Social care regulation proposals need more time
Plans to change the way social care workers are regulated must take into account the needs of people who use these services and of those who work in them, says Melanie Henwood
Much of the focus of debate of the health and social care bill currently before parliament is on the sweeping changes it presages for the NHS, with the transfer of commissioning to GPs and consortia. However, tucked away towards the back, the bill also addresses other crucial matters – not least the changes to the regulation of health and social care workers.
The government review of arm’s-length bodies published last July announced the abolition of the General Social Care Council (the social care workforce regulator). The review found “no compelling reason” why the GSCC should remain as an executive non-departmental public body in the arm’s-length bodies sector, and saw potentially significant benefits from “putting the regulation of social workers on a similar footing to the regulation of health professions”. The regulator should be funded by registration fees, it was argued, and thereby registrants would “buy into their professional standards”. To this end, part 7 of the bill provides for the abolition of the GSCC and for the transfer of functions to the Health Professions Council (HPC), which will be renamed the Health and Care Professions Council. The bill also makes provisions for the regulator to regulate or modify the regulation of social care workers (ie beyond social workers).
In a recent interview, the chief executive of the HPC, Marc Seale, said that a national registration scheme is being developed that would see the register being opened to sections of the social care workforce. He is quoted as saying that the council will be keen to develop a policy on regulating social care workers and “my hunch is we’ll do that fairly quickly”. In practice, it may prove more challenging. The sheer scale of the undertaking needs to be understood. While the HPC currently regulates 15 health professions, these total around 200,000 registrants. Taking over the registration of social workers will add around another 100,000. However, the wider social care workforce that could come into regulation numbers more than 1.5 million.
The issues are not simply about expanding scope and scale, but about the model of regulation adopted. The professional model is unlikely to be appropriate for a workforce that is not professionalised, often unqualified and transient. It is also generally low paid and the idea of paying a significant registration fee will be hard to sell either to the workforce or their employers. However, regulation needs to be meaningful and to drive up standards, and any model of regulation for the wider social care workforce must not be so diluted or tokenistic that it is of little value. Certainly, this could be a flaw of a voluntary registration system. Regulation has to be both risk-based and proportionate, and getting the right balance between those objectives will be far from straightforward.
Furthermore, the social care landscape is changing dramatically; the roll-out of personalisation and the expansion of personal budgets means that more and more people will become the employers of their own care workers and personal assistants. Any new model of regulation needs to be fit for purpose not only for the current workforce, but also for the emerging one. Ensuring that regulation is appropriate and compatible with principles of choice and control will require a sophisticated and flexible model, and one that is based on a clear understanding of the needs of people who use social care services, as well as those who work in social care. This will be especially demanding for a regulator whose expertise to date is solely in the medical model of healthcare. Any policy on future regulation to be developed by the HPC needs to be well aware of these tensions and to be grounded on consultation. It is hard to see how these requirements can be compatible with the development of policy “fairly quickly”, and any attempt to do so may prove to be misguided.
• Melanie Henwood is an independent social care consultant. She was a lay member and vice chair of the General Social Care Council