Table Of ContentInterpreting Professional
Self-Regulation
Regulation of professions is coming under increasing scrutiny. There has been
serious questioning of medical performance recently and doubt about how far it
is in the public interest that professions regulate themselves. Government is
introducing new forms of inspection and monitoring, and client groups are
increasingly calling for greater protection for vulnerable service users and for
participation in decisions about standards of education, practice and conduct in
the health field.
This book provides a history of the UKCC – the body that maintains a register
of nurses, midwives and health visitors – from its inception under legislation in
1979 to the present day. It covers the decade of battle before the legislation, and
tells the story of major reform of pre-registration education and pioneering work
to set standards for demonstrating competence to stay on the register. It also
analyses the disciplinary work of the UKCC in removing people from and
restoring them to the register.
Interpreting Professional Self-Regulation provides a deeper understanding of
what regulators do than has been available previously. It lays bare the tensions
between different groups within the professions and notes how the powers of
National Boards and Central Council have come into question. It shows just how
much behind-the-scenes negotiation there has been in contexts where the public
debate in parliament has been minimal and calls for much wider debate on
professional accountability.
This is an important text for all those who teach on professional and policy
issues in nursing, giving them a factual background that has never been brought
together before, enabling them to bring discussion of post-registration education,
discipline and other professional matters more firmly into the curriculum.
Celia Davies is Professor of Health Care, School of Health and Social Welfare,
The Open University. Abigail Beach is Research Fellow, School of Health and
Social Welfare, The Open University.
234x156 HB
Interpreting Professional
Self-Regulation
A history of the United Kingdom
Central Council for Nursing, Midwifery
and Health Visiting
Celia Davies and Abigail Beach
London and New York
First published 2000
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, O14 4RN
Simultaneously published in the USA and Canada
by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group
© 2000 Celia Davies and Abigail Beach
Typeset in Galliard by
BOOK NOW Ltd
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available
from the British Library
Library of Congress Cataloging in Publication Data
Davies, Celia, 1945–
Interpreting professional self-regulation : a history of the United Kingdom Central
Council for Nursing, Midwifery and Health Visiting / Celia Davies and Abigail Beach.
p. cm.
Includes bibliographical references and index.
1.United Kingdom Central Council for Nursing, Midwifery, and Health
Visiting—History. 2. Nurses—Licenses—Great Britain. 3. Nursing—Law and
legislation—Great Britain. 4. Nursing—Standards—Great Britain. 5.
Midwives—Licenses—Great Britain. 6. Midwives—Legal status, laws, etc.—Great Britain.
7. Midwifery—Standards—Great Britain. I. Beach, Abigail. II. Title.
RT11 .D38 2000
610.73(cid:1)02(cid:1)1841—dc21
00-027211
ISBN 0 415 23033 0
Contents
List of figures vii
Foreword ix
Acknowledgements xi
Abbreviations xiii
Introduction xv
PART I
The importance of context 1
1 ‘All is not well with nursing’: the Briggs Committee and a
new statutory framework 3
2 Legislation and its aftermath: making a reality of the
Council, 1979–83 24
3 Three Councils, 1983–98 40
PART II
The agenda develops 73
4 The reform of pre-registration education: hopes, fears
and realities 75
5 Upholding standards of professional conduct 97
6 Standards of professional practice: PREPP and after 120
PART III
Stakeholders and standards 141
7 Holding the professions together 143
vi Contents
8 Widening involvement in the work of regulation 168
9 Professional self-regulation in question 189
10 Conclusion 204
APPENDICES
Appendix 1: Chairmen, Presidents and senior officers 212
Appendix 2: The work of registration 215
Appendix 3: Professional conduct: procedures, cases and
Appendix 3: statistics 219
Appendix 4: UKCC publications 231
Appendix 5: Notes on sources 234
Index 241
Figures
3.1 Strategic objectives of the First Council 42
3.2 Strategic objectives of the Second Council 49
3.3 Strategic objectives of the Third Council 58
5.1 Common types of misconduct case 1990 102
9.1 The National Consumer Council Framework for Regulation 199
10.1 Transitions across three Councils 206
Foreword
The 1979 Nurses, Midwives and Health Visitors Act heralded far-reaching changes
in the regulation of these three professions. The new Act brought together nine
bodies previously responsible, in whole or in part, for separate regulation of the
three professions within the United Kingdom. The United Kingdom Central
Council for Nursing, Midwifery and Health Visiting and four National Boards
established by the new Act created, by far, the largest regulatory body for any
health care profession.
Following implementation of the new legislation, the profundity, frequency
and pace of change in health care management and provision was unparalleled in
the history of health care. The extent of critical focus on professional regulation by
consumers, government, the three professions and the national and professional
press also could not have been expected. The ‘shadow’ and subsequent consecu-
tive three Councils spanning an eighteen-year period – the period of this historical
review – had different challenges to anticipate and respond to. These included, by
the time of the Third Council, implementing significant changes arising from the
1992 amending Nurses, Midwives and Health Visitors Act and contributing to
the Government’s second quinquennial review of non-departmental public
bodies in 1997.
In 1996, the Council commissioned a history of its achievements and a review of
its activities in setting standards for education and conduct, the results of which are
recorded in these pages. Given the size of the three professions which the UKCC
regulates and therefore the mammoth volume of activity within the organisation,
together with the major projects undertaken throughout the eighteen-year period,
the authors Celia Davies and Abigail Beach were presented with a diverse and
complex task. The result of their work is a detailed, factual analysis and record of
events, captured in a way that reveals the different and significant contributions
which the ‘shadow’ and three Councils have made to professional self-regulation.
In doing this they have highlighted in a constructive manner the strengths and
weaknesses, ‘warts and all’, and have given due and fair consideration to the ten-
sions that surfaced from time to time, particularly between nurses and midwives.
But the text is much more than a factual record. It is balanced by critical scrutiny
and reflection on events of professional self-regulation. The authors pose signifi-
cant challenges at a time when fundamental questions are being raised about the
