3.1.1 There were 70 responses to the consultation from a broad range of individuals and organisations from across the United Kingdom. Respondents included NHS staff members, the independent health sector, the social services sector, trade unions and professional organisations, regulatory bodies, employees and employers, public representative groups, patient representative groups, members of the Healthcare Support Worker workforce, and educational institutions.
3.1.2 A significant number of NHS Boards, Trade Unions and Professional Organisations, Regulatory Bodies and Educational Institutions held consultations with their staff, and therefore their response was on behalf of a group, rather than individual responses.
3.2 Section One - Specific questions for the consultation on the draft Code of Conduct and Practice for employees
3.2.1 Q1. Is the draft code easy to understand for the target audience ( HCSWs)?
3.2.2 The predominant view was 'yes,' the draft code is easy for the target audience of HCSWs to understand. Of the 53 responses submitted via the response booklet, 94% or 49 indicated this.
3.2.3 Many contributors commented positively about the draft code's 'second person' approach, and most felt the draft code was user friendly, using clear and simple English, and was well set out. However, those that responded negatively, and some of those who qualified their positive responses, worried that the tone may be perceived as condescending or patronising. This constituted 4, or 8%, of respondents. Another 8% of respondents did not feel that the definition of Healthcare Support Worker was generic enough, and 6%, or 3 respondents; felt the layout could be improved.
3.2.4 The General Medical Council ( GMC) felt that the code is written in a way that is intended to be accessible to the majority of HCSWs regardless of where they work and what job they do. This was welcomed, and many of the examples such as 'advocacy', 'sensitivity', and 'consideration', for example, were considered to work well in this format. However, it trying to make the code accessible to all, it was recognised that there are some areas where there is the potential to oversimplify definitions. The term HCSW encapsulates a wide range of individuals who will be performing at a variety of levels and will vary in their contact with patients. The code should therefore contain enough flexibility for this variation. Particular examples of this are 'confidentiality' and 'consent'. The term HCSW encapsulates a wide range of individuals who will be performing at a variety of levels and will vary in their contact with patients. The code should therefore contain enough flexibility for this variation.
3.2.5 Whilst the draft code is written to be very accessible, the draft induction standards are therefore less clear. Is there any intention to provide more explanation of these requirements and guidelines? This would make the standard more meaningful, and ensure that HCSWs who did face confidentiality issues would not fall foul of the code.
3.2.6 One option would be to include separate references to relevant documents regarding consent and confidentiality (relevant to Scotland) in section 5 of the code ('Want to know more?')
3.2.7 Within the code, there is also a mixture of high level principles, positive and negative statements and more concrete standards, which seems to be due to trying to be accessible whilst at the same time portraying a HCSWs' obligations in the same document. This is particularly evident in the difference between sections 1-3 which are fairly relaxed in tone and section 4 which is much more formal.
3.2.8 The Health Professions Council ( HPC) considered the draft code of conduct for HCSWs to be written in clear, accessible English, which would be easy to understand for the target audience. The HPC also feel it is helpful and appropriate for there to be one common code for all healthcare support workers.
3.2.9 NHS Education Scotland ( NES) considered the draft code to be written in an accessible way and praised the approach used. However, to ensure that the target audience would find the document easy to understand, NES suggested it be 'road tested' by HCSWs before being accepted as a final version.
3.2.10 The Scottish Social Services Council ( SSSC) found the draft codes to be written in a straightforward manner, though the tone could be found to be condescending. The SSSC felt that the code was written in a language different to that used in the standards, and that having similar language between the two would be more beneficial to the target audience for ease of understanding.
3.2.11 The Royal College of Nursing Scotland ( RCN) felt the code was easy to understand for the target audience, though some aspects of the language needed to be made more explicit. The RCN considered that some areas of the language could be patronising, while in other areas it is too complex. Clarification and expansion on some points of the draft code for employees was also called for, for example in 1.6 there is a statement 'they will show you how…' - it is not clear who 'they' are. It was also felt that diversity and equality should be highlighted more
3.2.12 The Nursing and Midwifery Council ( NMC) found the language in the draft code to be, for the most part, user friendly. However, they also felt that it could sound patronising at times.
