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Research and policy update

Regulation research from Cardiff

Regulatory reform

We have been continuing to work with the Department of Health and Social Care on the significant reforms planned for all the regulators we oversee, across all functions. We are limited in what we can say as nothing is yet in the public domain, however it appears more than likely that we will be raising concerns about a number of the proposals in the consultation, which is expected in the next few months.

In particular, the Government wants to give regulators more flexible ways of making fitness to practise decisions about the competence or conduct of a healthcare professional, so that not all cases have to be settled by a panel. It is not clear though whether we will be given powers to challenge an unsafe decision made under the new model, in the same way that we can panel decisions. Find out more about how we challenge these fitness to practise decisions in the public interest. Or read our case studies which show how and why we appeal final fitness to practise decisions when we consider these decisions are insufficient to protect the public.

Learning from Covid-19

We are planning an event in February to look at some of the learning from Covid-19 following publication of the first part of our report looking at lessons learned. If you are interested in attending, we will be updating our website with more details, so keep a look out for more information.

Recent research published

Research with patients and the public

Earlier this year we contracted the agency Community Research to explore with patients and the public their perspective on future fitness to practise processes where hearings are not held. The study covered the potential impact of the emerging approach on public confidence, how patients, the public and carers would wish to be involved in the likely future model, and views on oversight of the new arrangements.

The researchers used online and face-to-face discussion groups with a broad range of participants, as well as telephone interviews with people who had recently complained specifically to health and care professional regulators. 

The report found that broadly participants were supportive of moves to reduce the number of public hearings and use a more consensual model. Participants did, however, feel there were risks in reducing the number of hearings since this would mean less external scrutiny of decisions. There was, therefore, a general view that independent oversight should be retained and the whole regulatory system leading to final decisions on fitness to practise would need to be robust.

Participants also wanted reassurance that, if there was no cross-examination in public at a hearing, the complainant would still have a voice and the evidence would be properly scrutinised and challenged. They called for witnesses to be able to give their side of the story in a way that is as user-friendly as possible and still able to convey nuance and emotion.

Given the low levels of awareness of regulation and fitness to practise cases, coupled with the relatively high levels of confidence in health and social care professions, there was a general feeling that the proposed changes are likely to have little impact on public confidence as a whole. However, it was acknowledged that this could change if a concerning case involving a professional, who had caused significant harm, came to light that had been dealt with inappropriately through a consensual process.

Find out more about what participants had to say in the full report and there is also a visual summary of the key findings in this infographic

A review of the research into health and care professional regulation

At the beginning of the year we commissioned an independent team at Cardiff University to undertake a review of the research into health and care professional regulation since 2011.

The three key objectives for this research were:

  1. To source research in the area of health and care professional regulation in English since 2011
  2. To evaluate the research and draw out what it has taught us
  3. To identify any gaps in the research and areas that would benefit from deeper exploration to inform the focus of further research and continue to build the evidence base in relation to health and care professional regulation.

In addition to the core of their work – a rapid evidence assessment of the published literature – the researchers carried out interviews with our key research and policy contacts at the regulators, as well as reviewing their websites.

In terms of what the literature has taught us, the key themes are grouped into six areas, including Education and Training and Harm Prevention and Patient Safety. A strong overall finding to emerge from the work is that – whereas health and care professional regulation studies is rapidly emerging as a new field – it is still less developed compared with other areas, such as financial, legal or aviation regulation studies.

You can read the full report or see a summary of key findings in this infographic. You can also read the guest blog from Professor Alison Bullock and Julie Browne from Cardiff University who undertook the review for us.


Candour and whistleblowing in the context of Covid-19 – online seminar

We have an ongoing interest in candour and whistleblowing, and how they affect patients and families. We are keen to understand what the extreme pressures being exerted on healthcare delivery mean for professionals’ willingness and ability to speak up when things have gone wrong, and what experiences patients can report in relation to candour from recent months. 

