The recent Professional Standards Authority (PSA) report, Rethinking Regulation, calls for wholesale changes both to the structure of and approach to regulation of health and care in the UK. The document doesn’t pull any punches, saying: “if regulation was going to improve care, it would have done it by now.” Just a month or so later, NCVO has published a hard-hitting report saying, quite clearly, that the current regulatory regime for charities isn’t working.
Value of regulators
The PSA report puts forward Harvard professor Mark Moore’s strategic triangle, which provides a framework for regulators to conceptualise their task. The three points of the triangle are public value, legitimacy & support and operational capabilities. The report suggests that regulators and indeed all public bodies should ask themselves some key questions in relation to this framework, including: ‘What value do we contribute to society?’ and ‘What gives us the ‘legitimacy and support’ to take actions in order to create that value?’
Answering these questions successfully relies heavily on effective public and stakeholder engagement. There needs to be continuous dialogue. In the health and care sector, the charity sector, indeed any area of society, the environment is constantly changing and shifting. Public expectations, perceptions of legitimacy and concepts of public value shift too. Just taking one regulator – the British Board of Film Classification – to illustrate the point, what was perceived by the general public as acceptable or risqué viewing at the cinema in 1965 is absolutely nothing like what would constitute the same in 2015. The shift is clear to us all and the standards of classification are based firmly upon regular consultation with the public.
Take a less well understood area of regulation and a shorter timescale and the shifts are more subtle and difficult to detect, but they will still exist. Things change, attitudes change and public bodies, especially those tasked with protecting the public, need to keep their finger firmly on the pulse. To protect the public a regulator must first understand the public’s views about risk and their expected standards, and this takes continuous effort.
At Community Research we are delighted that we are increasingly seeing this recognised; see our case studies for examples for our work with regulators. Over the past couple of years, many regulators and other public bodies have been setting up ongoing panels and communities made up of broadly representative samples of patients or the public whose views can be gathered flexibly and, when circumstances call for it, quickly. We hope many others will follow suit and see this as a core part of their function.
The issues raised in these recent critical reports will require both changes in legislation and a big cultural shift. Whilst continuous engagement and dialogue with the public and stakeholders cannot help with the first of these, it can certainly make a significant contribution to the latter.