Health concerns

Last updated: 16 December 2022

Contents

• About this guidance
• What is health impairment?
• Evidence raising a fitness to practise concern about a social worker's health
• Consideration at triage
• Investigations stage
• Completed investigations
• Case examiner decisions
• Final orders in health cases
• Interim orders in health cases
• Reviews of orders
• Publishing decisions
• Convictions for drink and drug driving related offences
• Cases with other grounds of impairment
• Insight
• Health conditions in remission
• Pausing the process
• Voluntary removal
• Support

About this guidance

This guidance notes what types of information and evidence may require Social Work England to investigate whether a social worker’s fitness to practise is impaired by reason of ill health.

It also contains guidance on how we may take these investigations forward and the factors that we will consider when making decisions in cases that involve concerns about a social worker’s health.

Who this guidance is for

The guidance is intended primarily for (any of the following):

• social workers
• employers of social workers
• fitness to practise case examiners and adjudicators
• wider Social Work England staff

It may also be useful for (any of the following):

• people with lived experience of social work
• the public

What is health impairment?

If a social worker is not adequately managing a health condition in a way that protects the public from any risks posed by the condition, their fitness to practise may be impaired by reason of physical or mental ill health.

Being unwell does not necessarily mean a social worker’s fitness to practise is impaired. The key question is the potential risk to public safety.

This risk depends on (all of the following):

• the nature of the health condition
• the social worker’s level of insight into their condition
• the social worker’s willingness or ability to self-limit their practice appropriately in light of their health condition

A social worker may pose no risk to public safety if they (do all of the following):

• have full insight into their health condition
• engage and comply with recommended treatment programmes
• either limit their practice appropriately or stop practising completely when unwell

If the social worker poses no risk to public safety, there is no need for us to be involved.

Types of health impairment

Physical health impairment

Physical ill health will usually reduce the capacity of the person to work and so is self-limiting in terms of potential risk to the public. Examples of exceptions might be where there is evidence of uncorrected deficient sight or hearing. However, in general it is very rare for physical ill health to warrant a fitness to practise investigation.

Mental health impairment

Mental health conditions and addictions are much more likely to warrant investigation. This is because of their potential impact on a social worker’s ability to exercise competent professional judgement and therefore on public safety.

What happens when there is a concern about a social worker's health?

Very often, health concerns can be managed locally through an employer’s occupational health scheme without the need to get us involved at all.

A social worker should not be referred to us on health grounds if (both of the following)

• they self-report their health condition to their employer
• they follow the recommendations of their occupational health department and/or treating physician for treatment and work arrangements

Health concerns should only be referred to us if the above criteria do not apply and there are concerns that the social worker’s health presents a risk to the public.

Even if a question of health impairment does arise, the best outcome involves us agreeing with the social worker what level of restriction is needed to protect the public while they recover. Ideally this should happen without the need for a fitness to practise hearing through what we call accepted disposal (disposal of a case without a hearing).

The fitness to practise process can be stressful which in some cases may worsen a social worker’s health condition. We want to support social workers who are unwell and to work in partnership with them to protect the public while they recover.

Evidence raising a fitness to practise concern about a social worker's health

A health concern may arise when (both of the following):

• there is evidence suggesting that the social worker has an identifiable health condition of a type that could impair their ability to practise safely
• there is evidence that (either or both of the following apply):
  • the social worker lacks insight into their condition and its potential impact on public safety
  • they are unwilling to or incapable of seeking or following recommended treatment programmes and practice limitations to protect the public

Before we can investigate further, there must be some evidence that is characteristic of an identifiable health concern.

For example, evidence of (any of the following):

• abuse of alcohol or drugs
• confused or delusional thinking
• symptoms of clinical depression
• irrational or excessive reactions to situations

It is not possible to give an exhaustive list of health conditions or scenarios that could suggest impairment by reason of ill health.

The key questions to ask are (all of the following):

• Does the evidence suggest a type of health condition that could mean the social worker poses a risk to public safety if not managed appropriately?
• • Does the evidence suggest the social worker may lack insight into their condition? For example:
  
  • Is the social worker failing to engage with reasonable requests for information about their current health, recommended treatment programmes or practice limitations?
  • Is the social worker unable to self-manage their condition to protect the public?

