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Time government got a grip on regulation

Paula Slater chairs the Alliance for Patient Safety, which represents the voluntary registers for clinical physiologists, cardiothoracic surgical assistants, ophthalmology and vision technologists, clinical technologists, clinical perfusionists and medical illustrators. She argues that the regulatory structure must change.

What are your expectations when you go into hospital?

The most basic, of course, is that you leave in a better state of health. For that to happen you require the best possible care from experienced and highly-qualified professionals who have the resources to treat you and adhere to rigorously enforced professional standards that ensure your wellbeing.

It should come as a shock, then, that the last of these is by no means guaranteed.

The government recently announced plans to introduce ‘associate physicians’ to support doctors’ ever-increasing workloads in hospitals. The model is taken from the US, where it has had success. But there are two major differences between doctors and associates. The first is training: associates will have two years’ training compared to a doctor’s seven. The second is that while doctors are regulated and answerable to the General Medical Council, associates will be unregulated.

That’s not to say that associate physicians will pose a risk to patients. They will doubtless by conscientious and highly skilled. But the question that has to be asked, particularly given the government’s push to improve standards in the wake of the Francis Review, is: how can professional standards be maintained in the absence of a statutory regulator?

The simple answer is that it is at best extremely difficult, and at worst impossible, to enforce standards without robust professional oversight and regulation in place. And we should not be naïve in thinking this only applies to associate physicians. Tens of thousands of highly-skilled practitioners currently working in our health service remain unregulated, despite the risk this poses to patient safety. These are the professionals who perform procedures and investigations that are vital to diagnosis and treatment, but which pose risk to patients if not performed correctly. They are the professionals who assist in cardiothoracic procedures.

Chances are, if you’ve been into hospital, one of these unregulated professionals has had a significant role in your diagnosis and treatment. But if they had caused you harm, due to accident or incompetence, there would have been no way to sanction that professional. Indeed, it would have been hard enough to identify that an incident had occurred. And to rub salt into the wound, even if the mistake cost that professional their job, there would be no barrier to them continuing their career in another hospital.

This, again, is not to suggest that the vast majority of these professionals, who include clinical physiologists and cardiothoracic surgical assistants, are not highly competent, skilled and dedicated. But it does mean that when something goes wrong, there is little that can be done to prevent it happening again.

And the government’s support for unregulated associate physicians serves as a timely reminder of its broader approach to healthcare regulation.

This approach has been to promote voluntary registers rather than statutory regulation. But the problem is that voluntary registers cannot guarantee patient safety. They are so devoid of authority that they can’t insist on fitness to practice assessments. They lack the resources to identify incidents and poor practice. And they have little power to sanction incompetent practitioners.

It is more likely that the professionals maintaining the register will face legal action for defamation of character than it is that an incompetent practitioner will be struck off.

That is not to say that every healthcare professional must be statutorily regulated, but in the case of those whose work poses a very real risk to patients, the voluntary registration model is fundamentally flawed. The chief executive of the Health and Care Professions Council has publicly described it as ‘useless’, and the House of Commons Health Select Committee has also noted the deficiencies of voluntary registers.

The plans to introduce associate physicians highlight not only the pressures on the health service, but also the government’s approach to healthcare regulation, which in the case of tens of thousands of professionals doesn’t go far enough and fails to provide patients with a threadbare safety net for protection. This isn’t about additional red tape but about making sure the standards of the health service are not only maintained but enforced.

And that simply can’t be done with registers incapable of requiring fitness to practice assessments and lacking the ability to sanction incompetent professionals who cause harm to patients. Unless practitioners whose work can cause harm are subject to statutory regulation, the government hasn’t used all the tools at its disposal to ensure patient care and patient safety.

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