Sheila Drayton - The rocky road to Regulation
Professional groups have long recognised the benefits of statutory regulation for both themselves and for their client groups: be they patients, pupils, or service users. Regulation provides the service user with reassurance that the professional is registered and therefore qualified and required to maintain certain standards. The professional benefits from the role being reserved to those registered with the statutory regulator. For example, the requirement for maintained schools and FE colleges in Wales to employ teachers and lecturers registered with the Education Workforce Council.
The medical profession was one of first professions in the UK to achieve statutory regulation, and that was in 1858. But the road to regulation has proved far more challenging for many groups, and much depends on the attitude of the government of the day.
Nursing Notes of January 1891 was full of hope that the year would see, “the passing of the Midwives Act so urgently needed for the protection of lying-in women”. In fact it was to be a further 11 years before the Midwives Act was passed in 1902. Nurses had to wait until 1919 for the Nurses Registration Act, and the General Dental Council was not established until 1956. The General Teaching Council for Scotland was established in 1965 following concerns that entry requirements for teaching had lowered after the Second World War.
The new millennium saw an increased interest in raising standards through statutory regulation, and in 2000 the General Teaching Councils (GTCs) for Wales and England were established. The GTCs for Northern Ireland and Ireland followed in 2002 and 2006 respectively. The General Social Care Councils for social workers were established in 2001, and the Health Professions Council came into being in 2002. It is now the Health and Care Professions Council (HCPC), and regulates 16 professions, including physiotherapists and psychologists.
Professional groups continue to seek the benefits of statutory regulation. Amongst others, the Healthcare Scientists presented their case, and were recommended for regulation by HCPC. However, the incoming coalition government had a different attitude towards regulation, and in 2011 the government stated that, in the future, statutory regulation will only be considered in ‘exceptional circumstances’i . Further, in 2012, the UK Government closed both the General Social Care Council and the GTC in England. The other three countries of the UK retained their Teaching and Social Care Councils.
The overarching role of most statutory regulators is to ensure that the public receive a safe and competent service from their registrants. The aims of the Education Workforce Council (EWC) include; ‘to maintain public trust and confidence and to safeguard the interests of learners, parents and the general public’.
In order to achieve this, the majority of regulators,
- Set standards for Education and Training
- Set standards of competence or proficiency
- Maintain a Register
- Set standards of conduct
- Set standards of continuing professional development
- Investigate complaints against registrants
These are core processes. They ensure that professionals are suitably qualified, maintain their knowledge and skills, and adhere to standards of conduct. The very few registrants who undermine public trust in the profession are investigated, and if necessary removed from the register. In this way, the profession continues to enjoy public confidence, which in turn underpins the profession’s status in society. Currently, the EWC does not undertake all of these functions, but the Education Minister is considering a wider role for the Council.
In the 1990s it was not unusual for regulatory councils to have more than 50 members; the majority from the profession. As recently as 2006, the General Medical Council (GMC) had over 30 members. There has, however, been a steady trend towards smaller, more board like councils, with increased lay representation. The GMC, the Nursing and Midwifery Council (NMC) and the HCPC now have 12 members each, six of whom are lay and six are registrants. All members are appointed by open competition against specified competencies. The lay members frequently bring a wide range of additional skills to the work of the council.
The councils work as boards, convening sub groups to address specific issues. The HCPC registers 16 professions so not all are ‘represented’ on the Council. However, good professional (and lay) input is central to its decision making. For example, it convened a working group involving professionals as well as other stakeholder groups to review its standards of conduct, performance and ethics.
The cost of investigating complaints and holding Fitness to Practise (FtP) hearings is usually the greatest expense for regulators. The procedures have to be fair to the registrant and to the complainant, and they have to be seen to be fair. This is a high profile activity for regulators, and it is central to maintaining public trust and confidence.
Historically, the professions valued statutory regulation and funded it themselves. That continues today with the majority of professions funding their own regulatory body through fees. In the public sector this includes nurses, midwives, the 16 professions registered by HCPC, osteopaths, chiropractors, doctors, and dentists. Fees are normally paid annually. The level of the fee is influenced by the regulator’s costs and the number of registrants. The NMC has in excess of 600,000 registrants and the annual fee is £120. Nurses are responsible for paying the fee themselves directly to the NMC. The HCPC has over 300,000 registrants who pay £80 annually, whilst the General Chiropractic Council with approximately 3000 registrants has a fee of £800 annually.
There are one or two regulators that are part funded by government and indeed this is the model for the EWC. School teachers in Wales who work in maintained schools also receive a subsidy towards their registration fee. Such practices however are rare and there are those who would argue that government support detracts from the independence of the regulatory body, but that debate has yet to be had in the teaching profession.
Turning now to the Education Workforce Council and the future: statutory regulation is hard won, and therefore it should be valued by the profession, by their representatives, and by those who employ teachers. Working together these groups will influence the quality of regulation and the extension of regulation to other groups in the education workforce. The EWC will be welcomed by the public who have come to expect professionals to be registered, and value the reassurance that regulation brings.
Sheila Drayton is a former health service director and professional and organisational development consultant. In parallel, Sheila has 20 years experience of serving as a council member with regulatory bodies for nursing, teaching and healthcare professionals, and continues to chair Fitness to Practise proceedings for the General Teaching Council for Wales. Sheila has provided training in regulation and in Fitness to Practise procedures for other regulators including Social Care Councils.
i. Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers, Department of Health, February 2011.