A UK wide Council for a UK wide Regulator

Vibrant, successful governance depends upon maintaining a strong team. In August, the Health and Care Professions Council (HCPC) is launching its recruitment campaign to appoint new members to its Council. Four of our existing members are coming to the end of their term of office, and cannot be re-appointed as they have reached the maximum time period allowed for serving on a Board.
This has been another year of achievement for the organisation. We continue to meet the standards set by the Professional Standards Authority, and we were described in its latest report as an effective regulator (1). Our UK wide Register holds 320,000 professionals from 16 professions, and we constantly improve our processes to ensure that we deliver our regulatory functions. There is no room for complacency, and as we grow we remain focused on continuous improvement in our processes. HCPC has always had a strong commitment to extending public protection through statutory regulation, and there is no sign of this diminishing. Next year, we will open a new register for Public Health specialists, and we continue to contribute to the debate about further professions and whether or not statutory regulation should be introduced for them. Over the last few years, we have had a particular focus on the challenges of holding care workers to account. This year, the Health Select Committee Report supported our proposals for the implementation of a new form of regulation for adult care workers (2).

Beyond this, we are undertaking further reviews of our standards and research to bring better understanding of regulation and its purpose. Health and social care is becoming ever more complex, and public expectations of what professionals deliver is changing. We continue to engage with other agencies and with government to raise standards and deal swiftly with instances of poor care.

These are just a few of the challenges that our four new members will be engaging with as they join our Council. We are non executives who want to see better protection for the public, and ever better, more efficient regulation of health and care professions across the UK. This UK wide perspective has always been of great importance to the HCPC, and throughout our history we have maintained a team drawn from all four countries of the UK. Health and social care is in a constant state of change, and there are significant differences between the four countries of the UK. The Council must continue to engage with this diversity and understand the implications for regulation.

Perhaps most critical of all, we are seeking new members with a personal commitment to public service (3). It was Bob Greenleaf who observed many years ago that legitimacy begins with trust. ‘The only sound basis for trust is for people to have the experience of being served by their institutions’  HCPC’s sole purpose is to deliver public protection. It exists to serve the public through setting and maintaining standards for many thousands of health and care professions. A huge, exciting challenge.



References
1. Professional Standards Authority Performance Review 2013-2014. www.professionalstandards.org.uk
2. 2014 Accountabilty hearing with the Health and Care Professions Council. First Report of Session 2014-15. http://www.parliament.uk/
3. Good governance http://hcpc-uk.blogspot.co.uk/2013/08/striving-for-good-governance.html

Anna van der Gaag
Chair
HCPC

Benefits of being a Council member

Abuse and older people: more personal accountability required

In May 2011, the nation was shocked by images of people with learning disabilities being abused by their carers at the Winterbourne View Care home near Bristol. Wednesday’s BBC Panorama programme showing more images of abuse and humiliation of elderly people in care homes only serve to reinforce fears that the current system of accountability in the care sector is not working.

Our view has always been that there needs to be a system of personal accountability in place to address poor care. In the programme, the company who run one of the care homes defended their business by saying that the incidents only involved "a small number of staff." Employers we have spoken to over the last two years say the same. Surely this points to the need for a more robust and responsive system for dealing with "the small number of staff" who should not be working in the care sector.

At the moment, there is no statutory code of conduct to hold care workers to account. We recognise that the majority of care workers, with the right support and supervision, do an excellent job in challenging circumstances.  However, there are too many reports of staff delivering poor care. The judge in the Winterbourne view case was told by one of the carers - "I wasn't trained in this. His response was - "you don't need to be trained to act humanely."  We also know from the sector that there are individuals who abuse elderly and vulnerable people, are dismissed from one employer and then employed in another setting. These serial offenders must be stopped. It is time to reinforce this message through legislative change.

So what is the solution?

Certainly, there are encouraging signs of change following the Cavendish Report, which advocated standardisation of training and supervision for support workers, and greater responsibilities on employers. The CQC is strengthening its inspection regime and is identifying poor care. Celebrating excellent care and promoting good recruitment processes are also part of change and improvement. We fully support and welcome all these initiatives, but they are not enough.

