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Report of Consultation on Regulation of Healthcare Support Staff and Social Care Support Staff in Scotland, 2004

DescriptionSummary report of the consultation on regulation of healthcare and socialcare support staff in Scotland, 2004.
ISBN
Official Print Publication Date
Website Publication DateMay 24, 2006

REGULATION OF

HEALTH CARE SUPPORT STAFF and

SOCIAL CARE SUPPORT STAFF in

SCOTLAND

Summary of Consultation Responses

Contents

1. Executive summary 1-3

2. Introduction 4

2.1 The consultation process 5-6

3. Responses 6-23

3.1 Q1 Should regulatory arrangements be extended ? 6-7

3.2 Q2 Should assistants and support staff be accountable for their own practice? 7-8

3.3 Q3 Should assistants and support staff set their own standards ? 8-9

3.4 Q4 How can multi-disciplinary issues best be addressed? 10-12

3.5 Q5 Is statutory regulation appropriate or should other approaches be taken? 12-13

3.6 Q6 Should Scotland follow any decision that might be taken in England ? 13-15

3.7 Q7 Should the Nursing and Midwifery Council (NMC) and the Health Professions Council

regulate those that work with the professions they regulate? 15-19

3.8 Q8 Should the Scottish Social Services Council be the regulatory body for all healthcare

support staff? 19-20

3.9 Q9 If the HPC is the most appropriate body, should regulation be by way of statutory

committee of the Health Professions Council? 20-21

3.10 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? 21-22

3.11 Q11 Are there any other options to consider? 22-23

4. Conclusion 23-25

Appendices

Appendix A List of respondents 26-28

Appendix B Key Stakeholders opinions 29-40

Appendix C Tables of results 41-43

Acknowledgements

We would like to thank all of those who have contributed to the consultation on the regulation of health and social care staff. In particular, we would like to thank the service leaders for consulting with their staff on these issues.

1. Executive Summary

1.1 The consultation paper was issued on 6 May, and closed for comment on 20 September 2004. It was targeted towards professional and regulatory bodies, and employers and employees of the health and social care sector, and invited comments on proposals for extending regulation to a wider group of health and social care staff; health care assistants, assistant practitioners in a wide range of care settings, AHP's assistants, healthcare scientist workforce, social care support staff, pathology assistant practitioners.

1.2 The aims of the consultation paper were to;

  • establish whether regulatory arrangements should be extended to include specified assistants and support staff
  • consider how to regulate groups of staff who move across or work outside of traditional boundaries
  • establish how we can ensure quality
  • determine the most appropriate form of regulation
  • establish who should regulate these groups of staff
  • consider whether there are alternatives to statutory regulation
1.3 122 responses were received. Key respondents were; The Nursing and Midwifery Council, The Health Professions Council, Scottish Social Services Council, The Council for Healthcare Regulatory Excellence, NHS Education for Scotland, The Royal College of Nursing and UNISON Scotland, NHSScotland Operating Divisions/Boards.

1.4 Summary Findings

  • 93% of responses indicated that regulatory arrangements should be extended to cover health and social care assistants and support staff.
  • 81% of responses felt that health and social care support staff should be accountable for their own practice, but that this should be dependent on their level of training and/or scope of practice.
  • 70% of responses felt that setting standards for assistants and support staff should be the responsibility of the manager/employer, done in consultation with support staff.
  • The consensus was that 'preferably' assistants and support staff should be regulated as a single group within a single framework. However, it was also felt to avoid multiple registration and to facilitate transferability of staff between the 4 UK countries, it would make sense for existing regulators to work together to develop core/common standards, with some discipline specific standards.
  • 90% of responses indicated that statutory regulation was the most appropriate way to ensure public protection.
  • 64% felt that Scotland should follow any decision that might be taken in England
  • There was no general consensus over which of the regulatory bodies should regulate these staff, 33% indicated it should be the relevant professional organisation. 60% indicated that if the HPC was selected to regulate this group of staff, then it should be done by statutory committee.
  • 84% indicated the Scottish Social Services Council should not be the regulatory body, with 33% of these indicating that the SSSC should be responsible for only social care staff
  • 85% of responses felt that regulation would not lead to problems such as second class workforce, that it would raise their profile, and lead to an enhanced workforce.
  • The majority were content that statutory regulation is the most appropriate way to ensure public protection. The Council for Healthcare Regulatory Excellence remains to be convinced that statutory regulation is appropriate and encourages the consideration of employer led regulation.

2. Introduction

2.1.1 Whilst the regulation of health professionals is a reserved matter, the regulation of currently unregulated staff is a matter for the devolved administrations in Scotland, Wales and in Northern Ireland (when devolved power is restored). Different patterns of service delivery may impact on changing roles within the workforce in each country of the UK. However, all 4 countries recognise the desirability of adopting a common approach to regulation in order to ensure that staff moving within the UK are not subject to different regulatory requirements

2.1.2 In Scotland, we have concluded that the way in which we are responding to changing health and social care requires consideration of the regulatory requirements for support staff in both health and social care.

2.1.3 The consultation document outlined the reasons as to why we feel that regulation should be extended to cover assistant and support health and social care staff.

The key reasons are;

  • To protect the public
  • To capture the changing roles of unregulated support staff
  • To close an existing loophole
  • To meet the needs of the Joint Future agenda

2.1.4 The consultation document outlined the case for regulation of these groups of staff. In particular it suggested the reasons why regulation would address issues such as quality of care, multi-disciplinary roles, forms of regulations, and it considered who the most appropriate body would be to undertake the responsibility to regulate this diverse group of staff.

2.1.5 The consultation document put forward 11 questions to address these issues, and in particular, suggested 4 options for regulation.

2.2 The consultation process

2.2.1 The consultation document invited comments on a set of proposals for extending regulation to a wider range of health and social care staff. The aims of the consultation were to;

  • establish whether regulatory arrangements should be extended to include health and social care specified assistants and support staff
  • consider how to regulate groups of staff who move across or work outside of traditional boundaries
  • establish how we can ensure high quality care
  • determine the most appropriate form of regulation
  • establish who should regulate these groups of staff
  • consider whether there are alternatives to statutory regulation

2.2.2 The consultation paper was targeted towards professional bodies, employers and employees of the of the health and social care sector. It was sent out by mail to Chief Executives of the relevant organisation and key staff contacts for comment inviting them to disseminate to workers in the wider health and social care setting. In order to make the consultation available to a wider audience and increase participation, the document was published on the SE internet site.

