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Welsh Assembly Government and the National Leadership and Innovation Agency for Healthcare

(NLIAH)

Focussed Consultation on a Model of Assurance

for Health Care Support Workers in Wales

Date of issue: 18 October 2010Responses by: 15 November 2010

Overview In recognition of the important contribution made by support staff, the Minister for Health and Social Services has decided that work should be undertaken to facilitate the safe practice and development of health care support workers working in NHS Wales. The focus of the initial phase of work is to establish a code of conduct for staff and a code of practice for employers.

As well as commenting upon the content of the documents as requested in the accompanying template, we want to know your views on a number of key areas which have been difficult to achieve consensus on in the past.

Who should respond?

These documents will be of interest to all Health Care Support Workers (HCSW) working in clinical and non clinical roles in NHS Wales. It will also impact upon professional staff, managers and trainers. The views of all partners represented as members of the Welsh Partnership Forum are sought.

How to respond This is a focussed consultation being managed via the Welsh Partnership Forum, the HCSW Steering group and the HCSW Expert Advisory Group. It is being facilitated via the NLIAH HCSW Skills Coordinators at a local level. Please read the documents in sections 2 and 3, and respond using the attached forms at section 4 via the route from which this document was received.

Collation of ResultsNLIAH will coordinate and analyse the information from the consultation process, which will have initially been summarised via the members of the Welsh Partnership Forum, the Steering Group and the Expert Advisory Group. The results will be reported through to the Steering Group and the Advisory Group for consideration, advice and action.

Amendments will be made to the draft documents to reflect the consensus view resulting from the consultation process.

Further information and related documents

Further copies of the consultation may be requested at the below email or postal address,

Contact Details For further information:

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Address:National Leadership and Innovation Agency for Healthcare Innovation House Bridgend Road Llanharan CF72 9RP

Email: [email protected]

Telephone: 01443 233 333

Website: www.nliah.wales.nhs.uk/

How to respond to consultation and how your comments will be collated and used

Two templates have been developed to capture views on the Code of Conduct for Health Care Support Workers and the Code of Practice for Employers. Each template contains a series of questions linked to the respective documents which can be completed electronically or manually. The templates offer respondents the opportunity to agree or disagree with each of the standard statements and also provides a facility for comments on some of the wider issues.

Consultation ProcessThere is a Skills Coordinator post in each Health Board within NHS Wales. These posts specifically focus on the development of Health Care Support Workers and were considered to be the most appropriate resource available to manage local consultation events within their organisations.

Staff will be provided with a range of opportunities to comment on the Code of Conduct for HCSW and the Code of Practice for Employers. The Skills Coordinators will be adopting a variety of approaches to support the consultation process and to ensure as many staff as possible have the opportunity to comment. The following opportunities will be exploited:

scheduled in-house training and development days;

bespoke consultation events; targeted mail shots; intranet; and facilitated focus groups.

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http://www.nliah.wales.nhs.uk/

Foreword

This consultation marks the start of a programme of work to develop and support health care support workers and assistant practitioners working in Wales. This is the first all Wales initiative which focuses exclusively on the needs of the support worker and assistant practitioner section of the health workforce. The initial phase of the work programme centres on getting the essential things right, specifically setting out a code of conduct for staff and a code of practice for employers.

Edwina Hart, the Minister for Health and Social Services, values the considerable contribution made to the delivery of high quality patient/client care by assistant and support staff across Wales. She is therefore keen that we make significant progress with this work this year.

I am very pleased to be chairing this initiative, which I think offers huge potential for the future development and support of staff, many of whom are working in very challenging environments. I encourage you to consider the proposed Codes set out in this document and contribute to the consultation process. We are using a focussed consultation approach and ask that you use the Local Health Care Support Worker Skills Coordinators and Wales Partnership Forum representatives to feed back your comments as this will enable us to respond to your views quickly and effectively.