Adverse incidents

​Any objective evidence of adverse incidents, even relatively minor, potentially arising from a suspected health condition, strongly suggests the need for us to investigate because this points to the social worker being unable to self-manage and control their condition. For example, a finding by a court that the social worker was drunk and disorderly may suggest that they are currently unable to limit their alcohol consumption. This might suggest an alcohol dependency which could be a risk to the public.

In the first instance it might be necessary to obtain further details of the court hearing to find out more background information, such as whether the court found the incident was uncharacteristic or isolated.

Is there a decline in performance?

If an employer is concerned that a decline in the standard of a social worker’s professional performance may be health related, they should first explore this through occupational health.

Whether or not a fitness to practise concern requires us to investigate may depend on:

• the strength of the evidence suggesting a health concern
• the extent to which the social worker has engaged with the employer to explore and address this possible health concern
  ​

Consideration at triage

What is triage?

When we receive fitness to practise concerns that relate to the social worker’s health, we must assess the concern and decide whether or not to open an investigation. This process is called triage.

How we assess whether or not to investigate

During the triage stage, our enquiries should be the minimum necessary to answer these questions:

• Does the social worker currently have a health condition that might risk public safety (now or in the future)?
• If so, is the social worker managing this condition in a way that fully addresses this risk?

Investigations into adverse health are not required or in the public interest if the health condition is being managed safely and appropriately.

Another potential relevant factor is whether the social worker referred the health concerns to us themselves, which may be indicative of insight into their health condition.

An investigation may be necessary if a condition is episodic and either of the following applies:

• the ability of the social worker to recognise and act in response to an onset of a new episode has not been established
• the social worker has previously failed to recognise and act in response to an episode

Investigations stage

If we decide to investigate a health concern, we will contact the social worker to:

• let them know what information we have received
• give them the opportunity to add their comments
• get consent for seeking further medical information, a health assessment and testing (if necessary)

Social workers will be encouraged to seek advice and support from their representative (if possible). Consenting to us getting more information and agreeing to health assessment and testing (where appropriate) enables us to fully understand the social worker’s state of health and the extent of any risk to the public.

This means we can make well-informed decisions about (both of the following):

• whether the social worker’s fitness to practise is impaired
• what is the most proportionate level of restriction that we may need to apply

Requesting medical information

Depending on what information we have so far, we may ask the social worker for consent for us to seek further information about their health condition.

This might involve requests for (any of the following):

• information about their health condition in general
• information about how their condition is being managed from their treating doctors or others who have been involved with their care
• medical records

We will only request information relevant to the health condition that may be affecting the social worker’s fitness to practise. If drugs or alcohol use is a concern, we may also ask the social worker to consent to a health assessment and/or toxicology testing.

There is more information about health assessments and testing later in this guidance.

We appreciate that social workers may have concerns about the release of their medical information. We will always seek to explain the purpose and scope of our request for information to ease those concerns.

Absence of up-to-date medical information

The absence of up-to-date medical information means (all of the following):

• we may not be able to accurately assess the scale of any risk posed by the social worker’s health condition
• it may be necessary to seek an interim order that either prevents the social worker from working at all or limits their practice
• our decision makers might have to apply an order that protects the public from all possible risks (including the most serious presentations of the condition) in order to guarantee public safety

Failure to respond

Social workers in England have a professional duty to cooperate with investigations into their fitness to practise. This professional duty reflects that social workers should work in partnership with employers and their regulator to ensure the public is protected from risk of harm.

The failure to respond to our requests for medical information, refusal to give consent or refusal to undergo assessment and testing may be:

• taken into account when we consider whether the social worker is complying with their professional obligations
• taken into account when we consider the social worker’s insight into their health condition
• added as a particular ground for regulatory concern

Health assessments

The purpose of a health assessment

The purpose of health assessment is (both of the following):

• to find out what level of risk a social worker’s current health condition may pose to public safety
• to assess the social worker’s insight and understanding of the impact of the health condition on their ability to practise safely

It is important to emphasise that health assessment is not a tool to find out if a social worker is unwell. There should already be sufficient evidence that the social worker is unwell in a way that might impact on their fitness to practise, even if we have not yet confirmed the precise nature and scale of the presenting condition.

The health assessment is one of two tools we use to determine the nature and scale of a social worker’s condition. The other tool is toxicology testing which we will discuss later in this guidance.

When can we request a health assessment?

