Mandated professional registration for adult social care workers?

Care England has released its latest publication ‘Care for our future – the roadmap to a sustainable future for adult social care’ which sets out an adult social care roadmap focusing on workforce, funding and integration.

The publication issues a series of policy recommendations for the government to implement within 100 days, two years and five years after taking office and is designed to “improve the quality of care, boost the economy and empower the sector’s welfare”.

One of the policy recommendations advocated by Care England calls for professional registration of all adult social care staff in England. This is a bold mandate, especially within the first 100 days of office, for a sector that is already struggling with low pay, lack of recognition and greater demands owing to a growing aging population.

What are the policy recommendations?

In brief, and within 100 days of the next government taking office, Care England proposes they should action the following:

• Mandate the professional registration of adult social care staff in England
• Zero-rate VAT for welfare services in England
• Mandate direct adult social care representation at all ICS levels in England.

Within two years of the next government taking office:

• Implement a fully-funded £15 minimum care wage and develop parity of esteem with NHS staff
• Close the Fair Cost of Care funding gap and repeat the exercise at a sector-wide level
• Publish a strategy for hospital discharge which introduces a national tariff of £1,500 per week.

Within five years of the next government taking office:

• Consolidate reforms within a fully-funded, long-term adult social care workforce plan
• Deliver a long-term adult social care funding settlement, with a £10bn annual funding boost
• Deliver a fully mapped prevention and integration plan.

Why are Care England advocating for professional registration?

According to Care England, professional registration of adult social care staff in England will help raise the status of those working in care, lay the foundations for professionalising the workforce, and offer a framework for recognising an individual’s training and experience.

In addition, England will be brought into regulation harmony with Scotland, Wales and Northern Ireland where social care workers are professionally regulated by statute.

In calling for professional registration, Care England have highlighted the following benefits:

1. The recruitment process would be expedited “with those registered having their references and DBS checks already validated”
2. The need to complete mandatory training when changing roles or employers would be minimised as the register would hold an up-to-date training record
3. Any associated registration costs should be “be met by the government, rather than by care staff”
4. “A professional register would represent a low cost, easily implementable measure that lays the foundation for a sustainable adult social care workforce”.

The reality of professional regulation

Whilst the call for professional registration is admirable and would indeed professionalise the workforce, the practicalities of professional registration, along with any associated timescales provided are not straight forward and need to be considered as part of any reforms. As an example, using the same numbering as above, the following is apparent:

1. Statutory registered healthcare professionals, and almost all Professional Standards Authority (“PSA”) voluntary registered healthcare professionals are not DBS checked at the point of entry to the register except for Osteopaths.

DBS checks are usually obtained by employers, along with professional references, once an offer of employment has been made. Using the statutory and PSA registers as regulatory models, the following would need to be addressed before expeditious recruitment practices could be facilitated:

• Consideration of data protection implications arising from potentially sharing references and DBS information with employers
• The amount of manpower hours, and cost involved in register-employed staff responding to each request from an employer
• DBS checks only capturing information present at the time the check was undertaken. Therefore, every registered professional would need to sign up to, and pay for the DBS’ Update Service otherwise ‘old’ information would habitually be provided to new employers and would not provide the required reassurances
• An employer being required to satisfy CQC they are employing fit and proper persons, as per Regulation 19, with their own recruitment checks
• Self-employed persons e.g. temporary workers being unable to directly obtain an enhanced DBS with barring check.

2. Statutory and PSA voluntary registers (“register”) set the required course content for approved qualifications or can approve qualifications by experience, in some registers, subject to regulatory scrutiny.

Once entry to the register has been obtained, professionals are deemed Fit to Practise (“FTP”) meaning they have the requisite skill, qualification and experience to practice as a particular healthcare professional and are of good character and health. Professionals are thereafter subject to continuing professional development (“CPD”) cycles which they are obliged to meet as part of their professional obligations and continued learning.

