Rebirth of a profession?

It is not often that people in the social care sector get what they
hope for. But now a 20-year-old dream has come true. A unifying set
of standards of conduct and practice for social care workers and
their employers has been published, declaring for the first time
how social care workers are expected to behave and eventually
making them individually accountable if they fail to meet those
standards. Social care employers have also gained a code of
practice which recognises that staff can only do a good job if
their employer enables them to do so.

Many hope that the codes of practice will enhance the professional
status of social care staff in the eyes of the public and attract
more people into the sector. If it works it will also raise
standards by giving staff, managers and employers a common
framework to discuss standards of practice and care, and by weeding
out individuals who shouldn’t be practicing at all rather than
allowing them to dodge from one unsuspecting employer to another.

The rules of registration also aim to protect service users from
people whose practice standards may be compromised by health
issues. Special health hearings will be an alternative to public
disciplinary hearings. A decision to suspend someone because of ill
health can then be lifted when they show they have recovered enough
to practise safely.

The codes of practice published last month by the General Social
Care Council have been the subject of long and hard debate. Unlike
the nurses’ code of conduct which covers a single professional
group with a shared qualification, the social care code of practice
applies not only to 60,000 qualified social workers but to all 1.2
million people working in a range of jobs in social care, most of
whom have no formal qualifications. Social workers will be the
first group to sign up when the GSCC register opens next year. The
GSCC expects it to take “a year or two” to register all qualified
social workers and several more before the whole social care
workforce will be covered. Once most social workers are on the
register, the GSCC will apply to the secretary of state for
“protected status” for the title of social worker, and only those
on the register will be allowed to practise. Eventually, other
social care jobs may also have protected status, but not before the
GSCC has completed the difficult job of categorising them
all.

So what impact will the code and the register have in the long term
on the standard of social care services and on the professional
status and morale of those who work within them? The nurses’ code
of professional conduct and regulatory framework have often been
viewed by social workers as an enviable badge of professionalism. A
new nurses’ code was published this year by the Nursing and
Midwifery Council, the statutory body that took over from the
United Kingdom Central Council last year. It replaces one drawn up
in the early 1980s, again following a regulatory regime. That in
turn replaced the “Nurses’ rules” which were first produced by the
General Nursing Council in 1919 – but which dealt more with
practical issues such as uniform than matters of professional
competence.

Tom Bolger, assistant general secretary of the Royal College of
Nursing, is equivocal about the extent to which the code has raised
standards in the profession. “It was produced by a national body so
it had some weight, and it is a useful guide, but I don’t know how
many nurses will have read it.”

When the code was introduced there was some optimism that nurses
would gain an enhanced status in relation to doctors as a result
but this was soon dented, according to Bolger, by a High Court case
which ruled that the code of conduct had no weight in law. He
believes the code has not significantly added to the
professionalisation of nursing. “My feeling is that it has been
used mostly by managers to beat nurses rather than by nurses to
uphold standards of care. The most common abuse has been when a
nurse has mistakenly given the wrong medication to a patient. In
the old days that would have been dealt with by discussion and
perhaps extra training but after the code of conduct they would use
the code to discipline you.”

Bolger says this trend has been mitigated in recent years by the
introduction of clinical governance in the NHS which emphasises the
shared responsibility of employers, managers and practitioners to
ensure mistakes do not happen, and shared accountability for when
things go well or otherwise.

The existence of a code for social care employers – there is no
equivalent code for nurses’ employers – does acknowledge that
employers share responsibility for the standards of practice on the
front line. Inspection organisations, including the joint reviews,
Social Services Inspectorate and National Care Standards
Commission, are expected to incorporate the provisions of the
employers’ code into their inspections. But the lines of
accountability get longer in relation to employers not covered by
the SSI or NCSC – such as a local voluntary sector organisation
running a family centre under contract with a local council.

So how can people report a breach of the code by an employer? Do
the codes and the framework of registration, investigations and
sanctions which back them up give individuals the clout to uphold
decent standards of practice?

The British Association of Social Workers’ professional officer
Nushra Mapstone welcomes the code as a huge step towards achieving
consistent services for vulnerable people, but she points out that
for professional social workers it represents a low threshold, and
it won’t replace BASW’s own code of ethics for social workers which
has been in place since 1976.

Mapstone and others have also expressed concerns about the
mechanisms through which individual staff can be protected if they
are victimised or disciplined by their employer as a result of
trying to uphold standards of practice. For example, if a social
worker lost their job for refusing to comply with a policy of
avoiding receiving 16 and 17 year olds into the looked-after
system, or the manager of a home who was demoted after raising
concerns about the effect of depleted staffing levels, where would
they go to make their case?

Mike Wardell, deputy chief executive of the General Social Care
Council, points out that the code includes a duty on social care
workers to “bring the attention of their employer or the
appropriate authority resource or operational difficulties that
might get in the way of the delivery of safe care”, and the GSCC
will be publishing guidance in the new year which will clarify how
and whom they should approach.

But Wardell adds a word of caution: “The person with responsibility
for providing the service is the employer – this is not a charter
for a social worker to impose their own standards above those of
their employer or to refuse to act in a particular way because they
disagree with the employer about the standard of service.”

Instead, he says, the codes should provide a shared platform for
staff and employers to discuss concerns about standards of care,
and a route for staff to take the matter further if they still
believe the situation is “unsafe”.

June Thoburn, a member of the GSCC and professor of social work at
the University of East Anglia, believes that although the code for
social care workers is no magic answer to the improvement of
services, it does represent a major gain for users. “From now on it
is going to strengthen the elbow of social workers and social care
workers who want to do a good job and, when necessary, take issue
with their employers about what a good job is.”