Memorandum submitted by General Social Care Council (H&SC 6)
GSCC submission to the Health and Social Care Bill 2007 Public Bill Committee
Introduction: About the General Social Care Council
The General Social Care Council (GSCC) is responsible for setting standards of conduct and practice for social care workers and their employers, for regulating the workforce, and for regulating social work education and training. The GSCC is a Non Departmental Public Body established in October 2001 under the Care Standards Act 2000 (CSA). It is sponsored by the Department of Health but works closely with the Department for Children, Schools and Families in delivering the children's and young people's care agenda. Similar bodies exist in Scotland, Northern Ireland and Wales.
The GSCC currently regulates Registered Social Workers and social work students and the Government has announced plans for the registration of domiciliary social care workers to start in 2008.
· The GSCC welcomes the creation of the new regulator CQC.
· The GSCC is keen to ensure that the registration of social care workers is enforced by the new regulator using the powers set out in Clause 16 of the Bill. Such powers are essential if GSCC is to deliver the Government's intention to register the social care workforce.
· The GSCC considers that the codes of practice for social care workers and social care employers should be given the same legal status under Clause 16 as the code relating to healthcare associated infections.
· The GSCC welcomes the powers set out in Clause 114 and Schedule 9 to amend GSCC's scope and remit by regulation. This brings GSCC in line with other healthcare professional regulators whose powers can be amended under Section 60 of the Health Act 1999. This Clause will permit GSCC to register all those social care workers working in 'regulated activity' as set out in Clause 5 of the Bill as well as those who fall outside this definition.
· The GSCC welcomes the introduction of the civil standard of proof in fitness to practise proceedings for the other healthcare professional regulators as set out in Clause 104 of the Bill. GSCC adopted this standard of proof from its inception and has successfully used this in its registration and conduct committee hearings. Clause 115 gives a statutory basis to GSCC's current practice.
Part 1. The establishment of the Care Quality Commission (CQC)
1. The GSCC welcomes the proposed creation of the new Care Quality Commission. A new regulator for both health and social care will deliver improvements in care for people who use services and will contribute to breaking down the health and social care divide. We welcome the Government's intention that the CQC will have a new and more flexible range of sanctions in order to enforce compliance with the new regulations. We also strongly welcome the fact that the new regulator will be a user-focused organisation committed to involving people who use services as set out in the DH response to the future regulation of health and adult social care in England.
2. However, the GSCC believes that it is important that the distinctive nature of social care and the values of social care regulation developed by the GSCC and CSCI continue to be recognised in the work of the CQC.
Clause 9 Condition requiring registered manager
3. The role of the manager within social care settings is key to ensuring the provision of high quality care and outcomes for people who use services. In order to guarantee the quality of this care, it is important that a named individual can be held to account. Whether this requires managers to register with CQC, as opposed to being a named individual, is a matter of debate, particularly as managers in social care will, over time, be brought into the GSCC's Social Care Register.
Clause 16 Regulation of regulated activities
4. The GSCC is keen to ensure that, where appropriate, social care providers registered with the CQC only employ GSCC registered workers. Employing GSCC registered workers, where appropriate, should, therefore, be a requirement of registration for those providers who are engaged in regulated activity within social care.
5. Section 22 (3) and (4) of the Care Standards Act 2000 allow the Secretary of State to make regulations requiring those who work for, or who manage, a social care agency or establishment to be registered with the GSCC. The GSCC is concerned that specific powers to make similar regulations are not contained within clause 16 of the Health and Social Care Bill. Although Section 16 (3) (a) and (c) does provide the Secretary of State with the powers to make regulations governing those who are fit to carry on and manage any agency, it is important that these are sufficient to require employers to employ only registered workers. The GSCC seeks an assurance that if these powers are deemed sufficient to enforce workforce registration, that regulations will in fact be introduced.
6. It is the Government's intention that the GSCC should register the entire social care workforce over time. In February 2007, the Care Services Minister Ivan Lewis announced that, in 2008, the GSCC will begin registering social care workers operating in domiciliary care settings regulated by the Commission for Social Care Inspection (CSCI). Registration of the social care workforce is, therefore, a key aspect of government policy and is a central part of the regulatory framework for social care. Workforce registration will improve public protection and drive up standards in social care.
7. Successful implementation of this policy requires that the new regulator, the CQC, has powers to ensure that care providers only employ GSCC registered workers. While it is common practice for health care providers to check the registration status of a professional before confirming an individual to post, such a convention does not exist within social care.
8. Therefore, the registration requirements for CQC will, in certain circumstances, need to be specific to social care provision. Regulations made under Clause 16 will also need to be sufficiently clear about the requirements of registration in order to be enforceable.
Clauses 16 and 17 Regulation of regulated activities - GSCC codes of practice
9. The GSCC considers that the GSCC codes of practice for social care workers and social care employers should be given the same legal status under Clause 16 as the code of practice relating to health care associated infections. Under Clause 16 social care providers should be required to comply with the codes as condition of their registration with CQC.
10. Under Section 62 (1) (a) of the CSA, the GSCC is required to issue codes of practice for social care workers and those who employ social care workers.
11. The GSCC codes of practice have been drawn up following extensive consultation with the social care sector. Over 2.5 million of these codes have been issued and they are widely accepted as an integral part of the standards framework within social care, informing best practice as well as training modules for care workers.
12. Amongst other things, the codes set out a requirement on care workers and employers to report abuse, to respect the dignity and rights of service users and for employers to provide induction training and development opportunities to their staff.
13. Currently, CSCI uses the codes of practice when inspecting care providers against the National Minimum Standards. Given the centrality of the codes in informing standards across social care, the GSCC believes that they should be given an enhanced legal status within the new regulatory framework.