The fitness to practise rules state that we can request a health assessment at any stage where the regulator is considering a case of fitness to practise by reason of the grounds of adverse physical or mental health. The rules also state that the assessment will be conducted by a healthcare professional nominated by the regulator, which is us. [note 1]

[note 1] Fitness to Practise Rules, rule 36

GP or specialist reports in place of a health assessment

A social worker may not need a separate health assessment if (both of the following apply):

• they are already under the care of a relevant specialist or general practitioner (GP)
• they are willing to consent to the specialist or GP providing us with regular reports on their current fitness to practise

Whether or not we request a separate health assessment will depend on (both of the following):

• the quality of the information the treating specialist or GP is able to provide
• whether they are experienced in assessing fitness to practise for social workers

The treating specialist or GP would also need to declare that they were fully aware of the concerns that had led to us opening an investigation.

Identifying a social worker’s prognosis and treatment needs is different from assessing the risk their condition may pose in the professional setting of social work. This may mean a treating specialist or GP is not best placed to provide the sort of opinion that will help us decide about a social worker’s fitness to practise.

If in doubt, we will normally invite the social worker to a health assessment because this ensures quality and consistency of approach in the opinions offered about fitness to practise concerns.

Who conducts a health assessment?

Health assessments are undertaken by our independent medical assessment provider. They will usually instruct a doctor registered with the General Medical Council to conduct the assessment.

For mental health and addiction concerns, we will usually request a psychiatrist to undertake the assessment. For other types of health concern, we will request a doctor with clinical experience relevant to the health condition.

We will select the health assessor from a pool of experts provided by our health assessment supplier. The assessor will have been appointed to this pool for their experience in assessing the impact of health conditions on health professionals and/or social workers’ ability to work safely. They are otherwise entirely independent of us.

We will make every effort to nominate a health assessor close to the social worker’s place of residence.

Physical examination

In most cases (including mental health cases), the health assessor will carry out a physical examination.

The assessor will also take a case history covering (any of the below):

• symptoms
• past history
• previous relevant health episodes

They will also ask about family and personal history including (any of the below):

• career
• education
• personal relationships
• hobbies and interests
• usage of alcohol and drugs

Part of this assessment may include the collection of samples for analysis when the health concern relates to drugs or alcohol abuse.

Other relevant information and tests

We will give the health assessor copies of any relevant information we have obtained. Our health assessment provider will usually also request copies of medical records that they consider necessary and relevant from the social worker's treating doctors and/or others who have been involved in their care.

The assessor will also carry out any other tests they think they need to assess the social worker’s fitness to practise.

Report and recommendation

The health assessor will produce a report that will be shared with (both of the following):

• the social worker
• Social Work England

This report will include a diagnosis using an internationally recognised classification system and an opinion on whether the social worker is (one of the following):

• fit to practise
• only fit to practise with restrictions
• not fit to practise at all

Where relevant, a recommendation will be given in the report about how to manage the social worker’s fitness to practise case from a health perspective.

The health assessment is not intended to make recommendations about treatment options – it is not our role to manage or direct a social worker’s treatment. The social worker must pursue this with their treating doctors. Our role is to determine what steps may be needed in respect of the social worker’s professional practice to protect the public while they recover their health.

The social worker may use or share this report with their GP or treating doctors if they find it helpful.

If no definitive diagnosis is found

Sometimes, the health assessor may be unable to make a definitive diagnosis and may suggest seeking a second opinion.

In this case, we would set up a second assessment with a different health assessor. We fully recognise the burden this might put on to the social worker, but it may be unavoidable to make sure that the outcome of the investigation is proportionate and fair.

Toxicology tests

When will we request a toxicology test?

Toxicology tests are often used alongside health assessments to better understand a social worker’s drug and alcohol use. These tests will only be undertaken if there is a concern that illicit (illegal) drugs are being used or alcohol is being consumed to an excessive level that impacts public protection. They are not used for any other health concern.

Toxicology tests can be undertaken in advance of the health assessment so the health assessor can use the results to assist with diagnosis and their recommendation on fitness to practise. They may also be undertaken at the request of our independent decision makers as part of a conditions of practice order, either interim or final order.

What does a toxicology test involve?

If we ask a social worker to undergo toxicology testing, it will include talking samples of (any of the following):

• blood
• hair
• fingernails or toenails
• saliva
• urine
• breath

Often only one type of test is needed but sometimes we may carry out 2 different types. The most common tests undertaken are blood and hair tests.

