This is a personal perspective and not one representing the views of the HCPC.
In the May (2013) edition of the Journal of Paramedic Practice (JPP) I read with much interest the article from my good friend and colleague, Mike Brady, entitled Health and Care Professions Council: protecting whom?
I suspect Mike's article is one which a number of paramedics can identify with, one which may reflect the feelings of many paramedics as to the role and indeed, the perceived need, of the Health and Care Professions Council (HCPC). However, as a paramedic and a registrant council member of the HCPC, I am going to give a differing personal position as to the role and philosophy of the organisation. This is not to suggest that Mike's position is less valid, indeed I have already eluded to the notion that it may be the view of many registrants, both paramedics and other professionals regulated by the HCPC. Instead, it is hoped this article will challenge some of the beliefs and perceptions around the role of the HCPC, and in so doing, give a different personal perspective of the organisation, along with its purpose and function.
So, I have already suggested that I suspect Mike's article is reflective of the thoughts and views of many HCPC registrants, especially those registered as paramedics. From my own anecdotal experience, I am very aware that many paramedics view the HCPC with scepticism and fear, perceiving them as a ‘policing’ authority, rather than a regulator. Yet, the HCPC is an independent, multi-professional regulator, regulating 16 professions, including social workers, which accounts for the change of name from the Health Professions Council (HPC) to the current Health and Care Professions Council (HCPC). Within the process of regulating these professions, the HCPC require both the educational institutions, along with the registrants, to meet various standards. These standards, such as the standards of education and training (SETs) of approved programmes of education, along with the standards of proficiency (SOPs) and standards of conduct, performance and ethics, and continuing professional development (CPD), illustrates the threshold level of competency for registration.
The May (2013) article makes reference to the role of the HCPC and its position within the legal framework. It states that the piece of legislation, known as the Health Professions Order 2001, gives the HCPC specific powers to protect the public by registering health professionals and ensuring these professionals meet the standards of proficiency, along with conduct, performance and ethics, and are accountable as practitioners. It is clear from the recent publication of the Francis Report, following the Mid Staffordshire NHS Foundation Trust inquiry, that public protection is of major concern, not just amongst the medical and nursing profession, but for all those professions and professionals who come into contact with patients/client groups. The need to protect vulnerable and isolated users of our services is of paramount importance (The Mid Stafforshire NHS Foundation Trust Public Inquiry, 2013).
Analysis of the HCPC's 2011 fitness to practise (FTP) data reveals that over the last 8 years the majority of complaints about, the then, HPC-registered health professionals concerned conduct, not competence. Last year, fitness to practise data analysis showed that only 8% of HPC cases were exclusively competence related. The remainder of concerns were either about conduct alone or conduct and competence of the practitioner, (Van der Gaag and Donaghy, 2013).
As the May 2013 article implies, the HCPC describes itself as a ‘regulator’ with a specific remit of public protection. This concept is then challenged within the article by suggesting the HCPC's behaviour, along with the skills and training standards, are not necessarily ensuring public protection, but rather inhibiting the future progression of the profession (Brady, 2013). Arguably, the recent transition of recognised paramedic training courses, such as the Institute of Health and Care Development (IHCD) award, migrating to educational programmes situated within higher education institutions, enhances and equips the paramedic with the necessary educational foundation underpinning clinical knowledge and decision making. This produces graduate practitioners, grounded in a body of knowledge, which one could argue enhances the paramedic profession (Donaghy, 2008). Here I am not suggesting that very experienced and grounded practitioners do not already exist in clinical practice, rather that the future profile of our profession appears to be changing.
However, I am confused as to how the primary role of the regulator, which we have already acknowledged as protecting the public, infers a negative effect on the paramedic profession (Brady, 2013). Clearly, public protection is paramount within a health and social care setting (The Mid Stafforshire NHS Foundation Trust Public Inquiry, 2013); protection of the public and patients should be the practitioner's ultimate aim. Whether we (paramedics) as a profession are more ‘professional’, since the advent of higher education is yet to be fully determined, indeed Mike's article in the JPP refers to Abbott and Meerabeau's (1998) work around professionalism, and the complex nature of embedding a discrete body of knowledge into the philosophy of a profession is one which I suggest the paramedic profession is still exploring. The work of Papadakis et al (2004) refers to the complex identification of ‘professionalism’ which others support, such as Freidson (2004), Lave and Wenger (2009), and Becker (2008).
Many paramedic practitioners work autonomously, and, whether as advanced practitioners or first responders, paramedics are exposed to a number of differing and often challenging situations, which we need to address as practitioners. We cannot lose sight of the fundamental role of the regulator, which is public protection. As autonomous practitioners, one is expected to make informed and reasonable evidence-based decisions, yet there appears to be a notion that in so doing one is being exposed to the perceived wrath of the HCPC. So, whether as a paramedic, emergency care practitioner, advanced paramedic or critical care paramedic, the clinical governance processes and procedures of ambulance organisations, whether NHS or private providers, will undoubtedly guide the practitioner through their ‘scope of practice’ along with the Joint Royal College of Ambulance Liaison Committee (JRCALC) guidelines. Arguably, as we build upon our ‘body of knowledge’ and explore this notion of professionalism and autonomy, we surely need guidance and limitations of our practice if we are to protect the public. We cannot refer to clinical errors and practitioner mistakes as opportunities for individual and professional improvement as Brady suggests. Although learning should take place when such unfortunate incidents do occur, as we clearly have a duty to learn from the experience, one cannot use this as the ‘norm’, but rather must be treated as an adverse incident which requires investigation.
As I have previously implied, this notion of professionalism is still to be fully explored within our profession and it is one which many paramedics aspire to. The perceived dissidence of the HCPC, which Brady (2013) refers to and which is held by a number of practitioners is, I believe, unfortunate and regrettable. I strongly believe the role of the HCPC is an important and necessary role if we are to protect the people who require our services. In the recent JPP article (May 2013), Brady indicates that Healy (2012) highlights similar issues within the nursing profession in relation to the Nursing and Midwifery Council (NMC), although the NMC have clear procedural and operational variations to that of the HCPC in how they identify and conduct FTP hearings. One can clearly see from the HCPC's historical FTP data that there are a number of cases where paramedics have indeed had ‘punitive’ sanctions placed upon them, with a number struck off the register for their actions. In many cases the rationale for this outcome is reasonable, such as incidences of theft, abusive treatment of patients, child pornography, voyeurism and fraud. Surely this has to be seen as protecting the public? I do not believe it is the HCPC holding back our professional development, as inferred in the recent article (Brady, 2013), rather a small minority of practitioners.
In conclusion, I am aware that a number of paramedics perceive the HCPC with some contempt and scepticism, which I find disappointing. We must not get confused with the various bodies that advise us, protect us, regulate us and promote us. The fundamental role of the HCPC is public protection, not necessarily to promote our professional aspirations and desires, as this is the role of the professional body, the College of Paramedics (COP). That said, they (COP and HCPC) do not work in isolation, but work in partnership with a number of various stakeholders in promoting the professional knowledge base, along with mapping this knowledge to the threshold entry level onto the HCPC register, in addition to public protection. As ‘professionals’, we should embrace this opportunity in shaping our profession, not in isolation, but in partnership with all our stakeholders, including our regulatory body. Clearly, we are still an aspirant and emergent group of people trying to understand what it means to be ‘professional’ as we proceed on this journey of discovery. However, I do strongly believe a more open and positive approach to understanding the work of the HCPC would help construct a way forward in developing the paramedic profession.