How regulators quality assure education

Summary

One of the key functions of UK health professional regulation is to assure the quality of education and training courses for students. We were asked to advise on the different approaches taken by the regulators. The report describes how the regulators’ involvement in quality assurance is valued by education providers for the confidence and specific expertise it provides.

However, regulators are only one of a number of parties with an interest in undergraduate health programmes. Funders and commissioners, and professional organisations, are also involved. Therefore concern has been expressed about the total impact and possible overlap of different quality assurance type processes on higher education.

In our report we conclude it would be impractical to try to seek a definitive solution to these different interests and it may be more productive to focus on establishing ways to live with change and manage any tensions that arise.

Introduction

In October 2008 CHRE were commissioned by the Secretary of State for Health to provide advice on the process for quality assurance of undergraduate health programmes by the nine healthcare professional regulators:

The Secretary of State requests advice about the quality assurance regimes applied by the health professions regulatory bodies on Higher Education Institutions. The Secretary of State wishes to ascertain:

(i) the similarities and differences in approach that are taken by different bodies in the quality assurance of undergraduate healthcare programmes across the UK;

(ii) how the health professions regulators keep pace with changes in professional practice that may influence the structure or content of professional education;

(iii) whether the approaches of health professions regulatory bodies ensure they meet their statutory duties to ensure that future healthcare professionals are trained to sufficient competence to ensure high levels of patient safety in their everyday practice (taking account of the relative risk to patient safety of different areas of healthcare professionals’ practice);

(iv) how the health professions regulators manage their relationships with the professional bodies; and

(v) whether there is potentially scope (should it be desirable to do so) to alter processes without adversely affecting public protection.

It would also be helpful if the Council could identify examples of good practice in the approach to quality assurance.

Public protection and patient safety must be the guiding principles throughout this analysis.

In February 2009 we provided an interim report on our work. This is reproduced in Annex 1, with slight revisions.

Our interim report discussed the current approaches taken by the regulatory bodies we oversee, under powers given to us in the NHS Reform and Health Care Professions Act 2002. We identified the broad similarities and differences, discussed the means by which these regulators keep pace with changes in practice, how quality assurance contributes to patient safety and public protection, and the way they work with other organisations in this field. In brief we found that:

• There are similarities and differences in the approaches taken by the regulatory bodies to quality assuring undergraduate education. The broad structure of the approaches is the same, following a pattern of programme approval, monitoring and reapproval, but differences become clear both in the methods and frequency regulators adopt in employing these aspects of quality assurance. The rationale for different approaches in part can be explained by the different role played by undergraduate education in meeting pre-registration requirements, but also reflects differences between the professions and the regulators themselves.
• Regulators have demonstrated methods and approaches to manage the impact of changes in practice on education and their quality assurance processes, through planned reviews of standards, strategic reviews of approaches to education and focusing on high-level outcomes and criteria that allow education providers to keep curricula current. Furthermore, if practice is changing, quality assurance by the regulators is a means by which we can be confident that educational programmes ensure that new professionals are fit to practise.
• Patient safety and public protection are at the heart of healthcare professional regulation and consequently underlie all work in quality assurance. The weakest student who passes a programme has to be fit to enter the register and fit to practise. The regulators work through a range of practical steps including methods and approaches in education programmes, involving patients and the public in quality assurance processes, integrating the principles of patient-centred care in the standards underpinning quality assurance, and through strong links to other areas of regulatory activity, including standards, registration and fitness to practise.
• Relationships between regulators and professional bodies in this area depend greatly on the nature of the individual profession. For some they are the only profession-focused organisation involved in quality assurance. The HPC work with the greatest number of professional bodies and told us they work to ensure that they coordinate quality assurance activities wherever possible.

This final report complements the interim report. Here we briefly describe the wider context of quality assurance of undergraduate education, before considering whether there is scope to change current approaches by regulators and identifying good practice.

We would like to acknowledge the help, advice and time given by colleagues across a range of organisations in completing this work. We have benefitted tremendously from the useful and wide-ranging discussions.