With talk of New Year’s resolutions still in the air, I thought it timely to reflect on a busy year and predict some key areas that the PSA will need to focus on as we settle into 2024.
Though I don’t have a crystal ball to hand, I may not need one as in the world of professional regulation, change happens at a measured pace. This means that as one year ends and another starts, what we focus on will not be dramatically different in 2024 from the work we were doing in 2023. We will still be very much focused on our role of protecting the public and making sure that this is a key consideration for both government and regulators during the upcoming reforms to regulators.
The end of 2023 saw a real milestone in efforts to reform professional regulation with the laying of the draft legislation to enable the General Medical Council (GMC) to regulate the Anaesthesia Associate and Physician Associate roles in the UK. This happened on 13 December and was almost a year in the making with the Government’s initial consultation on this launching in February 2023.
The intention is for this order to become the blueprint for full scale reform of other healthcare professional regulators (impacting more than 1.5 million professionals working in healthcare).
Reform is essential to make regulation of these professionals more flexible, efficient, consistent and proportionate. We support reform and all the things we hope it will achieve, but we don’t want it to come at the cost of public protection. Protecting the public throughout the reform process remains a key consideration for us. We encapsulated these views in our consultation response and the briefing we prepared for stakeholders. We have also worked intensely with the Department for Health and Social Care (DHSC) on the detail of the draft Order, highlighting areas where we felt that public protection could be better served.
In 2024, we expect we’ll need to increase our activities to support regulators as they get ready to exercise their new powers and ensure they continue to be as effective as possible in protecting the public. We are developing guidance for reformed regulators and will be consulting on this shortly. We expect to be continuing the conversation with the DHSC throughout the year on legislation to reform the other regulators.
A clear point emerging from our Safer care for all report published in 2022, was the need to collaborate across the health and social care sector if we are to have any chance of tackling the complex challenges identified in the report. The five themes of health inequalities, new risks, workforce crisis, accountability and fear and a flawed safety framework are too big for any one part of the system to address on its own. That’s why in June we held a symposium to bring together professional regulators, registers, professional bodies, system regulators, patient organisations, academics and others around the topic of how we can collaborate towards safer care for all. This timely event was well-received, promises to give birth to new working partnerships and in 2024 we will continue to convene a range of stakeholders to work towards solutions to the knotty issues identified and emerging ones. Collaborating is key but just as important is cooperation and communication.
2023 saw many stories of botched cosmetic treatments highlighting the popularity of procedures such as Botox and fillers and the lack of regulation around them.
The prevalence of these stories caused us to speak out about our concerns in July. We highlighted the great risk of harm to people and urged the Government to speed up their plans to put a new licensing scheme in place. We encouraged people to use a practitioner on an accredited register when getting such services, to help steer them towards safer practices. We were pleased to see the Government consultation on a new licensing scheme launched in September and we provided our views on the proposals. We expressed our support for setting a minimum age of 18 for access to all non-surgical cosmetic procedures, placing high-risk procedures under additional regulatory oversight, establishing a simple and transparent licensing system and taking a consistent approach across the four UK countries to avoid ‘cosmetic tourism’. We look forward in 2024, to the next steps the Government will take on this work and are ready to do all we can to support the speedy implementation of the new scheme so that people are better protected.
Regulation of NHS Managers
In August, the sad and shocking case of Lucy Letby and the baby deaths at the Countess of Chester Hospital brought the issue of regulation of non-clinical NHS Managers to the fore. It is an issue that had been raised previously and is now being reconsidered. We contacted NHS England to offer our expertise in exploring options for the way forward. With our oversight of statutory regulators and management of the Accredited Registers programme for voluntary registers, our understanding of the broad spectrum of regulatory options means we can bring valuable insights to the debate. Initial discussions have been positive and we remain keen to support collaborative efforts to address risks to patient safety in 2024 by helping to work towards appropriate solutions.
Scotland Patient Safety Commissioner Bill
A focus of Safer care for all was the gaps in the safety system. Our report highlighted the need for a coordinating function which could take an overarching view of where adjustments are needed to improve safety across the system. The establishment of a Patient Safety Commissioner in Scotland provided an opportunity to shape a role which could help to address some of the gaps we’ve identified, by making it a role with broad responsibility for identifying, monitoring, reporting, and advising on ways of addressing patient and service-user risks. We felt it was important to encourage a role that would be broader than the current English equivalent, which we would like to see expanded.
We expressed our views on this and submitted evidence to the Health, Social Care and Sport Committee in Scotland to inform the legislative process related to the Patient Safety Commissioner Bill. The Bill received Royal Assent in November and we are pleased that Scotland is going to have a commissioner that looks at the whole system to spot problems and recommend solutions. This is a vital step forward in ensuring that the system is capable of learning from its failings, as well as identifying and acting on risks before they lead to harm. In 2024, we look forward to the role and office being set up and building effective links with the Commissioner around areas where our work aligns.
Only the most determined of people will have been able to avoid talk of artificial intelligence (AI) over the past year. It seemed that ChatGPT entered our general lexicon and AI found its way into all sorts of areas from academia to courtrooms; and healthcare was no exception.
In the Safer care for all chapter on regulating for new risks, we mentioned the increasing use of technology in the delivery of health and care which can bring efficiencies and other advantages but also has the potential to blur lines of accountability and put professionals in uncertain positions. Last year we recognised the need for greater understanding of how AI will impact professional regulation. We made links with experts, joined relevant groups and networks and have been working to build up our knowledge in this area. And we are sharing this knowledge with others. As part of our role supporting regulators and registers on emerging issues, we are hosting a session between government officials from the Department of Science, Innovation and Technology and regulators/registers this month to map out areas where further knowledge-building and action may be needed in 2024 and beyond. We anticipate that this is an area we will need to keep exploring for some time to come.
And all that is in addition to our core work of reviewing the performance of regulators, accrediting registers and reviewing fitness to practise panel decisions. 2023 was a busy year for the PSA. With the need to keep supporting the areas we worked on last year and taking on the new issues which will emerge this year, 2024 promises to be just as busy as we continue to strive to better protect the public.