Rethinking Regulation

Rethinking RegulationA recent report from the professional standards association for health and social care argues that we need to rethink regulation.

The experience of Mid Staffs and beyond suggests that regulation often is not working. This partly reflects a lack of clarity about the role of the regulators. And often behind the debate is that old tussle between regulation and autonomy.  If regulation is too rigid then the regulator can begin to take over the role of the professional. In the case of healthcare governance, for instance, boards and board members can easily put their judgement to one side and simply follow the rules.

Kenneth Goodpaster suggests in the context of business ethics that such a dynamic can lead to teleopathy, the imbalance of core purpose. In turn it leads to what he refers to as fixation, rationalisation and detachment- in other words taking your eye off the ball. This partly means avoiding responsibility for exercising judgement in context. In one sense this is what autonomy is about- self-governance, taking responsibility for one’s own governance.

The problems with the debate, of course, is that we end up with polarisation, regulation over against autonomy. It is clear that to set the debate in these terms does not work. Professional practice in care has fully understood the need for regulation expressed in supervision which enables critical professional reflection. This suggests that genuine autonomy requires an external perspective. The test then for governance regulations is how can we develop regulations which enable genuine deliberation in the light of core values.

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