The Professional Standards Authority for Health and Social Care (PSA) has declared that regulation requires a “radical overhaul” in order to meet proposed changes to health and care services in the UK. In a report entitled Rethinking Regulation, published on 6 August 2015, the PSA sets out its proposal to “reshape” how regulation works.
The current position
As set out in the report, the aim of the PSA is to promote the health, safety and wellbeing of patients, service users and the public by raising standards of regulation and registration of people working in health and care. The report argues that the current system of regulation is working to improve the problems of the past rather than adapting to the needs and challenges of the future. The PSA workload has grown vastly in the last ten years: it reviewed 590 decisions in 2004-2005 and 4,043 in 2014-2015. This is a marked increase and reflects the large volume of fitness to practise investigations carried out by individual regulatory bodies’ year on year.
Improvements and recommendations to date
Whilst noting the valiant efforts of those involved in regulation and the considerable improvements in recent years, the report explains how regulation has evolved in a piecemeal manner since its inception which has led to “a vastly complicated and incoherent” system spanning nine separate regulators. Indeed, the Law Commission described the legal framework for regulation in the UK as “fragmented, inconsistent and poorly understood” (see our blog post for a detailed outline of the Law Commission’s draft bill ‘Legal Update: Regulation of Health and Social Care Professions Etc.’). The PSA report describes the Law Commission’s draft bill as a “serious effort” to simplify the legislative framework underpinning regulation as we know it and acknowledges that the remit of the Law Commission was limited to specific terms of reference which meant a radical overhaul was not considered.
The PSA report highlights what it describes as the “massive challenges” facing the healthcare system in the future with a growing aging population, long-term health conditions, comorbidities, the rising cost of health technologies and a global shortage of health and care workers.
The PSA argues that regulation today needs a radical approach to meet economic realities, workforce demands and changes to health and care delivery. Simplification of the current framework, it suggests, will not be sufficient to meet the demands of the future.
The PSA proposes a restructuring of the entire system of regulation in the UK arguing that “Regulation is asked to do too much, to do things it should not do, things it cannot do and things that don’t need doing”. This will, it argues, require a rethinking of what regulation should be aiming to achieve and ensuring that it is effective in achieving those objectives.
The PSA propose a number of essential principles for the development of a new and improved system of regulation:
- A shared ‘theory of regulation’ based on right-touch thinking
- Shared objectives for system and professional regulators, and greater clarity on respective roles and duties
- Transparent benchmarking to set standards
- A rebuilding of trust between professionals, the public and regulator
- A reduced scope of regulation so it focuses on what works (evidence based regulation)
- A proper risk assessment model for who and what should be regulated put into practice through a continuum of assurance
- To break down boundaries between statutory professions and accredited occupations
- To make it easier to create new roles and occupations within a continuum of assurance
- A drive for efficiency and reduced cost which may lead to mergers and deregulation
- To place real responsibility where it lies with the people who manage and deliver care.
The report provides academic discussion on the need to rethink regulation. Those involved in this area will no doubt await further developments with anticipation. The task of reforming the regulation of nine separate regulatory bodies each with different legislation, standards and systems will be enormous. If the theory and proposals outlined in the PSA’s report are to be implemented it will indeed result in a radical overhaul of the current system of regulation.