This was the third session of the Advocacy Sector Conversations forum held at the Queen Victoria Women’s Centre on 11 February 2020.
Overview
In Northern Ireland, social care workers have been regulated since 2016 which was phased in via a four year rolling programme starting in 2012. In that time over 36,000 workers from a range of social care disciplines across residential, community, housing and advocacy services were registered. As a public protection measure, the process involved engagement from a range of stakeholders including employers, people who use services and their families, government and trade unions. As part of this a Code of Fitness to Practice was introduced and standards developed to improve quality of delivery and consistency. Marian O’Rourke, Interim Director for Regulation and Standards, Northern Ireland Social Care Council & Fidelma Carolan, Senior Consultant, Leadership Centre, Health & Social Care Service Northern Ireland, share their experience and learning from the process and how the lessons might relate to the current process taking place here in Victoria.
Links to references mentioned in this session can be found at the end of this post.
Transcript & Audio
MELISSA HALE, DARU COORDINATOR:
It’s my great pleasure to welcome two very special guests all the way from Northern Ireland today Marian O’Rourke and Fidelma Carolan and they will be talking about the work of registration and quality and safeguarding people with disability in Northern Ireland.
In Northern Ireland, social care workers have been regulated in 2016, which was phased in by a four year rolling program starting in 2012. In that time over 36,000 workers from a range of social care disciplines across residential, community, housing and advocacy services were registered.
As a public protection measure the process involved engagement from a range of stakeholders including employers, people who use services and their families, governments and trades unions. As a part of this, a code of fitness to practice was introduced as standard developed to improve quality of delivery and consistency.
I would like to welcome them to talk about how this all works considering this is the space that Australia is starting to delve into now. Thank you and welcome.
MARIAN O’ROURKE:
Thank you very much, can everybody hear us okay, yes okay. Apologies that we’re going to set in terms of the live feed stream I think that’s going to work best but I appreciate maybe people in the room can’t necessarily see us so well but do feel free to move around.
We are going to use some slides for our presentation we will have a number of very short videos in this. Our apologies that our videos aren’t all subtitled. We need to get better at planning in terms of the whole range of audiences that we’ve had to present to. We talk about what we’ve been doing since we’ve come here. Apologies for the lack of subtitling on our videos. I’m going to start with me and then Fidelma can introduce herself in a minute.
My name is Marion. I’m the Director of Regulation and Standards with the Northern Ireland Social Care Council. We are the regulatory body for the social care and the social work forces in Northern Ireland. I will tell you about that in a minute.
FIDELMA CAROLAN:
My name is Fidelma Carolan and I’m a former Regional Organiser with the Trade Unison that is the largest trade union in the United Kingdom with 1.4 million members, 40,000 of whom are in Northern Ireland. Predominately health, social care, non-teaching staff and education and the community voluntary sector.
MARION O’ROURKE:
We’re going to start with I suppose a little overview of Northern Ireland. How many people in the audience have been to Northern Ireland? A few that’s great. Did you all like it?
FIDELMA CAROLAN:
Good you have to say that.
MARION O’ROURKE:
And those who haven’t been to Northern Ireland hopefully after this presentation you will be really keen to come and visit us.
AUDIENCE:
What is the difference between Northern Ireland and the other one.
MARION O’ROURKE:
Northern Ireland is part of the United Kingdom. We have Scotland, England and Wales as one, well three countries but joined up on one land mass. Then we have Northern Ireland and Southern Ireland just over to the left of them if you’re looking at the map.
Northern Ireland is part of the United Kingdom but we are on the island of Ireland. We have a border with north and south. Sorry?
AUDIENCE:
[Inaudible 0]
MARION O’ROURKE
Yes, unfortunately we are part of Brexit because we’re part of the UK. We have officially left Europe.
FIDELMA CAROLAN:
We left Northern Ireland to come here and United Kingdom left Europe on the same day.
MARION O’ROURKE:
Maybe we’ll just stay here in Australia and not go back because we don’t know what that’s going to look like.
Northern Ireland I suppose just to give you a wee overview we have a population of 1.8 million people, which isn’t very big particularly when you’re talking to people from Australia. We’re very small. As I said, we’re part of the United Kingdom.
