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Viewpoint - Christine Braithwaite

Join us in ‘divine discontent’

At our annual symposium earlier this year, we considered regulation’s role in supporting innovation. Stephen Dorrell, former Chair of the Health Committee and former health Minister, exhorted us all to be 'divinely discontented'. Like God, not content that 'having made man' he is perfect, but constantly striving to improve what we do for the benefit of humankind.

But what does ‘divine discontent’ mean for regulators?  I think it means doing, as we began in Rethinking regulation, reflecting on what we all do and achieve and critically challenging ourselves. It may be hard but it is vital to view one’s own work and say, ‘we meant well, but we have not yet achieved what we intended’. There is no room for complacency in divine discontent.

According to OECD, we in the UK are good at using quality improvement tools - yet our health outcomes are just average . The Patients Association is understandably appalled that 'never' events are not yet 'never' - but Roy Lilley  calculated that at almost 10 million interventions a year, the odds translate to a 1:38,000 chance of it happening, compared with 1:12,000 in  the US – which spends more on healthcare than we do.  So, is our quality improvement activity a waste of time and money because it's only achieving average, which others are achieving without it, or is it stopping us slipping below average?  Some other variables are obviously at work. Why, despite all our efforts in quality improvement and in regulation, are our outcomes average?  Discover the cause of that and we can move forward.

‘Imagine’ that the Manchester experiment works. ‘Suspend disbelief’, and believe that we can change health and care delivery. In bringing about such change Stephen Dorrell asked, ‘what must we not change, what unvarying principles should we hold on to?’  We have held onto the principle of (reasonably) equitable access to (almost) free healthcare.  We should hold onto it - and improve it.  We should hold onto the principle of Right-touch regulation and improve it.

We stand at the beginning of a new era of learning and discovery. Forced through circumstance to explore new ways of delivering health and care. Stimulated by research to examine what we don't yet understand. Given the opportunity to rethink professional regulation now that the Minister has announced the government's intention to develop a new Bill. Three elements coinciding in time and providing us with a fantastic opportunity to dig deep, think hard and design well. So, let's shake off disillusionment, suspend disbelief and work out what we need.

Over the next few months we will be thinking about the new Bill. Get in touch if you would like to share your ideas with us.

Christine Braithwaite
Director of Standards and Policy