Scottish Government

3 IMPLEMENTATION OF THE PILOT

Introduction

3.1 This chapter outlines the commissioning of pilot sites by SGHD and describes the participating pilot sites. We explore perceptions of initial guidance and early communication with the Scottish Government. Key findings from the formative stage include perceptions of reasons for early delay in implementation and understandings of key concepts on which the pilot was based ('patient safety and public protection' and the definition of and inclusion of healthcare support workers). The second section sets out the roles of NHSQIS and pilot coordinators and stakeholder views on development of processes and level of resource required for the pilot.

The SGHD invitation to tender

3.2 In July 2006 the Scottish Government Health Directorates ( SGHD³⁶) issued an invitation to Health Boards to bid ³⁷ to be a host site for the national pilot project to test out arrangements for employer-led regulation of healthcare support workers in Scotland. The invitation highlighted the high profile, unprecedented nature of the project, its role in informing future decisions about the regulation of HCSWs and its potential to inform the way forward across the UK. The pilot funding for a 12 month period (January 2007 to January 2008) was to cover three main elements of support: a financial contribution to assist retrospective Disclosure Scotland for existing employees; funding for one Local Pilot Coordinator per site; the support of the National Pilot Coordinator based at NHSQIS. The pilot and funding were subsequently extended until the end of December 2008.

3.3 The invitation detailed criteria to be met by Boards including: Board level support and partnership arrangements; services for inclusion and healthcare support worker sample; workplace supervision and support; arrangements for data entry to the 'list'; internal data collection and for the external evaluation; contribution to the project process including across Board pilot development. The pilot was to focus on mental health and children's services in particular and SGHD indicated that allHCSWs in these service areas were eligible to take part in order to achieve an appropriately sized sample.

3.4 Initially, six NHS Boards expressed interest in the pilot. Three Boards subsequently withdrew because it was felt that other priorities (such as Agenda for Change) were more pressing. The three NHS Boards submitting successful bids to SGHD (September 2006) were NHS Ayrshire & Arran, NHS Lothian and NHS Greater Glasgow & Clyde. Ross Hall Hospital, Glasgow, represented the independent healthcare sector and took full part in the pilot but not the independent evaluation ³⁸. NHS Glasgow and Clyde subsequently withdrew (early April 2007) and NHS Lanarkshire later joined the pilot to be the third site (July 2007).

3.5 There were multiple factors contributing to NHS Glasgow and Clyde's decision to withdraw from the pilot. The bid was completed at a time of local Health Board reorganisation (March 2006) and consequent restructuring of partnership arrangements. It was a challenge to identify and include all potentially interested parties within the short timescale for the bid. The bid was strongly initiated from within children's services and after discussion with SGHD Mental Health was subsequently brought on board. There was some break in continuity later as the mental health lead officer changed post.

The participating pilot sites

3.6 The Local Pilot Coordinators were placed within the practice and development teams for unqualified clinical staff. Ayrshire and Arran had a strong team of three lead officers: Head of Practice Development, Head of Organisational Development, and the Vocational Learning Manager. In Lothian, the project was managed by a Senior Nurse Clinical Support Worker and the lead was the Head of Continuing Professional and Practice Development. The Lanarkshire pilot was managed by the Support Workers Development Manager and overseen by the lead, Associate Director of Practice Development for Nursing, Midwifery and Allied Health Professions. Each participating site had an executive sponsor on the NHS Board and support from the Chief Executive.

3.7 The model was piloted in areas with vulnerable client groups. Ayrshire and Arran and Lothian began running the pilot within Children's services and Mental Health services. The Lanarkshire site included the Older People's Directorate and Old Age Psychiatry. At a later date, NHS Lothian expanded recruitment to include Older People's services. Bank services were involved at all three sites.

3.8 The original site bids varied in specificity of healthcare support workers ( HCSWs) to be included. NHS Ayrshire and Arran, was a relatively small site (500+) and expected the majority of recruits to be nursing assistants, with a lesser emphasis on ancillary staff (catering, portering, domestic, laboratory). NHS Lothian, a much larger site, anticipated a large and diverse sample (1500+), but no detailed breakdown was given at outset. The Lanarkshire site planned to initially focus upon clinical support workers and Bankaide but planned to engage support services at a later stage. At this site, children's services were excluded because most services were community based without eligible HCSWs and there were low numbers of ward based eligible HCSWs.

