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Professionals don't need regulating?
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Last month our Chief Executive, Alan Clamp, travelled out to Salt Lake City, USA to deliver a keynote lecture at the annual education conference of the Council on Licensure, Enforcement and Regulation (CLEAR). In his lecture, Alan reviewed the need for the regulation of professionals working in a wide range of roles and considered the criteria that should be used when deciding which professional groups to regulate; arguing that the binary choice of regulate or not regulate should be replaced by a continuum of assurance.
In addition, Alan made the case for refocusing professional regulation, emphasising that regulation should do more to prevent poor practice rather than just addressing the poor practice when it occurs. Errors and mistakes should be the focus of individual and organisational learning, and generally should not be areas of interest for action by regulators. Regulators should be primarily interested in conscious violations of standards, reckless behaviour and sabotage, and any decision on sanctions should take into account the operating context of the professionals. This refocusing will produce a more compassionate model of regulation, whilst still retaining a safety net for significant non-compliance with standards. Just as importantly, it will reduce the fear of regulation and contribute to more positive workplace cultures, where professionals are confident to speak up and where learning makes a major contribution to protecting the public.
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Regulating PAs and AAs
There is not as much to report back on for this issue. In our last newsletter, we talked about our response to, and the briefing we had produced for stakeholders on, the Government’s consultation on regulating Physician Associates and Anaesthesia Associates.
We are continuing to feedback on the proposals to amend the General Medical Council’s (GMC) legislation to take on regulating these roles and have been liaising with the Department of Health and Social Care (DHSC).
Our Chief Executive will be speaking at the Westminster Health Forum on 23 November along with representatives from government, regulation, law, the NHS and healthcare professionals on the next steps for professional healthcare regulation. We will be emphasising the need to keep public protection front of mind during the reform process and to listen to the patient voice.
Government consultation on licensing of non-surgical cosmetics in England
We recently published a briefing outlining the key points we will be making in our response to this consultation. We want to encourage stakeholders to respond and hope that they will find the briefing helpful. In short, we will be outlining:
- Support for the introduction of a licensing scheme to ensure that those who choose to undergo a non-surgical cosmetic procedure can be confident that the treatment they receive is safe and of a high standard.
- The need to ensure that the licensing scheme is simple and transparent to allow the public to easily understand requirements when choosing who to receive non-surgical cosmetic treatments from.
- It is important that the licensing scheme fits with existing regulatory mechanisms - the scheme should recognise and complement mechanisms such as the Accredited Registers programme which is already acting to raise standards in the area of non-surgical cosmetics.
- A call to those seeking non-surgical cosmetic procedures to choose a practitioner on a register accredited under our Accredited Register programme until a licensing scheme is in place.
- Encouraging all eligible non-surgical cosmetic practitioners to join an Accredited Register to demonstrate their competence and reduce risk to the public.
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Patient Safety Commissioner in Scotland
Introducing a patient safety commissioner (or equivalent) in each of the UK’s four countries was one of the main recommendations in Safer care for all. We wanted this role to be responsible for identifying, monitoring, reporting, and advising on ways of addressing patient and service user risks, including coordination and oversight of public inquiries.
We are pleased to see that the Scottish Government will be introducing a Patient Safety Commissioner and the Bill to do so has just gone through its third reading. However, we want this role to have more power to ensure that lessons are learned from health scandals and any recommendations arising from the resulting inquiries are tracked and there is follow-through. Alan Clamp, PSA’s Chief Executive said as much to The Scotsman in early October. You can read the full article here.
Safer care for all: continuing the conversation
Our most recent Board meeting took place in Edinburgh. We took the opportunity to discuss the themes from Safer care for all with Michael Matheson, Cabinet Secretary for NHS Recovery, Health and Social Care, the Chief Executive of Healthcare Improvement Scotland, and the Chair and Chief Executive of NHS Education for Scotland. These conversations focused on workforce and culture issues, the debates surrounding the cases of Letby and Eljamel and our themes from Safer care for all, particularly on accountability and regulatory strategies.
We also had a productive roundtable with patient groups to discuss barriers to complaints, which included a presentation from the Scottish Public Services Ombudsman.
