'Regulation of Health Care Support Staff and Social Care Support Staff in Scotland'

The UNISON Scotland Response.

August 2004

Executive summary

• UNISON Scotland agrees with the broad thrust of the consultation. We recognise that the highest possible levels of public protection must remain a priority and that staff, increasingly taking on new roles and responsibilities, must be properly trained within an appropriate career pathway
  
  
• We fully support the Executive's view that all health and social care staff whose work impacts on the care of patients should be subject to proper regulatory arrangements. However, we believe that the proposed regulatory framework needs to be drawn more broadly than is outlined in the consultation document.
  
  
• UNISON Scotland is conscious that some ancillary staff groups, e.g. porters and domestic/house-keeping staff, frequently have direct patient contact. As such, we believe that there may well be a case for extending regulation to these groups. We believe that such a move should be given serious consideration.
  
  
• UNISON Scotland acknowledges that the public has a right to expect high standards of competence and care from health and social care support staff. However, we also believe that in order to provide these high standards the Executive must be committed to fully fund the necessary training programmes for relevant staff to achieve any new set standards.
  
  
• UNISON Scotland believes that if support staff have to undergo more intensive training and achieve better qualifications the Executive must also be prepared to fully fund appropriate increases in remuneration for these groups of healthcare and social care workers.
  
  
• In addition, we believe that before a new regulatory system is established it is essential that the Executive ensure a comprehensive review of the training needs of the various groups has been carried out. In addition, we believe that the Executive must also ensure that all necessary training programmes are fully developed and rolled out in time to meet the requirements of any new legislation.
• A major concern for our members - and one not addressed by this consultation - is the key question of who bears the cost of regulation. Experience has shown that this is likely to fall upon those being regulated. We believe that such requirements should not be imposed on these staff, many of who are low paid, working part time and employed on temporary contracts.

• A related concern is, (once instigated) the arbitrary way registration fees are increased. Healthcare assistants and support staff are the lowest paid groups in this sector. We would oppose those being regulated having to bear this additional cost.

 

Introduction

UNISON Scotland welcomes this opportunity to comment on the Scottish Executive's proposals for the regulation of health care and social care support staff.

UNISON is Scotland's largest trade union representing 150,000 members working at the front line delivering public services. Over 85,000 of these members work for local authorities in Scotland, just under 50,000 are employed in the NHS in Scotland and 2,500 of our members are employed in the voluntary sector.

We represent NHS nursing, ancillary and clerical staff and a wide range of local authority and voluntary sector social care staff. They are all involved in building communities, supporting families, protecting vulnerable people and caring for children.

This paper constitutes UNISON Scotland's response to the Scottish Executive consultation document ‘Regulation of Health Care Support Staff and Social Care Support Staff in Scotland'.

Responses

Q1 Should regulatory requirements be extended to the groups of staff identified above? If not, which groups of staff should be included and on what criteria?

UNISON Scotland supports the statutory regulation of those groups of staff outlined in the consultation document. In addition, we believe that all staff who are involved in carrying out tasks which can substantially impact on patient health or welfare should also be regulated to ensure protection of the public and the continued maintenance of high standards of care.

UNISON Scotland believes that greater consideration should be given to extending regulation to ancillary staff groups like porters and domestic/house-keeping staff. These groups of staff frequently come into direct contact with patients and in discharging their duties they can impact directly on the health and welfare of patients. They are part of the care team and as such we believe that extending regulation to these groups should be given serious consideration.

In addition, UNISON Scotland is keen that these staff, not as yet regulated, have access to training opportunities for progress. The fact that they are not regulated should not mean that they are ignored for training and development, or considered less important to the overall patient journey than other groups who are regulated.

 

Q2 Should assistants and support staff be accountable for their own practice?

UNISON Scotland is disappointed at the assumptions made in the document that support staff, unlike other professional groups, are somehow incapable of self-regulation or delivering standards of competency. This ignores the fact that this group of staff are NOT unqualified NOR are they unprofessional in discharging their current roles.