3.9 It was anticipated that these three sites would be sufficiently different in terms of the settings' operations to allow the scheme to be tested in both urban settings (with large, dense populations, busy healthcare settings, and large staff groups) and in rural settings (with dispersed or remote healthcare settings covered by smaller staff teams).

Perceptions of the early stages of implementation

3.10 The bids from the three initial pilot sites were prepared in parallel to the Consultation on Standards but prior to the Guidance being written. The initial bids varied in terms of level of detail presented, and despite the criteria set out (para 3.3) there was a perception by some respondents within the pilot sites that they had been bidding 'blind'. The Glasgow bid was spearheaded from children's services and took longer to draw in mental health than the other sites. Moreover, partnership arrangements were not clearly specified by Boards in the initial bid. It was probably not a coincidence that the two sites with the most complete bids (Ayrshire and Arran and Lothian) were furthest ahead in the first few months, with Glasgow subsequently withdrawing from the pilot.

3.11 The initial focus on mental health and children's services was largely driven by the pragmatic need, at that stage to focus on specific cohorts of workers, but also by NHSQIS's concurrent overall strategic focus on these services. Respondents were largely happy with this focus as these services were expected to provide contrasting experiences, and both covered work in the home. HCSWs within children's services were more likely to have more SVQs, and to have high child protection awareness and to have achieved the standards already. In contrast, it was anticipated that within mental health services, the standards would provide a development opportunity for more HCSWs with a lower level of assessment achievement, and there would be opportunity to explore risk assessment and accountability for junior staff in unsupervised areas.

Guidance and early communications

3.12 The following nationally developed documents were produced at the intended points:

• Code of Conduct and Induction Standards for HCSWs; Code of Practice for Employers; the Standards consultation response (published on the web November 2006)
• Guidance for Employers and Employees in participating NHS Boards (December 2006)
• Four page generic publicity flyer about the pilot and standards
• Payroll insert distributed to all NHS employees (February 2007)

3.13 Pilot site respondents generally felt that early communication between Boards and SGHD had worked well. They felt they had opportunity to comment on draft standards and guidance although there appeared to have been some communication gaps around distribution of the general publicity flyer which arrived somewhat late to pilot sites. They thought it would have been beneficial to have draft documents at the outset (an assessment outline format plus more guidance on minimum standards) to help inform HCSWs and steering groups at the outset.

3.14 Whilst those in the pilot sites were realistic about the pressures of compressed timescales for the HCSW project and about how much pre-pilot activity could have been covered, they still felt some very key issues were not sufficiently addressed pre-pilot and these continued to surface throughout the pilot. In particular the following were not clear at the outset:

• What the level of co-ordination required from the National Pilot Coordinator and the information and training requirements via the Local Coordinator would be; the level of preparatory work if any already carried out by Boards; time required to train WPS and HCSW
• The induction processes already in place differed for each Board; they appeared clearer for some groups ( e.g. nursing assistants) than others ( e.g. ancillary staff)
• How the new standards might or should be operationalised and measured was not fully understood or shared
• The anticipated Board self-assessment process needed to be robust to gain confidence in employer-led regulation - and there were concerns for some that the format and consistency of employer-led regulation could affect support.

3.15 The evaluation team's perception was that the main early focus was on the HCSW induction standards and that other elements (Code of Practice and Board self-assessment) were of low profile. The wording of the overall term 'Standards' (for all three elements) and specific term 'induction standards' was not helpful and added to lack of clarity at times.

Delay in implementation

3.16 Many factors contributed to early delays including: withdrawal of Greater Glasgow and Clyde from the pilot, recruitment of National and Local Pilot Coordinators, slowness in establishing the national and local steering groups and pilot communication structures.

3.17 The appointment of the National and Local Coordinators was problematic from the start. The first National Coordinator due to commence early October 2006, with a view to getting underpinning processes underway, actually took up post two months late at the end of November (she was subsequently absent from post for some months). A second NPC was seconded on a two day per week basis from May 2007 and took up post four days per week from September 2007.

3.18 There were differing views, between SGHD, Boards and NHSQIS about the appropriate band level for both NPC and LPC posts and between Boards and NHSQIS about the recruitment approach for LPC posts. The original proposal was for central NHSQIS recruitment and management of the LPC posts but there were concerns from Boards about the perceived low banding of the NPC post, by NHSQIS, which in turn had implications for banding of LPC posts. There was also concern that the whole process was too rushed and driven from the centre. The pilot Boards decided to take over recruitment and management responsibilities locally. The initial delay caused by differences about banding and recruitment reflect the need for a shared approach to evaluation of posts for projects with both a national and local dimension.

