The Future of Regulation and Podiatric Surgery

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The Future of Regulation and Podiatric Surgery

• What will it mean for future determination of
  scope and practice?
• The Bob Prince Lecture
• by
• Pam Sabine

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The Future of Regulation and Podiatric Surgery

• Why do we need regulation?
• Surely we can continue to regulate ourselves?
• Is it possible to exist outside regulation
  nowadays? 
• Do we want to be regulated on a separate part of
  the Register, or be annotated on the existing
  Chiropodist/Podiatrist part?
• In going for a separate part of the register we
  might give away more than we gain.

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The Future of Regulation and Podiatric Surgery

• Potentially we might
• Give away our common educational background.
• Give away our licence to practise as Podiatrists.
  
• And...
• Need to develop a way of qualifying as a
  Podiatric Surgeon, as a stand alone profession,
  with separate Standards of Proficiency.

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The Future of Regulation and Podiatric Surgery

• The alternative is to annotate the current
  register, against evidence of training and
  qualification as a Podiatric Surgeon. (c/f POMS
  and LA, as well as Supplementary Prescribing).
• For those who are not regulation anoraks, this
  may seem unnecessary. However, to ignore the past
  and Government imperatives would be foolish and
  potential suicide.

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The Future of Regulation and Podiatric Surgery
Why the HPC??  
Professionals only have duties they do not
have privileges. They have duties over and above
the duties of being a citizen.   (Professor Sir
Ian Kennedy, Chairman of the Healthcare
Commission, 2005)
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The Future of Regulation and Podiatric Surgery
How did we get to where we are with current
regulation?
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The Future of Regulation and Podiatric Surgery
"Chiropody means and includes the diagnosis and
medical, mechanical and surgical treatment of the
foot ailments such as abnormal nails, bunions,
corns, warts and callosities, but it does not
include the performance of operations for which
an anaesthetic is required".  
(Chiropodists (Registration) Bill, 1928, promoted
by Viscount Novar)
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The Future of Regulation and Podiatric Surgery

• "As soon as possible, the services of a
  chiropodist should be made available in every
  general hospital and in those special hospitals
  and clinics
• where they are
• particularly required".
•  
• (Cope Report, 1951)

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The Future of Regulation and Podiatric Surgery
The move away from professional self
regulation The paramount aim of regulation
should be protection of the public. All other
aims should be subordinated to this one. How can
the paramount aim be achieved in the absence of
high standards and appropriate educational
processes?
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The Future of Regulation and Podiatric Surgery
While raising educational standards is desirable
in general, it is not necessarily in the public
interest, if it excludes the less academic from
training for clinical practice or leads to higher
costs for the service providers. We believe the
main focus for the regulatory body should be to
ensure appropriate standards to protect the
public.
(JM Consulting letter to stakeholders, 1995).

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The Future of Regulation and Podiatric Surgery
If the face of Parliament is turned towards the
East, what can be done to turn it towards the
West?

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The Future of Regulation and Podiatric Surgery
Equity and Equality do they exist in current
regulation?
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The Future of Regulation and Podiatric Surgery
How will the standards look?
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The Future of Regulation and Podiatric Surgery

• Hamstrung by the letter of the law or just
• open to
• interpretation?
• Which 50?

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The Future of Regulation and Podiatric Surgery

• Grandparenting - How would
• we assess competence?
• Article 13 of the order provides a transitional
  pathway to registration, which is open to those
  who can demonstrate that they have been
  practising safely and effectively or that their
  qualifications and experience are comparable to
  the current requirements for registration. In
  that context, perhaps I may make clear that in
  either case the HPC may, but need not, require
  them to pass a test of competence.
• (Baroness Hayman, Hansard)

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The Future of Regulation and Podiatric Surgery

• Competence versus proficiency.
• Competence the condition of being capable.
• Competent having sufficient skill, knowledge
  etc., capable suitable or sufficient for the
  purpose.
• Proficiency the noun from proficient.
• Proficient having great facility (in an art,
  occupation, etc.) skilled. An archaic word for
  an expert from the Latin proficere.

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The Future of Regulation and Podiatric Surgery

• Personal Responsibility
•  
• there must be agreed and published standards of
  clinical care for healthcare professionals to
  follow, so that the patients and the public know
  what to expect
•  
• (Bristol Royal Infirmary Enquiry Learning from
  Bristol)

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The Future of Regulation and Podiatric Surgery

• Postregistration
• qualifications should
• be recorded in the Register where these are
  relevant to patient care, risk management and are
  at a level substantially beyond the requirements
  for basic registration.
• (Trust, Assurance and Safety, 2007)

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The Future of Regulation and Podiatric Surgery

• Where do trust and regulation
• overlap?
•  
• Harold Shipman would, of course, have passed any
  appraisal of fitness to practise with flying
  colours
• (Osbourne Osbourne 2005).
•  
• The efforts to prevent the abuse of trust are
  gigantic, relentless and expensive their results
  will always be less than perfect
• (ONeill 2002).