In the short time since the spring general election, the new coalition government has announced significant changes to the health and social care regulatory sector.

These changes, which include the abolition or reform of several key regulatory bodies, were confirmed in the October Cabinet Office announcement on the reduction of the number of public bodies or quangos.

The report Liberating the NHS: Report of the Review of the Department of Health’s Arm’s-Length Bodies was published in July, following the white paper Equity and Excellence: Liberating the NHS.  The arm’s-length bodies are the national network of 18 Department of Health organisations which regulate the health system to improve standards of care and protect public welfare.

Against the background of the government’s commitment to reduce the administrative costs of the NHS by 45 per cent, this review focuses on ensuring that those bodies that are retained are fit-for-purpose and affordable by simplifying their structure, removing duplicate functions, and radically reducing the total number of NHS bodies. Those which are retained will be subject to tight governance and strict accountability requirements.

Key in the regulatory sector amongst the Report’s wide-ranging proposals is the abolition of the General Social Care Council. The GSCC introduced professional regulation for over 95,000 social workers in the UK. As an executive non-departmental public body, its position is anomalous as the only professional regulator accountable to the secretary of state for health. 

The Report finds no compelling reason to retain the GSCC and recommends that the regulation of social workers is put on the same footing as the health professions.  The GSCC will therefore be abolished by primary legislation, probably by April 2012.  Social workers’ regulation will move to the Health Professions Council, which currently regulates 185,000 registrants of 15 health-related professions including radiographers, psychologists and physiotherapists. The HPC will be renamed to reflect its new role, and regulation of social workers will become totally self-funding through registrants’ fees in common with all the healthcare professions. 

The Council for Healthcare Regulatory Excellence oversees the nine major health professions regulators in the UK, including the General Medical Council, the General Dental Council and the pharmacy regulators. CHRE’s functions are to be retained, but it will be removed from the ALB sector and become self-funding by means of a levy on the regulators it supervises.  It will also have an extended role in setting standards and assuring quality for voluntary registers.

The Office of the Health Professions Adjudicator was created by the Health & Social Care Act 2008 in the wake of a series of reviews of healthcare regulation, including the fifth Report of the Shipman Inquiry by Dame Janet Smith (now Lady Justice Smith).  Her report advocated that, if public protection and public confidence in healthcare regulation were to be secured, the function of adjudicating upon medical disciplinary cases should be separated from investigation and prosecution.  The GMC, in common with all the healthcare regulators, currently fulfils both roles with internal measures which aim to ensure independence in adjudication. 

OHPA was due to take over the GMC’s adjudication function in 2011, followed by that of the General Optical Council in 2012.  Other healthcare regulators were likely to follow later.  However, following the Report, the Government says it sees no compelling reason for OHPA and is not persuaded that the creation of another body is the most appropriate and proportionate way forward; steps to strengthen the adjudication process within the GMC can deliver substantially the same benefits and are the Government’s preferred option. 

OHPA’s future will now be reviewed following the consultation “Fitness to Practise Adjudication for Health Professionals: Assessing different mechanism for delivery”. Responses were due by 11 October. 

OHPA’s draft response suggests that the Government’s preferred option will necessitate similar mechanisms to strengthen independence of adjudication separately within each of the healthcare regulators.  This will be slower, more complex, and ultimately more costly than proceeding with OHPA.  Most importantly, it will not secure the confidence of the public in the effectiveness of healthcare regulation.

Another critical development, though not part of the ALBs review, is the announcement made in June by the secretary of state for education regarding his intention to introduce primary legislation to the abolish the General Teaching Council for England. The GTCE was created as the first regulator of the 580,000-strong teaching profession in England. There are no details yet as to how teachers will be regulated once it is dismantled.  

In the meantime, the GTCE must continue to perform its statutory functions, including those relating to professional regulation, until its abolition, which is likely to be in July 2011.

The combined effect of these proposals on the regulatory sector is substantial.  There is a question mark over the future of the regulation of two major professions, social work and teaching, as the detailed proposals for change and how it will be implemented are yet to be forthcoming.  There will be mixed opinions about the OHPA proposal, but some may take the view that the removal of the adjudication function to an entirely distinct body represented a key plank in the long-term programme of reform of healthcare regulation and may question whether alternative proposals for internal separation go far enough to re-establish public confidence in the system.