3.19 Dispute over banding delayed local Coordinator appointments by at least four months. The Lothian LPC took up post, one day per week from April 2007 then four days per week from June. The Ayrshire and Arran LPC began late May 2007. The Lanarkshire LPC, recruited late August 2007, began late 2007. (The first Lothian LPC moved post in April 2008, temporary cover was provided over the summer until a replacement LPC could be recruited).

3.20 The NHSQIS National Steering Group first met late April 2007 after two postponed meetings. It took some time to achieve full membership, with a Disclosure Scotland representative added after the first meeting and difficulty in securing a Human Resources Director. Considerable focus at initial meetings was on revision and sign off of project management documentation ( e.g. the Project Initiation Document, Communication Strategy).

3.21 Although the NHSQIS lead officer had met with site lead officers separately, there was minimal cross Board communication until the National Management group ( NPC and three LPCs) first met some four months into the pilot. The continued absence of the first NPC led to delay in a number of areas including clarification of what was already available at Boards, completion of the project plan and timescale and direction of the assessment framework. However, once the new NPC and LPC staff were in post, the pilot quickly picked up momentum. The NHSQIS project administrator appointed mid March 2007 worked part-time initially until the second NPC began to drive the project forward.

3.22 The first two local site steering groups were in place from late February: Ayrshire and Arran were furthest ahead and put a paper to the local Partnership Group in mid February. All three groups had a bank staff manager; Ayrshire and Arran and Lothian had input from Facilities managers.

3.23 It soon became clear that the proposed twelve month timescale was insufficient. There was consensus that a year of fully operational working was required once the Local Coordinators were in post and the first HCSWs were recruited (September 2007 - September 2008). Therefore SGHD extended the pilot by one year to end of December 2008 ³⁹.

3.24 This was in recognition of the delay in NPC and LPC starts. It was also recognised that LPCs faced a huge initial task in negotiating with Partnerships, and the clarification of existing induction and development arrangements. Once in post LPCs required time to engage HCSWs and individually gain consent. More time was required to clarify implications for both existing and new staff, especially in light of variation in Knowledge and Skills Framework implementation. A full year was required to see how HCSWs entered onto the list might be managed longer term; particularly to address any implications about information sharing across Boards. Longer than a year was required to assess whether the standards could be met and whether any changes to standards might be required.

Early perceptions of core concepts

3.25 The evaluation found that, in the formative stage of the pilot, there was great variation in understanding of and focus on key concepts underpinning the pilot and that these differences had potential to impact upon the way the pilot developed.

'patient safety' & 'public protection'

3.26 The terms 'patient safety' and 'public protection' were seen as a 'given' in documentation but, in fact, were inconsistently described, presented or emphasised by stakeholders and key informants. Focus varied between:

• top-down, possibly heavy-handed focus on protection - "bad" practitioners or individuals & protection from serious injury or death ( e.g. Soham, Shipman)
• safety and protection defined in terms of 'absence of harm'
• more positive focus in terms of overall improvements in the confidence and quality of practitioners and the work they undertake

3.27 This suggested that there may be a need for greater clarity and consistency in any documentation underpinning any future roll-out.

Definition of 'healthcare support worker'

3.28 There was a wide range of opinions about the healthcare support worker definition. At the outset, there was general consensus about including clinical support workers (nursing assistants & assistants to allied health professionals). There was far less clarity about including categories of worker who might not have direct contact with patients in ways that might overtly affect patient care (laboratory, ancillary staff, unqualified technical staff, catering staff, pharmacy assistants, and mortuary attendants).

3.29 Some advocated that the pilot should take a more focused approach and only include those working in areas where they had a direct involvement in patient care. Others supported a more inclusive approach, to include anyone who:

• supports professionals or assists in the delivery of care
• has direct contact or a direct role with potential impact upon patient
• has prolonged and particularly unsupervised contact with patients
• simply works in a healthcare setting and has potential access to patients

3.30 The early lack of consensus raised questions as to how the pilot might be implemented. The 4 Country Steering Group (April 2007) confirmed that in order to sufficiently explore and test the proposed model, all listed groups were to be included. There were also concerns as to whether specific categories of worker would perceive themselves as HCSWs and if not, whether that would affect whether they registered for the pilot.