2.2.3 The consultation paper was issued on 6 May 2004, and respondents were given a period of 12 weeks to return their comments/responses to the questions outlined.

2.2.4 Respondents were also asked to clarify if they were content for their response to be made available to the public via SE internet or the SE library. All responses were made available 20 days after the closing date of the consultation.

2.2.5 A total of 122 responses were received, the majority being group efforts. All responses were acknowledged upon receipt. Using a technique called 'coding' were converted into Excel format to aid data collection.

2.2.6 The findings are specific to the consultation exercise and do not necessarily reflect the weight or range of views within the population or sub populations as a whole, as the respondees have not been representatively or purposively sampled.

3. Responses

3.1.1 There were 122 responses to the consultation from a broad range of individuals and organisations from across the United Kingdom. Respondents included individual NHS staff members, NHSScotland Operating Divisions and Boards, Local Health Care Co-operatives, Local Authority Social Services Departments, Regulatory Bodies, Professional Associations, Royal Colleges, Educational Institutions and 1 Charity. A full breakdown of respondents is at Annex A.

3.1.2 A significant number of NHSScotland Operating Divisions and Boards held consultations with their staff, and therefore their response was on behalf of a group, rather than individual responses.

3.2 Q1 Should regulatory arrangements be extended to the assistants and support staff identified in paragraph 15? If not, which staff should be included and on what criteria?

3.2.1 The predominant view was that 'yes' regulatory arrangements should be extended to cover health and social care support staff.

3.2.2 Of 122 responses, 93% or 113 respondents indicated that regulatory arrangements should be extended to the groups of assistants and support staff outlined in the consultation document.

3.2.3 NHS Education for Scotland (NES), for example, indicated that they were broadly in support of regulatory arrangements for all staff groups delivering direct clinical services to patients. In practice NES believed that there are distinct categories of staff for whom the specific regulatory arrangements can usefully be distinguished.

3.2.4 UNISON Scotland believed 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.

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

3.3.1 99 responses, indicated that yes healthcare support workers should be accountable for their own practice. However, 41 of these responses, indicated that this should be dependent on the level of training, and/or scope of practice. For example,

  • Staff should be fully trained and acting within their job description
  • Staff are aware of the limits of their role
  • Trained staff have a responsibility to ensure support staff are competent to carry out tasks delegated to them
  • If acting under instruction they should be partially accountable

3.3.2 An additional 21 of these respondents indicated that they should only be partially accountable and that the employer has some degree of accountability.

3.3.3 8 responses indicated that health and social care support staff should not be held accountable for their own practice.

3.3.4 UNISON Scotland proposed 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. In addition, they believed 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.

3.3.5 The Nursing and Midwifery Council (NMC) believed that healthcare assistants and support staff should be accountable for their practice and should be regulated. However, the scope of their practice and the parameters that will determine a framework for supervision and accountability will require further definition and negotiation. The NMC also stressed that the employer plays an important role in determining a person's scope of practice

3.3.6 The Health Professions Council (HPC) believed that health and social care support workers should be accountable for their own practice. The HPC highlighted that although the decision to treat a patient was instigated by a professional, it must be the responsibility of the receiver of the task to decline or accept the task depending on their ability to undertake a delegated task.

3.3.7 NES believed that health and social care support staff should not be accountable for their own practice and that their accountability should be through supervised practice overseen by appropriate professionals fully trained in the relevant discipline or field of care.

3.3.8 The Council for Regulatory Excellence(CHRE) stated that there was first a need to decide the form of regulation and the groups to be regulated before it would be possible to determine the boundaries of accountability.

3.4 Q3 Shoul dassistants and support staff set their own stan dar ds OR shoul dthose with overall responsibility for the work of these staff share in, or take the lea d, in setting these stan dar ds?

3.4.1 85 responses indicated that assistants should not set their own standards and that this should be led by those with overall responsibility.

3.4.2 However, in order to ensure that workers has some form of ownership of the standards, 47 of these respondents argued that they should be set in full consultation with those affected. The ultimate decision and accountability should be with those with overall responsibility, but standards should be set in consultation with all relevant stakeholders including the general public.

3.4.3 This response was supported by amongst others, The Royal College of Nursing, Royal College of Midwives, Royal College of Physicians, National Association of Theatre Nurses, NHS Education for Scotland, UNISON Scotland,

3.4.4 14 respondents indicated that standard setting should be the responsibility of the profession overseeing each group of support worker, so as to allow employers greater autonomy in setting standards and also introduce assistant grades for those at SVQ level 3. This proposal was supported by the Royal Pharmaceutical Society for Great Britain, Boots the Chemists, and the British Dietetic Association.

3.4.5 16 respondents indicated that national minimum standards should be introduced and that these could be supplemented by locally set standards. Some respondents felt that the setting of standards should be a national responsibility, and that staff should adhere to a set of national standards, or those set by relevant professional bodies and existing regulatory groups. The respondees included 8 NHS Divisions, The Health Professions Council, Independent Healthcare Forum, The Royal College of Physicians, Stevenson College of Further Education and Glasgow University.

3.4.6 The NMC believed that regulatory arrangements should be in place to support the setting of standards for health and social care staff but the responsibility for setting standards should rest with the employers.

3.5 Q4 How can multi- disciplinary issues best be a dd ressed ? Should the regulators set common stand ard s and /or recognise each other's so that workers can move betweend ifferent 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 includ ing some shared stand ard s and somed iscipline-specific stand ard s?

3.5.1 The responses to this question often contradicted previous statements and thus were difficult to categorise. However, the general consensus was that 'preferably' assistants and support staff should be regulated as a single group within a single framework. However, issues such as flexibility, duplication, and multi-disciplinary professions, came through as key factors in determining the regulatory framework.

3.5.2 The responses indicated that regulation has to be relevant to the range of ways in which care is provided. It needs to support the development of flexible, multi-skilled staff working across traditional professional boundaries and across care settings. Flexibility to move across traditional professional boundaries and agency boundaries must therefore be addressed.

