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Learning across borders. Christine Braithwaite, Director of Policy and Research Douglas Bilton, Research and Knowledge Manager. CHRE’s role. Oversight and scrutiny of regulators Research and policy Partnership and public engagement Quality assurance of voluntary registers
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Learning across borders Christine Braithwaite, Director of Policy and Research Douglas Bilton, Research and Knowledge Manager
CHRE’s role • Oversight and scrutiny of regulators • Research and policy • Partnership and public engagement • Quality assurance of voluntary registers • Extension to care professions
UK health and care professional regulators • General Chiropractic Council • General Dental Council • General Medical Council • General Optical Council • General Osteopathic Council • Health Professions Council • Nursing and Midwifery Council • Pharmaceutical Society of Northern Ireland • Royal Pharmaceutical Society of Great Britain • General Social Care Council
arts therapists biomedical scientists chiropodists / podiatrists chiropractor clinical dental technicians clinical scientists dental hygienists dental nurses dental technicians dental therapists dentists dietitians dispensing opticians doctors hearing aid dispensers midwives nurses occupational therapists operating department practitioners optometrists orthodontic therapists orthoptists osteopaths paramedics pharmacists physiotherapists practitioner psychologists prosthetists / orthotists radiographers speech and language therapists. Regulated health professions in the UK
Scrutiny and Quality – areas of work • Review of regulatory bodies’ fitness to practise decisions • Audit of early stages of fitness to practise decisions • Performance reviews • Special investigations and other performance reviews
Oversight of FtP 2009/2010 • 1835 cases referred to CHRE • 1539 closed without further information requested • Learning points identified in 89 cases • 201 transcripts requested • Learning points identified in 77 further cases • Eight cases considered at case meetings • Six- advice given to regulator • Two- referred to court because of failure to protect the public.
Right-touch regulation ‘Right-touch regulation is based on a proper evaluation of risk, is proportionate and outcome focussed; it creates a framework in which professionalism can flourish and organisations can be excellent. Excellence is the consistent performance of good practice combined with continuous improvement.’ Harry Cayton CHRE Review 2009
Elements of the right-touch approach • Identify the problem before the solution • Quantify the risks • Get as close to the problem as possible • Focus on the outcome • Use regulation only when necessary • Keep it simple • Check for unintended consequences • Review and respond to change
High- quality healthcare The shared responsibility for high-quality healthcare
Recognising a new specialty Surgical podiatrists High quality healthcare
Residual risk Recognising a new specialty Surgical podiatrists High quality healthcare
Recognising a new specialty: conclusion Surgical podiatrists High quality healthcare
Unmanaged risk Regulating a new group Healthcare support workers High quality healthcare High quality healthcare
Residual risk Regulating a new group Healthcare support workers High quality healthcare High quality healthcare
Regulating a new group: conclusion Healthcare support workers High quality healthcare
1. What is the problem? 2. Is the problem about risk? Right-touch questions: step one • No – Stop, don’t regulate. If the problem is not about risk there’s no need to regulate • Yes – go to 3
3. What are the risks? 4. How great are the risks? 5. Are the risks currently managed? Right-touch questions: step two • Yes – Stop, don’t regulate, use the existing solution to manage the problem • No – go to 6
6. Where and why is the problem occurring? 7. Can the problem be solved locally? Right-touch questions: step three • Yes – Stop, don’t regulate, use targeted local approaches • No – go to 8
8. Is there a regulatory solution in line with the principles of good regulation? Right-touch questions: step four • No – consider other regulatory options - go back to 8 • Yes – go to 9
9. Are there any new risks or unintended consequences? Right-touch questions: step five • Yes – Stop, consider other regulatory options - go back to 8 • No – regulate. Review regularly and respond to change
Principles of good regulation • Proportionate • Targeted • Transparent • Accountable • Consistent • Agile
CHRE International Observatory • A collaboration between the UK’s Council for Healthcare Regulatory Excellence and LSE Health, an academic research centre of the London School of Economics
Why are we creating it? • To support international regulatory improvement • To support cross country learning • To identify good practice • To advance knowledge and understanding of health professional regulation • To become a resource that health professional regulators and others can benefit from
What will it do? • Report on how health professionals are regulated in different countries • Produce cross-cutting analytical reports • Operate a rapid-response facility to produce information and advice • Develop a broader research capability
What have we done so far? • Focus on doctors, nurses and pharmacists • Invited the regulators of those professions in 21 countries to become members (54 members to date) • Developed a questionnaire to be circulated to members on how they regulate under five core functions • Work well underway on country reports
Methodology: five core functions • Quality assurance of pre-qualification education • Licensure and registration • Setting and enforcing standards of conduct • Maintaining competence • Discipline
Why this methodology? • Assumes existence of health professional regulation as an entity • Holds across countries and professions • Accommodates structural variation • Avoids strong assumptions • Allows for comparison
What next? • Questionnaire distribution • Web development • Launch early 2011