Partnership, HCSW and patient/public representation to the pilot

Partnership involvement

3.31 Establishing Partnership support has been an integral part of the healthcare support worker project from the start. The evaluation has obtained opinions from partnership representatives at national and local level. UNISON is the main union which represents the largest number and a diverse range of healthcare staff across all disciplines in the health service. It seeks to present a global view on the issues and is represented on area and local Health Board Partnership Forums (management, trade unions and user groups).

3.32 Changes in UNISON representation on the 4 Country Steering Group at that time resulted in a lack of UNISON input to the Standards consultation document, although the union was able to issue written comments on the Standards consultation document at the same time as other agencies. A subsequent meeting was held between the SGHD adviser, 4 Country Steering Group lay chair and UNISON Scotland representatives to exchange information and views (February 2007), and after further discussion of key areas UNISON made clear its intention for continued involvement with the pilot. However, it was noted that UNISON Scotland has no jurisdiction over local branch activities.

3.33 Since then, UNISON Scotland has had active involvement on the 4 Country Steering Group to the pilot. The NHSQIS National Project Steering Group has two invited UNISON representatives and AMICUS representation.

3.34 There has also been active partnership representation and involvement at all local steering groups. Participating sites have provided Partnership groups with regular update reports. In particular, Partnership representatives have had direct input to: development of the pilots' documentation (information pack, assessment papers); examining the standards links with KSF; and the consultative workshop. Local representatives have actively supported the recruitment process and encouraged managers to facilitate HCSW attendance at HCSW information sessions. In Lothian, the Employee Director, joint chair of the partnership forum was a key member of the steering group and the local UNISON representative worked jointly with the LPC to deliver briefing sessions and promoted the pilot at wards where HCSWs had not been able to come to meetings.

3.35 Local partnership representatives fully supported the development opportunity. They had received largely positive feedback from support workers taking part. Their feedback also indicated that the learning and assessment burden for the HCSW and WPS was not found to be excessive by participants. Staff had indicated some potential for the induction standards to fit with KSF. It is worth noting that Union representatives had not had any individual cases or concerns concerning the pilot brought to them and this was confirmed by the evaluation surveys.

3.36 The key concerns from UNISON have remained constant since the first consultation on regulation: that the burden of any potential cost for future regulation does not fall upon this relatively low paid group of workers; that the 'employer-led' model does not disadvantage workers in any way via the potential conflict of interest felt to be inherent in the employer taking on a regulator role. Partnership representatives would wish to continue to be involved in considering further options post pilot and in moving towards national implementation.

HCSW and patient/public representation

3.37 A Public Partner (lay representative) sat on the 4 Country and NHSQIS National Project Group and two Public Partners took part in the peer-review site visits (Section 8.30).

3.38 It was agreed ( NHSQIS National Project Group, May 07) that local sites should invite HCSW representation onto their local steering groups. However this did not prove so easy in practice and Lothian and Lanarkshire were most successful in getting this representation. There was however HCSW and WPS representation to several NHSQIS National Management Groups and the 4 Country Group, and a good number attended the consultative workshop.

Development of the pilot

NHSQIS and the National and Local Pilot Coordinator roles

3.39 The SGHD commissioned NHS Quality Improvement Scotland ( NHSQIS), which has responsibility for clinical governance and patient safety across Scotland, to coordinate and manage the operation of the pilot. NHSQIS aimed to assist implementation of the three elements of the standards within the participating pilot sites and to capture learning from the experience, and the strengths and challenges of putting the standards into practice.

3.40 The key NHSQIS objectives were to:

• demonstrate compliance with all three elements of the national standards
• consider how pilot requirements interact with existing HR and governance arrangements
• develop and test systems for HCSWs achieving the standards to be entered upon an 'occupational list' ⁴⁰

3.41 Two tools were developed to achieve these aims:

• An assessment toolkit to demonstrate HCSW achievement of the public protection standards ( Chapter 4)
• A self-assessment framework for employers to demonstrate compliance with the Code of Practice for Employers ( Chapter 8)

3.42 The NPC role was to co-ordinate, support and project manage the pilot through to completion. This included a wide range of tasks including project management; supporting local steering groups and coordinating the three LPCs; developing systems, processes and documentation and the above assessment materials; ensuring internal and external communication about the pilot.