We’re a good place and some of these photographs are really just to entice you to come. This is a photograph of the Giants Causeway on the Coast, it’s a really nice place to come and visit.
A couple of facts just about us. We have a very good education system. We’re very proud of our education system and most of our young people will go on to either further or higher education.
However, we do have issues around a number of our school leavers leaving without formal qualifications. We have two Universities, two campus based Universities in Northern Ireland and we have the Open University as well. A good education system.
In terms of who the Social Care Council is. We are the regulatory body for social work and social care. That’s about driving up standards and ensuring a good quality of care and support for people who use our services in terms of social work and social care.
Everything we do I suppose is based on wanting to improve those standards. We take a valued space approach to our model of regulation and I suppose the one value that we focus on respect on dignity, on meeting the needs of the individual.
One of the things I wanted to talk to you about is in relation to partnership that we regulate within a model of partnership. We’ll talk a little bit about that later.
Just to give you an overview of our model of regulation. All regulators who regulate a workforce work on the basis of this set standards. We set standards for conduct and practice. We bring people onto a register and then we set requirements as to high to medium on that register. A big focus on remaining on the register and being part of the register for courses around professional development.
The third arm of our model of regulation is around how do we support people to meet those standards. Through workforce development, we have a whole range of relationships and ways we engage and work with our registrants. We work with people who use the services we work with employers. We work with education providers all to ensure that the quality of care and support that is delivered is of good standard.
We set standards for our social workers, social work students, our social care workers and I’ll describe to you what we mean by social care in a minute. As well as setting a code for our employers, employers have to support their workforce in terms of meeting their standards.
What am I talking about – I’m talking about almost 45,500 people on our register. The vast majority of those are people who work in social care services. Over 38,000 the rest are social workers and social work students.
What do I mean by social care worker? What we me mean here are people who work in adult residential care, children’s residential care, supported living so high schemes where there is onsite support. Home care where people go out into people’s homes to provide support. Day programs so when we talk about day care that’s not in relation to child care that’s in relation to day care programs for mostly adults provided at various centres.
That’s the breakdown of who we mean by social care. When Melissa talked about completing our registration over that time frame that’s the group of social workers that we bought onto our register.
FIDELMA CAROLAN::
Just to pick up there when we were introducing the notion of registration came in it was introduced for social care workers as a trade union we were really concerned. We had a significant number of members who worked particularly in homecare. These were highly skilled individuals but unqualified because there was no qualifications needed to come into a job in homecare or indeed many of the care professions at all.
Most of the profile of homecare were probably women over 40 whose child caring responsibilities had changed and were coming back into the workforce into a job where no qualifications were needed which suited them because generally they didn’t have a lot of qualification.
In Scotland, they introduced a qualifications based register. You must have had a minimum Level 2 qualification to even come onto the register. In Northern Ireland, we would’ve lost 80% of our workforce overnight in homecare.
We as a trades union and supported very much by the regulator introduced a non-qualifications based register. You come onto the register by virtual off the job role you’re doing. We went out to our members and there was a lot of engagement to provide assurance to them. They were very suspicious.
This was a government initiative, there was a feeling someone was trying to catch them out this was a way of getting them in trouble if they didn’t do everything right. Also the cost of becoming a registrant as a low paid workforce. Even things like literacy was an issue and whether or not that would be a barrier for them to continue in a profession that they really really loved.
But we saw tremendous benefits as a trade union. One of the key things for us was the professionalisation of the workforce. The recognition that this indeed is a workforce not a loose collection of people working kind of independently.
It was all seen, as very much it’s just a job. We saw registration as an opportunity for a career, which would attract new people into the field. One of the learning points is that homecare, the profile of the homecare workforce now has changed since then. You have a lot more younger people coming in to work in support roles, in homecare roles, in supported living. That for us is a really really good thing.
We also felt that because part of someone’s registration they must do a minimum of 90 hours learning over 5 years then while it was the individuals responsibility to find that learning the employer had a responsibility to support their staff member to access that learning.
