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Rethinking regulation; or stating the obvious?

7 August 2015

Rethinking regulation; or stating the obvious?

Hello readers and welcome to this week's newsletter! Who's enjoying the sunshine? If like me you are cooped up in the office/practice having to work whilst everyone else seems to be on holiday, pull up a chair, grab an unsweetened (remember kids, sugar is bad for you) beverage and enjoy the newsletter. 

So, the Professional Standards Authority has brought out a new report that explains just what exactly is wrong with current healthcare regulation in the UK. 

According to the report, Rethinking regulation, it is out of date, over-complicated and too expensive. 

For those of you (unlike me) who are too busy having lives to go through 25 pages of regulatory speak (granted, the lettering was quite large), I’ll pull out a few notable quotes for you: 

  • Regulation must be designed around the people it affects and in a way that protects patients and supports professionals, employers and other staff delivering care to achieve the standards required of them.


  • With a renewed focus on its purpose, it seems clear to us that regulators (including inspectorates) should redefine the outcomes that they are seeking to achieve, and rethink how they will do so, based on evidence of what works, and drawing on a wide range of research and data


  • Our regulatory system should be redesigned to encourage and support people as individuals and as teams to drive achievement and improvement. We must seek to understand what motivates individuals, teams and organisations to succeed, not attempt to frighten them to resentful compliance.


  • ...regulators must remember that their concern is not quality improvement, but quality control. The interventions of regulators should have the common purpose of seeking to minimise risk to the public. The aims of regulation and quality improvement are complementary, and regulators should be careful to ensure that their own activities do not constrain innovation, but their own contribution must remain focused on their core purpose.


Now I don’t know about you, but I have a vague recollection hearing phrases such as ‘unfit for purpose’ and ‘out of date’ when discussing regulation before…

Harry Cayton, Chief Exec of the PSA, said: “Piecemeal adjustments to health and care regulation have, over time, made the system cumbersome, ineffective and expensive. Every part of our health and care system is changing in order to meet future needs. If patients are to benefit, regulation must undergo radical change too. 

“Regulation is asked to do too much - and to do things it should not do. We need to understand that we cannot regulate risk out of healthcare and to use regulation only where we have evidence that it actually works. Ironically, the regulations that are meant to protect patients and service users are distracting professionals from this very task.”

At the time of writing this, only two of the nine regulators the PSA oversees thought the report was important enough to release a comment on it for its members.  The General Optical Council (GOC) and Nursing and Midwifery Council (NMC) both issued a comment from their respective Chief Execs. GOC Chief Exec, Samantha Peters, said: “The PSA’s report raises some very important issues about the future of healthcare regulation, and we encourage others to join a wider debate on this. It is essential we properly and comprehensively consider the best ways in which to approach the future of regulation, and the PSA’s report is a welcome step forward in initiating this conversation.”

NMC Chief Exec, Jackie Smith said: “We have been pressing both the previous and current governments for a bill that would modernise how we regulate the 683,000 nurses and midwives on our register. We welcome any contribution that furthers this debate. It is widely accepted that our current legal framework is clumsy and outdated and does not serve the professions we regulate, or the public well.”

But what about dentistry?  Well, the BDA has been hot on the heels of the report, calling on the Government to act on the PSA’s recommendations for the benefits of patients and practitioners. Mick Armstrong, Chair of the British Dental Association, commented: “There are over a million regulated healthcare practitioners in Britain, serving tens of millions of patients. Political intransigence is letting antiquated laws remain standard practice. And it’s come at a cost, in time and money, and patients and practitioners deserve better.

“Bosses at the major healthcare regulators are in receipt of salaries larger than the Prime Minister’s. The people running these fiefdoms are enjoying power without responsibility, and it’s about time they put patients first.

“We need to see a clear focus on the fundamentals. That means protecting patients, building firm foundations, not succumbing to inexorable mission creep.

“Too many regulators have lost the confidence of their professions. Effective independent regulation requires trust, and rebuilding that will mean genuine engagement, not just lip service.”

The PSA have set out a list of what they feel needs to change, including:

• A shared ‘theory of regulation’ based on right-touch thinking

• Shared objectives for system and professional regulators, and greater clarity on respective roles and duties

• Transparent benchmarking to set standards

• A rebuilding of trust between professionals, the public and regulators

• A reduced scope of regulation so it focuses on what works (evidence based regulation)

• A proper risk assessment model for who and what should be regulated put into practice through a continuum of assurance

• To break down boundaries between statutory professions and accredited occupations

• To make it easier to create new roles and occupations within a continuum of assurance

• A drive for efficiency and reduced cost which may lead to mergers and deregulation

• To place real responsibility where it lies with the people who manage and deliver care.

They concluded the report with this: It is time for a more nuanced, more sophisticated use of professional and system regulation working in concert to ensure that professionals are personally able to provide good care and are supported to do so within their workplace. If regulation was going to improve care, it would have done it by now. So it’s time to improve regulation.

No Sh*t Sherlock, as the saying goes.

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