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Regulation of health care support workers: An overview

Regulation of health care support workers: An overview. Tanis Hand, HCA Adviser. Regulation. The RCN believes all HCAs and APs should be regulated in the interests of public protection and is committed to supporting steps towards mandatory regulation

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Regulation of health care support workers: An overview

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  1. Regulation of health care support workers: An overview Tanis Hand, HCA Adviser

  2. Regulation

  3. The RCN believes all HCAs and APs should be regulated in the interests of public protection and is committed to supporting steps towards mandatory regulation This has been a major policy position for the RCN for many years

  4. Why regulate? • The work of the HCA and AP brings them into intimate contact with vulnerable patients and therefore raises significant issues for patient safety and public protection. (RCN 2004) • It is generally accepted by both the wider health team and HCSWs that regulation is necessary. (DH 2006) (RCN 2009)

  5. Benefits to the public • The register • Education • Competence • Performance management • Setting standards • Quality assurance • i.e. public protection

  6. Benefits to HCSW • Education and training • Code of conduct • Role definition • Career development • Recognition and value to the role

  7. Professionally-led (statutory) Employer-led Some models of regulation Voluntary registration

  8. Statutory regulation • Protects professional boundaries • Lists those entitled to practice • Protects professional title • Establishes professional standards for practice • Controls admission and removal from professional register

  9. Independence of the professional body Able to set and enforce standards separate from local employment context Could be costly for registrant Large potential numbers Who would register HCAs & APs in various disciplines or cross-discipline workers? Statutory model PROS & CONS

  10. Employer-led “regulation” NHS Scotland: From 1 Jan 2011 has established: • Mandatory induction standards for HCSW • Code of conduct for HCSWs • Code of practice for employers (n.b. covers Bands 1-4 and only NHS) • NHS Wales: From 20 Jan 2011 has established • “assurance codes”: • Code of conduct for HCSWs • Code of practice for employers (n.b. Also only NHS)

  11. Employers can hold relevant information on individual HCAs and APs Would enable regulation of HCAs/APs working across disciplines Mobile workforce – difficulty tracking HCAs/APs as they move around Hard to develop a model to cover all employers Consistency issues across different employers Employer-led model PROS & CONS

  12. Voluntary registration: command paper • Reducing regulation is a key priority for Coalition government • Aim: to drive up standards ... to improve service-users’ experience ... through a system of “assured voluntary registration” “Enabling Excellence” (DH 2011) A command paper is issued by the Government and presented to Parliament as conveying information or decisions that the Government think should be drawn to attention of Parliament

  13. “Enabling Excellence” (DH, Feb. 2011) • CHRE (Council for regulatory excellence) would become the national accrediting body for unregulated health professionals UK-wide • CHRE would set standards against which the voluntary registers will be judged • Existing statutory regulatory bodies would be given powers to establish voluntary registers (funded by those who choose to join the registers) • Voluntary registrants would not be subject to full statutory regulation

  14. Voluntary model PROS & CONS • Flexible, more “proportionate approach” • May assist public seeking care from self-employed practitioners to choose those on voluntary register • Regulation will be avoided by some • Removal from register would not be very meaningful • Employers are not compelled to employ staff from registers • There will still be a cost to register

  15. NMC opinion (House of Commons 2011a) • HCSWs should be regulated • Registration with a regulatory body should be mandatory, and a distinction must be made between regular HCSWs and APs • APs perform more invasive, higher-risk procedures and should therefore be regulated differently than other support workers

  16. NMC opinion (HOC 2011a) • Regulation must not just be about fitness to practice but must also focus on induction, standardised training and education. • There must be a mechanism in place to deal with HCSWs who do not perform to standard, and there is currently no such mechanism. (House of Commons Health Committee 14.06.11)

  17. House of Commons • Health Committee • _________________________ • Annual accountability • hearing with the • Nursing and Midwifery • Council • _________________ • Seventh Report of Session 2010–12 • Report, together with formal minutes, oral and • written evidence Health Select Committee 26 July 2011 (House of Commons 2011b)

  18. Health Select Committee (HOC 2011b) • Voluntary registration ... would “be avoided by the people about whom there is most concern.” The recent scandal at Winterboune View in Bristol underlines the issues around registration of healthcare assistants • The Committee believes that HCSWs should be regulated, not necessarily in an identical manner to nurses and midwives but there should be a regulatory framework that is not voluntary

  19. Health Select Committee (HOC 2011b) • The Committee endorses mandatory statutory regulation of healthcare assistants and support workers and we believe that this is the only approach which maximises public protection. • The NMC needs to make significant improvements in the conduct of its existing core functions (such as in how it manages fitness to practise cases) before powers to register these groups are handed to it.

  20. RCN response to HSC report 26/7/11 We absolutely support the recommendation for a system of mandatory, not voluntary regulation of healthcare assistants. The RCN has been calling for mandatory regulation for some time and we believe there is a public protection issue, particularly around care of the elderly and as witnessed in recent cases such as Winterbourne View. We are now committed to working with the NMC about how to make this a reality.

  21. References (1) • RCN 2004 The future nurse: The future for professional regulation. RCN, London • DH 2006 The regulation of the non-medical healthcare professions - A review by the Department of Health www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4137295.pdf • RCN 2009 The Assistant Practitioner Role: a Policy Discussion Paper. Policy briefing 06/2009. RCN, London. • DH 2011 Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers. Department of Health, Leeds.

  22. References (2) • HOC 2011a Health Committee 14.6.11: MPs question the professional regulators for doctors and nurses www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news/news---gmc-and-nmc-ev/ • HOC 2001b Health Committee 26.7.11: Seventh Report: Annual accountability hearing with the Nursing and Midwifery Council www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1428/142802.htm

  23. Any questions? hca@rcn.org.uk

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