Regulation of Health and Social Care Professionals Consultation

taken place with the Right Honourable Stephen Dorrell MP as chair of the House
of Commons Health Select Committee, Dame Janet Smith DBE as the chair of
the Shipman Inquiry, and senior advisers to the Privy Council.
HISTORICAL CONTEXT
1.10 For the best part of 150 years since the establishment of the General Medical
Council in 1858, health care professional regulation was based on a selfregulatory
model. Although definitions vary, self-regulation can be described as a
process whereby an organised group or body regulates the behaviour of its
members without interference from the state. 4
1.11 The emergence of self-regulation is often characterised as being the product of a
bargain struck between the medical profession and the state, with the state
devolving responsibility to the profession to assure the quality of its members and
services. Historically, this was based on the assumption that medical expertise
was beyond the ability of unqualified people to understand or evaluate. 5
1.12 The potential benefits of pure self-regulation were said to include the
development of practicable standards, which were policed effectively because
standard-setting and enforcement was the responsibility of the relevant
practitioners. Furthermore, peer pressure was seen to have created an
environment of high standards of behaviour which was more effective and
responsive than traditional legal methods of regulation. 6 As late as the 1970s the
Merrison Committee examining the role of the General Medical Council
concluded that the regulatory body must also be a professional body. 7
1.13 However, the last 15 years have seen a seismic shift away from self-regulation.
Three sources of pressure can be identified which undermined the legitimacy of
self-regulation and enabled this shift. First, successive Government policies of
market liberalisation and de-regulation transformed and challenged the health
professions in England. Examples include the introduction of payment by results,
expansion of the independent sector and establishment of NHS foundation
trusts. 8 At the same time, Governments across the UK have developed a range
of regulatory tools in relation to certain aspects of decision making, for example
through systems of clinical governance (such as the National Institute for Health
and Clinical Excellence) and service regulation (such as the Care Quality
Commission, Healthcare Improvement Scotland, the Regulation and Quality
Improvement Authority in Northern Ireland and the Health Inspectorate Wales,). 9
4
N Gunningham and P Grabosky, Smart Regulation: Designing Environmental Policy (1998)
pp 50 to 51.
5 See, for example, J Warring and others, “Modernising Medical Regulation: Where Are We
Now?” (2010) 24 Journal of Health Organisation and Management 6, 540.
6
N Gunningham and P Grabosky, Smart Regulation: Designing Environmental Policy (1998)
p 52.
7 A Merrison, Committee of Inquiry into the Regulation of the Medical Profession (1975).
8 See, for example, Civitas, The Impact of the NHS Market (2010) and Kings Fund,
Economic Regulation in Health Care: What Can We Learn from Other Regulators? (2011).
9 See, for example, C Ham and K Alberti, “The Medical Profession, the Public and
Government” (2002) British Medical Journal 324, 838.
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