We have been considering what the new UK Government's priorities for health and social care will mean for professional regulation. Much of the work is already in train, such as regulatory reform, is set to continue. Below, we give our reflections on some new areas of focus.
A National Care Service for England
We note with interest the Government’s plans for improvements to social care services, including the creation of a National Care Service for England, underpinned by national standards to support consistency of care. In our view, a strategic approach is needed to ensure that planning for these reforms includes consideration of professional regulation. Considering the most appropriate regulatory approach at the outset of the creation of a National Care Service could help make sure that registration requirements are proportionate, and do not aggravate issues such as retention of the workforce.
We are currently considering an initial application for accreditation from The Voluntary Care Professional Register (find out more in the Accredited Registers update).
Workforce planning, and regulatory strategies
More broadly, the UK Government has said that it will publish regular, independent workforce plans across health and social care. We think that what is needed alongside this is a strategy for its safe delivery. We would like to work with the NHS and other bodies involved in workforce planning in health and care to develop an overarching regulatory strategy that will support the further development of new roles and changing models of care. It could prove essential to addressing the challenges of ever-increasing demand and acute staff shortages facing health and care services UK-wide while promoting patient safety.
Mental health services
We note the commitment from the UK Government to ensuring mental health is given the same attention and focus as physical health (The King's Speech 2024 - GOV.UK (www.gov.uk)), the proposed Mental Health Bill, and the manifesto pledge to recruit 8,500 new mental health staff in Labour’s first term.
Many occupations essential to the provision of health and social care are not regulated by law in England, including counsellors, psychotherapists, and others delivering mental health services. Our Accredited Registers statutory accreditation scheme enables us to check whether registers of such occupations are well run, in the public interest. It provides assurance that practitioners have undergone adequate training and are committed to high standards of professional behaviours, and that complaints about them will be handled properly.
There are currently more than 85,000 people on our Accredited Registers providing mental health services. We have worked with NHS England to make sure that people in psychological professions roles who are not required to be regulated by law are on an Accredited Register. We think that using the scheme for the additional mental health staff would support the expansion of services in a safe and managed way.
We further support the proposal that the additional staff would be specially trained to support people at risk of suicide. We know that clinical guidance in this area is changing and are working with NHSE to make sure this is adopted by the Accredited Registers. We think there is a risk of inconsistent practice across the NHS and independent sector in this area, and across different professional groups. We are keen to use our oversight role to help address this.
Legislating for a ban on conversion practices
The UK Government has committed to legislate for a ban on conversion practices. The PSA supports the Memorandum of Understanding on Conversion Therapy and will not accredit any register that permits this practice. We think legislating for a ban could allow a clearer framework for professionals.
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We have written to Ministers to welcome them to their new roles and introduce them to our work. We will keep MPs updated on issues relating to professional regulation through our new, quarterly parliamentary bulletin and look forward to meeting with ministers and parliamentarians in due course.
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Enhanced oversight of the Nursing and Midwifery Council
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The independent culture review conducted by Nazir Afzal OBE and Rise Associates into the Nursing and Midwifery Council (NMC) found that people working in the organisation have experienced racism, discrimination and bullying, and evidence of safeguarding failures. This is concerning and these are matters we take very seriously.
The NMC has accepted all the recommendations set out in the Report. We have been in contact with the NMC’s Chair and Acting Chief Executive and colleagues from the Department for Health and Social Care and are in the process of establishing an independent oversight and support group. This group will:
- receive regular updates on the NMC’s progress;
- scrutinise the impact of measures introduced by the NMC to improve its culture and performance; and
- provide insight and advice on further actions required.
The group will include Chief Nursing Officers from the four UK nations, representatives from Trade Unions, policy officials from the DHSC and Devolved Administrations, and relevant experts, who will be identified by us.
We have also discussed the culture review with the Chairs of the other regulators we oversee. We have asked them to tell us about actions they are taking within their own organisations to assure themselves there are no similar concerns; and have asked for details of the arrangements they have in place to support staff who speak up and to act on concerns. We will take further actions if we do not think their arrangements are effective.
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Engagement in Wales - improving workplace culture
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Senedd Cymru
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The PSA has a UK-wide oversight role, and we rotate our Board meetings across the four UK nations. We combine this with stakeholder engagement, so we can hear views on our work directly. On 17 July, we held our Board meeting in Cardiff. The theme for our discussions with stakeholders was how workplace culture affects health and care.
We started with our Board meeting, in the morning. You can find the papers here. Topics under discussion included progress with key projects, such as regulatory reform and our guidance to support regulators implementing the new legislation introduced through regulatory reform. Our Board also took the opportunity of being together to have an initial discussion on the findings of the independent review of the NMC’s culture. The Board will have a further discussion in September, when we have analysed the review’s findings of the review in more detail. We’ve mentioned earlier in this newsletter the actions we are taking but you can also read through the statement we published here.
