In this Q&A, we explain what we mean by "under-regulation", why it matters for public protection, and how gaps in assurance can affect patients, practitioners and the wider health and care system. It sets out common issues in straightforward terms and highlights the role that proportionate oversight can play in managing risks and maintaining confidence.
Q. What do we mean when we talk about “under-regulation”?
A. By "under-regulation", we mean situations where activity that can affect patient safety, public confidence, or standards of care is not subject to sufficient oversight, safeguards, or accountability. This might be because a role, service, setting, or type of practice falls outside existing regulatory arrangements, or because the current framework has not kept pace with changes in how healthcare is delivered.
It does not necessarily mean that individuals or organisations are acting irresponsibly. Often, it means there are gaps in the system that make it harder to ensure consistent standards, manage risks, or take action when concerns arise.
Q. Can you give an example?
A. One example might be the growing use of services or roles that sit outside traditional professional regulation, but still have a direct impact on patients. For instance, some practitioners may provide health-related services without being part of a statutory regulatory framework, meaning there may be limited checks on their training, competence, conduct, or fitness to practise.
Another example could be emerging models of care, such as digital or remote services, where regulation may not always be clear or consistent across different providers, platforms, or professional groups.
Q. Do you think it is something that patients or the public are aware of?
A. In many cases, probably not. Patients and members of the public often assume that anyone providing healthcare, or presenting themselves as a healthcare professional, is subject to the same level of regulation and accountability. They may not be aware that protections can vary depending on a person’s role, title, setting, or the type of service being provided.
That means under-regulation can create a gap between what the public reasonably expects and what the system actually provides. Part of the challenge is explaining these differences clearly, without undermining trust in healthcare professionals or services.
Q. What can the Professional Standards Authority do to address these gaps?
A. The Professional Standards Authority can help when it identifies where gaps in assurance may create risks for patients and the public, and by bringing evidence, insight and independent analysis to inform decisions about how those risks should be managed. Its role is not to regulate individuals or services directly, but to support a clearer, more proportionate approach to public protection across the system.
One practical route to managing risks is through the Accredited Registers programme, which provides assurance for occupations that are not regulated by law. By setting standards for registers, assessing whether they meet those standards, and making it easier for the public and employers to check whether a practitioner is on an accredited register, the PSA can help strengthen safeguards where statutory regulation isn’t in place.
The PSA can also use its policy, research and oversight work to highlight emerging risks, advise governments and stakeholders, and promote right-touch regulation: regulation that is targeted, proportionate and focused on the areas where it can make the greatest difference to public protection. In some cases, that may mean recommending stronger assurance through voluntary registration; in others, it may mean making the case for clearer standards, better information-sharing, or statutory regulation where the level of risk justifies it.
