Health and social care regulation: meeting the challenges

27 March 2014

Although not all of the nine health and social care regulators were represented at the Westminster Health Forum conference on 13 March 2014, amongst those that were, there was one thing that was preoccupying them, the imminent publication by the Law Commission of the Regulation of Health and Social Care Professions etc. Bill, now expected in early April 2014.

Understandably, there was a shared hope amongst the regulators and the Law Commission alike that the Bill will make this year’s Queen’s speech and not go off for pre-legislative scrutiny.  More remarkable perhaps was the view of some that the Bill represents a panacea for some of the most pressing issues currently faced by the regulators. Of those, the ever growing rise in complaints was seen as a particularly significant challenge faced by regulators, a challenge in the authors' view which will not be remedied by its terms.

A rise in complaints
The public, it was agreed, are growing more demanding about the standard of care to which they are entitled and are more willing to complain when that standard is not met. The most striking trend faced by most if not all of the regulators is the year on year increase in the number of complaints.  The NMC expects to receive around 5000 complaints this year, compared to 1500 in 2008/2009, and the GDC has seen an increase of 110% in 3 years. As Jackie Smith of the Nursing and Midwifery Council rightly observed, fitness to practise is expensive and with complaints on the rise, this will only become more so. There was no articulation of how the Bill would address this seemingly unabaiting trend.

The key: education
One solution to the spiralling cost of (fitness to practise) FtP proceedings is to take steps to reduce the number of complaints made in the first instance, not by silencing service users or disempowering them, but by driving up quality and improving safety. The key to this seems to be education.

The most obvious way in which safety and quality can be safeguarded is to ensure that, post-qualification, health and social care professionals consistently maintain and develop their professional education, whether demonstrated through appraisal, revalidation or some other means. It is commonplace for registrants in FtP proceedings to submit impressive portfolios of CPD undertaken in order to satisfy a panel that the conduct complained of has been remedied and will not be repeated. If standards are to be improved and FtP complaints are to be reduced correspondingly, it is crucial that CPD and education are undertaken on a continual and consistent basis by professionals, and not just after the event or in a tick-box fashion.

Regulators have a large part to play in driving up the quantity and quality of post qualification education by encouraging further or mandating this.

Localism not centralism
Part of the solution must also be, as identified by Evlynne Gilvarry of the General Dental Council, education of practitioners about how to respond appropriately to service user complaints so that local resolution may be achieved, avoiding recourse to centralised FtP proceedings brought by the regulator.

Complaints to the regulator should be a matter of last resort but all too often, partly because of the ease in which complaints can be made and partly due to unsatisfactory local complaint mechanisms, this is not the case: unsatisfactory local resolution means a greater number of centralised complaints. Service Users must be able to fully voice their concerns and achieve resolution of their complaint through the professional concerned.

Know your limits
At its core, the Bill seeks to unify the disparate FtP regimes of the various regulators and will encourage joint working. It is long overdue and keenly awaited by all who operate in this field. It will not however address many of the issues faced by regulators, in particular the growing public appetite for regulatory accountability of professionals.

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