The Future of Regulation and Podiatric Surgery

2. The Future of Regulation and Podiatric Surgery What will it mean for future determination of scope and practice? The Bob Prince Lecture by Pam Sabine

3. The Future of Regulation and Podiatric Surgery • Why do we need regulation? • Surely we can continue to regulate ourselves? • Is it possible to exist outside regulation nowadays?  • Do we want to be regulated on a separate part of the Register, or be annotated on the existing Chiropodist/Podiatrist part? • In going for a separate part of the register we might give away more than we gain.

4. The Future of Regulation and Podiatric Surgery • Potentially we might: • Give away our common educational background. • Give away our licence to practise as Podiatrists. • And... • Need to develop a way of qualifying as a Podiatric Surgeon, as a stand alone profession, with separate Standards of Proficiency.

5. The Future of Regulation and Podiatric Surgery • The alternative is to annotate the current register, against evidence of training and qualification as a Podiatric Surgeon. (c/f POMS and LA, as well as Supplementary Prescribing). • For those who are not regulation ‘anoraks’, this may seem unnecessary. However, to ignore the past and Government imperatives would be foolish and potential suicide.

6. The Future of Regulation and Podiatric Surgery Why the HPC?? “Professionals only have duties – they do not have privileges. They have duties over and above the duties of being a citizen”. (Professor Sir Ian Kennedy, Chairman of the Healthcare Commission, 2005)

7. The Future of Regulation and Podiatric Surgery How did we get to where we are with current regulation?

8. The Future of Regulation and Podiatric Surgery "Chiropody means and includes the diagnosis and medical, mechanical and surgical treatment of the foot ailments such as abnormal nails, bunions, corns, warts and callosities, but it does not include the performance of operations for which an anaesthetic is required". (Chiropodists (Registration) Bill, 1928, promoted by Viscount Novar)

9. The Future of Regulation and Podiatric Surgery • "As soon as possible, the services of a chiropodist should be made available in every general hospital and in those special hospitals and clinics where they are particularly required". • (Cope Report, 1951)

10. The Future of Regulation and Podiatric Surgery The move away from professional self regulation ‘The paramount aim of regulation should be protection of the public’. All other aims should be subordinated to this one. How can the paramount aim be achieved in the absence of high standards and appropriate educational processes?

11. The Future of Regulation and Podiatric Surgery While raising educational standards is desirable in general, it is not necessarily in the public interest, if it excludes the ‘less academic’ from training for clinical practice or leads to higher costs for the service providers. We believe the main focus for the regulatory body should be to ensure appropriate standards to protect the public’. (JM Consulting – letter to stakeholders, 1995).

12. The Future of Regulation and Podiatric Surgery If the face of Parliament is turned towards the East, what can be done to turn it towards the West?

13. The Future of Regulation and Podiatric Surgery Equity and Equality – do they exist in current regulation?

14. The Future of Regulation and Podiatric Surgery How will the standards look?

15. The Future of Regulation and Podiatric Surgery Hamstrung by the letter of the law or just open to interpretation? Which 50%?

16. The Future of Regulation and Podiatric Surgery • Grandparenting - How would we assess competence? • “Article 13 of the order provides a transitional pathway to registration, which is open to those who can demonstrate that they have been practising safely and effectively or that their qualifications and experience are comparable to the current requirements for registration. In that context, perhaps I may make clear that in either case the HPC may, but need not, require them to pass a test of competence’. (Baroness Hayman, Hansard)

17. The Future of Regulation and Podiatric Surgery Competence versus proficiency. • Competence: the condition of being capable. • Competent: having sufficient skill, knowledge etc., capable; suitable or sufficient for the purpose. • Proficiency: the noun from proficient. • Proficient: having great facility (in an art, occupation, etc.); skilled. An archaic word for an expert – from the Latin ‘proficere’.

18. The Future of Regulation and Podiatric Surgery • Personal Responsibility • ‘there must be agreed and published standards of clinical care for healthcare professionals to follow, so that the patients and the public know what to expect’ (Bristol Royal Infirmary Enquiry ‘Learning from Bristol’)

19. The Future of Regulation and Podiatric Surgery • ‘Post–registration qualifications should be recorded in the Register where these are relevant to patient care, risk management and are at a level substantially beyond the requirementsfor basic registration’. (Trust, Assurance and Safety, 2007)

20. The Future of Regulation and Podiatric Surgery Where do trust and regulation overlap? • ‘Harold Shipman would, of course, have passed any appraisal of fitness to practise with flying colours’ (Osbourne & Osbourne 2005). • ‘The efforts to prevent the abuse of trust are gigantic, relentless and expensive; their results will always be less than perfect’ (O’Neill 2002).