Health and Social Care Bill

My Lords, the amendments deal with two discrete areas. The first set of amendments relates to our proposal to establish a system of assured voluntary registration and seeks to extend compulsory statutory regulation to clinical perfusionists and clinical physiologists, and to make further amendments to legislation to account for this. The second set relates to the transfer of the regulation of social workers in England from the General Social Care Council to the Health Professions Council, to the protection of the function of social workers, to the office of the chief social worker and to the approval of the training of best-interests assessors. Also included in this second group is a minor and technical government amendment intended to correct an inconsistency in drafting. As for assured voluntary registration, the vast majority of workers give the very highest quality of care. However, a minority let patients down. This is a cause for concern for all of us and it is right that there is discussion about how we can ensure high standards of care. The Government's view is that compulsory statutory regulation is not the only way of achieving this and can detract from the essential responsibility of employers to ensure that any person whom they appoint is suitably trained and competent for the role. As I reminded the House earlier, there are already existing tiers of regulation that protect service users, including the standards set by the Care Quality Commission and the vetting and barring scheme. We also need to be clear that professional regulation is not a panacea. It is no substitute, as I said previously, for good leadership at every level and the proper management of services. It can also constrain innovation in some circumstances and even the availability of services. Experience clearly demonstrates that a small number of workers who are subject to compulsory statutory regulation from time to time fail to ensure that their practice is up to date and delivered to the standard that we expect. In these circumstances, it is too often the case that regulation can react only after the event. The regulation of individuals will not prevent another Mid-Staffordshire, but strong and effective leadership of the workforce may do, and we believe that employers and managers who are closest to the point of risk must take responsibility for ensuring standards. The Government believe that a system of assured voluntary registration will support commissioners, employers and supervisors to deliver their responsibility for assuring standards by providing independently assured standards of conduct and training for those on accredited registers. We believe that this approach will work well for clinical physiologists, clinical perfusionists and other groups of health and social care workers. Here, we are building on the work started under the previous Government. The noble Baroness, Lady Finlay, is right that clinical perfusionists are not subject to statutory regulation, but I assure noble Lords that where failures or risks on the part of clinical perfusionists have been identified in the past, action has been taken action to address them. The Department of Health issued guidance in 1999 that the NHS should use only accredited clinical perfusionists, and further guidance in 2009 that clarified the systems and processes needed to ensure high-quality perfusion services. However, employers, commissioners and patients currently have no objective or independent way of determining how robust the accreditation arrangements are, as they not subject to independent scrutiny. In future, if the voluntary register is accredited by the PSA, they will be subject to such ongoing independent scrutiny. The noble Baroness, Lady Finlay, asked me about the administration of drugs by perfusionists and compliance with the Medicines Act. Perfusionists cannot prescribe drugs, although they do of course administer perfusions. I would say in my defence to the noble Baroness that compliance with the Medicines Act is rather a technical legal point. If she will allow, I am happy to write to her on that legal position. Both she and the noble Baroness, Lady Masham, indicated their view that voluntary registers already exist and do not work. Voluntary registers do exist, so standards for these professions exist as well. It has to be said that the Department of Health has little if any evidence of a general problem with the standards of practice for these groups, but, as I said previously, we currently have no objective way of saying to employers that if they rely on professionals who are on existing voluntary registers they can be sure that they are meeting appropriate standards. In future, where voluntary registers are accredited by the Professional Standards Authority, that will be possible. For unregulated groups, the key to ensuring consistent care is good recruitment, good training, delegation and supervision by employers. We believe that our new system of assured voluntary registration would assist them in taking local responsibility for the quality of their staff. Various noble Lords talked about the removal of unsatisfactory or dangerous people from the register. We would expect the professional standards authority's criteria for accreditation to include having proportionate methods for removal from the register. It is not clear to me why an individual could not be removed from a register if there is clear evidence that they are failing to meet the conditions set down for registration and due process has been followed. Further, if an individual has been found in possession of child pornography, which was the example given by the noble Baroness, Lady Finlay, they should be referred to the Independent Safeguarding Authority, and they could be barred from working with vulnerable adults and children. There is no reason why that should not have happened in that instance. Employers should undertake identity checks, and that applies whether or not an individual is statutorily regulated. Let me be clear: we are not ruling out compulsory statutory regulation for the groups mentioned in the amendments. As part of its process of assurance of accredited voluntary registers, the professional standards authority will continue, through its reviews, to monitor whether risks are being satisfactorily controlled within the context of the wider framework of public assurance. The authority will therefore be well placed to assess whether any further regulatory action is needed. I am sure it would advise the Government accordingly. I will turn now to the amendments which relate to the social work profession in England, which is where the noble Lord, Lord Hunt, started us off. I want to assure noble Lords that the Government are committed to the development of the social work profession. We see strengthening the regulation of social workers in England playing a key part in the reform of the profession. In 2009, following the discovery of a backlog of conduct cases, a report by the Council for Healthcare Regulatory Excellence found potentially dangerous failings in the GSCC's carrying out of its conduct function. The report recommended that the regulation of social workers in England move closer to the model of regulation used for healthcare professionals. Through the General Social Care Council under its new leadership, progress has been made in developing the organisation since 2009. However, there is still work to be done to bring it into line with the health profession's regulators. The noble Baroness, Lady Pitkeathley, made the point here. We do recognise that social workers in England need a strong voice. We support both the development of the College of Social Work and the recommendation of the Munro review for a chief social worker. The role of the college is to be the voice of the profession and lead on professional development, whereas the chief social worker will advise Government on the development of social work policy and practice. However, the role of a regulator is to assure the safety and quality of the individuals on its register. A direct role in supporting workforce development or promoting the profession is likely to present a conflict of interest for a regulator. The reforms to the regulation of social workers in England form part of a wider package of reforms aimed at strengthening social work. Social workers in England will benefit from regulation by the HPC in a whole variety of ways. They will be regulated on the same basis as other professionals. They will benefit from a truly independent regulator. They will, for the first time, have a set of standards of proficiency, many of which will have been tailored specifically for their profession rather than covering the full range of jobs in social care. They will also be subject to a fitness-to-practise process, which will be able to consider their conduct and competence in the round and which will enable a more rehabilitative approach to be taken by the regulator. This is all in contrast with the GSCC which can only admonish, suspend or remove from its register. The HPC has established a professional liaison group, whose membership includes representatives of social workers, their employers and those involved in their education and training, which has developed draft standards of proficiency for social workers in England. The HPC is currently recruiting social workers as partners, subject to the passage of the Bill. These partners will have a role in the council's approval of training and education, in considering fitness-to-practise cases and in assessing social workers' continuing professional development. This will, in combination, help to ensure that the HPC is aware of the nature and proposed development of the social work profession and is able to reflect this in a sensitive way in the standards set for social workers. The noble Lord, Lord Hunt, asked me whether I could confirm that the HPC will not be covering all professions in the future. I can confidently assure the noble Lord that there is no intention to bring all of the health professions within the scope of the HPC. I myself have received no hint of that within my department.