01.06.12
The need for statutory regulation
Source: National Health Executive May/June 2012
The Registration Council for Clinical Physiologists (RCCP) says that patient safety is being put at risk because the Government refuses to implement statutory regulation for the disciplines it covers. NHE talks to RCCP chair, Anne Burge.
In the latest salvo in a longstanding dispute over whether and how clinical physiologists should be regulated, the voluntary RCCP, which maintains the current voluntary register, has used the Freedom of Information Act to show just how many sensitive procedures that could put patients at risk are being carried out by its unregulated registrants.
The information given to the RCCP by 71 acute NHS trusts shows that the number of pacemakers fitted has increased by 33% since 2008, audiology assessments have increased by 20%; the number of echocardiograms conducted has increased by 23%; and the number of patient lung function tests has increased by 15%.
The RCCP says its register administrators have even been faced with civil action when attempting to reprimand registrants and ensure professional best practice. The voluntary register is the only form of professional oversight, despite the evidently increasing workload for the disciplines it oversees.
Anne Burge, who chairs RCCP, told NHE: “Procedures that may have been carried out by doctors have been passed down to clinical physiologists. Some increases in activity are because patient pathways have changed, or NICE guidance now states that if you have X condition you need to have Y test. That’s not a bad thing, but that’s running alongside the fact that some of the investigations that may have been carried out by much more highlypaid practitioners are now being undertaken by unregulated clinical physiologists.”
The RCCP has blamed the Government for being ideologically devoted to voluntary registration, for cost-saving reasons, and ignoring evidence that patient safety could be put at risk. The Health Professions Council recommended that clinical physiologists should be statutory regulated in 2004, but nothing has changed, and now the Government’s changed in the Health & Social Care Act fail to address the issues raised back then, the RCCP says.
Voluntary registration is just not powerful enough to address concerns, Burge said. She contrasted the very low number of complaints they had received about registrants – around four – and fact that no-one has been struck off, with the HPC, which typically strikes off about 6 registrants per 1,000.
Burge said: “Interestingly enough the chief executive of the HPC has written to us recently and said as far as it is concerned, we should still be regulated: there’s no doubt about it in their minds.”
She added: “There’s no difference between us and physios, or us and nurses. We undertake some riskier things than some of the other people who are regulated, in fact.”
The Government’s new structure – assured voluntary registration, with a ‘kitemark’ given by the new Professional Standards Authority for Health and Social Care (formerly CHRE, the Council for Healthcare Regulatory Excellence) – just will not work, the RCCP says, and relies on something going seriously wrong before statutory regulation will be considered.
Burge explained the confusing picture, saying: “We could choose to apply to the PSA for accreditation. We will then have to prove that we meet their standards, pay a fee of £20- 30,000 and, if we get accreditation, use their kitemark. We will still maintain the register. My understanding is, if you need to be statutory regulated, part of it will be a risk assessment: I assumed originally it meant if you really prove that you had the potential to do harm, that you would be regulated, but that’s not going to be the case. The voluntary registers will be accredited no matter what the risk is – they will do a risk assessment – and it’s only if it fails to operate that they will consider statutory regulation. That’s the latest I’ve heard from the DH. It will be like having a kitemark on what we’re already doing now. We’ve given the Government lots of evidence to suggest it’s not working. This situation is really unclear, and it’s taken a lot of argie-bargie to get this far. We don’t know what their criteria for ‘failure’ will be.”
She said the Government needed to look again at the evidence on risks to patient safety, saying: “If you don’t have the potential to do harm, and you don’t require statutory regulation, why should you sit on a voluntary register? That’s just a tax to work.
“Registrants are very frustrated, and very dubious about what’s going to happen. A lot of them are fed up with paying for a voluntary register, plus, if you take cardiology as an example, they may belong to at least three or four professional bodies.” Although the RCCP fee is only about £40 a year, those of professional bodies can charge £200-300 each.
Another issue, she said, is prescribing. “Some of them do prescribe, and that’s actually ‘illegal’, and some of them out there are being put at risk by their trust, because the trust might have some sort of a fudge, and have found out a way to do it: but in reality, the patient directive is quite clear. You have to be statutory regulated to prescribe.”
Speaking of the campaign for statutory regulation, Burge concluded: “This is something we’re only doing because we believe in patient safety. It doesn’t offer us anything in return.”
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