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Francis response: Hunt announces measures targeting HCAs and students

Healthcare assistants will not face statutory regulation but they will be subject to national minimum training and a code of conduct, under government proposals responding to the Francis report.

Health secretary Jeremy Hunt today made a statement in the Commons outlining the government’s response to the Mid Staffordshire Foundation Trust Public Inquiry report.

As reported by Nursing Times earlier this morning and trailed by the national press, students seeking funding for nursing degrees will first have to serve a year as a healthcare assistant.

“This will ensure that people who become nurses have the right and understand their roles,” he said.

He added: “Healthcare support workers and adult social care workers will now have a Code of Conduct and minimum training standards, both of which are being published today.”

A new chief inspector of hospitals will ensure “unsuitable” HCAs are barred from working in hospitals under the Home Office’s barring regime, Mr Hunt told the Commons.

In addition, he said the chief inspector had been instructed to ensure that hospitals were “properly recruiting, training and supporting healthcare assistants”, drawing on forthcoming recommendations from the new review into HCA training by Camilla Cavendish.

The Nursing and Midwifery Council and other professional regulators will also be required “to tighten their procedures for breaches of professional standards”.

Hospitals and other healthcare providers will be given action plans, under the Compassion in Practice nursing strategy, to give nurse ward managers the time to meet their supervisory and leadership role.

A statutory duty of candour, including a criminal sanction, will be applied to healthcare organisations requiring them to be open with patients and relatives if they believe treatment or care has caused death or serious injury – as revealed on Friday by Nursing Times.

Mr Hunt said: “We will introduce…a new statutory duty of candour for providers, to ensure that honesty and transparency are the norm in every organisation.”

He said the government had not ruled out extending a legal duty of candour to NHS workers below board level and would consider this after the review by patient safety expert Don Berwick which is due to report before the summer.

Mr Hunt told Nursing Times today a statutory duty of candour with criminal sanctions could “create a culture of fear” and may have unintended consequences.

It also emerged today that nurses will face the prospect of an annual revalidation scheme, similar to that imposed on doctors, to ensure their skills are up to date and they are fit to practise.

The Department of Health has said revalidation for nurses will only be introduced once the Nursing and Midwifery Council “turns around its current poor performance.”

Mr Hunt also restated the government’s existing policy that hourly ward rounds should be introduced across the acute sector.

All civil servants working for the Department of Health will have “sustained and meaningful experience of the frontline” within four years to “reconnect” them NHS staff and patients.

However, the government has rejected the suggestion for a specialist older person’s nurse and instead said it will strengthen the focus on older people throughout nursing care.

In his statement to the Commons, Mr Hunt described the Francis report should “mark a turning point in the history of the NHS”.

He said the government “accepts the essence” of the recommendations made by Francis report and would issue a full response later in the year.

But he said, “given the urgency of the need for change”, he was announcing today “key elements” of the government’s response to be implemented as quickly as possible.  

Readers' comments (43)

  • I totally support the idea of codes and training for HCA's - doesn't mention how this is to be regulated though? This will be an interesting one to follow.

    I came from a cadet nurse background, it made me sure that this was the career for me, especially has we had to do all the jobs - we wore brown uniforms for a reason back in the day!

    Shame about no specific older people's nursing, maybe it will be something for the future.

    Bottom line however is, will there actually be an NHS by the time this Government has finished privatisation via the back door and will the new care providers be expected to have exactly the same candour as those left in the public sector?

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  • There is nothing new in what jeremy hunt's statement... Nurses vave been advocating for these changes to be made for the past year or so.
    Furthermore, history has a habit of repeating itself, so, there must be 'safeguards built in to the student nurses years on the wards.
    The patients wont be any more looked after if there are dubious characters 'supposedly caring for them.
    Some students will still try to 'avoid' carrying out the 'dirty' work/chores, i.e., changing incontinent patients; clearing up faeces, vomit, sputum, blood, etc. That will be left, as usual, to the conscientious nurse.
    This is a GOLDEN opportunity for the govertnment; NHS; nusres; and nurse tutors; mentors, collectively, to reorganise a deteriorating patient care service , and transform it into the World Wide, highly valued service it used to be, when I started my nursing career, in 1966.

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  • It's going to be more challenging for recruitment and retention of nurses. It does not fully resolve difficulties of poor care or address problems of ill equipped staff. There might be an increase in early retirement for those able to.
    I cannot see prospective students wanting to join a tough, challenging and poorly remunerated profession by working in an even lower paid role where responsibilities are still high and treatment of staff is poor.

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  • Jeremy Hunt today made a statement in the Commons outlining the government’s response to the Mid Staffordshire Foundation Trust Public Inquiry report.

