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OPINION

'Regulate support workers to protect vulnerable people'

Senior lecturer, Peter Woodward, argues in light of the BBC Panorama case, the advantages of registration and the positive attitude of support staff towards registration, it should happen as soon as possible

The recent Panorama programme saw a covert reporter working in Winterbourne View, a private hospital for people with learning disabilities. This undercover investigation was spurred by the revelations of a nurse once employed at the hospital who contacted Panorama, having already reported this service to the Care Quality Commission on three occasions without action. Panorama presented evidence of systematic abuse and horrific cruelty that highlights a number of problems regarding the inspection, regulation, support and training staff receive.

People with learning disabilities remain marginalised and vulnerable, often within the services that are designed to support them. This is not the first example of institutionalised abuse. Recently, investigations in Cornwall and, in the wake of this, Sutton and Merton, have shown examples where services go inexcusably wrong and this vulnerable group suffers as a consequence.

The majority of those perpetrating abuse in Winterbourne View were unqualified support staff, four of whom were arrested. The nurses who managed the support workers are culpable too, complicit by doing nothing to stop the abuse.

While a qualified nurse is regulated by the Nursing and Midwifery Council and can lose their registration if found guilty of misconduct, support workers are still not regulated by a professional body. If the police find those arrested guilty of abuse at Winterbourne View, they should be unable to work elsewhere due to CRB checks revealing a criminal record. For those who do not face a criminal conviction, they may face dismissal with a job reference to reflect this - but there is nothing in place to stop them taking up similar employment elsewhere. It is uncommon for support staff to face criminal prosecution following abuse investigations so it is quite possible for someone to be suspended for misconduct in one service and to be working with vulnerable people for another provider the next day.

The call to regulate support staff is not new. I recall the UKCC recommending this in the late 1990s. Since then, the Department of Health has supported the idea and both the Health Professions Council and the NMC have been suggested as possible regulators. At present the NMC is exploring the feasibility of this.

It is estimated there are up to a million unqualified support staff working in the UK, the majority in private care. The numbers of people with learning disabilities and the older population are due to rise in the future and these vulnerable groups will have an increased reliance on unregulated staff. If unqualified staff are regulated, this should lead to a greater level of public protection by ensuring only the appropriately qualified gain entry onto the register, with revalidation to ensure standards and removal of those guilty of misconduct. This would also be to the advantage of service providers assured that they are employing someone who can safely undertake the role.

A recent Royal College of Nursing poll found 85% of healthcare assistants were in favour of regulation. Most support staff do an excellent job and deserve the benefits of being part of a professional body. Given the advantages of registration and the positive attitudes of support staff towards being regulated, it is difficult to see why this should not happen as soon as possible.

The introduction of a million people onto a register is not an easy task and without legislation this will not take place in the near future. It took a media exposé four decades ago to trigger the policies that began deinstitutionalisation for people with learning disabilities; it will be interesting to see if any change of policy is bought about by the latest.

Peter Woodward is senior lecturer in learning disabilities at the University of Greenwich

Readers' comments (7)

  • there must be thousands of excellent healthcare support workers who are serious and professional and dedicated to what is not an easy job.

    as well as assuring more standardised quality of care across the country, adequate and approprite training and national registration must also be in their own interests of security and protection in practice and give them a professional status where they are distinguished from the cowboys and criminal carers.

    as there are strict safeguards in place for working with children, so should there be for employment in any organisation providing care or support of any sort and for individuals of any age.

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  • Absolutely agree with this, and anon above too.

    I do not agree that it should be the NMC. HCA's should have their own separate regulatory body.

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  • Does registration of any kind, really protect patients? In the minority, I hope?

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  • Anonymous | 22-Jun-2011 2:24 am

    That is a key question. There will never be a full proof system to protect patients 100% from poor standards of care, malpractice and negligence but I think that in order to practice, registration is an essential start in order to prove that the required qualification and standards have been met and the right to remain on the register should be subject to regular review, as with the NMC. The onus should then be with employers to ensure that they have rigorous selection processes in place to engage suitable candidates for the job and provide them with adequate support and supervision and further training appropriate to the area of practice, bearing in mind and respecting the fact that each individual they employ is a valuable resource for their organisation and provision of the best possible care for their patients.

    Unfortunately, the misdeeds of the few after they have registered is much harder to regulate and control and effective ways to do this require further study. regulation of the self-employed is, in theory, far more problematic.

    Until other better solutions are found I believe that registration for all those employed by the healthcare and social organisations for the responsibility of caring for any human being is essential.

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  • Anonymous | 22-Jun-2011 2:24 am:
    in addition to the following comment, it is a method of accountability and henceforth ability to be employed anywhere else as a result. It isn't intended as a method of stopping any abuse or dodgy practice at first contact. Often it is a matter of training and support, but there are common examples of people whose issues should preclude them from having any contact with vulnerable people, full stop.

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  • Anonymous | 22-Jun-2011 2:24 am in short yes it does, but not in and of itself. It is simply one tool to ensure that a certain level of standards are being maintained, noone is expecting it to be as extensive as a registered Nurses I don't think, (in terms of cost, demands and cpd for example) but it is still important. One example I can give you that I have seen myself, a HCA who is completely unsuitable for the role can be disciplined and get the sack for appaling behaviour, but then simply go on to get another job as a HCA somewhere else regardless and continue that behaviour. A staff Nurse displaying the same abuse/behaviour would be struck off the register and not be able to practice again. Registration would stop the HCA doing so too. I hope that once implemented, registration of HCAs will help weed out those who should not be in the job in the first place (those who see it as simply a way to pick up a paycheque for example) and allow those really good HCAs who really care about what they do to ensure that they can demand constant and updated training.

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  • from Anonymous | 22-Jun-2011 2:24

    sorry mike, we are slightly at cross purposes as i went off there into my own little world from the specifics of hcas into the generalities of registration as a whole. i should have stuck to the main point of the discussion but i agree with what you say above entirely.

    Oh, silly me!
    this is what becomes of trying to take in so much info. in a short space of time and then trying to comment on it!

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