Cab drivers and care workers

The recent King’s Fund conference on the Francis Report has generated considerable debate and discussion, not least because Robert Francis was present to make some powerful observations on the challenges that lie ahead.

One of the areas that was addressed by many of the speakers was around future plans for healthcare support workers. During one of the sessions, we heard about a new approach to recruitment and retention of these staff. Lucy Connolly, Assistant Chief Nurse at York NHS Trust, described how the Trust had moved from a competency based approach in the recruitment of support workers to a values based approach. This includes a person specification with a primary emphasis on values, mandatory open events, which include talks from support workers and a DVD of interviews with support workers talking candidly about the role, and interviews with an emphasis on values and compassion. Once appointed, all support workers undergo a two-week induction, again with an emphasis on values and personal responsibilities. There is a year-long period of preceptorship with a competency assessment, and a buddy scheme to provide more informal support and mentoring. The new approach has had a measurable impact on sickness levels and staff turnover. There has been less reliance on temporary staff and a reduction in recruitment costs. Perhaps most importantly, there has been improvement in care indicators from patients.

This approach reinforced messages from other speakers at the conference about the need to make radical changes in the culture of the NHS. Some of this starts with the recruitment of staff. Francis himself placed great emphasis on the need to change values and behaviour and to reward good practice. However, he also very strongly supported the need for sanctions against those who do not deliver, be they boards, managers or staff. There are a minority of workers in every health and care setting who do not comply. The emphasis on values and behaviour, and employer-led initiatives like the one described by Lucy Connolly, are absolutely vital if we are to see change. But this will not stop those who fail patients, are asked to leave, and move on to another care setting.

One of the challenges of delivering high quality care is finding, training and retaining high quality staff, be they doctors, nurses, or support workers. Currently, there is no registration process in England for adult social care workers or for healthcare support workers. We have been exploring the options for how adult social care workers in England might best be regulated. Our favoured option is a statutory code of conduct that is enforceable. This is an alternative to statutory regulation but is nevertheless one that can hold to account the small minority of care workers who provide unacceptable care. We introduced a similar system for social work students last year, which is working well. It is already used in the UK to regulate estate agents. In New South Wales, Australia, it is used to regulate all those health workers who are currently not on a statutory register.

Last week, Robert Francis said: "It's extraordinary that the cab driver that takes you to the hospital has more regulation that the healthcare assistant who wipes the bottom of your grandmother. This is not acceptable. We need to disqualify people who fail our patients." I can only agree.

Anna van der Gaag
Chair, Health and Care Professions Council

Professionalism in healthcare professionals

What is professionalism?

There has been renewed interest over the last few months in the ‘professionalism’ of health care workers. One YouGov poll reported 41% of those surveyed thought that nurses were ‘less professional than they had ever been’. Whilst today’s wave of interest may be focused on nurses, it is in all our interests to reflect on why health and care workers are currently perceived in this way. The issues which have been a cause for concern – treating patients and service users with respect, communicating clearly, involving people in decisions about their own care, keeping accurate records of treatments and interventions – are all fundamental to good professional practise for all health and care professionals, and they are clearly articulated in the HPC’s standards.

One of the questions worth exploring in this complex arena is: what do professionals themselves think ‘professionalism’ means? As part of our commitment to building the evidence base of regulation, we commissioned researchers at Durham University to take a qualitative look at perceptions of ‘professionalism’. Specifically, we asked them to explore what the concept meant to students and educators in three professions; occupational therapists, paramedics and chiropodists / podiatrists. One hundred and fifteen students and educators participated in twenty focus groups.

What emerged from the research was that ‘professionalism’ was seen not so much as a competency but a judgement, a set of behaviours influenced by context, rather than a fixed, defined characteristic. These behaviours were strongly influenced by the particular care group, peer group, and knowledge and skills of an individual. How peers behaved, for example, could strongly influence how an individual viewed ‘professional’ behaviour, and what was appropriate in one context might not be in another. The use of humour, calling a patient by their first name, and dress codes, were all examples of behaviours which needed to be adapted depending on the context, and the skill of professionalism was in knowing when to do what. The report gives illuminating examples of unprofessional behaviour and why it was judged to be so. Standards and codes were seen as an important, if more remote, influence on behaviour – a baseline level of professionalism that would not be breached.

Why is this research important?

It is the first study of its kind into professions regulated by HPC. There has been a great deal of research on professionalism, but most of it in relation to doctors and nurses, very little specifically looks at the professions we regulate. The findings reveal more similarities than differences between students and educators from the three professions. We hope it will provoke further thinking about the centrality of behaviour, ethics and conduct in delivering good care.

There is a lot of discussion about whether or not support workers and assistants should be registered – mainly arising from reports about poor conduct, abusive relationships, and dishonest dealings with vulnerable people. There seems to be a renewed interest in defining and securing professional behaviours in our health and social care workforce, whether EA trained doctors, healthcare assistants, or paramedics. As a UK-wide regulator, we have an interest in promoting professionalism, stimulating debate and discussion about what part we play, and how this overlaps with the role played by others – systems regulators, employers, peers, patients and carers. I hope that many of you will see this report as an opportunity for debate and discussion about what professionalism means for you, in your context, and how it can be enhanced across the whole workforce. It is through debate and discussion that our individual and collective understanding of this important aspect of practise can develop still further.

Anna van der Gaag
HPC Chair

The research is available to download from the HPC website