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PSA publishes advice reviewing the role of ‘public confidence’ in the profession

PSA publishes advice to the Secretary of State examining how 'public confidence' in the profession is assessed in fitness to practise cases


‘How is public confidence in the profession maintained when fitness to practise decisions are made’ (PSA Advice to Secretary of State, published June 2019) forms part of the PSA’s ongoing work in the area, and responds to the Williams Review’s request for such advice following its urgent review of gross negligence manslaughter in the healthcare context, in the wake of the Bawa-Garba case.

The report provides:

  • A useful overview of the regulatory context.
  • Definitions and terminology (including what is meant by ‘the public’).
  • Commentary on the relevant guidance and some key case law.
  • How and when in FtP proceedings regulators consider the three limbs of public protection (including maintenance of public confidence) in the context of their overarching statutory objective.
  • The types of behavior which are said to be likely to undermine public confidence and the approach taken by difference regulators.


Among the report’s recommendations are:

  • Further definition is required from regulators as to the focus and purpose of public confidence as a concept.
  • Considerable variance in terminology in regulators’ guidance and standards is unhelpful.
  • A standardised language across regulators using the shared wording from their respective legislation would assist.
  • Cross-sector analysis of case law is needed to deepen understanding of the concept and how it should be applied.
  • More, extensive research across the UK is required with the public to understand their views on different types of behaviours and any difference in views depending on the profession involved.
  • Case analysis across regulators would assist in establishing whether ‘public confidence’ is considered more prominently, regularly or in depth depending upon case type or registrant categories; and whether a different approach is adopted at impairment and sanction stages.
  • Regulators should ensure panels have access to a wide-range of public views and are diverse in their membership.
  • There should be detailed analysis/comparison of the approach taken to public confidence by Case Examiners (e.g. upon consensual disposal without hearing) as against panels at hearing.


The report can be found on the PSA’s website accompanied by the research the PSA commissioned from University College London Medical School into how a methodology may be developed to assess the consistency of fitness to practise outcome across regulators.

Coincident upon publication of the above work, the High Court has recently examined, on an appeal by the PSA, the issue of a sanction imposed solely on ‘public confidence’ grounds.

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