1 April 2022

Our response to DHSC's consultation on healthcare regulation

We have responded to the Department of Health and Social Care consultation on 'Healthcare regulation: deciding when statutory regulation is appropriate.'

Summary

College responds to Department of Health and Social Care (DHSC) consultation on the criteria used to decide whether or not to regulate a profession. We have recommended that optometry should remain subject to statutory regulation into the foreseeable future, highlighting the expanding clinical role of optometrists and the role of optical practice within the health system. 

We have also recommended regulation in the optical sector to better manage the risks to patients that come from new challenges arising from the trends in health technology, such as Artificial Intelligence (AI), and those in online marketplaces where health care products and services are increasingly becoming accessible.

Q1. Do you agree or disagree that a qualitative and quantitative analysis of the risk of harm to patients is the most important factor to consider when deciding whether to regulate a health or care profession?

We agree.

The College of Optometrists agrees that the purpose of the regulation of health and social care professions is to protect the public from the risk of harm from the provision of health and social care services. We also agree that the risk of harm to patients is one of the most important factors to consider when deciding whether or not to regulate a profession, however, there are several other important criteria that should be equally assessed. These include the care settings within which health professions deliver care to patients (e.g. hospitals, community or primary care), the expected changes to roles as care services evolve, for example optometrists taking on increasing clinical autonomy for appropriate eye care services across the UK. As well as looking at evidence of the current risk, it is necessary to consider these expected developments in roles and the likely impact on risk. Also, as technology continues to develop and be further incorporated into health care, it is necessary to consider how these developments impact standards for patient safety.

We agree that risk assessment should involve both qualitative (e.g. nature of the harm, how and why it occurs) and quantitative (e.g. severity and likelihood of harm) analysis, but we would also recommend assessment of these elements to be evidence-based as far as is possible.

Finally, we recommend the Westminster Government actively seeks, and is informed by, the views of patients, the public and wider stakeholders before deciding whether a profession should or should not be regulated. Any system of regulation is effective only if it commands the confidence of the public, professionals and wider stakeholders.

Q2. Do you agree or disagree that proportionality, targeted regulation and consistency should also be considered in deciding whether to regulate a health or care profession?

We agree.

We agree that proportionality, targeted regulation and consistency should also be considered. However, the decision whether to regulate a health or care profession should primarily be based on the qualitative and quantitative analysis of the criteria we have set out in our response to question one above.

We would also recommend the Government follows additional principles such as transparency of its decision making and its accountability and scrutiny when deciding whether or not to regulate a health or care profession.

Q3. Do you agree or disagree that the currently regulated professions continue to satisfy the criteria for regulation and should remain subject to statutory regulation?

We agree.

We strongly believe that the optical professions (optometrists and dispensing opticians) regulated by the General Optical Council (GOC) continue to satisfy the criteria for regulation and should remain subject to statutory regulation into the foreseeable future, as envisaged by the consultation document. Indeed, as mentioned in our response to question one, optometry is a core part of NHS primary care and the clinical role of optometrists and the role of optical practice within the health system are expanding. The optical professions should also be regulated in the same way as for other primary care professions such as dentistry and pharmacy where risks to patients exist but are lower than those found in medicine. 

In addition, we recommend the regulation in the optical sector to better manage the risks to patients that arise from new challenges arising from the trends in health technology such as Artificial Intelligence (AI) and those in online marketplaces where health care products and services are increasingly becoming accessible.

We also believe that other health professions that provide eye care (e.g. nurses, orthoptists, and ophthalmologists) should remain subject to statutory regulation. At the start of 2020, NHS England/Improvement began planning a programme of Outpatient Transformation, which was to focus on Ophthalmology as its first speciality. The aims of this work include designing new models of care, reducing the number of hospital appointments and improving patient outcomes and experience. Many of the recommended changes to facilitate ophthalmology transformation have already been adopted in some parts of England. The eye health care team has changed and continues to develop to meet the demands placed on the hospital eye service. Aspects of clinical work that were previously the domain of the ophthalmologist are now being delivered by a broader multidisciplinary team. This new team of optometrists, orthoptists, ophthalmic nurses and ophthalmic clinical scientists have taken on expanded roles, which release ophthalmologists to deal with the more complex cases.

Any move to deregulate a profession would inevitably lead to disruption in health systems and risks for public protection at a time when health services must maintain a strong focus on recovering from COVID, service transformation and reducing backlogs for patients.

Q4. Do you agree or disagree that currently unregulated professions should remain unregulated and not subject to statutory regulation?

We do not know.

While we do not have the detail of all unregulated professions outside the eye care sector to be able to provide a definitive opinion, however, for the eye care sector we are confident that the current regulatory levels are appropriate to risk and have operated well in ensuring the public is protected from harm and visual impairment.

Submitted: April 2022

Related further reading

AI is pushing the boundaries of diagnosis, but are we on the verge of an antimicrobial dark age?

AI can give optometrists a head start in eye disease detection.

Kathy Oxtoby asks what optometrists need to know about antimicrobial resistance.