Revalidation Repercussions: Challenging the Power of Enforceable Trust
Publicised health care scandals in the United Kingdom (UK), and subsequent changing attitudes towards healthcare professionals, have provoked public and political calls for the reform of healthcare professional regulation. The recent introduction of ‘revalidation’, a government led policy of regulatory reform, signifies fundamental changes in the regulation of healthcare professionals. Revalidation represents a shift from embodied trust in professionals to enforced trust (Light, 2010), seeking to govern professionals by means of national and organisational objectives (Evetts, 2012). New regulatory policies, such as revalidation, are noted to frequently challenge professional power and self-regulatory privileges, however controversy remains as to whether such policies do actually shift the balance of power and what the resulting effects of policy introduction would be.
This paper presents primary observational research findings, exploring the real-time implementation of medical revalidation within a UK National Health Service (NHS) organisation, and its impact upon professional power. The national policy of revalidation was subject to the existing governance and management structures of the NHS organisation, resulting in the formal policy process being shaped at the local level by the informal processes of the organisation. This paper explores how the unorganised nature of the organisation seemingly hindered rather than facilitated robust processes of professional governance and regulation, fostering ritualistic rather than genuine professional engagement with the revalidation policy process. Ritualistic professional engagement assisted the medical profession in retaining self-regulatory privileges whilst maintaining professional power over the policy process. Medical professionals were therefore able to directly and indirectly influence the revalidation policy process at the local level, questioning the ability of national regulatory policy to shift the balance of power, and to govern and control professional groups. This paper concludes by challenging the theorisation that professional groups are effectively regulated and controlled by means of national and organisational objectives (Evetts, 2012), such as revalidation.