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Regulatory reform: the opportunities

26 Feb 2020

John Barwick

Chief Executive

I think it would be fair to say that many of the health and care regulatory processes are outdated, with different legislation and rules ranging from the ‘medieval’ to early 20th century through to the more modern and flexible legislation under which Social Work England is now operating.  Reform is needed, and all the regulators are working with the Department of Health & Social Care to make this a reality. In this blog, I explore the opportunities it will bring.


Implementing the right change

The need for legislative reform has long been mooted. It is therefore really encouraging that, following the Government’s response to the Promoting professionalism, reforming regulation consultation last year, the need for urgent reform has been recognised.

A pragmatic approach is being adopted, advancing legislative changes to those areas that will realise the greatest benefits for the regulators, registrants and the public.

Fitness to Practise has been rightly identified as a priority. In my blog, Opportunities for streamlining fitness to practise, you can read the areas I highlight as requiring attention which will make a significant difference. We want to create a process which supports professionals to address concerns about their practice and help create an environment of openness where there can be honest discussion when things go wrong.   

Changing the focus

When looking at proposals for reform I am often asked - is this really the best approach to public protection? Which seems logical as that is our purpose, but I wonder if, actually, that is the right question? Our aim must be to shift the focus from managing when things go wrong, to preventing harm in the first place.

Perhaps the most important part of the proposed changes to fitness to practise is the ability to free more resources from reactive regulation to focus more on ‘upstream’ regulation, preventing harm before it takes place.

Perhaps the question would be better phrased - Is this really the best way to support professionalism?

A more proactive approach to prevention

Each year we invest in a programme of engagement with our registrants and their employers and a significant focus in recent years has been given to strengthening the Standards of conduct performance and ethics to include reporting concerns and being open when things go wrong, and understanding of what this means. We have also invested in research to provide insights we can use to develop guidance and information for registrants and employers, for example how and when to refer a fitness to practise concern. We have blogged, emailed and remastered our events programme to more effectively share these messages, and developed our employer hub and enews.

Looking to a time when we can invest more, we have also scoped the development of a professional liaison team to support registrants and employers in the workplace.

Can reform deliver enough change fast enough?

My answer is - not without collaboration.

More flexibility in our regulatory approach, does run the risk of a fractured and disparate regulatory framework. If, as regulators, we ever lose sight of the need to work together, and the purpose of regulation the findings and recommendations set out in the Paterson Inquiry should serve as a timely reminder.

The Rt Rev James Graham points to the scale of the regulatory system and the layer upon layer of regulation which did not come together effectively to keep patients safe. Sadly, this is the latest in a long line of Inquiries where patients and their families have been failed by the system.

For me, collaboration is the crucial, final part of this regulatory jigsaw puzzle. It is essential if we are to give patient safety the priority it deserves and ensure joined up regulation.

Working together

We have made a start. The Chief Executives’ of all the professional health and care regulators are embarking on a combined programme of work. This includes, for example, exploring whether our standards of behaviour are coherent. It will also look at how we can improve the quality of the data we hold, analysing the underlying issues, and then share that data more effectively.

We have already signed up to the Emerging Concerns protocol with  other health and social care regulators, to sharing information and intelligence about risks to patients and their families.   

However, the reports into Paterson, Gosport and Morecambe Bay serve to remind us all there is still much more to do.

Maintaining the momentum

We have been on the brink of regulatory reform before to which our bookshelves can no doubt testify. This time round it feels there is momentum behind the need for regulatory reform and the pragmatic approach that is being proposed by Government. This does not happen often.

Regulatory reform provides an opportunity to recast professional healthcare regulation to ensure regulators work together to support professionalism and prioritise openness and learning to improve public protection.

It is therefore incumbent on all of us to continue to work tirelessly to ensure that the opportunities promised by reform become a reality and benefit the people who we are there to protect.



Page updated on: 26/02/2020