4 Proposed regulation of other professions
Herbal medicine
practitioners and non-medical public health specialists
56. The HCPC has been asked by Government to
add professions to its register at various points since its establishment,
most recently social workers in 2012. The Government has also
proposed that the HCPC should in future become responsible for
regulating herbal medicine practitioners and non-medical public
health specialists.[61]
57. The HCPC provided the following update of
recent developments on plans to regulate herbal medicine practitioners.
The late Professor Michael Pitilo published his
Report to Ministers from the Department of Health Steering Group
on the Statutory Regulation of Practitioners of Acupuncture, Herbal
Medicine, Traditional Chinese Medicine and Other Traditional Medicine
Systems Practiced in the UK in 2008. It concluded: "We are
firmly of the view that, in the interest of public safety, statutory
regulation should now proceed with all possible speed" (p.10).
The Government published a public consultation in 2009. On February
16 2011, the Secretary of State for Health, announced that the
Government would introduce statutory regulation, and that this
would be in place by April 2012.
On 9 July 2013, in a Westminster Hall debate
on herbal medicine, the Parliamentary Under Secretary of State
for Health announced the intention to set up a working group.
The first meeting of the Herbal Practitioners and Medicines Working
Group is scheduled to meet in early 2014.[62]
58. With regard to non-medical public health
specialists, the HCPC report that they are working with the Department
of Health, but awaiting legislation in this area:
59. We have been working with the Department
of Health on their project to deliver this policy. Our understanding
is that the Department of Health currently intends to legislate
in this parliament to regulate this group (as part of wider reforms
arising from the Law Commissions' review of the regulators' legislation),
with a register opening in autumn/ winter 2015. However, these
timescales are out of our control and may change.[63]
60. The Committee received written evidence from
the UK Public Health Register, which currently runs a voluntary
register for public health professionals who do not have a background
in medicine or dentistry. This group includes some nurses, pharmacists,
environmental health officers and others who are not regulated
elsewhere. The UK Public Health Register states:
The lack of engagement of the HCPC with existing
regulators has raised concerns over the capacity of the HCPC to
deliver a comparable regulatory system to ensure consistence of
regulation across the entire public health profession including
Medical and Dental Public Health Consultants.[64]
61. The UK Public Health Register raise some
specific concerns about the regulation of public health specialists:
The public health specialists may be differentiated
from most of the other professionals regulated by HCPC because
the focus for public health is on population-based interventions.
The knowledge, skills, competences and professional liabilities
associated with population-based occupations are very different
and, UKPHR would argue, require specialised competence
on the part of the regulator. Public health specialists who face
the prospect of regulation by HCPC might reasonably ask:
· Will HCPC expect these leaders in
public health to fit in with HCPC's existing approach to regulation
which inevitably, given the large number of registrants, involves
more of a "tick box" process?
· How will HCPC take account of the
role of public health specialists, carrying responsibility at
a strategic level for protecting and enhancing the public's health,
in differentiating an existing approach based largely on the regulation
of practitioners who work individually with clients?
· When will HCPC commence consultation
with UKPHR in particular and the wider public health community
as a whole to address the many complex issues that will arise
on a change of regulator?[65]
62. Marc Seale told the Committee that 'aspirant'
groups may become frustrated with a perceived lack of action from
the HCPC, but that the HCPC cannot invest resources into preparing
for new groups to join their register until the Government publishes
draft legislation:
[It] is at certain times slightly frustrating
for the aspirant groups, because until we see the draft legislation
it is not appropriate for us to put significant resources into
that project. So we will participate. We will give our advice
but we won't start, for example, changing our IT systems. As soon
as the Government makes the decision and publishes the draft legislation,
we hit the go button. I know there are groups out there who are
frustrated because they see us as not doing anything, but until
we get the go-ahead from the Government we really cannot put large
amounts of resources into that.[66]
There is something called a section 60, which
says which is the voluntary register that is going to come across.
It requires us to set a standard of proficiency for the profession.
It also requires us to set the standards of education and training.
We set up a working group, because we do not have that knowledge.
Off we go, and usually within a year or 18 months, we are ready
to open a register. However, we
cannot do that until the Government publish their legislation.
The history of new groups is that there is a commitment to regulate
new groups, then nothing happens. If we had started doing that,
we would have wasted a huge amount of resources; we can't do it.[67]
Statutory regulation of other
new groups
63. The Health and Social Work Professions Order
2001 states that the HCPC may make recommendations to the Secretary
of State and the Scottish Ministers concerning any profession
which in its opinion should be regulated. Since 2003, the HCPC
has recommended that 11 different professions should be regulated.[68]
Of these, only operating department practitioners (2004) and practitioner
psychologists (2009) have become regulated by the HCPC.