Clause 35 Bodies required to be notified of certain matters
14. Clause 35 states that where the CQC gives notice of an intention to take enforcement action such as suspend, impose a condition on or cancel registration, it must give a copy of this notice to named organisations such as the Primary Care Trust or local authority. Clause 35 (d) states that it can give a notice to other such persons as the Commission considers appropriate. It does not mention the GSCC.
15. The GSCC seeks assurance that it will be included as a body to which CQC sends notice of an intention to take enforcement action such as to suspend, impose a condition on or to cancel registration, in cases when the notice relates to a registered GSCC social care worker.
Disclosure of Information
16. Clause 73 (3) (d) and (e) states that the CQC may disclose information it holds if the disclosure is necessary or expedient for the purposes of protecting the welfare of any individual, or the disclosure is made to any person or body in circumstances where it is necessary or expedient for the person or body to have the information for the purpose of exercising its functions under any enactment.
17. Schedule 4, in particular section 9, states that the CQC may, if it thinks it appropriate to do so, provide advice or assistance to another public authority for the purpose of the exercise by that authority of that authority's functions. Our understanding is that this provision does not include sharing or disclosing data. Therefore, this schedule is of little assistance to the GSCC in obtaining data from other bodies for the purposes of undertaking its own functions.
18. The GSCC is concerned that, although the Bill makes provision for information sharing for the CQC, it does not do so similarly for the GSCC. We look for similar powers for the GSCC in respect of sharing information with other regulators, inspection bodies and with bodies concerned with workforce planning. In particular:
· the general power to require information from others and to disclose information, equivalent to the powers of the General Medical Council under the Medical Act 1983, and specifically to support the sharing of information with other regulators and with employers and the new barring system;
· a duty to share information with service inspection bodies;
· a power to share information with bodies concerned with workforce planning.
Clauses 91 -102 Office of the Health Professions Adjudicator (OHPA)
19. The GSCC welcomes the proposed creation of the body to be known as the Office of the Health Professions Adjudicator, which has functions in relation to professions regulated by the Medical Act 1983 and the Opticians Act 1989.
Clauses 105-109 Council for Healthcare Regulatory Excellence (CHRE)
20. The GSCC welcomes the changes to the remit and powers of the CHRE, which make it clear that the key function of the body is to promote the health safety and well-being of patients and the public.
Clause 114 Regulation of social care workers
21. The GSCC welcomes Clause 114 which will permit ministers to make regulations modifying the regulation of social care workers. This provision will allow the appropriate minister to make changes to some aspects of the GSCC's primary powers. The provision brings the GSCC in line with the other professional health care regulators whose powers can be amended by regulation under Section 60 of the Health Act 1999. This provision provides ministers and the GSCC with the flexibility to adapt the regulation of social care workers to meet the changing needs and expectations of service users.
22. In particular, the GSCC welcomes the powers set out in Clause 114 (4) (a) and (c) to amend the scope of registration for social care workers. The scope of regulated social care activity currently set out in Clause 5 of the Bill means that unless the GSCC's scope is amended via the powers set out in Clause 114 (4) (a) and (c), it will be unable to register all those social care workers operating in CQC regulated settings. In particular, the scope of regulated activity under the CQC will include those organisations who provide both 'personal care' and 'practical assistance'. Under Section 55 of the Care Standards Act 2000, the GSCC can only register those social care workers in specific listed settings and those who provide 'personal care'.
23. Also, the GSCC would like to be able to register those social care workers who provide housing related support services to vulnerable people under the Department for Communities and Local Government's Supporting People initiative. Currently only those workers who provide 'personal care' in these settings fall within the GSCC's scope.
24. In addition, as the provision of social care becomes more innovative and person centred, there may be instances of care provision which are not within the scope of the CQC's regulatory remit. However, there may still be a case for the GSCC to register workers operating in these settings. Clause 114 (4) (a) and (c) permits the GSCC to register such workers if intended by government.
25. The GSCC is keen to emphasise that there will be consultation with the social care workforce, and other interested bodies before the preparation of any draft regulations made under Clause 114. Draft regulations will then have to be published and made the subject of formal consultation with a report on the consultation laid before Parliament. It is a requirement that these regulations will have to be debated in both Houses under the affirmative procedure.
Clause 115 Standard of proof in proceedings relating to registration of social care worker
26. The GSCC welcomes the fact that the standard of proof relating to GSCC's registration and conduct proceedings is that which is applicable to civil proceedings. Clause 115, in effect, gives a statutory basis to the GSCC's current practice.
27. In addition, the GSCC welcomes the requirement under Clause 104 for all healthcare professional regulatory bodies to move to the civil, rather than the criminal, standard of proof. From its inception the GSCC decided that the civil standard of proof was the better standard to use in its conduct proceedings. Our experience so far is that this has not caused difficulty in taking appropriate action against Registered Social Workers and that it has helped to ensure that the interests of people who use services are fairly balanced with the interests of social care professionals. To date, the GSCC has held 24 conduct hearings and has removed seven social care workers from the Social Care Register. All decisions by GSCC committees are subject to appeal at the Care Standards Tribunal.
Clause 116 Education and training of approved mental health professionals
28. The GSCC welcomes the provision for ministers to make changes by regulation to the GSCC's powers in relation to the education and training of persons who are, or who wish to become, approved mental health professionals.
Clause 134 Direct Payments in lieu of provision of care services
29. The GSCC welcomes the extension of the right to direct payments to a number of previously excluded groups. This will help to boost the range and choice of services for people who lack capacity.