Resetting regulation – sparking the debate

Earlier this month, we held our 2020 Symposium virtually across three days for the first time. Our theme was Regulation Reset – prompted by the NHS Confederation’s campaign, NHS Reset, which seeks to reshape the way in which health and care services are delivered for the better while learning from experience in dealing with the Covid-19 pandemic. The NHS Confederation suggests that regulation also needs to adapt – and indeed all regulators have had to make fundamental changes.

Another significant issue this year has been the global reaction to the tragic killing of George Floyd and the spotlight now being shone on BAME inequalities. As evidence has shown, these inequalities are also pertinent in the context of the Covid-19 pandemic. We thought it was necessary to invoke a discussion between us all at the Symposium, to consider regulation’s role in promoting equality, diversity and inclusion (EDI).

Day 1 of Regulation Reset focused on regulating and supporting the current workforce, to consider what we have learnt from Covid-19 about regulating effectively, and whether there have been changes made that we would want to keep or lose. Speakers asked regulators to consider what role they can play, working with employers, to address workforce issues; for example, through using the data the regulators hold. They outlined some of the key changes that regulators had made in response to the pandemic and identified those which they would like to keep and those they would like to lose. The need for a common understanding of context was emphasised, as was the need for future judgements on fitness to practise to balance public protection with context and compassion. The need to reflect on how the pandemic and burnout has affected professionals, and to capture context going forward, was expressed. The session also considered the patient experience during the pandemic, as colleagues discussed the importance of co-production and patient voice to the regulatory approach.

On Day 2 we had a three-country perspective on how regulation should evolve to support the future workforce, with viewpoints from England, Wales and Northern Ireland. The panel considered how healthcare regulation and training could be improved based on the experience of the pandemic, and that the first wave of Covid-19 has demonstrated the need for an agile, flexible legislative and regulatory framework to provide a responsive healthcare education and training system. Speakers also discussed the need for adequate support services that adapt to current working conditions, including a ‘digital first’ approach to regulation with bespoke services for registrants and employers. Plans for the regulation of additional roles, particularly in social care in Wales, were covered, as well as the part that regulation may play in improvement. The session also went into detail about patient advocacy, and how the risk of discrimination against vulnerable people is heightened when guidance on ethical decision-making is compromised during an emergency. Issues caused by short-term thinking and groupthink mentality can be combatted by focusing on influence, negotiation and collaborative working. Some further suggestions for improvement involved going beyond individualism to look at greater consistency across regulators in their approach to advocacy, using evidence to back up principles and demonstrate their impact.

We chose to base the third day of Regulation Reset around the question: ‘Is regulation too white?’ as the panel discussed equality, diversity and inclusion (EDI) issues in the context of healthcare regulation and beyond. The panel identified reasons why some research has shown that Black and Minority Ethnic (BAME) individuals are twice as likely to be referred to their regulator by employers than their white peers – including lack of support, poor training, and poor induction processes for overseas practitioners. They also discussed how these issues manifest in other institutions, as attendees were reminded of the Stephen Lawrence case, demonstrating how service users are let down by those whose role it is to protect them. Attendees agreed that uncomfortable truths must be accepted and listened to, pointing to the power of mentoring, including reverse mentoring between senior members and colleagues. Speakers also noted that regulators need to encourage a culture of open learning and discussion – the ability to share experiences, ask questions, and be frank in a supportive space. BAME networks can allow staff to share their own perspectives, which can then be used to more effectively inform policy. A hesitancy of white colleagues in speaking up about race was identified as a barrier, which needs to be overcome so that colleagues can be effective allies to support EDI issues. Speakers also posed the question of whether regulatory approaches are culturally competent. Perhaps, the content of standards is too white, and we must reconceptualise standards in a way that better reflects and serves the community. In order to ensure that this is meaningful, it involves considering the experiences of registrants and service users themselves.

This is clearly a topic with a continued importance for regulation, and therefore the conversation must continue. Plans are underway to hold a follow-up event next year to act as a benchmark for which we will look to see tangible changes and assess results.

Read our guest blog from one of the speakers at the symposium – Chris Kenny, Chief Executive  of MDDUS (Medical and Dental Defence Union of Scotland) who picks up on the theme of his symposium presentation outlining some of the key changes that regulators have made in response to the pandemic and identifying changes MDDUS would like to keep and those they would like the regulators to lose.