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The shifting landscape of health and care delivery and regulation: an opportunity for a unified focus on prevention?

Melanie Venables, Director of Policy and Communications

24 Jul 2025

The past few weeks has brought several long-awaited publications: the NHS 10-year health plan for England (to be followed by a new long term workforce plan), the Dash review, the Leng review, and most recently, the report of the Department of Health and Social Care’s consultation on the regulation of NHS managers in England. In addition, the Scottish Government has committed to strengthening regulation of non-surgical cosmetics.

The regulation of health and care professionals is a devolved matter in the UK. Each of the four nations – England, Scotland, Wales, and Northern Ireland (NI) – has its own responsibilities and powers over health and social care, including aspects of professional regulation. While there are some common themes across healthcare delivery across the UK, such as on the importance of preventive healthcare, it is important to reflect on the implications of country-specific reports such as this at a UK-wide level.

Regulatory divergence and consistency

While the scopes of these reviews are country-specific, the implications for professional regulation are wider and need to be thought about at a four-country level. Will the new titles of physician assistants (PAs) and physician anaesthesia assistants (PAAs), adopted already in England following the recommendation by Leng, be adopted for physicians’ associates and anaesthesia associates working in Northern Ireland (NI), Scotland and Wales?  Would not doing so risk confusion and undermining the aim of this recommendation for greater clarity? Will England follow suit with the licensing of non-surgical cosmetics, having launched its initial consultation before the Scottish Government, but with no response yet published? 

The deeper shifts: beyond traditional professional boundaries

In a way, these are the simpler questions. The deeper shifts in how health and care are delivered, towards a more task-based approach and away from traditional professional boundaries referenced in the 10-year health plan for England require deeper self-reflection by regulators and policy makers. Education and regulatory frameworks are not currently designed in this way. Medical specialties are an example of education and training shaping an area of competence – but this is about equipping doctors with the right skills and knowledge to be able to practise safely and adapt in their field. Doing otherwise would restrict another key aspect of healthcare that is needed for us to move forward: innovation. 

Health and care roles are varied, with many, but by no means all, being subject to statutory professional regulation currently. The growing number of associate and assistant roles that have evolved in recent years within medicine, nursing and the psychological professions demonstrate the need for more diverse workforces. Because both health and care delivery, and many aspects of regulation, are devolved; there is great potential for divergence in how these roles are deployed, and regulated, across the UK. Nursing Associates (NAs) are an example of this: regulation by the Nursing and Midwifery Council (NMC) of these roles was introduced in 2019 for those working in England.  The Senedd has recently consulted on bringing NAs into regulation – but with defined parameters of practice, an approach that would be at variance with the other countries.

A right-touch approach 

This is not to say that the same approach to regulation is always the right one. Our right-touch regulation approach advocates for only using enough, and no more, regulation to address a risk to a tolerable level of assurance. In the healthcare context, risks can include physical, emotional, psychological, digital and financial harms. Regulation is often not, nor should it be, be the primary mitigation for these risks. The culture of an environment is crucial to patient safety – and so employers play an important role in creating the conditions in which safe care can be delivered. The context for health delivery is different across the four countries, and again within each country at a local level – so it is right that professional regulation is not used as a ‘broad brush’ but as one of a range of tools. 

Is the answer, then, to have a broad, overarching regulatory framework that can provide for consistency on the issues that matter most, while allowing enough flexibility for tailoring at a local level? This might be best focused on the areas where we need to make these shifts: for example, principles for regulating for the use of artificial intelligence by professionals. It might also mean a broader definition of patient harm, and a greater collective understanding of the priority risks for professional regulation at any given time. This could be described as a regulatory strategy to support workforce change.

Reform as an opportunity

Reform of the professional regulators presents an opportunity to achieve this. The intention to give the regulators greater flexibility and in turn, agility and doesn’t have to lessen public protection if underpinned by a shared understanding of the principles of good regulation and by collaborating to address new and emerging risks. At the PSA, we see our role about helping to achieve this. In the autumn, we will launch a new version of right-touch regulation, updated and enhanced to reflect the increasingly complex and dynamic environments regulators find themselves needing to navigate. We are also updating our Standards for the regulators and Accredited Registers we oversee, so they can better identify and promote best practice. 

We will continue to do this by engaging with others – as we know that collaboration is critical for the prevention of harm.