Philippa Ford MCSPPolicy Officer for the Chartered Society of PhysiotherapyChair of the Health Care Support Worker Development Steering Group

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SECTION ONE

1. Introduction

The health and social care workforce in Wales consists of many different types of workers who provide direct and indirect care. Some are registered professionals, such as nurses, doctors, social workers and therapists, however, a significant proportion of the workforce fulfil a support or assistant role.

In recent years the roles and functions of all members of the workforce have been changing to meet the demands of delivering modern health and social care services. Those who work as support workers or assistants have most profoundly felt this evolution in role and function. Health and social care support staff are essential to the delivery of high quality person-centred care and as such need appropriate education, training, ongoing development and support to fulfil their roles.

As support staff have extended their roles, there has been a growing demand to regulate health care support staff in some way. There are many types of regulation but the primary purpose behind all forms is to provide a model of assurance that can help to improve patient/client care and safety. Models of assurance can also have positive consequences for the staff affected, as this leads to greater clarity and preparation for their roles and improvements in practice. There continues to be discussion at a UK level about the right approach to be taken in the case of health care support and assistant staff and this debate forms the backdrop to this consultation. Appendix 1 identifies the legal framework within which this work has been taken forward.

2. What is this consultation about?

In recognition of the important contribution made by support staff, the Minister for Health and Social Services has decided that work should be undertaken to facilitate the safe practice and development of HCSW’s working in NHS Wales. The focus of the initial phase of work is to provide a model of employer led assurance that can contribute to public protection. The model of assurance would initially comprise of a code of conduct for staff and a code of practice for employers, to be complemented by All Wales Standards for Induction training in the future as required.

Initially, this document sets out the background to the work at UK and Wales levels. Sections 2 and 3 contain the proposed Code of Conduct and Code of Practice, with a final template section for your responses to a number of questions on which your views are sought.

As well as commenting upon the content of the documents we want to know your views on a number of key areas which have been difficult to achieve consensus on in the past. That is:

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How should we define ‘health care support worker’ for the purposes of this work?

Should the requirement to comply with the Code of Conduct be applied to existing staff if they move to new roles internally or within NHS Wales?

How should we monitor compliance? What are the implications for existing health care support workers, employers,

trainers and supervisors? What would be useful to be included in an induction framework that may be

specific to HCSW roles?

3. Why has it taken so long?

In March 2004, the Department of Health published a consultation document: Regulation of Health Care Staff in England and Wales. This document and the responses to it highlighted the complexity of issues that surround the decisions on regulation of this large part of the workforce. No consensus was achieved on:

who should be classified as health care support staff? And who should be regulated?;

what form should regulation take, e.g. voluntary, statutory or employer-led?; what body should act as the regulator?; how should staff who work across professional boundaries be regulated?; and what will be the impact of devolution and changes to social care regulation?

In an attempt to provide some evidence to inform future decisions, Scotland embarked on a pilot of employer-led regulation, which they undertook on behalf of the UK.

In addition, in March 2005 England announced a Review of the regulation of non medical healthcare professionals which reported in 2006 (known as the Foster Review).

The Foster Review concluded that, although there is a strong case for extending regulation to at least some support workers, it would be important to await the results of the Scottish pilot, as there is a need for factual information about the advantages and disadvantages of an actual scheme of regulation. Recommendations from the Foster Review and the Donaldson Review into medical regulation formed the basis of the White Paper Trust, Assurance and Safety: the regulation of health professionals in the 21st Century (2007).

The results of the Scottish Pilot evaluation were published in July 2009 at the same time as the report of the UK working group1 on Extending Professional and Occupational Regulation (EPR). The Scottish pilot had tested an employer-led approach, backed by a non-statutory register.

The evaluation findings confirmed support for induction standards for support workers but indicated the need to review their applicability to non-clinical groups. The introduction of a Code of Conduct for health care support workers was unanimously supported, as was a Code of Practice for employers. 1 The EPR working group was established following publication of the White Paper Trust Assurance and Safety 2007.

