Nursing and Midwifery Council legislation – amendments to modernise midwifery regulation and improve the effectiveness and efficiency of fitness to practise processes.

Fitness to Practise

This chapter sets out the Professional Standards Authority’s vision for a new approach to fitness to practise for professional regulation in the UK, building on the arguments for reform in Rethinking regulation, and on the outline proposals we set out in Regulation rethought.

In doing so, it examines the purpose and role of fitness to practise, and considers some of the key challenges and opportunities for reform presented by existing models in our sector.

Fitness to practise frameworks are complex and vary from one regulator to the next. We know that most regulators are struggling with increasing caseloads, and as we explained in the two aforementioned publications, the current framework is expensive and overly adversarial.

Reform

There is an appetite for reform in the sector of professional regulation in health and care. The Department of Health, on behalf of the four UK Governments, published the consultation document Promoting professionalism, reforming regulation on 31 October 2017. The consultation is an opportunity for all those with an interest in the way that health professionals are regulated to play their part in influencing the future direction of policy. However, as uncertainty remains as to whether this will result in large-scale legislative reform, it is important to consider what improvements can be made through more incremental changes, with or without the need for piecemeal amendments to existing legislation. There is room for improvement within the current frameworks. In particular there are two areas where more work is needed to deal with rising caseloads safely, and to ensure proportionality:

• Threshold criteria and processes at the early stages: these relate to the decisions to close or progress complaints that are made at any point up to, but excluding, the investigating committee or case examiner decision.
• Consensual disposal (undertakings): increasingly, cases that meet the threshold for onward referral at the end of an investigation can be disposed of consensually through undertakings.

We put forward this chapter in the hope that it might stimulate debate and discussion, and help to bring about a consensus on the future of fitness to practise.