THERE are nine professional regulators currently functioning in the health system covering everything from nursing and medicine right through to dentistry. The regulators keep a register of persons fit to practice their profession, determine standards of training and practice, advise on conduct and performance and run misconduct processes.

A health professional can be struck off the register if they fail to practice to the highest standards and a duty is placed upon them to put protecting the patient at the heart of everything they do.

When I was an NHS nurse I followed the Nursing and Midwifery Code for 28 years. The fear of losing your pin and being unable to work as a nurse ever again is a powerful motivator to do the right thing when delivering care to patients.

My professional code also went hand in hand with my duties as a GMB rep. I organised my colleagues into my union to oppose restructures, down-bandings and cuts; union members felt confident to take a stand. We all knew that opposing cutbacks was key to protecting services for our patients and this was fully aligned to our code of professional practice.

The white paper gives the secretary of state new powers to remove a profession from regulation and to abolish a regulator completely. Cost efficiency and “removing bureaucracy” are cited as good reasons for these additional powers.

The secretary of state will argue they are providing public protection in a modern and effective way — however the danger is that short-circuiting the regulatory system, or regulators subsuming the responsibilities of other professional regulators, could lead to internal confusion, increased workload and reduced scrutiny. Any resulting lowering of standards in the NHS will have an adverse impact on patient care.

The entire foundations of the nursing profession have been shaken up before. In the 1990s nurse training was radically changed to Project2k on the pretence of increasing the status and recognition of the nursing profession but instead had significant and long-lasting consequences for the delivery of patient care and a detrimental impact on pay, terms and conditions.

Nursing bodies were only too happy to agree to nurse training changes because a promise was made that the nursing profession would be elevated, properly recognised and this would make it more attractive as a career option and increase recruitment.

The pressure on student nurses grew as they were required to study to degree level whilst also acing clinical practice assessments; the drop-out rate is up to a third of all applicants.

The entire NHS had to adapt to Project2K because student nurses were granted supernumerary status meaning that their vital roles providing the bulk of patient care on wards and units were stripped out of the NHS.

Prior to project2K, ward sisters could feel confident that student nurses had a minimum of six weeks’ nurse training before they were allocated to wards, but they came under pressure to draft in new layers of people who had little or no training to provide patient care.

Over time, healthcare assistants became the backbone of the ward staffing compliment and to their credit they took on NVQ training and many aspects of the nursing role — but for a far lower rate of pay than a nursing role would attract.

The supernumerary status of student nurses has slipped: the student nurse bursary has been taken away and now many student nurses are in a situation where they are working for free on wards and piling up student debt as they support units to plug staffing shortages during Covid-19.

The result of the nurse training changes led the NHS into a nurse-recruitment crisis as experienced, highly qualified nurses with degrees have endured further pay cuts and freezes, forcing many to foodbanks to survive.

During the Covid-19 crisis NHS staff have been treated with utter contempt by this Tory government, which deliberately excluded them from the public-sector pay announcement at the end of last year.

Breaking down the barriers between NHS staff groups and deregulation supports a direction of travel that is familiar within the NHS. Roles and responsibilities have merged and staff across all of the bandings are taking on more responsibility for less pay.

The intention behind the white paper to further merge roles and deregulate professions will undermine the duty of care to patients. Most experienced NHS trade unionists will know that a consistent finding in many NHS Serious Untoward Incidents and professional misconduct cases is that lines of responsibility and accountability were unclear which caused harm to patients.

NHS staff take pride in their professional identities and nurses in particular have discovered a newfound solidarity as they are building the NHSPay15 campaign in the GMB and other trade unions. It is not difficult to imagine that any attempt to fundamentally alter what a nurse is could serve to undermine this growing solidarity.

Deregulation hasn’t worked across many spheres: it contributed to the banking crisis of 2008 and hollowing out the Health and Safety Executive has led to the failure to hold negligent employers to account for safety breaches during the pandemic.

Searching questions must be asked about plans to deregulate the NHS professions because the Tory Party track record has led to the type of cuts and privatisations that have had harmful consequences for patients and staff.

Helen O’Connor is Southern region organiser for the GMB.