    "Students seeking funding for nursing degrees will first have to serve a year as a healthcare assistant."

    “This will ensure that people who become nurses have the right and understand their roles,” he said.

    Perhaps a very good idea and one that should be considered when reflecting on some of the truly horrendous happenings of recent times. However, will he also stand up in the House and say that the same criteria will be expected of himself and his colleagues the, 'Honourable Members' who were elected to represent their constituents but instead robbed the public purse blind and continue to do so!

    Stones and glass houses and all that....

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  • Tempting not to reply. HCA's are the fall guys for the Francis report. Lets put the case that the report is accurate? How can a year spent by apiring student nurses help them to become better nurses.

    The real issue is about bad practice in placement areas. Many students are not allowed to perform tasks HCA's do routinely. Nurses should start their training early and need to be educated in safe and audited areas which create a good learning environment.

    The Francis report misses that the omissions wholly related to cuts in spending and resulting poor staffing levels. This has created an environment of minimalistic expectations resulting in bad practice.

    Some of us remember Pre Training Schools (PTS) which was just ''playing at nurses'' and deferring the reality. Without proper educational support and supervision these aspiring students will learn bad habits that will interfere with the Evidence Based Practice(EBP) which is taught by HE. EBP is seen by many clinicians as idealistic.

    To suggest nurses do not know their role is insulting. The key problem is the contant attack of the NHS, underfunding and poor staffing.

    Those students we recruit will learn best educated in good learning environments adequately resourced to provide the essential experience, support and supervision.

    More worrying is the suggested role of Home Office in barring HCA's. This either leaves the role of the NMC in question or confirms what most of know that there has been no honesty and transparency in their role and the role of the Chief Nursing Officers and the Government in finding a valid solution to the crisis.

    If HCA's need regulation and registration this ought to be done by the NMC but clearly they are not up to the task. A complete and fundamental change is required to get rid of the stuctures which have led to the problem.

    The people who were on watch should not be kept on watch as we surely are just a short time away from the next crisis. Get off the backs of Nurses. They are not the only Health Care Workers.

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  • As a lecturer in pre-registration nursing, I am beginning to despair at the degree of criticism that is levelled at nurse education today; primarily by people who have no background in nurse education or who were employed a generation or more ago when the role was much simpler than it is today.
    Student nurses in my institution are taught that caring, compassion, confidentiality, communication, dignity and person-centredness are key tenets of nursing. And before they learn any 'technical skills', they are taught to wash, dress, feed patients as well as attending to 'personal needs'.
    It is perhaps time that the nursing profession took greater control of the discussion around care delivery and defended the integrity, professionalism and dedication of the vast majority of hard-working nurses and student nurses that are trying to make best of a very bad ideology-driven lot.

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  • I note with interest that students seeking funding will need to work for up to a year. I presume this means that anyone with access to funds to pay their own way or wealthy parents can circumvent this. This feels like an attempt to end free nurse education. Also, what about midwives, no mention of them and a year experience.
    This proposal potentially discriminates against school leavers and the first legal challenge to this will I am sure not be too far away. HEI's will have to spend the first year trying to undo bad habits picked up in practice.

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  • michael stone

    There was something interesting, re this 'do some HCAing first' idea, on Radio 4 this lunchtime, when Julie Bailey (who raised the fuss over Mid Staffs) commented that in her own experience there, the newly-qualified nurses tende dto be the more caring, and some of the least-caring nurses were within the more senior ranks.

    There are questions, about whether there is something about the systemic factors in bad hospitals, that 'beats the caring out of' nurses - that is more to do with the 'bullying whistleblowers/fuss raisers' issue.

    And, paradoxically, might the people who inherently 'care the most' also be easier to 'bully' ?

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  • I totally agree that every one involved with care in the nhs or nursing homes should have a code of conduct and be regulated .i also agree that nurses should have some practical experience before going forward with training this may even allow the more formal training to be shorter as the experience in the ward could make the theory more relevant .i also think that all nurses should be more aware of the care that the elderly need but managers need to recognise that more dependency needs more care. The ratio of staff to patients needs to be addressed

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  • I am a first year student and previous I worked in a private care setting and within a hospital, all together for 8 years. I have the experience and knowledge before I became a student and it has helped me alot. There are students in my cohort who have not done it before, who have just finished school. How do they know this is what they want to do? Especially working in an environment were bad practice happens. Resulting in some dropping out.
    I agree at all students need the experience so they know what to expect.
    From a students perspective the newly qualified are the most helpful as well as some of the HCA's however there are 'old' staff, who have worked in the trust or organisation for a long period of time, they do 'what they like' they are rude and unhelpful. To be honest some ward managers are like this, some are lovely people and others are horrible to staff and students

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  • Surely the key would be to ensure that mentors of nursing students be given the support and status required so that they feel valued in their role so they can pass on their knowledge and skills. How are all those people wishing to commence nurse training ever going to get the opprotunity to work in the clinical area for 12 months? who will pay them and train them? they already sepnt 50% of their training in practice providing fundemental nursing care, surely it should be more about recruitment and widening access to training not narrowing it even further.

