CHRE Viewpoint #3

CHRE Viewpoint #3

This article is the third in our fortnightly series ‘CHRE Viewpoint’, which discusses topical issues in relation to health professional regulation.

Evaluate before you regulate

When problems emerge in society, there is often a strong temptation to blame a lack of regulation and call for more. This is true of healthcare and in other areas of public life.

We have challenged this reaction with our concept of right-touch regulation, and it was also questioned in a report published last week by the Regulatory Policy Committee. They recommended that we should not assume that regulation is the answer to problems and that other possibilities should be thoroughly investigated first.

Their report is a timely reminder in the light of a recent paper on the issue of regulating healthcare support workers from King’s College London. Here researchers investigated issues associated with the ‘unregulated’ status of healthcare support workers.

This distinct group in the healthcare workforce provides essential and valuable services in the care and treatment of patients and the public in a variety of settings. At present healthcare support workers are not regulated as individuals by a statutory regulatory body, the organisations they work in are usually subject to external regulation, scrutiny and oversight.

The researchers identified four ‘problems’ with this ‘unregulated’ group that they said indicated a strong case for regulation:

• They may have been dismissed for misconduct in a previous role but then employed elsewhere
• They may undertake tasks that they are not trained for
• They may work unsupervised when they should be under the direction of a registered practitioner
• They may be deployed subject to staffing levels and trust policies rather than their training and competence.

And yet, they also stated that ‘it has proved not possible to demonstrate unequivocally that an unregulated healthcare support workforce presents a risk to public safety and that this risk would be prevented by regulation.’ If this is so, how can we reasonably expect that extending statutory regulation to this group would be the most successful way of tackling these four problems?

Before costly decisions are taken to regulate new groups we must look at whether existing systems could be made to work better. We need to know why employers cannot check a job applicant’s past or provide training for their workforce, why registered professionals cannot supervise tasks they have delegated to colleagues, and why service providers cannot be trusted to deploy their workforce in a way that delivers high-quality healthcare.

In short, we need to know why existing approaches are not working. At a time when we need to be extra resourceful and identifying ways of getting better value from existing systems, the Regulatory Policy Committee’s report reminds us that more regulation is not the only way to manage problems.

Kate Webb, Senior Policy Analyst
12 August 2010