Protecting the Public Interest

Sandy Forrest, Director CHRE

CHRE Responsibilities:

(a) Promote the interests of the public and patients in relation to the regulation of healthcare professions

(b) Promote best practice in healthcare regulation

(c) Develop principles for good professionally-led regulation

(d) Promote co-operation between regulators and with other organisations

(NHS Reform and Health Care Professions Act 2002 – Sec 25)

CHRE Powers

o … the council may do anything which appears to it to be necessary or expedient for the purpose of, or in connection with, the performance of its functions (Sec 26(1))

o For example:(a) investigate, and report on, the performance by each regulatory body of its functions(b) where a regulatory body performs functions corresponding to those of another body (including another regulatory body), investigate and report on how the performance of such functions by the bodies in question compares(c) recommend to a regulatory body changes to the way in which it performs any of its functions (Sec 26(2))

Section 29 Cases

o CHRE have dealt with 1123 cases

o Only 92 were pharmacists

o Only 5 resulted in Sec 29 Case Meetings

o 24 cases to Court - no pharmacists (one case reconsidered by RPSGB)

o 2 Meetings with RPSGB and 1 with PSNI re learning points

Numbers of Registrants

NMC 660,500GMC 200,000HPC 156,000 RPSGB 48,000GDC 32,500GOC 17,000GOsC 3,500GCC 2,200PSNI 1,800

CHANGE

Why is change necessary?

CHANGE

Why is change inevitable?

‘Whole Industry’ Regulation

This Government has an apparent liking for ‘Whole Industry’ regulation viz:

OfgemOfcom

Ofsted

The “Burden of Regulation”

“But it is also right to lessen the burden of regulation and enhance our flexibility while still ensuring high standards.”

(Gordon Brown, Budget Speech 16 March 2005)

...and ‘Rationalisation’

o The Lyons Review (getting out of London)

o The Gershon Review (back office savings)

o The Arms Length Bodies Review (reducing number, staffing and cost of ALBs)

o Modernising the NHS Workforce(developing new Roles)

ALB Review Report

The Council for the Regulation of Health Care Professionals (CRHP) will continue to oversee the various statutory professional self-regulatory bodies (themselves beyond the scope of the ALB Review) and to facilitate closer working between them. It may need to develop a stronger role over time as part of the process of development referred to in the NHS Improvement Plan (paragraph 2.29). This is expected to lead to a greater commonality of approach across the professional regulatory bodies, possibly extending to include the regulation of social care staff. We do not propose to extend CRHP’s functions at this stage, but the position will be reviewed in the light of the report of the Shipman Inquiry, which is expected later in 2004. In the meantime, CRHP is exploring the potential for the professional regulatory bodies to make savings by sharing back-office functions."

‘It’s a Scandal!’

o Bristol Royal Infirmary o Nealeo Aylingo Shipmano Kerr/Haslamo Soham (Bichard Inquiry)

Neale Inquiry Report

“We Recommend: 1. That the Secretary of State for Health should consider setting up a new body, or expanding the power of an existing body such as the Council for Regulation of Healthcare Professionals, to take an overarching view of all aspects of the rules governing the appointment and employment of doctors. This body should have the necessary powers of investigation in the wider interests of patient safety, ensuring a robust and consistent approach to individual concerns that may arise in the future. (see page 217). This would give CRHP the ability to investigate concerns that arise over regulation of doctors, such as Richard Neale”

Ayling Inquiry Report

2.30 We therefore recommend that the DH convene an expert group under the auspices of the Chief Medical Officer to develop guidance and best practice for the NHS on this subject (ie sexualised behaviour). The group should include the NHS Confederation, the RCOG, the RCGP (and other Colleges as appropriate, such as the Royal College of Psychiatrists), the NCAA, the CRHP, the GMC and representatives of undergraduate and postgraduate medical education. The group should take advice from experience of dealing with “sexualised behaviour” elsewhere in the public sector such as educational services and from health care systems in other countries such as Canada.