3.43 The 4 Country Steering Group, serviced by SGHD, continued to maintain national level oversight of the pilot, and received reports from both NHSQIS and the independent evaluation team throughout the pilot. To support the pilot, NHSQIS developed a full management infrastructure ( Annexe L, M). Initially the NHSQIS National Project Steering Group was formed, meeting bi-monthly. The National Management group comprising the National Pilot Coordinator and three Local Pilot Coordinators met monthly. Comprehensive pilot documentation was developed, to steer and control the pilot process and quality, including: a Project Initiation Document (further refined from the initial SGHD draft coming from the National (Scotland) Group); a national project plan; a local project plan for each site; a national communications strategy and a national risk register.

3.44 The NPC also set up a number of processes to assure quality and aid in capture of project learning ( Chapter 9).

• External quality assurance of the induction standards learning and assessment process
• External consultant advice re organisational development ( OD) issues
• Internal pilot reporting system
• Local pilot site monitoring data

3.45 The role of the Local Pilot Coordinators was to manage the pilot locally on a day to day basis, to be in close communication with the NPC, and to facilitate achievement of pilot objectives. In the early months, the LPCs at the first two sites worked with the NPC to develop recruitment processes ( Chapter 6, Annexe I) and other underpinning pilot processes ( Chapter 4, Annexe I):

• Training and support of workplace supervisors
• Development of learning and assessment materials
• Exploring the fit with the Knowledge and Skills Framework
• Disclosure Scotland arrangements
• Setting up the occupational list on SWISS

Stakeholder views on pilot processes

3.46 The NHSQIS role was both to implement the standards and to devise ways of testing compliance with them. This role was a difficult one, requiring a fine balance between 'governance' and 'support' roles and as the central agency they endeavoured to ensure consistency of messages between Boards, NHSQIS and SGHD. Sometimes communication was more difficult as there were three Boards with different cultures and ways of working, and at times particular Boards had strong views about how they wished to approach certain aspects ( e.g. obtaining consent for Disclosure Scotland checks, considering mapping to SVQs).

3.47 NHS Board stakeholders welcomed the placement of the NPC within NHSQIS as it was seen to promote messages of quality, patient safety and clinical governance. On the whole Boards found the NHSQIS role very beneficial but found some NHSQIS demands ( QA processes, self-assessment, level of internal reporting) to be more burdensome than anticipated. Boards felt some pilot requirements were added as the pilot progressed (inclusion of bank staff at Ayrshire and Arran, refocus on ancillary staff at Lanarkshire, precise testing against KSF outlines).

3.48 The pilot work was aided by the high level of enthusiasm and motivation of all pilot implementation staff involved and the effort put into achieving their objectives. The overall structure largely worked well. The teams of site lead officers provided key support to Local Pilot Coordinators. On the whole the National Pilot Coordinator and three Local Pilot Coordinators worked well together as a team with complementary skills and experience. Early pilot sites sometimes took the lead on developing approaches and materials. Lead officers from Ayrshire and Arran also contributed substantial time to the development of learning and assessment materials. Site lead officers were particularly keen to have a Certificate to present to participating HCSWs and Workplace Supervisors (section 7.34).

3.49 NHSQIS provided specialist knowledge in project planning and development of documentation; other NHSQIS staff also gave considerable input to development of assessment tools. NHSQIS faced a number of challenges. The timescale was short and processes were in fact being developed and piloted simultaneously, the more usual method, for NHSQIS, would be to fully develop then implement and test. The assessment toolkit in particular, may have been more successful, had there been further development time to streamline it, remove duplication and inconsistencies. NHSQIS was charged with working with the standards as developed and already published by SGHD. There was, therefore, no scope to amend any wording or format of the induction standards and Codes. These documents had been designed, by SGHD, to stand alone and to serve different purposes. NHSQIS found the differences between the induction standards, Code of Conduct and Code of Practice, which had not been developed with specific measurement formats in mind, then made it difficult to develop approaches for measuring compliance. The first approach to developing a Board self-assessment tool, in line with Clinical Governance and Risk management as stated in Guidance, had to be abandoned as the standards did not lend themselves to being measured with a detailed tool.

3.50 From August 2007, the primary and continuing focus was on the identification and recruitment of HCSWs to the pilot ( Chapter 6). Implementation of the pilot required a high level of marketing and negotiation skills because of its voluntary nature. In comparison with the implementation of mandatory frameworks it required a different approach to encouraging staff to take part; neither managers nor HCSWs could be 'press-ganged' to be involved. This took up the majority of LPC time and in hindsight, the LPCs felt they should have refocused attention sooner towards ensuring HCSWs got through the stages of assessment ( Chapter 7). The coordination of the Board self-assessment document and the peer review visit process also demanded a lot of their time ( Chapter 8). Facilitating the external consultant meetings with HCSWs and WPS was an additional and unanticipated task (section 9.3).

