Standards of proficiency for social workers in England

On 1 August 2012 we will take over the regulation of social workers in England from the General Social Care Council (GSCC) which closes on 31 July 2012.

The preparations for this transfer are almost complete and last month, we published our standards of proficiency (SoPs) for social workers in England. The standards of proficiency set out what a social worker in England should know, understand and be able to do when they complete their social work training so that they can register with us. They set clear expectations of a social worker’s knowledge and abilities when they start practising.

We will use these standards when we approve undergraduate degree and masters degree programmes in social work to make sure that someone who successfully completes their degree has met the standards they need to practise safely and effectively as a social worker. We also use these standards to assess applications to join the Register from individuals who have qualified outside the UK.

We know that once a social worker becomes registered their practise might develop in lots of different ways – for example, they might work in different settings, specialise in a particular area of practise or become involved in training social work students. Because of this, once a social worker is registered with us we will expect them to continue to meet the standards of proficiency, but only those that continue to apply to their particular scope of practice.

The standards of proficiency include standards about ethics, communication skills, team working and safeguarding vulnerable people. Some examples of these standards are listed below:

• be able to undertake assessments of risk, need and capacity and respond appropriately

• be able to recognise and respond appropriately to unexpected situations and manage uncertainty

• be able to recognise signs of harm, abuse and neglect and know how to respond appropriately

Social workers in England will also have to meet the standards of conduct, performance and ethics. These standards set expectations in terms of ethics and behaviour and they are similar to the GSCC’s Code of Practice.

Our work to set the standards of proficiency took place whilst the Social Work Reform Board, and subsequently The College of Social Work, developed the Professional Capabilities Framework (PCF) for social workers. The PCF supports social workers throughout each stage of their career, beyond the threshold standards we set. The PCF acts as an overarching framework by setting out key capabilities expected of a social worker as they develop in their career. These include professionalism, values and ethics, knowledge, intervention and skills and professional leadership.

Whilst the PCF looks across a social worker’s career, from before they start their training to the very end, the standards of proficiency set out our expectations of social workers when they start practising for the first time.

We consulted on the standards of proficiency last year. Some respondents to the consultation asked about the interactions between the SoPs and the PCF and wanted more clarity on the different roles. Consultations are an important way of engaging with stakeholders and we made a number of changes to the standards following feedback from the consultation.

However, we also wanted to respond more generally to the comments about the interactions between the SoPs and the PCF. As a result, we have worked with The College of Social Work to produce a joint statement setting out the different, but complementary, roles of the SoPs and the PCF. We have also worked to produce a joint mapping of the SoPs to the PCF level of end of last placement.

The GSCC have published several reports setting out their experience of regulating social workers. In the report ‘Regulating social workers 2001 – 2012’, they say that they believe that the SoPs and the PCF are ‘significant improvements on the GSCC codes of practice for the specific regulation of social workers’.

Setting effective standards is an important part of our role in protecting the public. We are committed to working alongside the social work community to raise standards and achieve the vision of a safe, confident future for social work.

For more information please visit our website

By Charlotte Urwin, Policy Manager at the Health Professions Council (HPC)*

*From 1 August 2012, HPC will regulate social workers in England. At that time, we will be renamed the Health and Care Professions Council to reflect our new remit and the diverse range of professions on our Register.

Student fitness to practise: Finding a proportionate way forward

In recent months, we have been examining the most appropriate mechanism for assuring the fitness to practise of students during their education and training. We have undertaken this work because the General Social Care Council (GSCC), the current regulator of social workers in England, holds a register of social work students, as do the other Social Work Regulators in Scotland, Wales and Northern Ireland. In contrast, we do not hold a student register. Instead, we assure the fitness to practise of students through our standards of education and training and the approval of education and training programmes.

We consulted between November 2011 and March 2012 on whether or not a register for student social workers in England should be held by HPC, and whether or not a student register should exist for the 15 professions we currently regulate. We also commissioned an independent literature review.

 
It was clear from the literature review that student registers are the exception, rather than the norm in professional regulation, both in the UK and elsewhere. Other mechanisms, such as robust standards for educators and placement supervisors, well executed student fitness to practise processes, and holding students to account through standards and guidance on conduct are more commonly used. The review also highlighted the need to educate students about their responsibilities as professionals in training.

In the consultation the majority of those who responded from the social work community thought that registration of social work students should continue. Registration was seen as helpful in providing a ‘safety net ‘ which ensured that consistent decisions were made about the suitability and conduct of students. This was often considered useful in providing additional reassurance to employers accepting students on practice placements.