What happens if we request a toxicology test

If testing is needed, we will give the social worker a detailed donor sheet explaining exactly how the test will be performed.

Our independent laboratory will contact the social worker to explain the process and arrange a mutually convenient time and location for the test to take place.

The sample will be collected by an appropriately qualified healthcare professional. The appointment usually takes around 30 minutes.

Completed investigations

Further comments from the social worker

When we have completed our investigation including any health assessment and/or testing, we will usually invite the social worker to make any further comments on:

• the evidence we have gathered
• their current state of health

Investigation report for case examiners

After receiving any further comments from the social worker, we will create an investigation report for the case examiners.

Who are the case examiners?

There will be 2 case examiners assigned to a case:

• a lay case examiner (who will not be a social worker)
• a professional case examiner (who will be a social worker)

Case examiner decisions

Once the case examiners have received the investigation report, they must decide whether or not there is a realistic prospect that the adjudicators would find the social worker’s fitness to practise impaired at a hearing.

In making their decision, case examiners will take into consideration (both of the following):

• whether the social worker has a health condition that may pose a risk to the public if not adequately managed
• whether there is evidence calling into question the ability of the social worker to manage their condition or limit their practice adequately

When the case examiners have assessed the case, they will make one of 3 decisions:

1. close the case with no further action or advice (for example they might offer advice about the steps to be taken if the social worker suffers a relapse of a health condition that is currently in remission)
2. propose an accepted disposal
3. refer the case to a hearing

At this stage, if the case examiners are concerned about a risk to the public or the social worker themselves, they can choose to put an interim order in place. We will discuss interim orders in detail later in the guidance.

Accepted disposal

If the case examiners decide that there is a realistic prospect of a finding of impairment, but that is not in the public interest to refer the case for a hearing, they will explore accepted disposal as an option.

What is accepted disposal?

Accepted disposal involves (both of the following):

• deciding not to refer the case to a hearing
• inviting the social worker to agree to a proposed final order (an accepted disposal)

The social worker’s level of engagement during the investigation and insight into their condition is likely to be seen by the case examiners as highly relevant to whether accepted disposal is a possible option.

The proposed final order will normally be (one of the following):

• a conditions of practice order
• a suspension order

Conditions of practice orders will usually be the preferred course as they allow the social worker to undertake whatever level of practice is safe as and when they are able to do so. Further information on final orders in health cases is set out in the next section of this guidance.

Refer the case for a hearing

The case examiners will consider referring the matter to a hearing if:

• there is a realistic prospect of a finding of impairment; and
• there is a public interest in the matter being referred to a hearing; or
• the social worker does not accept a proposed order during accepted disposal

Final orders in health cases

What is a final order?

A final order places restrictions on a social worker’s practice at the end of a fitness to practise investigation. They can also be a means of offering advice to a social worker. A final order can be imposed if (one of the following):

• case examiners propose an accepted disposal
• adjudicators decide the social worker’s fitness to practise is impaired following a hearing and impose a final order

If the adjudicators find that the social worker’s fitness to practise is impaired or the case examiners determine there is a realistic prospect of the adjudicators finding impairment, the likely outcome in health cases is a conditions of practice or suspension order.

In theory, the outcome after an impairment finding could be no action or advice. However, any impairment finding must have been based on there being a current risk to public safety. It follows that these orders are unlikely to be sufficient to provide the necessary protection.

Conditions of practice orders

Conditions of practice orders need to reflect the presenting condition and the consequential level of risk in the particular case.

The order will usually include (some or all of the following):

• the social worker must nominate a medical supervisor for the case who must then be approved by us
• the social worker must remain under the supervision of the medical supervisor and should undergo any tests or assessments as and when requested or arranged by the medical supervisor
• the social worker must remain under the care of their treating doctors and must follow their recommendations about their treatment and their fitness for work
• the social worker should consent to the exchange of information and reports about their health between us, their medical supervisor, treating doctors and employers
• the social worker must cease or limit their practice immediately if advised to do so by their medical supervisor or treating doctors

Please refer to the fitness to practise conditions bank for further examples of the types of conditions that may be imposed.

