In September, the UK regulatory oversight body released a major report on recommended reforms to the regulation of health and social work professions. There is a lot of content in the 55-page report. Our subjective list of highlights for Canadian regulators are as follows:
- To address inequities in the provision of health care and their regulation, regulators should collect demographic data not only on applicants and registrants, but also on complainants.
- Regulators should improve the diversity of their leadership and decision makers (including committees).
- Regulators should review their complaints and discipline processes and their guidance to the professions to address more effectively allegations of racist and discriminatory behaviour.
- It is increasingly important for regulators to not only regulate individual practitioners, but also their business environment, which is often quickly evolving. Business practices of concern include hard sell tactics, overcharging, failing to maintain safe staffing levels, and otherwise putting undue pressure on registrants to meet commercial targets.
- Regulators should take a more aggressive approach in banning financial conflicts of interest where recommendations by registrants create a financial benefit (e.g., referrals in which there is a resulting benefit to the registrant making the referral).
- The report contains an interesting discussion, with persuasive examples, of the regulatory issues associated with telepractice and use of technologically assisted services, including biased algorithms.
- In terms of workforce planning issues, the report states: “In the past, we have held the firm view that professional regulation should not be drawn into adapting standards to respond to workforce issues. We now view this stance as unsustainable; the shortages are so great that the lack of workers may pose a greater risk to patient and service user safety than any changes in standards.” Proposed solutions include quicker training periods, expanded roles for related professions, registering practitioners with a limited scope of practice, recognizing alternative pathways to registration, team-based practice, greater delegation, and supporting better use of technology without unnecessary regulatory barriers.
- The report contains a nuanced discussion about balancing the “blame culture” (with the fear that it generates in registrants leading to undesirable conduct such as overcautiousness and cover ups) and the “just culture” (with its emphasis on making systemic improvements). The report argues that their individual accountability must be maintained even where systemic change is also appropriate. For example, serious individual incompetence or deep-seated altitudinal issues by a registrant often place clients at ongoing risk regardless of the systemic changes made. A predominantly no-fault approach of continuous quality improvement can lead to a lack of accountability and a diminution of expected standards of practice.
There is a lot of detail in the report that warrants reading it in full.