HC 1048-III Health CommitteeWritten evidence from Council for Healthcare Regulatory Excellence (PH 68)


CHRE welcomes the opportunity to contribute to the Health Committee’s inquiry into Public Health, particularly the future of the public health workforce, including the regulation of public health professionals.

We do not believe a robust case has been made for extending statutory regulation to public health practitioners.

We consider that voluntary registration as part of a framework that is supported by existing legislation and regulation, contractual terms required by employers, and the education and professional development of public health practitioners themselves, does provide proportionate protection for the public from the risks posed by the public health workforce.

The Government is proposing an assurance scheme for such voluntary registers in the Health and Social Care Bill and this should support public trust in public health practitioners.


1. The Council for Healthcare Regulatory Excellence (CHRE) promotes the health and well-being of patients and the public in the regulation of health professionals. We scrutinise and oversee the work of the nine regulatory bodies that set standards for training and conduct of health professionals. We share good practice and knowledge with the regulatory bodies, conduct research, and promote the concept of right-touch regulation. We advise the four UK government health departments on issues relating to the regulation of health professionals. We are an independent body accountable to the UK Parliament.

2. CHRE advocates the use of right-touch regulation, which is applying the minimum regulatory force required to achieve the desired result. This is the approach we adopt in the work we do, it is the approach that we encourage our regulators to work towards, and it frames the contributions we make to wider debates about the quality and safety of healthcare and the development of regulation. It complements the well established principles of good regulation, promoted by the Better Regulation Executive. Applying right-touch regulation helps us to answer questions about the appropriate regulatory framework for different groups working in health and social care.

The Future Regulation of Public Health Professionals

3. The Government outlined its position on extending statutory regulation in its recent Command Paper, Enabling Excellence:

…the extension of statutory regulation to currently unregulated professional or occupational groups … will only be considered where there is a compelling case on the basic of a public safety risk and where assured voluntary registers are not considered sufficient to manage this risk

4. Much of the public health workforce is already subject to statutory professional regulation, such as the 27,000 specialist community public health nurses on the Nursing and Midwifery Council register. Health professional regulatory bodies ensure the skills, competence and behaviour of registrants are sufficient to protect the public and promote confidence in the professions. Unregulated public health practitioners often come from a variety of professional and academic backgrounds, and can fulfil senior roles in public health.

5. Questions about the level of regulation required for public health professionals have been examined in a recent report, Review of the Regulation of Public Health Professionals which recommended statutory regulation for all practitioners. However, it is our view that the report fails to make the case for statutory regulation. Statutory regulation for the public health workforce would be an overly burdensome and inappropriate way of managing the risks that are presented.

6. Right-touch regulation means that that there is usually more than one way to solve a problem and that regulation is not always the best answer. Public health practitioners fulfil a wide range of roles in society from individual nutritional advice to the management of environmental hazards and disease control. Failure to manage risks in these areas can lead to harm for individuals or entire populations in extreme circumstances. Whilst the potential for risk is high, we have not seen compelling evidence to suggest that the existing mechanisms of control are failing to mitigate them effectively. We do not consider therefore, that additional statutory regulation of professionals is needed. Given this we should seek other ways to enhance the delivery of high-quality public health to the public. Non-regulatory safeguards currently exist, including voluntary registers, professional organisations, chartered institutes, existing safety legislation, plus oversight and performance management by employers.

7. Our view that extending statutory regulation would be inappropriate is supported by a recent report from the UK Public Health Register on risk in public health practice. It concluded that although some form of regulation is required at all levels of public health practice, quality assured voluntary regulation would successfully protect the public.

The Benefits of Assured Voluntary Registration

8. Under current proposals in the Health and Social Care Bill 2011, CHRE will become the Professional Standards Authority for Health and Social Care (“the Authority”) with powers to assure voluntary registers. We will

set standards against which the governance, procedures, registration criteria and performance of voluntary registers can be judged to establish whether they are sufficient to provide assurance to the public and employers about the training, skills and conduct of their registrants

9. The benefit of this approach means that assured voluntary registration will provide greater flexibility and give the public and local employers greater control and responsibility for how they assure themselves about the quality of staff.

10. Ultimately what keeps patients safe is health professionals’ personal commitment to acting competently, ethically and compassionately. Those who willingly sign up to a voluntary register demonstrate that commitment. In addition, the Authority will provide assurance that the register is being managed effectively and that it is delivering good outcomes for service users.

11. Under the Authority’s scheme, organisations operating assured voluntary registers will be required to:

Act in the best interests of the consumer.

Behave with integrity and authority.

Promote high standards of training, education and practice.

Apply rigorous standards to itself and its registrants.

Provide clear and accessible information to the public.

Act swiftly to protect the public when necessary.

12. Practitioners will benefit from registration with an organisation that is accredited by the Authority as an indicator to service users and employers that they are competent and committed to providing good standards of care, treatment, therapy or other service.

13. Employers can be confident that they can rely upon registration of a practitioner by an accredited body as a quality indicator, alongside reference checks of their own. Effective management of a professional’s performance with ongoing career-based training can benefit the individual and the reputation of the profession as a whole.

14. The relationship between employers and organisations running voluntary registers will be of benefit to both groups. Endorsements by employers choosing or requiring applicants belonging to an assured voluntary register will allow it promote standards within the workforce for the benefit of patients and the public. The existing voluntary register for public health specialists, the UKPHR, is endorsed by the NHS at senior levels.

15. CHRE considers that an assured voluntary register of public health practitioners would be an appropriate safeguard for the unregulated public health workforce. Membership of such a register will indicate the mark of safe, quality service expected from a public health professional, without the burden of unwarranted regulation and costs associated with this. As a pre-existing and successful voluntary register, CHRE has held constructive provisional discussions with UKPHR about developing relevant and functional standards for accreditation.

Further Information

16. We would be pleased to expand on any of the areas we have discussed if that would be useful to the Committee.

June 2011

Prepared 28th November 2011