Moving towards a more preventative regulatory approach

Too often, regulation is judged by how it responds once harm has already happened. Inquiries over the decades, from Bristol and Mid-Staffordshire to recent reports from the Thirlwall Inquiry and the Mann Review, have highlighted the consequences when warning signs are missed, concerns aren’t acted on or problems fall between organisations. 

As Deputy Chair of the Professional Standards Authority, I want to set out how we are shifting our focus upstream – encouraging the regulators and Accredited Registers we oversee to identify and address risks earlier, and holding ourselves to the same test. 

A framework for prevention

Right-touch regulation, refreshed last year, gives us the framework. Its core principles – identify the problem before the solution, get as close to the problem as possible, quantify and qualify the risks, focus on the outcome – are about prevention as much as proportionality. Its principle of agility speaks to the need for regulators to navigate new challenges and emerging risks, and its new emphasis on collaboration recognises that no single body sees the whole picture.

Putting prevention into practice

Our new combined Standards, which came into effect on 1 July, put that into practice. For the first time, one outcome-focused framework applies to both statutory regulators and Accredited Registers. That matters where care is delivered by a diverse and changing workforce that straddles multiple disciplines and professions. And our Standards for education and training aim to ensure regulators’ processes reflect the capabilities needed as services, technology and workforce models evolve across the four UK countries. 

Our updated framework also sets stronger expectations for local resolution, so that concerns are addressed early, preventing problems from escalating unnecessarily as well as ensuring these are handled proportionately and at the right level.   

Stronger governance, earlier action

Underpinning all of this is governance. Weak governance allows risks to go unspotted – in regulators, and in the organisations providing care. Boards need the right information, at the right time, to provide real challenge and to act on what they find. So we have introduced a Standard on governance and leadership. It sets the expectation that regulators will foster a culture of openness and learning, make risk-based decisions on the best available evidence, act on learning and best practice from external reports and inquiries, and report publicly on their own performance. 

Sharing intelligence to address risks

Preventative regulation depends on more systematic sharing of intelligence about risks and regulatory gaps. Our Standards will assess how effectively regulators work with others; and we are exploring whether our Right-touch assurance methodology could form the basis of a shared risk framework, looking at occupations across the system that are not currently subject to statutory regulation. We will also use our cross-regulator role to convene discussions and develop good practice guidance to turn identified risks into shared learning and practical change. 

Looking beyond a reactive approach

Of course, taking effective action to protect the public when things go wrong remains essential. Fitness to practise now has two separate Standards to support fair processes and a deeper analysis of the causes of delay, and our Standards also require effective risk mitigation and support for all parties in the process. 

But on its own, reacting after the event isn’t enough. Workforce pressures, fitness to practise backlogs and changing models of care all make earlier, coordinated intervention more pressing. Prevention is not an add-on to public protection. It is the goal.