Patients are better protected when systems are joined up. As Charles Vincent set out in a paper published in the BMJ, healthcare regulation is bewildering in its complexity and contains significant gaps. Addressing these gaps is vital to prevent harm.
Multiple inquiries have highlighted gaps between regulatory systems, including cases where gaps between organisations or jurisdictions result in risks to patients. Conversely, duplication of work or systems can also result in a gap, as it is assumed others will take responsibility. At our symposium this month, we explored some of the gaps and considered some of the ways in which regulators are trying to close them.
Bridging the gaps: listening to patients and service users
With the Covid 19 pandemic, rapid changes have been made to services largely without patient involvement. Failing to listen to or involve patients and service users results in missed opportunities to make people safer and maintain public confidence in regulators and regulation. We discussed initiatives to improve involvement, including working with patient representatives and patient safety forums. we considered how to best use and act on patient/service user feedback and complaints, which can be an early warning system for wider or more serious systemic issues.
Key areas of focus moving forward include recognising the value of feedback, strengthening intelligence sharing, standardising learning from complaints, making connections between complainants, employers and regulators, and continuing to share learning from casework.
Looking at maternity services as an example, we learnt how bringing together information from across the regulators of professionals and services can provide greater insight into when and why things go wrong.
Bridging the gap between the independent and public sectors
On the second day of the symposium attendees considered how to bridge the gap between professional regulation and regulation of businesses. Business regulation is considered increasingly important going forward, as regulators work to develop new protocols to address issues such as illegal practice and new forms of trading, especially online. This involves working with others, such as trading and advertising standards, as well as companies such as Amazon and Google to crackdown on illegal sales and poor practice.
The session then moved on to discuss social work, within which one of the biggest gaps is a lack of comprehensive social work data for England. Where organisations or structural boundaries do not line up, there becomes a mismatch between what service users need and what processes can do, which has implications for the care provided. There is confusion about who is responsible for what, as people feel alienated by the system, leading to stress and sometimes harm. As social workers work with people at points of transition in their lives, they are well-placed agents for identifying and bridging these gaps.
The session also considered the gaps between regulators and employers, particularly in members’ understanding of the relationships between regulators and the workforce, and why certain groups are, and aren’t, regulated. Colleagues also noted that the pandemic has demonstrated the positive impact that regulators can have in this space, for example in the experience of temporary registers for students and those returning to practise. Joint interventions with professional leads across the UK sent an important message, providing reassurance of the recognition of regulators and the extraordinary context in which professionals were working. There lies an important role for regulators around consistency, particularly within new roles.
Bridging the gaps in Equality, Diversity and Inclusion
On Day 3 of the symposium, colleagues talked about how the pandemic has affected gaps in EDI. In health and social care, this affected the experience of low paid staff, particularly those from black, Asian and ethnic minority backgrounds. Unsurprisingly, people have had a difficult experience – often because they have contracted roles and there isn’t a central database. The pandemic has also had effects on the education of young people, the gender pay gap, and the challenges in employment for disabled people, to name just a few. The session identified areas where regulators can help, which includes: data gathering, looking at guidance, building links and a community of interest, engaging staff and listening to different perspectives, and reviewing each of their own policies. Organisations can also do more to look at reasonable adjustments for disabled colleagues. The new Institute of Regulation (IoR) will be a platform for sharing good practice on areas such as equalities, and for regulators to work together.
The NHS is a vast collection of individuals and processes – and it has perhaps been too easy in the past for groups to lose focus, either because it is not prioritised by national leaders, or because it falls between the gaps of the structures. The establishment of Integrated Care Systems is an opportunity for organisations to bridge these gaps. Racial inequality and the level of stratification we have in the UK is also a global issue, that requires a system-wide response. Although the system itself is not the only enabler for equity, it has a significant role to play.
We heard about practical ways to address these issues, which emphasised the need to be accountable for progress, over time, and to ensure meaningful engagement. Progress also requires strong leadership - this is about actions, rather than words, and involves focusing on the right things, at the right time. It has been made clear through the pandemic that doing more of the same will not be good enough.
We collectively agreed that this marks a step change in our approach, and that tackling racism and health inequality requires us to collaborate, set bold ambitions, challenge each other, and hold ourselves to account. With this final session, the symposium had drawn to a close with an important focus, which is that regulation must remain a force for good.