EBME Forums Forums Management Professional Issues Statutory Regulation, Is there a Compelling Case?

This Command Paper sets out the Government strategy for reforming and simplifying the system for regulating healthcare workers in the UK and social workers and social care workers in England.
Policy paper Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff published 16 Feb 2011.

4.0 Unregulated Workers
4.1Regulation of the health and social care work force is sometimes necessary where there are significant risks to people using services which cannot be mitigated in other ways. However, in recent decades compulsory blanket statutory regulation of the health and social care workforce in England has too often been seen as the first resort, rather than the last, in deciding how best to assure safe, effective and respectful care. Where regulation has been extended, there has not always been a robust and transparent case made based on the level of presenting risk. Currently, nearly 1.4 million staff, in 3113 professional and occupational groups (which are regulated through enactments of the Westminster Parliament) are regulated in this way. If regulation of this type were to continue to be extended to all groups where the previous administration had made commitments to introduce regulation, an additional 1.3 million workers14 (many of whom are in relatively low paid support roles) would be obliged by law to pay registration fees in order to continue to pursue their livelihoods.

4.2 In many cases, the risk to service users and the general public posed by groups of unregulated health and social care workers is not considered to be such that regulation of individual workers is necessary, given the wider safeguards within the system, such as the Vetting and Barring Scheme in England and Wales and the regulation of most providers of health and social care services. In general terms, the Government does not believe that the extension of statutory regulation to all workers in the health sector across the UK and the social care sector in England would be a proportionate response. The emphasis should be on employers of unregulated workers to take responsibility for the quality of services provided.

4.3 However, we recognise that a more flexible system is needed to enable employers to assure themselves that prospective employees have met adequate standards of training and competence and to enable individual members of the public who seek care directly from unregulated self-employed professionals to assure themselves about their standards. Such a system should also allow people who work in professions or occupational groups who are not regulated in law to demonstrate, if they wish to, that they meet high standards.

4.4 To this end, the Government proposes to enable a system of assured voluntary registration to be developed for professionals and occupational groups which are currently not subject to statutory professional regulation. At present, there are a range of voluntary registers, but no system which allows the public, employers or professionals to gauge whether they operate effectively and to high, or common, standards. A system of assured voluntary registration is a more proportionate way of balancing the desire to drive up the quality of the workforce with the Coalition Government’s intention to avoid introducing regulation with its associated costs wherever possible.

4.5 The Government intends to establish the CHRE as the national accrediting body for health professionals UK-wide who are currently not regulated by statute, healthcare workers UK-wide and social care workers in England, as well as certain students and social care
professionals in England. The CHRE 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. The existing statutory regulatory bodies already have significant expertise in establishing and raising professional standards which could be used to support the development of other professional and occupational groups and they will be given powers to establish voluntary registers of persons in professions, occupations or trades which undertake roles which are related to the roles of professions they currently regulate on a statutory basis. In establishing voluntary registers, we would expect the regulators to draw on tools that already exist, such as the Knowledge and Skills Framework in the NHS, where appropriate.

4.6 The system of voluntary registration will be funded by those joining voluntary registers and the CHRE will provide strategic oversight and responsibility for the development of a coherent and cost-effective system of registers.

4.7 Where existing regulators establish new voluntary registers, we would expect them to introduce more proportionate approaches to the removal of persons from these registers (for example, by permitting removals by administrative means in certain types of case, but with the right for registrants to require an internal panel hearing if they choose). We would expect existing regulators to make it clear that registrants on voluntary registers are not subject to full statutory regulation and to require registrants themselves also to make this clear to their clients/patients. In view of the fact that membership of these registers would be voluntary, the effects of removal from a list would be less severe and this difference in approach would be proportionate, provided that there were robust internal appeals mechanisms in place. Any such mechanisms would of course need to be compliant with the European Convention on Human Rights.

4.8 We will also ensure that any voluntary registration systems accredited by the CHRE make appropriate links to the wider regulatory system and include appropriate policies on professional indemnity and safeguarding, including, where appropriate, procedures for making referrals to the Independent Safeguarding Authority (ISA) or Disclosure Scotland, where individuals are considered to pose a risk to the public. We will ask the CHRE to draw up detailed proposals for the way that a system of voluntary assured registration would operate in practice. The CHRE will need to ensure as part of its accreditation process that voluntary registers are not misused to enforce protectionist practices by any individual professions. We also believe that voluntary registration bodies could also act as a point of contact for persons wishing to raise concerns about the poor practice of unregistered persons in England and refer them to ISA where necessary. We plan to take forward these proposals as part of the work programme that follows from the Government’s review of the Vetting and Barring Scheme in England, Wales and Northern Ireland.

4.9 No staff will be compelled to join these registers and employers will not be required to employ staff from these registers, though they could choose to do so. Where providers and those that they provide care for see benefit in employing staff who are nationally assured through a voluntary register, they will be able to do so, either by requiring registration when advertising posts, or seeking a commitment to join a register and training and developing existing staff so that they are able to do so.

4.10 Similarly, commissioners of services from independent contractors who are not subject to regulation could give weight to providers using staff meeting criteria required by accredited registers when awarding contracts. Individual members of the public seeking care from self-employed practitioners will be able to choose to go to practitioners on an assured voluntary register. Independent practitioners themselves will take a judgement on whether to join the register in order to attract more patients or clients. To underpin this, we will need to ensure that members of the public, including those managing their own care, have adequate and appropriate information to enable them to make informed decisions about arranging their own care with independent practitioners.

4.11 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.

4.12 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.

Apologies for the length of this post, but there is some misconception from both sides about the current Governments stance on healthcare regulation, be that statutory or voluntary assured.

I have no doubt that as quoted "people may make the facts fit their case", but has there been a compelling enough argument made to make the Government change its stance towards statutory regulation of Clinical Technologist's?
Time will no doubt tell.

Kind regards
Sean Fearon

You ask "is there a compelling case"? To which my answer would have to be:- "none that I'm aware of".

But CHRE* ... or PSA?

How many more of these "regulatory bodies" are there out there?

And (more importantly) do any of them offer a route to the licencing of biomedical engineers and technicians via Certification (that is, by periodic examination) ... or even a Register for "hands-on" biomeds at all?

BTW:- notice that I'm not using the term "Clinical Technologists"!

* Council for Healthcare Regulatory Excellence

Professional Standards Authority - Accredited Voluntary Register Applicants

Second from the bottom, interesting entry!

Well spotted!*

So, have I got this right:- we could crank up our own Institute (should we so wish), and get our list of names added under the PSA umbrella? And that "voluntary register" would then have just as much (or as little) credence (standing, whatever) as any other?

* But I don't see any biomed engineering group listed there. Unless we include IPEM, that is.

Perhaps I have got this wrong, but the VRCT inform Professional Standards Agency that they wish to consider voluntary registration, whilst telling us that the VRCT (under the umbrella of the APS) is applying for statutory registration.
That sends an unambiguous message, doesn’t it?

Wow! Quite some list. There are some real whacky applicants in there.

Geoff in answer to your question, yes.

In theory, a group of Biomed’s could approach the PSA, with a view to setting up a voluntary assured register, this would then have the same standing as the other aspirant groups.

OK ... here's another one:- the Association of Retired Technicians (ART).

Anyone fancy becoming a Fellow?

They're just covering all the bases (hedging their bets), I guess.

No doubt someone will come on here tomorrow with some sort of explanation.