Michael Guthrie, director of policy and standards, Health and Care Professions Council on the role of governance in regulating healthcare professionals and meeting the challenges of creating a joined up and flexible framework across the sector’s nine regulators, which cover sixteen professions.
The Health and Care Professions Council (HCPC) is a professional regulator of 16 professions in health and care, including physiotherapists and social workers in England.
The role of the organisation is to protect members of the public and it does this by setting standards for competence and conduct; approving qualifying education and training; maintaining a register; and dealing with complaints that a professional may not be fit to practise.
The HCPC is set up in legislation but is independent of government. It is self-financed, with fees paid by its registrants covering day-to-day operating costs. We are one of nine regulators of health and care professionals.
In the sector, there are number of common challenges, two of which are described here.
Difficulties working across organisational boundaries
‘Good governance’ did not always translate to the organisational cultures we desire.
The first challenge is to ensure that regulation of individuals and regulation of services or organisations is joined up. The Francis Inquiry into failings at Mid Staffordshire hospital highlighted the importance of regulators sharing information and working together to ensure that warning signs are identified and acted upon promptly.
However, sharing information is made challenging by different organisational boundaries and different organisational remits; for example, not all the settings in which our registrants work are covered by a form of service regulation.
Need for a flexible legislative framework
The second challenge is the need for the regulators to have a legislative framework that allows them the flexibility to respond to operational challenges, whilst being subject to appropriate accountability.
Increasing volumes of complaints from members of the public have prompted debate both about the inconsistency in the regulators’ respective legislation and about how we might move towards a much more prevention-oriented model of regulation.
The desire for legislative change is tempered by the need to ensure that regulators operating independently from government are subject to appropriate accountability to ensure that they continue to make decisions, which are in the public interest.
A focus on internal governance
As a regulator of individual professionals in the healthcare sector (rather than of organisations, services or systems) the issue of governance has to date played out differently from other industries represented in the discussion.
The regulators and regulation can only be one lever in securing cultural change but nonetheless play an important role.
In recent years, reforms have focused on the internal governance of the regulators themselves, making sure that the regulators have governance arrangements, which command public confidence by ensuring a focus on the public interest.
As a result, governing bodies have transformed from large representative bodies to become smaller and more board-like, with equal representation of professionals and lay people. There is now an expectation that boards provide strategic oversight, holding their Executives to account.
A ‘light touch’ approach: parallels with financial services
The focus on governance and ‘light touch’ regulation in the financial services sector with its more proportionate approach to achieving desired outcomes has some parallels with our experience. It is mirrored perhaps in pressures on the healthcare professional regulators to be proportionate and outcomes focussed in their regulatory models, avoiding unwarranted prescription, which might add burden and increase pressure on registration fees.
The challenges of managing public, sector and political expectations described by the other regulators present at the meeting were also very familiar.
A lot of the discussion with our wider stakeholder group concerned culture – and the challenges for regulators in both securing and assessing that a productive, ‘healthy’ organisational culture exists. There was a concern that ‘good governance’ did not always translate to the organisational cultures we desire.
Many of the well-documented failings of care in the sector have led to calls for a change in culture, with reports referring to the need for behaviours to be modelled at every level of organisations – from ‘board to ward’. I tend to think that the regulators and regulation can only be one lever in securing cultural change but nonetheless play an important role.
In my context, this perhaps concerns how regulators through their standard setting roles can work with others to help ensure consistent messages throughout the system, at very least reducing perceived boundaries to change.
The views expressed in this article are the author’s own and not necessarily shared by Solvency II Wire.