For us that was tremendously important because our experience has been that the more qualifications you have the more training you get offered. If you’re already a qualified nurse or social worker, you get offered loads of training from your employer. If you’re a care worker, a support worker, a cleaner or catering assistant you’re lucky if you get your manager training.
This really was a requirement for employers to invest in people’s learning and development, which supported the idea of this being a career and not just a job and progression.
Also, this was about public protection. If I was talking to a group of thirty care workers in a room inevitably, at least half of them would have family members in receipt of care perhaps aged care. They wanted to be assured the person looking after their loved one was on a register and their practice could be stood over. If their practice was poor and didn’t meet the standards, they could be removed from that register and the people would be protected from poor practice.
A key thing for us as a trade union was the engagement with the regulator. We worked very well together because we had a common interest. As a trade union, we want to protect the right of workers but ultimately we want to ensure that they’re providing a really high quality valuable service to those they’re looking after or caring for or providing advocacy for.
It’s really important for us that that worker is well trained, is well supported, and can do the right thing every time and knows what they’re doing. They provide really high quality that’s good for the person who receives the care, it’s also good for the worker. There is no contradiction for us in that and that’s really really important.
One of the things we developed was whistle blowing. Unfortunately, some organisations were not very supportive and did not support the workers to provide good quality care. We developed a guide whereby if somebody felt their provision was being compromised or they saw poor practice they could call it out.
It’s very hard as a worker, a low paid worker to actually complain about your employer forcing you to provide poor quality care or seeing poor quality care because you’re afraid you will lose your job. In a rural area, perhaps members of your family are working for the same company. We provide guidelines to support people to be able to whistle blow properly.
MARION O’ROURKE:
I suppose what we were trying to do is introduce a whole system approach to what social care should look like. This slide might be a little difficult to read from a distance. What it really describes is a hierarchy of needs. What are the key things that need to be around to ensure good quality care, a good experience for the people who use services. I suppose a structure around what social care looks like.
In there you have a career structure, you have standards, you have supports for the development of the workforce. You have a values led workforce. A system whereby the people who are delivering the services are there because of a value base.
What different are we making? We have taken a phased approach to the roll out of registration. Our initial roll out began way back in 2004 when we opened the register to our social work workforce initially and then moved on through the various groups that I described throughout the social care workforce. As Melissa said, we completed that in 2016, 2017.
So what difference are we making? Our Department of Health have undertaken a survey in terms of impact on an annual basis since then. So after year two we were able to see that 73% of employers were telling us that the standards were making a difference to the quality of services they were able to support and deliver.
Two out of three of our social care workers were telling us that they had increased confidence in their ability to practice and deliver good quality services. Over 64% of staff telling us that the standards helped to reduce and manage risk that they felt that the people that they working with were better protected as a result of the services.
We’re going to play a very short video clip to give you a sense of what some our employers from the not for profit sector have been telling us about the difference that this scheme has made.
[VIDEO SHOWN]
MARION O’ROURKE:
Another aspect that I suppose we’ve learnt from this scheme and process is that there is a value to the economy from the social care sector that is often hidden and unseen and not really thought about in terms of government priorities.
One of the things we did was developed an economic review of the impact of social care in the economy. I think that’s really important. I put that kind of result from a scheme such as yours that you’re considering.
I suppose and I’m not going to dwell on this part of it for too long, but one of the things that any regulation scheme must include is a complaints process. For us we call that Fitness to Practice. That’s about making decision where someone’s fitness to practice well is called into question.
We have a whole robust and transparent system that sits around that but I should say that really only less than 1% of any workforce will eventually come before fitness to practice process. 99% of people out there are wanting and are doing a really good job. Very few are actually wanting deliberately or through their lack of knowledge and skills are causing real harm and damage to people that they work with.
As I said earlier, I suppose our focus therefore is around helping and supporting the workforce to develop. One of the things that we do through our regulation scheme and I think is one of the added values are the value proposition of your scheme is around how do you support learning and development. How do you encourage the workers on the register to develop their knowledge and skills.
We have worked quite closely with a range of partners to develop a whole range of online free resources and products. Some of them we’ve worked with unison with Fadelma in terms of the kind of learning that supports the development of good practice.