64. On 16 February 2011, the Government published
a command paper, Enabling Excellence Autonomy and Accountability
for Healthcare Workers, Social Workers and Social Care Workers,
which set out the coalition government's policy on professional
regulation:
Rather than a single statutory approach regardless
of local needs and local approaches, quality 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. For the overwhelming
majority of occupational and professional groups which are not
currently subject to statutory regulation and which are generally
not considered to present a high level of risk to the public,
but where recommendations that regulation should be introduced
have been made (including those groups recommended by the HPC
for statutory regulation in the past, but not yet registered),
the assumption will be that assured voluntary registration would
be the preferred option.
The extension of statutory regulation to currently
unregulated professional or occupational groups, such as some
groups in the healthcare science workforce, will only be considered
where there is a compelling case on the basis of a public safety
risk and where assured voluntary registers are not considered
sufficient to manage this risk.
The exception to this is practitioners of herbal
medicine, including Chinese herbal medicine. [69]
65. The Committee has received written evidence
from the Registration Council for Clinical Physiologists, arguing
strongly that Clinical Physiologists should be subject to statutory
regulation:
Clinical physiologists work directly with patients,
performing sensitive procedures such as assessments and adjustments
of pacemakers, lung function tests, and both assessing and diagnosing
and treating hearing loss. These can be invasive procedures, including
internal ultrasound and endoscopies. Doctors and surgeons then
act on the basis of the diagnosis by clinical physiologist, which
can include surgeries such as neurosurgery in the treatment of
epilepsy. All of these procedures pose serious risks to patients
if not carried out with the highest professional standards.
Despite the sensitive and risky nature of the
procedures they undertake, clinical physiologists are not subject
to statutory regulation in the same way as doctors or nurses-or
even professionals such as art therapists. Indeed, even though
professionals responsible for dispensing hearing aids on the high
street are statutorily regulated, clinical physiologists working
in NHS audiology services, prescribing and fitting devices to
both patients of all ages, are not.
Many of the procedures performed by clinical
physiologists in the UK are performed by statutorily regulated
professionals in much of Western Europe, such as doctors, and
by clinicians in the United States. As a result of a specifically
trained workforce, treatment and diagnosis can be provided more
cost effectively by clinical physiologists in the UK, while at
the same time freeing up doctors to deal with other patients.
This is already happening in some areas but further developments
could only take place if concerns around patient safety can be
addressed through a robust system of regulation.
Clinical physiology is an increasingly specialised
and advanced profession with a large number of dedicated professionals
working primarily in an NHS hospital setting. In the UK, there
are more than 5,000 clinical physiologists, they form part of
the wider Healthcare Science workforce that includes other statutory
professions such as Biomedical Scientists. Together, they carry
out around 80% of diagnostic procedures in healthcare.[70]
66. They argue that the "large number of
unregulated or voluntary regulated healthcare professions in the
NHS ... risks undermining public confidence in regulators",
as "patients generally assume that the professionals they
see in a hospital setting as an integral part of the patient care
pathway are regulated like doctors and nurses are."[71]
67. In the RCCP's view, Accredited Voluntary
Registration is not an appropriate alternative to statutory regulation:
From RCCP's experience, it is not an alternative
that is fit for patient safeguarding. As a voluntary register,
the powers of the RCCP are severely curbed-from being unable to
compel employers who contact RCCP with concerns about a registrant
to give evidence to the point where the register's administrators
have themselves faced civil legal action for 'defaming' incompetent
practitioners that they have attempted to bring sanctions against.
In practice this means that while RCCP operates
a disciplinary code and procedure, it cannot protect patients
from continuing to be treated by practitioners who have not been
registered and who are potentially unfit to practise, as it currently
has no powers of enforcement. Since 2001 the RCCP have received
ten complaints that have moved to the investigatory hearing stage.
In all ten cases the respondents have failed to respond and subsequently
have failed to renew their membership thus removing themselves
from the process. These practitioners then have the opportunity
to start again in a new NHS trust or private facility, helped
by a lack of awareness among NHS organisations of the voluntarily
registers and the legal grey area of making membership of a voluntary
registry a mandatory requirement for employment.[72]
68. We discussed the issue of statutory regulation
for further professional groups in our oral evidence session.