Conditions of practice orders should set the supervisory framework to protect the public and to support and monitor the social worker while they recover their health. Conditions of practice orders do not need to include drivers or goals in the treatment programme. That is for discussion and agreement between the social worker and their treating doctors.

Medical supervision

If a conditions of practice order has been put in place, a medical supervisor may be appointed.

The medical supervisor may be responsible for or involved in the social worker’s treatment or care (for example, their GP) and will also need to meet regularly with the social worker to discuss their progress.

The medical supervisor will report to us on a regular basis to give their opinion about:

• the social worker’s progress with treatment
• whether the social worker is complying with conditions
• the social worker’s fitness to practise in general

The medical supervisor may invite the social worker to a further health assessment as part of their reporting requirements. The type and frequency of assessments is a matter for the medical supervisor’s professional judgement. It may also be set out by the case examiners or adjudicators in their decision for the social worker to engage in a health assessment.

When a conditions of practice order may not suffice

Conditions of practice orders may not provide sufficient protection if there is evidence raising doubt about whether the social worker will be able or willing to comply with the order.

Decision makers should be slow to include conditions that are more about treatment and progress to recovery rather than directly about managing risk to the public.

For example, a condition to abstain from alcohol would require the social worker to be free from dependency. This may be a goal to be achieved in order to regain fitness to practise but may be challenging to the point of being unachievable while the social worker is still unwell and fitness to practise remains impaired.

At any time during a conditions of practice order, the medical supervisor or treating doctor can require the social worker to cease practice if they relapse into abusing alcohol.

If necessary, the case can then be listed for early review to see if more restrictive conditions or a suspension is required.

Suspension orders

A suspension order may be required if (any of the following apply):

• the social worker is not engaging
• the social worker is not currently capable of complying with conditions
• there are no workable conditions that could be put in place to protect the public

Even if the social worker is engaging, in some circumstances suspension may be a supportive outcome in a health case because it removes the pressure on the social worker to return to work while they recover. The social worker can ask for an early review of the suspension if they recover their health sufficiently enough to contemplate a phased return to work under a conditions of practice order.

Although a suspension order cannot directly include requirements such as that the social worker must remain under medical supervision, the reasons for the order should be clear about what a future reviewing panel will expect of the social worker. This is called a recommendation.

The social worker may be able to present positive evidence of insight and engagement to a review hearing where they have successfully followed these recommendations. This could include evidence that the social worker has undergone a health assessment shortly before the end of the period of suspension.

For more information, read our guidance for suspended social workers.

Removal orders

A removal order is removing the social worker from the register. This means they are no longer able to practise as a social worker or use the restricted title ‘social worker’.

If the adjudicators find the social worker unfit to practise on the ground of physical or mental health then a removal order cannot be made at a fitness to practise hearing. However, a removal order may be available to adjudicators when the suspension or conditions of practice order is reviewed.

Interim orders

What is an interim order?

If there are immediate concerns about a risk to the public or to the social worker themselves if they continue to practise, we may seek an interim order to be put in place while the case is ongoing.

When can an interim order be put in place?

We can make a referral to the adjudicators at any point during an investigation if the risk to the public or the social worker is sufficiently serious. The adjudicators can order either that the social worker be suspended from practice or that they practise with restriction (which is called a conditions of practice order).

Interim conditions of practice order

There are a range of possible conditions that can be imposed in health cases at this stage.

An interim conditions of practice order may require:

• regular reporting from a GP
• toxicology testing
• abstinence from drugs or alcohol
• workplace supervision to make sure that:
  
  • people with lived experience of social work are not negatively affected
  • the social worker engages with treatment and medical advice

See the fitness to practise conditions bank for further examples of conditions that might be imposed in health cases at the interim order stage.

How long can an interim order be imposed for?

An interim order can be imposed for a maximum of 18 months. After this time, any further extension would need to be agreed by the High Court.

Read more about interim orders.

Reviews of orders

When will a conditions of practice or suspension order be reviewed?

Orders for conditions of practice or suspension must be reviewed before they expire. We can direct an early review if circumstances change, for example if the current order is:

• no longer sufficient to protect the public
• no longer workable
• no longer necessary and can be reduced or removed

We will consider whether to direct an early review as and when we receive further evidence about (both of the following):

• the social worker’s current state of health
• how this affects any potential risk to the public

It’s very important that the social worker keeps us informed of any such evidence and continues to allow us to engage with treating doctors and medical supervisors.

