THE RIGHT TOUCH

Harry Cayton on his transformative work in licensing and professional regulation

The Registrar staff

In the global regulatory community, one would be hardpressed to not know the name Harry Cayton. The former head of the Professional Standards Authority (PSA) in the U.K. has been instrumental in evaluating and redesigning structures and approaches in health and regulation, governance, and public policy. Cayton has also advised regulatory bodies and governments in Canada, Australia, and Ireland, and New Zealand, Hong Kong, and other countries.

A transformative start

The early years of Harry Cayton were just as momentous as his future career. His parents met in Manchuria, China in the late 1930’s during the Japanese occupation in World War Two, before reuniting and returning to Bristol to start and raise a family. As a young man, Cayton worked different roles, including teaching children with disabilities. Eventually, through a chance opportunity, he was offered a Canadian Commonwealth Fellowship to work in Canada, and, in 1983, made his way to St. Mary’s University in Halifax, Nova Scotia . As both an Officer of the Order of the British Empire (OBE) and Commander of the Order of the British Empire (CBE), distinctions earned in 2000 and 2015 respectively, Cayton was recognized for his prominent contributions to health and regulation reform in the U.K.

Cayton believes his interest and commitment to public health likely began after his family was confronted with an illness that afflicted his father. The younger Cayton says he was shocked to discover how little support was available for families in need, and sought to change that. In 1992, he led The Alzheimer’s Disease Society. Under his leadership, the organization grew from 14 staff to several hundred care workers in just 12 years. Taking note, the Tony Blair government appointed Cayton as National Director for Patients and the Public, a critical public sector role intended to refocus the provision of public health services.

Following his successful non-profit career at the Society, Cayton recalls the limitations in government bureaucracies and the slow pace of change. “I was feeling a bit fed up with not making decisions,” Cayton says. “I had 20 years of being a Chief Executive and now I was advising people what to do, yet they weren’t doing it.”

When the British government created a new body to oversee health regulators, eventually growing into the U.K.’s PSA in 2002, Cayton was appointed to the chief executive role. It was here that he became the architect of modern licensing and professional regulation and laid the foundation that cemented his legacy as its unofficial chief strategist.

Outcomes-focused leadership

Cayton’s initial work in regulation was very different than it is today, noting that things were highly mechanical early on. Regulation is a social invention and not a law of nature, Cayton says. “I was struck by what I would call a lack of intellectual conception about what regulation was meant to be,” he explains. “The people who were meant to be regulators were primarily just doing it, but if you asked them why, they’d reply with ‘this is just what we do,’” Cayton says.

Despite the good intentions laid out by regulators, there was rarely a focus on measuring regulatory impact, Cayton says. Citing the need for greater purpose in regulation, Cayton and his PSA colleagues developed the eight principles of right-touch regulation, aiming to reduce regulation to a common-sense system by emphasizing outcomes.

Shifting the emphasis away from the process of regulation and towards outcome and measurable-based results was at the centre of this approach, Cayton says.

“How do you know that you’re making a difference?” Cayton said of regulatory bodies and their mandates to protect the public interest. “One of the statements of right-touch regulation is that regulation provides a framework in which professionalism can flourish ,” Cayton says. “The truth is, in my opinion, that we shouldn’t think about how to build public confidence in regulation but, instead, think about how we keep the public safe from harm. If you do that well, you instill public confidence where good professionals are recognized by keeping their patients safe.”

While right-touch regulation was developed for a U.K. public, Cayton was surprised how well it was received internationally. In 2018, a PSA paper, entitled ‘Right-touch regulation in practice – international perspectives,’ showcased how regulators around the world adopted the principles of right-touch regulation to modernize their approaches. Case studies from the College of Registered Nurses of Alberta (CRNA), the Royal College of Dental Surgeons of Ontario, Great Britain’s General Pharmaceutical Council , and the Australian Health Practitioner Regulation Agency were all included in the paper. In 2022, CRNA was recognized by the Council on Licensure, Enforcement and Regulation (CLEAR) for the excellence of its work in applying the principles of right-ouch regulation.

