Regulation of Health and Social Care Professionals Consultation

considerably to 24 members or fewer.
4.5 However, the debate over the strategic role of the General Council goes beyond
relatively straightforward matters such as its size and composition, with many
arguing that Councils should become more board-like in their operation. For
example, the Enhancing Confidence report commissioned by the Department of
Health concluded that Councils should set the direction of the organisation in line
with its mission and purpose, and ensure systems are in place to hold the
executive to account, while Council members should “bring their knowledge, skill
and experience to bear to ensure that all statutory duties are delivered in a costeffective
and appropriate manner”. 4
4.6 This approach is influenced heavily by the work of John Carver, whereby the role
of the Council should be demarcated clearly as deciding the "ends" of the
organisation rather than the "means" by which these ends may be achieved. 5
Under this approach, the Council defines the organisation’s policies, holds the
executive to account for organisational performance and ensures that public
protection is central to all decisions, and Council members are not able to sit on
its internal operational committees. Some of the regulators have already adopted
this approach through informal means such as issuing policy statements on the
proper role of the Council and the role of officials. 6
4.7 Arguably, the major disadvantage with this approach is that it merely tinkers with
a system ill-designed for modern regulation. As noted previously, the role of the
Council was defined largely during the era of self-regulation. General Councils
are essentially voluntary bodies of people whose other job is elsewhere and who
in the past ensured professional control of the regulator.
4.8 Legally, this system is based on the notion that the Councils and its staff are one
and the same, and the majority of statutory functions are therefore given directly
to the General Council. In order to make this work in practice, most Councils
have developed systems of internal delegation to enable the executive to carry
out the day-to-day running of the organisation. This process can be seen as
procedurally cumbersome and ill-suited to, for example, unforeseen
circumstances which require an urgent response. Moreover, it fails to recognise
the significant role played by the executive who in practice are responsible for
operational matters and implementing policy and strategy.
Executive board model
4.9 An alternative approach would be to establish a legal structure which is focused
on the role of the executive, allows it to operate effectively and efficiently, and
builds in a system to hold it to account. Accordingly, the regulators would be
governed by a statutory executive board. The legal duties and powers of the
4 As above, paras 2.2 and 7.1.
5
See J Carver, Boards that Make a Difference: A New Design for Leadership in Non-profit
and Public Organizations (2006).
6 For example, General Dental Council, Matters Reserved to the Council and Matters
Delegated to the Chief Executive (2011).
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