“Busting Bureaucracy” a step in the right direction?

On 24 November, the Department of Health and Social Care announced a new drive to ‘bust bureaucracy’, locking in changes introduced in the pandemic with the aim of allowing front line health and care staff to focus more on care provision and less on paperwork. Here, I focus on the changes that may be of the greatest interest to regulated organisations and individuals.

The report can be found here.

A call for evidence was made in July, with the message in response highlighting that changes introduced in light of the pandemic were changes made for the better. Respondees did not want to revert to old ways.

The report highlights key changes that were introduced during the pandemic including;

  • Changes to CQC inspection and revalidation through the introduction of the Emergency Support Framework
  • Optimisation of data requests and data sharing
  • Better used of digital tools to provide support around the sector
  • Introduction of a less bureaucratic discharge system
  • Mission orientated decision making (allowing organisations to make their own decisions)

Eight priority areas are identified for action and plans for that action announced as being;

  • Data information will be shared, asked for and used intelligently

One request for data will lead to that data being used ‘in many ways’, to maximise the benefit to patients and reduce the burden on staff. To achieve this, a data strategy for health and social care will be launched and implemented within months. In addition the DHSC will consult on changes to primary and secondary legislation for data collection and Control of Patient Information notices issued in response to Covid-19 will be kept under review and extended if necessary.

A new Data Alliance Partnership is also to be set up, involving the CQC, NHS Business Services Authority, Public Health England and NICE to agree principles on data sharing and minimise the burden of data collection and processing. Those involved in incident reporting and reviews will welcome the introduction of a new patient safety incident reporting framework which is said to have the aim of asking whether “changes have been made which led to a measurable and sustainable reduction in recurrence of repeat incidents.”

Implementation of the NHS Long Term Plan is to be considered, with options being explored to promote the use of a manageable number of metrics at national level and local organisations will be encouraged to review their own data and information requests for internal governance processes.

  • Regulation will be proportionate and intelligent

The report highlights the need for focused and intelligence-driven with a primary purpose of improvement and high quality care. This will surely be welcomed by regulated organisations and individuals alike.

The first regulatory change identified by the report is the new CQC strategy which has been published in draft and will go for formal consultation in the spring. The strategy proposes moving away from periodic inspections and towards a regulatory process of data gathering and assessment to proactively assess quality of care and determine risk.

CQC fees are to be maintained at current levels for 21/22, provided there is no change in registration or provider size.

Professional regulation will also see proposals for change in the form of a public consultation by the DHSC on detailed proposals to reform the professional regulation framework. This is anticipated in early 2021.

Certainly, the outlined proposals sound promising and may see the introduction of changes that had been anticipated following the publication of the Government response to ‘Promoting Professionalism Reforming Regulation‘ a consultation undertaken in 2018 which was envisaged to reform the “bureaucratic, inflexible” legislation governing healthcare professional regulation.

The report suggests a need to simplify, streamline and modernise the legal framework and that DHSC will make it easier for regulators to resolve complaints about conduct or competence more quickly and in a less adversarial way. With processes becoming seemingly more adversarial and investigations becoming more prolonged in recent years, any change which aims to reduce both consequences would certainly appear to be change for the better.

The DHSC anticipates a new system for regulation that will respond to future changes in healthcare and which it anticipates will remove the bureaucracy of current processes. It is also said that changes will increase collaboration between regulators. This is an approach that was suggested some years ago, with collaboration then envisaged through the introduction of a single adjudication body. Said to be part of the consultation is a proposal that the number of regulators will be reviewed, to reduce the inefficiency and confusion of the current system. It is perhaps too early to say what the DHSC envisages and those acting for regulators and registrants should await the publication of the consultation for more detail, but a collaborative approach rather than each regulator acting in isolation is long overdue. In part this has been a key feature of the response to the pandemic, with joint statements being published by the main healthcare regulators relating to their response to the challenges that professionals faced.

Emergency powers introduced by the Coronavirus Act 2020 also feature, with the DHSC placing the emergency powers on a permanent footing.

From later this year, Physician and Anaesthesia Associates will be regulated by the GMC, to support greater workforce flexibilities.

  • Day-to Day Staff processes will be simple, helpful and effective

This required digitalisation of patient record management processes, more efficient HR systems and the introduction of a basic minimum viable shared care record solution by September 2021.

All local areas are be able to access linked health and care data, this being timetabled to be fully in place by 2024.

Cross organisational patient records and care plans allowing the integration of person focused care across local health and care systems are to be accelerated to improve care planning and delivery.

Clinical staff will be able to log into systems without multiple passwords to reduce unnecessary duplication, provide secure access and reduce time lost by clinicians in moving between systems and applications. Digital staff passports will be provided to multiple groups to improve agility and support staff development. Priority groups for passports will be junior doctors and specialists such as those working in maternity or stroke care who often need to be rapidly deployed to different locations.

International registration will be simplified, with the reform of legislation to allow the GMC to adapt its overseas registration process.

  • The government will legislate to make procurement more flexible

A single procurement regime for the NHSE will be introduced through legislation, which will remove the two regimes that are currently in place. A consultation will commence on how this would operate.

  • GPs will have more time to focus on patient care

Some change for GP’s is expected before the end of the year with multiple strategies considered in the report including reform of the process for issuing fit notes by exploring digital solutions and extending certification to a wider group of health care professionals and permanent removal of Cremation Form 5 requirements allowing emailed or scanned copies of the Medical Certificate Cause of Death to be submitted in place of Form 5.

The DHSC estimates that the review of GP bureaucracy will free up 50 million GP appointments annually with further benefits being an increase in job satisfaction, retention and role attractiveness.

  • Appraisals will be streamlined and their impact increased

The pandemic has seen the simplification of the appraisal process for clinicians and the DHSC encourages a continued streamlining to allow appraisal to be used for development purposes.

The BMA, Academy of Royal Medical Colleges and GMC have introduced a new appraisal process from October 2020 which takes less time to complete, requires less supporting evidence, places greater emphasis on health and wellbeing and allows online completion of the process where appropriate.

The effectiveness of the new process will be evaluated in the next appraisal cycle.

For trainee doctors,  the Annual Review of Competency Progression has been streamlined to include virtual panel and feedback conversations, reduction in panellist numbers to a minimum of 2 in exceptional circumstances and greater emphasis on the Education Supervisor’s report.

  • Supporting greater digitalisation of services

This will include remote monitoring, said to assist in optimising referrals and post consultation care. A system and procurement framework was launched in September 2020 to allow organisations to identify the most appropriate system for their needs.

Digital tools will be used to increase the use of electronic prescribing for 100% of hospital inpatients by 2024. The current figure stands at 60%.

  • Supportive culture at national and local level

Alongside the specific actions identified in the report, it highlights a need for leadership to embrace them and for organisations and individuals to question and call out habits or local rules which increase excess bureaucracy

Conclusion

Some positives arise for health and care organisations and staff, despite the overwhelming pressure placed on all through the pandemic. Whilst the actions described in the report will require commitment and increased work by all during the implementation period, any steps which reduce the bureaucracy and allow clinicians to focus on patient care are to be welcomed.

The actions that DHSC are committed to taking certainly seem to set out to achieve such an aim but care will need to be taken to ensure that in reducing bureaucracy, there is not a consequential reduction in safeguards or a negative impact on those in receipt of health and social care in the future.

Positive reform to professional regulation is now long overdue and the report takes a step in the right direction to outline what’s next on the horizon for regulators and registrants. We will certainly provide greater detail when the consultation is published.


Written by Clare Chapman at BLM clare.chapman@blmlaw.com

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