Safety versus choice: should hiring a personal assistant be more closely regulated?

Safety is a prime concern for disabled people when hiring a personal assistant, but must the price be extra bureaucracy and the loss of choice, asks Vern Pitt

Katy Etherington pictured with her personal assistant Kasia Miszczak (pic: Tom Parkes)

 Finding a personal assistant (PA) is hard, finding a good one is harder and knowing they are a safe person to invite into your home is hardest of all. “When you are trying to recruit you are trying to do it quickly most of the time. You usually end up with someone you are not entirely happy with because you have no choice,” says Katy Etherington, PA user and director of PA Pool. Etherington started PA Pool in 2006 to connect people who need PAs with PAs working in their area in a planned, manageable manner.

While PA Pool can make it easier for PA users to find high quality staff it doesn’t offer any guarantees about how safe it is to let those people into users’ homes. It is, however, developing checks for training and criminal convictions with local authorities.

Personal assistants are far less regulated than other care workers, a reflection of the view that providing service users with genuine choice and control means leaving them free to choose who cares for them.

Care regulators like the Care Quality Commission do not monitor settings in which PAs are employed.

Unlike employers of domiciliary or residential care workers, service users in England and Wales are not required to have their employees checked by the Criminal Records Bureau for past convictions or police concerns. A tougher regime applies in Scotland where some councils demand checks.

Although service users can apply for a CRB check in England and Wales, this often does not happen in practice. A Skills for Care survey in 2008 found 48% of users did not run CRB checks on potential PAs who they did not know.

PAs were also never covered by the Protection of Vulnerable Adults scheme, under which English and Welsh care agencies were required to check whether a potential employees were on the Pova list of barred staff, and to refer those who had harmed users for inclusion.

Pova replaced

Pova was replaced by a broader list of people barred from working with vulnerable adults last October, under the Independent Safeguarding Authority, as a prelude to the full implementation of the vetting and barring scheme (VBS) conceived following the Soham murders.

The VBS, which would cover England, Wales and Northern Ireland, has now been put on hold pending a review initiated by the coalition to “scale it back to common sense levels”.

However, even if the VBS had been implemented as planned this year, PAs would not have been required to register with the scheme, nor would service users have been required to check potential employees against it. The same is true of the equivalent Protecting Vulnerable Groups Scheme in Scotland, which comes into force in February 2011. On the plus side for those who favour greater regulation, service users would have been able check the ISA register to see if PAs were safe to hire, while barred individuals would be committing an offence by seeking work as a PA.

Growing market

It is clear that the market for PAs’ services is growing. A Skills for Care report this year estimated that the number of personal assistants employed in England would rise from 168,000 in 2010 to 722,000 in 2025, if personalisation continues at its current pace. There will be significant growth over the coming two years with the government bent on having all users in England on personal budgets by 2013.

This future has led to strong support for a system to register PAs, including among service users.

Etherington says there is a large number of people on PA Pool’s books who would welcome an approved registration scheme for PAs, a position backed by Action on Elder Abuse chief executive Gary FitzGerald. He says: “There are a large number of people out there who want to engage with PAs but want that level of reassurance through a select approved list of people to go to.”

A registration system will prevent abusers from using their employment with one service user to gain access to other vulnerable people, says Peter Morgan, chair of the Practitioners Alliance Against Abuse of Vulnerable Adults.

“A PA is seen as a person who can be trusted,” he says, “and, if you’re looking to abuse, having got access to one vulnerable person you can get access to others. It’s that balance between empowering the service user but also protecting others.”

Robust regulation

FitzGerald says any such scheme must not just look at criminal history but for a history of abuse in employment. It must allow service user employers to make referrals about concerns and build up a picture of a person’s past professional conduct. This would make sense considering that PAs are, by the nature of their work, cut off from the rest of the social care workforce, meaning there is less available information on them.

Morgan adds that regulation must be robust enough for councils to be able to show that they are spending public money wisely when service users on personal budgets are employing PAs. Balancing choice with public responsibility is key, he argues.

Etherington, however, is sceptical of a register, warning that it could restrict user choice and exclude talented, if untested, PAs.

“A lot of foreign workers come to the UK and do PA work for some quick money and then go off and do something else,” she says. “I’ve had a lot of people who had no experience of being a PA and they have been brilliant. If it stops people like that from doing it I’m not in favour of it.”

Outcome of review

The future for the regulation of PAs – in England at least – will depend on the outcome of the vetting and barring scheme review, forthcoming recommendations on the regulation of the social care workforce, and a strategy on PAs due next year.

The government’s proposed reforms to the performance framework for adult social care, issued last week, point to a strong commitment to the deregulation of the sector as a means of encouraging improvement. This, along with its strong support for personalisation and user choice, suggests that those wanting to see greater regulation of PAs will have a tough battle on their hands.

Case study: ‘I was abandoned by my PA while abroad’

My safety has been put at risk on a number of occasions. I’ve had just about every kind of abuse that you could think of apart from sexual,” says Richard George*, a disabled man who is reliant on PAs for many basic tasks such as getting into and out of bed.

Even though the abuse has taken many forms, from many different PAs over 19 years, George remains fearful of retribution and so prefers not to use his real name.

“I’ve had PAs try to assert control over me. I’ve had PAs who have made threats and said, ‘If you don’t do this I will walk out now’, and I’ve had stuff stolen things like cameras and money,” he recalls.

In one particularly scary incident, a PA abandoned him on a business trip to the US. Although George’s employers were paying for the PA to accompany him and ensure his safety, his PA used the trip to meet up with friends instead of doing the job.

With a business background and years of recruitment experience, George is convinced that under the present rules such things are unavoidable. He argues that stronger regulation of PAs is necessary to enable PA users to make informed choices about the people they are employing.

*Not his real name

Also in this special report:

Direct payments and personal assistants for people who lack capacity

A dating-agency style matching of PAs to budget holders

Alex Fox on why personal assistants should band together

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