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Francis report: HCAs should face regulation

Healthcare support workers should be subject to regulation by the Nursing and Midwifery Council in one of 290 recommendations from the Mid Staffordshire Foundation Trust public inquiry.

Inquiry chair Robert Francis QC said HCAs should not allowed to deliver personal care to patients in any healthcare setting without first being registered.

He has also demanded a national code of conduct and a national set of standards for training of HCAs who he said should also be clearly identified and distinguishable from a registered nurse.

In his report, which makes a total of 290 recommendations, Robert Francis QC said the Nursing and Midwifery Council should be in charge of regulating the HCA workforce but he also called on the Department of Health to launch a nationwide system to “protect patients”.

It should be a national entry-level requirement for student nurses to spend a minimum period of time, at least three months, working on direct care of patients. A satisfactory completion of this should be a pre-condition for continuing training, Mr Francis argues.

The report also calls for nursing students to be recruited based on values with “constant support and incentivisation” for nurses, “which values the work they do.”

Mr Francis says nurse education should be reviewed to ensure sufficient practical elements that ensure trainees have a “consistent standard” and he suggests the NMC should develop an “aptitude test” for student nurses.

He also calls for the Department of Health and the NMC to develop the idea of a Responsible Officer for Nursing, and for a system of annual revalidation similar to doctors to be created with nurses having to demonstrate key skills and knowledge and include feedback from patients.

Ward nurse managers should not be office bound and should know about care plans for each patient, Robert Francis said. They should be visible to patients and staff alike and act as a role model and mentor to other nurses.

A key recommendation was for each patient to be allocated for each shift a key nurse responsible for their care and this nurse should be present at every interaction between the patient and the doctor.

Mr Francis also backed the use of a cultural barometer on wards and backed further efforts to develop a tool for assessing the needs for minimum staffing on wards.

Readers' comments (31)

  • tinkerbell

    Good man Robert Francis. Tell it like it is QC.

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  • tinkerbell

    who regulates the managers?

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  • Any person who is involved in the direct care of patients must be regulated. By being regulated, we have codes of conduct and regulations to abide by which are there to protect everyone. At the moment, anybody can be employed as an HCA without any training. Suitable training and regulation of HCA's is the only way we can provide a high standard of care across the board where everyone is accountable for their actions. Regulation of HCA's can't come soon enough.

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  • tinkerbell, simple . . . noone regulates the managers. Whilst there is a lot of good stuff in this report, Mr Francis QC has not had the guts to go that far!!

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  • Bill Rollings | 6-Feb-2013 2:44 pm

    if all of the recommendations are implemented, which it looks as though there is a good chance they will be, and with the government and the opposition on the NHS, patients' and nurses side, it looks as if they won't get away with nearly as much any more. Everybody will see to that. Besides, more power is being handed to clinicians and patients and their families and to those who lodge complaints or blow the whistle.

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  • Susan Markham

    At last, vindication for what I have been saying for years. As much as HCAs and APs would love to call themselves “Nurses” (with a capital N) because they can take blood etc etc... the Francis report has finally named one of the many “elephants” standing in the room.

    If you are not regulated by a professional body that is internationally recognized – then you do not have the right to call yourself “Nurse!”

    Do a nationally recognized, standardized and regulated training, pass the exam, become registered with a professional regulatory body that is internationally recognized, pay an annual fee and THEN you can claim to be a Nurse (with a capital N!)

    If you cannot, or don't want to do this, then claiming to be a Nurse merely makes you part of the problem - which is the conspiracy to devalue the role of the Registered Nurse... as witnessed by the Royal Cornwall Hospitals Trust attempt at obfuscation by including assistant practitioners in its skill mix ratio figures.

    In reality I don't hold out much hope of many of the recommendations of this report being implemented... it simply goes against the government's hidden agenda of privatizing the NHS. It will be watered down and a few token gestures will be made but eventually I foresee that Nurses will end up becoming the scapegoats.

    BUT... I hope they nail that bastard scheme at the Royal Cornwall Hospitals Trust and fire the incompetents who devised the damn thing in the first place!

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  • Susan Markham

    tinkerbell | 6-Feb-2013 12:45 pm

    "who regulates the managers?"

    Indeed Tink. Just another reason why the good intentions of this report will eventually come to naught.

    Common sense 101 - don't leave the lunatics in charge of the asylum.

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  • you can susan and tink regulate managers you can do everything? i would be very happy after 28 years of direct care just wash, feed, toliet,listen,our patient that is the most rewarding post no paperwork! i wouldn't thank you for a post as a nurse people ask me if i was a nurse and why i didn't do my training i said I AM NOT STUPIED i could see this coming many years ago it only needs a couple off kids to start a fire oh well?

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  • Susan Markham

    Anonymous | 6-Feb-2013 5:35 pm

    Exactly! I am a Registered Nurse not a frigging administrator.

    I started my nursing career back in 1974 and my goal was to become a State Registered Nurse who cared for the health of patients. I didn't sign up to become a quasi-doctor or manager... but that is what the formation of Health Trusts (originally formed under Thatcher's “Sainsbury Report” in the 80's) forced me to become.

    Hehehehe... fortunately I resisted joining the club and I turned down many offers of promotion.

    You were very wise my friend to recognize your competency and to stick to it. Not that many people have your courage and fortitude.... BTW... I DID!

