The Professional Standards Authority (“PSA”) has recently published its latest proposals for the reform of regulation titled ‘Regulation Rethought’. The publication sets out proposals for a transformation of the regulation of health and care professionals and suggests key changes to legislation to make this possible, with a primary focus on public protection and professional responsibility. The publication links to the radical overhaul in regulation suggested in its previous paper, ‘Rethinking Regulation (August 2015)’, and is intended to support the achievement of the Five Year Forward View.
Regulation Rethought focuses on putting into practice some of the ideas set out in Rethinking Regulation. It proposes a complete restructuring of the regulation of health and care professionals including the introduction of a shared purpose for regulators to ensure all professional regulators are working to the same core values. It states the core values should be:
- Protecting patients and reducing harm;
- Promoting professional standards; and
- Securing public trust in professionals.
- All regulatory functions and activities should be directed towards, and only towards, these purposes.
It is intended that these values would be built upon for different types of health and care professionals to ensure they are relevant to the particular profession. The PSA states the purpose behind the core values is to enable regulators and others to operate more effectively as a safety system, rather than the current unconnected objectives that may be seen to dilute the impact of regulation.
Another proposed action under the ‘shared purpose’ is to simplify the language used in regulation. The aim of which is to create a better understanding of regulation by the public. Therefore, terms such as ‘fitness to practice’, ‘impairment’ and ‘revalidation’ should be avoided and replaced with plain English. The PSA proposes that further work will be required to find a way of describing regulation that is more accessible to the public. This suggests that professionals will need to familiarise themselves with a new system of terminology if the proposals are put into practice.
The PSA further proposes a renewed focus on core functions. It proposes that the set of core functions should be:
- To maintain a shared, public register of appropriately qualified health and care practitioners;
- To award and renew licences to practise in specific occupations;
- To set common standards that all registrants must meet; and
- To investigate allegations that registrants do not meet the standards and take action.
It recognises that there is a general disconnect between the types of services certain regulators are able to regulate. For example, under current arrangements the CQC inspects dentist and GP premises but not pharmacies or the premises of opticians, osteopaths or chiropractors. It is proposed that merging the regulation of people and premises has advantages for patient safety. The proposals therefore suggest that the premises of those working in ‘High Street’ practice is brought within the scope of the professional regulator. The application of this change will need to be carefully thought through to avoid the risk of duplication of checks between different regulators.
In line with the core functions and increasing public understanding is the proposal of a licencing system similar to that of the DVLA (Driver and Vehicle Licensing Agency). This would comprise a shared public register for statutorily regulated professions with the potential to be extended to include accredited registers and other currently unregistered occupations. Risk profiling is intended to help decide the appropriate level of licensing for different professions. It is proposed that registrants will be required to sign up to a ‘statement of professional practice’ encompassing the core standards that would apply to all professionals on the register. Whilst the licensing system will be more complex than that of the DVLA, this can provide a frame which can make the purpose and function of regulation clearer and more accessible to the public. It is also proposed that registration and deregistration could be linked to the Disclosure and Barring Service to further streamline processes.
Other key proposed reforms include:
- An increased focus by regulating bodies on effectiveness and efficiency.
- Working in partnership to prevent harm and promote professionalism.
- A significant change in approach to maintaining standards and preventing harm – focusing on a registrant’s fitness to practice and moving towards shorter, less costly and more consensual ways to close cases.
- Exploring a new approach to education and training regulation.
- A methodology for assessing occupational risk, with which to determine which occupations should be statutorily regulated, which risks are effectively controlled with an accredited register, and which can be well managed by employers.
The proposals are ambitious and whilst the paper states it provides suggestions of how new regulation can be achieved, this is very high level and there is little information on how exactly the plans can be actioned in practice and the effect it may have on health and care professionals in the long run. It is thought that a government white paper may be published soon with a number of significant proposals reflecting the ideas put forward in ‘Regulation Rethought’.
One aspect the proposals don’t address is the potential cost of the proposed changes. This includes both the development of core standards that apply to all regulated areas and the likely increased cost of regulating services that have to date not been subject to a professional regulator (thus increasing the workload of such regulators). The ideas proposed appear to be on the whole reasonable but the practical application needs considerable thought.