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  • I fail to see how the government will afford this. If EVERY nursing student has to complete a year as an HCA, thousands of new, student ring fenced, HCA positions will need to be created and competitive salaries paid. The only rational alternative would be to make all existing HCA's redundant and staff their jobs with pre-nursing students. If existing HCAs are to continue to be employed, then the pre nursing students would HAVE to be paid at the existing HCA rates, in order for fairness to be seen to be done.

    As far as I can see, there just isn't room in current staffing regimes to fit in all the compulsory pre nursing HCAs.

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  • Congratulations Jeremy.

    You have done it again. It is so easy to turn nurses against one another, isn't it? The new nurses blaming the more experienced nurses for 'bad practice'; the more experienced nurses blaming students for not wanting to do the 'dirty' jobs; the lecturer blaming older nurses for, well, everything and the HCAs claiming 'fall-guy' status for mid-staffs.

    Job done, mate. Carry on underfunding and understaffing the NHS. The nurses are too busy fighting amongst themelves to do anything about it.

    Iama Cynic | 26-Mar-2013 1:26 pm

    "This is a GOLDEN opportunity for the government; NHS; nurses; and nurse tutors; mentors, collectively, to reorganise a deteriorating patient care service , and transform it into the World Wide, highly valued service it used to be..."


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  • Anonymous | 26-Mar-2013 2:03 pm

    "The Francis report misses that the omissions wholly related to cuts in spending and resulting poor staffing levels."

    I largely agree with your post, but the Francis Report did include the issues of budgetary pressures and poor staffing levels (although,it has stopped short of recommending compulsory minimum staffing levels). It is the governmemnt who are choosing to completely ignore much of the report and its recommendations. Francis places much of the blame at the feet of managers, the culture they create and the financial considerations which are put firmly before patients.

    Some nurses were complicit in what went on at Mid Staffs. Patients died through lack of basic care. There are accounts of patients being bullied and shouted at by staff, drinking from vases, starving to death. That is nothing to do with short staffing and everything to do with a complete lack of human decency. This government has chosen to focus on this aspect of the report. It is easier and costs less to blame the nurses. Whilst the issues of why these incidents CONTINUE to occur (because they most certainly did in the 'good old days' to which, so many seem to think that we should return), the vast majority of problems at the Stafford Hospital were due to systemic management failures and a bullying culture which placed the patient at the bottom of the priority list. That is rife throughout the NHS and this government doesn't have the inclination or the ability to fix it. Rather it will be used as a further opportunity to erode the nursing profession and privatise the NHS.

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  • looks like some comments have been deleted!

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  • so now to become a student nurse you have to do a year as a healthcare assistant. Does this still mean you have to have 2 A's and a B to access the course. if so, it makes it extremely difficult for people to access the course.

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  • Anonymous | 27-Mar-2013 12:48 pm

    I agree. I posted in answer to someone last evening, and both posts have simply disappeared rather than been deleted for content. Both posts were rather benign, so I don't know what's gone on there.

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  • looks like some comments have been deleted!

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  • As a first year mature student nurse I feel that the move towards prospective student nurses spending a year as a HCA means that the Nursing profession will miss out on the valuable life skills, maturity and life experience of those that choose to change vocation and become nurses.

    Personally, I have had a little but limited experience in a care setting but I made sure I did my research before applying (especially as I was giving up a full time job) and I am 100% sure that I made the right decision at the right time to take up my nursing vocation so that I can care compassionately for my patients and their needs.

    The questions I have are:
    How are mature individuals who choose to leave their jobs in industry going to be supported financially when they take up a HCA role - I took a cut in salary but the cut would have been greater if I had taken a HCA salary than on student funding?

    How will they get a HCA role if they haven't had any care experience previously or qualifications in care?

    On another note, so far the Nurses and Health Care professionals I have encountered on placement have been excellent and I have witnessed caring, compassionate individuals who put their patients at the centre of what they do. I am of the belief that whilst there are bad Nurses and Health Care professionals out there, the good ones far outnumber the bad and we just need to find a way of weeding out the bad and growing some more good ones.

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  • My comment from yesterday evening has also disappeared. I replied to an earlier anonymous comment and made great effort to ensure that it was not offensive. So can't understand why it has been removed.

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