3.5.3 The NMC's preferred option would be to regulate all health and social care assistants and support staff within a single framework. If this is to be achieved new standards for proficiency will need to be developed, implemented and regulated. The NMC indicated that they would like to be actively involved in the setting of these standards.

3.5.4 The CHRE supports the use of a collaborative frameworks if it is achievable, as it facilitates movement across boundaries of roles or sectors. However, this does not exclude the single framework, which could co-exist with greater consistency between regulators

3.5.5 The Scottish Social Services Council stressed the importance of a regulatory framework which does not lock staff into existing professional groupings but enables them to develop new career pathways. They felt that it is important that there is as much alignment as possible between standards and requirements set by regulatory bodies.

3.5.6 This framework must also support work in joint health and social care multidisciplinary and multi-agency teams that potentially combine the roles of support staff working to different professions and in different agencies. Therefore new arrangements must fit with existing regimes and be organised in a manner that avoids confusion and duplication. These arrangements must be accessible and make sense to service users, carers, workers, and employers.

3.5.7 The HPC believed that all existing regulators of healthcare professionals and Health Care Workers should be encouraged to use common standards. The HPC would aim to maximise the use of common standards wherever possible, in particular standards of education and training, standards of conduct, performance and ethics, and standards of proficiency.

3.5.8 UNISON Scotland recognised 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.

3.5.9 UNISON Scotland 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.

3.5.10 NES believed that the shift in health and social care to roles which are defined in terms of competencies should provide the basis for developing a common framework of standards which can be contextualised to capture the specific knowledge/skills required for a specific discipline, or service.

3.5.11 The Royal College of Nursing believed that a national induction programme be introduced and that this should apply across both health and social care sectors. Successful completion would mean automatic registration recognised at a national level.

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

3.6.1 90% of responses indicated that statutory regulation was the most appropriate method to ensure public protection. This included; 19 Educational Institutions, 4 Royal Colleges, 2 Charities, 4 individuals, 11 Local Government, 32 NHS Operating Divisions, 9 Other NHS Bodies, 4 Private Providers, 18 Professional Associations, 3 Regulators, 1 Union, DHSSPS.

3.6.2 Professional Associations included; Association of Scottish Colleges, Scottish Consumer Council, Scottish Medical and Scientific Advisory Committee, Capability Scotland, Association of Pharmacy Technicians UK, The British Psychological Society, Allied Health Professions Professional Committee, National Association of Theatre Nurses, UK Board for Scotland, Royal College of Midwives, British Association for Counselling and Psychotherapy, Scottish Arts Therapies Forum, SAMH, British Dietetics Association, Scottish Board, Allied Health Professions Advisory Committee, National Allied Health Professions Advisory Committee, Allied Health Professions Advisory Committee, Care Scotland SQA, Social Care Association.

3.6.3 NES agreed that statutory regulation would be the most appropriate route.

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

3.6.5 The HPC recommended statutory self-regulation because it has been tried and tested as a credible process throughout the world, it is independent of employers and trade unions, it is an integrated process with economies of scale, flexible and has the backing of criminal law.

3.6.6 The CRHE believed that a more creative approach should have been considered such as employer led or government sponsored regulatory arrangements, but stated that since this was not an option then statutory regulation appeared the viable option.

3.6.7 The CHRE recommended that there should be further debate over the definition of clinical or other risks that may exist, which categories of staff should be regulated and the form that regulation of health and social care staff should take.

3.6.8 One NHS Operating Division suggested that the document did not make clear which form of regulation was being proposed, or whether statutory regulation included the options of self or shared regulation. Almost all responses indicated that if statutory regulatory arrangements are appropriate this should not be by the form of statutory self-regulation.

3.6.9 The SSSC believed that regulation is necessary to protect the public and enhance and support the conduct and competence of workers and enable the mobility and career progression of workers within evolving service delivery arrangements.

3.6.10 Some suggested that not all healthcare professions needed to be regulated including Boots, and the Royal College of Physicians Edinburgh. It was suggested that in some cases it should be limited to those with SVQ level 3 and above.

3.7 Q6 Shoul dScotlan dfollow any decision that might be taken in England in ord er to ensure both transferability of staff and public protection by ensuring one system for theUK ?

3.7.1 78 respondents indicated that 'Yes' Scotland should adopt the same policy as England. This included 23 NHS Operating Divisions, 12 Professional Associations, 13 Educational Institutions, 5 Royal Colleges, 5 Local Government.

3.7.2 Professional Associations included; The Society & College of Radiographers, Royal Pharmaceutical Society of Great Britain, RCN, NMC, Royal College of Midwives, The British Psychological Society, Scottish Medical and Scientific Advisory Committee, Scottish Consumer Council, ,Scottish Arts Therapies Forum, National Association of Theatre Nurses, Glasgow Caledonian University, Independent Healthcare Forum, Capability Scotland, Allied Health Professions Advisory Committee, British Dietetics Association.

3.7.3 The reasons for adopting the same approach as England, was to ensure the transferability of staff throughout all 4 UK countries.

3.7.4 The NMC believed that a unified approach is essential across the UK in the interests of public protection, and to ensure continuity across borders. If healthcare support staff were to be regulated separately in each of the four countries, it may be difficult to ensure consistent public protection standards.

3.7.5 36 % or 44 respondents felt that Scotland should not follow any decision taken in England. This included, 12 NHS Operating Divisions, 6 Local Government, and 8 Professional Associations including;

Association of Scottish Colleges, Association of Pharmacy Technicians UK, Allied Health Professions Professional Committee, SAMH, Social Care Association, AHP Advisory Committee, CareScotland, SQA, Society for General Microbiology, NHS Education for Scotland, UNISON Scotland

3.7.6 The main reasons for not following England were;

  • Scotland should determine its own policy
  • provides an opportunity for Scotland to take the lead in the health and social care agenda
  • provides an opportunity to develop cross cutting services, between health and social care.
  • arrangements can be put in place for the exchange of information between registration bodies in the 4 UK countries and between health and social care.

3.7.7 One respondent pointed out the there may be a problem if Scotland does not follow England, in relation to social care support staff, as there would be a different system in Scotland whereby staff can transfer between sectors, but not between countries.

