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Viewpoint - Sally Irvine 

PGA Personal View

Jeremy Bentham was of the view that the more we are watched, the more we behave. With the increase in all matters regulatory in the NHS today, this should lead to perfect behaviour in individuals and organisations. This clearly is not so – indeed one might argue that the increase in ‘regulatory’ activity has been commensurate with an increase in instances of unacceptable care, poor behaviour and substandard performance. The counter to that is that ‘regulation’ raises standards and increases information and evidence, and therefore it is not surprising that more sub-standard performance is revealed.

Regulation is a much used word covering many concepts, and the ‘regulatory’ machinery currently in place varies so much that it is confusing for the regulated and the regulators. Professional regulation is consensual, set up with the consent of the regulated, who agree the standards to which they should aspire, and the significance of educational and value-based codes of behaviour in achieving those standards.

On the other hand, organisational regulation, the biggest area of growth in health-care organisations, is inspectorial, frequently unannounced, punitive, and targets rather than standards based, and therefore perceived as non-consensual. Moreover the public has been encouraged to believe it is entitled to 100% error free health care. The continuing call for ‘heads to roll’ when such regulatory targets are not achieved simply leads to a knee-jerk imposition of more inspectorial regulation in the erroneous belief it can help prospectively. Instead it necessarily works retrospectively, dealing with what has occurred, not preventing future occurrences.

Society needs to find a better balance between these two approaches without degenerating further into a punitive, demoralising, tick-box culture, or else the essential trust between patients and health workers will be infected by loss of overall public confidence in health delivery institutions. The Authority has led the way and right touch regulation is self-assessed, targeted, supportive, planned, standards and evidence based. But sadly this concept has yet to percolate through to the organisational regulators, and their decision-makers.

Sally Irvine