A statutory regulatory regime for registering and authenticating physiologists could avoid serious threats to patient safety, says Amanda Casey

Amanda Casey

Amanda Casey

Amanda Casey

What would your reaction be if you were admitted to hospital, had an operation, then learned the surgeon responsible wasn’t qualified for the job? Chances are you’d be horrified, outraged, dumbstruck such a thing could happen, and expect such a travesty to be front page national news.

At the end of May, a man was imprisoned for lying about his clinical qualifications. Terrifyingly, at the time he was the deputy head of the Cardiac Physiology Department at the Heart of England Foundation Trust in Birmingham. He was responsible for staff and for the undertaking of crucial investigations on patients as part of their diagnosis and treatment.

Regulation in this instance is about guaranteeing patient safety

And you’ve probably never heard of this incident before.

If this individual had been a doctor, he would have been regulated by the General Medical Council and – while not absolutely certain – it’s reasonable to assume his omissions would have been picked up earlier. If he’d been a dietician or physiotherapist, he would have been regulated by the Health & Care Professions Council (HCPC), with the same likely result.

But by virtue of being a clinical physiologist, this person was not regulated, despite performing investigations on patients with the potential to cause significant harm if not performed to the highest professional standards.

This shocking example highlights a major flaw in professional scrutiny within the NHS. The Registration Council for Clinical Physiologists (RCCP) exists for practitioners in cardiac physiology and other disciplines. Many NHS employers prefer clinical physiologists that are registrants of the RCCP.

Critics might claim regulation is a costly waste of time and does nothing more than make practitioners more valuable by adding a line to their CVs. Such arguments are simply nonsense.

But ultimately it’s a voluntary register, so practitioners cannot be compelled to sign up. And even if they do, a voluntary register doesn’t have the authority to discipline, sanction and ultimately strike off practitioners if they commit malpractice.

The fact that this man did not have the qualifications he claimed wasn’t picked up because of the lack of regulatory oversight. It would be a mistake to think that, had this individual been an RCCP registrant, his falsehoods would have come to light sooner.

Voluntary registers are not only hamstrung by a lack of authority, they are also hamstrung by a lack of resources, and it would have been a struggle to identify this issue.

But there is a bigger problem. A senior health practitioner overstating or falsifying their CV is bad enough, particularly when these untruths land them in positions of authority. But what if a mistake by an unregulated practitioner led to the injury or death of a patient?

In the absence of an effective and statutory regulatory regime, it would be nigh on impossible to prevent that practitioner finding work elsewhere in the health service, either as a permanent member of staff or as a locum, given there’s no requirement to disclose previous incidents to a new employer.

Necessity

These are scary scenarios, but ones that could be easily addressed and eliminated. The RCCP is a voluntary register for most clinical physiologists in the country.

This ensures a level of accreditation and high standards, without the ability to sanction incompetent practitioners. This could be solved by bringing clinical physiologists under the umbrella of the HCPC.

This idea has been recommended to the health secretary on two occasions in recent years. Both times this recommendation, which came from the HCPC itself, has been ignored. Instead the government has for the past six years consistently endorsed voluntary registration rather than statutory regulation when it comes to unregulated health practitioners.

Many NHS employers prefer clinical physiologists that are registrants of the RCCP.

Granted, not everyone needs to be regulated. But most people would like to think there is a comprehensive and compulsory regime in place in order to scrutinise the efforts of practitioners responsible for checking pacemakers, and conducting vital investigations such as ECGs, EKGs, and sensitive procedures that might include ultrasounds for victims of sexual abuse.

This is a necessity. Critics might claim regulation is a costly waste of time and does nothing more than make practitioners more valuable by adding a line to their CVs. Such arguments are simply nonsense.

Regulation in this instance is about guaranteeing patient safety. And using the HCPC for this purpose would minimise any potential costs.

We should be outraged that the conditions existed for an individual to mislead the NHS about their qualifications and assume a position with responsibility for patient safety. This cannot, however, be laid at the feet of the NHS trust, which could only operate with the information available to it.

Voluntary registers are not only hamstrung by a lack of authority, they are also hamstrung by a lack of resources.

But we’ve had this and many other warnings. It’s now past time for ministers to accept that, in the case of clinical physiologists, voluntary registration is not sufficient. We need a similar regime to doctors, nurses, dieticians, physiotherapists and others.

The structures are in place to achieve this transition efficiently and at low cost. And, most importantly, it will improve the safety of patients.

Amanda Casey is chair of the Registration Council for Clinical Physiologists