The Department of Health’s plans to register 300,000 home care workers in England suffered another setback last month. Kirsty McGregor examines the future for the scheme, and why the UK administrations are divided on the issue
Andrew Wilson, who is hard of hearing, blind in one eye and unable to walk more than a few steps, lives on his own and depends on several home care visits a day.
In June 2008, an exposé by BBC One’s Panorama programme, which revealed poor standards of care at three domiciliary providers, showed a care worker bathing the 78-year-old while chatting on her mobile the entire time.
His half-hour visits were often cut short because workers were on such tight schedules.
When Panorama’s undercover investigation aired in April, the General Social Care Council renewed its case for registering all home care staff in England.
It said this would improve the quality of care for service users by ensuring minimum standards of training and conduct while protecting them from unsuitable workers, who could be banned from practising.
However, the Department of Health announced last month that the registration process, which was due to start in 2010 on a voluntary basis after repeated delays, has been suspended while the GSCC strengthens its social worker conduct function.
The uncertainty is a cause of great concern for providers and service user groups. Caroline Bernard, policy and communications manager at Counsel and Care, says older people receiving care at home are being put “at risk of abuse and poor quality care” as a result of the lack of regulation.
“The Department of Health needs to review its priorities,” she says. “If it wants more older people to remain independent at home for as long as possible, it needs to ensure that the workforce charged with providing that care is properly regulated, trained and supported,” she says.
Paying for registration
But national registration must be paid for somehow, and there is widespread concern about the impact registration fees would have on recruitment and retention in such a low-paid sector, where many staff are part-time. The average hourly wage for workers is £6.20 to £7, while annual staff turnover is 25%.
Les Clarke, director of older people’s services at home care provider Housing 21, says: “If we ask care staff to pay even £60 every three years then at the time that payment is due it will require them to work about 15 to 20 hours after tax, travel, national insurance and pension to pay for re-registration.”
The DH expects to continue working with the GSCC after the conduct backlog has been cleared (see news, pp4-7). However, GSCC chair Rosie Varley claims registration is being further delayed by a lack of clarity over the right model.
“There can be no doubt that some form of regulation is needed,” said Varley. “However, there has been and continues to be considerable discussion as to the form that regulation should take and whether it is feasible or desirable simply to roll out the professional regulatory model for social workers to the rest of the workforce.”
In its adult social care workforce strategy, published in April, the DH says conventional models of statutory regulation, of the kind used for social workers, may be “disproportionate” to home care. The DH is considering a licensing model instead, but Clarke says that would “add further confusion and further delay in reaching a conclusion”.
Registration is complicated by the diverse nature of the sector: 80% of the UK’s 6,300 home care providers are in the private and voluntary sector.
However, moves towards a more conventional form of registration are already under way in Scotland, Northern Ireland and Wales (see diagram).
The UK Home Care Association, which represents 1,850 providers, supports registration, but also raises concerns about the impact of fees and says that it should use the time allowed by the DH’s postponement of its strategy to reassess the most effective model for the future in England.
But for campaigners such as Counsel and Care, which believe older people deserve compassion and dignity as an absolute minimum, blanket regulation of the home care workforce cannot come soon enough.
UK registration divisions
● Estimated workforce: 300,000
● Priority for registration: high
● Deadline: unknown
● Who the social care register is open to: social workers (compulsory)
● Care council’s position: the General Social Care Council wants to open the register to the entire social care workforce over the next 10 years.
● Government policy: the Department of Health wants to register home care workers first because they work unsupervised in people’s homes and are mainly employed by private and third sector agencies. It believes registration will “improve safety, assure protection and improve the quality of services”.
● Potential model: the DH is considering a number of models including a “licence to practise”. A report on extending professional regulation, published in July, proposed giving healthcare workers the protected title of “licensed healthcare practitioner”. Participants in the scheme would still be expected to fulfil training requirements, but the key difference is that, although it is expected to be voluntary and employer-led, the public would be encouraged to be treated only by licensed practitioners.
● Expert’s view: Jill Manthorpe, director of the social care workforce research unit at King’s College London, says professional licences are not necessarily a lighter touch. She draws comparisons with those used in the US for airline pilots, lawyers and medics, where there are “great incentives” to be licensed. “There is no stricter scheme than an airline pilot’s licence,” she says. “What’s being talked about is proportionality and the distress that’s caused when things go wrong versus the hassles caused by regulatory systems.”
● Estimated workforce: 33,000
● Who the social care register is open to: social workers, residential childcare workers and managers (compulsory), day care workers in adults’ and children’s services (voluntary)
● Priority for compulsory registering domiciliary workforce: medium
● Deadline: after 2015
● Recent announcements: Scottish Social Services Council will begin registering managers of care at home services, as they are called in Scotland, in December 2010. A consultation on qualification requirements and fee levels is under way.
● Care council’s position: the SSSC believes registration is a major part of the drive for higher standards in social services.
● Government policy: chose other groups of workers ahead of care at home staff in the next phase of registration over the next six years. This decision is based on the findings of a consultation in 2000, which found widespread support for regulating home care agencies, rather than individual workers.
● Estimated workforce: 13,500
● Who the social care register is open to: social workers (compulsory), residential childcare workers and managers, adult residential workers and managers, adult day centre managers, domiciliary care managers (voluntary)
● Priority for compulsory registration in domiciliary care: high
● Deadline: July 2013
● Recent announcements: a Northern Ireland executive consultation on the introduction of compulsory registration for all groups of social care workers to be phased in by July 2013 closed last month.
● Care council’s position: the Northern Ireland Social Care Council wants to register all groups of social care workers in order to safeguard vulnerable service users and ensure a competent, confident workforce. Registrants wishing to work in other parts of the UK can transfer their registration to that area or apply for additional registration with the relevant care council.
● Government policy: health and social services minister Michael McGimpsey believes registration is key to ensuring “high standards of care, protection and conduct” in the workforce. Some parts of the workforce have chosen to register under the voluntary scheme but, because this is not across the board and not compulsory, “full take-up will not be achieved within an acceptable timeframe”.
● Estimated workforce: 6,000
● Who the social care register is open to: social workers and residential childcare workers and managers (compulsory); adult residential workers and managers, domiciliary workers and managers (voluntary)
● Priority for compulsory registration in domiciliary care: medium
● Deadline: after 2012
● Recent announcements: registration will be compulsory for home care managers by July 2012.
● Care council’s position: the Care Council for Wales believes registration puts social care workers on a similar footing to other public service professions such as medicine and teaching.
● Government policy: Gwenda Thomas, deputy minister for social services in the Welsh Assembly, said in July that the registration of domiciliary managers was intended “to promote the development of a high quality and well qualified workforce”. She has asked government officials to gather further evidence about the impact of mandatory registration on social care workers.
Timeline: Delay after delay and, finally, suspension
March 2006: Care services minister Liam Byrne announces England’s social care register will open in stages to residential and domiciliary care staff in April 2007
February 2007: Byrne’s successor, Ivan Lewis, says the register will be extended to home care staff alone in late 2007 or early 2008 February 2008: Lewis says he hopes registration will happen by “late summer” April 2009: Department of Health’s adult social care workforce strategy promises registration of home care workers on a voluntary basis in 2010, becoming compulsory thereafter July 2009: General Social Care Council discovers a backlog of more than 200 conduct cases involving social workers, leading to the suspension of chief executive Mike Wardle
October 2009: Department of Health announces it will suspend registration of home care staff until after the GSCC has strengthened its conduct function
This article is published in the 12 November issue of Community Care magazine under the heading Risk concerns fail to register