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Stakeholders presented mixed views as to whether a national occupational list would be a proportionate response to the perceived level of risk, and it was therefore suggested that further work was needed.

In response to both the Report on Extending Professional and Occupational Regulation (2009) and the results from the Scottish pilot of an employer-led model, the four UK Governments supported the following principles to guide discussions on the future extension of regulation to professional and occupational groups:

the primary purpose of regulation is to secure safe, effective, high quality, and respectful care for the individuals who depend on health care staff for their health and well-being;

regulation should be proportionate to the risk to patients and the public and should lead to improvements in the quality of care for health care users;

new regulatory systems need to take account of the wider matrix of regulation and governance systems to minimise duplication and maximise benefit; and

consistency and coherence of the principles of regulation is desirable, accommodating the different perspectives of England, Scotland, Northern Ireland and Wales as well as being aligned with the European Union and the requirement of free movement.

4. What has brought us to this point?

Following the report on Extending Professional Regulation and results from the Scottish pilot, the Minister for Health and Social Services requested an impact assessment in Wales of the adoption of a code of conduct, code of practice and induction standards as tested in Scotland and aligned to the codes and standards currently utilised by the Care Council for Wales. In addition, the Minister requested wider stakeholder engagement to consider what further systems may be required for clinically focussed health care support workers in addition to the codes and induction standards.

In January 2010 a HCSW summit with an invited audience of representatives from various stakeholder groups, was held to agree next steps. It is as a result of the summit and the impact assessment that the Minister requested the establishment of a Steering Group chaired by Philippa Ford, Policy Officer for the Chartered Society of Physiotherapy. An expert advisory group was also established to maximise participation from a wide range of stakeholders. (Terms of reference and membership of both groups are at Appendix 1).

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The focus of this work is initially upon HCSWs who are employed within NHS Wales. Work around the development of health and social care workers (or generic workers) is out-with the scope of this consultation. Appendix 1 also makes reference to the legal framework upon which this work will be based.

The consultation documents at Sections 2 and 3 have been developed based upon the published codes for social care in Wales as well as the codes used in the Scottish Pilot which were the subject of public consultation across the UK in 2007. It is the intention that following consultation both codes will become mandatory for all health care support workers entering employment in NHS Wales from an agreed date early in 2011.

During the development process the HCSW Steering Group concluded that the production of induction standards required further debate and consideration. Standards of good practice for induction apply to all staff entering the NHS and entering new organisations. In addition, there may be specific learning needs for different groups of staff including HCSWs which will need to be specified. We have therefore decided to delay the production of HCSW specific induction standards until a core framework applicable to all staff can be defined.

5. What will happen next?

Following the responses to this consultation, any changes made will be subject to Ministerial approval. Introduction will become mandatory from a given date in 2011, for all new starters. Work will then continue, led by the Steering Group, to address the variation in support for existing health care support workers and to determine what further steps should be taken to develop this part of the workforce.

SECTION TWO

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Introduction

The Code of Conduct for Healthcare Support Workers in NHS Wales has been developed for Healthcare Support Workers, their managers and the public to define the standards of work expected on a day to day basis. The Codes will enable service users and members of the public to understand how a Healthcare Support Worker should work and behave towards them and how NHS employers should be supporting Healthcare Support Workers. Healthcare Support Workers have an important role to play in the delivery of high quality care to service users and the Code of Conduct illustrates and supports the vital work that these workers undertake. The Code reflects the considerable amount of existing good practice from across NHS Wales.

This Code is part of a set of standards for the Healthcare Support Worker in NHS Wales, which includes the Code of Practice for Employers and Induction Standards for Healthcare Support Workers. This Code of Conduct applies to all Healthcare Support Workers in NHS Wales and will be referenced in job descriptions.

What will this Code mean for Health Care Support Workers?

The Code will provide you with a set of standards to work to, so you can be sure what standards of conduct you are expected to meet.

