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Patients and professionals - striking a balance

The health profession regulation sector is about to embark on some significant reform. It is a time of great opportunity to modernise and address the weaknesses of the previous regulatory system.

The changes proposed to extend regulators’ powers to dispose of all cases, whether relatively minor or serious, under consensual disposal are major.

Ordinarily, consensual disposal by a pair of decision-makers (case examiners) is used in less serious cases, where the facts are agreed and the registrant demonstrates insight. The proposed changes, to be implemented first by the new regulator, Social Work England, will allow regulators to dispose of serious cases this way too.

Health and care professionals may be breathing a sigh of relief at the shift in dialogue from regulators and reformers as they recognise the need to hear and respect the clear messages from the professions that they are under pressure as never before. The health professions have never lacked a voice and they are not shy of expressing their frustrations and unhappiness about clunky fitness to practise processes that they feel add to their stress and do not reflect the realities of modern healthcare delivery. At root, they feel some regulation is unfair - and a system perceived as unfair can alienate those it is meant to regulate - and those it is meant to protect.

As colleagues in the sector know, the Authority is a firm proponent of evidence-based regulation and we have a keen interest in understanding the psychology of health and care professionals. I therefore fully acknowledge that it is important for professional regulators to draw upon Professor Gerry McGivern’s work on ‘relational regulation’ and re-position their connection and discourse with the professions.

But, it is necessary that patients’ and the public voice are equally heard. Doctors were deeply unhappy over the Bawa-Garba case, where rumours and mis-apprehensions still abound - patients and the public however were by comparison, largely silent. Those that did speak, including Jack Adcock’s mother, opposed any leniency.

When patients and the public have spoken out it has been to express their dismay not just at the mishaps that have befallen them, but also at the secrecy which has sometimes appeared to surround them. Health professionals in Northern Ireland were criticised by Judge O’Hara following the Hyponatraemia Inquiry and some are uncertain about the impact of a statutory duty of candour on individuals - the first of its kind. Patients and the public, however, mostly appear to support it.

The failure of a regulatory system to hear patients and to take seriously the concerns of those affected by poor care risk impeding safe care and not being perceived to be fair. It can also deter patients from raising concerns, which ultimately makes it harder for regulators to protect the public.

Our research with the public demonstrates that the public, when properly informed, support the move to resolving cases without a panel hearing provided they continue to be involved and the process and results are entirely transparent.

The Authority fully supports moves to reform fitness to practise processes where we retain appropriate oversight to ensure the public are protected. But, regulators and reformers must take care to involve and listen to patients and the public at least as much as they do the professions and regulators. To do otherwise risks unfairness, loss of public confidence and diminished public protection. Public protection thrives in the light. 

Related material

You can find out more about our thoughts on regulatory reform from here. You can also find more details on how we think the fitness to practise process should be reformed:

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Please note the views expressed in these blogs are those of the individual bloggers and do not necessarily reflect those of the Professional Standards Authority.