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Research and policy update

Performance review

Reshaping regulation

We have published our short report outlining our views on the implications for professional regulation of the Health and Care Bill. The Bill, currently being reviewed by a Parliamentary committee, proposes powers for the Secretary of State for Health and Social Care to abolish regulators as well as deregulate professions. In parallel with the progress of the Bill, an independent review, commissioned by the Department of Health and Social Care (DHSC), is looking at the regulatory landscape and will provide options for the exercise of such powers.

The report describes the complexity of the current regulatory system can still fail to keep patients and service users safe. We reaffirm our position that the best way to address the problems with the current system would be through creating a single assurance body. This would yield the clearest benefits with the least trade-offs. However, if this isn’t considered politically viable then a reduction in the numbers of regulators could be a helpful first step towards a clearer, simpler and more coherent system.

The report also restates the need for a risk-based approach to which professions are regulated by law. It also calls for a more coherent approach to assure different occupations in health and care, bringing together methods of managing risk across regulated and unregulated groups.

The report can be downloaded from our website here.

Why sorry seems to be the hardest word – Scotland duty of candour seminar

Following on from last year’s seminar on the duty of candour and how the pandemic might impact it, we held a longer, virtual conference on 30 September. Putting candour into practice: how is it working and what more needs to be done? Around 100 delegates attended, mainly from Scottish organisations. The event was co-hosted by our Council member Moi Ali and Annie Sorbie from the University of Edinburgh

The keynote speaker was Clea Harmer, (Chief Executive of SANDS - the Stillbirth and Neo-natal deaths charity). In her presentation, Clea explained that saying sorry at the start and involving bereaved parents in conversations about what went wrong can help them on their grief journey, noting that it is not an experience from which parents can recover. All sorts of factors can come into play to prevent professionals from being open and candid, including fear – fear of being blamed, fear of litigation or even just fear of upsetting parents by saying the wrong thing.

There were further presentations looking at the more practical steps and initiatives underway to embed and encourage candour in organisations. The seminar closed by coming full circle and focusing on the patient perspective and why being open when things go wrong with care is so important, not only from a patient view but also for helping staff deal with their own feelings of guilt and fear, which in turn will help with learning. It was also noted that there are proven benefits to organisations as openness when things have gone wrong is shown to reduce the likelihood of subsequent litigation claims being brought.

Some consistent messages emerged from the presentations and discussions: about how individual and organisational capacity to respond constructively and positively to things going wrong affects the experience of the patient or family members. Another key theme was the apparent tension between accountability and learning.

We will continue to explore this subject and hope to hold a further seminar next year. You can find all our publications on the professional duty of candour here as well as our A compendium on candour – we have pulled together all our blogs on this topic into one publication.

Ethics in extraordinary times

We published this report in the summer. It describes how the pandemic shaped and altered the ethical experiences of practitioners.

We commissioned Professor Bowman to conduct research to explore the ethical experiences of practitioners working in health and social care professions during the Covid-19 pandemic. This included a scoping literature review, interviews and focus groups conducted with practitioners from a range of professions.

The results present a picture of nuance and complexity. The ethical experiences of practitioners across the professions have taken a significant personal and systemic toll and will inform practitioner and patient experiences for years to come. The report concludes that this research suggests it is time to think about and approach ethics in a different way that is grounded in the experience of practitioners and focuses on building ethical confidence and capability. Specifically, by focusing on moral distress, the ethics of care, the role of judgement and practical ways of providing ethical support, learning from the pandemic will be grounded in what has been experienced and has significant potential.

The report makes recommendations for regulators, but also those interested in ethical practice. Those recommendations reflect the findings of this research and invite reflection, collaboration, learning and development in the interests of professionals and patients.

Read more about why we commissioned this research in Douglas Bilton's blog, which goes into detail about the idea of relational regulation or read the report here.

Research reports round-up

Did you miss any of the reports we published to help us inform our response to the Government’s consultation on Reforming healthcare regulation, protecting the public? We published several reports earlier on in the year. If you have missed any, you can find them all on our website here, but to sum up:

  • Cognitive biases in fitness to practise decision-making: from understanding to mitigation We might believe our conscious mind is in the driving seat when we are making decisions – but there are all sorts of factors coming into play behind the scenes – cognitive biases. We asked an expert – Leslie Cuthbert – to look at cognitive bias specifically in fitness to practise. Find out more and read his advice in the report.
  • Does consistency between regulators matter? What are the public, patient and professional perspectives on consistency between regulators and does it matter? We commissioned research to find out from Simon Christmas Ltd to find out more. You can read the full report or a visual summary in this infographic.

Consultation responses

Regulating healthcare professionals, protecting the public

We of course also submitted our response to the government’s consultation: Regulating healthcare professionals, protecting the public. Though, we outlined our support of many of the proposals in the consultation document, we also set out that we did not support everything. We believe key changes needed to make the reforms a success. These included:

  • Applying the public protection safety net we have now to all final fitness to practise decisions, and not just those that are made by panels
  • Keeping the powers regulators have now to handle health concerns about a professional if there is a risk to the public
  • Keeping some independent checks and balances to make sure that the way regulation works is safe and consistent across professions where it needs to be.

You can find out more from the dedicated web page on reform.

Other consultation responses

We have recently responded to several regulator consultations as well as other consultations:

You can find all our consultation responses here.