You can use the Code to check whether you are working to standard and if not to change the way you are working

You should use the Code to identify areas for improvement. You need to be able to do your job properly, behave properly and

do the right thing at all times. This is essential to protect service users, public and others from harm.

How will this Code help managers?

The Code will help your employer to understand what standards they can expect of you and your colleagues.

Your employer has a Code that outlines how they should treat and support you to achieve the standards within this Code.

How will this Code help the public?

The Code helps members of the public to understand what standards they could expect of you.

NHS Wales has a legal duty and responsibility to protect the interests and wellbeing of its service users.

Public protection is at the core of each statement and the Code mirrors what is required of all regulated Healthcare professionals that you may work alongside.

Health Care Support Workers must:

1. Be accountable by making sure that you can always answer for your actions or omissions.

2. Promote dignity and respect the rights and wellbeing of service users and their carers at all times.

3. Work in collaboration with your colleagues as part of a team to ensure the delivery of high quality care to service users.

4. Communicate in an open and effective way to promote the wellbeing of service users and carers, within your proven level of competence.

5. Respect a person’s right to confidentiality and protect their privacy.

6. Improve the quality of care to service users by updating your knowledge and experience through personal and professional development.

7. In order to promote equality all service users, colleagues and members of the public are entitled to be treated fairly and without bias.

Be accountable by making sure that you can always answer for your actions or omissions.

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Guidance StatementsAs a Health Care Support Worker in Wales you must:

1. make sure you can justify your actions or your omissions to service users, your employer, members of the public, your supervisor, and others;

2. always seek assistance from your manager/supervisor if you do not feel able or adequately prepared to carry out any aspect of your work, or you are not sure about how to proceed in a work matter;

3. be honest with yourself and others about what you can do, recognise the limitations of your competence and only carry out those tasks agreed in your job description and in which you have gained competence;

4. establish and actively maintain clear and appropriate boundaries in their relationships with service users and their carers at all times;

5. inform your manager/supervisor about any personal difficulties that might affect your ability to do your job competently and safely. If you do not feel competent to undertake an activity, you must report this to a registered practitioner;

6. behave in a way, in work or outside work, which would not call into question your suitability to work in a health care environment;

7. be honest, trustworthy, reliable, dependable and uphold public trust and confidence by acting with integrity at all times and be a good ambassador for NHS Wales;

8. decline any offers of loans/gifts, favour or hospitality from anyone in your care or anyone close to them;

9. comply with the employer’s dress code policies; and

10. report any actions or omissions by yourself or colleagues that you feel may have compromised the care you deliver.

Promote dignity and respect the rights and wellbeing of service users and their carers at all times.

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Guidance Statements

As a Health Care Support Worker in Wales you must:

1. treat each person as an individual, promote independence and self care and assist service users to exercise their rights and make informed choices about care;

2. Consider, respect and protect the privacy and dignity of service users, carers and colleagues;

3. Not abuse, neglect, harm or exploit service users, carers or colleagues;

4. Always do your best to make sure nothing you or anyone else does or does not do, will harm the person's health or wellbeing or delay their recovery;

5. Contribute to health care environments that are safe for practice and act without delay by following established procedures and protocols to challenge and report dangerous, abusive, discriminatory or exploitative behaviour or practice; and

6. Always take complaints seriously, respond to them in line with the organisation’s policy and inform a senior member of staff.

Work in collaboration with your colleagues as part of a team to ensure the delivery of high quality care to service users.

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Guidance Statements


1. work openly and co-operatively with colleagues including those from other disciplines and treat them with respect;

2. value the part you play in the team and respect the part played by other members of the team;

3. honour work commitments, agreements and arrangements and be reliable and dependable; and

4. recognise and respect the roles and expertise of colleagues from other agencies and disciplines and work in partnership with them.

Communicate in an open and effective way to promote the wellbeing of service users and carers, within your proven level of competence.