3.2.13 "Fair For All" agreed that the language and format of the guidance was appropriate for the target audience. With regard to the presentation, it was recommended that the text should be produced in Ariel font size 14 to make it accessible to a wider audience, and an easy read section should be produced to enable access to those with learning disabilities.
3.3 Q2. Is the draft code for employees expressed appropriately for the intended audience?
3.3.1 48 responses, or 89% of respondents, indicated positively that the draft code was expressed appropriately for the intended audience.
3.3.2 The main message in comments was that the draft code was expressed appropriately, using clear English and good presentation. 3 respondents felt the language was in danger of being perceived as patronising. Contrarily, 1 respondent worried that the language was too academic. 3 respondents felt that the language was at times overly simplistic, and that this would need to be addressed to ensure that the draft code was fully understood.
3.3.3 6 respondents felt the phrasing could be improved in certain areas to give greater clarity and precision.
3.3.4 1 respondent felt that the draft code was not generic enough.
3.3.5 1 respondent felt further examples were needed to fully illustrate what the draft code was trying to put across to its intended audience.
3.3.6 The Department of Health in England ( DH) liked the Codes of Conduct and Practice for employees and employers, considering them effective and useful documents. They approved of the style and language.
3.3.7 The Department of Health, Social Services and Public Safety in Northern Ireland ( DHSSPSNI) felt that the draft code was too vague in places and not always presented in plain English.
3.3.8 The RCN in Scotland considered that some areas of the language could be considered patronising, while in other areas it is too complex. Clarification and expansion on some points of the draft code for employees was called for and that diversity and equality be highlighted more.
3.3.9 The NMC found the language in the draft code to be, for the most part, user friendly. However, their view was that it can sound patronising at times. The NMC also considered some of the wording needed clarification, and at times strengthening, to fully put across what the employee is meant to understand from the draft code, such as the full implications of, for example, 'advocacy,' 'confidentiality,' and 'consent', could be in any given situation, in particular such as those concerning children and young people.
3.3.10 The HPC commented that the draft code of conduct for HCSWs includes many of the principles core to healthcare regulation emphasised by the HPC, and that it shared a strong common ethos with codes of conduct produced for professionals. In particular, it was felt that the key messages of personal responsibility and accountability were well expressed in the draft code of conduct for HCSWs.
3.3.11 NES considered the draft code appropriately expressed, but suggested minor drafting amendments, in order to clarify meaning and ensure the document would be easily and fully understood.
3.3.12 The SSSC expressed concern that the draft code was in danger of oversimplifying complex practice issues. However, the organisation found the draft codes to be written in a straightforward manner, even though the tone could be found to be condescending.
3.3.13 The Society of Chiropodists and Podiatrists ( SCP) felt that the definition of healthcare support worker was not generic enough, and that it could be re-worded to clearly show who is and is not included in the definition of healthcare support worker. A list of the types of workers included in the definition is suggested as a possible way of dealing with this.
3.3.14 The Association for Perioperative Practice ( AfPP) felt positively about all aspects of the draft code of conduct and practice for employees. Its only comments were to change wording to be more consistent, specific or clear. Clearer definitions of terms used such as 'advocacy' and 'accountability', etc, were asked for and a glossary of such terms was suggested.
3.3.15 The Chartered Society of Physiotherapy ( CSP) also consider that the codes and standards should be checked for compliance with the Plain English Campaign standard.
3.4 Q3. Is the draft code sufficiently comprehensive to reflect a healthcare support worker's responsibilities to service users, particularly in relation to public protection standards?
3.4.1 Overall, the code was praised for its comprehensiveness and clarity, with 87% or 46 out of 53, of respondents answering positively that the draft code was sufficiently comprehensive.
3.4.2 The majority of comments focussed on the need to make explicit issues such as public protection and accountability. The importance of knowing who is responsible for what, and having this effectively communicated, was flagged by 6 respondents. 4 of these respondents also highlighted the difficulty in applying the code to various levels of responsibility.
3.4.3 4 respondents felt it was important to explain how individuals are expected to assess themselves, if this is what is intended.
