Public protection at the heart of reform

With legislative reform underway, what are the next steps for professional healthcare regulation? 

This was the theme of the recent Westminster Health Forum Policy Conference, chaired by Lord Hunt of Kings Health (representing the All-Party Parliamentary Health Group), at which I spoke about the need to put public protection at the heart of regulatory reform.

In my presentation I focused on:

• the necessity of reform;
• the need to get the legislation right; and
• our commitment to support implementation of the reforms.

I also discussed how we can promote safer care for all by using reform and by refocusing regulation.

Why do we need reform?

So, why do we need reform? Some might say to improve the efficiency of regulation; to provide up-to-date and more flexible legislation; to have simpler, more coherent and more consistent regulation; or to introduce more proportionate, less adversarial fitness to practise processes. All laudable aims, but secondary to the importance of improving public protection. We need reform to keep us safer – the efficiency, flexibility and proportionality of the processes are important, but not if any of them come at the expense of protecting the public.

For this reason, it is vital we get the legislation right. Along with the obvious desire for the legislation to be fit for purpose, we know that it is the intention of the government to use the forthcoming legislation – which will regulate a few thousand physician and anaesthesia associates – as the blueprint for reform of most of the other regulators. These regulators oversee more than 1.5 million professionals working in health and social care. If it turns out that the legislation isn’t as good as it needs to be to improve public protection, then we must improve it before it is rolled out across the sector.

Reform will replace prescriptive legislation with enabling legislation. We are essentially saying to the regulators, “Here are the powers; it is up to you how to use them”. This additional flexibility brings with it a need for greater accountability and implies that guidance on using the powers will be beneficial.

What is the PSA's position on reform?

The PSA’s position on reform is simple and has not changed: we welcome reform; we will work with others to design legislation that enhances public protection; and we will do everything within our remit, powers and capacity to ensure that reformed regulation is as effective as possible in protecting the public. On this point, we will soon be consulting on our initial guidance documents that will support the implementation of reform.

Driving reform, getting the legislation right, and supporting the implementation of reform will all lead to better regulation. Better regulation can make an even greater contribution to safer care for all. It can help to support effective workforce strategies, respond to new risks, and tackle inequalities – all in the interests of public protection.

This is all good stuff. It is ambitious and forward-looking. The future is bright. But here is the elephant in the room: we don’t yet have large scale reform. The process is slow and clunky, there has been little contribution from the patient voice, the legislation may well need more work before a widescale rollout, and there is a risk that it could all grind to a halt. We can’t let that happen.

If we can keep the momentum going, get the legislation right and support the reforms, then we may just get there one day. But what about the problems we face today, or next week, or next year? Reform is not going to provide the answers to these challenges.

Refocusing regulation

Regulation needs refocusing now to keep us safer. This does not require reform. We need to focus on violations and recklessness, and much less on errors and mistakes. We need to focus on positive and preventative regulation – for example, initial training, continuing fitness to practise, and information, advice and guidance to support professionals to meet high standards of competence and conduct. And we need to focus on a kinder, more compassionate model of regulation.

This does not mean compromising standards, just ensuring that regulation is not excessively draconian in its methods or sanctions. This will reduce fear, promote a just culture, support retention of professionals, and, to quote the Patient Safety Commissioner for England, encourage more “speaking up, listening up and following up”.

Refocused regulation matters – it is better, fairer, more cost-effective and keeps us safer. Refocused regulation is about doing a good job today and an even better job tomorrow. Then, when we get reform, we can use it as an opportunity for a step change in public protection and safer care for all.

Find out more

• Read through our statement in response to the draft legislation laid before the UK and Scottish Parliaments on Wednesday, 13 December 2023 which will give the General Medical Council the statutory powers it needs to regulate the Anaesthesia Associate and Physician Associate professions in the UK.
• Or find out more about reforming regulation here.