3.7.8 The Social Care Association suggested that Scotland should have registration requirements that meet the needs of Scotland's service users and workforce. However, in saying this they recognise that same conclusion as in England may be reached , but not simply for the sake of transferability.

3.7.9 NES does not believe that Scotland should necessarily follow the decision taken by the Department of Health about the regulation of health and social care support staff. NES indicated that transferability of regulatory arrangements can be secured through a variety of mechanisms, including compacts of agreement based on consistent UK standards.

3.7.10 UNISON Scotland believed it would be desirable for a common regulatory approach to be adopted within the UK. However, UNISON Scotland stressed that simply complying with any English-based regulatory judgement or decisions would constitute considerably more than just ensuring a 'common approach' to regulation.

3.7.11 However, 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.

3.7.12 UNISON Scotland believed 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.

3.8 Q7 Should the Nursing and Midwifery Council (NMC) and the Health Professions Council (HPC) regulate those groups of assistants and support staff that work with the professions they regulate? Are other options preferable?

3.8.1 The responses to these three questions overlap, and respondents had mixed opinions and views about the whether the HPC and NMC should be sole regulators for these groups of staff.

3.8.2 33% respondents, felt that healthcare support staff should be regulated by the regulators within the profession whom they already regulate.

3.8.3 Many felt that neither the NMC or the HPC were viable options for regulating this group of staff. One response recommended that the aim should not be who regulates this group but who developed shared/mutually compatible standards to facilitate movement across health and social care settings; similar to the development of national occupational standards and skills for health. However, they also agreed that if they are regulated then the most appropriate body to maintain standards of conduct is the HPC.

3.8.4 NES is of the opinion that health and social care workers need not be regulated as a single group. NES believed that where those health and social care workers' knowledge and skills are specifically derived from the competencies of the registered professional with a view to facilitating access for the support workers to full professional training, the case can be made for regulatory arrangements for the support workers to be managed in tandem with the regulation of the relevant registered professional group within HPC.

3.8.5 However, for those whose work is less exclusively aligned with a single registered professional group or who are expected to work across dynamic care contexts it would make sense for regulation to be customised to each country's specific health and social care services. In addition NES believe that it would seem unfortunate to fragment new regulatory arrangements between two London-based bodies. Therefore, NES would be of the opinion that the HPC, who have put forward a set of arrangements, which appear prudent and sensibly costed, would be the most appropriate regulatory body. NES also believe that for this group of staff then regulation by way of a Statutory Health Occupations Committee would be appropriate.

3.8.6 The NMC believed that it should be the sole regulator of those healthcare support workers who work under the supervision of the NMC's registrants. The NMC believed that it is better placed to make an assessment of the likely impact of Fitness to Practice issues.

3.8.7 The RCN believed that the family of nursing should be regulated together and that the setting in which nursing care is being delivered should not determine the boundaries of that regulation. The RCN believed that nurses should be regulated by the same body that regulates nurses and by implication there would be national standards.

3.8.8 The HPC recommended that it should solely be responsible for the regulation of Health Care Workers based upon its recent experience of; multi-professional regulation, assessing which aspirant groups to regulate, opening new parts to the register, project experience of implementing new legislation to timetable and budget, and also the scalability of the HPC's operating systems.

3.8.9 The HPC believed that a single organisation should regulate all non-professional Health Care Workers, as this will: utilise economies of scale, keep costs to a minimum, ease communication to key stakeholders, ensure common standards, ensure a single set criteria is used to decide which Health Care workers to regulate and will avoid the necessity of amending and updating more than one piece of legislation.

3.8.10 The CHRE remained unconvinced that statutory self-regulation is the best option for all categories of staff mentioned in the document. The CHRE recommended further debate before deciding which option of regulation and which regulatory body should regulate this category of staff.

3.8.11 The SSSC believed that regulation is undertaken by those with the relevant professional knowledge and background to make informed decisions about matters relating to the competence and conduct of registered workers.

3.8.12 The SSSC suggested the establishment of a qualifications based register, where qualification requirements are set for entry to each part of the register, an approach adopted by Scottish Executive through the SSSC by regulation of the social services workforce. It is important that there is as much alignment as possible between standards and requirements set by regulatory bodies.

3.8.13 For example, the SSSC suggested that it may be appropriate for support staff working under the supervision of nurses in secondary or primary care settings to be regulated by the NMC while nursing assistants working in some community settings might be more appropriately regulated by the SSSC.

3.8.14 The SSSC is of the view that there needs to be more clarity about the scope of the proposed regulation to give a definitive view about which body/bodies should regulate 'health and social care staff'. However it is of the view that a fuller scoping exercise , focussed on the role and practice context of workers, is likely to result in the identification of a number of relevant regulatory bodies rather than just one appropriate regulatory body.

3.8.15 UNISON Scotland considered that in order to progress this matter a more extensive scoping exercise of the social care workforce is required. UNISON Scotland believed that a scoping 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.

3.8.16 The General Medical Council (GMC) supports the statutory regulation of support staff, although would have liked more exploration of the alternatives within the consultation document. However, they agree that regulation by the HPC has the virtue of being cost effective, flexible, the least controversial and consistent of the options described. The GMC suggest that consideration should be given to regulation of administrative and managerial staff.

3.8.17 The Royal Pharmaceutical Society (RPSBB) for Great Britain supports the regulation of staff whose work impacts on the clinical care of patients. As far as pharmacy support staff are concerned, the Society's view is that registration is only necessary at this time for pharmacy technicians. Other pharmacy support staff groups work under direct supervision of a pharmacist or pharmacy technician and therefore can be regulated adequately by setting professional requirements covering their training and/or competence. The RPSGB also believe that they should regulate pharmacy support staff.

3.9 Q8 Should the Scottish Social Services Council be the regulatory body for all healthcare support staff or should they only be responsible for social care support staff?

3.9.1 74 respondents stated that 'no' the SSSC should not be the regulatory body for all healthcare support staff. This was supported by 10 Educational Institutions, 24 NHS Operating Divisions, 8 Professional Associations, including the NMC, HPC, RCN, RCM, UNISON.