However, we also heard concerns from social work employers and other stakeholders about some of the current supervision arrangements for social work students on practice placements and in particular, about social work students’ unsupervised contact with vulnerable service users whilst on placement. In contrast, the majority of professions currently regulated by HPC did not think a student register was appropriate, considering that these issues were best managed by education providers in accordance with our standards, assured through our programme approval arrangements.

It seems clear from the consultation that whatever stakeholders’ views on registration, we all want to achieve the same outcome – students who understand the professional responsibilities expected of them and who are fit to practise and equipped to work with service users when they complete their training.

We recently looked at the results of the consultation and the evidence from the review and decided that there should be no new register for the 15 professions we currently regulate. We also agreed that, in the longer term, the most effective and proportionate means of quality assuring the fitness to practise of student social workers in England would be through the HPC’s existing mechanisms. (To read my Guardian article on this click here)

After the register of social workers in England opens in August 2012 education providers will have to meet our standards of education and training. At this time, all the programmes approved by the GSCC will be treated on a transitional basis as if they were approved by us and we will begin scrutinising those programmes to ensure that our standards are met.

These standards will ensure that social work education providers retain overall responsibility for their programmes, including owning and managing the potential risks associated with the character and conduct of students. For example, education providers are required to have arrangements in place for dealing with concerns about students on placements; and have arrangements in place for managing and monitoring practice placements effectively, including ensuring that students receive appropriate supervision and that there is effective partnership working with employers. They also ensure that students understand their obligations under our standards of conduct, performance and ethics.

Many education providers are likely to already meet these requirements. However, we know that the Social Work Task Force  has previously reported continuing concerns about some social work practice placements, so some providers may well find the new requirements challenging to meet.

In our discussions, we were mindful of the potential impact that not registering social work students and applying our standards might have on social work education providers and employers. The Council therefore decided that it would be preferable to introduce interim arrangements over the next two to three years whilst the approval of programmes takes place.

At our meeting on 19 June 2012, we agreed to implement a new process for dealing with concerns about student fitness to practise - a social work student suitability scheme. The key features of this scheme are:

• There is no HCPC register of all social work students
• There is a mechanism for referral to us where,
• in exceptional circumstances, an education provider requires an opinion on whether an applicant is of suitable character to be admitted to a programme.
• a student has been removed from a programme or has withdrawn from a programme following a complaint
• an education provider has not dealt with a credible complaint appropriately.
• Students who have complaints upheld via the scheme may be placed on a list which would prevent them from being admitted to, or participating in, a social work programme.

 The scheme has several benefits. It provides a transitional ‘safety net’ of a kind that social work stakeholders have suggested is necessary. It will allow educators, employers, colleagues and members of the public, to refer their concerns to the regulator during the transition to HCPC standards. It is proportionate, in that it only affects those students and prospective students who are a cause for concern. It will send a clear message to educators that they are responsible for ensuring that student fitness to practise is managed and quality assured according to HCPC standards.

We have listened to the concerns expressed by social work stakeholders, and we are conscious of the huge changes that are underway in the social work profession. Our aim is to work with the social work community to drive up standards. HPC has a good track record in quality assuring education and training programmes through its standards of education and training and approvals process. Ultimately, these standards will apply across all social work programmes. But this will not happen overnight. The suitability scheme does not compromise the role or purpose of HPC’s standards, but does provide a proportionate mechanism to mitigate risk and allow time for change.

 Anna van der Gaag

Chair

Click here to read HPC's media statement

Service user involvement in the design and delivery of approved programmes

In 2011, we asked researchers at Kingston University and St George’s (University of London) to undertake some research for us looking at the involvement of service users in the design and delivery of education and training programmes approved by the HPC. The research included a literature review; a survey of education providers; and focus groups with students, educators and service users. The final research report is now available to download from our website. I would like to thank all the educators, service users and students who participated in the research.
Most previous research on this topic is about medicine, nursing and social work education, so we hope that this work will make a positive contribution to this area. The research should be useful for education providers thinking about how they might involve service users in their programmes.

Q. Why did we commission research in this area?

Our standards of education and training guidance already encourage education providers to provide evidence of service user involvement in their programmes. However, involvement is not currently an explicit part of the standards, so it is possible we could approve a programme which did not involve service users at all.

In August 2012 we will become responsible for regulating social workers in England. Service user and carer involvement is a particular focus in social work education. There are existing regulatory requirements that service users and carers should be involved in all aspects of social work programmes – including in selection, teaching, assessment and quality assurance.

We have been considering whether we might strengthen our requirements in this area by amending our standards of education and training to require service user involvement for a programme to be approved with us and commissioned the research to help us in making that decision. We wanted to find out more about good practice in involving service users in education and training programmes; the extent and types of involvement activities already undertaken by education providers whose programmes we approve; and to learn more about the drivers, benefits and challenges of involving service users.
 