Interest in right-touch regulation continues to grow and Cayton sees why. “I think it’s much more important to think about Right-touch regulation as an approach to problem-solving, rather than just regulation,” Cayton says. “It’s something I’ve been advocating for 23 years, and I’m quite astonished to find that even more countries, including for instance Saudi Arabia, have reached out to say that they want to use these guiding principles.”

Protecting the public(s)

The common denominator in Cayton’s decades-long career is his unwavering commitment to the public interest. He says that it’s crucial that the public sees regulators as an important part of society.

Cayton sees many regulators around the world operating on a ‘transmit,’ rather than a ‘receive’ mode. Instead of regulators informing the general public of their role and importance, Cayton embraces the need for more targeted listening and engagement. Each regulatory body has its own public, which he refers to as publics, and more effort is required to protect each one. It’s then up to those publics to define the value of the regulator.

“As we become more conscious of diversity, equity, and inclusion (DEI), [for example] we find that there is no such thing as ‘the public,’” Cayton says. “There are many different publics who may have conflicting interests and regulators need to understand this beyond seeing them as a generalized monolith.”

Inclusion and belonging

While understanding the importance of DEI, Cayton views the term as reductionist, diminishing the complexity of important social relationships and vulnerability to an acronym. Anti-racism efforts need to be discussed more, Cayton explains, as it is an underlying thread of a regulator’s failure to implement diversity, equity, and inclusion separately from each other.

The recent move by regulators to take a more inclusive approach to protecting the public has taken many forms and Cayton commends the shift. Recognizing the need is a positive step, however, he cautions regulator-driven solutions. “Practising anti-racism, alongside diversity, equity, and inclusion, is so much harder than just talking about it,” Cayton said. “It’s right that we care about it, but we need to deconstruct DEI and talk about what each of those terms mean on their own.”

A smaller board can make a regulator’s governance models more effective. Cayton, as a believer in small boards, says that while professionals from a specific public don’t have to sit on a board to get involved with the profession, their voices can still be heard through different means of engagement. An all-inclusive board simply isn’t effective or realistic, Cayton says, if true diversity is to be achieved.

“You have to understand who these publics are and what they think, especially minority publics, who need to be engaged with through your focus groups and your surveys,” Cayton says. “For example, are western models of regulation practised in Canada or the U.S.A. imposed on Asian or African communities with different health care structures a form of colonialism? “While I don’t have any answers, there needs be an understanding that there isn’t just one way of doing professional regulation.”

Current regulatory trends

The shortage of health care workers in Canada and other countries has critically challenged Canada’s health care infrastructure. To Cayton, the idea that an Alberta-licensed physician may not practise in New Brunswick without special permission is impractical. While there are historical contexts applying to a province’s identity within Canada, Cayton says that labour mobility remains crucial overall and breaking down provincial barriers are necessary. He looks to the Australian Health Practitioner Regulatory Agency (AHPRA) governance model as a success story where national licensure enables cross jurisdictional practice with ease.

Cayton also reflects on artificial intelligence (AI) and suggests it could be a powerful tool for analyzing large datasets, the sharing of this data between regulators could speed up many processes including renewals or licensing. However, he cautions that regulating AI itself should not be the end goal. Rather, Cayton believes that regulators should regulate the consequences of using AI.

“Focusing on the outcomes on the way people use AI should be the primary focus, Cayton said. “We need to emphasize the harms that AI can cause to patients, such as the loss of jobs, so that employers can build new opportunities for professionals.”

People-first leadership

To Cayton, public bodies need to look outwards, and not always inwards. This means that there must be an understanding of the harms that are likely to happen in the industry being regulated, a recognition of the likelihood of those harms reoccurring, and differentiating those harms and the impacts to all communities.

“At the end of the day, I believe regulators need to put less into thinking about the profession they regulate, and start thinking more about the people they regulate for.”