Annual report and accounts 2015-16

Chair's Foreword

I am very pleased to have been appointed as Chair of the Professional Standards Authority at an exciting time for the regulation of health and social care.

This last year has seen our transition to the self-funding and more independent public body established by the 2012 Health and Social Care Act and the Department of Health is planning to consult on significant reforms to health and social care professional regulation.

Since August 2015 we have been funded primarily by a fee paid by the regulators we oversee. This fee covers the cost of our statutory functions as set out in regulations. Because of the transitional arrangements we had to consult the regulators twice in the last financial year and we are grateful to them for their constructive engagement with the new arrangements.

In parallel the accredited registers programme is funded by fees paid by the holders of registers for their accreditation and annual renewal.

We had recognised 19 registers by the financial year end. All obtaining accreditation have improved their performance and applied for renewal. Other income comes from commissions from the UK governments or from regulators or governments in other countries. In 2015/2016 we had two international commissions; one from the Ontario Ministry of Health and Long-term Care and one from the College of Registered Nurses of British Columbia.

During the year we concluded a major review and consultation on how we assess and report on the performance of the regulators. We wanted to create a more proportionate but rigorous process so we could focus our attention on areas of change or concern and have more comparable data on regulatory performance.

During the year we reviewed nearly 4,000 decisions by fitness to practise committees. We appealed 14 cases to the High Court. Our appeals were settled by consent or upheld in all those cases but one. That case is subject to a further appeal by us.

Our commitment to improving regulation and building a research base has continued with a successful research conference with the Collaborating Centre for Values-Based Practice at St Catherine’s College, Oxford. We published an important and widely read paper Rethinking Regulation and revised Right-touch Regulation in light of its practical applications over the last five years.

I cannot conclude without paying tribute to my predecessor as chair, Baroness Pitkeathley. Her outstanding leadership and many skills have made a huge contribution to the Authority’s work over the last seven years. The delivery of the substantial programme of work recorded in this report is a tribute to our hard-working and talented staff but also to effective oversight by the Board. We are fortunate in the quality and commitment of our non-executives. I am confident that the Authority is well led by the directors and Board as we go through further challenging times. 

Review of regulation and registration of health and care occupations

This report describes our view of the regulation and registration of people working in health and care in the UK in 2015/16. Our observations draw on evidence from review, assessment, policy and research activities. We have also taken note of the views of people who have contacted us about the regulators and accredited registers or responded to consultations and have drawn on published sources.

This is the first Review of professional regulation and registration in this new format. It gives us the opportunity in one report, to draw out general themes arising from our oversight of the nine professional regulators and, for the first time, reflect on the performance of the accredited registers programme and the way that the registers are meeting the standards for accreditation.

The UK, like many countries is operating within a professional regulatory model conceived in the nineteenth century and implemented in the twentieth. This regulatory framework is struggling with the demands of contemporary healthcare.

The extent to which professional regulation is written into primary legislation across a large number of Acts makes reform costly and slow when it needs to be agile and to keep pace with the extensive changes taking place in health and social care. In the UK two attempts at regulatory reform have foundered in the last five years and a third is in progress. This year has seen a number of incremental changes to legislation which we think problematic and reflect the difficulties with making piecemeal changes.

The vast majority of healthcare professionals have internalised standards of conduct and hard won standards of competence. There are in the region of 1.5 million regulated people employed in the UK health service. Only about 4,000 a year ever reach a fitness to practise proceeding so our focus is on the small minority, who, through their moral failings and behaviours cause or are complicit with, harm or wrong-doing. Many of the regulators are now turning their attention upstream, looking for ways to prevent or reduce opportunities for harm rather than only intervening when harm has been done.