Introduction

For the past two decades, the way in which health professionals are regulated has undergone major evolutionary change. There have been inquiries, reports, new legislation, changes in practice and new institutions. The traditional form of self-regulation has given way to appointed professional councils that regulate professionals across nine professions, which since 2002 have been overseen by a meta-regulator. The Professional Standards Authority for Healthcare and Social Care (PSA), previously named the Council for Health Regulatory Excellence (CHRE), regulates the regulators in the United Kingdom (UK). Since 2012, their remit has extended to social work, as well as the health care professions. The PSA is an ‘arm’s-length’ agency of the Department of Health, England. A recent report from the Law Commission (2014) proposes further change. From the onset of the reforms, the aim has been to protect people who use professional services by ensuring safe practice although regulation also has an impact on the professionals who provide these services.

In this chapter we aim to describe and analyse the reform process. We look at the special case of regulating professional work, the underlying changes that created a case for reform, and the events that led to government action. We then clarify our understanding of ‘regulation’, and give an account of the reforms beginning in 2002 with the establishment of the meta-regulator. We go on to describe the changes in the structure of the professional councils following from the Health and Social Care Act 2008, which introduced a corporate form of governance, and an expansion of activity. Finally, we assess the outcome of reforms and the case for further change.

In order to assess the outcome of the reforms, we draw on data collected in 2004, when we were commissioned by the CHRE to undertake a scoping study of the nine regulatory councils (Allsop et al, 2004). Data were collected using a template pro-forma, which was completed by council officers. This covered their founding legislation, the structure of governance and selected indicators on resources and activity. In addition, we documented their role in:

• • keeping a register of professionals;

• • setting standards for education and practice;

• • responding to complaints from the public through investigation to establish whether a professional's practice was impaired;

• • adjudication by a panel to determine what action to take.