Written Evidence submitted by the Chartered Society of Physiotherapy (CRC0043)

Introduction

•              The Chartered Society of Physiotherapy (CSP) is the professional, education and trade union body for the physiotherapy profession. The CSP has 52, 000 members, representing 95 per cent of qualified physiotherapists, as well as physiotherapy support workers and students. CSP members work in NHS, private and voluntary providers in all sectors of health and care.

•              The CSP supported and was a signatory to the ‘Speaking Up Charter’[1]   along with other health unions, health regulators, professional associations and representative professional bodies. The Charter aims to develop and foster a culture where people feel able to raise concerns, be they staff, users of health and social care services, their relatives, or anyone else.

1.              Handling of complaints made by patients and families about care received in the health and care sectors, including both primary and secondary care providers

1.1              The CSP has no evidence to submit on this. 

2.              Handling of concerns raised by staff about care given in the health and care sectors

2.1              Creating a culture of learning and openness is the most important, overriding factor in addressing concerns and problems at an early stage.

This means individual practitioners and teams being enabled, supported and confident to learn from mistakes, reflecting on less good practice and providing peer-to-peer feedback when they observe poor practice.

2.2              Physiotherapy staff commonly work, and often lead, multi-disciplinary teams. Among the many benefits of a multi-disciplinary approach is that it prevents ‘group think’ within any one profession and enables concerns to be raised through different professional channels making it more likely that problems are challenged.

3.              The extent to which the findings of recent inquiries have been incorporated into the complaints process

3.1              The CSP has no evidence to submit on this.

4.              Support for patients, the public and staff who wish to make complaints or raise concerns

4.1              It is vital that staff feel protected and supported should they be in a position where they have to make a complaint or raise concerns. Whistle-blowing should be a last resort. It’s a sign that procedures have failed and must be recognised as such. There is no substitute for good organisational processes which, if in place and adhered to by all sides, are the best way to ensure safe and high quality services and help nurture a learning culture.

4.2              Such processes must include well structured and comprehensive appraisal systems, clear objectives and expectations of staff, an understanding by managers of their role when staff members raise concerns and how to support staff in this, and high quality education and training for staff. While staff teams have a vital role in complying with such processes, it remains the primary responsibility of employers to ensure that they are in place.   

4.3              The Francis, Keogh and Berwick reviews all recognised staff engagement is key to improving the quality of care, and the importance of the ‘staff voice’ in developing an open and learning culture. The Francis Inquiry specifically  recommended that staff representation in hospitals should be made more effective by highlighting the need to have enough representatives on site to effectively represent staff, union representatives being given sufficient time and support to carry out their duties representing colleagues, and union members in attending union meetings.

4.4              Where staff members do raise concerns and feel that these have not been dealt with appropriately it is important that they have alternative ways to seek support and ensure that they have been listened to. Processes should be regularly reviewed by employers, working with local trade unions to ensure that they are effective in making people feel able to raise concerns.  

4.5              Allied health professions (AHPs) are the third largest clinical workforce with a well developed culture of professionalism. This is evidenced by records collected by the regulator, the HCPC, comparing favourably to the records collected by the NMC and GMC for example. However, the focus on medical and nursing staff in the health system leaves AHPs without a strategic voice at senior levels, and this creates difficulties for physiotherapists to have their concerns raised and addressed. This is a system-wide failure that needs to be corrected.

5              The consequence of complaints for care providers and of raising concerns for the employment prospects of staff

5.1              In the CSP’s experience is it clear that many NHS staff still have serious concerns about the impact that speaking out about poor practice may have. Against the background of continuing efficiency savings staff members are understandably concerned that taking such action could have a detrimental impact on their current and future employment prospects. Individuals fear for example that they may be singled out for downbanding, redundancy or transfer to another post during any review of the service that they work in. 

5.2              The examples in the media of what has happened to NHS staff who have taken action to reveal poor treatment of patients shows that these fears are founded in fact. It is clear that it will take a long time to establish a culture of trust across the NHS where staff feel that their concerns will be taken seriously, dealt with appropriately and result in changes to practices.

5.3              Where staff members feel that they have been victimised, bullied or harassed as a result of speaking out this must be taken seriously and be seen to be dealt with in a supportive manner to prevent others from being deterred.

6              Openness about complaints and concerns, and accessibility of information

6.1              The CSP believes that the corporate requirement of service providers should include the need for staff to be open with patients and their families/carers when failings in care occur.

7              The role of commissioners, system regulators and professional regulators with regard to complaints and concerns

7.1              The CSP supports robust regulatory arrangements and the value of ensuring that existing standards and processes are sufficiently explicit about, and inclusive of, all health and care professions’ candour responsibilities.

7.2              The CSP believes that seeking information from providers about how they have implemented their duty of candour responsibilities should be an integral part of the CQC’s regulatory role.

7.3              This should include how providers have developed a supporting, learning culture and through enacting robust mechanisms for identifying, implementing and evaluating changes made in response to concerns raised.

7.4              Stronger links need to be made between the CQC’s regulation of providers and the professional regulator’s oversight of a registrant’s practice.

7.5              In our experience little credit is given to registrants who are open and honest in identifying issues or errors, and registrants can perceive that they are being punished for openness. At the same time practitioners can be put under undue pressure by employers when they try to meet their professional obligations. There are a number of ways that this situation could be improved:

7.6              Regulators should actively promote registrants codes of contact to employers. This should include the way in which such codes might impact on workloads or caseloads and duties employees are asked to undertake.

7.7              Regulators could also give credit to registrants who have self-reported incidents and this fact should be publicised and then taken into account at all stages of the process. For example, where registrants have self-reported and a sanction is later imposed, the sanction can be reduced as a result of the registrant’s honesty in self-reporting.

7.8              It is essential that the different regulators’ approach to candour is coordinated and consistent. Activity in pursuing cases involving registrants of different regulators also need to be coordinated so that registrants are treated fairly and consistently, and can develop confidence that this is the case.

7.9              It would be helpful for the HCPC and other professional regulators to develop their guidance for registrants on duty of candour in consultation with each other. This should ensure that their respective standards are complementary, recognising the growing importance of inter-professional collaboration and team-working for delivering effective, integrated services to patients.

7.10              It would also be helpful for the HCPC to review its Standards of Conduct, Performance and Ethics and include explicit reference to its expectations around candour.

7.11              The CSP welcomed the proposal from the Government for a strengthened and more systematised relationship between professional bodies and regulators. In the CSP’s view this relationship is critical to the effectiveness of the regulator in dealing with complaints and concerns. The CSP would like to see these proposals applied to the HCPC.

7.12              The CSP would like to see HCPC’s evident focus on protecting the public brought to the fore more through reflecting a patient-centred approach to its activity, such as user involvement in pre-registration.

7.13              The CSP plays a key role in ensuring high professional standards in the UK physiotherapy profession. It sets out clear expectations of members’ professionalism through a Code of Professional Values and Behaviour[2] and Quality Assurance Standards[3].  The CSP is also in the process of producing guidance for members on their responsibilities and rights to raise concerns[4]. 

8              The operation of the Public Interest Disclosure Act 1998 in relation to health and social care

8.1              The CSP has no evidence to submit on this.

9              Future plans for improvements in this area

9.1              The CSP has no evidence to submit on this.

7 March 2014