According to the Point of Care Foundation (Behind Closed Doors), healthcare staff are taking the brunt of pressures in the healthcare system, which is not sustainable and may jeopardise care. On 18 September 2018, Unison surveyed over 18,000 staff to understand what it was like to work in the health service over a 24-hour period. Just Another Day reported compromised care, staff shortages and serious stress and, they point out, that’s before the winter pressures came into play. Whether it is reports of staff vacancies, waiting lists rising, financial deficits or social media chatter, it seems pretty clear that many healthcare professionals are working in a tough environment. When Brexit finally arrives whatever that transpires to be – healthcare professionals will shoulder some of the impact.
Hitherto, UK professional regulators do not get involved in workforce or workplace matters, but should they now – and if they do enter this uncharted territory, what role should they play and how far does the border extend?
The strength of the professional regulatory system is that it sets universal standards capable of being applied to the multitude of situations encountered by professionals delivering healthcare. Regulators may provide additional guidance such as that about the professional duty of candour, to help professionals understand how to interpret their standards in certain situations. A plea as to workplace conditions impacting fitness to practise may potentially be considered a mitigating factor, but generally regulators expect professionals to abide by their standards and to be held to account for their practice.
The furore that erupted following the General Medical Council's decisions about Dr Bawa-Garba threw into sharp relief the tension between professional responsibility and accountability and challenging workplace conditions. The GMC has responded by, amongst other things, announcing the introduction of human factors training for its staff. The General Dental Council similarly is providing training. Regulators are also beginning to sound alarms about workplace pressures and are considering the potential impacts of Brexit including the impact on supplies of workers, medicines and devices.
Whilst hoping that the worst-case Brexit scenarios prophesised do not materialise it is nonetheless sensible to consider them when testing business continuity plans. One issue likely be uppermost in health professionals’ minds is ‘if something goes wrong, how will I be judged?’ And for patients, ‘will my care be less safe?’. For regulators therefore the question is, if exceptional circumstances prevail, where should the thresholds for regulatory action lie? It is easy – and perhaps correct – to say the standard must prevail, but achieving fairness for everyone may require a careful balancing act.