We believe our proposals would address specific failures by ‘the small number of staff’ whose behaviour and care is unacceptable.  Three elements - a statutory code that articulates the requirements for honesty, integrity and respect, together with an adjudication process that can hold individuals to account, and public access to a register of those not fit to work as carers, would make a difference. These changes would be proportionate, cost effective and stronger than the current system.

There needs to be greater personal accountability, backed by legislation. I am very encouraged that our proposals for such a system have been incorporated into the Law Commissions’ draft Bill currently being considered by the government. Decisive legislative action is needed so we can deliver more effective protection for the elderly and most vulnerable members of our society.

Anna van der Gaag
Chair
Health and Care Professions Council

Further reading
Full details of the HCPC's proposals are set out in our policy statement - see section 4.8 http://www.hcpc-uk.org/assets/documents/10003F1AHCPCpolicystatement-RegulatingadultsocialcareworkersinEngland.pdfhttp://www.hcpc-uk.org/assets/documents/10003F1AHCPCpolicystatement-RegulatingadultsocialcareworkersinEngland.pdf

The Law Commissions’ final report and draft legislation sets out the recommendation and proposals to introduce barring schemes - see p66 and p359 (part7) http://lawcommission.justice.gov.uk/publications/Healthcare-professions.htmhttp://lawcommission.justice.gov.uk/publications/Healthcare-professions.htm

Reflections on the Narey and Croisdale-Appleby Reports: A system in transition

At the end of March, HCPC’s Council considered the Narey and Croisdale Appleby Reports, commissioned by different government departments to review the state of social work education in England. Narey’s report focused on the landscape of children’s social work, whilst Croisdale Appleby looked at social work education more broadly in relation to adult services.

The paper we considered looked at six themes – future responsibility for regulation, generic versus specialisation in social work education, standards, the education approvals process, licence to practice and continuing fitness to practice. Council concluded that certain recommendations, such as Narey’s recommendation that regulation should be transferred to the professional body, were a matter for government. There was discussion around the value of separating regulatory functions from professional body functions, and agreement that the role of the regulator was to protect the public by maintaining and upholding standards, whereas the role of the professional body was to develop and promote the contribution of the profession. These complementary roles best serve the public - and the profession - if they are kept separate and distinct. The days of self regulation by a profession are long gone, and evidence shows that there is little appetite for a return to the past.

The Council saw the reports as ‘snapshots of a system in transition’ – at times disappointing in that they did not reflect the complexity of the current educational landscape. Social work education involves many different players – internal and external quality assurance processes, as well as students, employers and service users. There is much about the quality assurance of social work programmes that is far in advance of other sectors in the ways in which service users are involved in the approvals process. HCPC has learned and changed as a result of this experience.

Perhaps most important, the impact of the new regulatory landscape has yet to be felt across the whole sector. The current approvals system is in transition. Only a third of all social work programmes have been through the entire HCPC approval process.  We have required nearly all programmes to make changes to meet our standards. Students who are now enrolled on these new approved programmes are yet to complete their first year of study, meaning their engagement with placement learning and integration as the future workforce is still ahead of us. Similarly, social workers in England have not yet been audited against HCPC standards on CPD, with its strong focus on personal responsibility for learning and outcomes based approach.

What then of Narey’s concerns? Are placements in child protection in short supply? Do some students miss out on such placements during their training? Could more be done to support students in training to ensure that they have the necessary knowledge and skills to protect children from harm? Perhaps. We will be keeping a close eye on placements as we visit the programmes. If we find that there are not enough high quality placements in children’s services, we will alert providers to this shortfall. If, at the end of the process of visiting programmes, we see that there is a need to revise the current standards, we will do so. But we are not there yet. What of Croisdale Appleby’s proposals to augment the standards? If, at the completion of the visits, there is an appetite within the profession to do so, we will engage fully with the profession to introduce improvements.

The clear message was that the impact of the new system of regulation for social workers in England cannot be fully evaluated until it is complete.  HCPC aspires to be an evidence based regulator. It has a track record in thorough review, adherence to clear scrutiny processes and careful ongoing monitoring. It is applying these same principles to its work in social work education. However, if there are areas for development in the standards, or weaknesses in programmes that are causing concern now, we would welcome further information on them. If the failures of Mid Staffordshire mean anything, they must surely point towards identifying weak links in the chain, whether in education or in practice.

