Perspectives from Northern Ireland, Scotland and Wales

A. Geraldine (Northern Ireland): 

I’ve been involved in professional regulation since 2007, so I do come with a good knowledge base of the challenges in professional regulation and the potential for it to drive forward better patient and service user outcomes. I know that professions can face very different challenges, varying levels of risk and different cohorts of people that need to be identified and engaged with to ensure regulation works for them. A uniformity of approach can be missing on some of the big-ticket regulation questions such as what constitutes ‘seriousness’ or what upstream regulation could and should look like. However, we apply overarching standards that allow for consistency in terms of high-level outcomes, but flexibility in terms of how the regulators achieve these. 

A. Eleanor (Wales): 

I was Ofcom’s Director for Wales until early 2024. Ofcom is the regulator for communication services, so I had experience of regulation, but not regulation in the healthcare sector. 

A. Ali (Scotland): 

It feels like an organisation that is growing into a new phase as the regulatory and operating context develops – this excites me. I also like the strategic role it has of shaping the regulatory landscape alongside overseeing a large number of individual regulators.

A. Eleanor (Wales): 

I have been the Vice Chair of Hywel Dda University Health Board for nearly two years and find it to be rewarding, challenging, interesting and I have a passion for making a difference in the service for the population of our area. I am passionate about people getting the best care, in the right place and at the right time. The role appealed straight away. It’s a well-run organisation, and somewhere where I could use my knowledge of Wales, regulation and health board perspective and gain that UK perspective. The PSA’s mission of protecting the public and improving the quality of regulation fitted with my values, and I welcomed the chance to be part of that journey. 

A. Geraldine (Northern Ireland):

I joined at the start of any exciting year for the PSA with plans to review our Standards, revisit Right-touch regulation and developing our next three year Strategic Plan. I would like to ensure that regulation stays relevant to the health and social care professionals that work within it;  that we understand and continue to have an opinion on what and where the touchpoints are that impact the daily working lives of professionals and affect how they are  holding the line and maintaining standards., I believe the PSA is well placed to encourage those conversations and challenge where that intersection is impacting on patient and service user outcomes and is  in-keeping with our role protecting the public. I would also like to bring my experience of involving patients and service users in regulatory decision-making to ensure the PSA is doing what we need to and involving who we need to, to ensure we have the voices of people with lived experience front and centre.

A. Ali (Scotland):

Help the Board achieve the right balance between the regulatory “big picture” during a time of change while still ensuring a close eye on our core functions. It is this balance that ensures our effectiveness and strategic influence.

Q. And as the PSA moves into its next strategic plan period – what would you like to see the PSA achieve?

A. Geraldine (Northern Ireland):

I think that whilst achieving the ‘bread and butter’ work of the PSA such as holding the regulators and Accredited Registers to account with our new standards, we have the potential to move the conversation to a different level, looking at the external factors influencing the delivery of safe and effective care by professionals and encouraging collaboration in addressing these. (We are a very small organisation with limited resources, so we will need to carefully identify priority areas to work within and where  we can leverage our trusted position to achieve impact.

A. Ali (Scotland):

To build on its ability to use its influencing and convening functions to ensure the regulatory landscape remains fit for purpose. Be prepared to be bold in pursuit of the best outcomes.

A. Eleanor (Wales): 

I would like the PSA to be better known for the good work it does, to be a thought-leader on high quality, proportionate, transparent regulation with a reputation for protecting the public. I would like to see the PSA be more externally focused and driving the sharing of regulatory good practice across the sector.

Areas of interest/expertise

Q. Ali, you are an advocate for inclusion – how do you think regulation can help? What can it do?

A. Ali (Scotland):

Inclusion is essential for both patients and professional practitioners in a successful health and care system. Everyone must feel seen, heard and respected in their contact with the system. With increasingly diverse service users and professionals operating in a system that is frequently under stress, mistakes or failures can more easily occur in situations of distance, marginalisation, misunderstanding or even prejudice. Professional regulation allows structures and standards to be embedded that minimise those risks.

Q. Geraldine, you are an advocate for involving patients and service users in regulatory decision-making, particularly those least likely to be heard but most likely to be affected by decisions. What can we do better or more of to make sure we are involving patients?

A. Geraldine (Northern Ireland):

One question I think we may need to ask ourselves is: ‘Do we have the mechanisms in place to harness the voices of people who have been harmed within health and social care provision, specifically to understand how regulation has let them down and where it could be strengthened to avoid re-occurrence. We need to always be mindful of whether the evidence framework for the Standards we use is seeking and getting the right assurance that regulation is learning from harm-related incidents and reviews and acting on that learning in an up-stream fashion. Good networking and making connections is key and always holding the thought that when things have gone wrong for people in health and social care, they want to connect to see change, contribute to learning and not see the mistakes of the past repeated.

Q. Eleanor, you have held leadership roles during your career, we are planning to introduce a Standard on Governance and Leadership – what difference do you think good governance/leadership can make to an organisation?

A. Eleanor (Wales):

Good governance and leadership allows an organisation to be creative, innovative and creates an environment for people to thrive. In thinking about regulation, good governance should lead to implementation of regulation that is effective, proportionate and keeps people safe.

The big issues in Northern Ireland, Scotland and Wales 

Q. We have just published a manifesto highlighting to the next government of Scotland some of the key issues facing healthcare. What do you think are the challenges specific to Scotland in our sector? And how can regulation make a difference to these?

A. Ali: 

The primary challenge seems to be the very testing conditions in which many health and social care professionals are currently operating. I think this is difficult across the UK, but Scotland has particular distinctions in terms of both workforce profiles and capacity. I also think alignment of standards makes sense so there is work to do on building common understanding, purpose and impact in areas such as (for example) regulation of non-surgical cosmetics or establishing common definitions of patient harm/risk.

Q. What are the challenges for Wales?

A. Eleanor:

We have recently published a manifesto for the next Welsh Government. In this we highlight workforce shortages, especially for medicine and dentistry. It also provides some stark statistics for about staff sickness levels and 87% of GPs in Wales are concerned they are unable to provide quality and safe care to patients. It sets out our top three priorities for the next Welsh Government and also outlines how professional regulation can help.

Q. Are there any challenges specific to Northern Ireland in our sector? And how can regulation make a difference to these?

A. Geraldine: 

The Reset Plan for Health and Social Care’ published in July 2025 sets out clear expectations for health and social care professionals to work differently going forward. For example, the concept of ‘People to Partners’ – building a new relationship with citizens as assets in resetting and reshaping health and social care is gaining traction in supporting this reset. This may be a step further than the professional standards that are set for professionals and their relationships with patients and service users and so it would be interesting to see how regulation could support professionals in terms of this culture shift and sharing of risk. There is also an emphasis on driving improvement through digital transformation and data. Regulation may need to assure itself that risk management frameworks for the development of assisted technology intersect effectively with professional accountability for patient safety and outcomes.

The ‘Being Human: Framework for Safety Culture within Health and Social Care’ was launched in September and sets out what good looks like in relation to safety culture in Northern Ireland - safe and compassionate; just and open; and continually learning and improving - all issues that regulation needs to have a voice in. One question regulation may need to be asking itself is: How do we ensure compassion is deep in the psyche of every health and care professional and that the education outcomes for professionals support the development of the next generation of health and social care professionals to operate effectively within a Safety Culture Framework.