Regulation of Health and Social Care Professionals Consultation

1.14 Second, recent times have witnessed shifting social and political attitudes that
have reflected a decline in trust in expert and governing elites to safeguard public
interests. Traditional social deference is being challenged by a “more demanding,
less deferential, more vociferous” public who are more willing to challenge
professional judgements. 10 Moreover, professional control of information has
been challenged by the development of the internet and greater access to
information about illness and treatment, including information about the quality
and effectiveness of such interventions. UK policy makers have encouraged
people to take more responsibility for their own health (known as
“responsibilisation”). This can be seen, for example, in the proliferation of
statistics and league tables related to public service performance. 11
1.15 Finally, there have been a series of regulatory failures in medicine. Three cases
above all others were instrumental in altering the regulatory landscape, and each
resulted in wide-ranging inquiries into medical professional regulation and
recommendations for reform. These inquiries were the:
(1) Bristol Royal Infirmary Inquiry, which followed revelations that surgeons
had continued to operate on children with heart defects when they knew
their death rates were unacceptably high and a doctor manager had
been alerted to the high mortality but failed to stop the operations; 12
(2) Alder Hey Inquiry into the removal, retention and disposal of human
organs and tissues from children without the consent of their parents
following post-mortem examinations (see also the McLean Report in
Scotland); 13 and
(3) Shipman Inquiry, which arose following the conviction of Dr Harold
Shipman, a general practitioner, for the murder of 15 of his middle-aged
and older female patients by lethal injections of diamorphine. Subsequent
revelations showed that he had in fact killed 215 of his patients. 14
1.16 In addition, the same period saw a series of official investigations into why certain
doctors had been allowed to continue to practise even though concerns had been
raised about their conduct which caused death and lasting injuries to patients;
10
C Ham and K Alberti, “The Medical Profession, the Public and Government” (2002) British
Medical Journal 324, 838.
11 M Dent, “Patient Choice and Medicine in Health Care: Responsibilisation, Governance and
Proto-professionalism” (2006) 8 Public Management Review 3, 449 and S Harrison, “New
Labour, Modernisation and the Medical Labour Process” (2002) 31 Journal of Social Policy
3, 465.
12 Learning from Bristol: the Report of the Public Inquiry into Children's Heart Surgery at the
Bristol Royal Infirmary 1984 -1995 – Final Report (2001) Cm 5207.
13 The Royal Liverpool Children's Inquiry Report (2000-01) No 0012-II and Independent
Review Group on the Retention of Organs at Post-Mortem, Report on Stage 3 (the
“McLean Report”) (2003).
14 The Shipman Inquiry Fifth Report: Safeguarding Patients, Lessons from the Past –
Proposals for the Future (2004) Cm 6394.
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