3.4.4 The GMC recognised that although many aspects of the responsibilities to service users are covered (dignity, sensitivity and advocacy for example), there is not really much that has been said in the code about public protection. There is more elaboration of this principle in the draft induction standards and it might be useful to incorporate some of this into the draft code.
3.4.5 The HPC expressed the view that the draft code of conduct for HCSWs includes many of the principles core to healthcare regulation emphasised by the HPC, and shares a strong common ethos with codes of conduct produced for professionals. In particular, it was felt that the key messages of personal responsibility and accountability were well expressed in the draft code of conduct for HCSWs.
3.4.6 As the draft code for employees appears to sufficiently cover the conduct expected of HCSWs whatever the context of their practice, the SSSC felt that calling the draft code a code of conduct rather than a code of practice may make it easier to understand for the target audience.
3.4.7 The NMC asked for an inclusion of an explanation regarding the standards that are also expected of NMC registrants in the exercise of their accountability and practice. The NMC also commented on a lack of clarity as to the accountability of the support worker following the delegation of work that they are to undertake. Indeed, an emphasis on the need to fully explain to whom responsibility, accountability and liability falls to in any given situation at any given point in both draft codes and the draft standards was highlighted as imperative by the NMC.
3.4.8 "Fair For All" felt that the standards in the draft code for employees did not refer to equality and diversity beyond the standards on objectivity and on dignity. Consequently, in their view, the standard on objectivity requires to be rewritten instructing healthcare support workers to provide equal treatment to all, irrespective of their race, disability, gender, sexual orientation, age, or religious belief. Furthermore, Fair For All recommended the addition of a footnote, in which it was explained that the law stipulates that disabled people receive equality with respect to goods and services, a law which applies to the NHS.
3.5 Q4. Do you agree with the definition of 'good character' set out on page 13 of the consultation document?
3.5.1 42 responses (81%) indicated that they agreed with the definition of 'good character' as set out in the consultation document.
3.5.2 However, many responses were qualified through comments, many of which echoed the sentiments of the negative respondents that the phrase 'the definition of good health and good character as being someone who is capable of safe and effective practice' needs to be embellished to give a full definition of what 'good character' is exactly. In total, 9 respondents commented to this effect, a total of 20% or one in five respondents.
3.5.3 Other isolated comments included employing vigorous competency development so as to ensure that the concept of 'good character' is something that is understood and maintained throughout one's career. A concern that language was slightly too vague was also expressed.
3.5.4 The GMC considered the definition to be reasonable.
3.5.5 NES highlighted the need to strengthen the definition of good character by adding ' at all times' to the end of the sentence ' someone who is capable of person-centred, ethical, safe and effective practice', to ensure that the requirements of 'good character' were fully understood and appreciated.
3.5.6 The SSSC considered the definition of good character was too subtle, yet the RCN in Scotland considered the definition of good character to be adequate.
3.6 Section Two - Specific questions for the consultation on the draft Code of Practice for employers
3.7 Q1. Is the draft code easy to understand for the target audience (employers in NHS Scotland)?
3.7.1 Overwhelming support was given to the draft Code of Practice for employers, with 100% of respondents finding it easy to understand for the target audience of employers in NHS Scotland.
3.7.2 Of the responses that had any comments to make, 2 feared that the wording may at times be perceived as patronising, and a further one asked for greater clarity in the wording. 2 felt the presentation could be improved. A further 2 felt that the definitions needed to be more generic.
3.7.3 Many respondents praised the second person approach of the wording as helping to make the draft code easy to understand.
3.7.4 The DHSSPSNI felt that some of the references were unclear.
3.7.5 The HPC felt the code of conduct for employers of HCSWs was comprehensive and appropriately focused on the responsibilities of employers to ensure the suitability of applicants, provision of opportunities for training and development and existence of mechanisms for dealing with performance concerns.
3.7.6 The AfPP also responded very positively, suggesting that the draft code supported mentoring and adequate support for a HCSW's induction period, with sufficient time dedicated to the achievement of the codes and standards. They felt that the workplace as a learning environment was championed.
3.7.7 The SSSC expressed concern that the draft code for employers focussed more on the employers' responsibilities in relation to healthcare support workers than on their responsibilities to patients.