On Friday, 4 September we held an online webinar jointly with the University of Edinburgh Law School, to discuss how the pandemic is affecting candour and whistleblowing, bringing together professional and patient perspectives. The seminar was chaired by our Board member, Moi Ali, alongside Annie Sorbie, from the University of Edinburgh’s School of Law. Annie also worked with us on producing our report Telling patients the truth when things have gone wrong – published in January 2019.

There were about 80 attendees who joined us to listen to presentations from Fraser Gilmore from Care Opinion Scotland and Gail Adams from UNISON. They presented findings from their respective organisations as well as their personal insights. Their presentations were followed by an engaging and lively conversation, as attendees discussed how to implement the professional duty of candour effectively in Scotland, and what can be learned from our experiences this year.

One positive that can be gleaned from the pandemic seems to be that when needed, we have been able to rapidly change the way services are provided. Some of the challenges, in contrast, have derived from the variation in codes of conduct for different professionals and staff. This confusion has made it difficult for patients to navigate complaints procedures, while staff have felt frustrated. This suggests that more can be done to work collaboratively, something that is hindered by separate legislation. 

One of the biggest barriers to candour, it appears, is that not everyone understands what candour is. It’s a basic framework that needs building upon. Greater investment in training, as well as developing the technology to enable this training, has been essential during Covid-19, and perhaps regulators therefore need to maintain this momentum as we enter new phases of the pandemic, investing and reinvesting in processes to implement codes of conduct as the situation evolves. 

We are planning to hold a one-day seminar in June next year, to consider what the healthcare system in Scotland – and professional regulation in particular – can do to address barriers to openness. This webinar was successful in pinpointing some of the key issues and areas for further discussion, which we look forward to delving into at our seminar next summer.

Find out more about our research on the duty of candour as well as a series of blogs on the duty here.

Symposium on Regulation Reset

We are currently hosting our annual Symposium (though it is online so we are hosting it over three days for shorter sessions and it started on 3 November). This year we have chosen the theme Regulation Reset. The title has been prompted by the NHS Confederation’s campaign, NHS Reset, which seeks to reshape the way in which health and care services are delivered for the better, learning from experience in dealing with the Covid-19 pandemic. The NHS Confederation suggests that regulation needs to adapt too, and indeed all regulators have had to make fundamental changes and there may be some they would like to keep.

Also significant this year has been the global reaction to the tragic killing of George Floyd and the spotlight now being shone on BAME inequalities. This too we think would benefit from discussion between us all to consider regulation’s role in promoting equality, diversity and inclusion.

With regulatory reform on the table, it is an opportune time to consider what lessons we draw from Covid-19; and equality, diversity and inclusion issues. What is it we want to keep, resist or initiate?

Due to holding the symposium online and aware of the issues around staring at screens for long periods of time, the symposium is taking place over three half days this week so delegates can dip in and out of the sessions that most interest them. Day 1 will focused on Regulating and supporting the current workforce – what have we learnt from Covid-19 about regulating effectively?  Have changes been made that you would want to keep, or are former ways better? Day 2 will look at Developing and regulating the future workforce – how should regulation evolve to support the future workforce? Day 3 will ask: What is regulation’s role in promoting equality, with a focus on BAME registrants and patients? The main focus question for this is: is regulation too white?

We will provide a fuller update on the outcome of the discussions in our next newsletter. 

First do no harm - our response to Baroness Cumberlege's review

We published our response to Baroness Cumberlege's report - First Do No Harm - the Independent Medicines and Medical Devices Safety Review in September. In our response, we acknowledge the huge damage caused to patients by the medicines and medical devices examined within this review, and agree fully that the system must change to prevent this happening again.

You can read our response here.

Research and policy in 2019/20

We also published our annual report in July – you can find out more about our research and policy activities during 2019/20, including events and publications in the full reporta snapshot of our work during the year, or a summary of key stats for the policy and research in 2019/20 in this infographic.