Failing professions should be brought to account by people they serve

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 co-authored by University of Liverpool and leading independent think tank ResPublica.

The report, "In Professions We Trust," says there is a crisis of confidence in the professions. It suggests that instead of being seen as serving the public, many in the professions 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 report co-authors, Professor Elena Antonacopoulou, from the University of Liverpool Management School and ResPublica Director, Phillip Blond.

Ordinary morality

Prof Antonacopoulou said: "Professional politics and unwritten mandates often stand in the way of ordinary morality according to individual and social conscience.

"These and other conditions provide a framework that simply does not work, and codes of ethical conduct do little to avert professional misconduct. They do not work to inspire, motivate and engage professionals to perform professional practice with pride and confidence, dutifulness and conviction, aspiration and ambition, attentiveness and tenacity. They merely encourage and reward mediocrity and getting by with what it is possible to do, and still get away with it."

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. Citizens' Juries should have far reaching powers, including the ability to dismiss boards and appoint new members.

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.

"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."

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 excellent practice in their professions. The report says that, rather than creating more rules and regulations, all three professions must move towards rewarding virtuous character in those exemplifying the best of their professions.

Important debate

Prof Antonacopoulou added: "What is needed are modes of learning and changing, otherwise referred to as 'reflexive critique', that promote not only exercising judgement in widening the repertoire of action, but also examining professional and personal life holistically and thus, practising virtuousness through a code of chivalry, and with altruism."

Among the other recommendations in the report, which was launched at the House of Lords, are the introduction of Local School Support Zones and University Schools in education; a Duty to Mediate and a requirement for mandatory pro-bono work in the legal profession; as well as the incorporation of a Stop the Line system and cross-disciplinary teams to oversee healthcare.

Welcoming 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."