In a recent report, the Professional Standards Authority (PSA) for Health and Social Care sets out its view on the biggest challenges affecting the quality and safety of health and social care. In this blog, Alan Clamp, PSA's chief executive, summarises these challenges and the possible solutions.
You can also read Patient Safety Learning's reflections on the PSA report here.
Working together to achieve safer care for all
There are some big challenges ahead that need us all to work together to solve them. In our new report, 'Safer Care for All: solutions from professional regulation and beyond', we set out four key challenges for patient and service user safety:
- Tackling inequalities.
- Keeping pace with changes to technology and the delivery of care.
- Facing up to the workforce crisis.
- Addressing issues of accountability, fear and public safety.
We suggest possible solutions as well as one major overarching recommendation: that each UK nation should have a Health and Social Care Safety Commissioner. These Commissioners would have broad responsibility for identifying, monitoring and advising on ways of addressing patient and service user risks.
Tackling inequalities in health and care professional regulation
Inequalities in the health and care sector affect both patients and registrants (healthcare professionals). For patients, this can result in significantly worse outcomes, such as black women being four times more likely to die in childbirth than white women in the UK.
For registrants, inequalities affect career attainment and experiences of disciplinary processes. In England, amongst NHS staff as a whole, black, Asian and minority ethnic (BAME) staff are more likely to enter local disciplinary processes and, according to General Medical Council (GMC) research, are twice as likely to be referred to the GMC by employers compared to white doctors; and international medical graduates face an increased likelihood of receiving a serious sanction. This is echoed in the findings of other regulators, which indicate that BAME professionals are overrepresented at all stages of the fitness to practise process. Regulators and employers need to work together to tackle this issue.
There is also a lot we still do not know about how inequalities affect all-important complaints mechanisms when care has gone wrong, which is crucial to addressing health inequalities for patients and service users.
We recommend a range of actions to help tackle inequalities, and for our part have committed to ensuring that our equality, diversity and inclusion (EDI) standards for regulators are stretching and stimulate continuous improvement.
Keeping pace with changes in how care is delivered and funded
Health and care is changing, with more care being delivered by the private sector and online. Technology is being used increasingly to diagnose and treat conditions, presenting both opportunities and risks to patient care. Regulation can be slow to adapt; instead it needs to keep pace and be agile enough to adapt quickly to new delivery models and emerging risks to patient care.
Some of the issues we examine in the report are the interplay between profit and the best interests of patients and staff, individual conflicts of interest, online care provision and new technologies.
We recommend a cross-sector review of arrangements to address financial conflicts of interest among healthcare professionals and that regulators do more to tackle any business practices that fail to put patients first.
We also highlight the opportunity to give regulators greater agility to address new and developing risks through the Government’s reform programme for professional regulation.
Facing up to the workforce crisis
It is estimated that the UK needs over a million extra health and care workers in the next decade. But it takes time to train healthcare professionals and we fear it will be too little too late without some radical change.
We consider what might be done differently to grow the workforce and adapt to new ways of working, and how professional regulation might help. Our recommendations include considering whether regulated professionals can be trained faster. We believe that the risks posed by the lack of staff is now so severe that a new approach is required. This means regulators, educators and professional bodies exploring whether there are opportunities for accelerating training safely. We also recommend that better and smarter use be made of unregulated roles.
We propose a new strategy for the regulation of health and care professionals to be developed by the four UK Governments to support delivery of their national health and social care workforce strategies.
Accountability, fear and public safety
The report considers how to make individual accountability work in a system that learns from mistakes, is safe for patients and service users, and fair to professionals.
We ask whether professional regulation can do more to explain its role in keeping people safe so that professionals are not practising in fear of unfair sanctions.
We raise questions about how to ensure that the ‘safe spaces’ approach to safety investigations doesn’t cut across the professional duty of candour and individual accountability mechanisms. Regulators may have to investigate and take action relating to individuals involved in a safety incident, and individual accountability plays a key part in keeping people safe in health and care. Further, and understandably, when care has gone wrong, victims and families typically want the truth about what happened. Candour and transparency are key to this.
In order to ensure that ‘safe spaces’ approaches address more risks than they create, we recommend that the UK Government should build in a review of the policy and assess how compatible it is with the professional duty of candour.
The way forward
There have been improvements in health and care regulation, but the patient safety landscape is still fragmented and complex. Concerns often fall between organisations or are left unaddressed due to jurisdiction issues or insufficient powers. Large-scale failures of care still occur frequently, as repeated inquiries testify. That’s why we think a new role is needed to oversee patient safety.
The Health and Social Care Safety Commissioners would help to identify current, emerging and potential risks across the whole health and social care system, and bring about the necessary action across organisations. They would also coordinate public inquiries and reviews, and monitor how recommendations are addressed.
In the meantime, there is action we, the regulators and registers we oversee, the four UK Governments, workforce bodies, employers, registrant organisations, health and social care services, and education bodies, can take to help make the system safer and more coherent. However, it is essential this is done hand in hand with patients, service users and organisations like Patient Safety Learning.
I hope you will read the report and join us in working together towards safer care for all.
- NHS Race and Health Observatory. Ethnic Inequalities in Healthcare: A Rapid Evidence Review. February 2022.
- Atewologun D, Kline R, Ochieng M. Fair to refer? Reducing disproportionality in fitness to practise concerns reported to the GMC. 2019.
About the Author
Alan Clamp is Chief Executive at the Professional Standards Authority.