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'Incoherent' health and social care regulation needs 'radical overhaul'

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Healthcare regulation in the UK  is ‘incoherent’, ‘expensive’ and requires a ‘radical overhaul’ according to a review by the body which oversees the work of organisations such as the General Medical Council.


The Professional Standards Authority, which presides over the nine professional healthcare regulators, also said there is “little evidence” as to how effective regulation is in improving health and social care standards.

Man with clipbaord making notes

The PSA said there was a lack of understanding among regulators about the influence their work has on staff

The review said changes in the way the healthcare system will work in the future – such as the shift of focus from acute to community as proposed in the Five Year Forward View – also required reform of regulation.

“We need to… understand better what regulation can and can’t do to control the risk of harms, to deregulate in some areas and focus regulation more effectively in others. We need to remove barriers between professions and create new roles,” the report said.

The PSA said there are a number of problems with the system in its current form.

It said the sheer number of regulators – more than 20, including nine professional bodies and system regulators such as the Care Quality Commission – was slowing the pace of change in the sector.

The PSA also pointed to a lack of understanding among regulators about what influence their work has on healthcare workers’ behaviour.

The review said: “Despite the fact that fitness to practise allegations are made against a small percentage of the total number of registrants, the continuing instances of harm to patients and the public resulting from unprofessional conduct is of great concern.”

It called for a better understanding by regulators of the different risks involved in each of the healthcare professions and for adjustments to be made to regulation accordingly.

The PSA also pointed to the “demoralising impact” on the healthcare worker of the onerous process involved in some regulation.

Preventative action – by regulators using their influence and interventions to reduce noncompliance with standards – should be a key focus for the future, it also said.

The report noted “with concern” the contradictory public messages about “blame” in relation to the practice of healthcare professionals.

“The recently published [government] response to the Freedom to Speak Up Review is called Learning Not Blaming, but at the same time the government has passed legislation to criminalise ‘avoidable harm’,” it said.

The report said regulators had a role to play in creating a more open culture and through redesigning the system they should  encourage professionals to drive improvement.

“We must seek to understand what motivates individuals, teams and organisations to succeed, not attempt to frighten them to resentful compliance,” it added.

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