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Guidance Statements


1. communicate in an open, accurate, effective and straightforward way;

2. document and maintain clear and accurate records of your care and immediately report any changes or concerns in the condition of individuals to a senior member of staff;

3. always explain and discuss the care or procedure you intend to carry out with the service user and only continue if they give consent; and

4. communicate effectively and consult colleagues as appropriate.

Respect a person’s right to confidentiality and protect their privacy.

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Guidance Statements


1. not discuss those in receipt of care/services with anyone other than colleagues in the team or other professionals who need to know the information to help in the delivery of care/services to the service user and only disclose relevant information;

2. regard all service user information as confidential and use it only for the reason that it was given to you;

3. seek guidance from a senior member of staff regarding any information or issues that you are concerned about; and

4. always discuss issues surrounding confidentiality with a senior member of staff prior to considering any form of disclosure.

Improve the quality of care to service users by updating your knowledge and experience through personal and professional development.

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Guidance Statements


1. in agreement with your managers ensure up to date compliance with all statutory/mandatory training;

2. participate in the development of a personal development plan to support achievement of competencies required for your role;

3. undertake competency based training and education in line with local review processes;

4. maintain an up to date record of training and development; and

5. contribute to the learning and development of others where appropriate.

In order to promote equality all service users, colleagues and members of the public are entitled to be treated fairly and without bias.

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Guidance Statements


1. respect the individuality and diversity of service users, carers and colleagues and do not discriminate against them in any way;

2. promote equal opportunities for service users and carers;

3. not discriminate or condone discrimination against service users, carers or colleague; and

4. report concerns to a senior member of staff.

SECTION THREE

Version 2

The pre-amble to this document will contain the legal requirements of employers.

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To meet their responsibilities in relation to supporting Health Care Support Workers (HCSW) to comply with their Code of Conduct, employers must:

1. make sure people are suitable to enter the health care workforce and that they understand their roles and responsibilities;

2. have procedures in place so that HCSWs can meet the requirements of their Code of Conduct;

3. provide timely, appropriate and accessible training and development opportunities so HCSWs can develop and strengthen their skills and knowledge; and

4. promote this Code of Practice and the Code of Conduct for support workers in healthcare to your staff, HCSWs, Service Users and other Stakeholders and influence its use in the day to day practice within your organisation.

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Make sure people are suitable to enter the healthcare workforce and that they understand their roles and responsibilities.

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Guidance Statements

As an Employer you must:

1. use rigorous and thorough recruitment and selection processes to ensure the appointment of HCSWs who have the appropriate knowledge and skills and who are suitable and eligible to work in healthcare;

2. make sure HCSWs have clear information on their roles and responsibilities and make them aware of relevant legislation, policies and procedures they must follow;

3. manage the performance of healthcare support workers to ensure high quality and safe care is delivered to service users; and

4. support HCSWs who claim they are being asked to perform outside of their role and ability and investigate any complaints thoroughly.

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Have procedures in place so Health Care Support Workers can meet the requirements of their Code of Conduct.

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Guidance Statements


1. implement and monitor written policies and procedures to help HCSWs achieve the standards set out in the employee Code of Conduct;

2. have policies in place to enable HCSWs to report inadequate resources or operational difficulties which might impede the delivery of safe care;

3. ensure the care and safety of service users is a priority by providing appropriate assistance to HCSWs whose work is affected by ill health.

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Provide timely, appropriate and accessible training and development opportunities so Health Care Support Workers can develop and strengthen their skills and knowledge.

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Guidance Statements


1. ensure appropriate induction training and other learning opportunities to ensure continued development of their role;

2. establish effective ways to mentor, supervise, monitor and assess HCSWs;

3. support appropriate continuing personal and professional development for HCSWs.

4. ensure all HCSWs have adequate support of supervisory staff who are competent to mentor, coach and review their development, and requirements and to address any capability issues that arise.