FIDELMA CAROLAN:
In unison, we have unison college where we offer members a range of free workshops. Everything from autism, suffering learning disabilities also resilience, mental health awareness, palliative care and dementia and it’s free to members. That’s one of the benefits of being part of our union.
From that point of view, it means we get to engage with our members on a regular basis. It’s a really important offering as a member of our trade union. It’s something they can get it’s not just when they get in trouble they may need a trade union they get access to our learning.
It also helps them be better at what they do, it helps them aspire to maybe progress in other areas. Because it’s not necessarily job related it also helps people personally.
We could have a classroom assistant who comes and does a dementia course because one of their parents have been diagnosed with dementia. You get someone who will do our suicide awareness course because they are a volunteer in their local church youth group.
In a work environment they can really only access learning that’s only related to the job they’re doing not perhaps the job they aspire to or maybe to access more general support like resilience or mindfulness training which might help them in a more general way.
MARION O’ROURKE:
Again, we’re just going to play a very short video clip from one of our social care managers who talks a little about the value of learning.
[VIDEO SHOWN]
So what’s our future direction? I suppose a number of years into the scheme. For us registration has provided us with a number of opportunities. One I suppose is about how to influence up into the system. In Northern Ireland, we are going through a whole range of transformation pieces of work around our health and social care system.
What we’re recognising is the pivotal role that social care has in transforming health services. A real recognition about the impact that social care can make on people’s lives. There is very much a better focus a better policy focus around where social care can fit into the whole system.
The other developments that we’re currently focusing on is around our use of technology. Both in terms of assistive technology and high technology supports people to live their lives better but also in terms of our use of technology in engaging with our workforce and providing them with learning opportunities.
Also, a recognition that we are now in a better position to develop a qualifications framework. We want to move towards a qualifications based register . We feel that we have the opportunity to begin to do that in terms of how a career in social care might look like.
Finally, I suppose we have a great opportunity and you do too through your registration scheme to get involved in the whole leadership agenda. In making sure that, the profile of social care gets right up to leadership levels. We do that through a partnership approach.
So we’ve talked for long enough I think. We have one last video that we’re going to leave you with which captures a lot of the messages that we’ve tried to talk about. After that, we are really interested to hear from you, to hear your experience and to have some discussion with you.
[VIDEO SHOWN]
That just gives you a flavour and overview of some of the messages that have come out of some of our experience in the registration scheme in Northern Ireland. We’re happy to hear from you now.
QUESTION:
do you have an LGBTIQ policy in your scheme?
FIDELMA CAROLAN
Within the trade union, we have a very strong LGBTIQ + group. Within the social care counsel as a public body it’s obliged under Section 75 which includes sexual orientation and gender identity in terms of any policies that come out of a public body that comes out of Northern Ireland must make sure it does not have an adverse impact on people on certain grounds which includes LGBTIQ + and gender identity so yes.
QUESTION:
This is one question, and one point. Does the care quality commission operate in Northern Ireland?
FIDELMA CAROLAN:
No, it’s England only.
QUESTION :
One of the major problems here as far as we’re concerned in residential care is minder care. Do you have that problem?
FIDELMA CAROLAN:
Can you explain what you mean by that, I’m not familiar with that phrase.
QUESTION :
Talking residential care. Your term residential care may not be similar to ours but we’re talking group homes where they mind the residents rather than improving their quality of life and their skills and all this sort of thing. They’re just minding them.
FIDELMA CAROLAN:
We have three types of care. One is residential care, secondly nursing care where you would have a nurse, so there would be some medical needs that would need to be supported and then independent living.
In residential care, a lot of residential homes would have things like activities coordinators but not all homes would have the likes of activities coordinators. The standards that are set by the service user regulator would include ensuring that their residents are still engaged with their communities of interest for example that could be a religious faith based community.
We would argue from a LGBTIQ perspective that they should be encouraged to access the likes of Pride and supported to do that. It does depend very much on the individual at home and their ethos how much I suppose emphasis they have on the development of the residents rather than as you say just minding them and meeting their basic health needs.
