twenty-first century system of professional regulation. The powers the Government
has taken to itself in the Health Act 1999 to influence professional regulation fall
short of what will be needed to achieve true root and branch reform. It will require
primary legislation of some magnitude that, unless it is preceded by a process of
major education and debate leading to some winning of professional hearts, minds
and confidence will encounter massive opposition. Surely the time has come to
initiate that debate, and for the Government to take the lead.
Perhaps a window of opportunity has opened. In March 2000 the National
Health Service Executive released for consultation a document entitledModernis-
ing Medical Regulation: Interim Strengthening of the GMC's Fitness to Practice Pro-
cedures[14]. It can presumably be inferred from the use of the word interim' that something more definitive and permanent is to follow within a reasonably short time. Could this opportunity be used to take the radical step that I now believe to be necessary? I do not pretend that it would be easy, and along the way there is no doubt that someturf wars' would become apparent. But the longer a radical
change is deferred the greater will become the need for it, and the level of public
disenchantment with the current system will grow.
When I was serving as the UKCC's Director for Professional Conduct it was
sometimes the case that, as the Council's solicitors investigated allegations against
some registered nurses, it became apparent that other registered health profes-
sionals ± usually but not invariably doctors ± had been involved in the same
allegedly culpable conduct. It was sometimes a matter of grievance to the nurses
involved that while they were the subject of complaint to the UKCC, no compar-
able complaints in respect of the doctors had reached the General Medical
Council. Where, however, both parties were the subject of complaint alleging
misconduct, the regulatory processes that then applied .and still apply) meant that
the evidence in support of the allegations would be heard at separate times by two
entirely separate groups of people and often result in distinctly different conclu-
sions. How can this be regarded as either right or efficient?
3.5.1 Professional defensiveness
Why do members of the health professions feel so anxious and insecure about the
wider involvement of articulate members of the public, and appear so reluctant to
see them playing a more significant role in the regulation of their professions? Has
it, perhaps, something to do with the negative connotations that associate with the
word lay' when used by some health professionals? Margaret Stacey has stated her position on what she describes asProfessional
knowledge and people knowledge' [15] She contends:
`On the whole I prefer to speak of ``people knowledge'' rather than ``lay
knowledge''. This is because ``lay'' .even though it originally comes from a Greek
word meaning ``of the people'') tends to be used for those people who do not
belong to a specific profession... In referring to people who lack particular
qualifications, ``lay'' suggests the absence of something valuable or prestigious,
and may imply less competence, or even less moral worth. Thus it underlines the
very distinction I wish to argue is false except in a limited technical sense.'42 Nursing Law and Ethics