes improved.”

Co-Investigator from The University of Edinburgh, Annie Sorbie said:The provision of written and oral evidence by witnesses is a crucial part of the fitness to practise process.  This helps to ensure that when regulators make decisions about whether health and care professionals are fit to practise, these are fair, timely and protect the public.  Our study will provide novel insights into the experiences of witnesses, and use these findings to create resources and guidance that enable people to be better supported when they provide evidence. I am delighted to work on this NIHR funded project with colleagues across the UK and from a range of disciplinary backgrounds.

How Fitness to Practise investigations currently work

If it is alleged that a professional has failed to meet their regulator’s standards, they may face a FtP investigation and, in some cases, a hearing (tribunal) to decide whether they are fit to practise, and whether sanctions should be imposed to protect the public. This is relatively rare compared to the number of registered professionals in the UK, and the number of complaints made about professionals, with around 2,700 cases per year going to a final hearing.

Distress caused by recalling traumatic events in hearings

Witnesses to misconduct can be called to give written and/or oral evidence in FtP proceedings. These might include patients, service users and colleagues who give evidence in relation to significant harm that they or someone else have 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, we do not know how this participation in FtP 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 within these hearings can be deeply distressing.

Sarah Seddon of the Harmed Patient’s Alliance who will advise the project, has blogged about her own experience of being cross examined as a witness after her baby was stillborn as “an attempt to annihilate me. He blames, belittles, bullies and tries to confuse me. He fabricates scenarios and suggests that I was too busy for my unborn baby and that I should have known that something was wrong with my midwife’s advice. I had no idea the process would be this brutal".

The availability of clear and timely witness evidence is also vital to help regulators make decisions about professionals’ fitness to practise fairly and expediently.

This independent research is funded by the National Institute for Health Research (NIHR) under its Health Services and Delivery Research Programme (NIHR 131322). The views expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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