Notification and registration of social care
An Irish solution to an Irish problem
Niall McElwee and John S.G. Wells
A paper was recently given to the Association of Psychiatric Nurse Managers at their Annual Conference (McElwee, May, 1999) where Minister Fahey was criticised for his failure to move on State registration of social care workers. This criticism was articulated because there is a pressing need both morally and professionally to register social care workers in the current political climate surrounding the history of child care in Ireland. For example, the recent "States of Fear" programmes broadcast by RTE highlighted the whole issue of the degree and focus of professional training that should be required before an individual is allowed to work with vulnerable children. The majority of people working with such children are social care workers, yet not one social care worker was interviewed during the course of the three programmes. Once again, in a scandal directly affecting social care workers, their perspective and professional views went unheard and were ignored. Instead, if they are to be heard at all, it is as contributors on radio chat shows or in the letter to the editor sections of newspapers up and down this country.
This is simply not good enough. Surely we have learned from the *Kilkenny Incest Case, the Trudder House case and the Madonna House case to name but some … Successive Ministers have been allowed to 'kick to touch' on State registration, but it is now essential that we move on registration.
This situation is even more ironic when we consider the recent announcement by Minister O’Donohue that legislation will be passed requiring convicted paedophiles and other sex offenders to "register" with the State! Indeed, one might well ask of the government, in considering these two policy positions, does the right hand know what the left hand is doing? Even more so, when the country is about to experience the most painful tribunal yet — an investigation of the systematic and institutional abuse of children that passed itself off as a system of child care in this country for the last hundred years.
A climate for State registration
As a result of a number of high profile scandals reported in the media, the public is now (generally) aware that there is neither notification nor registration in place for social care workers. There are no comprehensive and accurate national statistics for active social care workers employed in either the voluntary or statutory sectors. A number of social care workers are members of the Irish Association of Care Workers, whilst others have chosen union representation or no representation at all. The point is that lack of a national register means that the State has no data regarding numbers, level and range of qualifications. Nor does it have any means at present of being able to assess how many social workers are unsuitable for practice. If there is one important point to arise out of the "States of Fear" documentaries it was that not every incident ends up in a criminal prosecution — that is the whole point. Proposals about "tracking" sex offenders, and requirements that sex offenders inform the authorities if they intend to seek employment in an area involving children, rely on conviction in the criminal justice system. Yet the standard of proof is such in this system that not all cases are prosecuted and those that are do not always result in a conviction. A registering body would be able to take a more "holistic" view of an individual’s suitability for practice and would therefore be an effective means of protecting the public in ways not possible for the criminal justice system.
The case for registration
It seems, from reading through back issues of Curam (the Irish Association of Care Workers official mouthpiece), that social care workers want a State registration system. Indeed, the issue has been consistently raised at a number of annual conferences. So, if social care workers favour State registration, why has it not happened? It seems that the reasons State registration has not occurred in Ireland heretofore are (a) because no politician was/is interested or powerful enough to ensure that it was/is pursued and (b) registration carries a financial cost that the Government has not been prepared to meet. One also might wonder if there is both political and professional resistance from certain quarters to what the establishment of a register would mean for the various vested interests. After all, a national register to practice would enhance the professional status of social care workers with regard other disciplines; something they lack at present. It would also greatly enhance the "political voice" of the profession amongst the general public and the councils of government. At a time of State contrition and inquiries about the past, this might not be welcome.
We do not want to minimise the administrative difficulties of establishing a register. These are by no means inconsiderable, for example, minimum criteria for registration, the establishment of a code of practice and so on. However, if there is a political will and a collaborative spirit between Government and social care representatives these are not insurmountable.
However, the logic for a state registration of social care workers is overwhelming. We want to briefly outline our case. It is the norm elsewhere for this discipline and it is also the norm for our colleagues in related areas such as psychiatric nursing to register on completion of an agreed period of study. Indeed nursing has had a successful state registration since 1919. One of the ironies is that it is a requirement for psychiatric nurses, working with the same population of vulnerable children that social care workers often initially work with, to be registered before they can practice.
