Introduction

Despite substantial reform of the regulatory systems for UK healthcare professionals over the past decade,1 public and political faith in the professions and their regulators is lower than ever before. In part this results from authoritative criticism in several public inquiries2—most notably the Bristol and Shipman inquiry reports.3 4 But another factor has been the constant litany of apparent failure to deal with incompetence, serious dishonesty, sexual misconduct, and unchecked wrongdoing such as the cases of Richard Neale,5 Clifford Ayling,6 Rodney Ledward,7 Peter Green,8 and Dick van Velzen.9 Recent legal reforms created a new Council for Healthcare Regulatory Excellence to oversee the regulators. The council has the power to refer regulators' decisions on fitness to practise that it regards as unduly lenient to the High Court for review. This process has also thrown up a series of apparent failures of professional regulation that do little to build public confidence.10

The changes to professional regulation have been painfully slow (see box). Progress has often been achieved only in the face of considerable resistance from powerful professional lobbies.11 Yet, as the Shipman inquiry's comprehensive critique of medical regulation shows, much remains to be done. In the wake of the Shipman inquiry, the Department of Health has established not one but two reviews to explore the further reform of medical regulation12 and non-medical professional regulation.13 More change now seems likely, but what form should those changes take and what can we learn from the process of regulatory reform to date?

Strategy for reform

The changes to professional regulation mapped out in the box show an incremental and piecemeal approach to …