‘Why are such a disproportionate number of complaints made against paramedics and social workers to the HCPC?’

11 October 2017

The University of Surrey’s final report ‘People Like Us?  Understanding Complaints about paramedics and social workers’ has been published on the HCPC website.

The study explored the reasons behind the disproportionate number of complaints made to the Health and Care Professions Council (HCPC) about paramedics and social workers relative to other HCPC professions. The study also considered what preventative action could be taken to address the issue.

The HCPC is an independent UK wide regulator of 350,000 individuals from 16 health and care professions.  6% of those on the register are paramedics from across the UK and 27% are social workers from England.   Paramedics represented 10.65% and social workers 57.65% of all Fitness to Practise cases in 2014 – 2015. 

The study used a mixed methods approach which included a literature review, a Delphi exercise with international experts, interviews with professionals and service users and the analysis of a random sample of cases from the three stages of the HCPC Fitness to Practise process. 


The study found that the literature relevant to paramedic complaints was limited.  One potential reason for this is that in the UK paramedics have only been regulated since 2000.

There were however a number of studies on the nature of paramedic practice which were relevant to the preventative action point being considered by the study.  These studies revealed a rapid expansion in the scope and autonomy of the profession along with significant increases in the pressure on paramedics.  In addition the review of the literature highlighted changes in society’s expectations of paramedics with the public expecting a consistently rapid response time from highly trained professional staff.

Several of the studies reviewed indicated that there is a tendency in paramedic cultures to under report errors and to focus blame on the work environment.  There is also evidence to suggest that paramedics demonstrate low scores on health and well-being indices. 

The review of literature in relation to social work revealed the difficulties faced by those whose job roles are to care but also control and societies mixed feelings about their work with dangerous service users. 

Further the reviews considered suggested that poor conditions in work places and high levels of stress were potentially factors that contributed to poor judgement, unethical and incompetent practice. 

Delphi exercise

The Delphi exercise was undertaken with 14 international experts from regulation, social work and para-medicine.  The Delphi method is a structured group communication process, which is designed to achieve group consensus amongst a panel of experts where knowledge is uncertain.  Those interviewed all agreed that a way to contribute to preventing complaints was to place emphasis on the importance of interagency collaboration and to improve communication about handling complaints. This would reduce unnecessary referrals to the regulator.

Case analysis

The case analysis covered all three stages of the HCPC investigative process. It revealed a higher number of older male practitioners in the overall sample relative to their numbers on the registers in both professions. 

Further there was a disproportionately high number of self-referrals from paramedics, 46% compared with an average of 10% for social workers and 6% across all other HCPC regulated health professions during this period.  With regards to social workers, 56% of referrals were from members of the public compared with an average of 18% for paramedics and 12% for all other HCPC regulated professionals.  The study found a disproportionate number of referrals to the regulator that did not meet the threshold for further investigation. 

The majority of these cases occurred in circumstances where the Registrants were working in unclear and highly pressurised environments. They often felt they were lacking manager support and were also dealing with patient and service user frustrations with the service as a whole.  

Of those cases that did make it through to the final hearing stage, these were typically cumulative incidents of incompetence or breaches of ethical standards.


The study found overall that many of the complaints were made against ‘people like us’ rather than people who differ in terms of their motivations, circumstances and actions. 

Further the report findings suggested the adoption of a more nuanced set of regulatory tools, with much greater emphasis on local employer led interventions. 

The report highlights the important role professional regulation has and points out that there is no evidence to suggest that the HCPC’s current system of regulation does not meet its obligations to the public.

It suggests that responsibility for delivering a more proportionate response lies with agencies such as employers, professional bodies and educators all working together.            

Comment- this report has highlighted a number of interesting statistics regarding the complaints that are made to the HCPC in relation to both professions.  It affirms the role of the HCPC in the protection of the public but wants to see employers and educators working together to reduce the number of inappropriate complaints being made to the HCPC. We await any proposals put forward at a local level in response to these findings.          

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