27.03.13
Government stops short of mandatory healthcare assistant registration
The Government is to introduce national minimum standards for healthcare assistants, but has decided against a statutory register as had been recommended by the Francis report, the RCN, the Nursing & Midwifery Council, Action against Medical Accidents and the Health Select Committee amongst others.
The Department of Health has never liked the idea and ministers have suggested it would be too bureaucratic and expensive, and it was also opposed by NHS Employers and some who gave evidence to the Francis inquiry, including Sir David Nicholson and former chief nursing officer Dame Christine Beasley.
The Francis report says: “There is almost no protection available to patients or the public…Should a healthcare support worker be dismissed by an employer for being unfit to undertake this form of work, there is no system which prevents the worker being re-engaged by another employer, or even to ensure that a prospective employer is aware of any adverse past history.”
Julia Manning, CEO of 2020health and a member of NHE’s editorial board, said: “What confidence can people have without at least having a registration system for HCAs to ensure those who have been censored are not simply moving to another job?”
Commenting on the Government’s other new measures in response to Francis, she welcomed the prerequisite for nurses to train as healthcare assistants first, but added: “We simply can't afford all the staff to give the ‘soft’ care of washing, feeding, toileting that is required – friends and family must still expect to be involved. We should think of the Friends and Family test in reverse – were you there when your relative needed you?”
She added that appointing a chief inspector for hospitals who will report to the CQC, despite responsibility for dealing with problems residing with Monitor was “very convoluted and a recipe for problems falling between the regulators”. The statutory duty of candour should also apply to all staff, not just providers, Manning added.
Chris Ham, chief executive of The King’s Fund, welcomed the Government choosing not to introduce new legislation, as “it is only actions on the ward and board that will deliver compassionate care for patients”. But he questioned the value of aggregated ratings for hospitals and supported ratings for specific services instead.
Cathy Warwick, chief executive of the Royal College of Midwives, expressed her disappointment with the “muddled and piecemeal response”, particularly the failure to set minimum safe staffing levels and to introduce a mandatory register of HCAs.
She added: “The pilot scheme for nurses to spend up to a year working as support workers lacks detail. Overall, the Government’s report raises more questions than it answers.”
Chris Hopson, chief executive of the FTN, said the response feels “considered and proportionate, and avoids the temptation to slap excessive regulation on the NHS, which simply wouldn’t have worked”.
The decision to avoid “unnecessary” statutory registration and regulation of NHS managers was “sensible” and Hopson said it was important to cut “unnecessary bureaucracy and move to a smaller number of clear, essential, ‘irreducible minimum’, standards”.
Monitor stated: “We accept our share of responsibility for the failures in regulatory oversight of Mid Staffordshire NHS Foundation Trust and commit to working closely with partners to make sure that patients come first in all our future regulatory work.
“We have already implemented a significant number of the Francis recommendations that are relevant to Monitor and we welcome many of the report's proposals for further change.”
National Voices welcomed the legal duty of candour, which could remove “a huge chunk of the culture of cover-up”.
Jane Cummings, chief nursing officer at NHS England, said: “We have to respond to Mid Staffs with clear action and not just with words in order to benefits all of the patients who need our care.”
Mike Farrar, chief executive of the NHS Confederation, said the response was “overarching” rather than something which tries to tick all the boxes and welcomed the duty of candour.
He said: “The NHS now has a real opportunity to do things differently, and it is the responsibility of all of us to make a real difference to the care provided to patients.”
And Dean Royles, chief executive of the NHS Employers organisation, said: “We can't say that poor care is because of culture but excellent care exists despite it.”
He called for strong leadership and collaboration to improve quality of care, and warned against creating a climate of fear, which may be an unintended consequence of the duty of candour.
But Royles welcomed the focus on staff, particularly recruitment and training: “The minimum standards and code of conduct for healthcare assistants will provide support to employers in ensuring effective training and support for this key staff group.
“Regulation of healthcare assistants would have been the wrong response to wrong the question. You can't regulate for kindness and compassion but we can do more to test that people wanting to train in healthcare have the right values, and the right access to training and to good supervision.”
The RCP’s Dr Patrick Cadigan said: “A focus on clear information regarding hospital standards is welcome.
“However, the Government is right to recognise that a rating system for hospitals will be complex and should consider the different types of care and services provided in varying wards to the full range of patients.”
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