Q. What were the research findings?

There were no programmes that did not involve service users in some way in how they were designed (e.g. monitoring and evaluation of programmes) and/or delivered (e.g. selection, teaching, assessment). Service user involvement was most common in the area of programme planning. There were no notable trends between different professions or between different types of programme or education provider.

Most involvement activity is piecemeal rather than systematic. There was limited evidence to demonstrate a clear, causal link between service user involvement and outcomes such as improvements in the quality of treatment and care. However, overall, the research indicated that service user involvement is likely to, or is perceived to have a number of positive effects, including programmes which better reflect the needs and wishes of users of services, resulting in practitioners who are able to involve service users in decisions about their care or services.
One challenge was the definition of service users. A variety of different potential service users were identified, including patients, clients, carers and colleagues. The term was used differently in the literature and by stakeholders involved in the research and it was acknowledged that some professions do not have direct patient or client facing contact. The term ‘end recipient of a service’ was suggested as a means to define the scope of the term. A variety of facilitators and barriers to involvement were identified including funding, leadership and the representativeness and vulnerability of service users. There was general support for amending the standards of education and training, with some caveats and concerns about the need for a standard; the scope of the standard; and the practicalities of meeting it.

Q. What have we concluded?

The research was discussed by our Education and Training Committee at its meeting in March 2012. The Committee agreed that service user involvement in approved programmes was important and, in principle, that an additional standard of education and training could act as a driver for education providers to involve service users in their programmes, sending out a strong message that service user involvement is important for public protection.

The research revealed general support for a standard but with some concerns and caveats. We want to develop a proposed standard which is enabling and meaningful. It needs to be applicable across the diversity of professions and programmes we approve, allowing for flexibility whilst setting an appropriate threshold benchmark for all.

If we were to agree a new standard, we would propose that education providers should have a longer than normal lead-in period so that we can communicate our requirements clearly to education providers, for example, via ‘Education update’ and in our annual seminars with education providers. This will also allow education providers the time to make any changes to their programmes which might be necessary.

Q. What happens next?

We will be considering the wording of a proposed standard and supporting guidance at our next Education and Training Committee meeting in June 2012. Subject to Committee and Council approval, we currently anticipate that a public consultation on the proposed standard and guidance might take place from September 2012.

Michael Guthrie
Director of Policy and Standards
HPC

Crafting strategy: HPC’s strategic intent 2012 to 2015

I remember reading from the economist JK Galbraith’s writings about economic regulators, in which he observed: ‘...regulatory bodies, like the people who comprise them, have a marked life cycle. In youth they are vigorous, aggressive, evangelistic, and even intolerant. Later they mellow, and in old age - after a matter of ten or fifteen years - they become, with some exceptions, either an arm of the industry they are regulating or senile.’(1)

HPC celebrates its 10th anniversary this year, hardly a lifetime, but long enough to look back and ask – have we remained true to our central objective - to protect the public? One of the ways we address this question is to reflect on our strategic intent document on a regular basis. This document, above all others, should articulate that central objective. It should set out clearly who we are, what we do and how we do it.

The strategic conversations that we have on the Council range from conversations that aim to make sense of new policies and changes in health and social care from a regulatory perspective, to those that focus on organisational priorities and outcomes. Creating strategy is not a science; it is a craft, one part of an organisation’s way of responding to internal and external influences whilst maintaining a clear focus on what it is there to do. This ‘crafting’ is inextricably linked to the organisational culture and the quality of working relationships which allow the conversations to flow into actions.

The revised strategic intent document that you will find on our web pages is, therefore, our current statement on how we think we should deliver public protection in health and social care. It describes our values – the underlying principles and ethical basis for what we do, our vision – how we would like to be seen in the future, and our key objectives. We aim to deliver efficient and effective regulation, maintaining our ‘can do’ culture of continuous quality improvement, tackling difficult decisions in an informed way, collaborating, anticipating and being proactive in our approach. The ways in which we deliver this must change as we do. As we grow in size and complexity, working with new groups and new stakeholders, we must maintain clarity of purpose and fidelity to our values and vision. This is the strongest defence against Galbraith’s sound and salutary observations. Complacency is surely the enemy of excellence, and the seedbed of senility.

Anna van der Gaag
Chair
HPC

Ref:

(1) Galbraith, John Kenneth (1954). The Great Crash, 1929.

Have you had the conversation yet?