3.8 Q2. Is the draft code sufficiently comprehensive to reflect an employer's responsibilities to both service users and healthcare support workers in relation to public protection standards?
3.8.1 90% of respondents found the draft code sufficiently comprehensive.
3.8.2 Isolated comments included a desire for monitoring arrangements to be set up, acknowledging that centralised regulation and a register would complement this.
3.8.3 The DHSSPSNI suggested that the code needs to be read in conjunction with employers' responsibilities with health and safety and pay and employment. The code raises the question as to what is hoped to be covered by these standards in addition to what is already in place?
3.8.4 The GMC did not consider that there was enough emphasis on public protection standards in the codes and that there should be more.
3.8.5 The AfPP considered the draft code of practice for employers to be concise, and highlighted the employer's responsibilities and duties as stated by existing systems of healthcare governance. AfPP recommended that each organisation identifies a Board or Human Resources Lead to assess, implement, monitor and evaluate the implementation of the code of practice.
3.8.6 Regarding section two, on the draft code for employers, Fair For All-Disability praised the inclusion of guidance that requires healthcare support workers to be cognisant of relevant legislation as this could allow for the NHS to provide workers with information on the Disability Discrimination Act. It was felt that the guidance in this section should require the NHS to use the Scottish Executive Equality Impact Assessment Toolkit ( EQIA) to ensure that their recruitment policies are not excluding disabled people from accessing work. This section of the standards should also alert employers to the need to monitor its workforce of healthcare support workers to ascertain the extent to which it is diverse and reflects the community.
3.9 Q3. Is the draft code sufficiently compatible with existing employer responsibilities through staff and clinical governance arrangements to keep additional responsibilities to a minimum?
3.9.1 As some respondents were not involved in work that utilised the staff and clinical governance arrangements, they felt it not appropriate to answer this question. A total of seven respondents found themselves in this position.
3.9.2 Of the remaining 46 respondents, 42 or 91% found that the draft code was sufficiently compatible with existing employer responsibilities through staff and clinical governance arrangements to keep additional responsibilities to a minimum.
3.9.3 2 respondents felt that it was necessary to make clearer how information relating to unsafe and dangerous practice could be disseminated across employers, to ensure public protection.
3.9.4 The DHSSPSNI felt that there is duplication between the code of practice for employers and what already exists, and that the area regarding supervision and assessment in relation to regulation would bring extra responsibilities.
3.9.5 The KSF sub-group of NHS Employers (England) welcomed the links that had been made between these proposals and existing staff governance arrangements to ensure that staff are well informed and appropriately trained, and that employers are legally accountable for this.
3.10 Section Three - Specific questions for the consultation on the draft induction standards
3.11 Q1. Are the standards comprehensive?
3.11.1 88% of respondents indicated that the standards were comprehensive. 2 respondents did not specify.
3.11.2 Comments generally reflected praise for the standards in terms of their comprehensiveness, clarity and scope, and clear English. Praise was also given for the close link between the standards and the KSF framework.
3.11.3 However, 4 respondents considered the standards' terminology inconsistent, particularly in relation to the interchange between phrases such as 'customer', 'client', 'patient', 'service user' etc. It was felt that one term overall should be used for greater clarity and consistency.
3.11.4 3 respondents felt that the standards were not generic enough to be able to sufficiently cover the changing nature of healthcare support work and healthcare support workers.
3.11.5 In their comments, the DH's biggest concerns lay with the induction standards. They considered that the principle behind the standards was good, but they may be too far-reaching for lower levels of staff, e.g. are HCSWs expected to seek information on health and safety, or should they take notice of information provided and check their understanding of it? Similarly, can they evaluate and reflect on their knowledge and skills when they may not have much at this level? The principle was felt to be good, but it may not match the level of staff.
3.11.6 For the DH, covering all levels of HCSW was their biggest concern, wondering whether it was possible to write standards which adequately covered all four levels on the career framework.
3.11.7 The DHSSPSNI felt that the standards appeared to be overly comprehensive.
The GMC felt that it would be useful for the standards to include more about the requirements to seek consent and to respect confidentiality.