If the social worker has been subject to a conditions of practice or suspension order imposed by the adjudicators for more than 2 years continuously, the adjudicators can consider directing a removal order. In health cases, this is the likely outcome if the social worker has failed to engage during the case.

Publishing decisions

We are required to publish decisions in fitness to practise cases, including those agreed through the accepted disposal route.

Read about our publications policy.

Confidentiality

Any information capable of identifying the nature of the health condition will be put in a confidential annex to the decision and will not be published wherever possible. This might include some conditions in a conditions of practice order. For example a requirement to be under the care of a treating psychiatrist or to undergo toxicology testing for drug or alcohol abuse.

Sharing confidential information

We may need to share the confidential annex with (any of the following):

• current employers
• prospective employers
• medical professionals

We will not share it with any complainant in the case. We will always inform the social worker if and when we share the information with others.

Convictions for drink and drug driving related offences

Driving while under the influence of alcohol or drugs is a criminal offence and as such will usually result in an investigation of impaired fitness to practise by reason of the conviction.

In cases where a social worker is convicted of a drink or drug driving offence we cannot assume that they have an unmanaged health condition that requires further exploration.

The circumstances in which we would consider further exploration of health may be if one or more of the following factors are identified:

1. Is there evidence of an underlying health condition, including stress and anxiety, linked to the social worker’s use of alcohol and/or drugs identified in the submissions of the social worker or evidence of other parties?
2. If so, is there an absence of evidence as to how any underlying conditions are being managed?
3. Does the social worker have a history of similar offending? For example more than one drink or drug driving offence.
4. Was the social worker significantly over the limit?

If we identify one or more of these factors, we may consider requesting information relating to the health of the social worker.

Cases with other grounds of impairment

Very often, health is just 1 factor in a case where there are other grounds of impairment. In many of these cases there will be a direct link between these grounds.

In conduct or capability and competence cases, health may be a factor that has contributed to the events giving rise to the other grounds of impairment. A key consideration in deciding what order may be proportionate is whether the ill health caused the other concerns.

For example:

• A conviction for driving while under the influence of alcohol points to grounds for impairment by reason of conviction and health.
• Lack of capability or competence might be as a result of an impairing health condition, especially mental illness.

It’s very important that if social workers believe health to be a factor in cases of conduct, capability or competence, they tell us at the very beginning of a fitness to practise investigation and submit any supporting medical evidence to us. Decision makers may give submissions about ill health less weight if these are only made at the time they are making a final decision on disposal of the case.

Capability and competence

Investigation of health in capability and competence cases may need to explore whether recovery from the ill health is likely to result in a restoration of the social worker’s capability or competence. In some exceptional cases, it may be that the lack of competence or capability is entirely explained by ill health, in which case a finding of impairment on health grounds alone may be appropriate.

Conduct

In conduct cases, however, the presence of a health condition is very unlikely to explain misconduct to an extent that we do not need to investigate the misconduct as well. Illness is not usually accepted as a defence to offences of bad character.

Furthermore, maintaining public confidence in, and the professional standards of, social workers requires that we act in response to serious misconduct, even if the misconduct is linked to ill health.

In some cases, this may even require a removal order for the conduct element. An example might be stealing drugs from a service user for personal use. The issues of dishonesty, abuse of trust, and risk to the safety of the service user would mean that a removal order might be inevitable, even if the social worker’s drug addiction explained the behaviour.

Insight

Insight is a very important factor in a social worker’s fitness to practise. This is because the level of insight is directly linked to the risk of repetition.

Insight is especially relevant in cases of accepted disposal, which will not normally be available if the social worker does not accept the facts that are core to the question of impairment.

What do we mean by insight?

Insight usually requires the social worker to (all of the following):

• fully accept the alleged facts that support a ground of impairment
• demonstrate an understanding of what circumstances led the social worker to act as they did and how this might be avoided in the future

A social worker may be asked to produce a reflective piece to demonstrate their insight.

Insight in health cases

In health cases, the social worker may have limited or no control over the onset of or relapse into a health condition, so the question of insight is less relevant to the risk of repetition. For some health conditions, the very nature of the condition may also compromise the capacity of the social worker to have full insight. Particularly with mental health conditions, the social worker may be unable or unwilling to accept the diagnosis or the severity of their illness.