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  • The spelling and grammar posted above by many is a prime example why nursing needs to raise its standards. It is not about being a 'semi-doctor' - as technology and treatments progress so should nursing. I, for one, believe that these regulations cannot come soon enough; and probably could be more stringent.

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  • I do however agree wholeheartedly with Susan concerning HCAs stepping outside of their roles and seeing themselves on an equal footing with registered nurses. If you want the responsibility, do the training.

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  • tinkerbell

    Anonymous | 6-Feb-2013 5:35 pm

    I'm sorry but not sure what you mean when you say me and susan can do everything and regulate the managers.

    I have spent many years in hands on care and very little time on paperwork apart from what is essential.

    I have managed to get away with doing as little paperwork as possible and spend my time with the patients and i have never been reprimanded for it.

    Who's the daddy?

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  • Let's just hope they don't completely devalue nursing. I think the HCAs have been allowed to take on too many roles without understanding the implications of what they are doing and with insufficient training. Assistant Practitioners are just a cheaper alternative to enrolled nurses that the government brought in. Whatever the government decide, it will be centred on saving money - let's just see what they do with Agenda for Change and taxing our pension lump sums and more pay freezes and of course this will be combined with an increase in our NMC fees!!! Oh and my educated guess is that the government will then dismantle the NHS and make it means-tested for all who are not on benefits - something which we will be paying for through our taxes!!!

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  • Very good idea about the regulation of HCA. I have always said it is a very very good idea to have HCAs regulated. At the moment a vast amount of them do as they like and pleased, whilst the poor RGN struggle with all the responsibility. Many of them have terrible attitude problems, not to say some RGNs have not got attitude probles as well, but they are regulated + can get into serious trouble for this, whilst the HCAs often gets away with it. The HCA tends not to go the extra mile if you are busy, because they are not answerable to no 'BODY'

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  • On reading most of the comments I am a little bit disgusted with someof the awful things written about HCA's. I am a student nurse and was working as a HCA for 14 years previous to starting my nursing training.
    Yes Iv seen some badly trained, lazy, rude and abrasive HCA's during my years working as one so I fully agree that they do require regulating and provided with suitable training to be permitted to work in direct contact with patients, and also be compitent and able to support the nursing staff.
    I have also had the pleasure of working with some excellent HCA's who are dedicated to patient care and wellbeing and who find their role a rewarding one, they dont class themselves as qualified nurses but do get called nurse by the patients they care for as nurse is easier for the patient to say than heath care assistant, nursing assistant, associate nurse, auxillary nurse or what ever other title HCA's are given.
    I have also had the misfortune of working with some bad nurses during my time on the various wards that I have worked who have liked nothing better than to delegate nursing jobs to the HCA's who have not completed training or had experience in the task delegated to them for instance taking BM readings, doing vital sign observations with out training and not being aware of what constitutes a normal or abnormal reading. The HCA's who are not happy to complete these tasks due to their lack of knowledge can feel under pressure from the nurse. This seems quite a common practice, I have also experienced a nurse saying she did not spend three years training to wipe arses, and leaving the HCA to carry out the task of patient care unsupported and alone while the nurse has been looking at personal stuff on google or reading magazines.
    Like in any profession you get the dedicated people but unfortunatley a few bad apples slip through the net.
    What happened to team work and supporting each other? surley that is more beneficial to patient care than annomosity towards each other.



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  • good this is all true and i thank you for your comment,you will be a good nurse and go far !!!!!! all the best for your future dont let any nurse take your true jugement away from you. well done

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  • we have 3 excellent HCA,s who work alongside us nurses. the care they provide has been excellent and has been given with care and compassion there are good and bad in both trained and untrained. care should be provided by a team of nurseswith responsibility being the nurse in charge of the care for their patient. It would be good to provide the HCA,s with some kind of recognition for the job they do

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  • There always seems to be some confusion about RNs taking full responsibility and being held accountable for the actions of the HCAs.

    Surely if an HCA is trained to undertake a particular type of care, whether it be a bedbath or a BM then they are responsible for what they have done, not the RN who asked them to do it. They are accountable to their patients and their employer, not the RN. If they report something abnormal to an RN then the responsibility changes, I'd have thought a good RN would go round and check their patients, look at the obs, BMs, pressure areas, fluid charts anyway even if they hadn't performed that care. If an HCA has full training in NEWs but never adds them up correctly or date and times them then that is their fault, not the RN.

    Surely the RN and the HCAs responsibility is to ensure the HCA has the correct training, correct support and is competent and happy to carry out the care asked. All staff, at whatever level, students, HCAs, staff nurses have to be able to say 'no, I'm sorry I haven't been shown or taught how to do that yet, please can you arrange training, I will help you by assisting or observing'. All staff also need to have received training to care for patients, that is so obvious it shouldn't even be an issue.

    We are all here to work together, it shouldn't be about 'HCAs do the bottoms, RNs only do the drugs' attitude.

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  • sorry but it is and has been for a good while and as far as training with specialized skills we have done this but we still get it in the neck about us and nurses hca's damed if you do and damed if you don't we just work and work with no support it will be higher and lower so no matter what h c a 's do it wont be right no matter what grade this will be a head to head for years to come

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  • the is not any feel good foctor as h c a's are put down to the lowest we work from beginning to end of shift forget the work and go home to our loving familys and come back next day. nomatter how muchband 6 lay in to band 5 when they do wrong it gets passed down to h c a 's

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