3.11.8 The HPC considered the induction standards to be comprehensive and easy to understand for both employers and employees. The principles expressed in the codes of conduct were felt to be helpfully built upon by the induction standards and helpfully referenced to the core dimensions of the NHS Knowledge and Skills Framework ( KSF).
3.11.9 NES suggested that more explicit reference be made to dignity, privacy and understanding roles within teams. Some of the response team at NES expressed the view that some standards go beyond what a HCSW could be reasonably expected to achieve. A clearer definition of 'supervision' was also called for.
3.11.10 The SSSC considered the induction standards too dense and not readily accessible for employers or employees. The organisation also worried how non- NHSHCSWs would be able to adopt the standards, and how these groups of HCSWs could be monitored and assessed. Indeed, it is not implicit in the standards how any HCSW will be assessed or measured. The SSSC consider it essential that the whole workforce grouping across this sector is subject to the same standards. As they currently stand, the standards can only be read as aspirational or, at best, useful guidance.
3.11.11 The RCN were pleased that the draft induction standards tied in with the KSF, but expressed concern that the language was more complex than it is in the draft code.
3.11.12 With regard to the standards, the AfPP are supportive of the idea that all assistants and support staff are regulated as a single group within a single framework based on KSF dimensions. However, AfPP recommend there is recognition of discipline specific standards which could be formulated locally to enhance the code of practice.
3.11.13 "Fair For All" were pleased to see the list of criteria listed under the heading of equality and diversity. The standards were considered to be comprehensive and extremely welcome. It was of concern however that the language only seemed to reflect race, as seen through the repeated use of words such as 'culture', 'beliefs' and 'values'. In the interest of clarity Fair For All ask that it is ensured that the standards are applied to all strands of equality and diversity groups.
3.12 Q2. Are the standards easy to understand for the employer?
3.12.1 90% of respondents considered the standards easy to understand for the employer. 1 respondent did not specify.
3.12.2 Many respondents acknowledged that the standards were clearly set out and clearly written.
3.12.3 However, some respondents felt the standards were too lengthy in their current state, and 2 respondents felt the standards lacked clarity on some of the points, particularly regarding employer responsibility and accountability.
3.12.4 Individual respondents felt that the format could be set out in a more user-friendly way, and that links between the codes of practice and standards could be made clearer. 1 respondent felt that an outline of what would happen should the standards not be met would be beneficial.
3.12.5 The DHSSPSNI felt that though possibly overly comprehensive, the standards were largely easy to understand for the employee.
3.12.6 NES did not feel the language was generally as clear in Section Three as it had been in other sections, and disliked the inconsistency in terminology for patients. Some language was also considered to be confusing and/or complex in the Health, Safety and Security section. A clarification or expansion of what constitutes 'support effective group dynamics' was also called for.
3.12.7 The SSSC considered the induction standards too dense and not readily accessible for employers or employees. They also felt the language of the standards is not very accessible and seems to be at the opposite extreme of the language in the Code of Practice for Employees which is more simplistic.
3.12.8 The SCP held the view that the induction standards document, in particular the section relating to performance criteria, is too lengthy to be easily digestible, and ought to be made more concise and user-friendly.
3.12.9 The CSP consider that the codes and standards should be checked for compliance with the Plain English Campaign standard.
3.13 Q3. Are the standards easy to understand for the employee?
3.13.1 82% of respondents considered the standards easy to understand for the employee. 3 respondents did not specify.
3.13.2 Overall, comments were positive. However, some qualified criticisms or queries were voiced:
3.13.3 In Q1, respondents recognised the need for consistent terminology regarding the 'patient', 'client' etc, and as in Q2, respondents felt the standards perhaps too lengthy.
3.13.4 A number of respondents (6 in total), felt that the language used may be too advanced for some lower level or new healthcare support workers. Respondents feared that the combination of excessive length and difficult language might make the standards overwhelming or inaccessible for lower level or new healthcare support workers. 1 respondent felt the layout needed to be more user-friendly.
3.13.5 DHSSPSNI felt that the standards were largely easy to understand for employers, but links to KSF need to be made clearer.
3.13.6 NES did not feel the language was generally as clear in Section Three as it had been in other sections, and disliked the inconsistency in terminology for patients. Some language was also considered to be confusing and/or complex in the Health, Safety and Security section. A clarification or expansion of what constitutes 'support effective group dynamics' was also called for.
