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

Striving for good governance

On 29 July, the Health and Care Professions Council (HCPC) launched its campaign to recruit a new Council. This rose from a government directive that all UK professional regulatory bodies for health and care create smaller, ‘more board like’ governance structures. The General Medical Council, the Nursing and Midwifery Council and the General Dental Council have already made this change. Over the last 7 years, HCPC has moved from a Council of 26 appointed and elected members and 13 alternate members (39 in total), to 20 appointed members. It is now moving to an appointed Council of 12 members.

HCPC has enjoyed a period of substantial growth under the direction of a strong and cohesive Council. We must maintain our UK wide focus and ensure that we recruit individuals who provide the strategic and financial oversight required. I have no doubt that we will continue to attract individuals with a wide range of skills and expertise from different arenas including service user advocacy, social care, health and psychological services, education, commerce and finance.

We also need individuals who can engage with the big, difficult issues facing public services. Recent events have revealed serious breaches of public trust and confidence in the governance of health and social care providers. Mid Staffordshire, Winterbourne, Ash Grove, Gwent, Vale of Leven and Rochdale all point towards serious failures of governance as well as failures of care. There will continue to be conversations around the HCPC table about these failures and how and why they occurred and what can be done to mitigate the risk of such failures occurring in other contexts. No-one in health and social care regulation can be complacent and HCPC has a shared responsibility with other regulators to make improvements.

The move to a smaller Council also creates the space to think about the underpinnings of good governance. We need people with a range of skills and expertise and big picture thinking, but we also need to create a governing body with shared values. One of the themes across a range of guidance documents on governance (1-4)  is fidelity to values. This means not simply being able to articulate the seven principle of public life, (4) but to have an appetite to re-visit what they mean on a day to day basis, how they impact on relationships, decision making, outcomes. How they can challenge and create conflict. How they influence the culture of the organisation at every level.

It is the combination of skills, expertise and the values of public service that are critical to this new Council. We need individuals who can hold the purpose of professional regulation at the centre of corporate decision making. That purpose is to provide public protection for those who use the services of professionals on the HCPC Register. Clarity of purpose, fidelity to core values are key.


Anna van der Gaag
Chair
The HCPC

References

1. Carver, J. (2006) Boards that make a Difference. Jossey-Bass, California

2. Independent Commission on Good Governance in Public Services (2004)
http://www.jrf.org.uk/publications/good-governance-standard-public-services

3. PSA (2013) Fit and Proper? Governance in the public interest.
www.professionalstandards.org.uk

4. Committee on Standards in Public Life (2013) Standards matter: a review of best practice in promoting good behaviour in public life.

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