5. address any capability issues that arise, including situations where HCSWs cannot produce evidence of performing competently; and

6. ensure that anyone who delegates tasks should be aware of their responsibility to support HCSWs, and their accountability for the way they perform those tasks, to reduce risk to service users.

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Promote this Code of Practice and the Code of Conduct for support workers in healthcare to your staff, Health Care Support Workers, Service Users and other Stakeholders and influence its use in the day to day practice within your organisation.

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Guidance Statements


1. inform HCSWs and all other staff about this Code of Practice and the employer’s responsibility to comply with it;

2. promote the Code of Conduct and reinforce the personal responsibility of HCSWs to meet the standards within the Code;

3. include information about the Code of Conduct in relevant communication material and mechanisms within the organisation and for the public as appropriate; and

4. ensure HCSWs understand the requirements of the Code of Conduct, utilising opportunities at recruitment and during induction.

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SECTION FOUR

Template for responses

Consultation Response Form Your name:

Organisation (if applicable):

Email / telephone number:

Your address:

Question XX: We have asked a number of specific questions. If you have any related issues which we have not specifically addressed, please use this space to report them:

Please enter here:

1(a) Are there any amendments needed to Standard 1?

Be accountable by making sure that you can always answer for your actions

or omissions.

Mark with ‘X’ 1(b)

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YES NO

If YES please provide comments

Version 2

1(c) Do you have any comments on the Guidance Statements supporting Standard 1?

*****************2(a) Are there any amendments needed to Standard 2?

Promote dignity and respect the rights and wellbeing of service users and

their carers at all times.

Mark with ‘X’

2(b)



Work in collaboration with your colleagues as part of a team to ensure the

delivery of high quality care to service users.

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YES NO


YES NO

Version 2

Mark with ‘X’

3(b)


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Communicate in an open and effective way to promote the wellbeing of

service users and carers, within your proven level of competence.

Mark with ‘X’

4(b)



Respect a person’s right to confidentiality and protect their privacy.

Mark with ‘X’

5(b)

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YES NO


YES NO


Version 2



Improve the quality of care to service users by updating your knowledge and

experience through personal and professional development.

Mark with ‘X’

6(b)

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YES NO


Version 2



In order to promote equality all service users, colleagues and members of the

public are entitled to be treated fairly and without bias.

Mark with ‘X’

7(b)


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YES NO


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8. Are there any omissions?

9. Are there any areas not covered that you feel should be included?

10. Should the Code of Conduct for HCSW be applied to (A-F) or (A-D)

A Healthcare Support Worker means a person who is a health care worker “serving” the public, and who is engaged in any of the following:

a. in a direct clinical role, under supervision of a health care professional;

b. in an indirect clinical role, under the supervision of a health care professional;

c. in a direct service provision role, with access to patients and members of the public;

d. dealing with personal identifiable patient data; e. having responsibility for maintaining premises or equipment used by

patients; or f. involved in the preparation / delivery of goods or services directly for /

to service users.g. Other

Mark with ‘X’

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A-F A-D

Don’t Know

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11. How should we monitor compliance with this Code of Conduct?

12. Should the requirement to comply with the Code of Conduct be applied to existing staff if:

(a)they move to new roles internally?

Mark with ‘X’

(b)they move to a new role within NHS Wales?

Mark with ‘X’

13. What are the implications of introducing the Code of Conduct on the following:

(a) Health care support workers

(b) Employers

(c) Trainers and supervisors

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YES NO

YES NO

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1(a) Are there any amendments needed to Standard 1?

Make sure people are suitable to enter the healthcare workforce and

understand their roles and responsibilities.

Mark with ‘X’ 1(b)



Have procedures in place so Healthcare Support Workers can meet the

requirements of their Code of Conduct.

Mark with ‘X’

2(b)

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NO


NO


YES

YES

Version 2



Provide timely, appropriate and accessible training and development

opportunities so HCSWs can develop and strengthen their skills and

knowledge.