3.13.7 The SSSC considered the induction standards too dense and not readily accessible for employers or employees. They also felt the language of the standards is not very accessible and seems to be at the opposite extreme of the language in the Code of Practice for Employees which is more simplistic.
3.13.8 The SCP held the view that the induction standards document, in particular the section relating to performance criteria, is too lengthy to be easily digestible, and ought to be made more concise and user-friendly.
3.13.9 The CSP also consider that the codes and standards should be checked for compliance with the Plain English Campaign standard.
3.14 Q4. Do the performance criteria identified provide sufficient evidence for the achievement of the standards?
3.14.1 83% of respondents indicated that the performance criteria identified did provide sufficient evidence for the achievement of the standards. 3 respondents did not specify.
3.14.2 Again, most of the comments were positive regarding the performance criteria, and how they are presented in the consultation document.
3.14.3 However, a number of respondents raised concerns as to how evidence of achievement of the standards was to be assessed or monitored, and by whom.
3.14.4 Wording, inconsistent terminology and the length of the standards were again highlighted as potentially problematic.
3.14.5 2 respondents felt the performance criteria needed to be aligned more to the KSF, within a centralised regulatory framework.
3.14.6 The DHSSPSNI felt that the level of accountability expected of HCSWs appears too broad, and that the statements should be focused to the range of duties in which the HCSW will be engaged.
3.14.7 The GMC considered that there was a mixture of approaches used in the guidance. Some of these are more comprehensive than others and it is unclear from these documents how the criteria should be applied where performance is called into question - do all criteria need to be breached; can a mixture of breaches lead to questions about performance; and are some considered more serious than others? The GMC felt that there should be some clear guidance on how these will be applied in practice. Whilst the GMC recognised that there are difficulties in defining specific thresholds, some indication of thresholds for breaching the code would provide more clarity.
3.14.8 The SSSC did not feel that it was clear how the performance criteria could evidence achievement of the standards.
3.14.9 The SCP held the view that the induction standards document, in particular the section relating to performance criteria, is too lengthy to be easily digestible, and ought to be made more concise and user-friendly.
3.15 Q5. a) Do you think that it is feasible for the standards (as currently defined) to be achieved by HCSWs within three months?
3.15.1 63% of respondents indicated that it was feasible for HCSWs to achieve the standards within three months. 3 respondents did not specify.
3.15.2 63% of responses thought it was feasible for the standards to be achieved by HCSWs within three months.
3.15.3 Of the 37% that disagreed with this, and those that had answered 'Yes' but added additional commentary:
- 12% of responses felt it more feasible to have the standards achieved in three-six months.
- 55% felt six months was a more feasible timescale.
- 24% felt twelve months was more feasible.
- 6% felt six-twelve months was more feasible.
- 3% indicated 'other', but did not specify a timescale.
3.16 b) If the answer to this is 'no', indicate how long you think it will take for HCSWs to achieve the standards as currently defined.
3.16.1 Though almost two thirds of respondents considered three months a feasible timeframe for HCSWs to achieve the standards, many made further comment stating that the timeframe was variable dependent on the individual and their capabilities. These further comments have been added to those received that thought three months was not a feasible timeframe (37%), to give a flavour of the opinions of respondents.
3.16.2 55% of respondents selected 6 months as a feasible timeframe for achievement of the standards. 24% of respondents considered 12 months a more feasible timeframe for achievement of standards. 12% considered between 3 and 6 months more feasible, and 6% considered between 6 and twelve months a more feasible timeframe. 1 respondent, or 3%, selected 'Other', but did not specify a timeframe.
3.16.3 The three biggest issues raised by a minority of respondents highlighted the view that three months was not sufficient time for a healthcare support worker to adequately demonstrate their capabilities, and thus achieve the standards. It was determined by the vast majority that the time it will take a healthcare support worker to complete their induction is dependent on a number of varying factors. These include most prominently the varying capabilities of the individual and the availability of support and mentoring to guide the healthcare support worker through their induction. The fact that healthcare support workers often work part-time or out-of hours was also a significant reason given for why three months would not provide sufficient time for the standards to be achieved. Other, lesser cited problems included the need to have the support worker assessed (queries were raised as to how this should be done), and a fear that forcing support workers to achieve the standards in three months, rather than a longer and more relaxed timescale, would potentially sacrifice quality.