Fifth Report of the Shipman Inquiry

• “The Council for the regulation of Healthcare Professionals (now known as the Council for Healthcare regulatory Excellence) should be invited to set up a panel of professionals and lay people (similar in nature to the Sentencing Advisory Panel) which should  assist in the process of developing the necessary standards, criteria and thresholds (recommendation 56 .p 58 and Ch 21 and para 27.230)”

• “There should in the future be a review of the powers of the CRHP/CHRE with a view to ascertaining whether any extension of its powers and functions is necessary to enable it to act effectively to ensure that patients are sufficiently protected by the GMC (recommendation 159 and para 27.283 and Ch 21)”

• “In three to five years’ time there should be a thorough review of the operation of the new FTP procedures, to be carried out by an independent organisation.  This task should be undertaken by or on the instructions of the CRHP/CHRE ) Para 27.307” (R105)

Kerr-Haslam Inquiry Report

The Secretary of State should invite CHRE to consider (with a grant of additional powers if necessary), in relation to the regulation of healthcare professionals, the application of common standards, practices and procedures so that patient safety can more effectively be protected.

Govt. Response to Shipman 4

The Government will in England:

• discuss with the CHRE and with the professional regulatory bodies the best way to strengthen professional and ethical guidance on:(a) prescribing beyond the limits of one’s competence and experience(b) prescribing for oneself(c) providing treatment on a regular basis or prescribing for one’s immediate family; and(d) prescribing outside a genuine professional relationship, making clear in each case their particular application to controlled drug prescribing

• work with CHRE to encourage the GDC, RPSGB and NMC, and other professional regulatory bodies where appropriate, to follow the GMC in placing prescribers under a professional obligation to notify them of any controlled drug-related convictions or cautions within a reasonable period of time para 3.22 (pp31-32)

Govt. Response to Shipman 4

…cont./

• work with the CHRE to encourage the GDC, RPSGB, NMC and other professional regulatory bodies to develop transparent arrangements for internal and external audit of the decisions taken by their fitness to practise committees

• work with the CHRE and with professional regulatory bodies to issue NHS and professional guidance to the effect that single prescriptions of controlled drugs should normally be limited to a supply of 28 or 30 days, and clearly defining the clinical reasons which might justify a longer supply

Bichard Implementation Project

Bichard Vetting and Barring Scheme (BVBS)

for people seeking work, paid or unpaid, with children or vulnerable adults (Rec. 19 in the Bichard Report into systemic failures highlighted by the Soham murders).

Phased introduction (starting with anyone ‘joining or moving’ in relevant positions)

will commence in mid-2007, with back-conversion to the rest of the relevant population over a 5 year period thereafter.

It’s Review Time

o CMO Review of the GMC

o Andrew Foster’s Review of ‘Non-Medical’ Regulation

CMO Review - REMIT

The review will identify measures to:

• Strengthen procedures for assuring the safety of patients in situations where a doctor’s performance or conduct poses a risk to patient safety or the effective functioning of services

• Ensure the operation of an effective system of revalidation

• Modify the role, structure and functions of the General Medical Council (GMC)

Foster Review - REMIT

• Effective fitness to practise procedures for dealing with allegations that a professional is not safe to practise

• Measures needed to ensure that practitioners undertake effective continuing professional development to maintain their fitness to practise

• What measures are needed for staff working in new roles, and support staff who are not regulated at present, and

• Whether any changes are needed to the role, structure, functions and number of regulators.

Foster Review ‘Themes’

o Demonstrating Initial and Continuing Fitness to Practise

o Fitness to Practise Investigationso Regulation of Healthcare Support Workerso Regulation of New Advanced Practitioner Roleso How does regulation fit into the context of

issues currently facing health serviceso The role, functions, governance, structure and

numbers of regulatorsAlso developing Common definitions

ISSUES IN PHARMACY

o Promoting the professiono Regulating organisations and

premiseso Governance arrangementso Range of FTP Sanctions

Admonition, reprimand, removal, refusal to reinstate, removal of all/some business premises – use of adjournment

Section 60 Order

o Interim Orderso Conditionso Suspensiono A Health Committeeo Power to require information

Big Issues

o Number of Regulatorso A ‘Single Act’ or Section 60 Orderso Outsourced Adjudicationo Tiered regulation ie defining roles of

registrant, employer, and regulatoro Regulation of Studentso Revalidation