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Regulation of Health Care Professionals Regulation of Social Care Professionals in England Consultation Analysis

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Regulation of Health Care Professionals Regulation of Social Care Professionals in England Consultation Analysis Regulation of health care professionals Regulation of social care professionals in England Consultation Analysis Joint Consultation Paper LCCP 202 / SLCDP 153 / NILC 12 (2012) (Consultation Analysis) 20 February 2013 LAW COMMISSION SCOTTISH LAW COMMISSION NORTHERN IRELAND LAW COMMISSION REGULATION OF HEALTH CARE PROFESSIONALS REGULATION OF SOCIAL CARE PROFESSIONALS IN ENGLAND CONTENTS PART 1: INTRODUCTION 1 PART 2: THE STRUCTURE OF REFORM AND ACCOUNTABILITY 3 PART 3: MAIN DUTY AND GENERAL FUNCTIONS OF THE REGULATORS 30 PART 4: GOVERNANCE 39 PART 5: REGISTERS 56 PART 6: EDUCATION, CONDUCT AND PRACTICE 102 PART 7: FITNESS TO PRACTISE: IMPAIRMENT 133 PART 8: FITNESS TO PRACTISE: INVESTIGATION 145 PART 9: FITNESS TO PRACTISE: ADJUDICATION 184 PART 10: THE PROFESSIONAL STANDARDS AUTHORITY 236 PART 11: BUSINESS REGULATION 247 PART 12: OVERLAP ISSUES 258 PART 13: CROSS BORDER ISSUES 272 PART 14: OTHER ISSUES 284 APPENDIX A: INDEX OF WRITTEN RESPONSES 288 APPENDIX B: CONSULTATION EVENTS 296 i ii PART 1 INTRODUCTION 1.1 This document sets out the responses to the Law Commissions’ consultation paper, Regulation of Health Care Professionals; Regulation of Social Care Professionals in England.1 It describes the views of consultees in relation to each of the 111 provisional proposals and 66 consultation questions put forward. The consultation process 1.2 The consultation paper was published on 1 March 2012. The public consultation process ran from publication until 31 May 2012, and we received 192 submissions. These were received from a wide range of consultees which included: (1) the relevant Government departments for England, Wales, Scotland, and Northern Ireland; (2) the regulators, the Professional Standards Authority, the Northern Ireland Social Care Council, the Scottish Care Council and the Care Council for Wales; (3) non-departmental public bodies, including the Equality and Human Rights Commission and the Care Quality Commission; (4) 26 professional representative bodies; (5) defence organisations and unions; (6) patient representative groups and charities, including the Patients Association, Action Against Medical Accidents and the NSPCC; (7) 4 local authorities; (8) 7 NHS Trusts; (9) academics and legal practitioners; and (10) individual health and social care practitioners and patients. 1.3 A full list of formal written responses is provided in Appendix A. In addition, the Law Commission attended 42 events across England, Wales, Scotland and Northern Ireland. These events covered a wide audience, including regulators, professional bodies, academics, legal practitioners and defence organisations. A full list of events attended is provided in Appendix B. 1 Regulation of Health Care Professionals, Regulation of Social Care Professionals in England (2012) Law Commission Consultation Paper No 202; Northern Ireland Law Commission Consultation Paper No 12; Scottish Law Commission Discussion Paper No 153. 1 1.4 We are very grateful to all those who took part in consultation events and submitted formal responses. Next steps 1.5 Nothing in this document should be read as indicating that the Law Commissions have come to any conclusions about our final recommendations. All of our provisional proposals will be reviewed in the light of the evidence received at the consultation events and the formal responses to our consultation paper from individuals and organisations. Our final report and draft Bill will be published in early 2014. 2 PART 2 THE STRUCTURE OF REFORM AND ACCOUNTABILITY Provisional Proposal 2-1: All the existing governing legislation should be repealed and a single Act of Parliament introduced which would provide the legal framework for all the professional regulators. 2.1 A large majority of consultees who expressed a view agreed with this proposal.1 For example, the General Medical Council argued that: A single, overarching Act focused on high level principles will support overall consistency across health care regulation while releasing individual regulators to develop policies and operational approaches appropriate to the circumstances of the professions they regulate. 2.2 Similarly, the Professional Standards Authority argued that: based on our experience of reviewing the performance of the health professional regulators, such a move would provide greater consistency of approach and outcome, enable the legislation pertinent to all regulatory bodies to be changed at the same time and provide the prospect of better understanding of regulation by registrants and the public. 