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'Expensive' and 'incoherent' healthcare regulation needs 'radical overhaul'


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.

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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”

Jackie Smith

“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.




Readers' comments (15)

  • I would ask what the significant improvements are and where the results are evident ???
    I would also ask where this dynamic regulator is seeing what can be done ahead to aid prevention ????

    Is it just me or is this more political twaddle as per norm.

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  • Well said 6:10pm - couldn't have put it better myself.

    Some examples, from my own sphere, of NMC's "dynamic" behaviour;

    - their knee-jerk reaction to the EU nurses English proficiency issue: they are proposing an insanely high level of English (reading, writing, speaking and listening) - the required IELTS-based standard is equal to that of doctors and, frankly, half of the existing nursing workforce in the UK would not pass, regardless that English may be their first language. And yet this test includes no assessment of medical/care vocabulary and takes no account of regional accents or colloquialisms. Thanks to this heavy-handed approach we can expect EU nurse recruitments to slow to a trickle, just when we need them more than ever, and those few nurses that do come through still won't necessarily have sufficient healthcare-related vocabulary to function as a nurse!

    - the absurdity of their requirement that every single EU nurse applying for registration in the UK must supply certified translations of all their documentation, even though the NMC has probably seen a Portuguese/Spanish/Italian nursing accreditation hundreds of times already: why not employ, even on a temporary basis, staff who speak these languages (Spanish, Portuguese, Italian, etc.)? This IS 2015 and this IS the European Union, but NMC still behaves like it's 1860 and "these foreigners can't be trusted, you know"!

    - registration of an EU nurse for practice in the UK takes a minimum of 3 months! Why? I can get a new passport issued on the same day - why does it take three months to confirm that an EU qualified nurse is, indeed, a qualified nurse?

    The NMC needs a bonfire lit under its backside!

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  • I like the valid point about there being too many regulators

    this is very true

    Time to merge regulators

    the NMC is not fit for task and seems a blunt adjunct to employer disciplinary measures

    the nmc is there for the employer and government

    it is not for patients or nurses

    Time to replace nmc before nursing is smashed in this country

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  • michael stone

    I downloaded the guidance yesterday, but I am only about half-way through it (it isn't exactly short).

    The general theme - so far as I can work out - is that too many 'registers' is bad, and instead of thinking about 'risk' (which I take to mean potential harm) the level of regulatory control/interference should be based on 'harm' (which I take to mean 'measured actual outcomes' [as opposed to 'theoretically possible bad outcomes'].

    The other theme is that the current regulatory structure (not that the authors seem to think there is a coherent structure) developed in a piece-meal and patchwork fashion, and that 'we need to start again, having properly thought out what is needed from scratch'.

    All of which seems to make sense - but achieving it, is a different thing.

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  • My husband is a registrant CISSP and CISSM Information security manager in charge of twoeuropean airlines two low cost carriers and a couple of other companies. To maintain his registration he pays an annual fee and maintains a log of his learning which he discusses with his line manager at his annual review.
    Somehow there is no question that he is not performing at the top of his game or that he puts the many thousands of passengers which fly with these airlines at risk of harm.
    My point is that if he were not doing his job effectively then a robust performance review would pick this up and he would loose his job. He is not required to complete these activities in his own time, nor is he expected to complete the myriad of extra activities that we may soon be expected to by revalidation, he is treated like an adult.

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  • "Yes we agree withe PSA but we're bloody wonderful - just look at our spanking new revalidation procedure as an example!"

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  • What I find most interesting is the veiled criticism of the "regulatory bodies" that the PSA do not oversee - Monitor, CQC, etc.

    These guys are one step removed from the institutional command and control bodies but still can see the problems with, and felt the need to take a swipe at, the "usual suspects".

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  • Take a peek at their board members - the NMC is on " the jollies circuit": 50% of their board are cushy appointments (with a fat salary) for members of "The Club", the civil service reward merry-go-round. The other 50% is made up of people who started as nurses but have "left all that behind" a long time ago to join the elevated ranks of academics or senior NHS management.

    Not exactly "in touch" with working nurses.

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  • ?
    michael stone
    michael stone | 8-Aug-2015 11:39 am

    further down vote for Stone, reminder of those evil sone garden gnomes

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  • michael stone

    Anonymous | 8-Aug-2015 9:51 pm

    Actually, the report is 'quite nice' about the CQC in several places:

    'Frustrated by the apparent persistence of
    poor quality care, the government sought to turn it from inspectorate to regulator, giving it enforcement powers and finally merging the Commission for Social Care Inspection, Healthcare Commission and Mental Health Act Commission into the CQC. Government has continued to add new responsibilities to the CQC.

    As independent evaluations of the work
    of these bodies have shown, they have
    had a positive impact whether by causing
    organisations to get on with fixing problems
    already known to them or sometimes
    shedding light on poor practice.'

    'The National Audit Office report published in July 2015 recognises that CQC has made ‘substantial progress’, but also states that it has a considerable challenge ahead to establish that it is effective and value for money, and recommends that it introduces benchmarking measures to assess its impact on quality and safety'

    'Amongst the professional regulators the GMC and the NMC in particular have made some real advances in sharing intelligence with the CQC. As the National Audit Office states the CQC has made real progress with using intelligence to identify risk'

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