Health and Social Care Bill

Baroness Northover Excerpts

Monday 19th December 2011 Lords Chamber

[Lord Newton of Braintree]

My Lords, prompted only by the debate, I ask one simple question of my noble friend on the Front Bench. What assurance can she give me, in the light of the concerns that have been expressed, that this move will not end up with the same problems that we have had with the CQC, which was asked to take on too much, too fast, and proved incapable of doing it effectively?

[Baroness Northover]

These amendments on whether the clauses should stand part relate to the transfer of the regulation of social workers in England from the General Social Care Council to the Health Professions Council, and I thank noble Lords for them. The regulation of social workers in England is a very important issue, and I welcome the opportunity to discuss it.

The noble Lord, Lord Hunt, having played a key role in the establishment of various of these bodies, argues his usual very strong case. We are committed to the development of the social work profession and the transfer of the regulation of social workers in England to the Health Professions Council as part of the ongoing work to reform the profession and to ensure that such regulation is effective and sustainable. Like the noble Baroness, Lady Pitkeathley, I, too, pay tribute to those who have been involved in these changes. I have met a number of them and find impressive their commitment to the profession and to making sure that, whether they supported the changes in the first place or do now, they are doing their very best to make sure that this works as effectively as possible. The noble Baroness’s tribute to them is well deserved.

The purpose of compulsory statutory regulation is to assure the quality and safety of the regulated professions. That, of course, is separate from the development of the profession itself. We are clear that if we separate professional regulation from professional representation, action needs to be taken to ensure that social work has a strong professional voice, and that is why we are supporting the development of the College of Social Work and the appointment of a chief social worker. The proposed transfer of functions to the Health and Care Professions Council will bring a number of further benefits in the form of standards of proficiency, many of which will have been developed by and tailored for the profession, and a fitness to practise process that will look at conduct and competence in the round.

The noble Lord, Lord Hunt, raised some issues about the General Social Care Council and the costs and so on. The council has made progress in developing the organisation since the discovery of a backlog of contact cases in June 2009. However, while the council is improving, there is still a lot of work to be done to bring it into line with the other professional regulators, such as the Health Professions Council. In addition, the council estimated that its costs would significantly rise as a result of these changes, and it would have been challenging for individual social workers to meet those costs.

[Lord Hunt of Kings Heath]

The noble Baroness says that, but my understanding is that the latest estimate given by the GSCC is that as an independent regulator, the cost to registrants would be no different from that to the cost of registrants under the HPC, so I just do not understand the costs issue.

[Baroness Northover]

As the noble Lord will be aware, the figures provided by the General Social Care Council indicated that the costs would rise from £21 million to £25 million per annum, which would indeed cost about £250 per social worker. I realise that the council later revised this downwards, but the noble Lord knows as well as I do that those were the original figures based upon what the council estimated at the time. Even with the revision downwards, it was still not in line with the HPC, as I am sure the noble Lord is well aware.

However, it is extremely important to make sure that the arrangements that are in place regulate the social work profession properly and separate out the professionalisation of social work. The noble Lord will remember that he asked a question on this, and I drew the distinction for the medical profession with which the noble Lord, Lord Walton, will be familiar; the GMC regulates the medical profession, and the royal colleges do a fantastic job in promoting the profession and taking it further. The original arrangements that the noble Lord introduced were an earlier stage for social work, and the task now is to take it to the next level of development.

Regulation by the Health and Care Professions Council will bring social work regulation in England within the scope of the professional standards authority, with the added scrutiny that that will bring. It is our view that it would be wrong to require the Health Professions Council to move away from its tried and tested system of regulation solely for the social work profession.

[Baroness Meacher]

May I ask the Minister whether she agrees that the standards set by the HPC are just lower than standards that social workers are used to and require to do the job properly?

[Baroness Northover]

I am not sure that I would agree with that. If the noble Baroness bears in mind that the HPC will regulate the profession and that other means will be used to drive further forward the training standards and the education of the profession in conjunction with the regulator, it may very well be that those two things have become conflated and it is important that they are separated out.

[Baroness Meacher]

Would the Minister be willing to write to me to explain how these things will work? As I understand it, some standards might be set elsewhere but the standards that will be regulated will be those of the HPC, which will be very low. The HPC is the one with the regulatory powers and therefore it will not regulate the higher standards that might be set, for example, as good examples by the college. It would be helpful if we could have an explanation of how that will work in practice.

