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Health regulation system needs radical overhaul, claim

UK’s regulation system is ‘cumbersome, ineffective and expensive’

Adrian O'Dowd

Thursday, 06 August 2015

The whole system for regulating health and social care in the UK needs to be radically rethought, according to the Professional Standards Authority (PSA), the body that oversees all health regulators.

The PSA has today published its Rethinking regulation report in which it argues that the regulatory framework for health and social care is out of date, over-complicated and too expensive.

Without reform, said the PSA, health and care systems in the UK would not be able to face up to future challenges including an ageing population, long-term conditions, co-morbidity, the rising cost of health technologies and a global shortage of health and care workers.

The report explains that nine organisations regulate health professionals in the UK and social workers in England, including the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC).

Much was wrong with how the system currently operated, it claims.

“In England, all three consecutive regulators, the CHI [Commission for Health Improvement], Healthcare Commission and Care Quality Commission (CQC) were each established quickly, with little time for preparation,” says the report.

“As independent evaluations of the work of these bodies have shown, they have had a positive impact whether by causing organisations to get on with fixing problems already known to them or sometimes shedding light on poor practice.

“However, a regulator’s role is to minimise harm and to seek to do so by changing individual or organisational behaviour. It is not at all clear whether system regulators have improved the quality of care in a significant, sustained way, or if the benefit of this approach outweighs the very considerable costs.”

The authors said regulation costs kept rising, as they added: “It is reasonable to assume that the current total annual operating costs of regulation are in the region of £600 million.”

The report praises some of the efforts of regulators, saying: “Amongst the professional regulators the GMC and the NMC in particular have made some real advances in sharing intelligence with the CQC. As the National Audit Office states the CQC has made real progress with using intelligence to identify risk.”

It makes several recommendations, such as having:

  • shared objectives for system and professional regulators
  • transparent benchmarking to set standards
  • a rebuilding of trust between professionals, the public and regulators
  • a reduced scope of regulation so it focuses on what works
  • a proper risk assessment model

The authors conclude: “It is time for a more nuanced, more sophisticated use of professional and system regulation working in concert to ensure that professionals are personally able to provide good care and are supported to do so within their workplace.”

Harry Cayton, PSA chief executive, said: “Piecemeal adjustments to health and care regulation have, over time, made the system cumbersome, ineffective and expensive. Every part of our health and care system is changing in order to meet future needs. If patients are to benefit, regulation must undergo radical change too.

“Regulation is asked to do too much - and to do things it should not do. We need to understand that we cannot regulate risk out of healthcare and to use regulation only where we have evidence that it actually works.”

Responding to the report, NMC Chief Executive and Registrar Jackie Smith said: “We have been pressing both the previous and current governments for a bill that would modernise how we regulate the 683,000 nurses and midwives on our register. We welcome any contribution that furthers this debate. It is widely accepted that our current legal framework is clumsy and outdated and does not serve the professions we regulate, or the public well.

“Our 2015-2020 strategy sets out our aim to be a dynamic regulator working as part of a wider system of regulation focusing more on prevention than responding to concerns. The public expect all regulators to deliver public protection efficiently, effectively and fairly. We have made significant improvements to how we do that, and the results are evident but there is more to do. We can only do that with new legislation.”

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