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Exclusive: fears raised over HCA apprenticeship schemes

Concerns have been raised that teenage apprentices are increasingly carrying out tasks normally done by healthcare assistants, sometimes with insufficient training and supervision.    

These include key tasks such as care of deceased patients and recording key clinical observations such as blood pressure and oxygen saturation levels. They are also helping patients to use toilets, assisting with feeding and liaising with relatives.

Use of apprentices in the NHS has been growing, with around 8,000 places during 2012-13. Although the apprenticeship schemes can cover a range of roles, including admin, Nursing Times has identified a number of trusts using or advertising for HCA apprentices.

Homerton University Hospital Foundation Trust in London is advertising for 10 HCA apprentices, while James Paget University Hospitals Foundation Trust is looking for one apprentice to work on a rehab ward on a salary of £109 a week. Norfolk Community Health and Care Trust is also advertising for HCA apprentices.

Gloucester Hospitals Foundation Trust has 34 apprentices already working on its wards, after launching a scheme in September last year.

However, a healthcare assistant who works alongside apprentices at the trust contacted Nursing Times with concerns that their training and supervision was not sufficient.

“Some are under 18, so you’re asking teenagers to be at cardiac arrests and to lay out dead patients, it’s wrong,” they said. “One teenager was on a respiratory ward and she was asked to lay a patient out and freaked.

“They are doing the exact same job as me, but they’re only paying them £9,000 a year. That’s £6,000 less than a HCA, for the exact same job,” they added. “But they haven’t had the training and in some cases [are left] on their own.”

“In my opinion it is a way of cutting the staff budget and it totally undermines us. They are not bad kids to be honest, but it’s just cheap labour.”

The trust refuted the claims and insisted all of its apprentices, which include one 16-year-old and four 17-year-olds, were under constant supervision.

Maggie Arnold, the trust’s director of nursing, said: “Our apprentices are supervised at all times as well as having a mentor within the trust. They also learn a great deal by working on the job and this necessarily involves assisting in the provision of individualised, planned patient care.”

The trust said apprentices received a two-day induction plus a protected study day each month.

A spokesman for Norfolk Community Health and Care Trust said its apprentices had extensive training for three months before working under “continuous” supervision. He added: “Apprentices work alongside the trust’s qualified staff, but do not replace these roles.”

The NHS Employers organisation and the national skills council Skills for Health are working with the government to increase the number of apprentices in the health sector.

Skills for Health has developed a framework to guide trusts in what tasks apprentices can do and issues certificates at the end of their placement.

The framework does not discuss which areas of direct patient care that apprentices should be allowed to do but neither does it state those that they should not be engaged in.

However, the document says:  “Apprenticeships are one of the many ways in which employers within the health sector are seeking to address… increasing pressures. Support workers tend to have delegated responsibility for a range of tasks which enables the professionally qualified staff – eg nurses, doctors, allied health professionals – to fulfil their own roles more effectively.”

Angelo Varetto, head of apprenticeships at Skills for Health, said apprentices should have a minimum of 670 hours of learning in 12 months and should not be left unsupervised.

“The expectation is they would have someone with them to make sure they are doing the job properly,” he said. “We would not expect them to be working alone.

“Apprentices and particularly young people should not be put in those types of situations and shouldn’t be asked to do things like that,” he added.

However, the introduction of HCA apprentices prompted concerns from the Royal College of Nursing.

RCN head of policy Howard Catton said it “could mark the next stage of evolution in terms of skill mix dilution” among the nursing workforce.

He said there was nothing wrong with the idea of apprenticeships, but they needed to be properly structured and constituted.

“If there are cases where this is not happening, it raises big questions about whether these schemes should be called apprenticeships at all,” he said.

Mr Catton added: “For a registered nurse to delegate any task under these circumstances could be inappropriate and raise patient safety issues. The nurse would need to be extremely careful as they could put their registration in jeopardy.”

He urged nurses with concerns over the use of HCA apprentices to raise them with their line manager.

Professor Ieuan Ellis, chair of the council of Deans of Health, added: “Patient safety must be paramount. It is unacceptable both to patients and apprentices if they are required to work beyond their skills or experience, and without close supervision.”

A spokesman for the Nursing and Midwifery Council warned nurses they needed to be mindful of its code of conduct.

“Registrants need to satisfy themselves that delegation is appropriate in a given situation,” he said.

A spokesman for NHS Employers said: “These staff bring fresh skills and positivity to the NHS and their growing numbers are widely recognised as good for patient care – helping ensure quality, dignified care in the future.”

Sign our Speak Out Safely petition to support a transparent and open NHS. We are calling on the government to implement recommendations from the Francis report that will increase protection for staff who raise concerns about patient care.

Readers' comments (22)

  • I am a senior HCA in an emergency department. I am fully up date and trained with the relevant skills but when I first started this job 6 years ago. I was thrown in at the deep end. Within 2 weeks of being in the department I was allocated to work in Resus and take part in a Cardiac Arrest. Yes I had CPR training the week before but only wished I could have just watched on that particular day to see how Resus runs and what happens when a blue call arrives. There is a big difference in doing CPR on a dummy to doing it on a real patient. I was totally distressed that day as the patient did not survive and I was made to prepare the body for viewing along side a qualified nurse. All I wanted to do at the time was go outside for air. The good thing that came out of this was I pressed my manager to put me on an ILS training course whish she did. 6 years on with loads of training in different areas and certificates to show I am fully confident and competent in what I do but I agree more support is needed for new HCA's just starting out.