[Baroness Northover]

I am more than happy to write to the noble Baroness. In the discussions that I have had with various organisations, including the HPC, that is not the conclusion that I come away with. I hope that she is reassured.

[Lord Walton of Detchant]

I apologise for interrupting and I do not wish to prolong the debate but the noble Baroness was kind enough to refer to my presence at the General Medical Council, which ended in 1989. Things have changed a little since that time. Of course, the GMC was concerned primarily with standards of education and ensuring that those who were properly educated and qualified were fit to practise in the first instance. Secondly, it was concerned with fitness to practise and with individuals in the profession who deviated from proper standards of practice as defined by the standards committee. It was concerned with the ethics of the profession and with ongoing and further education as well as with many other responsibilities. My understanding was that all those matters were within the ambit of the General Social Care Council in relation to its responsibilities. When the General Social Care Council transfers to the Health Professions Council, can we be assured that all those responsibilities that fall to the General Social Care Council, which is very young and only just finding its way, will be taken on board?

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[Baroness Northover]

I will write with all the details so that noble Lords can see that there is no falling back in terms of the standards that people need to reach. We would hope that this separation out will drive standards up further. I will write to the noble Lord so that he can see that for himself.

On whether there should be a specific mention of social workers in the HPC and on the other points raised by the noble Lord, Lord Hunt, currently none of the professions regulated by the Health Professions Council has its own committee, director, or representation on the council. Neither is any profession mentioned in the council’s title. Ultimately, it should be for the Health Professions Council to decide how best to regulate social workers and it has already established committees and appointed staff. It is very actively involved with the organisations involved in the transfer to see how best they need to gear things so that they are dealing with social workers appropriately.

The Council for Healthcare Regulatory Excellence has made it clear that in its view it is important that council members are focused on the governance of the organisation rather than on representing particular professional interests. We agree with this. The proposed new name of the council was decided upon with reference to the views of the Social Work Regulation Oversight Group, which includes in its membership Moira Gibb, chair of the Social Work Reform Board. None of the professions that the Health Professions Council currently regulates is specifically mentioned in the name and it would not be right to single out one profession now.

The Health Professions Council does, of course, recognise how vital the expertise and knowledge of social workers will be if it is to regulate them well. Its draft standards of proficiency for social workers have been developed by a professional liaison group which included representatives of social workers, their employers and educators. In addition, it uses members of a profession as partners to support its work. These partners have a role in approving training courses, hearing fitness to practise cases and assessing continuing professional development. They will ensure that decisions made about social workers are informed by an understanding of the complexities and challenges facing the profession.

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[Baroness Meacher]

I wonder whether the Minister would consider that there should be a compulsory requirement. If the HPC is registering these courses, could it not be made compulsory that the course must register the students?

[Baroness Northover]

As I just said, the HPC is currently consulting. I strongly suggest that the noble Baroness feeds into the consultation her recommendations and the evidence on which they are based so that they can be properly considered.

The question was raised of how social workers might be linked to the wider reform programme. The Health Professions Council is represented on the reform board and will be able to contribute its expertise to the ongoing reform of social work. Moira Gibb, chair of the reform board, is also a member of the Social Work Regulation Oversight Group. Her professional expertise and knowledge is contributing to the transfer process. Many organisations on the HPC’s professional liaison group, which has developed draft standards of proficiency for social workers in England, are also on the Social Work Reform Board, which has ensured that the development of standards has been informed by wider developments in social work in England.

I hope that noble Lords will see that a lot of attention is being focused on trying to ensure that the change will operate as effectively as possible and will be in the interests of those with whom social workers work. It is exceptionally important that we protect the vulnerable people whom social workers look after, and we are acutely aware of that. On the basis of what I have said, I hope that noble Lords will not press the amendments in this group.

[Lord Hunt of Kings Heath]

My Lords, I am very grateful for the noble Baroness’s response. Of course I agree with her last point that the end result will be the impact on people to whom social workers provide a service. However, she did not respond to her noble friend Lord Newton, who asked whether creating this new body would not repeat some of the issues that were faced by the CQC. I am left with puzzlement. I have not heard one point in favour of this happening. It is beyond me to understand why it is being done. No argument with any thought behind it has been put to suggest that this will improve the regulation of social workers.