Regarding clinical physiologists, the HCPC was clear in its support
for their statutory regulation.[73]
69. Discussing the issues relating to introducing
statutory regulation more broadly, Dr van der Gaag observed that
health and care regulation is currently "not a very logical
landscape", and went on to say that "if you had a clean
piece of paper and redesigned the system, you would do it very
differently". However, she acknowledged the need for a pragmatic
approach: "you have what you have and, in a sense, we have
to move forward."[74]
70. Marc Seale argued that "regulation is
a huge badge of respectability, professionalism and endorsement."[75]
The Committee asked the HCPC where, in their view, the line should
be drawn on extending statutory regulation to other professions.
The HCPC reported that over a number of years they had received
inquiries from 53 different professions asking to be brought into
statutory regulation.[76]
They stated, however, that in their view, beyond the groups they
have recommended should be subject to statutory regulation, "there
are not another 30 or 40 groups out there ready to be brought
into the system." [77]
71. Considering the wider issue of on what basis
decisions about which professions should have statutory regulation
should be made, Anna van der Gaag made the following observations:
Clearly, this debate has been going on for some
time. Where do you stop? It is a very good question. In a sense,
as health care evolves, regulation has to respond and make decisions
based primarily on public safety and protection, and it must be
driven by that. There are strong and opposing views about the
nature of evidence, the credibility of evidence and the evidence
base of different types of professional practice ... there are
certainly lots of highly contested views about the nature of evidence.
We are aware of that, and to some extent that is an important
driver, but it is not the primary driver for us on decisions about
regulation, because the primary driver is public safety. All professions
have gaps in their evidence base. I think that doctors would see
that there are gaps in their evidence base, and the allied health
professions would certainly say the same.[78]
72. The HCPC has a record of
assimilating new professional groups onto its register, and most
recently the Government has suggested that herbal medicine practitioners
and non-medical public health specialists should be added. Members
of 'aspirant' groups such as these may experience frustration
owing to delays and uncertainty, as the HCPC has reported to us
that it is unable to commit resources to developing its approach
to potential new groups until the Government has introduced legislation.
The UK Public Health Register has raised a number of concerns
relating to the proposed regulation of non-medical public health
specialists. We recommend that the HCPC engages directly with
the UK Public Health Register to ensure its concerns are registered.
73. In addition to this, since
2003, the HCPC has recommended to Government that statutory regulation
be extended to eleven other professions. Of these, the only group
to receive statutory regulation to date are operating department
practitioners and practitioner psychologists. Statutory regulation
gives professions, in the words of the HCPC, "a huge badge
of respectability, professionalism and endorsement." Decisions
about whether to extend statutory regulation to different professions
need to be informed both by considerations of issues of patient
safety, and consideration of the evidence base for that profession.
We do not seek to make judgements on either of these factors for
individual professions, and, although as the HCPC has pointed
out that health and care regulation is not currently "a very
logical landscape", at this stage we are not seeking to make
recommendations for change simply to address inconsistencies.
However, if there are unregulated groups which need to be regulated
on the grounds of patient safety, this should be dealt with swiftly.
74. We received written evidence
from the Registration Council of Clinical Physiologists arguing
strongly that Clinical Physiologists should be subject to statutory
regulation, a position that the HCPC agreed with. We recommend
that, in responding to this report, the HCPC lists any professional
groups for which they feel there is a compelling patient safety
case for statutory regulation so that we can take this further
with the Department of Health as a matter of urgency. We are concerned
at the length of time it can take for professional groups to gain
statutory regulation. As we understand that new groups can be
added to the HCPC's register by means of secondary legislation
we see no reason why there should be undue delay in extending
statutory regulation to professional groups where there is a compelling
patient safety case for doing so.
61 HCPC (HCP 0001), para 3.13 Back
62
HCPC supplementary evidence (HCP 0012), p3 Back
63
HCPC supplementary evidence (HCP 0012),
p3
Back
64
UK Public Health Register, (HCP 007) p1 Back
65
UK Public Health Register, (HCP 007) , para 10 Back
66
Q37 Back
67
Q47 Back
68
HCPC website, new professions process page
http://www.hcpc-uk.org/aboutregistration/aspirantgroups/newprofessionsprocess/
Back
69
HCPC supplementary evidence (HCP 0012),
p2 Back
70
Registration Council for Clinical Physiologists (HCP0005), para
3.2 - 3.5 Back
71
Registration Council for Clinical Physiologists (HCP0005), para
2.3 Back
72
Registration Council for Clinical Physiologists (HCP0005),, para
2.4 - 2.6 Back
73
Q49 Back
74
Q36 Back
75
Q56 Back
76
Q51 Back
77
Q50 Back
78
Q50 Back
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