Doctors, teachers and lawyers who cause harm to the public or bring their professions into disrepute should be brought to account by the communities they serve, according to a report from the leading independent think tank ResPublica.
Published today the report ‘In Professions We Trust’ says there is a crisis of confidence in the professions. Scandal after scandal has left their reputation in tatters. Instead of being seen as serving the public many practitioners are now judged to be serving their own interests.
A radical change is needed to put the public back at the heart of what professionals do, say the authors.
The report recommends establishing Local Citizens’ Juries to restore power to communities. Citizens’ Juries would be made up of members of the local community and would have the power to convene and compel testimony from the professions. Authors say Citizens’ Juries should have far reaching powers including the ability to dismiss boards and appoint new members.
Report author and ResPublica director Phillip Blond, says that while the professions have their origins in guilds and organisations set up to best operate for the public good, they are now all too often seen as self-serving interest groups propagating their own agenda and interests.
Mr Blond said: “Action is needed in the face of health service scandals such as the appalling lack of care exposed at the Mid Staffordshire NHS Trust in 2013, a negative attitude towards lawyers and an education system which sees around 40% of teachers leave the profession within five years. (1)
"While state intervention is used to solve problems this can see money taken away from professions such as law and centralisation only serves to create a disconnected NHS. In teaching, a rule-driven regulatory system compounds the problems of low morale among classroom staff, thereby reducing levels of performance.”
To improve standards in teaching the report recommends appointing Queen’s Scholars’ in secondary schools. Queen’s Scholars’ would bring the latest thinking into secondary schools raising the levels of attainment and merging the dividing line between secondary education and university. These Scholars would be graduates studying for PhDs and they would spend a year in secondary schools.
The report says every NHS patient must have the ‘right to holistic care’, a system to ensure they are not passed back and forth between services. A ‘relationship holder’, either a doctor or a nurse, should be appointed to oversee their care. ResPublica calls on the health service regulator Monitor to uphold this ‘right to holistic care.’
External suppliers should be allowed to compete to supply this wrap around care if the NHS can’t provide it.
For the law profession ‘In Professions We Trust’ says lawyers should be made to swear an oath making a public commitment to act ethically and for the common good.
The report also outlines a rewards system where doctors, teachers and lawyers who embody the ideals of their professions are lauded. These people would be ‘Ambassadors’ for best practice in their professions. The report says rather than creating more rules and regulations all three professions must move towards rewarding virtuous character in those exemplifying the best of their professions.
Other recommendations are:
For the Medical Profession:
• 'Stop the Line’: Implement a system whereby any health service employee can stop a process that harms the fundamental mission of a hospital.
• Cross-disciplinary teams to oversee care: Regular meetings with all professionals concerned with patient care to ensure an integrated and holistic service is provided.
For the Teaching Profession:
• 'Local School Support Zones’: Establish a system where successful schools are linked to poorly performing schools to elevate standards.
• University Schools: Develop partnerships between schools and local universities to create hubs of educational excellence.
For the Law Profession:
• 'Duty to mediate’: Report authors call on the Government to assess the benefits of primary legislation that could create a duty to mediate in every case.
• Mandatory pro-bono work: All lawyers should be obliged to do pro-bono work to increase access to justice for the poorest in society. The pro-bono obligation should be set at 10% of all work done by solicitors and barristers. ResPublica says this would produce 26 million hours of free legal advice for the public every year in England and Wales.
Supporting the report Chief Executive of the General Medical Council, Niall Dickson, said:
"The report is a useful contribution to an incredibly important debate and its message reflects many of the principles we are adopting in our work on medical professionalism. While clinical and technical skills remain absolutely essential, we recognise just how vital it is to foster professional skills which countless inquiries have shown are also vital if patients are to receive safe, effective and compassionate care.”