Regulation of Health care Professionals

1
Regulation of Health care Professionals

• Joy Wingfield, Professor of Pharmacy Law and
  Ethics
• University of Nottingham
• 26th September 2007

2
Overview

• Where we were
• Self-regulated learned professions
• What happened?
• Shipman mostly, but not helped by Bristol, Alder
  Hey, Ayling, Neale, Kerr and Haslam
• Where we are
• Titular self-regulation
• External control, lay predominance, consistency
  and rigour for public protection

3
The learned professions

• The law, the church, medicine
• Repository of education and power
• A vocation religious calling
• Superior technical and moral authority
• Paternalism and self regulation

4
Standards of Conduct

• Hippocratic Oath 500 BCE
• Codes for individual professions to self regulate
• Statutory underpinning to allow self regulation
• The Bolam standard is self referential
• European Convention on Human Rights
• Declaration of Tokyo 1975 re torture, etc
• International Code of Medical Ethics 1983
• Declaration of Helsinki (rev 1996) re research

5
What happened?

• Rise of objective standards of practice
• Clinical governance and accountability
• Value for public money
• Substitution of skills, blurred borders
• Demystification of professionals
• Errors, patient safety revelations
• Scandals concerning individual practitioners

6
What scandals?

• Bristol - high mortality rates in paediatric
  cardiac care
• Alder Hey cavalier approach to child post
  mortems and pathology samples
• Shipman - diversion of CDs to murder patients
• Kerr/Haslam and Ayling psychiatric care and
  patient abuse
• Neale botched obstetrics

7
Responses

• Regulate the operational practice clinical
  governance, patient power, National Patient
  Safety Agency, Healthcare Commission, Commission
  for Social Care Inspection .
• Regulate the regulators and so
• Regulate the individual professionals

8
Flurry of white papers and law

• Health Act 1999 section 60 Orders
• NHS Plan 2000, modernising regulation of health
  professionals consultation 2001
• Reform GMC,NMC and others
• Health Professions Order 2001 (and 2007)
• Health Professions Council
• NHS and Healthcare Professions Act 2002
• Council for Regulation of Healthcare
  Professionals, Excellence, CHRE

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Council for Healthcare Regulatory Excellence

• Protect the public from you.
• Promote best practice in professionally-led
  regulation (Fitness to practise FtP)
• Annual report to Parliament
• Promote consistency of regulation
• Develop principles of good regulation.
• Advise Ministers across the UK

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And

• Receives details of all fitness to practise cases
• Can refer a regulators final decision on a
  fitness to practise case to the High Court (but
  only if too lenient!)
• Order a regulator to change its rules for the
  protection of the public (this requires the
  permission of both Houses of Parliament).

11
Still not enough

• 2006 Donaldson report re medicine, Foster report
  re everyone else
• Strengthening regulation of health professionals
• 2007 response Shipman Fifth report and others
• handling of complaints, raising concerns about
  GPs, General Medical Council procedures and its
  proposal for revalidation of doctors
• Professionals boundaries and whistle blowing
• 2007 Trust assurance and safety regulation of
  healthcare professionals in the 21st century

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21st Century Regulation

• Governance of regulators
• Revalidation
• Investigation
• Education
• Information
• New roles and professions
• Implementation

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Key messages?

• At least parity of lay members, annual reports,
  appointments to regulator Council
• Separation of investigation from adjudication
• Revalidation will happen definition of practice
• Sharing of information
• Radical reform for pharmacy

14
Regulatory climate

• Statutory force to objective criteria
• good character?
• Regulator independent of profession
• Consistent sanctions and procedures
• Self and peer whistle blowing
• Involvement of employer and the state in
  complaints or even allegations
• Mandatory proof of competence

15
You think youve got problems?

• Separation of professional, regulator and general
  enforcement roles of Royal Pharmaceutical Society
  of Great Britain
• Incorporation of Pharmaceutical Society of
  Northern Ireland, also a combined professional
  and regulatory body
• Watch your own spaces!