Mark with ‘X’

3(b)

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YES NO

Version 2



Promote this code of practice and the Code of Conduct for support workers in

healthcare to your staff, HCSWs, Service Users and other Stakeholders and

influence its use in the day to day practice within your organisation.

Mark with ‘X’

4(b)


*****************48


YES NO

Version 2

5. Are there any omissions?

6. Are there any areas not covered that you feel should be included?

7. How should we monitor compliance with this Code of Practice?

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Appendix 1WELSH ASSEMBLY GOVERNMENT

Health Care Support Worker Development

Steering Group- Terms of Reference

Health Care Support Workers (HCSW) are an important part of the workforce. Meeting the present and future needs and expectations of the people of Wales has led to changes in the way that health and social care is delivered. This has often led to the roles of HCSWs changing, with an extension of their skills to undertake work previously carried out by registered professionals. As roles continue to expand, it is important to ensure that education, training, development and additional learning opportunities are made available to support this indispensible part of our workforce. It is essential that the whole workforce share a value-set focussed on a citizen-centred approach to care so that the public can have confidence in our services.

At the request of the Minister for Health and Social Services, this group has been established to oversee developments to support this section of the workforce.

Purpose

The purpose of the Steering Group is to address the future developmental and regulatory requirements (see legal framework below) of HCSWs in the interest of public protection.

Phase 1 of this work will be to;

Develop and oversee the implementation of an all Wales Code of Conduct, employer Code of Practice and Induction Framework for HCSWs in NHS Wales, building on existing good practice and including focussed consultation with stakeholders. This work will be aligned to the codes and frameworks utilised by the social care workforce in Wales to be introduced prospectively.

Continuing phases of this work will; Consider the development needs of the existing workforce Review UK developments in regulatory frameworks and their

application in Wales

Terms of referenceThe group will:

1. define the scope and stages of the work in relation to the future development of the HCSW role, the introduction of codes and induction frameworks, and the potential for future regulatory models if appropriate;

2. establish an engagement strategy which will include consultation and engagement with health care support workers to determine their views;

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3. ensure full engagement with trade unions/professional associations and other key stakeholder groups, including regulatory bodies;

4. ensure changes support integration across health and social care;

5. consider implications for independent and voluntary sector organisations;

6. utilise evidence in relation to piloting of a licensing model in other parts of the UK and other relevant research to inform longer term developments;

7. explore the need for and means of accreditation of training;

8. determine what, if anything should be put in place for support staff working in posts at A4C band 5 and above in line with the KSF;

9. consider long-term funding and resource implications; and

10.address the equality and diversity implications of all proposals/products developed during this programme of work.

Scope

The definition of HCSW will be agreed as part of this work. The HCSW Steering Group will focus initially on those support staff employed by NHS Wales. Applicability of deliverables and enforceability out-with the NHS will be considered in phase 2 of the work.

Support staff working across health and social care including developments in relation to generic worker roles is not within the scope of this programme. This agenda is being taken forward in partnership between the Workforce Modernisation Programme Board and the Social Work and Social Care Workforce Task Group. The outcomes will be reported to the HCSW Steering Group.

Legal FrameworkStatutory regulation of health care professionals is not devolved to Wales2. The Welsh Assembly Government therefore does not have the legal powers to statutorily regulate healthcare professionals or health care support staff.

Powers of the Welsh Assembly Government in relation to the Health Service are as follows:

i) Section 1 of the National Health Service (Wales) Act (NHSWA) 2006 imposes a duty on the Welsh Ministers to continue the promotion in Wales of a comprehensive health service;

ii) Section 2 of the 2006 Act provides for Welsh ministers to do anything else which is calculated to facilitate, or is conducive or incidental to, the discharge of such a duty;

iii) Section 12 and Section 19 of the NHSWA provides the power to issue directions to LHBs and Trusts; and

2 The main legislation dealing with the regulation of healthcare professions are the Health Act 1999, s.60, and the NHS Reform and Health Care professions Act 2002 s.25 – neither of which is devolved in relation to Wales

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iv) Section 71 of the Government of Wales Act 2006 provides that Welsh Ministers may do anything which is calculated to facilitate, or is conducive or incidental to, the exercise of any of their other functions.