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Improving workplace culture: stakeholder event
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Following the Board meeting, we hosted a stakeholder event, to discuss improving workplace culture. It was well attended, and included representatives from Wales Health Boards, the Chief Nursing Officer, and Public Health Wales. We heard about the challenges – including the lack of a clear baseline, or even definition, of what ‘culture’ is. But we also heard about work that is making a difference, such as Anti-racist Wales Action Plan, which covers all public services and which people told us provides a clear framework from which their organisations can develop implementation plans. We will use the feedback to inform our own work on this area, including consideration of whether to incorporate culture and governance into our Standards of Good Regulation. (You can find out more about this later on in this newsletter, including how to contribute.)
Members of our Executive Leadership Team and Board also met with Welsh MPs, including the Cabinet Secretary for Health, Social Care and Welsh Language, Eluned Morgan MS, subsequently confirmed on 6 August as First Minister) and Mabon ap Gwynfor MS, Plaid Cymru health spokesperson and member of the Health and Social Care Committee. We will monitor updates closely and continue to work with Welsh Government officials to raise awareness of the PSA and the role of professional regulation.
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Watch our short animation to find out more about the third priority in Making care safer for all: a manifesto for change, focusing on workplace culture.
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We have just started a review of our Standards and it includes both sets: our Standards of Good Regulation; and our Standards for Accredited Registers. We thought it was timely as the Standards of Good Regulation were last updated in 2018 and, though the Standards for Accredited Registers were recently updated, we want to explore with stakeholders whether we should have one set of Standards or align them more closely. As part of the review, we are considering whether our Standards should cover culture and governance. The publication of the NMC independent culture review has further highlighted the importance of this. We know from our own research that toxic workplace cultures can impact safety, so it seems an opportune moment to ask the question and explore it in more detail.
We will be asking stakeholders for their thoughts, including on:
- Should we have fewer standards?
- Should we have more standards?
- Should we have one set of Standards for both regulators and Accredited Registers?
- Or, if not, should they align more closely?
- Should the Standards take account of culture and governance?
We plan to consult on this in the autumn. But, to help us fine-tune what the consultation should focus on, we are talking to stakeholders and plan to hold workshops in early September. If you would be interested in finding out more about how to contribute or attend a workshop, please get in touch with us by emailing: StandardsReview@professionalstandards.org.uk
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Fitness to Practise Appeals update
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In the past few months, we have concluded 10 appeals of regulator final fitness to practise decisions. (This included one appeal we withdrew after arguments were raised based on documentation that we had not received.) We decided to appeal these decisions based on our belief that they were insufficient to protect the public. The cases we have appealed cover a range of issues, including cases involving:
- A registrant who provided poor care and the case was not properly presented
- A registrant who behaved inappropriately towards students and a patient’s relative
- A registrant who did not intervene to stop abuse of a patient and then lied about it
- A registrant who did not assist a patient who was self-harming, erroneously administered medication to another patient, and then lied about it
- A registrant who verbally abused patients and did not treat them with dignity
- A registrant who covertly administered medication without clinical justification, left medication unattended, and pressured a colleague to lie about it
- A registrant who carried out an intimate examination without clinical justification
- A registrant who was convicted of causing death by dangerous driving
- A registrant who was convicted of lying about having immediately started CPR on a patient when they had not.
You can find out more details here. Where we decide not to appeal a decision, we often send learning points to the regulator. We have recently sent out our first learning points bulletin. Covering the period April 2023 to March 2024, we issued a total of 131 learning points to the regulators and appealed 30 decisions. We also saw a rise in the number of appeals relating to sexual misconduct/sexual motivation increasing from three appeals in 2022/23 to nine in 2023/24. You can read the bulletin here.
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We’ve published our first performance review for the 2024/25 cycle. It was for the General Osteopathic Council (GOsC). The GOsC met all the Standards of Good Regulation and we explain more about this in one of our longer and more detailed Periodic Reviews. If you are pressed for time, you can also read through our shorter snapshot.
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The GOsC is the first report to be published using a new approach for assessing regulators against our Equality, Diversity and Inclusion (EDI) Standard 3. To meet the Standard, regulators need to assure us they are delivering the four high-level outcomes supported by our new evidence matrix. These are:
- The regulator has appropriate governance, structures and processes in place to embed EDI across its regulatory activities.
- In terms of EDI, the regulator ensures that registrants and students are equipped to provide appropriate care to all patients and service users, and have appropriate EDI knowledge and skills.
- In terms of EDI, the regulator makes fair decisions across all regulatory functions.
- The regulator engages with and influences others to advance EDI issues and reduce unfair differential outcomes.
The GOsC has met the Standard and has demonstrated good practice in taking action to secure external input into its policy work and in the clear EDI focus of the standards required for registrants, students and Osteopathic Education Institutions.
