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The road to reform success: addressing known problems without creating new ones

The Government plans for reforming professional regulation of healthcare workers are at a crucial stage. The draft legislation is starting to take shape, and there are plans to consult in the new year on the policy proposals. The most recent Government consultation on reform took place at the end of 2017, and it is over a year since the Government published its response. Much has changed since.

We believe that the framework we have now is disjointed, expensive, and inflexible, and we support the drive for reform. We have identified some key considerations for the Government to take into account in the remaining phases of policy development, to help make the reforms a success.

Learning from Covid-19

It is vital that the Government takes the opportunity to incorporate any learning from the pandemic response into the reforms.

Covid-19 has shone a light both on the ingenuity that can result in times of severe pressure, and areas of the healthcare system that need to change to ensure the system is better prepared for the challenges of the future.

In the light of this, the Secretary of State  announced a call for evidence on reducing bureaucracy in the health service, with a particular mention of the Government’s intention to reform health and care professional regulation. The Government has recently published the outcome of this. We have ourselves called for a more streamlined, coherent regulatory system that reduces the burden on all involved, and is agile enough to support and adapt to changes needed within the health service.

We have also proposed a less adversarial, quicker means of dealing with professionals who fall short of their professional standards – provided this can be done safely and transparently. The increased pressures on professionals and the health and care system as a result of Covid-19 only strengthen the case for such a streamlined approach.

We do not want to miss this opportunity to design a system that works for all stakeholders both in normal times, and in times of stress such as a pandemic.

Learning from the mistakes of the past

The current reforms should address the failings identified in the Paterson and Cumberlege inquiries

Since the Government published its response in July last year, two significant public inquiries have brought to light worrying gaps in the regulatory frameworks designed to protect patients.

The Paterson Inquiry made the arguments for greater coherence of the regulatory system in stark, compelling terms. It also called for greater powers for the Authority to hold the professional regulators to account, stating that it was ‘not assured through the evidence [it] heard, that the PSA has the mandate or power fully to grip the system.’

The Cumberlege Review, First Do No Harm, was equally damning in its assessment of the failure of the multiple regulatory bodies to take responsibility for protecting patients.

Some of the failings they point to are historical failings that have long been addressed, but many have not. We cannot afford to be complacent – there is much that needs improving in professional regulation to ensure that harm is not repeated.

These reforms will have failed if they undermine improvements to professional regulation made through earlier reforms

The Authority has consistently called for reform and is supportive of the intention behind the reforms and many of the changes Government has proposed.

It seems now that it is also necessary to state explicitly that reform of professional regulation must preserve the significant improvements made over the last 20 years in response to earlier high-profile failings.

In particular, these improvements have increased independence, transparency and accountability of decision-making, produced fairer and more just decisions that can be challenged in the appropriate fora, and provided for the necessary degree of separation between investigation, adjudication, and appeal. The Authority’s powers have made a significant contribution to this.

These improvements have made it possible for regulators to protect the public more effectively, garner greater levels of public confidence, and do more to declare and uphold professional standards. Any moves to streamline fitness to practise processes must maintain the above elements of progress.

We encourage the Government to reflect on how these reforms could improve patient safety and support the delivery of high quality care in good times and bad, alongside reductions in bureaucracy, costs, and burdens on systems and individuals.

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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.