It later adds:
`They should be invited to join health professionals to participate in public
policy development to ensure that the essential purpose of the health care
system and the role of health professions are observed.'Although I did not arrive at this conclusion when I was serving as the consultant
for ICN's expert group whose work resulted in this text, it now seems to me that
this offers the essence of a case and even part of a formula for a single regulatory
body for all the professions whose members provide health services.
Celia Davies [12] has argued that a key idea for the future is a form of stake-
holder regulation. That would seem to resonate well with much of what can be
found in the ICN text and would create the prospect, if only the key people and
organisations are unblinkered enough to engage in constructive debate, for
creating an effective twenty-first century model of professional regulation. Davies
contends that:
`... these questions about standard-setting and the maintenance of standards,
and the way they are given effect through the register, need to be placed at the
centre of a modern understanding of professional regulation.'To this she adds that
`... since safeguarding professional standards is an activity in which a number
of parties have an interest and which each of them can promote or undermine,
they all need to be involved. The question of standards thus needs to be
addressed through a dialogue in which there is space for the voices of patients,
employers, educators, professional associations and trade unions as well as
government. There needs to be a credible process of balanced decision-making,
which precludes the possibility of domination by any one of the parties.'That is the principal idea around which she proposes a stakeholder model of
regulation. That expression of the idea alone is adequate to use as a litmus test for
the future Order.
3.5 The new context for professional regulation
Much has changed, not only since the Medical Act of 1858 provided the legislation
that became the model for professional regulatory systems in the United Kingdom
.and many other countries), but also since the current Acts of Parliament for the
various health professions came into effect. This has been explored in some detail
by Dingwall, Rafferty and Webster [13]. The speed of change to which they refer
has accelerated in the last decade.
The regulation of the health professions now has to operate in a situation in
which members of the public are more inclined to challenge and question, and
much less deferential. They have higher expectations of the health professions.
They are better informed about issues that affect their lives and better equipped to
express their concerns. In these circumstances the time must surely have come to
engage both public and professions in major debate aimed at creating a valid
The Professional Dimension 41