If we miss the opportunity to shake up outdated regulation we risk leaving the NHS workforce - and patients - dangerously exposed as pressure grows, warns Harry Cayton
Everywhere in healthcare we face a shortage of the right workers with the right skills. Recent reports suggest there are 80,000 vacancies in the NHS, that we are short of 30,000 nurses and that GPs are retiring faster than they are being trained.
The Health Foundation reports that applications from EU nurses to work in the UK have dropped 90 percent in a year. Of course, the reasons for the shortage are many; dissatisfaction with pay and working conditions, changes to training, the vote to leave the EU making international graduates feel unwelcome and the fall in the value of the pound making pay less attractive.
We are also not alone; there is a global shortage of healthcare workers, some 13 million according to WHO and, in a recent academic paper, predicted to rise to 15 million by 2030.
One of the solutions – and there will need to be many - is to develop new roles, to break down the boundaries between professions, to create healthcare workers who can complement and extend the capacity of doctors or pharmacists or nurses.
New roles like nursing associates and physician associates are being created, care assistants are being better trained and sometimes better paid; healthcare providers are identifying needs and filling gaps.
But will we stifle this workforce innovation and creativity before it grows by regulating it out of existence? Professional regulation creates boundaries and barriers, it defines and specifies, it focuses on individuals not teams and it is a tax on work, pushing up costs for worker and employer alike.
One of the solutions is to develop new roles, to break down the boundaries between professions, to create healthcare workers who can complement doctors
And yet the Department of Health is pressing ahead with regulating nursing associates before the role is even properly defined and is consulting on regulating several varieties of medical associate professions too. This expansion of regulation has, it seems, the support of the colleges and unions; after all new, unregulated and less expensive workers threaten the status quo.
Surprisingly, we do have an opportunity to stop the regulatory juggernaut from crushing innovation under its wheels. The government is also consulting on serious regulatory reform.
It has set out its ideas in Promoting Professionalism, reforming regulation. These ideas include common standards of conduct for all health professions, a reduction in the number of regulators, perhaps from nine to three, replacing adversarial disciplinary procedures with consent and restoration, using intelligence to prevent harm and an objective methodology for deciding what level of regulatory assurance is needed for different occupations.
Our model of occupation based regulatory councils was designed in the 19th century, implemented in the 20th century and is no longer fit for purpose in the 21st century. But the opportunity for regulatory reform comes rarely. We need to act now to develop professional regulation fit for future healthcare and a future workforce using future technologies.
Regulatory oversight can be seen as a distant, authoritative force to be ignored because often it is only when disciplinary action is taken that regulatory bodies come fully into view
Therefore, it’s absolutely crucial that patients and healthcare workers help shape the rules. Regulatory oversight can be seen as a distant, authoritative force to be ignored or feared because often it is only when disciplinary action is taken that regulatory bodies come fully into view. However, right touch regulation can be a flexible and useful way for practitioners to ensure they have a framework in which their skills and professionalism can flourish.
Of course, financial and workforce challenges are part of the stress of a healthcare system seeking to adapt to an ageing population, multiple long term conditions, the rising cost of health technologies and global shortage of health and care workers.
Regulators are seeking to understand the new ways in which the risk of harm to patients may evolve, through an overstretched and depleted workforce, through a lack of resources for training and development, through a loss of focus on monitoring and appraisal or indeed through new technologies and artificial intelligence. But innovation by regulators is itself hampered by their outdated legislation and cumbersome rules and procedures.
In the event of substantial reform of health regulation, the Professional Standards Authority would like to see formal adjudication only for cases where there was a dispute between regulator and registrant over material facts, the decision by the regulator to take action, or the outcome proposed by the regulator.
All other cases would be dealt with consensually, including cases where remediation was considered the most effective means of protecting the public. Investigations would take on a more inquiring role, focused on establishing the facts rather than building a case against the registrant.
The process would seek to be less adversarial, and elicit greater co-operation between all involved. The views of patients or service users would be sought as a matter of course and the impact of the professional’s action on them would be taken into account in the decision about the outcome.
Regulator reform is too important to be left only to regulatory nerds. We need the views of patients and service users, front line staff to contribute their ideas
Regulator reform is too important to be left only to regulatory nerds as I have become. The secretary of state himself called reform “boring but necessary”. That’s an invitation to ignore the consultation but I urge you not to.
We need the views of patients and service users, front line staff and middle managers, we need students and young people who will be working in healthcare in 25 years’ time to contribute their ideas. It’s not too late to get online and give the government your views. Otherwise change will not happen.
This consultation gives all of us an opportunity to shape a regulatory framework for 2050 and beyond for a very different kind of health workforce. The consultation period is open for a couple more weeks - I hope everyone who cares about healthcare will seize this chance to help create a regulatory framework fit for future health and care services run by a increasingly multiskilled, flexible and diverse workforce.