Proposals to improve the training and status of healthcare assistants do not go far enough to protect the public – but could make regulation of the workforce easier in future, Nursing Times has been told.
The Sunday Times journalist Camilla Cavendish was commissioned by the government to review the recruitment training and support of HCAs in the wake of the publication of the Francis report into care failings at Stafford Hospital.
Her review, published last week, recommended all support workers in health and social care should complete a “certificate of fundamental care” before being allowed to work unsupervised.
On completing the certificate, those working in healthcare would be called “nursing assistants”, in a bid to cut the wide variety of titles currently in use for health support roles and make it easier for the public to understand.
The review also called for nursing directors to take over responsibility for the HCA workforce from their human resources departments, in order to put “this group of staff onto the agenda” of trust boards.
Ms Cavendish’s recommendations were largely welcomed by nursing unions and professional bodies. However, some also argued that, while they were a step in the right direction, they did not go far enough.
Unison, the Royal College of Nursing and the Queen’s Nursing Institute all said the review proposals were no substitute for the statutory regulation of the HCA workforce.
QNI chief executive Crystal Oldman said: “A certificate of fundamental care would provide a minimum agreed level of education and training. But we need to go further to protect the public and introduce a system of national regulation.”
She noted that mandatory regulation was particularly important in community settings, where many HCAs worked unsupervised.
Ms Oldman acknowledged that a certificate would be a step towards a national education framework, which would be necessary before “regulation could be successfully introduced”.
RCN head of policy Howard Catton agreed that the introduction of the fundamental care certificate could make it easier to move towards regulation in future.
“If there is an agreed curriculum with assessment and review and a certificate that’s a requirement for employment, there’s only one more step to some sort of mandatory register,” he said. “In a way we will have done an awful lot of the heavy lifting, from that point it might feel it’s a step rather than a leap to regulation.”
Mandatory HCA regulation itself was not part of the review’s terms of reference.
Speaking to Nursing Times about her findings, Ms Cavendish said she had not been able to ignore the issue of regulation, but did not think it was a practical measure to introduce at present.
She did however call for the government to tackle the “mythology” that it was impossible to get rid of poorly performing NHS staff.
Her review report stressed the importance of line managers, usually ward sisters, in conducting fair and accurate appraisals. Ms Cavendish said employment lawyers had highlighted to her that the NHS culture of giving positive appraisals made it difficult to dismiss individuals.
The review also proposed that student nurses also complete the fundamental care certificate alongside HCAs.
Ms Cavendish told Nursing Times it was important that HCAs were “regarded as part of the nursing group”, and evidence suggested joint training helped to develop that common language.
“I’m surprised by the extent of resentment we heard from some HCAs about some nurses,” she added.
The joint training idea was inspired by the experience of some US hospitals, as well as London’s Guy’s and St Thomas’ Foundation Trust, and the airline industry where pilots and cabin crew complete safety training together.
At Guy’s and Thomas’, joint training for teams working on its three older people’s wards led to a 14% reduction in patients raising concerns and HCAs reported feeling more respected and optimistic about their careers.
Trish Morris-Thompson, visiting professor at Buckinghamshire New University and former NHS London chief nurse, told Nursing Times that shared learning “across the nursing family was fantastic for developing shared values”.
The Cavendish review also recommended the development of a “senior nursing assistant” role. This title would require completion of a proposed “higher certificate of fundamental care”, which the review said should count towards a nursing degree.
In its response to the review, the Nursing and Midwifery Council said the idea of a nationally-recognised certificate would assist nurses in assuring themselves they were delegating appropriately.
Ms Cavendish said there had been “huge demand” for the title of nursing assistant from the hundreds of HCAs who contributed to the review.
Many had also wanted to see the state enrolled nurses bought back. The role was abolished as part of project 2000 and the move to an all graduate profession.
She said: “I’m quite upset that when the move to all degree nursing was decided no thought was given to the impact on this group [HCAs]. It’s another example of how this group has been undervalued.”
The government is considering the recommendations and will respond in the autumn.
Are you able to Speak Out Safely? Sign our petition to put pressure on your trust to support an open and transparent NHS.