Because insight may be a function of the social worker’s health condition, it may be unrealistic to require that the social worker displays complete insight into the facts of their illness while they recover their health. The important factors in terms of future risk are whether the social worker has sufficient insight to (do all of the following):

• recognise the onset of symptoms of their illness
• act appropriately by limiting or stopping practising as necessary
• fully engage with whatever protective and supportive measures are in place to manage their condition

A social worker who does not accept a diagnosis or description of their health condition may still be capable of demonstrating sufficient insight by (doing all of the following):

• agreeing the primary importance of public protection
• identifying and accepting when they may need to limit or stop their practice
• following any recommendations and directions about managing their condition

For example, a social worker may be unwilling to accept that they have a drug dependency but may nonetheless be willing to agree to (any of the following):

• medical supervision
• toxicology testing
• limitations on their practice

In conditions of an episodic nature such as bipolar disorder, it is important the social worker is capable of recognising the symptoms at the onset of an episode and of taking the necessary steps to limit or suspend their practice and to seek help. This might include agreeing to colleagues being made aware of the condition so that they can help the social worker when symptoms appear.

Whether or not the social worker accepts the bipolar disorder diagnosis is of less importance than whether they accept these supportive and protective measures.

Health conditions in remission

Whether a social worker whose health condition is in remission is fit to practise will depend on (both of the following):

• the risk of relapse
• whether the social worker has demonstrated sufficient insight to seek help and support and to limit their practice where necessary in response to a new episode

As this guidance has emphasised throughout, being unwell is not the defining factor in whether fitness to practise is impaired. The core issue is the capacity of the social worker to (do both of the following):

• self-manage their condition
• limit their practice as necessary to protect the public

We may need to maintain a fitness to practise order on the social worker’s registration if (either of the following apply):

• the social worker has previously not been able to manage their condition adequately
• we do not yet have evidence that the social worker is able to manage their condition adequately (for example, if they have not yet returned to work)

An order may stay in place until this can be assessed further, even if the health condition is in remission.

Updated health assessments may help guide any decision on whether the social worker has sufficient insight to self-manage their condition and their practice in response to a new episode.

Pausing the process

If a social worker’s illness is so severe that it prevents them from engaging with us then we will not progress a fitness to practise case until they are well enough to do so.

In this situation, we will usually need (both of the following):

• a medical report to confirm that the current health condition means the social worker is incapable of taking part in the fitness to practise case
• to seek an interim suspension order to protect the public while the case is on hold

In some cases, engaging with us may add to a social worker’s stress and may make their condition worse. At a social worker’s request, we can consider pausing a health investigation to allow time for a social worker who is not currently practising to recover enough to engage with us. Again, we will probably need to seek an interim suspension order.

If there are other grounds for impairment involved

We will not usually be able to pause an investigation if there are other grounds of impairment in the case because of (both of the following):

• the public interest in us determining those other grounds
• the risk that evidence about those other grounds could become unavailable

These can be complex decisions and we will need to assess each case on its facts. However, we are committed to being as supportive as we can of social workers when they are ill, while meeting our responsibility to protect the public.

Voluntary removal

Our Regulations state that a social worker may be removed from the register by Social Work England (‘the regulator’) whilst subject to fitness to practise proceedings. This may be without the need for further consideration by the case examiners and/or adjudicators at a hearing.

Social workers may submit an application for voluntary removal at any time during ongoing fitness to practise proceedings.

The circumstances in which we will agree to a voluntary removal during fitness to practise proceedings must not undermine the overarching objectives of the fitness to practise process.

We will only consider a voluntary request for removal if (all of the following apply):

• a social worker has stopped practising as a social worker (and has no intention to practise in the future)
• the circumstances of their fitness to practise case mean that it is not in the public interest to be considered by case examiners or adjudicators at a public hearing
• immediate removal from the register without further action by the case examiners or adjudicators is considered the best way to protect the public
• we are satisfied that further action is not required to ensure public confidence in social workers and to uphold professional standards

We will consider a range of factors when deciding whether to agree a voluntary removal application including (both of the following):

• the social worker’s state of health
• the likelihood of their health condition improving

Read more about voluntary removal.

Support

We acknowledge the pressures that social workers face and we appreciate the impact that the fitness to practise process can have, particularly for those in ill health.

We encourage social workers to access dedicated support services.