2.3 The Chartered Society of Physiotherapy thought that the proposal: should streamline arrangements, thereby increasing effectiveness and efficiency, and achieve greater transparency, commonality of approach and public understanding. All this should enhance both patient safety and clarity for registrants. 2.4 The General Pharmaceutical Council felt that a single Act presented “opportunities for regulators to learn and adapt from best practice more quickly”. Others argued that the existing legislative structure encourages the regulators to work in silos and inhibits joint working and the sharing of functions and facilities. 2.5 A small number of consultees expressed qualified support for the proposal. For example, the British Medical Association felt that unless there is “sufficient flexibility to ensure each regulator can reflect its profession”, the single Act could prevent innovation. The Academy of Royal Medical Colleges noted that “the different circumstances in which the regulators operate may mean that differences are justifiable and sometimes vital to their work”. 2.6 The proposal was opposed outright by the Royal College of Midwives which argued that a single statute would entail dismantling essential regulatory frameworks. The Royal College supported a system which recognises 1 Of the 192 submissions which were received, 35 expressed a view on this proposal: 31 agreed, 1 disagreed, whilst 3 held equivocal positions. 3 professional differences and where nursing is not combined with midwifery. Moreover, at consultation events, a small number of attendees felt that separate statutes for each profession recognised the status and uniqueness of each profession, and therefore ensured professional buy-in and support. Provisional Proposal 2-2: The new legal framework should impose consistency across the regulators where it is necessary in order to establish the same core functions, guarantee certain minimum procedural requirements and establish certain core requirements in the public interest. But otherwise the regulators should be given greater autonomy in the exercise of their statutory responsibilities and to adopt their own approach to regulation in the light of their circumstances and resources. 2.7 An overwhelming majority supported this proposal.2 However, in general terms, consultation responses were divided between those who supported greater autonomy and those who wanted greater consistency imposed across the regulators. Support for greater autonomy 2.8 Most of the regulators supported the need for enhanced autonomy. For example, the General Optical Council argued that consistency should not be imposed “for its own sake at a high level”, but limited to certain “core principles”: The areas in which consistency is sought across regulators through the overarching legislation will need to be carefully chosen, and appropriate safeguards and opportunities for collaboration put in place to ensure an appropriate balance is maintained in respect of consistency and regulator flexibility. 2.9 The General Medical Council also felt that consistency should be limited to certain “core principles”: It would be wrong for the statute to impose a “one size fits all approach” and regulators must have the policy and operational autonomy to develop regulation in the way that is most appropriate to the sector. 2.10 The General Osteopathic Council also emphasised that: Consistency should not imply uniformity. Each regulated profession operates in different circumstances and at different stages of development that determine the most appropriate way for them to be regulated. It is also important to recognise that innovation in the field of regulation comes from regulators doing things differently, not working to a single set formula. 2.11 The General Dental Council argued that the compulsory elements of the legal framework should be “carefully chosen” and that: 2 Of the 192 submissions which were received, 54 expressed a view on this proposal: 52 agreed, whilst 2 held equivocal positions. 4 Simplicity and consistency should not be at the expense of an individual regulator’s ability to deliver its functions in a way that is suited to the profession concerned and which promotes confidence in its regulation. 2.12 The General Social Care Council suggested economic reasons for flexibility: The increase in referrals which many professional regulators have experienced over recent years, as well as the expectation from Government (and the professions) that the cost of regulation should not be increased, makes this ability to react to changed circumstances imperative. 2.13 A number of professional bodies also supported increased autonomy. For example, the Royal College of Physicians in Edinburgh felt that “regulators must have autonomy to adapt their own approach in light of their circumstances and resources”. Support for consistency 2.14 Many consultees expressed concern that our proposal failed to impose greater consistency across the regulators. For example, the Allied
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