The ‘new’ NHS: opportunity or threat for advanced clinical practice?

Monica Duncan discusses the implications of the Health and Care Bill 2021 for advanced clinical practice and professional regulation.

Response—Corruption, Trust, and Professional Regulation

In their 2018 article in the Cambridge Quarterly of Healthcare Ethics, Little, Lipworth, and Kerridge unpack the concept of corruption and clarify the mechanisms that foster corruption and allow it to persist, noting that organizations are “corruptogenic.” To address the “so-what” question, I draw on research about trust and trustworthiness, emphasizing that a person’s well-being and sense of security require trust to be present at both the individual and organizational levels—which is not possible in an environment where corruption and misconduct prevail. I highlight similarities in Little et al.’s framing of corruption to the persistent problem of scientific misconduct in research and publishing. I acknowledge the challenges in stemming corruption in science and medicine and conclude with a discussion about the need to reinvigorate a web of stakeholders to actively engage in professional regulation.

Insights on Professional Identification and Licensure from Community Practice Social Workers

This article describes a qualitative study designed to explore both how community practice social workers identify professionally and to examine their view towards professional regulation. Thirty-five MSW-level social workers in a large metropolitan region who self-identified as community practice social worker participated in in-depth interviews. The respondents shared their views regarding professional identification as social workers and the impact of professional identity on their work as community practitioners. Approximately half of the respondents indicated that they only sometimes or never identify as a social worker. The respondents were generally critical of the licensing burden placed upon them as community practice social workers.

From the community handywomen to frontline heroes: Charting a century of Irish nursing and midwifery regulation

This paper argues that professional regulatory frameworks are shaped by sociocultural factors and prevailing ideologies that stem from society’s interactions with and expectations of the regulated professions. Taking a century of Irish nursing and midwifery regulation as a case reflection, the paper highlights five regulatory pivot points to provide a historical narrative of how adopting a sociocultural perspective can enlighten our understanding of the current regulatory form. A form that in early twenty-first-century Ireland resulted in the establishment of a professionally contentious, non-professional (lay) majority on the regulatory board for these frontline professions. The paper concludes by suggesting that when viewed through a sociocultural lens, regulatory change is to be expected. As prevailing ideologies change, power, influence and cultures alter to support and reinforce the new ideology. Professional regulation thereby becomes reflective of society’s views on professionalism and professional identity, drawing on society’s historical experiences of the professions.

The regulation of healthcare professions and support workers in international context

Background The objective of this paper is to outline and compare the regulation of paid healthcare professions and associated support workers in international context, bringing out the lessons to be learned as appropriate. Modern neo-liberal societies have sought to enhance healthcare through greater professional regulation, albeit in different ways and at variable pace. This general trend is illustrated with reference to medicine in the UK. However, although such reforms have helpfully cascaded to other health professions, government policy in high-income countries has not yet adequately regulated the interrelated group of non-professionalised health support workers who form the largest and least recognised part of the workforce. Nonetheless, in low- and middle-income (LMIC) countries—aside from the greater need for regulation of health professions—there is even more of an imperative to regulate the disparate, largely invisible support workforce. Methods With reference to existing studies of the medical and wider health professions in the UK and selected other higher income societies, the importance of health professional regulation to the public is underlined in the Global North. The larger gap in the regulation of support workers in modern neo-liberal countries is also emphasised on a similar basis, with an increasingly ageing population and advances in healthcare. It is argued from the very limited patchwork of secondary literature, though, that policy-makers may want to focus even more on enhancing regulation of both the professional and non-professional workforce in LMIC societies centred mainly in the Global South, drawing on lessons from the Global North. Results/conclusions Efforts to reform health professional regulatory approaches in more economically developed countries, while needing refinement, are likely to have had a positive effect. However, even in these societies there are still substantial shortfalls in the regulation of health support workers. There are even larger gaps in LMICs where there are fewer health professional staff and a greater dependence on support workers. With higher rates of morbidity and mortality, there is much more scope here for reforming health regulation in the public interest to extend standards and mitigate risk, following the pattern for healthcare professions in the Global North.

Licensed professions: a new look at the association between social origins and educational attainments in Italy

It has long been known that Italy is characterized by the highest levels of professional regulation in Europe, but little attention has been given to the link between professional regulation and educational stratification. This article investigates the association between social origins and education by focusing on fields of study within tertiary education and by disaggregating the upper class of social origin into different micro-classes of professionals. Thus, since these professions are regulated in the first place by educational fields of study, it assesses how processes of social closure enhance occupational intergenerational immobility in the professional employment in Italy. Recently, deregulation of liberal professions in Italy has been central in many public and political debates. It contributes to these debates by examining the micro-level dynamics in the professionals’ social reproduction and related practises of social exclusion, which may have strong implications for policy interventions. By using ISTAT’s “Sbocchi Professionali dei Laureati” survey (2011), and employing multinomial logistic regressions, it shows how social selection into highly regulated fields of study is guided by parents’ professional domain. The analyses indicate that both sons and daughters of licensed professionals are more inclined to graduate in a field of study that is in line with the father’s profession and that this propensity is stronger among children of regulated self-employed professionals.

Bar Authorities and Prosecutors

The professional regulation of U.S. prosecutors is primarily the responsibility of state judiciaries, which regulate all attorneys, including prosecutors, through the adoption and interpretation of professional conduct rules and by enforcing these rules in the attorney discipline process. Although Bar associations have no formal role in regulating prosecutors, they wield informal influence by drafting and interpreting the professional conduct rules that state judiciaries adopt and by publishing standards that offer guidance to prosecutors. Ultimately, professional regulation has limited practical significance for U.S. prosecutors because many professional conduct rules are inapplicable or minimally applicable to their work, and because those rules that do apply (such as those governing attorneys’ advocacy) are uncontroversial and largely coextensive with constitutional law and other law governing prosecutorial misconduct. The rules do not significantly address prosecutors’ charging and plea bargaining decisions—controversial areas of practice relegated to prosecutorial discretion—and do not codify some professional expectations, such as those regarding prosecutors’ heightened duty of candor, that are expressed in court decisions and in unenforceable guidelines. Occasionally, the Bar has tried to persuade courts to adopt more demanding rules for prosecutors or to interpret existing rules more demandingly. Prosecutors have generally opposed these efforts, which have achieved limited success while exacerbating tensions between prosecutors and the Bar. Consequently, professional conduct rules do not fully capture the conventional understanding that prosecutors have a unique professional role that gives rise to different and, in some respects, more demanding professional obligations than those of other lawyers. The professional conduct rules have only limited influence and do not constrain some of prosecutors’ most controversial and troublesome decisions and behaviors.