3.16.4 DH feared that lengthy induction processes could put potential recruits off, as it would be costly for employers, and burdensome for employees. One month's training was considered the most appropriate time-scale for training and induction. However, apart from UNISON commenting that extra costs to employees should be avoided, this is the only response that mentioned extra expense being a potential criticism of the draft induction standards.
3.16.5 The DHSSPSNI did not feel that 3 months was a realistic timeframe for a HCSW to be able to achieve the standards in. It was considered that induction processes need to be strengthened and accompanied by ongoing training and development for staff. With this in mind, 6 months were suggested as more realistic.
3.16.6 The Office of the Chief Nursing Officer of the Welsh Assembly's view was that induction standards could be achieved in 3 months.
3.16.7 With regard to the expected timescales considered appropriate for a HCSW to achieve the standards, NES felt that this depended upon the individual's capabilities, and upon the variability of available support. As such, NES suggested that 6-12 months was a more feasible timescale. This was in line with 6% of responses.
3.16.8 The SSSC commented that it is difficult to see how induction training could be performed in a meaningful way given the density of the material. The achievement of standards may therefore be superficial.
3.16.9 The CSP considered that 3 months was sufficient time for a healthcare support worker to achieve the standards. However, it was recognised that the time needed to achieve the standards will vary from person to person, depending on their existing knowledge, previous experience and capability. As such, it might be possible for some workers to achieve the standards sooner than 3 months whilst others may take longer.
3.16.10 The AfPP recommended that six months may provide a more realistic time-frame, allowing for greater flexibility within available resources and the adequate identification of learning needs. The AfPP also commented that there is a need to link support workers' development and assessment to completion of Health Awards where employers demonstrate commitment to their employees pursuing a national standard/benchmarked programme of study.
3.17 Q6. Other comments received which are out with the scope of the consultation
3.17.1 There were a number of comments relating to the model of regulation which are out with the scope of the consultation on standards. However, they have been included here for interest.
3.17.2 Some comments included questions over who would lead training and induction, and who would provide mentoring.
3.17.3 Comments relating to the consultation document itself generally praised the initiative to centralise healthcare support work regulation, and expressed the view that this initiative should be adopted on a UK-wide basis.
3.17.4 Concerns were raised that the standards may not be applicable to all HCSWs as currently worded.
3.17.5 DH called for read-across between health and social care, as this was considered relevant to the nature of movement of a contemporary healthcare support worker. It was suggested that this needed to be reflected in the wording and application of standards and code of practice and conduct.
3.17.6 A number of quality assurance issues were raised, such as who would be responsible for supporting workers through induction training, and whether or not the standards could be adapted to apply to employers and employees out with the NHS. Should the standards be adopted in England, DH, under current arrangements would not be able to direct the KSF sub-group of NHS Employers to use them, as staff governance arrangements are different in England.
3.17.7 The DHSSPSNI asked how the framework for the standards linked to KSF, and asked what arrangements would be put in place to address renewal of registration and notification cases. They considered that the Vetting and Barring scheme has the potential to cover the necessary safety considerations for people working in HCSW roles. The organisation also asked what added value the standards bring to the existing NHS standards covering public safety aspects under Clinical and Social Care governance?
3.17.8 NES noted that the code of practice for employers referred specifically to employers in NHS Scotland and recommended that GPs and other independent contractors caring for NHS patients adopt the employers' code of practice.
3.17.9 NES also considered that the induction standards should be more explicitly linked to the PIN Guideline on Induction.
3.17.10 The SSSC noted that there is no indication of what recognition will be awarded to staff that are deemed to have achieved the standards, i.e. what is the incentive for them?
3.17.11 The SSSC expressed concern that the standards are not transferable, will have extremely limited value or 'currency' out with the NHS and will not facilitate workforce mobility.
3.17.12 The KSF sub-group of NHS Employers (England) did not feel that it was clear from the proposals whether there is a plan to assure the quality of employer-led arrangements, something the organisation would recommend.
