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