Anna van der Gaag
Chair
Health and Care Professions Council

An opportunity to stop poor care through new Law Commissions' Draft Bill

Last month I attended a lecture by Robert Francis QC at the Royal Society of Medicine. Predictably, he was reflecting on the lessons from his Inquiry into events at the Mid Staffordshire Hospital Trust. At the end of a powerful lecture, challenging doctors to take action, he was asked for his reaction to the lack of progress on his recommendation to regulate care assistants. He responded by saying that in his view, “too little was being done”, adding that he was waiting with interest to see how the recommendations of the Cavendish review would unfold.

There is broad consensus that Camilla Cavendish provided a very clear direction on the roles and responsibilities of employers and managers, the importance of training and supervision and mentoring for support workers, emphasising the vital role they play in delivering health and social care. However, these mechanisms will not stop the tiny minority of individuals in the care sector who commit serial offences, and who successfully move from one care setting to another without redress. This is the group that HCPC have suggested require legislative change to bring them into a system of personal accountability.

Part 7 of the recently published Law Commissions Health Bill was therefore a welcome development in this long running, complex, and challenging area. The draft legislation from the Law Commissions make provisions for professional regulators to establish barring schemes which would allow investigation and adjudication of unregistered care workers. If a complaint was upheld, the individual would be barred from working in the sector and would be put on a list circulated to employers and available to the public on the internet. This would be a cost effective and proportionate mechanism for dealing swiftly with poor care. 

The evidence from Australia, where this scheme is already in place, is that it is having a positive impact, proving a critical deterrent to those who would circumvent the system of accountability. We know from the data there that this kind of behaviour is not common, but where it does occur it can have a devastating effect on patients, service users and their families. After the shocking events of Winterbourne View, I wrote a piece on this blog which described why regulators as well as employers needed to act to bring about change in the care sector. The subsequent stories of appalling care in Mid Staffordshire, in Lanarkshire, in West Sussex and London, all point to the need for legislative change. I commend this section in the Law Commissions' Bill and look forward to seeing it become law. HCPC, if given powers to take action in the social care sector, will do so with vigour and determination.

Anna van der Gaag
Chair
Health and Care Professions Council

References
The Independent, 9 April 2014
http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-bad-eggs-could-be-struck-off-under-new-regulation-plans-drawn-up-by-the-law-commission-in-response-to-midstaffs-scandal-9231222.html

Flynn M (2012) Winterbourne View Hospital: A Serious Case Review. South Gloucestershire Safeguarding Adults Board
http://hosted.southglos.gov.uk/wv/report.pdf

HCPC seminar series asks: Who are your service users?

The new standard of education and training

Following research in 2012 and consultation last year, we have decided to amend the standards to require the involvement of service users and carers in all approved programmes. This recognises the important role this involvement plays in ensuring students are fit to practise at the point they complete their programmes and join the Register.

The new standard states: "Service users and carers must be involved in the programme."

Service user and carer involvement seminars

To introduce the new standard support education and training providers, we have held a series of seminars throughout the UK.

At these seminars, delegates were given a brief overview of the new standard and what it means for them as education providers, before undertaking some group activities to determine who they can involve in their programme and how. Education providers were given the unique opportunity to play the HCPC’s ‘Service User and Carer Card Game’.

For this, delegate groups were given a series of cards detailing fictional characters and asked to decide who would be service users or carers for a certain HCPC profession, under the new standard’s guidance. Taryn, a barmaid who participates in research studies, and Charles, a welfare benefits solicitor, were just two of the 26 characters, who each sparked some thought-provoking questions and discussions between delegates, such as:

• Are the service users and carers necessarily individuals or can they be groups or organisations?
• Are they all direct users of the services for a profession or can the perspectives of those indirectly affected by the work of health and care professionals be relevant?
• Are they the end users of a service or might intermediate users of services, such as other professionals, also have valuable contributions?
• And to what extent can different groups or individuals get involved in an education and training programme?

“The game was a great way to think about who service users and carers might be. I’d like to bring it back to my own team.”