3.17.13 The Care Commission welcomed the standards, but considered they should also be required for the independent and voluntary healthcare sectors, as well as the NHS. The Care Commission also considered that the standards should also consider that an integrated service delivery is appropriate where social care and healthcare are jointly provided within the same service settings. As such, provisions for the regulation of social care must be taken into consideration.
3.17.14 The Royal Pharmaceutical Society of Great Britain ( RPSGB) sought clarification on whether or not it is intended that the obligation to adhere to the draft codes and standards would also apply to those contracted to provide services to NHS Scotland, e.g. community pharmacy contractors.
3.17.15 RSPGB expressed the view that it is difficult to comment on the detail of the standards without specific information about who would be responsible for assessing that a) the performance criteria had been met and b) the required occupational competence of assessors had been assured.
3.17.16 The SCP echoed previous comments received that the draft codes and standards should be expanded to cover more than simply those employed by NHS Scotland, but those employed in the independent and voluntary sector also.
3.17.17 The CSP commented that the standards, and any future centralised mandatory register, should be for all healthcare sectors and not simply the NHS. The CSP voiced the concern that simply regulating those working within the NHS could lead to a two-class system of support worker.
3.17.18 The CSP also expressed the view that there is a need to resolve who will assess if and how healthcare support workers have achieved the standards. Equally, whether monitoring of employers' compliance with its own code of practice will take place, and by whom, needs to be clarified.
3.17.19 Acknowledgement of and adherence to the Disability Discrimination Act was called for by the Chief Nursing Officer's office of the Welsh Assembly.
3.17.20 AfPP recommend that induction assessment criteria and results be made available to all Health Boards, to facilitate worker migration and prevent duplication of the generic elements of the induction programme. This would also enable both the HCSW and their new employer to identify the specific learning needs for the new post-holder.
3.17.21 "Fair For All" recommend that all healthcare support workers receive equality and diversity training. The recruitment and retention of disabled employees should be monitored and any barriers removed, and the Equality Impact Assessment Toolkit should be used to assess the impact of NHS policies and practices on disabled healthcare support workers.
3.18 Q7. In your opinion, should all three sets of standards as outlined in this consultation document be mandatory?
3.18.1 Only half of the respondents answered this question. Of these 27 responses, however, 25 or 93% considered that all three sets of standards as outlined in the consultation should be mandatory.
3.18.2 Many of the comments regarding this question expressed the view having three sets of mandatory standards would increase the profile of healthcare support workers, and would raise and maintain the standard of work of a healthcare support worker. It would also increase public confidence, protection, and safety. Indeed, many expressed the view that mandatory standards of practice and conduct should be considered a basic requirement of any public service.
3.18.3 Making the standards mandatory was also perceived to be beneficial as this would bring into line all forms of healthcare support work, and would ease worker migration, as well as assuring employer confidence that employees were fit to practise.
3.18.4 The DHSSPSNI considered that yes, all three sets of standards should be mandatory, and should cover the private/voluntary/independent sectors also.
3.18.5 NES considered that the standards should be made mandatory, as this would help them be perceived as a priority which would support achievement. NES also believe that it would be advisable to ensure that non- NHS providers providing care for NHS patients are required to sign up to the standards prior to being commissioned to provide services, to strengthen the ultimate goal of public protection in Scotland.
3.18.6 The SSSC are concerned that these standards are not transferable, will have extremely limited value or 'currency' out with the NHS and will not facilitate workforce mobility. For these reasons, the SSSC would not advise that these standards be made mandatory. Their view is that it is difficult to envisage how these standards will contribute to public protection.
3.18.7 The KSF sub-group of NHS Employers agreed that a centralised, mandatory, occupational register would contribute to public protection and help raise the profile of the need for statutory regulation.
3.18.8 The CSP agreed that all three sets of standards should be made mandatory, but that "considerable attention to detail [will be required] when devising systems and procedures for monitoring and for taking actions against those who do not meet the code or standards."
3.18.9 The AfPP considered that the standards should be mandatory, but whether or not the standards will involve a contractual arrangement between employer and employee needs clarification.