Restoring Public Confidence

Pat Tonner of Care Scotland stresses just how crucial an issue regulation of the care workforce has become…

A number of high profile and distressing criminal cases in recent years have exposed weaknesses and highlighted loopholes in the systems for recruitment, vetting and monitoring of staff employed to care for vulnerable adults and children.

Such cases have dented public confidence in the caring professions and alarmed everyone involved in the selection and management of staff in care settings. Calls for Public Inquiries into these dreadful events have resulted in a raft of measures being introduced to regulate the workforce and prevent such tragedies occurring again.

This article seeks to examine these measures and the duties that are now placed on employers before care workers can be employed.

The case of GP Harold Shipman led to an enquiry by Dame Janet Smith which has produced no less than six reports containing far-reaching recommendations for all health professionals. The fifth report considered the handling of complaints against general practitioners (GPs), the raising of concerns about GPs, General Medical Council procedures and its proposal for revalidation of doctors. She has made recommendations for change based upon her findings. This will have implications for other health care professionals through the Foster Review being conducted by the Department of Health. The terms of reference of the Foster Review are to put in place comprehensive and consistent measures to ensure all professionals treating patients remain fit to practise through effective continuing professional development and appraisal systems.

Most health care professional staff are already regulated by a number of bodies such as the Nursing and Midwifery Council (NMC) and the Royal Pharmaceutical Society of Great Britain (RPSGB). Each profession has its own regulatory body operating within its own legal framework. Central to the functions of those bodies is the conduct of hearings to assess the fitness for practice of individuals, which may result in ‘striking off’ or other disciplinary action. {mospagebreak}

Social care professionals are in the process of being regulated by the Scottish Social Services Council and significant progress has been made towards extending statutory regulation to more professions who aspire to regulation, such as Operating Department staff, healthcare scientists and psychotherapists. However, under the current regulatory framework, staff who have been removed or suspended from an existing register could return to work in a setting as a support worker.

Currently support workers – including health care assistants, and other support staff in laboratories, diagnostic departments and the full range of clinical facilities in hospitals and primary care – are not subject to regulation of any kind. The Foster Review is examining how to regulate this very large group of staff. A widespread consultation was carried out in 2004 about possible ways of regulating support workers. The regulation of currently unregulated staff is a matter for the devolved administration in Scotland and the Scottish Executive who, following a consultation in Scotland on the regulation of support workers in 2004, are currently considering how to take this forward. It is vital that the two countries work closely as the consultation in Scotland suggested that any proposed regulatory bodies should work together to develop common standards to facilitate transferability of staff between the four UK countries.

Although there was a general agreement that some form of regulation was needed, there was no consensus about how this might be brought about. It was agreed however that it was, and indeed is, essential that all staff groups who have direct contact with patients and service users provide high quality care.

Quality of care will be strengthened if arrangements are put in place that require health and social care staff to meet standards of practice, conduct and training that can deal with those who do not meet the standards. The concern is that currently, even if the behaviour or lack of competence in a specific job leads to disciplinary action, they may then be able to take up a similar post with a different healthcare employer with little difficulty. {mospagebreak}

Many support workers in health care are extending their skills so that they can undertake work previously done by registered professionals. National occupational standards which form the basis of health and social care vocational qualifications already exist, and give professional staff the confidence to delegate more skilled work to assistants and support staff.

The development of the Joint Future agenda means that the proposed regulation of health and social care support staff needs to accommodate workers in the NHS, local authorities, and the voluntary and private sector in Scotland, and provide flexibility across professional, sector, agency and cross-border boundaries. The current situation, whereby a client can receive care in the home from workers often performing similar tasks, but where one will require to register with a regulatory body and the other not, is untenable.

In England, The Protection of Vulnerable Adults – POVA – scheme was brought in to ban those professionals who have harmed vulnerable adults in their care. It adds an extra layer of protection to the pre-employment processes, including Criminal Records Bureau checks, which already take place and is designed to stop known abusers from entering the care workforce.

In addition to the pre-employment checks, employers are required to make a referral to the list whenever a worker has been seen to be guilty of misconduct that harmed, or placed vulnerable adults at risk of harm. In the scheme’s first year of operation over 700 people have been barred from working in regulated social care settings. The vast majority (87%) of referrals involved front line workers, care assistants and support workers.{mospagebreak}

There are plans to have a similar list in Scotland but also to introduce comprehensive legislation to protect vulnerable adults following an investigation and report into the circumstances surrounding the case of Borders Council and Miss X.

The final consultation on the Protection of Vulnerable adults is currently being undertaken. However, in the meantime the information contained on the POVA list in England is not shared with authorities in Scotland.

Following the Soham murders in 2004, an independent enquiry chaired by Sir Michael Bichard found errors, omissions and shortcomings which meant that an unsuitable person was able to gain access to young children. The Bichard enquiry made a number of recommendations including the introduction of a national police intelligence system, which Scotland already has. The Protection of Children Scotland Act 2003, brought in after the Cullen Inquiry into the shootings at Dunblane Primary School, places a duty upon employers and the courts to refer people to the List of Persons Unsuitable to Work with Children if they have harmed children or put children at risk of harm, whether paid or unpaid. Failing to make referrals is an offence. Those on the List (other than provisionally) commit a criminal offence if they apply to or work with children. It will be an offence for an organisation to knowingly employ a person to work with children if that person is on the List (other than provisionally). Safeguards for the individual are included in the Act including the right to appeal to a sheriff.

These new and proposed measures will place a much greater burden on employers when recruiting staff to work in care settings, but places a duty on everyone working in care to challenge and report any instance of actual or potential abuse of vulnerable adults and children if public confidence in the caring professions is to be restored.

The onus therefore is on everyone working in care to be alert to the possible indicators of abuse and bad practice, and to feel confident that action will be taken against those responsible if the confidence of the workforce is to be restored.