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Letters to the Editor
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Professional regulation
Apparent conflicting conclusions need to be reconciled
From Professor A. R. Michell
The Foster and Donaldson reviews are now published and subject to consultation
until November. There will be much for all the health care professions
to consider and opportunities to improve the position of both patients
and staff. Moreover, with the entire range of health provision under
scrutiny, many will be considering the recommendations from both sides
of the fence.
While there is much to welcome in the reports, there is one astonishing
omission. When I wrote to The Journal earlier this year (PJ, 18 March,
p319), I said that it was essential, in the interests of logic and joined-up
policy development, that the validity of any new approach has to be assessed
against the perceived defects of the Kennedy approach where these appear
to be in conflict. Extraordinarily, this has not happened. It is only
four years since “Learning from Bristol” — the Government
response to the Kennedy Report — embraced those principles to establish “a
modern framework that puts the patient at the heart of the process and
gives the public greater safeguards”. This framework was established
long after the crimes of Harold Shipman, so there is no intrinsic rationale
for further change. Even last week’s press release is disconcerting,
citing the Donaldson Report as “the first comprehensive review
of medical regulation for over 30 years”, although Chapter 3 of
Donaldson is headed “the three inquiries” — Kennedy,
Donaldson and Foster you might imagine. Not so: there is no mention of
Kennedy. Yet this report into the “Bristol babies heart surgery” tragedy “offered
a view of the way forward for the NHS” and reached unanimous conclusions
regarding almost every aspect of health care regulation.
It may have been “comprehensive”, eg, in analysing changes
in the role of the General Medical Council, but the last nine chapters
were implicitly or explicitly about the safeguarding of patients’ interests,
of competence and other core aspects of regulation, including the thorny
problem of revalidation. In particular it emphasised the concept of the
integrated functions of a regulator — “Regulation, as we
have defined it, therefore extends from entry into a profession, to continuing
in it, to ensuring that competence is up to date through revalidation,
to processes of support for improvement and, if that fails, to removal
from the register. … Thus for each group of health care professions
there should be one body charged with overseeing all aspects of professional
life: education, registration, training, continuing education, continuing
professional development, revalidation and discipline. … Regulation
of health care professionals is not just about disciplinary matters.
It should be understood to encapsulate all the systems which combine
to assure the competence of health professionals.”
It could not be clearer. Yet the whole thrust of the current inquiries
is to distance disciplinary issues from the other regulatory obligations.
Either the Kennedy Report was right or subsequent experience has revealed
misconceptions. If so, the evidence needs to be discussed and conflicting
conclusions reconciled: it is not in the public interest for detailed
analysis of the same problem simply to ignore one another’s arguments.
Bob Michell
Member of Council
Royal Pharmaceutical Society
Correction
Unfortunately there were typographical errors in this letter from Bob Michell. The third paragraph should have begun “It may not have been comprehensive …” and the third line from the end should have contained the word “analyses” not “analysis”.
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The
Pharmaceutical Journal