To continue this work, we are also are currently hoping to run a joint event with the Parliamentary and Health Service Ombudsman for early in the new year to reprise our discussions around barriers to complaints. We will provide an update in the next issue.
How can regulation research contribute to safer care for all?
Places are still available at our research conference on 14 November, at Coin Street Conference Centre in Central London. We will be talking about the role of research in a range of issues, including:
- Engaging the public in regulatory policy making
- Sexual misconduct and regulation
- How regulators should respond to the workforce crisis
- The experience of witness in fitness to practise procedures (NIHR funded ‘Witness to Harm’ project)
- Understanding inequalities
The full programme can be viewed here, and the Eventbrite registration page is available here. There is a £75* registration fee.
*The registration charge for this event is to contribute to costs and to help keep our fees down. If paying to attend causes you particular financial problems please get in touch. The PSA may be able to provide a small number of fixed cost bursaries to support, for example, small charities and patient organisations to send an attendee to the conference. Please let us know if you would like to request this support, you can email us at engagement@professionalstandards.org.uk.
How can we collaborate for safer care for all?
This was the question we asked at our June symposium and brought together a range of speakers to answer it. They shared their experience and expertise on the benefits, disadvantages and the lessons they had learned when collaborating. We have captured the results of these conversations in a visual summary and you can also find out more here, including the presentations delivered on the day or why not watch our short animation below which also sums up some of the highlights.
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Find out more:
Find out more about Safer care for all, including links through to the executive summary, full report, chapters as well as the recommendations
Read our thoughts on the Patient Safety Commissioner role in Scotland in this article in The Scotsman
Find out more about our upcoming conference How can regulation research contribute to safer care for all? by reading through the programme or find out more about how to book to attend on the Eventbrite registration page available here
Find out more about our June Symposium on collaboration here or read through a visual summary
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Equality, Diversity and Inclusion
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CLEAR presentations: assessing Equality, Diversity and Inclusion in regulators and Accredited Registers
As mentioned earlier, along with our Chief Executive, colleagues from our Performance Review and Accredited Registers Teams travelled out to Salt Lake City to deliver presentations at the CLEAR conference. The conference is attended by those working within regulation in a variety of sectors from around the world.
One of the themes of this year’s conference was Equality, Diversity and Inclusion. Louise Appleby and Steve Wright who work in Regulation and Accreditation presented on the PSA’s approach to assessing EDI in the organisations we oversee (health professional regulators and the Accredited Registers). They discussed the changes we have introduced to how regulators meet Standard 3 of the Standards of Good Regulation (for regulators) and, following the consultation we carried out towards the end of 2022, the development of the new Standard Nine for the Standards for Accredited Registers. The presentation covered our approach, the results of the public consultation and the challenges faced in developing a new Standard.
In the discussions that followed, it was apparent that many organisations are grappling with issues around EDI and some are further along their EDI journey than others. Topics considered included how do you encourage people to fill in EDI data surveys so that they are meaningful and can lead to positive change and also reassure them that their data is safely stored. ‘Equity’ versus ‘Equality’ was another theme mentioned in discussions.
We will publish more about our experiences and insight from CLEAR in a follow-up blog so keep an eye on our website if you want to find out more.
Research: Perspectives on discriminatory behaviours in health and care
We mentioned this research briefly in our Spring newsletter as it was just about to be published.
We commissioned this research to help form part of a wider evidence base and take forward work following the publication of our Safer care for all report. In the chapter on Tackling inequalities, we had observed that, although regulators take discriminatory behaviour by their registrants seriously, how the different regulators deal with such behaviour by their registrants can vary. This was qualitative research involving a mixture of group discussions and interviews. The research was undertaken by Research Works and the report compiled by them on the PSA’s behalf.
Participants in the research discussed what they saw as discriminatory behaviour in health and care and how this can have an impact on confidence in healthcare professionals and on patient safety. A key aim of the research was to help the regulators and Accredited Registers we oversee take a more consistent approach in dealing with this type of behaviour.
Participants set out the markers that they think indicate how serious the behaviour is. These markers can help inform what fitness to practise sanction is appropriate:
- Intent – was the behaviour deliberately discriminatory/unfair or through lack of awareness/training?
