Sophie Lister speaks to Harry Cayton OBE, Chief Executive of the Council for Healthcare Regulatory Excellence (CHRE), about the advent of the Professional Standards Authority for Health and Social Care, the changes brought about by the Health and Social Care Act 2012 and the Law Commission’s recent consultation on the regulation of healthcare professionals in the UK and social care professionals in England.

CHRE will become known as the Professional Standards Authority by the end of this year.  In what ways will the Authority and its role differ from that of the CHRE?

The Authority will come into being in stages during the year. Our first new power, which is the oversight of appointments to the governing councils of the regulators, has already come into effect. We are currently working with the General Medical Council (GMC) overseeing the appointment of the new Chair, and in the autumn we will start with the appointment to the new Chair for the General Chiropractic Council. As that progresses, more and more Council Members and Chair appointments will come under our oversight.  So, this process is now coming together as the first part of our new responsibilities.  The appointments themselves will be made by the Privy Council not by us.

One of the big differences for us, in terms of our role, is the extension of our remit to social workers. For the first time, we are not just a healthcare organisation but are overseeing professionals across the health and social care system. 

This also includes the assured voluntary registers scheme, which will commence in November. That will extend our range quite significantly.  We have been talking to over 40 occupational groups, in the last year or so, in planning for that.  It is obviously not going to be 40 organisations at the beginning, but we expect there to be five organisations at least, in the pilot phase, which we will be working through in the autumn.

The legal change of name will be in November, but we will be starting to publish material using our new name over the next few months. We expect everything to be in place by the end of this financial year. 

So, all of the changes, and maintaining the day job, are keeping us very busy!

You recently provided the CHRE’s response to the Law Commission consultation on the regulation of healthcare professionals in the UK and social care professionals in England.  Please summarise the CHRE’s views.

In general we found the Law Commission's analysis very thorough and clear. They have consulted extremely effectively, and quite a lot of their proposals are very much to be welcomed. 

We did make an overall statement that we feel the Commission could have been more ambitious for the future.  To some extent, what they are proposing is a tidying up of the present, whereas this is probably the only piece of serious legislation we are going to get about professional regulation in the next decade. Therefore, we should really be thinking about what kind of regulatory framework we want for our health and care workforce for the next 20 years, rather than for now. 

We hope that in their final deliberations they will be a bit more forward-looking, particularly around the area of mobility between professions. Increasingly we are seeing the boundaries between healthcare professions flexing to some extent; new roles and tasks being taken on by professionals who did not do them previously, and I think we are going to need a greater adaptability for the workforce in the future. Regulation needs to adapt to that, so I think the framework that the Law Commission produces for us, long term, needs to be enabling of greater flexibility around regulation. I think they themselves have recognised that there are also issues of uncertainty around accountability and governance.  For instance, they have proposed that the regulators should have greater autonomy.  However, if they have greater autonomy, there is then the question about how we could strengthen their accountability, which remains slightly unclear. Of course, one of their proposals was that the Authority might take on a greater role in that area, but I think we can accept that is probably a controversial proposal; there will be some people who think giving the Authority more power is a bad thing. So we will have to see how that plays out, but certainly, we need to strengthen the accountability if we are going to give the regulators greater autonomy.

The consultation period for the CHRE’s consultation on the accreditation standards for voluntary registration has just ended. How did the process go?

The consultation has just closed; we had over 450 responses, which is fantastic. The headline figure at the moment is that around 80% of those are positive about standards and about the scheme. The general response is that the standards have been very much welcomed and we have had both a good response to the consultation but also a positive one. 

In setting up this new scheme, we have very much seen it as a co-creation activity with the organisations who might join it, so we have worked closely with them in preparing what we can and should do in trying to apply our principles of ‘right-touch’ to it. That is, being risk-based, proportionate and flexible in the way we regulate and the way we oversee the scheme. So far, we have had a very positive response from potential members, so we are looking forward to setting up the scheme over the next six months. 

Could voluntary registration ever be an alternative to a statutory regime?

We do not see voluntary registration as ‘statutory regulation light’. We think voluntary registration is different and consider it to be a form of consumer protection. With this in mind, we are working with groups of people in health and care occupations who want to improve their own practice, define education standards, standards of conduct and competence and who want to have a good complaints system. Of course this is never going to be statutory regulation because although you can remove a person from a voluntary register, this does not necessarily stop that person from working.  It is important that people do not think it is a cheap version of regulation; it is something different, it is professional development and it is consumer protection. 

Which professions are a priority, in terms of voluntary registration?

The groups that are strongly coming forward include counselling and psychotherapy, which will definitely be in the first pilots. We have also heard from public health practitioners who are not regulated at the moment, those involved in play therapy (people working with children) and interestingly, the medical illustrators. These are quite important people within the health care sciences group. The fifth group that we are likely to be working with early on are acupuncturists. In summary, we have a good spread across healthcare, health science, psychotherapy, public health and complementary practice in the first wave of potential members.

Where do you see professional discipline in ten years’ time?

This is an interesting question and links back to the Law Commission. Some of the changes that are going to take place are international in impact, as will be the consequences. For instance, we are seeing very significant mobility of health professionals around the world, of course significantly in Europe, but we have many doctors, nurses, dentists and others who come from beyond Europe as well. Therefore, there is going to be a need for greater international collaboration around regulation and the sharing of information about health professionals. 

There is going to be the issue of roles, with new roles being developed, like Physicians’ Assistants, and other people taking on tasks which they have not previously carried out.   With this in mind, I think we will see a need for much greater flexibility by regulators. 

I think all the regulators are looking at greater use of various forms of consensual disciplinary practice, whether it is people agreeing to leave the register or people agreeing to do required training and development, so avoiding the formality of full fitness to practise proceedings. If those things can be done in a way that is transparent and has the confidence of the public and registrants, that would be a good thing and would reduce the overall costs of regulation.

We are about to publish our report on cost effectiveness of the regulators and there is some significant information in there about the additional costs to employers, the universities and to registrants of regulation. It is not just the direct cost of regulation, there are significant indirect costs. Regulation is an expensive activity which must justify itself in terms of its protection of the public.