We have identified opportunities for the GOsC to enhance its work on EDI by increasing the completeness of the data it collects on registrants’ protected characteristics.
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Accredited Registers update
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Meet our new Head of Accreditation
We are pleased to welcome Osama (Os) Ammar as he takes up post as Head of Accreditation. Os joins us from a long career in statutory regulation. He has been a key part of preparing for and introducing significant change in regulation and professional education over the course of 20 years, including leading on the work to introduce revalidation for pharmacy professionals and shaping the response to the impact of COVID-19 on dentistry and its regulation. As well as occupying roles in statutory regulators, Os has worked as a consultant to the Academy for Healthcare Science during its formation and in the health service in England and Wales to develop strategies, workforce plans and explore and improve culture by restoring psychological safety.
Society of Clinical Perfusion Scientists Standard One publication
We have published our report on the Society of Clinical Perfusion Scientists’ (SCPS) application for an assessment against Standard One of our Standards for Accredited Registers. Also known as ‘the public interest test’, we assess whether the benefits of the activities of the roles registered by the SCPS are likely to outweigh the risks. We found that, overall, the public interest test is met. However, our Accreditation Panel also determined that the risks appear sufficiently high, and potential impacts on patients sufficiently great, to recommend that the four UK governments should consider whether accredited registration is likely to be adequate.
Not sure what a clinical perfusion scientist is? They are part of the wider team in operating theatres. They operate specialist equipment in hospital settings in both the NHS and the independent sector. They work mostly in operating theatres alongside surgical teams. They may also work in intensive care, emergency departments and non-cardiac theatres.
NACAS new application
We mentioned earlier that we had received a Standard One application to accredit the Voluntary Care Professional Registered managed by the National Association of Care and Support Workers (NACAS). The register has been set up to provide assurance for care workers in England where this occupation is not regulated by statute as it is in other UK nations. The register is supported by Care England. We anticipate publishing the outcome of the assessment in early Autumn 2024. The Register was developed by NACAS following a period of consultation. Professor Martin Green, CEO of Care England, has said that “Care England warmly welcomes the launch of the Voluntary Care Professional Register (VCPR) a significant milestone in enhancing recognition and improving the status of care professionals in England.”
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A change of name and a change of face
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In early July, Christine Braithwaite, our Director of Standards and Policy retired. Melanie Venables, previously our Head of Accreditation, was appointed to the renamed role of Director of Policy and Communications on 1 July 2024. Before Christine retired, we asked her to reflect on her 30 or so years working within professional regulation in the form of a short Q&A and you can read a few snippets of how Christine answered below:
Q. Can you share a success story from your time at the PSA when you feel like you really saw the impact of the PSA’s work?
A. It has to be Right-touch regulation. It has shaped everything we do – and a sizeable swathe of the international community too. The Accredited Registers programme has been a huge success.
Q. What do you find most challenging about this sector/health and care regulation?
A. Political churn. Since 2015, there have been at least 12 health and care ministers in post (probably more now following the election).
Q. What advice would you give to someone starting a career in professional regulation?
A. Understand your sector back to front, upside down and inside out. Get out there, visit the front line, talk to and, most importantly, listen to those delivering and receiving care. You cannot ‘regulate’ health and care if you don’t understand how it works.
Q. You’ve worked for almost 30 years in this sector – what has changed in the sector since you started?
A. The biggest change is that quality of care and safety are firmly on the agenda. In the old days, it was all about corporate governance, not clinical governance. Then the Commission for Health Improvement was set up and led by Sir Ian Kennedy and Peter Homa – a great double act – that put clinical governance and risk-based regulation on the map. Sir Ian’s other great achievement, reform of professional regulation further enhanced by Dame Janet Smith, completed the toolkit. It’s up to us from here.
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Christine Braithwaite was presented with a Chairman’s Award for Excellence, acknowledging her contribution to patient safety and the formation of the Academy for Healthcare Science's Accredited Register. The AHCS Fellowship Awards took place on 20 May 2024 at the Palace of Westminster, hosted by the Earl of Lindsay.
This photo shows Christine wiith the Earl of Lindsay and her Award.
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… and Q&A with someone new to regulation
Ruth Ajayi has recently joined our Board as an Associate Board Member. Though not new to the health and care sector, she is relatively new to professional regulation. We asked her for her first impressions. Ruth has written a blog for us, also in the form of a Q&A, where she explains more about why she applied to join our Board and what she hopes to learn from the experience as well as contribute to it with an emphasis on patient-centred care. You can read the full blog here.
We also bid a fond farewell to our outgoing Board Member and Chair of our Audit and Risk Committee, Frances Done, who is retiring from the role. We want to extend our thanks to her for her commitment to our work and wish her well for the future.
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