Healthcare regulation in the UK is “incoherent”, “expensive” and requires a “radical overhaul” according to a review by the body which oversees the work of organisations including the Nursing and Midwifery Council.
The Professional Standards Authority, which presides over all nine professional regulators, also said there is “little evidence” as to how effective regulation currently was in improving health and social care standards.
The body said changes in the way the healthcare system will work in the future – such as the shift of focus from acute to community as proposed in NHS England’s Five Year Forward View – also required a reform of regulation.
“We need to …understand better what regulation can and can’t do to control the risk of harms”
PSA’s Rethinking Regulation report
“We need to …understand better what regulation can and can’t do to control the risk of harms, to deregulate in some areas and focus regulation more effectively in others. We need to remove barriers between professions and create new roles,” said the report, called Rethinking Regulation.
The body pointed out a series of problems with the system in its current form.
It said the sheer number of regulators – more than 20, including nine professional ones and systems regulators such as the Care Quality Commission - that had appeared over the years were slowing the pace of change in the sector.
Meanwhile, it pointed to a lack of understanding among regulators about what influence their work has on healthcare workers’ behaviours.
“The continuing instances of harm to patients and the public resulting from unprofessional conduct is of great concern”
PSA’s Rethinking Regulation
“Despite the fact that fitness to practise allegations are made against a small percentage of the total number of registrants, the continuing instances of harm to patients and the public resulting from unprofessional conduct is of great concern,” said the report.
It called for a better understanding by regulators of the different risks involved in each of the healthcare professions and for adjustments to be made to regulation accordingly.
The PSA also pointed to the “demoralising impact” on the healthcare worker of the onerous process involved in some regulation.
Preventative action - by regulators using their influence and interventions to reduce noncompliance with standards – should be a key focus for the future, it also said.
Meanwhile, the report noted “with concern” the contradictory public messages about “blame” in relation to the practice of healthcare professionals.
“Our 2015-2020 strategy sets out our aim to be a dynamic regulator working…focusing more on prevention than responding to concerns”
“The recently published [government] response to the Freedom to Speak Up Review is called Learning Not Blaming, but at the same time the government has passed legislation to criminalise ‘avoidable harm’,” it said.
The report said regulators had a role to play in creating a more open culture and through redesigning the system they should encourage professionals to drive improvement.
“We must seek to understand what motivates individuals, teams and organisations to succeed, not attempt to frighten them to resentful compliance,” it added.
Responding to the report, NMC chief executive Jackie Smith said the body had for some time been calling for a change in the law that would enable it to modernise its regulation.
“Our 2015-2020 strategy sets out our aim to be a dynamic regulator working as part of a wider system of regulation focusing more on prevention than responding to concerns,” she said.
“The public expect all regulators to deliver public protection efficiently, effectively and fairly. We have made significant improvements to how we do that, and the results are evident but there is more to do. We can only do that with new legislation,” added Ms Smith.