The Scottish Government

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1.0 Introduction and background

1.01 This consultation document seeks comments on draft standards relating to healthcare support workers ( HCSWs) employed by NHS Scotland. Standards outlined in the document relate specifically to:

• a Code of Conduct and Practice for Employees
• a Code of Practice for Employers
• Induction Standards.

As previously stated, for the purpose of the project, 'Healthcare Support Workers' are defined as those support workers who provide a direct service to patients and members of the public in the name of NHS Scotland (and, potentially over time, the other three health services in England, Wales and Northern Ireland). This will include those in support roles to the healthcare professions (such as care assistants) as well as those in other areas (such as porters and mortuary attendants). For ease of definition, anyone who has direct contact ² with a patient and who is not already statutorily regulated, or due to be, would be included. Standards could also be voluntarily adopted by those working in independent or voluntary health care settings.

1.02 Some form of regulation ³ for support workers is considered key to promoting the safety of the public. A consultation on the Regulation of Health Care Support Staff and Social Care Support Staff in Scotland, held between May and August 2004, indicated overwhelming support (93%) for the extension of regulatory arrangements to HCSWs, with 90% of responses identifying this as the most appropriate way to ensure public protection. The Executive Summary of consultation responses can be found at Appendix 1.

1.03 There was also significant awareness among respondents to the consultation of the need to avoid multiple registrations and ease transferability of staff among the four UK countries.

1.04 A similar consultation was undertaken in England and Wales. Again, broad support for statutory regulation was expressed, but questions which required further debate were also raised. Initial discussions on employer-led regulation progressed with the NHS England Modernisation Agency, and the Department of Health in England ( DH) has just completed a review of non-medical health professions' regulation under the chairmanship of Andrew Foster (Former Director of Workforce at DH). One of the six key themes explored through the review was the need for regulation of HCSWs. The review's recommendations are still awaited at the time of writing.

1.1. National (Scotland) Group

1.1.1 In order to progress discussions on how the 2004 consultation outputs should be addressed, a short-life, strategically focused National (Scotland) Group for the Regulation of Healthcare Support Workers was set up in May 2005, meeting twice. The group, whose membership consisted of key stakeholders ⁴ (see Appendix 2 ), considered a number of statutory and non-statutory options for the regulation of HCSWs.

1.1.2 The outcome was an expressed preference for a model of service-led regulation with the addition of a centralised, mandatory, occupational register. Interest was expressed in testing the viability of this option on behalf of the four UK countries. Statutory regulation was not considered achievable on a UK-wide basis within a timeframe acceptable to the group. The group therefore expressed a preference to progress with measures on a Scotland-only basis until the other three home countries were in a position to consider their own approaches. The National (Scotland) Group was keen to see public protection measures implemented for the people of Scotland sooner rather than later. The principles underpinning the Group's preferred option are outlined in Appendix 3.

1.1.3 As a result of the work of the National (Scotland) Group, the 'Regulation of Healthcare Support Workers' project was born.

1.2. The 'Regulation of Healthcare Support Workers' project

1.2.1 The wider Regulation of Healthcare Support Workers project provides the context for this consultation document. Its aim is to secure an appropriate form of regulation for HCSWs on the grounds of public protection.

1.2.2 The introduction of a form of regulation for HCSWs across NHS Scotland will be in line with public protection measures and enhanced systems of quality. It is acknowledged that in contemporary, well-developed healthcare systems, any form of regulation will be augmented by systems of healthcare and staff governance.

1.2.3 Regulation on a Scotland-wide basis will allow Scotland to dovetail arrangements with existing UK-wide frameworks such as the Knowledge and Skills Framework (as part of Agenda for Change) and Skills for Health products (for example, National Occupational Standards and National Workforce Competences), where appropriate. This is important so that duplication of effort is kept to a minimum and existing staff governance arrangements are utilised. Implementation of the model as described will allow Scotland to test arrangements and lead the way for the rest of the UK.

1.2.4 Implementation will also allow further debate on what regulation could look like when applied across Scotland and will respond to the overall reaction to the 2004 consultation. The draft standards attached to this paper are threshold standards which have been developed as part of a Supported Pilot (more information on the pilot follows in section 1.3 below).

1.2.5 These draft standards represent the first step towards helping both employers and employees in NHS Scotland fulfil their obligations to patient safety and public protection as part of a potential future regulatory framework for HCSWs.

1.2.6 In the meantime, work continues which aims to establish whether additional measures (such as a register of those who have achieved the standards) are also needed, and, if so, whether these measures need to be set in statute.

1.2.7 The approach outlined above meets the ultimate goal of public protection within Scotland. It also provides a transparent approach to regulation which is of benefit to stakeholders and provides a robust model that covers requirements for public protection. It will articulate well with legislation for the protection of children, young people and adults at risk.

1.2.8 In summary, it is anticipated that regulation of HCSWs will involve compliance with a set of nationally agreed standards. These standards are set out in draft format here. Further consideration is being given to the need for, and feasibility of, a centralised occupational register for HCSWs, as well as to who should keep it and whether it should be mandatory or otherwise.

1.3 Supported pilot

1.3.1 In 2005, the secretariat to the DH Review of Non-medical Regulation (referred to in section 1.04 above) requested that a SEHD position paper be presented to its Advisory Group setting out details of the Scottish model. This was presented on 4 July 2005. As a result, it was agreed that Scotland would continue to lead on, and progress, a supported pilot, with input and support from each home nation. In late 2005, a four-country Steering Group and a Working Group were established (see Appendices 4 and 5 for membership) to steer the pilot project towards meeting its objectives.

1.3.2 Two of the main objectives of the pilot most relevant to this consultation are as follows. These objectives will be inherent in whatever wider framework of regulation is developed in the future:

• Negotiate nationally agreed standards for safe recruitment, employee conduct and practice, and induction.
• Develop systems for monitoring compliance with standards in line with existing governance arrangements (such as staff governance and clinical governance frameworks).

1.4 This consultation

1.4.1 This document seeks views on the proposed national standards relating to HCSWs. It is anticipated that these standards will form the basis for a future form of regulation for this group of staff in NHS Scotland. The standards focus on safe recruitment practice, conduct and practice of HCSWs, and induction for HCSWs. All standards focus on public protection.

The consultation closes on 31 ^st August 2006. Details on how to respond are contained in the separate response booklet.

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