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  • Isn't that what HCAs are doing in most places too?

    Just to paraphrase the first paragraph,

    "increasingly carrying out tasks normally done by qualified nurses, often with insufficient training and supervision."

    It's care by the cheapest bidder! You don't need skill, education, qualifications or experience, there will always be someone beneath you without any of that who managers can get to do your job for less money. Little things like quality of care don't matter.

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  • michael stone

    This is interesting, considering that a common criticism is that there is no formal requirement for HCAs to be adequately trained !

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  • Nursing will be destroyed whilst we all sit and moan....

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  • Maggie Arnold Director of Nursing Glouc“Our apprentices are supervised at all times as well as having a mentor within the trust. They also learn a great deal by working on the job and this necessarily involves assisting in the provision of individualised, planned patient care.”
    So who is supervising, mentoring and working with the Students of Nursing?

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  • If this is correct, management should hang their heads in shame as should the government.

    Why on earth anybody wants to train as a nurse these days is beyond me. What is the point other than to shoulder the blame when the inevitable outcome of inadequate training of staff is the Mid Staffs scenario.

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  • tinkerbell

    cheaper unregulated staff, no accountability, what could possibly go wrong? Suits the private sector ideology to make a profit at the expense of quality of care without any accountability to the patient other than to their share holders. This is what it appears is to take the place of what was our nhs.

    Like the bankers no accountability but this time it is peoples lives they are playing with where they put profit before safety.

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  • Tinkerbell, I agree with your comments, with great sadness

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  • What is an apprentice? - what are they learning to be - an HCA? a student nurse?. You become an apprentice to learn a skill, not get dumped on as cheapo labour.

    Sorry to disagree with some people but HCAs and student nurses will inevitably witness emergencies and cardiac arrests. It is part of the job and there will always be a 'first time' for everyone, sometimes all the staff on duty have to get involved, we can't guarantee that there are enough people at the time so that staff can just observe, that is why employers insist on BLS training.

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  • so, inevitably, if a RN delegates a task to someone inappropriately then their registration is at risk. if staff are moved to wards inappropriately or expected to work with inappropriate staffing levels or skill mix whose 'registration' or job is at risk? - let me guess, no-ones.

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  • If an apprentice is doing the same job as a band 2 HCA they should be paid the same. If apprentice workers, HCAs and student nurses are supposed to work 'under supervision' then we need more RNs to supervise them.
    This is all just cheap labour, we need more RNs in every health setting.
    We are now in a position where cheapest seems to be best, you've got low paid apprentices doing an HCA job for 6 months, student nurses doing an HCA job for a year - is this going to be the end of permanent HCA jobs?
    Health care is the most important job anyone could do yet everyone working in health care is underpaid and undervalued.
    Health workers are responsible for peoples lives, don't those who set our wages and conditions realise the importance of that?

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  • I agree with all of you - I know 17-18 yrs olds doing what they call the 'nasty' tasks and doing it because they want/need the money not because they want to care for people. It is so much about cheap labour and as for the RN losing her registration if she delegates incorrectly what can we do-if there is no-one else to do the job do we left the job undone? Poor patients.

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  • I will accept "apprentices" in my Dept until
    the foolish. idiotic, brain dead clown, of a DNS who determines that such people should be employed ------PERSONALLY provides the required supervision.

    Guess I will not be entertaining many "apprentices" -----

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  • Apprenticeships are a cheap way of emplying a hca for 18months (£90 per week on average £2.80 per hr). Plus what concerns me is school leavers will be exposed to the reality of illness and witness events which will shock them and embarass them. Apprentices are vulnerable. Care must be taken during the recruitment process whether a school leaver has the resilience and integrity to withstand these situations and promote the reputation of our profession positively.

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  • Please can people stop talking about young people as if we need to "protect" them? The only problem with putting young people into jobs like this is that they start with 0 experience- none from caring for their own children, none from caring from their elders- but what they don't need is protecting. No, they wont run a mile when they are trained to look after sick people, they wont start crying when they asked to wash someone in bed- as long as they are trained properly. Do you not think they are aware that people get ill or die? I am 100% in agreement with the point that the HCA apprenticeship is a chance to pay people less for the same work full-paid HCAs are doing, but the only thing "protecting" young people will do is add to the stigma around old age and death and the idea that it's a topic to avoid. I would hate for it to be me lying on my death bed with these people turning their heads and guiding young people away as if I might damage their sanity.

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  • Who remembers the YTS Scheme?
    It was created to give the youth a training scheme/apprenticeships into jobs

    The problem was a lot of these schemes were never supervised properly so the youngsters just ended up making tea and never learnt anything.

    Comedians would make jokes about these during stand up

    The schemes need proper supervision and a carefully thought out training scheme. The young people who want to become nurses need respect and be valued and be taught properly and this is expensive.

    How can this take place on a busy, understaffed ward?

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  • School leavers are 16 - 17 yrs old are not legally an adult until 18 yrs. This is a legal implication which cannot be overlooked. At the age of 16 I would not want my own daughter or son to be exposed to death, personal care knowing that they where still under my guardianship. You cannot avoid that they are vulnerable and do need protection from being exposed to the above at an impressionable age.

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  • Safeguarding applies to children in further education up to the age of 18 yrs. Up until the age of 18yrs a parent has guardianship and parental responsibility.

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  • how old do you have to be to start student nurse training or join the police, fire service, ambulance service or join the armed forces?

    how old do you have to be to have a baby?

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