On the question of costs, whatever the original estimate, the General Social Care Council produced new work. The noble Baroness shakes her head. Is she saying that the General Social Care Council is misleading Parliament on the issue? It stated clearly that it can produce a regulatory system that will cost the Health Professions Council very little.

Thirdly, on the question of student registration, the problem is that I know what the outcome will be of the work that the HPC will do. It will continue with the system that it applies to the health professions. It is clear that the HPC, although it is a good body, is completely inflexible and will not change its approach because a new profession has been added to it. There is no trust out there—I have fallen into the trap set by the noble Lord, Lord Mawhinney. I am talking about the professions. There is no trust because the record of the HPC is simply to embrace profession after profession, which all have to be moulded into the system that the HPC has set. While that will work for health professions, my concern is that social work is a completely different profession. This point was put by the noble Lord, Lord Walton.

I understand why my noble friend Lady Pitkeathley is concerned about an amendment that stresses the importance of having social workers on the council of the HPC. However, because of the very new nature of the body, when one brings in a completely new profession some protection needs to be given. There needs to be some assurance that the HPC will have people at a very senior level who understand social work. I still do not know why a new council is not being appointed. If good faith was being shown by the Government to the social work profession, the current council would have been stood down and a new council appointed. That is why I tabled my amendment.

Finally, I turn to the name. The noble Baroness said that we cannot put “social work” in the name of the organisation because none of the other professions covered by the HPC is in the current HPC name. If that is the case, why does Clause 210 refer to the Health and Social Work Professions Order? The Government have no problem whatever recognising “social work” in an order before Parliament. Surely it is not up to the HPC to depart from that view. Clause 219 refers to the Professional Standards Authority for Health and Social Care. Therefore, if the noble Baroness does not like “social worker” in the title of the organisation, why would she not accept “health and social care professions”? Why is there an attempt to completely remove the concept of social work and social care from the title?

Unfortunately, an existing health body is simply taking over the social work profession without any genuflection whatever to the need to embrace social workers in the new organisation, whether in governance, remit or title. It is very disappointing that the Government are not prepared to reconsider the matter.

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[Lord Hunt of Kings Heath]

My Lords, that is a very helpful offer from my noble friend. I welcome the debate and I am grateful to the noble Baroness, Lady Masham, for moving the amendment. It seems to me that there are two issues. First, we have already had a debate about whether certain professions, particularly healthcare assistants, should be statutorily regulated. No doubt, the noble Baroness, Lady Emerton, will bring that back on Report. Secondly, notwithstanding whether one might agree or disagree about which profession should be statutorily regulated, is there some benefit in a voluntary register alongside statutory regulation or is there a halfway house, as the noble Lord, Lord Walton, has suggested, of strengthening what voluntary registration means? I have not sought to amend on the principle of voluntary registration. However, if it is accepted that there is benefit in having a voluntary register—the noble Baroness gave some powerful reasons in relation to healthcare assistants in our debate before the Statement—and if it is taken further and statutory bodies such as the NHS say, “We won’t employ you unless you are on a voluntary register”, there is then the problem that people could move on to other places and work in other care settings. Such people might have been sacked or removed by a trust. There is no guarantee of safeguards for the public. I have a sense that, once you have gone down the pathway of acknowledging that there is benefit in voluntary regulation, you are acknowledging that there should be statutory regulation.

I was very interested in what the noble Lord, Lord Ramsbotham, had to say and he will know that I have a particular interest in prison healthcare. I think that the involvement of the National Health Service in prison healthcare has led to a great improvement but more needs to be done. The points that he raised are very important.

I have put my name to Amendment 339BZA, which is in the name of the noble Lord, Lord Low, who, unfortunately, is unable to be here today. Perhaps I may briefly say that he has some strong arguments in relation to rehabilitation officers for the blind. He has pointed out that such officers work within the same legal framework as occupational therapists and social workers. They case-manage clients, devise and manage packages of care, oversee the work of lower skilled workers and manage risk-intensive situations with already vulnerable people. In Wales, statutory regulation for rehabilitation officers is due to be finalised at the end of this year. The noble Lord, Lord Low, would like some recognition that at least voluntary registration could be considered for this profession under the terms of the Bill. On that basis, I hope that the noble Baroness may be able to give some positive response to the noble Lord’s amendment.