3.9.2 NES believed that for health care workers in Scotland who support nurses and midwives and those groups of allied health professionals currently regulated by the Health Professions Council (HPC), it would have been appropriate for regulatory arrangements to be managed by a Scotland based organisation. However, at present no appropriate Scottish organisation stands ready to meet the timescales for regulation which are detailed in the consultation, and resources have not been costed.

3.9.3 UNISON Scotland recognised 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.

3.9.4 UNISON Scotland believed that additional work is needed to identify and define the scope of the proposed regulatory arrangements. 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.

3.9.5 The NMC recommended a shared approach to the regulation of social care support staff. There is an opinion within the Council that the SSSC should only regulate social care support staff. Staff regulated in Scotland moving within the UK may have difficulties registering if the system is different in the rest of the UK.

3.9.6 Questions remain regarding the difference that might exist between regulatory frameworks and procedures for social work care assistants and healthcare support staff. If responsibility for care delivery rests with social services, then a clear definition is required to determine the scope of practice of each group.

3.9.7 The SSSC strongly endorses the view that regulatory systems must support rather than hinder the changing nature of care. They must recognise and reflect the evolving service delivery context for health and social care services, in particular jointly provided services and shared posts that have been developed to meet policy objectives of Joint Futures Agenda.

3.10 Q9 If the HPC is the most appropriate bo dy, shoul dregulation be by way of statutory committee of the Health Professions Council or woul dother options be preferable

3.10.1 Of those who supported regulation through the HPC, the vast majority agreed the Health Occupations Committee would be the preferred route. This included 16 NHS Operating Divisions, Allied Health Professions Committee, The British Psychological Society, Social Care Association, NHS Education for Scotland, General Medical Council, Council for Healthcare Regulatory Excellence, Health Professions Council.

3.10.2 NES was of the opinion that the HPC, who have put forward a set of arrangements which appear prudent and sensibly costed would be the most appropriate regulatory body. NES also believe that for this group of staff then regulation by way of Statutory Health Occupations Committee would be appropriate.

3.10.3 In addition, those who did not indicate the HPC as the most suitable regulator, also said that this would be the most appropriate method if the HPC was to be the regulator.

3.10.4 The remaining respondents were either unsure or did not think that the HPC was the most appropriate body to regulate these groups.

3.11 Q10 Woul dregulation of assistants and support staff by the bo dies responsible for regulating those whom they support lea dto other problems such as "secon dclass" workers?

3.11.1 104 responses indicated that the opposite would be true and that regulation would lead to an enhanced workforce.

3.11.2 This option was supported by 29 NHS Operating Divisions, 17 Professional Associations, 13 Educational Institutions, 5 Regulatory Bodies, including, RCN, The Royal Society & College of Radiographers.

3.11.3 NHS Education for Scotland and UNISON indicated that regulation would help raise the profile, status, pay, level of development and support for healthcare support workers.

3.11.4 Other advantages listed included, clearer progression routes, increased recognition and value, professional identity, consistency with concept of team-working, professional groups confidence, encouragement of appropriate use of skills mix and being held to same standards as professions.

3.11.5 19 respondents indicated that they felt that regulation may lead to problems of a second class workforce, similar to the scenario of Enrolled Nurse status.

3.11.6 The RCN acknowledged that Second Class workers may become a potential problem, and that this notion must be avoided.

3.12 Q11 Are there other options for the structure of statutory self regulation we shoul dconsi der?

3.12.1 The majority of respondents agreed that all of the options for the structure of statutory self-regulation had been discussed in the consultation document. Some responses suggested that there should be further debate.

3.12.2 In these circumstances UNISON Scotland felt that in order to progress this matter, a more extensive scoping exercise of the social care workforce is required. UNISON Scotland believed that a scoping 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.

3.12.3 The CHRE remained unconvinced that statutory self-regulation is the best option for all categories of staff mentioned in the document. The CHRE recommended further debate before deciding which option of regulation and which regulatory body should regulate this category of staff.

3.12.4 The CHRE strongly recommended that the Scottish Executive consider regulation through the employment route, possibly with further safeguards.

3.12.5 Since regulation of social services workers is a devolved matter it is important that the proposed regulatory arrangements are properly aligned with those of the SSSC. Given the growth in multi-disciplinary service arrangements this alignment will need to include agreements about how regulatory bodies will collaborate when they have a shared interest in the investigation and handling of alleged misconduct by registered workers.

3.12.6 The British Association of Prosthetists and Orthotists claimed that there was no good reason why a separate body for support workers could not be established.

3.12.7 The Royal College of Physicians, suggested that statutory self regulation could be incorporated within Accreditation schemes of the employer and linked up to the present system of colleges.

3.12.8 The British Psychological Society stated that specifically for psychology assistant and support staff, but potentially for others, statutory self regulation may be an option where the regulation of staff may be integrated into innovative schemes incorporating flexible approaches to extended training under supervision. In the case of psychology it may be possible to draw parallels with the conditional chartered status that is available to Society members who are on an approved training route.

4. Conclusion

4.1 It would seem apparent that the general consensus from the responses to the consultation paper is that regulatory arrangements should be extended to those health and social care support workers listed in the consultation paper. However, there needs to be further debate around whether there should be other categories of staff, and around the definitions of a social care assistant. 4.2 Health and social care support workers should be held accountable for their own practice, dependent upon their level of training and experience/ or scope of practice. 4.3 Health and social care assistants should be actively consulted in the process of setting standards, but overall responsibility should lie with the employer. In addition to this, it would seem appropriate to develop a set of national or common standards, similar to those already designed by Skills for Health.4.4 Multi-disciplinary issues can be addressed by adopting a set of common standards to allow transferability of skills and flexibility of the workforce. It would be preferable that this group of staff were regulated within a single framework but this may be unrealistic due to the many and wide variety of staff in both the health and social care settings. It was apparent a consistent approach should be adopted throughout the UK.4.5 There needs to be further debate around who should regulate these groups of staff. There was no general consensus as to which body would be the most appropriate, apart from the indication that the Scottish Social Services Council should regulate social care staff only. In addition, if the HPC is to be the preferred body, then the majority would be content for regulation to be by way of Statutory Committee of the HPC such as the Health Occupations Committee.4.6 The general consensus is that there are no other alternatives, however some of the key stakeholders are not content that all options have been explored. The HPC believed that it should be the sole regulator of these groups of staff and have put forward their argument for doing so. Similarly the NMC believed that they should be the regulator for all staff working under existing registrants of the NMC. This is supported by the RCN who believed that nursing should remain within the family of nursing. NES believed that some of these staff should remain the responsibility of the overlying professional body; others should be regulated by the regulatory body within the profession they work, such as the HPC; and for non specialist nursing and social care staff then this should be by statutory committee of the HPC. The SSSC believed that regulation should be undertaken by those with the relevant professional knowledge and experience. The Council for Healthcare Regulatory Excellence strongly recommended the consideration of employer led regulation. 4.7 Further debate is required before a decision can be made as to which groups of staff should be regulated, which form of regulation should be undertaken and as to which of the regulatory bodies is the most appropriate to undertake regulation of health and social care staff in Scotland.

