The last six months have seen big developments towards reforming the professional regulators in health and care. In October 2017, the four-country consultation on the future of the professional regulators was published, Promoting professionalism, reforming regulation. The consultation asked for views on a number of proposals for change, including radical options such as merging regulators together to create a small number of larger organisations. In November, we published a highly detailed report on the ways we thought that the sector should change, Right-touch reform, and followed this up with our response to the consultation. Many other bodies and organisations also submitted their views, evidence and opinions to the consultation, and at the time of writing we are looking forward to learning more about what will happen next.
So why is that these steps are being taken? What’s wrong with what we’ve got?
The current regulatory system is a recipe for confusion. There are nine statutory regulators; there are currently 25 registers under the Authority’s accreditation scheme, with a larger number of organisations playing a role in supporting those registers and others outside the scheme; and there are other parts of the workforce whose work raises risks to patients and the public but who are not captured under either of these arrangements. Looking just at the statutory regulators, there are differences of size, approach, culture, legislation, standards, and performance. You can describe it however you like, but beware generalisations – there’s a list of exceptions for every rule. What’s more, there’s no formal way at the moment to decide what is the right kind of regulation for different groups.
If even health professionals don't understand who regulates them and what those regulators do, surely there is something wrong?
Over and over, we see widespread misunderstanding of the purposes of regulators and their different functions. We hear the frustration of members of the public for whom the distinction between a complaints process and a fitness to practise process is academic. We hear registrants express the view that they should be getting a service back for their registration fees, as if regulation was focused on their interests and needs rather than the public’s. (Of course regulators should be efficient and fair, but it’s not their job to provide a ‘service’ to registrants – they’re acting on behalf of the public.) Employers and educators have to deal with different standards and different quality assurance processes.
There is no simple way to explain professional healthcare regulation
Navigating this maze can be baffling to say the least. A few years ago, we once tried to map out the path that a complaint might take through the regulators and other potential ports of call. We tried to base this first on the London Underground map, then on a roadmap, then on a snakes and ladders board. You name it, but it didn’t work; a mere two dimensions didn’t seem to be enough to capture how complicated it was. We just couldn’t find a way to set out simply what someone should do who wanted to raise a concern where different organisations would be involved, particularly where this concerned a situation involving registrants of different regulators.
The current regulatory legislation for dealing with complaints and concerns harks back to a time when we understood far less about the real reasons things go wrong in health and care, and the real reasons that human beings’ performance sometimes fails and causes harm, or exposes people to risk of harm unnecessarily. Current fitness to practise processes are too confrontational, protracted and expensive and don’t focus enough on really understanding the different aspects of a situation where someone hasn’t followed professional standards. While we can see that the regulators are working to do the best with what they’ve got, what’s really needed is a radical overhaul of legislation, structures and processes.
Time for a change?
For these and other reasons that we’ve set out elsewhere in great detail, we think that change is overdue. Our preferred option is a single regulatory organisation, with a single set of professional standards, a shared way of handling and investigating complaints and concerns, which could ultimately encompass all health and care professions and occupations. For those professions and occupations whose work is riskiest, we think there should be a licensing system, rather like a driving licence with permission to drive different kinds of vehicle depending on the tests you’ve passed. Behind it all, we need a way of deciding who needs a licence and who doesn’t – to compare the range of work of professions side by side and determine how risky they are. The Authority has developed a model to do this, which we’re looking forward to doing more work on and trying out on more groups as soon as we can.
We think the ‘single assurance body’ that we’ve proposed would save money in the longer term. Of course, at first, organisational change is expensive, but once a new structure is set up, we think there is a lot of scope for savings and efficiency.
We’re looking forward to hearing what the Government plans to do next, and will be doing all we can to make sure it’s influenced by the best evidence that there is, and that it’s focused on the interests of patients and the public. In the meantime, if you’re interested to read more, you might like to dip into Right-touch reform.
Find out more about why we think regulation needs to be reformed.