In the interest of public protection, the Welsh Assembly Government can direct NHS Wales to implement an employer model of assurance for all HCSW, which could include a code of conduct for employees and a code of practice for employers.Compliance would be monitored via Healthcare Inspectorate Wales

In contrast, regulation of the social care workforce is devolved to Wales. The Care Council for Wales was established by the Care Standards Act 2000. Section 56 specifies that the council shall maintain a register of (a) social workers; and (b) social care workers of any other description specified by the appropriate Minister by order. By virtue of s.121 of the Act and schedule 11 paragraph 30 to the Government of Wales Act 2006 the appropriate Minister is the Welsh Ministers. The power to make such order must be exercised by statutory instrument.

The powers to introduce models of assurance or regulation of staff who work across health and social care employed as ‘generic workers’, will need to be addressed according to their employing sector. Issues of accountability will need to be addressed at a local level.

Membership of Steering Group

Chair – Appointed by the Minister for Health and Social Services Philippa Ford – Policy Officer for Chartered Society of Physiotherapy. Care Council for WalesDirector of Workforce and OD NHS Wales – Anne PhilimoreNLIAH – Charlette MiddlemissRCN – Tina Donnelly UNISON – Dave GalliganWelsh Assembly Government officials:- Workforce and OD, Barbara Bale; Nursing, Jean White; Midwifery, Polly Fergusson; AHP/HCS, Linda Donovan/Angela Hillier Secretariat provided by Welsh Assembly Government

Meetings will be held at least 4 times per year

The Steering Group will be supported by an Expert Advisory Group

MembershipRepresentative(s) from:Association of Directors of Social Services WalesCare Forum WalesCommunity Health CouncilsChronic Conditions Management pilot siteCommunity Nursing Strategy Implementation groupCollege of Occupational Therapists (COT) HCSWs x 4Higher Education

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Knowledge and Skills Framework (KSF) advisor NHS Director of Nursing NHS Director of Primary Care and Community NHS Director of Therapies and Healthcare ScientistsNHS Education Training OfficerProfessional Advisory Committee Representatives (WSAC, WTAC, WMNC, WMed WGPC)Public Health RegulationRoyal College of Midwives (RCM)Skills for HealthWales Ambulance Service NHS TrustWelsh Partnership Forum x 2Wales Council for Voluntary Action

Terms of Reference of the Expert Advisory Group

To inform the thinking of the Steering Group and support the development of documentation prepared for wider consultation

To provide expert advice on the implications of proposals developed by the Steering Group.

To test products in advance of consultation

To support consultation processes

To advise on monitoring of compliance

To provide communication and feedback to their stakeholder groups

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Appendix 2

Reference List

Reference website Date

Healthcare Support Workers in Scotland: Evaluation of a National Pilot of Standards and Listing in Three NHS Boards - Research Findings, on behalf of UK SEHD

http://www.scotland.gov.uk/Publications/2009/06/01144651/1

2007 - 2008

Moving forward with healthcaresupport workforce regulationA scoping review: evidence,questions, risks and options – Kings College London

http://www.nmc-uk.org/Documents/Research%20papers/NNRU%20report%20into%20the%20regulation%20of%20HCSWs%20July%202010.PDF

July 2010

Department of Health (2006) - Modernising Nursing Careers: Setting the direction

http://www.dh.gov.uk/en/Aboutus/Chiefprofessionalofficers/Chiefnursingofficer/DH_108368

2006

This list is not exhaustive – if you feel that we have drawn upon work not mentioned above, please comment in the consultation section and we will ensure that all correct references are made.

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