In November 2011, we published a research report exploring what professionalism meant to students and educators in three different professions. Whilst, perhaps unsurprisingly, the research found that there was no one definition of professionalism, participants generally saw professional behaviour as a ‘situational judgement’ – knowing what to do, and what not to do, in a given situation – and it was defined in contrast to behaviour which was considered ‘unprofessional’. The skill of ‘knowing what to do’ included the importance of identifying poor practice and taking appropriate action.

The professionalism of health and care staff certainly seems to be in question in recent, unfortunately repeated, reports about failures in standards of care in hospitals and care homes. These examples will not be repeated here, but, quite rightly, they have led commentators to question not only the role of the regulators involved in monitoring standards, but the responsibility of individual professionals and other staff in speaking-up about poor practice. Last week, the Commission on Dignity in Care for Older People published a draft report for public consultation suggesting ways to ensure that older people are treated with compassion and dignity and receive the services they need. The Commission proposes a number of recommendations to improve the care provided to older people, and of central importance is the concept of responsibility, not just at board and managerial level, but throughout hospitals and care homes. All staff have ‘personal responsibility’ for patient care and ‘should be required to challenge practices they believe are not in the best interests of the people in their care’. These are certainly requirements that are familiar to HPC registrants. They are included in the HPC’s standards of conduct, performance and ethics and we have also published additional information on our website about raising and escalating concerns.

However, I strongly believe it is important in this debate not to focus too much on the negative - the minority who appear before our fitness to practise panels and whose unprofessional behaviour damages public trust. We should not be complacent about poor conduct or poor practice but this means that we need to focus on the majority and our shared responsibility to identify and challenge unprofessional behaviour when it occurs. As one recent report clearly argues, this is important territory. The recently published report (enclosure 08) of a working group established by the Chief Nursing Officer in Scotland to look at professionalism across the nursing, midwifery and allied health professions emphasises the need for professionalism to be clearly articulated throughout the NHS in Scotland in a way which can support all staff to display the behaviours, attitudes and values at the heart of what it is to be a professional. Professionalism is intimately linked with the trust service users place in practitioners and, crucially, with high quality services.

What all these reports indicate is the need for professionals to engage in debates about professionalism. In her February bulletin, Karen Middleton, Chief Health Professions Officer at the Department of Health in England, has recently invited allied health professionals (‘AHPs’) to engage in a ‘big conversation’ about professionalism, but her call to action is surely relevant to all the professions on the HPC Register, in all the various contexts in which they work. The aim is to create an ‘environment where unprofessional behaviour is challenged immediately and constructively on an individual basis’ and we are encouraged to start talking to each other about professionalism and professional behaviour, ‘whenever and wherever’.

So, what do you think is professional or unprofessional behaviour? When is the last time your team had a conversation about professionalism? If you witnessed behaviour that you thought was unprofessional, what would you do?

Have YOU had the conversation yet?

Anna van der Gaag
Chair of the Health Professions Council

Student fitness to practise and registration – consultation ends 2 March 2012

Q. What risks do students training to be health and care professionals pose to the service users they come into contact with?

Q. How effectively do education providers deal with cases of poor conduct by students?

Q. How can we best make sure that students understand the responsibilities of them as future registrants?

Q. Should social work students (in England) continue to be registered?

These questions and more are discussed in our on-going consultation looking at student fitness to practise and registration.

We are seeking the views of all of our stakeholders on the most effective way of assuring the fitness to practise of students, including the registration of social work students in England. The consultation is being held partly because we will become responsible for regulating social workers in England from 1 August this year. Social work students are required to register with the General Social Care Council (GSCC) but the HPC does not currently register students.

Alongside the consultation, we also asked some researchers to undertake a review of the published literature in this area. This was so that we could build an increased understanding of the levels of risk from students in each of the 15 professions we regulate, and in social work, and benefit from any evidence about the best ways in which that risk might be managed. We will consider the research alongside the responses to the consultation.

The launch of the consultation prompted a renewed debate amongst the professions about the best way of managing student fitness to practise. In the social work field, Community Care reported on the potential costs if social work students continued to be registered. The General Social Care Council (GSCC) argued that registration of student social workers was crucial, in order to ‘uphold standards’ and because of the ‘unique risks associated with practice placements’.

In the consultation we have not made any specific proposals – for example, we have not proposed that social work students should or should not be registered. Instead, we wanted to stimulate discussion amongst all the professions on this topic, to help us reach an informed view on the best approach to take. So it is encouraging to see that in the professional press, in the conversations I have had with a wide range of stakeholders since we launched the consultation, and in the responses to the consultation we have received so far, we are hearing a wide range of different perspectives on this issue.

The consultation closes on 2 March 2012 and I would encourage anyone with an interest in this area to let us know what they think here.

Michael Guthrie
Director of Policy and Standards
Health 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