Using scenarios, delegates then built on these themes, comparing possible approaches that education programmes might take and looking at some of the potential barriers and benefits that may arise.
Recruitment, support, representativeness and avoiding tokenism were all topics for consideration, whilst also looking at the appropriateness of involvement activities in the context of the other SETs.

The seminars also featured videos to encourage reflection and discussion around the theme, which triggered some delegates to consider the use of digital media and platforms in embedding service user and carer contributions in education or training programmes.



Service user representatives attended some sessions, enriching the discussions with invaluable insights into the education and training of professionals from their perspective.

The seminars proved an important opportunity for education providers to share their experiences with representatives from other professions and programmes, and talk to us about our expectations for the new standard.

“I found the activities very thought provoking.”

“I have learned a great deal about the HCPC today as well.”

Service user and carer involvement and you

What do you think are some of the approaches you could take to involve service users in your own programme? What are some of the challenges? Do you have experience with a successful way to involve service users? Please share your thoughts and comments below.

Nicola Baker
Education Officer
HCPC

Notes:

• Download a copy of the new standard and supporting guidance here [PDF]. 
• We will be rolling out the new standard on a phased basis and will apply as follows.
• From 2014–15 - new programmes, transitionally approved programmes and programmes requiring a visit as a result of a major change or annual monitoring submission.
• From 2015–16 - all other approved programmes, including prescribing programmes, formally assessed through annual monitoring
• Immediately -  Approved Mental Health Professional (AMHP) programmes at approval visits.
• If you have any questions about the new standard and what it means for education and training providers, please contact us at education@hcpc-uk.org 
• Education seminars take place each year on relevant topics for education and training providers. You can find out more information here.

A journey of a thousand small steps: Thinking about competence in a different way

Last week, a year to the day after the Francis Report on Mid Staffordshire was published, we hosted a seminar to continue our discussions on professionalism and to launch the next stage of our research (1). The seminar was led by Professor Zubin Austin from the University of Toronto, who has a particular expertise around competence and how we understand it in a health and care context (2). We were particularly pleased to welcome so many representatives from professional bodies, employers, educators and other regulators to this forum.

Professor Zubin Austin’s work in Ontario illustrates a number of important themes highly relevant to the collective desire to see improvement in health and social care in the aftermath of Mid Staffordshire.

First, that patients and service users are likely to have different expectations of professional competence from professionals. Service users and patients want professionals to be ‘accessible’, and ‘affable’. Technical know-how is important, but not more important than clear communication and authentic respect.

Second, the evidence suggests that professionals who are competent have several characteristics in common: they are professionally networked, and express satisfation with their career choice and with their personal lives. The key factor in what Zubin calls ‘competency drift’ is isolation. Zubin suggested that disengagement in one’s workplace is often linked to disatisfaction more widely, and that the ‘firewall’ that existed for previous generations between the personal and the professional world no longer exists. The core problem with competency has very little to do with technical skills alone and everything to do with the individual.

During the discussions, there was agreement that competency is multifactorial and is influenced by the environment as well as the individual. There was an appetite for exploring this new discourse on disengagement further, and encouraging people in health and social care to talk about how and why it occurs. Some were concerned about how this could be measured, whilst others proposed that it was the conversations themselves that were key to change. The evidence from Ontario is encouraging. Where interventions along these lines have been introduced, complaints to regulators have reduced.

There was an acknowledgement that all the agencies have a role to play in this discourse. If we can recognise and address personal and professional isolation before it becomes the trigger for poor practice, we may have an influence on the number and nature of complaints that are made.  

Professor Zubin Austin called it a journey of a thousand small steps. For service users, patients and professionals, it is surely a journey  worth making.

Anna van der Gaag
Chair
HCPC

Anna, Zubin and colleagues feed back on the event


Dr Anna van der Gaag in conversation with Professor Zubin Austin

Notes:

(1) HCPC is commissioning research to look at the factors which can lead to poor practise, why things go wrong when they do using a qualitative study of fitness to practise cases. This work will be published in January 2015.

(2) Austin Z. (2013) How competent are we at assessing competency?
Keynote, CLEAR Congress on Professional and Occupational Regulation, Edinburgh, June 27-28,  2013 www.clearhq.org.