Government accused of 'contradictory' health regulation policies

The Professional Standards Authority says action is needed to reform regulation to bring it up to date and “protect the public effectively”.

The PSA is responsible for overseeing nine regulators including the Nursing and Midwifery Council, the General Medical Council, and the Health and Care Professions Council.

In the past year, the PSA reviewed 4,285 fitness to practise cases by regulators but referred only 13 of these to the High Court.

Harry Cayton, chief executive of the authority, said: “Professional regulation is at a critical juncture. It needs to modernise to be able to protect the public today and in the future, and to do so we need new law.”

In its annual report to Parliament, the PSA said: “The UK is operating an outdated professional regulatory framework that requires reform to protect the public effectively and to enable it to respond to changing workforce needs. Three things drive the need for change.

“First, as the Law Commission recommended, change is needed to remove restrictive and disjointed legislation which gets in the way of public protection. Second, it is out of step with the needs of a contemporary health and care system, which requires flexibility to accommodate innovation. Third, our understanding of the reasons for misconduct and incompetence has advanced so that a system predicated upon finding and removing individual ‘bad apples’ is inadequate to protect the public.”

David Cameron had promised reform of professional regulation after the Mid Staffordshire scandal and health secretary Jeremy Hunt has said he supports changes to the law. However, so far no action has been taken.

The PSA highlighted individual regulators were doing what they could within existing rules – such as allowing professionals to agree to sanctions without the need for case to go to a full hearing.

But the PSA said: “Government policy needs to be coordinated and consistent if the regulatory system is to operate with certainty. We have noted a number of policy decisions and actions that we think are contradictory.

“For example, a general intention to deregulate on the one hand and the recreation of a separate social worker regulator [on the other], removing social work regulation from the Health and Care Professions Council a mere five years after disbanding the former General Social Care Council.

“Similarly, the decision to regulate nursing associates with its attendant costs, taken in the absence of a proper role definition, assessment of the risks and the extent of assurance needed to manage them. We are perplexed by the emphasis on transparency and the imposition of a duty of candour, set against the creation of confidential enquiries by the new Healthcare Safety Investigation Branch.”

It also highlighted a concern that the GMC had been granted its own right of appeal against decisions by the medical practitioners’ tribunal, which hears fitness to practise cases against doctors, mirroring the PSA’s own powers of appeal. It warned: “As we predicted, this is adding complexity and increasing costs without obviously improving public protection.”

PSA chair George Jenkins added: “We continue to be hopeful about what everyone now agrees is the necessary reform of professional regulation to meet the needs of a modern health and care workforce. We are also frustrated by the slow progress the government is making. Plans for a formal consultation on reform, based to a significant extent on our policy work, have been postponed and parliamentary time for the necessary legislation will be in short supply given the demands of leaving the EU.

“In fact, the impact on the health and care work force of ending free movement of labour is likely to be considerable which makes regulatory reform to create flexibility even more necessary.”

The Department of Health was approached for comment.