3.51 All LPCs felt their role was seriously hampered by lack of adequate administrative support ⁴¹. On the whole, LPCs had to manage all administrative tasks themselves, including all mail outs, organisation of briefings, preparation of all materials, and assessment papers, collation into packs, all photocopying etc. Very limited support was provided from the base teams in Lothian and Ayrshire and Arran but none was available in Lanarkshire. Had administrative resource been available then more LPC time could have been spent upon progress chasing of individual HCSWs to ensure completion of the process.

Pilot sites future plans

3.52 All three pilot Boards already strongly supported the clinical support worker role with training and development opportunities and they found that the pilot complemented this. The three sites varied in plans for continuation of the pilot processes. Ayrshire & Arran and Lothian intended to support the final recruits into January 2008 to complete assessment. However Lanarkshire faced resource issues concerning the 100 who had yet to begin the observation stage.

3.53 All three sites planned to continue development of HCSWs. In Lothian the new LPC post had been extended by a year to facilitate this, but there were no future decisions on incorporating the pilot standards. There were considerable resource implications for supporting the pilot components. Ayrshire and Arran had presented options for adopting elements of the standards to senior clinical managers and had strong expectation the standards would be used to some degree alongside other initiatives to develop HCSWs. Lanarkshire hoped to continue using the induction standards as a tool for induction (and specifically with Bankaide staff) but this required further work, and they hoped to use the standards to inform PDP and KSF reviews.

3.54 The pilot sites intended to consider the final NHSQIS Code of Practice compliance monitoring report but did not have any specific plans to take forward any of the issues raised until the pilot outcomes were published.

Stakeholder views on resources to support implementation

3.55 Many respondents expressed concern as to how well the model might work once it went beyond being a pilot. There were concerns that Boards' efforts might be less focused and that the whole process might take more time across a wider range of HCSWs, and across all services and new and existing employees. It was felt that the current HCSW pilot volunteers were long serving employees, probably the most enthusiastic and motivated, able and better qualified (many with SVQs). The current Workplace Supervisors were also likely to be the most motivated. It could be anticipated that newer staff and less motivated existing staff might take longer to achieve the standards. A variety of implementation approaches might be required to suit different groups of workers ( e.g. new or existing staff; with or without SVQs). Lothian's experience, where it was a challenge to attract and support existing staff through the process, suggests that the resource implications may be more significant for larger Health Boards across multiple service areas with large numbers of new staff.

3.56 Boards felt they faced significant additional costs not covered by the SGHD pilot funding. The overall level of human resource entailed by the pilot was not apparent at the outset. Sites felt they contributed at least 20% of the site lead officer's time for day to day pilot business and one site funded the Local Pilot Coordinator at a higher band. All sites relied on the great flexibility and commitment of individual Local Pilot Coordinators to cover night and weekend staff and administrative tasks. Sites also resourced time for Workplace Supervisor training and assessment (particularly costly in relation to bank and night staff); staff side representation at meetings and briefings; steering group membership attendance. There were also substantial materials and communications costs: photocopying all paperwork, preparing packs, provision of folders, postage, and the cost of any administrative support provided by host teams. However it should be noted that an SGHD offer of funding allocated for DS checks, but not spent due to slow recruitment, was not taken up by Boards.

Summary

3.57 The SGHD July 2006 'invitation to bid' set out criteria to be met by Health Boards interested in hosting the pilot to test out arrangements for the employer-led regulation of healthcare support workers in Scotland. Three Boards were successful, NHS Ayrshire and Arran, NHS Lothian, NHS Glasgow and Clyde (withdrawn April 2007) and NHS Lanarkshire joined later (July 2007). The pilot was run across Mental Health, Children's and Older People's services and across a wide variety of settings. There was early shared consensus on including clinical support workers in the pilot but less clarity about non-clinical support workers.

3.58 The pilot was extended by one year in recognition of the size of the pilot task and following early delay caused by multiple factors. The National and Local Pilot Coordinators worked well together to devise, implement and test a range of tools and processes to monitor individual HCSW and NHS Board compliance with the standards. All three pilot sites supported the principle of continued development of HCSWs but felt additional resource may be required to support full implementation of the tested standards in future. Partnership representatives were involved throughout and fully supported the aims of the pilot.