Lay Involvement in Professional Regulation: A Study of Public Appointment‐holders in the Health Field

Abstract

By Celia Davies, The Open University, School of Health and Social Welfare, Milton Keynes. Research Reports, October 2001, £4.00 (cheques payable to The Open University), 49 pp. Available online from j.a.stock@open.ac.uk It is presently the government policy to ensure that lay people are appointed to national professional governance, standard-setting and regulatory bodies. It is assumed that they will bring the public's and patients’ perspectives and values to professional decisions and so protect the public interest. But many issues around the lay role and membership are inadequately defined and debated, especially in the light of social changes, including a better-informed and less-trusting public and the growth of the consumer or patient empowerment movement. Celia Davies’ study of the backgrounds, self-reported contributions and views of the lay members of eight professional regulatory bodies in the UK in 2000/2001 provides new findings and discussion for the debate. At the time of the study, there were 97 lay members of these bodies (the General Medical Council, the General Dental Council, etc); 74 filled in questionnaires, of whom 43 were interviewed. Lay meant not on the register of the relevant profession, so some other practising health professionals were included (unfortunately, data from them were not analysed separately from those from ‘real’ lay people). A majority were men, over 55 years old, white, high achievers in their own fields, middle or upper class, and had held other appointments in public services. So the membership did not reflect the more diverse backgrounds that could now be expected. The members’ definitions of their role included their ability as outsiders to question professionals’‘narrow views’ and challenge their ‘tunnel vision’ from their own broader life experiences, thus encouraging professionals to see things from a different angle – their worldly wise role. They also saw themselves as public guardians, seeing fair play between patients and professionals; as amateurs, asking ‘naive’ but purposeful questions; and as enablers, diffusing conflict and moving debate towards a new consensus. They were accustomed to engaging with professionals as equals and gave examples of successful and less successful working together. Davies’ most important finding from members’ views was that most saw their individual accumulated knowledge and experience as sufficient for their role. This was true both of ‘traditionally lay’ members – those who had brought expertise from outside the health service to previous public service appointments – and of ‘professionally lay’ members – those who had been expected to bring service users’ perspectives to previous appointments. But a small minority saw their own individual knowledge and experience as insufficient for the role. They thought it necessary to keep in direct touch with public's and users’ experiences, perceptions and views by close contacts with community and campaigning patient groups. This group Davies terms ‘positively lay’, a not altogether apt term as it devalues other kinds of lay contribution. Davies believes that the approach of this last group accords best with current ideas about public and patient participation in public services. It puts patients’ concerns at the centre of lay members’ work and goes some way towards ensuring that they know what those concerns actually are. Davies also takes the simple but powerful step of reconceptualizing the lay role as ‘re-presenting’ the public/patient voice rather than as ‘representing it’. This offers a welcome escape from the confusion over the multiple meanings of represent and representative that allows health professionals to marginalize patient-side views. Re-presentation also conveys a sense of the work involved in gathering the relevant evidence and honing the necessary arguments. And it implies support for extensive research into patients’ experiences and views. Davies’‘positively lay’ and ‘re-presentation’ are close to the patient representative (transatlantic consumer advocate) role as it is developing in the consumer or patient empowerment movement in western health care, for many patient representatives regard their legitimacy and much of their knowledge as coming from their direct links with patient groups and patients. Davies does not make this comparison and so does not say whether she sees similarities or whether the public and patients are different from each other in the context of regulation. But the use of terms with uncertain meanings and the search for new ones that will be just right is common as roles develop and differentiate. Taking up the idea of ‘positively lay’ or an equivalent term, defined as entailing an active link to the recipients of a service and an ability to re-present their voice, could form part of a policy for increasing effective public participation at national and governance level in all public services. A second major issue is the statutory base of regulation itself. The lay members pointed out that some current regulations and institutional frameworks preclude regulatory bodies from taking steps to protect the public and patients from potential harm; from setting standards for professional practice acceptable to the public and to the profession and for handling complaints acceptably. The lay members believed that their and their professional colleagues’ hands were tied in ways that no longer accord with the justifiable expectations of patients and the public. These issues needs to be taken up by the regulatory bodies themselves and by the government as a matter of public policy. The study provides much detailed and illuminating discussion and examples of other issues that concern lay members, including recruitment and barriers to more broadly based appointments, time commitments, remuneration if any, dilemmas and seeming paradoxes, critiques of current policy, views of training and support, views of the direct appointment of patients or patient group members and of the appointment of ancillary members to help carry out some of the tasks of the lay members on the councils of the regulatory bodies. Again, there is much of relevance to other lay-professional and public service bodies. As well as making recommendations for policy development, this short publication is rich in observations and fruitful ideas, clearly organized and expressed. In the neglected field of professional regulation, it breaks new ground admirably.