Speed and transparency, accountability and lay involvement - this is the mantra for modernising the regulation of health professions. The 1999 Health Act gave the potential for change without primary legislation. Recent alterations to general medical council powers show just how speedy this can be. Both the professions allied to medicine and the nurses and midwives have now got their long-awaited consultation documents on reform.
What does all this add up to? A while ago it looked as if the game plan was to wait for the results this autumn of both the Bristol doctors inquiry and the inquiry into the Shipman case before giving real substance to reform. The successful bid of relatives for a public inquiry into the behaviour of Dr Shipman has put paid to that.
The institutions we have no longer reflect the values of a society that is more diverse and less deferential. No matter what regulatory bodies are doing and have done to modernise and adjust - with the spotlight relentlessly upon them, they are found wanting. We now have an impatient government with a very heavy quality agenda of its own and a raft of new institutions to match. We have regulators working in the glare of negative publicity, front-line professionals feeling under threat, and few outside with in depth knowledge of the issues. Can all this really result in a 21st century regulatory framework?
The one piece of new thinking on regulation in the NHS plan is the creation of a council of regulators. Seen in the right light, it has the potential to help create a modern framework of regulation for those in the health professions - or indeed for all those have a hands-on relationship with vulnerable people in health and social care.
There is precious little in the legislation that spells out the logic of maintaining a register or clarifies when and why such a regulatory regime should apply. The new council would do well to reflect on the historical sense that the idea of a publicly available register made in an era of autonomous, solo practice, and to consider how uneasily that notion has adapted across professions and over time. Getting today's multiple regulatory mechanisms to mesh, bringing some order into thinking about regulating people, places and programmes, are the priorities.
Maintaining a register means setting standards for entry to it, for remaining on it and for removal from it. Each of these aspects has its challenges. The government has now taken a very tough line on entry level education. Cut out academic drift; ensure fitness for purpose in the NHS, since it after all pays. But not every practitioner works for the NHS.
And professionals argue that they need a wider fitness for practice - the analytical and critical capacities that will enable them to rise to the task of service redesign that is at the heart of the NHS plan. I worry that weakened regulatory bodies are not at present in a position to challenge the government on this.
And then there is the matter of removal from the register. There is some seriously woolly thinking here. Appearance at a disciplinary hearing of a regulatory body is in danger of becoming a first rather than the last resort.
The workload of professional conduct at the GMC and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting has become untenable. Reducing the burden of proof and introducing informal mediation, to my mind, is the wrong way to go. Active management of professionals looks to be a better solution for the majority. Whether such matters could be separated sufficiently from those relating to competence so that a single, separate, lay panel could make judgements on these issues remains to be seen.
The new Council would do well to lend its weight early on to a programme of systematic research on matters of discipline and conduct.
Above all, however, the public wants simpler and clearer channels of redress. Sorting out relations with complaints procedures and with civil and criminal law are priorities.
What kind of a Council could carry out these tasks? Who is best placed to understand the concerns of professions and public, digest the experience of the different regulatory bodies, and not least, acknowledge the ambiguous role of government as guardian of the public interest but also as a provider of sometimes inadequate resources and facilities? A small group, where people without preconceived ideas work actively to secure the knowledge of participants and processes that they need, seems a better bet than going down the vexed route of interest representation.
The Council of Regulators, then, needs to look afresh at the 'what?' the 'how?' and the 'who?' of regulation. These are fundamental questions to do with the trust that we can put in professionals and the support we need to give them to do a good job. The public and the professions must have confidence in the new institutions we create. At present we are a long way from that.