Does consistency between regulators matter?

‘What should be the same’? ‘What should be different’? Research on perspectives on consistency in health/care professional regulation

In some respects, the ways in which different health and care professionals are regulated are very similar. Doctors, nurses, social workers, osteopaths and other regulated professionals will only be able to register and practise their profession if they have the appropriate education and training, and meet standards set by their regulator. Their information will be published on a public register. For the small number of professionals that have concerns raised about their practice, they may become subject to fitness to practise proceedings. Ultimately, they could be struck off.

But the nuts and bolts of how each regulator carries out its work in education and training, registration, setting standards, or fitness to practise can be very different. It’s not always clear whether these differences are justified, or whether inconsistencies between the regulators affect people’s perceptions of regulation. For example, if a doctor and an osteopath are suspended from practice, should this be noted on the register for the same amount of time? Should regulators of different professions have different policies about how they handle cases of drink-driving by registrants? What do the public, patients, and professions think about consistency between health and care professional regulators?

Why did we commission the research?

We wanted to find out what patients, carers, the public and registrants think about consistency in health and care professional regulation – is it valuable, and if so when and why? We also wanted to understand whether their views differ according to which area of the regulator’s responsibilities we are talking about for example, education and training, registration, and the fitness to practise process.

We commissioned Simon Christmas Ltd – an independent research organisation to conduct qualitative research on the subject of consistency and get public, patient and professionals’ perspectives on it.

Consistency is a complicated concept and the deeper you delve into it as part of the regulatory process, the more complicated it becomes. To avoid getting mired in potential sources of confusion when talking to interviewees, the researchers focused instead on the questions that underpin the concept:

What should be the same, when, and why?

A further challenge following from these questions: was the sheer range of types of answer that can be given to these kinds of ‘what’ questions. To help focus discussions, the researchers also produced a list of the types of profession under discussion and took the opportunity to remind participants that regulated professionals work not just in the NHS but in a range of different settings and contexts. The list included professions such as:

What did the research reveal?

Arguments for ‘same’

The research identified five kinds of argument made by participants for making regulation the same across different groups. These were typically based on ideas about underpinning similarities between professions. Which argument was relevant depended not on regulatory function, but the perceived role of the regulator in that instance. For example, where participants saw a regulator performing the role of an arbiter (for example, when making decisions about fitness to practise cases), arguments for sameness would rest on beliefs about fairness or what the correct decision should be. By contrast, where participants saw a regulator performing a service provider role (for example, when responding to concerns and providing updates to complainants), arguments for sameness related to adequacy or simplicity. These relationships between the regulators’ perceived roles and arguments for sameness are helpfully laid out diagrammatically with illustrative quotes in the main report.

Arguments for ‘difference’

The research also explored participants’ views about justifiable differences in the way that different professions are regulated. Five arguments for difference were identified, reflecting ways in which professions are different in some important respect, with many of these related to differences in the interactions between professionals and patients (such as the level of risk associated with practice; the involvement – or not - of a team, etc.).

Ultimately, the report finds that for patients, the public and registrants, advocating for consistency between regulators rarely means asserting that regulators should operate identically. It instead involves balancing the value of different kinds of sameness – reflecting assumptions about regulators’ roles – with arguments for justifiable difference.

How was the research carried out?

The researchers conducted online focus groups with patients, carers and members of the public, as well as one-to-one interviews with registrants of different regulators. Using illustrative examples of current differences in the regulation of different health and care professionals, participants were asked to consider what should be the same, what should be different, and their reasons for similarity or difference. This approach to answering the research question aimed to address some of the challenges posed by exploring a nuanced and potentially value-laden concept (“consistency”) with participants with limited prior knowledge about professional practice or regulation. Rather than asking participants if they thought consistency was valuable or not, the researchers catalogued participants’ arguments about whether sameness or difference was appropriate with respect to various aspects of regulation.