Memorandum submitted by the Council for
Healthcare Regulatory Excellence
1. SUMMARY
The Council for Healthcare Regulatory Excellence
is an independent body accountable to Parliament. Our primary
purpose is to promote the health, safety and well-being of patients
and other members of the public. We scrutinise and oversee the
nine regulators of healthcare professionals.[85]
We also carry out research, develop policy and give advice on
regulatory issues.
In anticipation of the Government's intended
review of healthcare professional regulation in 2011 we are
currently undertaking policy work in a number of key areas. These
include developing the concept of "agility" in regulation
(as supplementary to the Better Regulation Executive five principles);
exploring alternatives to the current geographical boundaries
of regulation; developing protocols for regulation to learn from
crisis when it occurs; and exploring how the interests of patients
and the public can be ensured where they are multiple and complex
regulatory systems. We expand on these points below.
The principal focus of our work is the regulation
of healthcare professionals and how that engages with other healthcare
regulatory systems. However, we believe there is substantial read-across
to the regulation of other sectors. Increasingly we are involving
representatives of regulatory bodies outside health in our policy
development work, from both the public and other sectors, in order
to promote learning and best practice sharing. We are also looking
to inform our policy development work with research into how regulation
is conducted internationally.
Although the success measures in healthcare
professional regulation may be different from those in other sectors,
nevertheless there is significant potential for learning across
these boundaries in the way that regulation is conducted. We are
concerned in all of our work to promote "right-touch"
regulation; that is, regulation that is neither so light as to
be ineffective nor so heavy as to present unreasonable demands
to those regulated, and which does not restrict innovations in
practice.
In the next section we give a description of
a number of key policy development areas. We would be pleased
to expand on any of these areas, were that useful to the Committee.
2. FOUR KEY
AREAS OF
CHRE'S POLICY
DEVELOPMENT WORK
(i) Agility
The underpinning of much of our policy work
is the Better Regulation Executive's five principles of regulation—that
it should be proportionate, accountable, consistent, transparent
and targeted. In our policy work we are developing a sixth principle—that
it should be agile. In other words, regulatory bodies should be
staying up to date with the changes in registrants' practice and
the environment in which they work. Responsive to change, regulatory
activity should pay closest attention to the areas of highest
risk to patients and the public.
The concept of agility as a sixth principle
arose from a commission from the Department of Health to advise
on aspects of the establishment of the new General Pharmaceutical
Council. Our research demonstrated that pharmacy practice was
likely to undergo significant and rapid change over the next 5-10 years.
Therefore, its new regulatory body would need to demonstrate agility
in order to regulate practice effectively and meaningfully. Our
advice is enclosed as an appendix, and we direct your attention
to paragraphs 2.3 and 5.1-5.22.
(ii) The geographical boundaries of regulation
Another area of focus for us is the geographical
boundaries of regulatory activity. At the current time, the regulation
of healthcare professionals is principally UK-based, with standards
common to the registrants of the regulatory bodies irrespective
of where in the UK they practise. The exception to this is pharmacy,
where there are separate regulatory bodies for Northern Ireland
(the Pharmaceutical Society of Northern Ireland) and Great Britain
(the Royal Pharmaceutical Society of Great Britain, whose regulatory
functions are soon to be taken over by the General Pharmaceutical
Council). As part of our policy development work we will be examining
the risks and benefits that would arise were regulation to be
conducted at a country or local level, or indeed at a European
level. We are mindful in this work of such considerations as (i)
the different powers of the devolved administrations where healthcare
professional regulation is concerned (ii) economies of scale and
other cost impacts and (iii) relevant European law and the free
movement of both healthcare professionals and patients.
(iii) Learning from crisis
A recurring theme in CHRE's discussions with
stakeholders has been that the focus of regulatory policy development
is too backward-looking—that regulation focuses too much
on preventing the last crisis from happening again. This might
be at the expense of being forward looking and working to address
future areas of high risk, the agility theme described above.
Of course, this is not to say that crises when they occur should
be ignored. Rather, the question is how regulatory bodies should
learn the lessons without allowing crisis prevention to monopolise
the policy development agenda, or over-reacting with unnecessarily
heavy regulation. This will be another key area of our policy
development work.
(iv) Multiple and complex regulatory systems
There are numerous bodies involved in regulating
different aspects of health and social care, looking at professionals,
systems, products and premises. A further area of policy analysis
for us will be to consider whether the interests of patients and
the public are best served by the way that these systems are constructed
and interact with each other. There is a high level of public
interest in the way that different services interact and communicate
to look after their needs, and particularly when they fail. We
will be looking at whether there are gaps between regulatory systems;
whether the number of different systems and organisations causes
confusion to the public; and how boundaries between systems should
best be managed.
March 2009
85 General Chiropractic Council, General Dental Council,
General Medical Council, General Optical Council, General Osteopathic
Council, Health Professions Council, Nursing and Midwifery Council,
Pharmaceutical Society of Northern Ireland, Royal Pharmaceutical
Society of Great Britain. Back
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