Transcript Why regulate?

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
This has been a major policy position for the
RCN for many years
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)
Benefits to the public
The register
Education
Competence
Performance management
Setting standards
Quality assurance
i.e. public protection
Benefits to HCSW
Education and training
Code of conduct
Role definition
Career development
Recognition and value to the role
Some models of regulation
Professionally-led
(statutory)
Employer-led
Voluntary registration
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
Statutory model
PROS
&
Independence of the
professional body
Able to set and
enforce standards
separate from local
employment context
CONS
Could be costly for
registrant
Large potential
numbers
Who would register
HCAs & APs in
various disciplines or
cross-discipline
workers?
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)
Employer-led model
PROS
&
CONS
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
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
“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
Voluntary model
PROS
&
Flexible, more
“proportionate
approach”
May assist public
seeking care from selfemployed practitioners
to choose those on
voluntary register
CONS
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
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
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)
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)
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
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.
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.
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.
References (2)
HOC 2011a Health Committee 14.6.11: MPs question the
professional regulators for doctors and nurses
www.parliament.uk/business/committees/committees-az/commons-select/health-committee/news/news---gmc-and-nmcev/
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/cmhe
alth/1428/142802.htm
Any
questions
?
[email protected]