MARION O’ROURKE:
I suppose in terms of some of our carer homes, it is very much about trying to meet the individualised needs of the person living there. They will decide what level of engagement they will want particularly around supported living where people maybe with a physical disability live in independent accommodation, maybe they have their own apartment but they have onsite support.
People in those situations will decide how much level of engagement I will choose to or need to have in terms of the support that’s available on the site. The staff who are there are registered, are trained, are supported to be able to either provide the level of support that the person seeks or knows how to provide access to that level of support.
Just going back to your question around CQC we don’t have but we do say as Fidelma says a service regulator in Norther Ireland the OQRI and it’s their job to inspect services and employers provision of services. Yes, we do have a regulator that sits across that.
QUESTION:
Thank you.
QUESTION:
I just had a quick question, does this include youth workers?
MARION O’ROURKE:
In terms of the registration scheme?
QUESTION?:
Yes.
MARION O’ROURKE:
No, youth workers are not one of the designated groups that are identified through our legislation. However, there is grey areas because we took a phased approach to the introduction of the compulsion around registration. We do open the register to people and employers who felt that the services that they were delivering fell into social care.
A lot of youth and community workers and people working within maybe homelessness or addictions felt that they did sit in there. They can be on our registrar on a voluntary basis and supported by their employer.
One of the things we think will be interesting and necessary for us to look at is do we need to revisit the legislation and take this further. We’re not really ready to do that at this point in time in terms of legislative approach. We do work with employers to see whether registration fits as broadly as possible with the needs.
They can get on to the register but are not one of the compulsory groups.
QUESTION:
Thank you very much for that presentation it was really really valuable. I’m from Carers Victoria and I’m trying to put together our submission related to the Victorian Disability Regulation Scheme.
I’ve just got a couple of questions about how the Northern Irish scheme came about. First of all, what level of employer input was there in the actual standards?
MARION O’ROURKE:
Okay so as part of the development of our standards we had a really wide ranging engagement program. Employers were very much a part of that process. The way we would’ve done that would’ve been through a series of workshops. We would’ve talked broadly about what standards needed to look like and then we would’ve begun some drafting and testing. You know what that looks like.
Employers were a key part of that particularly given that we had such a wide range of employers in Northern Ireland because we were working right across the whole sector not just one part of the sector. We had employers from disability, from mental health, from older people, a whole range.
We have employers who provide services both in terms of the statutory for profit and not for profit sector again we had to engage with those. Equally important, in fact more important to the employers was the people who use the services.
We had a significant program of engagement with them as well.
We have within our structures I mentioned partnership early and partnership was really key to how we work. We have participation partnership which is a partnership of people who use services and their carers and their family members who come together to help us through all aspects of our work.
Also on our council, the board of our council one third of the council is made up of service user and carer representatives as well as one third come from stakeholders so that can be employers and then another third is registrants.
We try to make sure that we engage and listen as much as possible. We don’t always get it right. But we do work hard at it. The standards are freely available from the website so that might be a good starting point for consideration.
QUESTION:
I will look into that, I’ve got two more questions. How casualised is the workforce and did you see a difference between when registration started and then now?
FIDELMA CAROLAN:
It’s more casualised than me, a trade union would like. It varies, we have statutory provision and obviously, that’s contracted hours. We have been working with employers to provide contracted hours for staff. A key element of that has been about security and also being able to – because people on casual hours can’t plan, can’t budget.
That’s all very well and good till retailers and big business realise that people weren’t spending money because they couldn’t plan and couldn’t budget and the casualisation of the workforce more generally was impacting on the economy.
Interesting we had very strange alliance with big business around reducing the casualisation of the workforce. It’s always a challenge because these are commission services. These are commission services, so once it goes into the profit, not for profit sectors then they’re all competing against each other to provide a service and tend to undercut each other.
What happens then they struggle to provide a service because they’ve undercut to the lowest common denominator, which is not good for the organisation in terms of reputation. Certainly not the worker and definitely not the person who is receiving the service.
I think regulation has supported the professionalisation and therefore organisations having to look at the workers rather than just casual jobs, even if the hours are casual. They need continuity. It’s very expensive for an organisation when they just churn.
