Excessive regulation is creating a bureaucratic jungle for the NHS workforce, writes Maisie Borrows
NHS workforce regulation was recently described as “as much an accident of history as a rigorous risk-based assessment”. In reality, this has meant the decision to regulate has not always been based on patient risk. Regulation creates a bureaucratic jungle of box-ticking and reporting. Regulation is also too restrictive. Unregulated professionals are not able to complete tasks they can do and this has led the NMC to recently call for increased regulation because of unregulated professionals using “nurse” in their job title.
A disjointed model of care
Expanding the 9 professional regulatory bodies is not the answer. This will not only be costly, but also entrench the siloed model of care, which is strikingly different to the spirit of the Five Year Forward View (FYFV). Reform research, published today argues, instead, the NHS should seek to deregulate. It should do this by adopting a coherent model of risk-based regulation. This will be more transparent and go a long way in reshaping a workforce fit for integrated care.
Integrated care means an NHS of generalists who are able to flex their skills to the needs of the patient. Currently, regulation is creating the opposite. Regulation forms a disjointed model of care in which patients are referred around the system to different regulated professionals. Overregulation restricts certain tasks to the remit of regulated professions, when they could more efficiently and safely be carried out by others.
the responsibilities of regulatory bodies have extended unnecessarily; regulation standards act like a performance management tool rather than a way to control risk.
For some professionals, the decision to regulate seems wholly unrelated to patient risk. For example, music therapists, who use music to help people with emotional or behavioural issues, are regulated, whilst art therapists, who use art for the same purpose, are not. Moreover, the responsibilities of regulatory bodies have extended unnecessarily; regulation standards act like a performance management tool rather than a way to control risk. The regulatory body of paramedics issues standards of proficiency that include the ability to communicate effectively with colleagues. Arguably, this should be the employer’s responsibility, not the regulators.
A risk-based approach
Deregulation is needed. This means low-risk tasks should be lifted out of professional regulation. In practice, a nurse would be regulated for the high-risk task of dispensing drugs, but not for working cooperatively with colleagues. Working cooperatively with colleagues should be included in performance management. The GMC has recognised the benefits of scaling back “intrusive” over-regulation and a risk-based approach. Indeed, they have created the UK Medical Education Database (UKMED), which maps data to professionals and highlights key risk areas. Other regulators should create databases akin to this, with the long-term aim of using this evidence to deregulate appropriate tasks.
If a risk-based approach to regulation is adopted, employers need to ensure staff are completing deregulated tasks to an appropriate standard. The Cavendish Review described appraisals “as not worth the paper they are written on”. Improved performance management needs to support a deregulatory approach and meaningful, outcomes-based appraisals should be universal.
The number of voluntary resignations from lack of opportunities in the NHS has increased by 68 per cent in the last five years. The Skills Pass would provide much needed progression opportunities
Appraisals should promote the use of a new training framework or Skills Pass. The Skills Pass would cover unregulated tasks including simple clinical tasks such as wound dressing and cannulation, caring for someone in their own home and digital skills. The number of voluntary resignations from lack of opportunities in the NHS has increased by 68 per cent in the last five years. The Skills Pass would provide much needed progression opportunities and, in the long-term, be a key enabler to a more flexible workforce.
Introducing more professional regulation into an already confusing and over-bureaucratic system will do little to deliver a workforce fit for the future. Rather, a radical reshaping of regulation is needed. A deregulatory approach based on risk should be introduced and supported by improved performance management. This will play a significant role in developing a workforce capable of integrated care.
Maisie Borrows, researcher, Reform