Employers and members of the public would be reassured that an adult social care worker has met a minimum competence level, which the register would need to establish and communicate to all adult social care workers in advance of registration commencing. However, a register would not be able to publicly display a training record. The same concerns as above apply – for example data protection implications, and time and cost for a register to respond. A register could, however, display a qualification and year obtained as statutory regulators do.

It should be noted, however, that establishing a threshold of competence, or method for approving qualifications by experience, takes time – and consultations with the relevant professionals are required before implementation.

It cannot be achieved through a ‘quick fix’ and will result in some professionals being excluded from registration meaning they will be required to undertake additional training, at cost, to register.

3. Registration costs for statutory and PSA voluntary registered professionals are paid for by the registered professionals themselves. This is part of a professional’s commitment to remaining on the register and meeting their professional requirements.

In turn, non-payment results in the professional being removed from the register. If parity is sought with NHS professionally registered staff, then adult social care workers would need to pay their own professional fees. Additionally, and with government funding currently being overstretched, it is unlikely the government would cover such professional fees.

4. Establishing any professional register which will be robust, independent, protect the public and uphold the reputation of the profession takes time and costs money. For example, Social Work England began registering social workers in December 2019 despite the primary legislation coming into effect in 2017.

These timescales, however, do not include the years of preparation involved in obtaining government approval, drafting the proposed legislation and rules, and establishing and staffing the various regulatory departments.

If PSA voluntary accreditation was sought, which would not achieve the required mandated adult social care registration, time would also be required to complete the requisite accreditation paperwork and for the PSA to accredit the register where all relevant requirements are met.

In making such a public recommendation, Care England have cited a pilot voluntary register established by the National Association of Care & Support Workers (“NACAS”) in partnership with the Institute of Health & Social Care Management. They states that this register “should be taken forward in adopting a standardized approach for the country”. However, this is a voluntary register and would not achieve the required mandate for adult social care registration.

As alluded to above, an alternate means of expediting registration of adult social care workers could be for Social Work England (the statutory regulator of social workers in England) to become the regulator for adult social care workers in England. This is the equivalent position in Wales, Northern Ireland and Scotland and would be somewhat easier and quicker than setting up a new register. However, government approval would still be required, consultations would need to be undertaken, and legislation and rules updated.

What would regulation mean for providers and professionals?

If adult social care workers were to become professionally registered, providers would gain a sense of surety that the professional they are hiring is suitably qualified and experienced, fit to practise and is meeting their professional obligations.

This, in turn, provides assurances to service users, and their families, that their care worker(s) are subject to register oversight and complaints can be directly escalated to the register. Equally, adult social care workers would benefit reputationally from being a registered professional.

By virtue of employing or contracting with professionally registered staff, there is, however, an onus on employers to ensure that registered professionals remain registered with the register, are meeting their CPD requirements, and are obliged to notify the regulator if this is not the case.

Furthermore, providers will also be obligated to notify the register if they hold concerns regarding the professionals conduct or competence and will be duty bound to assist with any FTP investigations.

Whilst this may appear to be burdensome, it would become easier to assure CQC of Regulation 18 (safe staffing) and Regulation 19 as adult social care workers would be subject to regulatory scrutiny.

Whilst a call has been made for the government to cover adult social care workers professional fees, employers could decide to cover registration costs as a benefit in kind to employees. This would be an additional cost to the service but could be a means of attracting the best talent.

Conclusion

As outlined above, the establishment of a professional register for adult social care workers would indeed professionalise the workforce providing a robust, independent register is established.

However, the fact remains that the establishment of any professional register takes time and money, and there must be government and adult social care worker appetite for change. If there truly is appetite for regulation, expanding the regulatory remit of Social Work England to include the regulation of adult social care workers could be a viable option.

This would, as detailed above, bring England into regulatory harmony with Scotland, Wales and Northern Ireland and provide the mandatory level of regulatory oversight required.