You bring people in they leave, you invest in them for a short period of time, you put them through induction and they leave. We’ve been trying to encourage employers to recruit people with value. Look at what you’re going to pay people. If someone is going to be paid an hour more over the road they’re going to move.
You need to look at the added value of the organisation. As much as people love the work and are really committed to people, they have to earn a living. I think there is a combination of in some ways the commission services and moving out to for profit and not for profit sectors has increased casualisation to some degree but in some ways the job is seen in a much more professional capacity.
We’re hoping long term there will be more continuity and more stability.
QUESTION:
I’m not sure you know but the workforce here is very casualised. Not the social care workforce in the aged sector for some reason it’s totally different.
One more question, you mentioned your complaint system is transparent. What do you put in place to support that?
MARION O’ROURKE:
Okay well I suppose a number of things that we do and all workforce regulators will do this. The process is available at the point of registration and available as information on all our websites. It’s available to anyone who wishes to see it.
We also set very clear threshold standards and standards what we call standards of acceptance. We worked with the unions as well and through our registrant’s forums. As well as a participation forum we have a registrant forums. On our registrant forums there are trade union colleagues and we worked with them to develop guidance around what the fitness to practice process would look like what the threshold is and to help employers understand what that is.
There is a lot of I suppose behaviours or incidents that really fall within the remit of the disciplinary policies with employers don’t need to come to the regulator. We don’t want to clog up the system, clog up our system with stuff that employers need to deal with.
We publish very clearly what our thresholds are around. First of all we have the burden of proof is beyond reasonable doubt. We have an investigation process. We are particularly interested in the people who and this was if you think about fitness to practice, the people who are potentially not fit to be in practice. Safeguarding issues, issues of real concern.
The kind of things that we tend to see coming forward are around dishonesty and values and relationship based stuff around abuse or neglect of their duties, false record keeping and deliberate and harm those kind of things.
The transparency then progresses on in terms of we publish all of our – through a notification system we publish all of the details of our fitness to practice cases. That’s readily available on our websites so people can see why a person has been removed from our register.
Also Fidelma has reminded me the committees who undertake the adjudication process are all independently appointed, to their committees and of independent appointment.
FIDELMA CAROLAN:
And everybody has a right to representation. If someone is a member of the trade union I can go and represent them under that process.
I think one of the challenges for Victoria is that you’re introducing a voluntary register. We’ve heard the terms register of exclusion. Because we have a compulsory register you can only work if you’re on the register. If you’re removed from the register you can no longer work in social care.
This is going to be the real challenge for you. It falls very short as a public protection measure. There is also a real opportunity as part of a voluntary registration scheme to link it very closely to learning and development.
In our experiences 99%, I’m not going to do the maths but it’s over 36,000 people are doing a really good job every day. Why would we put all of the investment into the 1%? It’s really important that regulation is linked to learning and development.
I think again because the casualisation of workforce and because of self-management, I think that can be also a real challenge for workers to be able to access learning and development. Our conversations we’ve had here with government, with FSSI with RMIT, looking at things like micro credits, things like VCOSS, organisations that are umbrella organisations or peak bodies as you call them working together and sharing resources to provide training and learning opportunities for each other’s staff.
There is lots of things that organisations could do really really cleverly and at very little cost to try and support people to access learning and development opportunities which ultimately will allow them to be better at what they do and support people more effectively.
There is no losers here in this process as far as we can see.
MELISSA HALE:
Any last questions?
FIDELMA CAROLAN:
There were no hard questions, that’s great.
MARION O’ROURKE:
Thank you all so much for having us today. It’s been a real privilege for us to be here with you. Thank you for those questions. We certainly wish you luck in your journey towards registration of the disability workforce. We think it is a great opportunity.
I am sure this forum will debate a lot of the questions that come out of that and the journey around that. Thank you to the staff here for looking after us and hosting us. Thank you very much.
MELISSA HALE:
Thank you very much. It really is a privilege to have you both here today.
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- Author:
- DARU
- Date published:
- Tue 11th Feb, 2020