Profile of Responses

A total of 122 responses were received .

Profile of respondees by sector

Charity 2

Colleges (Royal) i 5

Educational Institution 19

Individual 5

Local Government 11

N.I Department of Health 1

NHS Division 35

Other NHS ii 12

Private Provider 4

Professional Association iii 21

Regulator iv 6

Union 1

Main Interest Groups

NHS Boards and Operating Divisions

Professional Associations

Educational Institutions

Other NHS

Local Government

i Colleges (Royal)

The Royal College of Nursing

The Royal College of Physicians

The Society and College of Radiographers

The Royal College of Pathologists

College of Occupational Therapists

ii Other NHS/Healthcare

Awareness to the Public & Professions

NHS Education for Scotland

NHS National Services Scotland

Clinical Guidelines Implementation Unit, NHS 24

Greater Glasgow Health Council

Fife Health Council

Golden Jubilee National Hospital

Borders Local Health Council

Kirkcaldy & Levenmouth LHCC, NHS Fife

NiCHE Progamme Steering Group

Direct Payments Scotland

North of Scotland Regional Planning Team

iii Professional Associations

Association of Scottish Colleges

Scottish Consumer Council

Scottish Medical and Scientific Advisory Committee

Royal Pharmaceutical Society of Great Britain

Capability Scotland

Association of Pharmacy Technicians UK

The British Psychological Society

Allied Health Professions Professional Committee, NHS Ayrshire & Arran

National Association of Theatre Nurses

UK Board for Scotland, Royal College of Midwives

British Association for Counselling and Psychotherapy

Scottish Arts Therapies Forum

SAMH

British Dietetics Association, Scottish Board

Social Care Association

Allied Health Professions Advisory Committee, NHS Lanarkshire

National Allied Health Professions Advisory Committee, Glasgow Caledonian University

