Walter Merricks presents at Blake Lapthorn solicitor's Professional Regulatory seminar on 16 Sept


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Blake Lapthorn solicitors Professional Regulatory team held their Autumn seminar on 16 September 2010 with Walter Merricks as guest speaker.

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Walter Merricks presents at Blake Lapthorn solicitor's Professional Regulatory seminar on 16 Sept

  1. 1. The changing face of adjudication? Walter Merricks Chair September 20, 2010
  2. 2. Content <ul><li>Origins & purpose of OHPA </li></ul><ul><li>OHPA policy & procedural developments </li></ul><ul><ul><li>Transition of GMC </li></ul></ul><ul><ul><li>The wider health & social care caseload </li></ul></ul><ul><li>Alternate mechanisms to adjudication – DH consultation </li></ul><ul><li>Q&A </li></ul>
  3. 3. Origins & purpose of OHPA
  4. 4. Origins <ul><li>Government’s action programme in response to the recommendations of the Shipman Inquiry 2007 & other major inquiries </li></ul><ul><li>Trust, Assurance & Safety – the regulation of health professionals in the 21 st century (White Paper) 2007 </li></ul><ul><li>Tribunals, Courts & Enforcement Act 2007 </li></ul><ul><li>Health & Social Care Act 2008 (Chapter 14) </li></ul><ul><li>Tackling Concerns Nationally 2009 </li></ul><ul><li>Health Care & Associated Professions: the OHPA Regulations 2009 </li></ul><ul><li>OHPA became a legal entity on 25 January 2010 </li></ul>
  5. 5. OHPA’s Purpose & Benefits <ul><li>OHPA will schedule and case manage fitness to practise hearings as referred to it by the GMC in appropriate facilities, with panellists trained to operate against a set of OHPA defined rules and apply sanctions as defined by a set of GMC defined guidelines </li></ul><ul><li>Independence of adjudication from investigation and presentation to bolster public confidence </li></ul><ul><li>Leveraging benefits of independence to secure robust case management, reduction of delays </li></ul><ul><li>Harmonisation of adjudication across health regulators </li></ul><ul><li>Using economies of scale and opportunities for process re-engineering to make the process more efficient </li></ul><ul><li>Learning from experience of other justice institutions </li></ul>
  6. 6. Improvements that front-line staff believe could be made to fitness to practise adjudication Reduce stress Be more independent/objective Speed up the process Restore public trust Be more efficient Reduce fees Be more transparent Increase buy in Be more supportive Represent professionals Be more consistent Increase trust
  7. 7. OHPA policy & procedural developments – the transition of the GMC
  8. 8. GMC Fitness to Practise Procedure Enquiry Triage Investigation Case Examiner Case Preparation Panel Hearing Case Review Investigation Stage Adjudication Stage Interim Orders Panel procedures at any time 5000 enquiries 3000 decisions to follow up 1500 full investigations 360 cases referred to panel
  9. 9. Referrals – the potential legacy Number of doctors with decisions to refer a case for a FTP panel hearing (2007- 2010)
  10. 10. Policy decisions – the pros & cons <ul><li>Lift & shift – offers ease & speed, but, GMC by another name which does not entice other regulators; </li></ul><ul><li>Adopt & adapt – still offers ease & speed and demonstrates OHPA direction of travel, but, still only applicable to GMC so not attractive to others unless combined with policy ambitions for the future; </li></ul><ul><li>Big bang – new rules & procedures for day one provides absolute clarity of the role and culture of OHPA, but, most difficult & time consuming due to significant rule & procedure changes & risk to OHPA commencing 1 st April 2011. </li></ul>
  11. 11. Opportunities for change <ul><li>More active case management & standard directions </li></ul><ul><ul><li>No. of particulars considered </li></ul></ul><ul><ul><li>Sanction contended for </li></ul></ul><ul><ul><li>Disclosure of evidence </li></ul></ul><ul><ul><li>Expert witness agreements </li></ul></ul><ul><li>Reviews on papers & use of Consent Orders </li></ul><ul><li>No legal assessor where there is a legally qualified chair </li></ul><ul><li>Experience for appointment to panel chair </li></ul><ul><li>Panels of 3 (reduced from 5) with substitution mid-hearing permitted </li></ul><ul><li>Hearings in public </li></ul>
  12. 12. Change at what cost? <ul><li>Forecast annual cost to deliver adjudication within GMC is £20.7M (£16.7M direct, £4.0M overheads) </li></ul><ul><li>Assuming all early opportunities for change are introduced then annual savings on current adjudication costs of £3.8M predicted </li></ul><ul><li>Greatest saving is reduction of panels from 5 to 3 (£2.5M) – based upon ‘like for like’ with no volume increase </li></ul><ul><li>Fees Regulations to collect fixed and variable fees from the GMC (and others in time) – no central funding </li></ul>
  13. 13. OHPA policy & procedural developments – the wider health & social care caseload
  14. 14. Comparison of referrals & hearings No. of registrants No. of complaints No. of cases referred to FtP Panel No. of FtP Hearings GMC 247,530 5,195 359 270 GOC 23,319 150 31 16 RPSGB 57,086 1,153 84 84 NMC 676,547 2,178 417 712 GDC 95,387 898 164 192 HPC 185,000 483 206 311 GOsC 4,261 25 17 11 GCC 2,489 43 17 19 PSNI 2,000 N/A 59 35 GSCC 95,511 158 N/A 33
  15. 15. Emerging policy ambitions <ul><li>Establish OHPA as a Tribunal & appoint a President </li></ul><ul><li>Further increase in use of case management </li></ul><ul><li>Preliminary hearings </li></ul><ul><li>Two-stage rather than three-stage process </li></ul><ul><li>Impact statements </li></ul><ul><li>Broad use of cost powers </li></ul><ul><li>Cost capping </li></ul><ul><li>More efficient use of hearing rooms and empanelment ( cf . Magistrates consultation) </li></ul><ul><li>Duty solicitor or McKenzie Friends for unrepresented professionals </li></ul><ul><li>Record hearings (ie no transcription except on request) </li></ul>
  16. 16. Impact & ease of implementation of changes
  17. 17. Alternate mechanisms to adjudication
  18. 18. DH launch consultation <ul><li>Government not yet convinced of need for OHPA </li></ul><ul><li>Consulting on preferred option to repeal legislation relating to OHPA, and in separate legislation provide for GMC to introduce a Doctor’s Disciplinary Tribunal (and other regulators?) </li></ul><ul><li>Closes 11 th October 2010 </li></ul><ul><li> </li></ul>
  19. 19. OHPA Board view <ul><li>Independence & public confidence </li></ul><ul><li>Delays </li></ul><ul><li>Development of Tribunal </li></ul><ul><li>Restoring trust among professionals </li></ul><ul><li>Applicability across the health professions - joining-up the system </li></ul><ul><li>Scrutiny and appeals </li></ul><ul><li>Improving speed and reducing inefficiencies </li></ul><ul><li>Short and long-term costs </li></ul><ul><li> </li></ul>
  20. 20. The future of health profession adjudication
  21. 21. Questions?