Regulating the regulators: the rise of the United Kingdom Professional Standards Authority

In the United Kingdom reforms to professional regulation have been introduced to enhance public protection. This chapter accounts for changes from 2002 to 2016 with the introduction of a meta-regulator to oversee nine statutory professional Councils. It examines the expansion of the role of the meta-regulator and reforms within the professional councils themselves. It draws on data collected to show increases in costs and activity and explains the shift from self-regulation to top-down governance using corporate management techniques of audit and review. It demonstrates that the reforms have been evolutionary and that further reform is ongoing.

The regulation of health care in Scandinavia: professionals, the public interest and trust

Scandinavian health systems have traditionally been portrayed as relatively similar examples of decentralised, public integrated health systems. However, recent decades have seen significant public policy developments in the region that should lead us to modify our understanding. Several dimensions are important for understanding such developments. First, several of the countries have undergone structural reforms creating larger governance units and strengthening the state level capacity to regulate professionals and steer developments at the regional and municipal levels. Secondly, the three Nordic countries studied experienced an increase in the purchase of voluntary health insurance and the use of private providers. This introduces several issues for the equality of users and the efficiency of the system. This paper will investigate such trends and address the question: Is the Nordic health system model changing, and what are the consequences for trust, professional regulation and the public interest?

Medical regulation for the public interest in the United Kingdom

Regulation of the medical profession has a long history in the United Kingdom but a number of high profile failures of National Health Service (NHS) organisations to deliver safe health care and the unlawful killing of more than 200 patients by one rogue doctor have led to a clamour for change. Many of these tragedies have been the subject of public inquiries and have created significant public disquiet about the role and effectiveness of the medical regulator. United Kingdom governments have responded to these inquiries by means of a combination of strengthening professional regulation and the introduction of new mechanisms of appeal against the sanctions imposed on doctors by tribunals. The historical development of medical regulation is reviewed and the more recent changes to address the public interest and crises in the confidence in the regulation of health care are described.

The informalisation of professional–patient interactions and the consequences for regulation in the United Kingdom

Seeking to illustrate the usefulness of Eliasian approaches for debates on health care professional regulation, this chapter examines how long-term social processes have transformed the character of health care professional-patient interactions in the United Kingdom in recent decades, rendering them more informal and less asymmetric. The chapter goes on to consider three key implications and challenges of such transformations for regulatory design and practice, first exploring how performances of compassion and care have become more central to understandings of ‘quality’ health care practice. Secondly, these less asymmetric and structured interactions are also less stable, posing problems for quality assurance and regulation. Finally, informalisation processes are bound up with moves away from a more blanket profession-based trust towards a more critical, interaction-won trust. The chapter concludes by considering the implications of new trust dynamics for regulating quality care amid the processes of informalisation, and how heightened demands for reflexivity may open new possibilities for cultivating (professional) virtue through a dialogue between social research and health care practice.

Birth of the hydra-headed monster: a unique antipodean model of health workforce governance

This chapter explicates the multi-profession scheme in Australia that incorporates medical practitioners, nurses and twelve other professional groups. It considers the origins and establishment of the National Scheme for the Registration and Accreditation of the Health Professions introduced in Australia in 2010, within the context of wider regulatory and public policy reforms and initiatives. The key structural aspects of the Scheme’s model of accountability to ministers and parliaments are analysed. It emphasises the extent to which the Scheme has been influenced by Australia’s federal system and the respective responsibilities of each layer of government. The chapter explains how governments in Australia, as represented by their Health Ministers, through the Australian Health Workforce Ministerial Council, have taken on the appearance of the mythical hydra-headed monster, concurrently a unitary and disparate form purposely constructed to act in the public interest in a unique antipodean model of health workforce governance.

Governing complementary and alternative medicine (CAM) in Brazil and Portugal: implications for CAM professionals and the public

Sociological research on the governance of complementary and alternative medicine (CAM) in Western societies has vastly increased in the last decades. Yet there has been a less marked expression of qualitative studies which put such governance into comparative perspective. Furthermore, research has shown that CAM regulation in Western countries has been very diverse, and so is probably best conceptualised on a spectrum containing several regulatory models. This chapter investigates CAM’s modes of governance in two historically, culturally and politically related countries, Brazil and Portugal. It analyses the extent to which CAM governance has changed over time in these two countries, the main modes of CAM governance in these same countries, and the implications of these modes of CAM governance for CAM professionals themselves and the public. It is concluded that Brazil and Portugal present some similar patterns in the way they govern CAM, but also contrasting differences, particularly in relation to the status of these therapies within the public and the private health care systems, and the implications of this status for CAM professionals themselves and the wider public.

Patterns of medical oversight and regulation in Canada

Physicians in Canada are entrusted with one of the highest degrees of self-regulatory privilege of medical professionals, associated in neo-Weberian terms with exclusionary social closure in a competitive marketplace. To protect the public, though, such power must be accompanied by structures which successfully ensure that standards of professional quality are well defined and rigorously implemented. Yet little is known about the performance of presently implemented regulatory structures in medicine in Canada in terms of quality definition and assurance. Drawing on original research, this chapter provides an overview of the standards and regulatory goals and the various formal mechanisms for implementing these in Canada. As such, it will outline how provincial and territorial medical colleges explicitly and implicitly understand, describe, and put into practice their own standards of performance. Appropriate alignment of the colleges with quality assurance in this respect is considered vital in terms of the wider public good.

Introduction: professional health regulation in the public interest

This chapter provides a commentary on, and introduces, the collection of papers in this volume. It begins by outlining how professional forms of health care expertise have become increasingly subject over the last four decades to third-party scrutiny, as well as how we have witnessed greater public involvement in the monitoring and quality assurance of healthcare work, particularly in Western neo-liberal societies. It then discusses how these changes have led the ‘social closure’ model of professional work to become revised, and in doing so how this raises concerns regarding academic engagement with members of the public as part of a broader patient advocacy and policy reform agenda focused on the promotion of the public interest. This discussion helps set the scene for subsequent chapters, which together seek to unpack the complex relationships that exist between health care practitioners, civil society, the state and professional groups in a variety of different international borders and regulatory jurisdictions. In doing so, each author seeks to explore critically how calls for increased efficiency and cost effectiveness in healthcare are balanced with the need to promote the public interest through providing citizens with essential health services.

Trust and the regulation of health systems: insights from India

It has been argued that the health system in India appears to be systematically falling short in achieving equitable improvements in health status, quality of care, and social and financial risk protection. The poor performance of the health system is to a large extent due to the failure of the state regulators and of the professional associations to uphold their mandates, which in turn appears to be related to a broader and more fundamental failure of ‘trust’ in the expert systems that deliver health care and in institutions that are mandated to oversee this ‘entrustment’. This chapter attempts to identify the sources of this erosion of trust by analysing the regulatory and stewardship arrangements of the health system in India

Health complaints entities in Australia and New Zealand: serving the public interest?

This chapter describes health complaints entities in Australia and New Zealand, with an analytical focus on the ways in which they do, or do not, serve the public interest. The concept of public interest is explored with reference to the aims and functions of these entities, and the competing interests at work in their design, establishment, administration and operation. We also examine significant events and social movements that have created the impetus for health complaints system reform, and examine the impact and effectiveness of these. We examine the evidence, as well as the lack thereof, regarding the extent to which current complaints commissioners achieve their stated goals. Finally, the chapter identifies emerging challenges with implications and opportunities for the contribution of health complaints entities to the public interest.