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Consistency and confidence in fitness to practise cases

Today we are publishing two reports resulting from the Williams Review into gross negligence manslaughter in healthcare. The Williams Review was set up in the wake of the case of Dr Bawa-Garba and recommended that we looked at:

  • the extent and reasons for different fitness to practise outcomes in similar cases; and
  • how the impact on public confidence is assessed in reaching fitness to practise decisions about individual healthcare professionals.

The Department for Health and Social Care subsequently commissioned our advice – these two reports are the result.

Developing a methodology to assess the consistency of fitness to practise outcomes sets out a structured approach to understanding the factors influencing consistency and proposes a methodology that could take this work forward. We contracted UCL Research Department of Medical Education to undertake this study. Assessing consistency would be a major piece of work because the nine professional regulators work under different legislation with varying rules and guidance which are each applied to the particular circumstances of an individual case.

How is public confidence maintained when fitness to practise decisions are made? This report highlights the fact that:

  • there is no agreed definition amongst the regulators of what public confidence is; or
  • what types of behaviour or regulatory action may impact upon it in the context of health professional regulation; and
  • the public have different views in relation to different professions.

We conclude that there are differences in approach across the regulators which are shaped by a range of factors. However, it is unclear what impact this has on the decisions made and whether this impacts markedly on fitness to practise outcomes. A large-scale case analysis would be needed to assess this.

Both reports underline that this is a complex area of healthcare regulation – rife with inconsistencies in language, differing definitions and outdated terminology.

Both reports are available on our website.


Professional Standards Authority for Health and Social Care

Christine Braithwaite, Director Standards and Policy

Reception: 020 7389 8030


Notes to the Editor

  1. The Professional Standards Authority for Health and Social Care oversees nine statutory bodies that regulate health and social care professionals in the UK.
  2. We assess their performance and report to Parliament. We also conduct audits and investigations and can appeal fitness to practise cases to the courts if we consider that sanctions are insufficient to protect the public and it is in the public interest.
  3. We also set standards for organisations holding voluntary registers for health and social care occupations and accredit those that meet them.
  4. We share good practice and knowledge, conduct research and introduce new ideas to our sector. We monitor policy developments in the UK and internationally and provide advice on issues relating to professional standards in health and social care.
  5. We do this to promote the health, safety and wellbeing of users of health and social care services and the public. We are an independent body, accountable to the UK Parliament.
  6. Our values are at the heart of who we are and what we do. We are committed to being impartial, fair, accessible and consistent in the application of our values.
  7. More information about our work and the approach we take is available at
  8. Sir Norman Williams 2018, Gross negligence manslaughter in healthcare: the report of a rapid policy review. Available at: