Regulation of independent health care amendments: consultation analysis

Chapter 3: Responses on further regulation for independent healthcare services

There were five questions in the consultation document that related to further regulation of independent healthcare services in Scotland.

This analysis follows the layout of the consultation document.

The majority of those who responded to this question (76%) believed that further regulation of independent healthcare services in Scotland was required. Over 50% of the responses felt that all independent healthcare providers should be regulated and 36% believed regulation improves safety and can improve outcomes for patients. The respondents that were not of this view (15%) had varying reasons for not being supportive of further regulation, including the belief that all services are regulated already, that regulation does not improve service, and the Scottish Government should be focussing on regulating aesthetic services.

Four respondents chose "don't know" but none provided reasoning. Out of those that did not select a particular option, one provided comments nonetheless, stating that they are "keen for these changes to come into force as soon as possible as they will have a positive effect on the overall quality of healthcare provided in the independent sector".

A significant majority of those who responded to this question (82%) agreed with the proposal that "independent health care services provided by pharmacists and pharmacy technicians which are not provided from a registered pharmacy or under the terms of an NHS contract should be regulated by Healthcare Improvement Scotland".

Reasons given for this view included the firm belief that everyone should be regulated and that regulation improves patient safety. The few respondents that were not of this view generally thought that regulation is not required whatsoever, and one suggested that regulation by the GPhC already provides sufficient regulation.

Some respondents answered "don't know" to question 2, questioning whether Healthcare Improvement Scotland is the best organisation for managing the regulations, and whether other options were considered.

Again, a majority of those who responded to this question (76%) believed that "independent medical agencies where services are provided by a medical practitioner, dental practitioner, registered nurse, registered midwife, dental care professional, pharmacist or pharmacy technician should be regulated by Healthcare Improvement Scotland".

As with responses to the first two questions, the majority of individuals who responded in the affirmative offered views that everyone should be regulated, and that regulation would improve safety for patients and service users. A small number of respondents felt the amendments would close a legislative loophole.

15% of respondents disagreed with this proposal, with the majority of comments centred on the belief that the professional bodies already regulate these professions, and further regulation is not required.

Five respondents answered "don't know" to question 3, and all provided varying reasons. One felt that "allowing non-medical people to carry out treatments that can cause significant harm unregulated is massively hypocritical". Another felt that HIS is not the right organisation to be the regulator for independent healthcare providers and others should be considered. As with many of the responses who answered "no" to this question, one respondent believed that the professional bodies already regulate these professions, and further regulation is not required.

A majority (75%) of respondents felt that currently unregulated independent medical agencies operating entirely online and headquartered in Scotland should be regulated by Healthcare Improvement Scotland. Reasons provided included improving safety for service users and "if independent medical agencies are to be regulated, then those that operate entirely online should be included in that regulation. The distinction between the physical and the online presence of a service is no longer meaningful in terms of the protection of the public". Eight respondents specifically mentioned that they felt it important that all four nations should have a joined up approach when regulating online independent medical agencies.

Following a similar theme to responses from previous questions, there is an overriding belief from some people who responded "no" that regulation from professional bodies is sufficient and further regulation is not required. One respondent felt online businesses providing medical services should be banned altogether.

A small number of respondents who answered "don't know" to this question and provided comments highlighted a lack of clarity around the question, specifically on how the regulations will impact online businesses headquartered outside of Scotland but providing services to Scottish people.

Over two thirds of respondents (69%) agreed that "Healthcare Improvement Scotland should be able to cancel the registration of any independent health care service that fails to pay its continuation fees after a certain period of time". They felt this would improve equality, protect people from bad business practices, and that it would be an important step to ensuring HIS can self-fund. Caveats to this included the idea that fees should be proportionate to the size of the business and cancellation should only occur after a warning or payment scheme was offered.

From those who disagreed with the proposal, cancellation was felt to be too extreme a response, and could lead to an abuse of power. A few respondents suggested that there should be no fees and regulation should be funded entirely by the taxpayer.

One respondent who answered "don't know" and provided comments worried about such an extreme consequence if a genuine mistake was made – what if someone just forgot to pay their fee?