If we want transparency, it's time to untangle the twisted web of regulation

Don Berwick's approach will require robust and effective regulation if it is to be successful, says Anne Burge. Photograph: Bloomberg via Getty Images

When Professor Don Berwick published his much anticipated review into patient safety in the NHS, it did not include many of the measures – such as a legal duty of candour – that he was expected to recommend. While stressing the need for a culture of transparency and learning to eliminate mistakes, the review put the ball firmly back in the government's court as to how this culture should be achieved.

Berwick's approach, while more reliant on the carrot than the stick, appears to require robust regulation if it is to be successful. What is particularly interesting about the report is the way it exposes the complexity of health regulation today, and its suggestion that all of these regimes could be merged to create a simpler system for patients, their families and healthcare professionals themselves.

This suggestion tallies with the recommendations of the Francis report following failings at Mid Staffordshire Hospital, and Berwick's comments on the subject of regulation lend enormous credibility to Francis's proposal of a single regulator, a suggestion the Department of Health is yet to act upon.

The status quo – which involves a range of bodies including the Care Quality Commission, Monitor, the Health and Care Professions Council (HCPC) and others – is enormously complex. Rationalising these various bodies would involve significant upheaval, but there is merit to considering the option if it leads to a simpler system for patients to navigate and greater transparency in the event of a failure of care.

So where does this leave the thousands of unregulated healthcare staff, many of whom are listed only on a series of voluntary registers (which add a further layer of complexity to the current regime)? Many of these professionals, such as clinical physiologists and cardio-thoracic surgical assistants, have roles that affect patient safety. They perform tasks such as testing and installing medical equipment or perform procedures on patients directly, yet are not subject to regulation in the same way as doctors or nurses – despite many of these positions having been recommended for regulation by the HCPC in the past.

There are now two questions for the government: will it act on the comments made by Francis and Berwick on the regulation of NHS professionals, and if action is taken, can transparency be achieved if thousands of health professionals remain outside the bounds of regulation?

It is worth remembering that Berwick has produced a government-commissioned report before, and that his recommendations were ultimately ignored by the government of the day.

Patient groups should demand that government take action this time. If we are to take a lead from Berwick's admirable positivity and insistency on transparency, then revolutionising our convoluted system of checks and balances would be an excellent start.

But if any action is to be successful, it cannot just apply to those professionals who are already regulated – it should encompass those sitting on voluntary registers which have had little or no power to act on mistakes. Only then can transparency and patient safety be assured.

Anne Burge is the chair of the Alliance for Patient Safety, which campaigns for statutory regulation on behalf of voluntary registers of unregulated healthcare professionals

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