Time to embrace Francis recommendations on regulation

This year has been a difficult one for the NHS. If 2010–2012 were the years of NHS reorganisation, then so far 2013 has been the year of scrutiny of patient care standards, during which we have seen the publication of not one but three much-anticipated and highly critical reports into the quality of patient care in the health service, these being the Francis Report and recently Sir Bruce Keogh's review and the Berwick review. It is difficult to overemphasise the impact of these two reports, and as more than one astute political commentator has noted, they have dealt a significant – and potentially critical – blow to the aura of infallibility that has surrounded the NHS for much of the time since its inception in 1948.

Quite simply, gone are the days when politicians and the general public looked at the NHS through rose-tinted spectacles and, while it remains a world leader in many aspects of healthcare, there is a far greater appreciation for and understanding of the fact that there are flaws in the health service that have included significant deficiencies in patient care standards. This point has been demonstrated comprehensively by both Keogh and Francis, and is one issue that Health Secretary Jeremy Hunt is eager to address as he seeks to define himself as a champion for NHS patients and seize the initiative ahead of the General Election in 2015.

One of the recommendations made in the Francis Report was that there should henceforth be a single regulator with the remit of ensuring quality of patient care, and this is an idea with significant merit. This is not to suggest that bodies such as the General Medical Council and others do not perform vital roles or are necessarily deficient, but rather that existing regulatory systems or frameworks are unnecessarily fractured. The status quo, even to those working within the health service, is a confusing picture and it is unreasonable to expect patients and their families to know, or be able to find out, which regulatory body they are supposed to raise issues with during what is likely to be a time of significant stress and emotional distress. More worrying is that a fractured system could actually be preventing instances of poor practice being reported and the necessary action being taken.

This is the point Francis was making, and it is reasonable to expect that a single regulator would ensure greater clarity for patients, who should then be able to report incidents more easily. Whether the Care Quality Commission (CQC) – the body Francis suggested as the single regulator – is up to this task is another matter, and without doubt the Commission and its new leadership will have to overcome a number of very public deficiencies and failures that have taken a sizeable toll on its reputation. Nevertheless, Francis’ recommendation is based on sound logic in suggesting that an existing body should be empowered for this task, rather than creating a wholly new organisation at significant cost and unnecessary disruption.

However, the Department of Health should not just be looking to implement this particular recommendation by Francis, which would ensure that only those currently regulated healthcare professionals would come under an expanded regulator such as the CQC. Rather, the Government should be looking to grasp a nettle that it has hitherto avoided: the regulation of healthcare professionals who are currently only subject to ineffectual voluntary registration without the ‘teeth’ to either identify or sanction incompetent or negligent practitioners. It was for this purpose that the Alliance for Patient Safety was formed – namely to call for the Government to urgently introduce regulation for professionals such as clinical physiologists, cardiothoracic surgical assistants and medical technologists, all of whom play a vital role in the diagnosis and treatment of patients but who remain unregulated despite carrying out sensitive and sometimes invasive procedures on patients with the potential to cause significant harm. If the Government is serious about ensuring that the types of scandals reviewed by Keogh and Francis never happen again, this is an area in which they need to act, as the Government’s currently policy of ‘Assured Voluntary Registration’ for as yet unregulated healthcare professionals is insufficient and unfit for purpose.

Voluntary registers are by definition severely limited in their scope, and it is deeply concerning that the Government is so entrenched in its endorsement of them, which will make acts of negligence by incompetent practitioners far harder to detect and almost impossible to act on. That certain groups, such as clinical physiologists, are not yet regulated does not mean there is zero risk, and ministers would do well to remember that many of the groups falling under these voluntary registers have been recommended for regulation by the Health and Care Professions Council in order to ensure patient safety.

Jeremy Hunt has, in the past, claimed that regulating currently unregulated healthcare professionals would risk a ‘bureaucratic quagmire’. This is a risk, and no system of regulation should be so stultifying that it actually inhibits the delivery of patient care. Yet such a dismissive attitude to the issue of regulation runs contrary to the Health Secretary’s efforts to portray himself as a patients’ champion, and he should ensure that Francis’ sensible suggestions on the issue of regulation are not only implemented in full, but are used as an opportunity to provide comprehensive coverage of the NHS workforce – including those professionals currently subject to voluntary registration but whose responsibilities not merit but demand regulation. Only this will guarantee patient safety and help ensure we do not see more reports like those of Francis and Keogh in future.

Anne Burge is the Chair of the Alliance for Patient Safety, which campaigns for statutory regulation for professions including clinical physiologists, cardiothoracic surgical assistants and medical technologists.