27 September 2012

Accountability and the adult social care workforce

When Polly Toynbee referred to Jeremy Hunt’s in-tray as "a pyramid of hand grenades with loose pins,"(1) she may not have had the regulation of support workers in mind. However, for those of us involved in professional regulation, we have been debating the issue for some time. Winterbourne View brought home the toxic consequences of mismanagement, lack of training and a "hospital run by support workers" (2). We know from different sources that the ratio of professional staff to support staff is changing throughout the country and that many are employed directly by people with disabilities in their own homes. Estimates on the numbers in the adult home care workforce are around about 400,000 in England.

It is likely that the vast majority of these individuals are committed, compassionate individuals who have been involved in caring work for many years. Without them, society would not be able to function. However, we also know that there are a minority who fall short of the high standards we expect of someone caring for our mothers or grandmothers. These are the individuals we want to ensure are made accountable and are not able to move from place to place when concerns begin to be raised about their behavior or conduct.

The government has asked the HCPC to look at the options for regulating this workforce. At our Council meeting last week, we agreed that, as a statutory regulator, we were not minded to set up a voluntary register because it would not provide the public reassurance and protection that is needed here. Statutory regulation for this workforce would not be a proportionate response and is one that the coalition government would probably not support. A third option would be to introduce a negative registration process, in effect, a register of individuals who cannot work in the sector, rather than one for those who can. Any individual who is found to fall below statutory national standards of behavior and conduct could be placed on an HCPC ‘negative’ register. The system could impose a range of sanctions on individuals, for example, require specific training or supervision to be put in place. One key question is: how much would it cost? The answer is: much less than any of the alternatives. The evidence from other countries that have a similar model shows that few people are stopped from working in the sector permanently. However, the statutory nature of the negative registration scheme means that there is a clear deterrent, an enforceable means of holding individuals to account. This is what is missing at the moment.

As a Council, we are clear that our responsibility is to explore all the options and reach an informed decision before making any recommendations to government. We will be looking at this alongside the regulation of care home managers. As in all our endeavors, we will be seeking the views of stakeholders from across the sector to assist us.

Anna van der Gaag

(1) The Guardian, 6 September 2012.

(2) Flynn M (2012) Winterbourne View Hospital: A Serious Case Review. South Gloucestershire Safeguarding Adults Board.