UNISON Scotland believes that just because Health and Social Care Support workers have a more limited scope of practice compared to that of Health and Social Care professionals, this does not mean that they cannot be responsible for deciding when they do not have the skills to undertake a delegated task.

UNISON Scotland believes that assistants and support staff should be accountable for their own practice up to individual levels of skills, knowledge and experience in the role that they are currently employed to perform. We believe that the limits and limitations of what work is carried out must be clearly defined and within that defined area of practice, the limitations of work must be explicit to all members of the team.

 

Q3 Should assistants and support staff set their own standards OR should those with overall responsibility for the work of these staff share in, or take, the lead in setting these standards?

UNISON Scotland believes that the task of setting standards should be approached in a spirit of partnership. We would support a system in which support staff are given the lead role in setting the standards and in which they are afforded the fullest opportunity to develop the extent and range of these standards, in close co-operation with other relevant groups.

In addition, UNISON Scotland believes that it is incumbent on those with overall responsibility to provide good leadership and encourage active participation from assistants and support staff during the process of developing these standards.

 

Q4 How can multi-disciplinary and multi-agency issues best be addressed? Should the regulators set common standards and/or recognise each others so that workers can move between different health and social care settings without the need for multiple registration? OR could all assistants and support staff be regulated as a single group within a single framework including some shared standards and some discipline-specific standards?

UNISON Scotland recognises that there needs to be a system supporting the development of flexible, multi-skilled staff working across traditional professional boundaries and across specific care settings.

UNISON would welcome shared standards of competency, fitness and conduct and would support the development of a collaborative framework between regulators in both health and social care in order to extend the protection of regulation without setting unnecessary barriers to staff movement.

 

Q5 Is statutory regulation appropriate or should other approaches be taken?

UNISON Scotland fully supports the principle of statutory registration in relation to healthcare and social care support staff.

Q6 Should Scotland follow any decision that might be reached in England in order to make sure transferability of staff and public protection by having one system for the UK?

UNISON Scotland believes it would be desirable for a common regulatory approach to be adopted within the UK. We believe that the regulatory structure must be consistent to enable free movement throughout the UK and combined with flexibility, which permits mobility into and across occupational groupings.

However, we believe that simply complying with any English-based regulatory judgement or decisions would constitute considerably more than just ensuring a ‘common approach' to regulation.

The fact that this issue is a devolved matter and that the Scottish Executive has undertaken a separate consultation exercise on this issue from that of the DoE in England and Wales highlights the need for a distinctive Scottish dimension to this issue.

UNSION Scotland believes that any regulatory system, which is established, must be flexible enough to give regard to the differences between Scottish and English delivery of health and social care services.

Q7 Should the Nursing and Midwifery Council (NMC) regulate those groups of assistants and support staff who currently work with the professions they regulate? Should the Health Professions Council (HPC) regulate those groups of assistants and support staff who currently work with the professions they regulate?

Q8 Should the SSSC be the regulatory body for all health and social care support staff or for social care support staff only?

Q9 If the HPC is the most appropriate body, should regulation be by way of a statutory Health Occupations Committee or would other options be preferable?

UNISON Scotland recognises that currently there are differences in employee cultures between health and local government, which present an impediment to joint working and the progression of the Joint Future agenda.

As such, we believe that additional work is needed to identify and define the scope of the proposed regulatory arrangements. Importantly, we believe that further clarification is required to establish which staff are considered to be social care staff and the way in which they differ from the definition of social service workers as outlined in the Regulation of Care (Scotland) Act 2001.

In these circumstances UNISON Scotland feels that in order to progress this matter a more extensive scoping exercise of the social care workforce is required. We believe this exercise would identify the need for a number of regulatory bodies, rather than a single co-ordinating regulating body, taking responsibility for regulating support staff across the agencies.

Q10 Would regulation of assistants and support staff by the bodies responsible for regulating those whom they support lead to other problems such as "second class workers"?

UNISON Scotland believes that this perception must be avoided at all cost. We believe that having a shared understanding of the key issues which matter most to those supporting as well as being supported is crucial to better quality services.