[Baroness Northover]

My Lords, I thank noble Lords for these amendments, which raise important issues about the ways in which we assure the quality and safety of our health and social care workforce. It is another bite of a very important cherry, as the noble Baroness, Lady Masham, put it, which is a wonderfully graphic image. We had a full discussion of this issue earlier. Perhaps I may emphasise again that the Government are committed to embedding quality of care and patient safety at the heart of health and social care provision. These are the key drivers of our policy on workforce assurance.

I fully agree with the noble Baroness, Lady Masham, that we need to drive up quality, which has run through a lot of our debates today. In considering how we achieve this, we need to ensure that any system is proportionate and effective and properly balances the need for local responsibility for providing high-quality, safe services, and the need for consistent and rigorous national standards. I assure noble Lords that we are not ruling out compulsory statutory regulation for any groups of workers. Compulsory statutory regulation will be considered where there is a clear body of evidence that the risks presented by specific groups cannot be mitigated by assured voluntary registration alongside other existing systems of assurance of standards, such as supervision of workers by qualified professionals, enforcement of standards by employers, registration with the Care Quality Commission, and the vetting and barring system.

However, compulsory statutory regulation, as we discussed earlier although we did not all agree, is not a panacea. It is no substitute for good leadership at every level and proper and visible management of health and social care services. The best protection for the public is, of course, well run services focused on the individual and delivered by qualified staff and appropriately trained and supervised care workers. Employers, commissioners and managers must take responsibility for ensuring this and we need to make sure that local service providers and commissioners are held to account for managing problems effectively and promptly.

The Care Quality Commission sets standards of care for all providers of regulated activities and takes action when they are not met. These standards include a requirement that providers use suitable numbers of appropriately trained and qualified workers. In the rare cases where health and social care workers present a risk of harm to service users, the vetting and barring system can be used to ban individuals from working with vulnerable adults and children. In this context, our view is that the standards of unregulated groups of health and social care workers can generally be assured without imposing compulsory statutory regulation. However, we recognise that we need to ensure that commissioners, employers, supervisors and individual users of services have the knowledge needed appropriately to employ, delegate to and supervise health and social care workers. The Government believe, as noble Lords have clearly picked up, that assured voluntary registration enables this to be achieved.

The amendment tabled by the noble Lord, Lord Low, and spoken to by the noble Lord, Lord Hunt, seeks to enable regulatory bodies to establish and maintain voluntary registers of unregulated rehabilitation officers for the blind in England. The assured voluntary registration of this important group of workers would enable standards to be set for entry to and practice of the profession. I hope that I can reassure the noble Lord, Lord Low, through the noble Lord, Lord Hunt, that the amendment is unnecessary as we are confident that the provisions which enable voluntary registers as social care workers in England to be established by the Health and Care Professions Council and accredited by the Professional Standards Authority for Health and Social Care are already wide enough to include such officers.

The noble Lord, Lord Ramsbotham, flagged up key areas with his particular concern about prisoners’ mental health and the mental health of those coming out of the Army. The Health and Care Professions Council will be given the power to set up voluntary registers of workers. Perhaps I may clarify for him the possible confusion over the roles of the various bodies. The council can set up voluntary registers of workers. The Professional Standards Authority for Health and Social Care will not hold registers, but will have the function of accrediting them to ensure that they are robust. However, I am happy to write with further details to clarify the situation for the noble Lord so as to ensure that he is quite happy with the way that things will be organised.

In referring back to our earlier debate, perhaps I may assure my noble friend Lady Barker, who is absolutely right in terms of training, that we place great importance on improving the training of health and social care workers, and especially on further integrating it, something flagged up not only by my noble friend, but also earlier by the noble Baroness, Lady Emerton, and others.

I hope that I have been able to reassure noble Lords of our commitment to assuring the quality and safety of health and social care workers and the contribution assured voluntary registration can make to the existing systems of assurance of the standards of health and social care workers. I hope, therefore, that the noble Baroness will feel able to withdraw her amendment.

[Baroness Masham of Ilton]

My Lords, I thank all the supporters of the amendment. In an ideal situation, what the Minister has said might work, but it is not an ideal world. The important point is that of picking up those people who will not come forward for voluntary registration. What does one do with them? Some agencies might not take people on who have not voluntarily registered, but others take on anyone without even taking up references. There must be safeguards, as the noble Lord, Lord Hunt, has said. We live for the Report stage. With that, I beg leave to withdraw the amendment.