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Approaches to handling health and social care student fitness to practise

Professor Tim David of the University of Manchester and Sarah Ellson, Partner, Fieldfisher LLP, explain the differences in approach to managing cases about students' fitness to practise compared to that for registrants.

Universities have to provide mechanisms to deal with health and social care pre-registration students whose behaviour raises concerns about a student’s fitness to practise. Students are every bit as capable as registrants of exhibiting extremes of behaviour. However, the arrangements for dealing with such cases differ markedly from the approach to registrants.

The main contrasting features can be summarised as:

  • Unlike registrants, in whom fitness to practise concerns are dealt with by one of the national regulators, student cases are dealt with locally by the university, and each university is subject to Byelaws and has different regulations not just for dealing with fitness to practise matters but for all other academic and disciplinary matters.
  • The process for handling registrants is supported by input from lawyers, acting for registrants, the regulator, and advising the panel (the chair of which is sometimes legally qualified). Although published data is unavailable, approximately 50 per cent of universities disallow students to be accompanied or represented by a lawyer at a fitness to practise committee, which we find concerning [Education Law Journal 2011; 12(4):239-245]. Where lawyers are allowed, medical, dental and pharmacy students who are members of a relevant defence organisation can usually obtain free legal advice and representation, but most other students are unable to afford this.
  • Although the regulators may not necessarily see it in this way, they all benefit from the external scrutiny of every fitness to practise determination by the Professional Standards Authority, which often provides invaluable feedback which is likely to drive up the quality of work. In contrast, there is no mechanism for feedback to university fitness to practise committees. The Authority has considered whether regulators should receive every student fitness to practise outcome (Professional Standards Authority February 2010) and recommended regulators collect aggregated data and share good practice.
  • Although published data does not exist, to a varying degree it appears that a considerable proportion of student fitness to practise cases are dealt with without any sort of due process. Either wayward students are simply being informed by a senior member of staff that their career is over, or, alternatively, students with serious problems are allowed to progress unchallenged. There are many programmes where there has never been a fitness to practise referral, raising the question of whether there is an analogy with incident reporting and patient safety, the argument being that the safest hospitals are the ones with the highest rates of incident reporting.
  • Registrant cases are dealt with by the relevant regulator, each having different rules and processes. Many universities have discipline-specific processes, whereas at the University of Manchester (and a small number of other universities) all health and social care student fitness to practise cases are dealt with by a single fitness to practise committee. If there is a plan to unify all regulatory matters under a single regulator, then Manchester might be seen to be well ahead of the game.