It matters to midwives – developing professional regulation fit for the future

By Harry Cayton, Chief Executive of the Professional Standards Authority on 09 January 2018 Midwives Consultations

It matters to midwives.

Despite the Secretary of State saying it is 'boring but necessary'. 

It matters to 1.2million health and care workers.

It could save or cost professionals and their employers millions of pounds a year.

It matters to students in training and to the future shape of the workforce.

It is the government's consultation on the reform of professional regulation

There are still a couple of weeks to go so it's not too late to give your views. And your views matter because at heart professional regulation is about the standards that you practice everyday, about maintaining public confidence in midwifery and ultimately about the safety of mothers and babies.

It's easy not to think about regulators. And no harm in that. Regulation is like the drains; we only notice it when there's a smell.  And similarly to our sewers our current model of regulation was created in the 19th century, built in the 20th and is no long fit for purpose in the 21st.

Workforce needs are changing as healthcare changes. Everywhere we face a shortage of the right workers with the right skills. Recent reports suggest there are eighty thousand vacancies in the NHS. According to the RCM and Birthrate Plus estimates , the UK is 3,500 midwives short and latest vacancies in England are running at around 1200. We are also short of 30,000 nurses and General Practitioners are retiring faster than they are being trained. Of course the reasons for the shortage are many; dissatisfaction with pay and working conditions, changes to training, the vote to leave the EU making international graduates feel unwelcome and the fall in the value of the pound making pay less attractive. We are also not alone; there is a global shortage of healthcare workers, some 13 million according to WHO and, in a recent academic paper, predicted to rise to 15 million by 2030.

One of the solutions – and there will need to be as many as there are problems- is to develop new roles, to break down the boundaries between professions. Maternity support workers have an established role within the maternity workforce supporting midwives, there is a need to create healthcare workers who can complement and extend the capacity of doctors or pharmacists or nurses. New roles like nursing associates and physician associates are being created, care assistants are being better trained and sometimes better paid; healthcare providers are identifying needs and filling gaps. And with new roles come personal challenges around delegation, accountability and professional identity.

But will we stifle this workforce innovation and creativity before it grows by regulating it out of existence? Professional regulation creates boundaries and barriers, it defines and specifies, it focusses on individuals not teams and it is a tax on work, pushing up costs for worker and employer alike. And yet the Department of Health is pressing ahead with regulating nursing associates before the role is even properly defined and is consulting on regulating several varieties of physician associates too.

Surprisingly we do have an opportunity to stop the regulatory juggernaut as it crushes innovation under its wheels. The Government is also consulting on serious regulatory reform. It has set out its ideas in Promoting Professionalism, reforming regulation. These ideas include common standards of conduct for all health professions, a reduction in the number of regulators, perhaps from nine to three, replacing adversarial disciplinary procedures with consent and restoration, using intelligence to prevent harm and an objective methodology for deciding what level of regulatory assurance is needed for different occupations. The opportunity for regulatory reform comes rarely. We need to act now to develop professional regulation fit for future healthcare and a future workforce using future technologies.

Therefore it’s absolutely crucial that healthcare workers including midwives and mothers help shape the rules. Regulators are of course seeking to understand the new ways in which the risk of harm to patients may evolve, through an overstretched and depleted workforce, through a lack of resources for training and development, through a loss of focus on monitoring and appraisal or indeed though new technologies and artificial intelligence. But innovation by regulators is itself hampered by their outdated legislation and cumbersome rules and procedures.

In the event of substantial reform of health regulation, the Professional Standards Authority would like to see formal adjudication only for cases where there is a dispute between regulator and registrant over material facts, the decision by the regulator to take action, or the outcome proposed by the regulator. All other cases should be dealt with consensually, including cases where remediation is considered the most effective means of protecting the public. Investigations then would take on a more inquiring role, focused on establishing the facts rather than building a case against the registrant. The process would seek to be less adversarial, and seek cooperation between all involved. The views of patients or service users would be sought as a matter of course and the impact of the professional’s action on them would be taken into account in the decision about the outcome.

Regulator reform is too important to be left only to regulatory nerds as I have become. The Secretary of State himself called reform 'boring but necessary'.  That's an invitation to ignore the consultation but I urge you not to. We need the views of patients and women as service users, midwives and managers and midwifery students. Students and young people who will be working in healthcare in twenty-five years particularly need to contribute their ideas. It’s not too late for RCM members to get on-line and give the government your views. Otherwise change will not happen.

This consultation gives all of us an opportunity to shape a regulatory framework for 2050 and beyond for a very different kind of health workforce. The consultation period is open for a couple more weeks - I hope everyone who cares about healthcare will seize this chance to help create a regulatory framework fit for future health and care services run by a increasingly multi-skilled, flexible and diverse workforce.

Let us know your views – send any comments you may have about the consultation to: [email protected]