AHP Advisory Committee, NHS Greater Glasgow

CareScotland, SQA

Independent Healthcare Forum

Society for General Microbiology

iv Regulators

Health Professions Council

General Medical Council

Scottish Commission for Regulation of Care

Scottish Social Services Council

Nursing and Midwifery Council

Council for Healthcare Regulatory Excellence

1. Key Stakeholders Views

2. NHS Education for Scotland2.1 NES indicated that they are broadly in support of regulatory arrangements for all staff groups delivering direct clinical services to patients. In practice NES believed that there are distinct categories of staff for whom the specific regulatory arrangements can usefully be distinguished.2.2 NES believed that health and social care support staff should not be accountable for their own practice and that their accountability should be through supervised practice overseen by appropriate professionals fully trained in the relevant discipline or field of care.2.3 NES is of the opinion that the work of assistants and support staff is conducted to standards set and monitored by those with overall responsibility for the work which those staff share. 2.4 NES believed that the shift in health and social care to roles which are defined in terms of competencies should provide the basis for developing a common framework of standards which can be contextualised to capture the specific knowledge/skills required for a specific discipline, or service.2.5 NES agrees that statutory regulation is likely to be the most appropriate route.2.6 NES does not believe that Scotland should necessarily follow the decision taken by the Department of Health about the regulation of health and social care support staff. NES indicates that transferability of regulatory arrangements can be secured through a variety of mechanisms, including compacts of agreement based on consistent UK standards.2.7 NES is of the opinion that health and social care workers need not be regulated as a single group. NES believed that where those heath and social care workers' knowledge and skills are specifically derived from the competencies of the registered professional with a view to facilitating access for the support workers to full professional training, the case can be made for regulatory arrangements for the support workers to be managed in tandem with the regulation of the relevant registered professional group within HPC.2.8 However, for those whose work is less exclusively aligned with a single registered professional group or who are expected to work across dynamic care contexts it would make sense for regulation to be customised to each country's specific health and social care services. In addition NES believe that it would seem unfortunate to fragment new regulatory arrangements between two London-based bodies. Therefore, NES would be of the opinion that the HPC, who have put forward a set of arrangements, which appear prudent and sensibly costed, would be the most appropriate regulatory body. NES also believe that for this group of staff then regulation by way of Statutory Health Occupations Committee would be appropriate.2.9 NES also indicate that theoretically it seems highly appropriate that a Scotland-based regulator such as SSSC might have regulated the whole group of health and social care staff. This would have provided a solution which met Scotland's devolved health and social care policy agenda. In practice, however, the timescales provided in the consultation document make SSSC regulation unrealistic, given its current commitment to the regulation of social services workers in Scotland.2.10 For health care workers in Scotland who support nurses and midwives and those twelve groups of allied health professionals currently regulated by the Health Professions Council (HPC), it would have been appropriate for regulatory arrangements to be managed by a Scotland based organisation. However, at present no appropriate Scottish organisation stands ready to meet the timescales for regulation which are detailed in the consultation, and resources have not been costed. In contrast, the HPC has provided a detailed case for the regulation of this category of staff. There may be an arguement for the HPC to take on arrangements for this category's regulation, with a review in five years, by which time a Scotland-based organisation might be ready to take over. In the meantime, it will be imperative that regulation of Scotland's health care support workers takes place within the context of its specific health and social care policy agenda.3. UNISON3.1 UNISON Scotland supports the statutory regulation of those groups of staff outlined in the consultation document. In addition, UNISON Scotland believed 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.3.2 UNISON Scotland believed 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.3.3 UNISON Scotland believed 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. UNISON Scotland believed 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.3.4 UNISON Scotland believed that the task of setting standards should be approached in a spirit of partnership. UNISON Scotland 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.3.5 In addition, UNISON Scotland believed 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.3.6 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.3.7 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.3.8 UNISON Scotland fully supports the principle of statutory registration in relation to healthcare and social care support staff.3.9 UNISON Scotland believed 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.3.10 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.3.11 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.3.12 UNSION Scotland believed 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.3.13 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.3.14 UNISON Scotland believed that additional work is needed to identify and define the scope of the proposed regulatory arrangements. 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 2001.3.15 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. UNISON Scotland believed that a scoping 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.3.16 UNISON Scotland believed that this perception of 'second class workers' must be avoided at all cost.4. The Health Professions Council4.1 The HPC believed that health and social care support workers should be accountable for their own practice. The HPC highlighted that although the decision to treat a patient is instigated by a professional, it must be the responsibility of the receiver of the task to decline or accept the task depending on their ability to undertake a delegated task. 4.2 The HPC recommends that the setting of standards should not be undertaken alone either by registrants, their representative bodies such as a trade associations or trade unions or by employers. The HPC is of the opinion that the setting of standards should involve input from all stakeholders, in particular members of the public. That this process should be undertaken by an independent statutory regulator, and that that the setting of standards must involve extensive public consultation, the creation of Rules approved by Parliament, and the publication of guidelines.4.3 The HPC believed that all existing regulators of healthcare professionals and Health Care Workers should be encouraged to use common standards. The HPC would aim to maximise the use of common standards wherever possible, in particular standards of education and training, standards of conduct, performance and ethics, and standards of proficiency.4.4 The HPC believed that the principles of statutory self-regulation should be used. The HPC recommends statutory self-regulation because it has been tried and tested as a credible process throughout the world, it is independent of employers and trade unions, it is an integrated process with economies of scale, flexible and has the backing of criminal law.4.5 The HPC believed that a single organisation should regulate all non-professional Health Care Workers, as this will: utilise economies of scale, keep costs to a minimum, ease communication to key stakeholders, ensure common standards, ensure a single set criteria is used to decide which Health Care workers to regulate and will avoid the necessity of amending and updating more than one piece of legislation.4.6 The HPC recommends that it should solely be responsible for the regulation of Health Care Workers based upon its recent experience of; multi-professional regulation, assessing which aspirant groups to regulate, opening new parts to the register, project experience of implementing new legislation to timetable and budget, and also the scalability of the HPC's operating systems.5. Nursing and Midwifery Council5.1 The NMC accepts that all staff that engage in the delivery of hands-on care in health and social care settings should be regulated.5.2 The NMC believed that healthcare assistants and support staff should be accountable for their practice and should be regulated. However, the scope of their practice and the parameters that will determine a framework for supervision and accountability will require further definition and negotiation. The NMC believed that the employer plays an important role in determining a person's scope of practice.5.3 The NMC believed that regulatory arrangements should be in place to support the setting of standards for health and social care staff but the responsibility for setting standards should rest with the employers.5.4 The NMC believed that a broad set of education and practice standards could be used for this group, in consultation with users of services, employers, registered practitioners, and all healthcare support staff.5.5 The NMC's preferred option would be to regulate all health and social care assistants and support staff within a single framework. If this is to be achieved new standards for proficiency will need to be developed, implemented and regulated. The NMC would like to be actively involved in the setting of these standards.5.6 The NMC believed that a unified approach is essential across the UK in the interests of public protection, and to ensure continuity across borders. If healthcare support staff were to be regulated separately in each of the four countries, it may be difficult to ensure consistent public protection standards. 5.7 The NMC believed that it should be the sole regulator of those healthcare support workers who work under the supervision of the NMC's registrants. The NMC believed that it is better placed to make an assessment of the likely impact of Fitness to Practice Issues.5.8 The NMC believed that although models of regulation can be shared across regulatory bodies, regulators must work together and recognise each other's specific responsibilities and priorities.5.9 The NMC recommends a shared approach to the regulation of social care support staff. There is an opinion within the council that the SSSC should only regulate social care support staff. Staff regulated in Scotland moving within the UK may have difficulties registering if the system is different in the rest of the UK.5.10 Questions remain regarding the difference that might exist between regulatory frameworks and procedures for social work care assistants and healthcare support staff. If responsibility for care delivery rests with social services, then a clear definition is required to determine the scope of practice of each group.5.11 The NMC also believed it should be working with the HPC, and that the role of regulation in this context need not solely be that of the NMC's.6. Council for Healthcare Regulatory Excellence6.1 The CHRE welcomes the Scottish Executive's commitment to protect the public by requiring health and social care support staff to meet standards of practice, training and conduct, and by dealing with those who do not meet these standards. The CHRE strongly agrees that the aim of reforms should be that all staff whose work has a direct impact on clinical care are safe and competent.6.2 The CHRE recommends that there should be further debate over the definition of clinical or other risks that may exist, which categories of staff should be regulated and the form that regulation of health and social care staff should take.6.3 The CHRE believed that there needs to wider debate before deciding whether health and social care assistants should be accountable for their own practice. In practice, this may be difficult. The term 'health and social care support staff', however, covers a wide range of staff. Some of them may be better placed than others to be accountable for their own practice.6.4 The CHRE recommends that standards are co-ordinated between the health and social care sectors, as there are already standards set for social care staff by Skills for Health. The CHRE believe that the setting of standards lies at the heart of the difference between statutory self-regulation and statutory regulation. Traditionally, one of the key elements of self-regulation is the determination by professions themselves of their own standards of competence. Having standards set by others means that the form of regulation envisaged is not statutory self-regulation, but may be statutory regulation.6.5 The CHRE supports collaborative frameworks if it is achievable, as it facilitates movement across boundaries of roles or sectors. This does not exclude the single framework, which could co-exist with greater consistency between regulators.6.6 The CHRE believe that professional self -regulation may not be the most appropriate form of minimising risks and ensuring quality of care for this group of staff, or for all various categories covered. This raises questions about which categories of staff should be covered by statutory self regulation, and whether their should be recommended levels of qualification or skills for categories of staff whom statutory self-regulation may be appropriate. The CHRE recommends further debate on these issues before deciding on the appropriate form of regulation.6.7 CHRE strongly recommends that the Scottish Executive, Department of Health and the Welsh Assembly Government should work together to implement the same system of regulation in Scotland, England and Wales. Public protection must be the primary consideration. Different systems may create anomalies or loopholes, and would be very burdensome for staff moving from one country to the other. The CHRE recommends that if implementing the same system proves impossible, then the Department of Health, Scottish Executive and Welsh Assembly Government, and the regulators who would regulate health and social care staff, co-ordinate standards, education requirements and fitness to practice processes.6.8 The CHRE remains unconvinced that statutory self-regulation is the best option for all categories of staff mentioned in the document. The CHRE recommends further debate before deciding which option of regulation and which regulatory body should regulate this category of staff.6.9 The CHRE strongly recommends that the Scottish Executive consider regulation through the employment route, possibly with further safeguards.7. Scottish Social Services Council7.1 The SSSC believed that the proposed extension of regulation is necessary in order to protect the public, enhance and support the conduct and competence of workers, ensure mobility and career progression of workers within evolving service delivery arrangements. It will be important that new arrangements fit appropriately with exiting regulatory regimes and are organised in a manner that avoids confusion and duplication and that is accessible and makes sense to service users, carers, workers, and employers. 7.2 The SSSC believed that regulation is undertaken by those with the relevant professional knowledge and background to make informed decisions about matters relating to the competence and conduct of registered workers.7.3 A flexible approach in the context of evolving service delivery might be to require these regulatory bodies to set mutually compatible standards and requirements for support workers and to require these workers to be registered with one of a number of specified regulatory bodies. The Scottish Executive has already agreed this approach with some workers subject to regulation by the SSSC e.g. Care Commission Officers who are already registered with a relevant regulatory body e.g.NMC are not required to register with SSSC.7.4 The SSSC would like to contribute in developing such regulatory arrangements.7.5 The SSSC believe that the regulation of the workforce should contribute to the provision of high quality health and social services and therefore supports regulation based on clear codes of ethics/practice and the inclusion of competence and good conduct as eligibility criteria for registration. The Scottish Executive has already taken this approach through the SSSC to the regulation of the social services workforce. The SSSC has issued codes of practice for social service workers and their employers and is establishing a qualifications based Register i.e. qualification requirements are being set for entry onto each part of the Register. SSSC believed that similar arrangements should be put in place in the proposed regulation of health and social care staff.7.6 For example, it may be appropriate for support staff working under the supervision of nurses in secondary or primary care settings to be regulated by the NMC while nursing assistants working in some community settings might be more appropriately regulated by the SSSC.7.7 The SSSc is committed to working in a collaborative manner with the other regulatory bodies to ensure effective and comprehensive regulation of the health and social care workforce.7.8 The SSSC is of the view that further work is required to identify the scope of the proposed regulatory arrangements. In particular it is not clear what workers are considered to be 'social care staff' and how they are seen to differ from social service workers as defined in 77 (1) (b) of the Regulation of Care Act 2001.7.9 The SSSC is of the view that there needs to be more clarity about the scope of the proposed regulation to give a definitive view about which body/bodies should regulate 'health and social care staff'. However it is of the view that a fuller scoping exercise , focussed on the role and practice context of workers, is likely to result in the identification of a number of relevant regulatory bodies rather than just one appropriate regulatory body.7.10 Since regulation of social services workers is a devolved matter it is important that the proposed regulatory arrangements are properly aligned with those of the SSSC. Given the growth in multi-disciplinary service arrangements this alignment will need to include agreements about how regulatory bodies will collaborate when they have a shared interest in the investigation and handling of alleged misconduct by registered workers.

