Regulatory system patient safety priority

Accept

System and professional regulators have an overarching statutory objective to protect, promote and maintain the health, safety and wellbeing of the public.

The healthcare regulators referenced in the inquiry (GMC, NMC and CQC) exist to protect patient safety and this is reflected in their new corporate strategies. They have also taken a number of actions to encourage information-sharing between organisations, and to enable patients and professionals to raise concerns.

DHSC’s 2021 consultation regulating healthcare professionals, protecting the public sets out proposals that address the issues raised in the inquiry, including a proposal to place a duty to co-operate on all regulators.

DHSC plans to draft legislation in relation to the GMC in 2022.

The government accepts this recommendation in full. Patient safety is at the heart of healthcare regulation, and both system and professional regulators have an overarching statutory objective to protect, promote and maintain the health, safety and wellbeing of the public.

The Government’s regulatory reform programme will modernise the legislative frameworks for healthcare professionals in the United Kingdom. We are currently consulting on the draft General Medical Council Order, with further information available on the GOV.UK website, and this includes provisions that aim to deliver greater collaboration between regulators, and organisations and persons listed in Article 14 of the order. The intention is to improve the regulation of health and care professionals and the services they provide or contribute to. This could be through engagement or by sharing of information. The same provisions will be rolled out to the rest of the professional regulators when their legislation is subsequently modernised.

This recommendation predates the merger of Monitor and the NHS Trust Development Authority into NHS England with a single oversight framework now in place which seeks to ensure the alignment of priorities across the NHS and with wider system partners including Integrated Care Boards.

Professional regulators are members of the Joint Strategic Oversight Group (JSOG), which was established to support the joint working of regulators and oversight organisations including the GMC, Nursing and Midwifery Council (NMC), Health Education England (now part of NHS England) and CQC. JSOG is the forum for sharing intelligence, enhancing the sharing of information and coordinating regulatory action in response to safety concerns.

In addition:

• NHS England and the CQC are committed to working together to deliver the statutory duty set out in the Health and Social Care Act 2012 to co-operate and to deliver their common purpose to improve outcomes for patients. NHS England also continues to work to form wider strong working relationships with regulators through various channels.
• CQC, NMC and GMC have launched new strategies with a focus on collaboration and patient safety and also worked together on a shared data platform, initially for maternity services, to help share data and identify concerns.
• The National Quality Board has published National guidance on System Quality Groups (SQGs), including how SQGs can share intelligence to identify quality concerns and risks in an ICS. This guidance explicitly includes Independent Sector providers within its scope. Risk surveillance tools, such as the quality risk profile tool, are additionally in use and inform these discussions to identify quality concerns, share intelligence across organisations and co-ordinate interventions to support providers.

The Government is clear that sexual violence or misconduct is unacceptable and has no place in the medical profession. It is currently considering its approach to healthcare professional regulation, including whether to remove any legislative restrictions which prevent certain regulators such as the GMC from being able to consider sexual abuse allegations more than five years after they came to light.

The Department of Health and Social Care has been working on changes to the Medical Profession (Responsible Officers) Regulations 2010, intended to strengthen clinical governance arrangements and improve patient safety. The work had been split into two tranches, with the aim of making legislative changes in the later part of 2024; exact timings are subject to views and priorities of the new Government.

In December 2023, the government laid legislation to bring Anaesthesia Associates and Physician Associates into statutory regulation. This legislation was designed to act as a blueprint for the wider reform of all healthcare professional regulators’ legislation. Subject to views from ministers, this legislation could be further developed and used to reform all healthcare professional regulators’ legislation over the coming years.

Action 8.1 Actions include:

CQC, NMC and GMC have launched new strategies with a focus on collaboration and patient safety.

CQC, NMC and GMC have also worked together on a shared data platform, initially for maternity services, to help share data and identify concerns.

CQC has been rolling out a new regulatory model accompanied by a new single assessment framework.

NQB has published National guidance on System Quality Groups, including how SQGs can share intelligence to identify quality concerns and risks in an ICS. This guidance explicitly includes IS providers within its scope.

DHSC is also bringing forward a programme of reform through a series of statutory instruments from the end of 2023 to modernise the regulatory system for healthcare professionals, including a consistent duty to co-operate for all healthcare regulators. DHSC is working on changes to the Medical Profession (Responsible Officers) Regulations 2010 and is aiming to lay the reformed regulations in Summer 2024.

Action 8.1:

Accepted by the government in full.

The steps undertaken by the regulators as detailed above to encourage information-sharing and through provision of new guidance also contribute to this.

The government proposes to provide a consistent regulatory framework for fitness to practise across all professional healthcare regulators. Our proposed changes will enable faster resolution of cases and deliver public protection more quickly. It also proposes to remove the 5-year rule, which was highlighted by the inquiry as a potential barrier to public protection. The removal of the 5-year rule will ensure that regulators are able to investigate concerns based on evidence, rather than an arbitrary time limit. This will form part of the Department of Health and Social Care consultations on legislation (below).

The Department of Health and Social Care published a 2021 consultation which sets out proposals that address the issues raised in the Inquiry, including a proposal to place a duty to co-operate on all regulators.

The Care Quality Commission has published the new single assessment framework and is in the process of developing a new regulatory model, with this due to be rolled out in 2023.

The Department of Health and Social Care is working on changes to the Medical Profession (Responsible Officers) Regulations 2010 and expected the reformed regulations to be laid in spring or summer 2023. It was also preparing a series of statutory instruments to achieve a programme of reform to modernise the regulatory system for healthcare professionals, including a duty to co-operate. The first statutory instrument was due to be introduced at the end of 2023.

These documents are still outstanding; there was a consultation in 2021 on regulating healthcare professionals which concluded in February 2023, and there is a further consultation on the draft legislation which is in progress, with responses being closed in May 2023.

We still think that improvements are needed to the structures in place to identify and act on safety risks and prevent another Paterson.