THE scale of the Muckamore Abbey abuse scandal has sparked concerns about the fact that healthcare support workers do not have to register with a professional body - meaning they can work anywhere in the NHS unchecked.
Notes leaked to the Irish News show the most senior officials in the Department of Health have admitted the registration 'gap' in light of the unprecedented number of suspensions from the Co Antrim hospital following abuse of vulnerable patients.
To date 19 staff have been suspended from Muckamore - at least five of whom are healthcare support workers while the majority are nurses - after CCTV cameras reportedly showed physical and mental ill treatment of adults with severe learning disabilities.
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Most of the nurses have all been referred to their regulator, the Nursing and Midwifery Council (NMC) and have received 'interim' suspension orders of 18 months which effectively bans them from working in the NHS or private sector.
At a private meeting last September between the father of a Muckamore patient and the north's chief social worker, Sean Holland, the parent probed him about the 'no man's land' status of support workers - who are also known as nursing assistants or healthcare assistants - in terms of their registration.
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Mr Holland admitted there while nurses and social care workers must be signed up with professional regulators, the same monitoring did not exist for less skilled support staff - despite their close contact with patients.
The senior social worker, who is based at the Department, said the failing needed to be tackled.
"Healthcare assistants aren't registered with anyone, it’s a gap. It needs addressed," Mr Holland told the parent.
"That doesn't mean they can’t be subject to internal disciplinary processes or indeed referred to the police but that additional level of protection of being a registrant - which means you could be struck off - doesn't apply to nursing assistants in Northern Ireland or anywhere else in UK."
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Mr Holland added that the Department recognised that some social care workers, such as domicillary workers, work in isolation in people's home and "could pose a risk" - so they needed to be registered.
"But there was a view historically that health care support workers are meant to be working under the direct supervision of a nurse - and that is meant to provide a level of accountability."
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Claire McKeegan, a human rights lawyer who is mounting a class action on behalf of some of the families whose loved ones were abused, said the lack of oversight of these workers was "crying out" for an overhaul and change in legislation.
"Given the failings that have been discovered at Muckamore this latest development is extremely worrying. It basically means that a number of healthcare staff can move from one organisation to another almost with impunity," she said.
"There is no proper oversight or governance."
A police investigation into the abuse has been ongoing for over a year, with the National Crime Agency assisting in the probe. No-one has been arrested.