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Getting it right for public protection – designing a regulatory framework that works in good times and bad

The Professional Standards Authority (or its predecessor body the Council for Healthcare and Regulatory Excellence – CHRE) was set up as a result of a report highlighting the very worst events that can arise when regulation fails – the report into the standard of care provided to children receiving complex cardiac surgery at Bristol Royal Infirmary.

Regulation was a key theme of the report along with the importance of ensuring that the regulatory framework was sufficiently independent of government: ‘While it is the proper role of government to establish the regulatory framework to ensure safety and promote quality, that framework must be as independent as possible of the Department of Health.’   

The report also recommended the creation of ‘an overarching mechanism to co-ordinate and align the activities of the various bodies (the General Medical Council (GMC), the Nursing and Midwifery Council (NMC) and others) to ensure that they serve patients’ interests’ and that this should be realised by the creation of the body which has since become the Professional Standards Authority.

Since its creation the Authority has taken this role of ensuring that the regulators ‘serve patients' interests’ as its guiding principle and mission. Our independence from government, the professions and the regulators puts us in a unique position to ensure that the public interest is upheld, and the protection of patients remains at the heart of the way that regulation works.

This has very much guided our response to the recent Government consultation on far-reaching reforms to healthcare professional regulation. Whilst we have been vocal in supporting the case for reform and have welcomed much of what is in the consultation we have highlighted key changes that we believe are needed to ensure that the proposals maintain or improve the overall level of public protection provided by regulation.  

A key issue for the Authority and many stakeholders we have spoken to during this consultation including both patient and professional groups, is the balance between flexibility and accountability. As it stands, regulators will have powers to resolve complaints about professionals outside of public panel hearings if the registrant agrees. However, under current proposals, unlike decisions made by panels these cases won’t be subject to the Authority’s independent appeal powers if the outcome doesn’t protect the public.

In addition, regulators will be able to make changes to the rules that outline their operating procedures with no independent oversight. Currently most rule changes need to be approved by the Privy Council. Whilst we think that increased flexibility is good, it’s our view that there should be some independent checks to make sure that rules protect the public and don’t lead to unjustifiable inconsistencies in approach across regulators. The Law Commissions in their review of the legislation of the healthcare professional regulators in 2014 proposed this role for the Authority and we would support being given these powers now.

None of this is to suggest that the regulators we oversee do not share the objective of protecting the public – we know that they do and work tirelessly in pursuit of this collective aim. However, we know from our role as an oversight body that things do not always go to plan. Regulators are subject to a great many pressures and competing interests which may lead to mistakes being made, hence the need for appropriate safeguards.

In addition, whilst there have been many improvements in regulator performance in recent years, we know from experience that performance can deteriorate quickly and recover slowly. There are a number of regulators that had previously been high-performing where we have identified concerns in recent years. Significant regulatory change over the next few years may heighten the risk of organisational instability.

All of this has led us to the view that the regulatory system must be prepared for both good times and bad. It has been encouraging and helpful to talk to a great many stakeholders over the last few weeks and months who share this view.       

We have now submitted and published our final response to the Government consultation and this is available on our website here. We would urge any organisations or individuals yet to respond to do so by the deadline of 11.45 pm on 16 June. This is an important chance to have your say on the future of healthcare professional regulation and all voices matter.  

Whatever the outcome from this consultation we look forward to working with colleagues at the Department for Health and Social Care, patient groups, professional organisations, the regulators and all other stakeholders with an interest to ensure that the reforms work as well as they possibly can and that regulation continues to serve its primary purpose of protecting the public.  

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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.