The Regulator: Voluntary regulation in healthcare

SPRING 2012

Maggy Wallace describes the setting up of the Complementary and Natural Healthcare Council (CNHC) as a voluntary regulatory body for complementary healthcare. She looks at the background and processes associated with the establishment of such a body and offers a brief comparison of voluntary and statutory regulation.

Personal comment

It is a privilege given to very few to be asked to establish a brand new
organisation. The challenges and achievements of the past four years have
been satisfying and frustrating in almost equal measure but if asked to do this again, I would without question.

What is complementary healthcare?

It is difficult to comment on the different types of regulatory body per se without
giving some consideration to the specific aspects associated with the regulation of complementary healthcare. For example:

How do you define it?

In the absence of any agreed formal definitions of terminology across the sector, CNHC uses the following approach:

‘Complementary’ healthcare is that which sits alongside what is variously known as conventional medicine, allopathy, or the NHS. ‘Alternative’ is something which is used ‘instead of _ _’ and raises far more difficult questions about the health practitioner/client/disease paradigm. However, the phrase CAM (Complementary and Alternative Medicine) is frequently still used by many as a convenient shorthand.

Who uses it?

It is difficult to tell, as it is a poorly described and very fluid sector, but anecdotally it appears that numbers are increasing significantly.

Who are the practitioners?

Again, it is very hard to tell. Standards vary hugely, from those who have
completed degree level programmes to weekend courses. Accurate statistics
are still hard to come by, despite our best efforts.

Does everyone believe in it?

This is certainly not the case. Much of our work is given to dealing with the so-called detractors who think all complementary healthcare is ‘quackery’.

Background to complementary healthcare regulation

The House of Lords’ Select Committee on Science and Technology Report on Complementary and Alternative Medicine 2000’01

In November 2000, following a 15 month enquiry, the House of Lords’ Select Committee on Science and Technology produced a report on complementary and alternative medicine.

The Committee’s main recommendation in relation to regulation was “that the
public interest will best be served by improved regulatory structures of many
CAM professions”.02 This was the main driver for the following activity over
the next ten years. The current position remains variable and, interestingly, does not match the recommendations of the House of Lords’ Select Committee Report in many ways.

The Prince’s Foundation for Integrated Health

Following the House of Lords’ Select Committee report, the Prince’s Foundation for Integrated Health (PFIH) worked with 15 disciplines (mainly from Group 2 of the Report)03 to start the process of standard setting. A final report was produced in 2008 which provided the impetus for the establishment of the independent voluntary regulatory body for complementary healthcare which became known as the CNHC.04

Establishment of CNHC

Meeting for the first time in January 2008, the CNHC Board had a busy year.
The organisation was designed very much on the lines of a statutory regulator
for two main reasons. Firstly, it was important to achieve maximum credibility
within the healthcare sector and more widely. Secondly, it was also the model
with which we were familiar and we were therefore able to adopt the best elements whilst avoiding some of the problems of the existing bodies.

During 2008 we:

1.  Agreed on:

• CNHC’s values, mission and objectives;
• Professional standards such as entry requirements to the register;
• key policies and associated documentation, such as the Code of Conduct, Performance and Ethics05 and complaints (fitness to practise) processes06;

2. Established CNHC as a company limited by guarantee

3.  Appointed:

• A small staff;
• Professional support, for example Kingsley Napley;
• Committee members;

4.  Established a web site and a webbased register capable of managing the registration, maintenance and, if necessary, removal, of several thousand registrants;

5.  Undertook numerous speaking engagements and meetings to spread the word and get people signed up to the new concept of a voluntary regulator for the complementary healthcare sector.

Where are we now?

Four years on and we are well established: over 5,300 on the register across 13 different disciplines; clear and definitive standards in place for entry on to the register; explicit CPD standards for maintenance of registration; a complaints process which provides a route for removal. We can evidence our standards and can confirm that entry on the CNHC register means that the individual registrant meets those standards.

Within the wider arena CNHC has achieved significant success in terms of
CNHC registration being a requisite for employment, particularly in palliative
care, including the major London NHS Trusts. Several private healthcare insurers now also reimburse costs from care given by CNHC registrants.

Statutory v Voluntary regulation

Having worked for both statutory and voluntary regulators, I would identify the key differences as shown in Figure A.

The way forward

In a short article like this, it has only been possible to scratch the surface of the issues. Given that there is a clear political imperative for no more statutory regulation unless there is a significant public safety issue,07 I believe we will
see more voluntary approaches being tried. They do have many advantages.
However, the key issue is which system offers the best public protection? To have maximum effect, voluntary regulation needs clear and explicit employer and public support. Hopefully the proposed initiatives arising from the draft Health Bill (2011), regarding the expansion of role for the Council for Healthcare Regulatory Excellence (CHRE) into the Professional Standards Authority for Health and Social Care (PSA), will have the desired effect as its work on assured voluntary registers progresses. CNHC anticipate being one of the first assured registers.

Maggy Wallace MA BA DipN DipEd FHEA 

Chair of CNHC

Maggy Wallace has had wide and varied experience in clinical practice,
education and governance in the health service, in the statutory and voluntary regulation of professionals in the UK and internationally as a World Health Organisation expert on regulation.

FOOTNOTES

01 House of Lords’ Select Committee on Science and Technology,
“Complementary and Alternative medicine”, HMSO, London (2000) http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm

02 http://www.publications.parliament.uk/pa/ld200102/ldinfo/ldscpn02.htm

03 The House of Lords’ Select Committee on Science and Technology organised therapies into three groups within their report. The second group consisted of those therapies that often “complement conventional medicine and do not purport to embrace diagnostic skills.” The group consists of aromatherapy; the Alexander Technique; body work therapies, including massage; counselling, stress therapy; hypnotherapy; reflexology and probably shiatsu, meditation and healing.

04 PFIH “A Federal Approach to Professionally-Led Voluntary Regulation for Complementary Healthcare: A Plan for Action”, London PFIH (2008)

05 CNHC “Code of Conduct, Performance and Ethics for Registrants”, London CNHC (2008)

06 CNHC “Complaints Procedure”, London CNHC (2008); CNHC “Complaints Handling Process”, London CNHC (2008)

07 Enabling Excellence 2011