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Regulating HCAs would not cost 'too much', says Robert Francis


Regulating healthcare assistants would be simple and would not “cost too much money”, Robert Francis QC has told Nursing Times.

In an interview following the publication of his landmark report from the Mid Staffordshire Foundation Trust public inquiry yesterday, Mr Francis said he believed regulating the HCA workforce was necessary to protect the public.

His comments are in contrast to those of prime minister David Cameron who said regulating HCAs could be “complicated” during his Commons statement responding to the inquiry report.

The report had identified the Nursing and Midwifery Council as the orgnisation that should handle any future regulation of HCAs. Mr Francis told Nursing Times he recognised there were concerns about the way the NMC had been delivering on nurse regulation.

He said: “All organisations have to ensure they are working properly and efficiently and that shouldn’t necessarily cost more money.”

But he said his recommendation on HCA regulation had been designed “not to be resource hungry”.

“Looking into it, it didn’t appear to me that it would cost a huge amount of money if you got a registration fee paid by each HCA, which would be less than it costs to regulate nurses - because in theory, at least, it’s a simpler job.

“We do need a system that protects the public by ensuring people are prohibited from continuing in that role when it’s not safe that they do so,” he added.

Mr Francis also explained why he wanted to see student nurses tested for their values before beginning their training arguing he was not suggesting nursing was not a technical job.

He said: “It seems to me to be a fundamental requirement of nursing that you have the personal qualities and commitment to make you a compassionate and caring person.

“I believe people doing this work need to demonstrate their aptitude for it otherwise they shouldn’t be coming in to do the work. Delivering compassionate work may sound easy but many people would not like to do the work that these people do.”

One key recommendation in the report was the creation of a legally-binding duty of candour on all NHS nurses and healthcare organisations.

Mr Francis said this would protect nurses who spoke out against poor care or risks to patients. He said: “There is support of a statutory nature for people you would loosely call whistleblowers.

“I have called for a statutory duty of candour that trusts tell the truth to regulators and that there should be criminal sanctions if there’s willful obstruction of anyone performing their duties and informing their trusts about concerns to patients,” he said.

“That is about as rigorous protection of whistleblowers as you can imagine and that’s what I intended.”

Commenting on his wider hopes for the NHS, Mr Francis said the system had to change and learn the lessons from the events at Mid Staffordshire.

“The leopard has to change its spots if the public are to retain trust in the system,” he said.

“The NHS mustn’t sit back and expect to be told what to do; it must take responsibility for implementing the recommendations. We need leaders to accept the lessons of the report and take the matter forward.”



Readers' comments (11)

  • David Cameron does not do anything he doesn't want to do, and he won't bring in regulation of healthcare assistants because he doesn't want it.

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  • Back in the day 2007 as a nursing student I was writing about the need to regulate the role of H.C.A it is an important role, but needs control and support, it is not fair for our fellow workers to still be waiting.

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  • Having worked as a HCA for the last 20 years,I would welcome regulation. As in doing so it would ensure the public and the HCA's are protected. I also feel it would contribute to patients receiving a better quality of care.We need people to be accountable for their actions, as it is the only way, we can improve the quality of care we deliver.

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  • Years ago, HCA's were introduced into the NHS to 'support' the 'qualified nurses', by carrying out the 'non-nursing' work, so that the qualified nurse could perform the more intricate nursing skills required in patient care. In principal, the NCA's function appeared of a significant value to the service offered to the paitents.
    Sadly, the qualified nurses, became a bit idle, and 'passed on many of their 'trained' skills to the NCA's, whilst they sat around 'nursing stations', doing precious little. Susequently, Hospital managers, reconising the importance of this, evaluated every nurse's job practice, and 'upgrade' everyone, according to what they were doing.
    Which is why today we have a situation wherein, 'unqualified' NCAs are doing the 'so called 'skilled jobs', and the 'Qualified staff's' jobs are on the decline.
    Result? Patients are 'neglected in the wards.
    This, was a prediction I made in the 1970's, but in those days, my views were ignored!

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  • As a student nurse I have seen some HCA's who are excellent, who have taught me a lot and provide high quality compassionate care to their patients. I have also encountered some who have shown little understanding of patient focused care. Example ... an HCA who, whilst washing a patient together, complained that they had been an HCA for 10 years and it's not fair that "these 18 yr olds - no offense, get to train and then drop out after 6 months, but I can't afford to train!" I, as a 'mature' student replied "none taken, I'm not 18" and focused my attention on talking to the patient, something the HCA had not done once! My reaction was lost on the HCA (I was a captured audience after all). By the time the patient was washed we had heard how the HCA was "old school" and "taught by proper sisters", "not like these new nurses now". I was stunned by this HCA's attitude towards the patient and their colleagues and that they felt this was acceptable to discuss whilst providing intimate care! I don't necessarily think it's their fault, they should be regulated and have more regular training and support, with increased emphasis on best practice and being patient not task focused. From my experience so far regulation should happen. It would recognise the HCA's who are, compassionate, hard-woking and fantastic at what they do and whittle out those with little understanding of the responsibility and privilege it is to care for people at their most vulnerable no matter what your role is.

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  • I too have had the "I can't afford to do the training" scenario from a long time HCA. I had very little money when started training, but I did it, and still glad I did. That said, I've found the whole Mid Staffs situation very sad and disturbing, and also upset that the general public seem to be tarring all the nursing profession with the same brush, when the vast majority of us work very hard under difficult circumstances.

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  • 'Mature' student again ... Anonymous 8-Feb-2013 10.27 am ... I agree that Mid Staffs is both very sad and disturbing indeed. It is more shocking because the placement experiences I have had could not be further from what happened there (despite the above example, which is the exception, not the rule and an experience which made me reflect upon the need for regulation of HCA's). It is very sad that nursing as a whole has been portrayed in the light it has been recently, when as you say nurses work very hard under difficult circumstances. Despite the recent media, it's the nurses I meet during my placements which make me proud to call myself a student nurse.

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  • Regulating HCAs will make no difference.
    Education and training set against national competence frameworks will. Employers should have a statutory responsibility to ensure HCAs meet these national standards. Regulation will place the onus on the HCA - it doesn't work with current professionally regulated staff so where is the evidence that it will work with HCAs?

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  • I agree that regulation is not necessarily the way to go for HCA/auxiliary/care worker, what ever the title.
    What is important is that people who do anything to a sick person however technical or personal, manor or major, must have the appropriate training and support.During that training it will become clear if that person is fit for the role or cut out to do it.
    This will not only ensure the quality of care is high but will make the worker feel proud in what they do, make them feel part of the team and encourages them to do even more, even better.
    Win, win.
    Well that's my hope anyway

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  • Anonymous | 8-Feb-2013 10:14 am
    I too am a Student nurse and completely agree with you. I have seen some wonderful caring HCAS but also some downright dangerous ones. Ive seen a HCA drag a frail patient up the bed by one arm whilst telling me that "I didn't see that", see them constantly talk over patients, sit on patients beds chatting to one another, copying resp rates over from last obs because "the breathing looks alright and I don't really know how to do it". Its shocking how much responsibility they have with no accountability, it actually scares the life out of me.

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