Sarah.devaney@manchester.ac.uk
Margaret.R.Brazier@manchester.ac.uk
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ManReg: the Manchester Centre for
Regulation and Governance
◦ Regulating Reputations
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Centre for Social Ethics and Policy
◦ Role of the Criminal Law in Healthcare
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Effective regulation: regulators responsive to
the culture and needs of their regulatees
◦ which regulators use reputation and how (and
which regulators could resort to it but do not)
◦ which regulatees respond to it and why
◦ in what circumstances it is effective and why.
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Credible, effective, legitimate regulators
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‘sustained and focused attempt to alter the
behaviour of others according to defined
standards or purposes with the intention of
producing a broadly identified outcome or
outcomes’. Julia Black (2002)
‘obligations imposed by public law designed
to induce individuals and firms to outcomes
which they would not voluntarily reach.’
Anthony Ogus (2009)
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Command and Control
Right touch etc
Traffic lights
Healthcare – nudging
Regulation that will influence the behaviour of
healthcare providers to care for patients in as
safe and effective a way as possible in
compliance with Good Medical Practice.
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‘an unhealthy and dangerous culture pervaded
not only the Trust … but the system of oversight
and regulation as a whole and at every level.’
Trust Board: ‘tolerance of poor standards and a
disengagement from managerial and leadership
responsibilities’
Regulation: achievement of national targets,
financial balance and foundation trust status
prioritised the above patient care - agencies,
regulators and professional bodies failed to step
in
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Distress, stress and worry
Compliance is ‘the right thing to do’
Pride in being part of the solicitors’
profession, and the role of regulation in
upholding the standards of the profession
Fear of reputational damage and a denting of
‘professional pride’ of greater significance
than risk of sanction (SRA 2011)
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Little evidence of the behavioural effects of
regulatory activity and interventions on those
regulated
Complex:
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Goals and incentives of doctors
Habits and self-belief
Reconciling personal judgement with guidelines
Team working and human factors
Morale, workload and resources
Organisational culture (Scraggs et al 2012)
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Why is reputation not important?
◦ Markets (but commissioning)
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Can it become more important?
Complexity inhibiting professionalism?
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Major outputs
D Griffiths and A Sanders Medicine Crime and
Society (CUP, 2012)
M Brazier and S Ost Bioethics and Medicine in
the Theatre of the Criminal Process (CUP,
2013)
A Alghrani, R Bennett and S Ost The Criminal
Law and Bioethical Conflict (CUP, 2012)