The first question often asked with regard the issue of registration is what is the difference between notification and registration? One of the authors (Niall McElwee) was an invited member of the Expert Working Group on Childcare and co-ordinated the search for material on registration for his sub group (training and registration). It was agreed (1998, p. 46) that the principal difference between notification and registration is:
When a system of notification is in place, the onus is on the person or organisation providing the service to notify the relevant authority
Registration, on the other hand, requires the State to agree to register or licence a service as meeting the minimum standards; it also empowers the State to refuse registration and allows for annual review.
The specifics of State registration
Registration moves legal responsibility to the State for regulating standards of practice and everyone, social care workers, clients and the public, are clear about this.
All social care workers who want to work would have to provide a full background profile to the registration body for consideration. This material could be held centrally and could be monitored on a constant basis. This approach is already used in the United Kingdom, where the United Kingdom Central Council for Nursing, Midwifery and Health Visiting requires that all registered nurses maintain a professional portfolio of their professional development and maintenance of their competence that will be periodically called in for inspection as a requirement to maintain their registration.
Such a scheme would provide a database that would be invaluable for future information needs and social and educational policy formulation.
A rating system for courses could be developed whereby a national standard could be agreed. For example, there are an estimated 4,000 people registered on childcare courses in over 50 centres nationally with widely varying standards and qualifications.
A code of practice and conduct could be established by which a social care worker would be expected to abide. A social care worker who is disciplined for infringing the code, for example through inappropriate practice (such as sexually, psychologically or physically abusing a child in his/her care) could be struck from the register and this noted with all relevant bodies to ensure that this person does not gain entry into social care again. Employers could seek such information or workers be required to produce proof of registration before they could take up employment. Although this is contentious, if we really are concerned about the ‘best interests of the child’ (UN Convention, 1989, Child Care Act, 1991) we have to be proactive rather than reactive.
To ensure fairness and equity, an appeals panel would need to be established. Any appeals process should have predetermined routes of complaint and procedure.
State registration with an independent body would remove any ‘difficulties’ in the market place where collusion between favoured employees and employers could potentially arise. State registration would assist in the "professionalisation" of social care.
We do not believe that notification is an effective enough step in the social care debate, not least because it does not command a legitimacy amongst many that registration would. Collating the information for State registration will, in the short term, prove costly and demanding. It will require collaboration at government, academic and practice level amongst organisations and individuals.
At the moment Ireland is focused on what was done in the past to vulnerable children by those charged with their care, in particular the religious. However, Government and Irish society created the attitudinal and institutional environment which allowed children’s needs and perspectives to be dismissed and placed faith in a closed world of prelates immune to outside scrutiny. In such an environment it was not surprising that abusers found a safe haven. There is no excuse for this blinkered attitude now. The lesson of the past is that regulation from the outside through a system of State Registration to Practice is the most effective way to protect children. It won’t necessarily stop the isolated abusive incident happening, but it will ensure that the days when a serial abuser could go on blithely without fear of examination will not return to haunt Irish child care work again.
* These are all scandals
affecting social care workers where investigations were commissioned by
the governments of the day.
Expert Working Group on Childcare. (1998). Final Draft of the Report. National Childcare Framework: Partnership 2000 for Inclusion, Employment and Competitiveness.
McElwee, C. N. (1998). Beyond the Far Side: Risk and Adolescence. Mental Health and Young People. Irish Journal of Applied Social Studies/ Mental Health and Social Care Research Group Forum. Waterford Institute of Technology. 8.9.1998.
McElwee, C. N. (1998). The Challenge for the Future. Children at Risk in Early Education. National Forum on Early Childhood Education. Dept. of Justice, Equality and Law Reform. Dublin Castle. 25.3.1998.
McElwee, C. N. (1998). Mental Health, Social Care and Adolescence: Two Disciplines Divided by a Common Language. Paper to the Association of Psychiatric Nurse Managers Annual Conference. Kilkenny May 20th, 1999.