Tables of Results

Q1 Should regulatory arrangements be extended to the assistants and support staff identified in paragraph 15? If not, which staff should be included and on what criteria?

Table 1.

Yes

No

Total

No of responses

113

9

122

%

93%

7%



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

Table 2

Yes

No

No, those with overall responsibility

Yes, but ultimately by the manager/employer

Dependant on level of training & experience/scope of practice

Total

Number of responses

37

8

14

21

42

122

%

30

6

12

18

34

100



Q3 Shoul dassistants and support staff set their own stan dar ds OR shoul dthose with overall responsibility for the work of these staff share in, or take the lea d, in setting these standards?

Table 3

No, those with Overall responsibility

No, a collaborative approach, managers & employees

It should be Professional Staff

Should adhere to National Standards

Standards set by Regulatory Body

Total

Number of responses

38

47

14

16

7

122

%

31%

39%

12%

13%

6%

100%



Q4 How can multi- disciplinary issues best be a dd ressed ? Should the regulators set common stand ard s and /or recognise each other's so that workers can move betweend ifferent 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 includ ing some shared stand ard s and somed iscipline-specific stand ard s?

Chart 1

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

Table 4

Yes

No

Total

No of responses

110

12

122

%

90%

10%



Q6 Shoul dScotlan dfollow any decision that might be taken in England in ord er to ensure both transferability of staff and public protection by ensuring one system for theUK ?

Table 5

Yes

No

Total

No of responses

78

44

122

%

64%

36%

100%



Q7 Should the Nursing and Midwifery Council (NMC) and the Health Professions Council (HPC) regulate those groups of assistants and support staff that work with the professions they regulate? Are other options preferable?

Table 6

Yes

NMC/HPC

SSSC

NMC

Only

HPC

Only

HOC or new body

3 bodies aligned

Number of responses

40

21

5

21

23

12

%

33%

17%

4%

17%

19%

10%



Q8 Should the Scottish Social Services Council be the regulatory body for all healthcare support staff or should they only be responsible for social care support staff?

Chart 2

Q9 If the HPC is the most appropriate bo dy, shoul dregulation be by way of statutory committee of the Health Professions Council or woul dother options be preferable?

Table 6

HOC

No

Unsure

Total

Number of responses

61

50

11

122

%

50%

41%

9%

100%



Q10 Woul dregulation of assistants and support staff by the bo dies responsible for regulating those whom they support lea dto other problems such as "secon dclass" workers?

Table 7

Yes

No

Total

Number of responses

18

104

122

%

15%

85%