- Vulnerability and outcome for the patient – how vulnerable is the patient on the receiving end of the behaviour, how bad was the outcome for the patient?
- Frequency – was this a one-off or is it repeated enough to form a pattern of behaviour?
The full report and accompanying infographic can be found here: Perspectives on discriminatory behaviours in health and care.
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"What does inclusion mean to me?"
This year we supported Inclusive Employers National Inclusion Week. The week ran from 25 September to 1 October and we asked some of our colleagues ‘What does inclusion mean to me?’ You can find out how they answered in some short vox pops here.
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Expanding our work on safeguarding
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You may be familiar with, or responded to, our public consultation on introducing requirements for Accredited Registers to access criminal records checks. Whilst there was general support for introducing these checks for Accredited Register practitioners, there were also concerns about what this could mean in practice. The consultation highlighted two competing public interests: that of the rights of people with a criminal record, and of protection of the public against people whose past record suggests that there may be unacceptable risks in them working in certain occupations.
These issues are also highlighted in the Government’s review of the Disclosure and Barring Regime (the Bailey Review). They are relevant to people registered with the statutory regulators, as well as the Accredited Registers.
In recognition of this, in July our Board decide to extend our work on safeguarding and criminal records checks to consider the arrangements affecting the statutory regulators. A cross-organisational project team is scoping the work, which will be reported to our Board in November. We expect the first stage to involve gaining a better understanding of any potential weaknesses in the current framework, particularly in regard to self-employed registrants. We will then engage with key interests to gauge the nature of these risks. We will continue to liaise with the Government to make sure that any next steps are in alignment with its response to the Bailey Review, which at the time of writing is still awaited.
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Update on our work checking final fitness to practise decisions
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Recent results and outcomes of Section 29 appeals
In the past few months, we have concluded five appeals of regulator final fitness to practise decisions. We decided to appeal these decisions based on our belief that they were insufficient to protect the public. The cases we have appealed cover a range of issues, including cases involving:
- A registrant who was convicted of racially aggravated intentional harassment
- A registrant who had a sexual relationship with a vulnerable patient
- A registrant who subjected her own children to emotional abuse and distress and was also dishonest in a job interview about being the subject of fitness to practise investigations
- A registrant who was convicted of controlling or coercive behaviour and was also barred from working with children and adults by the Disclosure and Barring Service
- A registrant who breached professional boundaries with three patients
Cases we have appealed in the last few months include fitness to practise decisions from the General Medical Council, the Health and Care Professions Council, the Nursing and Midwifery Council and Social Work England. You can find out more about all these cases here.
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Reviewing regulators' performance
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We have published three reports since the last newsletter. They were for:
Evaluating our new approach
We have recently published our evaluation of the new performance review approach, following the completion of the first year of the new cycle. Further information on the report can be found here.
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Accredited Registers update
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Welcoming the CBT Register UK
In In August, we accredited the CBT Register UK which is run by the British Association for Behavioural & Cognitive Psychotherapies (BABCP) and the Association for Rational Emotive Behaviour Therapy (AREBT). There are over 12,000 people on the CBT register, working in roles which play an important part in helping to provide access to evidence-based psychological therapies. People working in some of these roles in the NHS in England must be on the CBT Register UK or registered with the British Psychological Society (on their Wider Psychological Workforce register which is also accredited by the PSA) as a condition of their employment.
We will be making further decisions on new applications over coming months.
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From 6 December we will be covered by a different set of Welsh Language Standards. This means that we need to know if any of our e-newsletter readers would prefer to receive the newsletter in Welsh.
We are also hoping to set up an improved Stakeholder Relationship Management system which can help us send emails to readers who are interested in certain aspects of our work – for example, each time we publish a performance review. This provides us with an opportunity to get in touch with you and ask you a few questions about the kind of updates you want from us. We are not quite sure when this will be so please keep a look out for it and let us know.
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And one last thing
We were shocked and saddened by the Letby case. Following the verdict, there were calls for regulation of NHS managers and you can find our statement in response to this here. You can find all our latest news statements here.
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