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'Healthcare assistants do not need statutory regulation'


We already have a comprehensive system of checks in place for support workers, argues Christine Braithwaite

Statutory regulation of healthcare assistants is the wrong solution to the wrong problem. Instead, we should be focusing on making sure that nurses and HCAs are supported by employers to do their jobs well. Patients rightly hold both in high regard and are aware they need effective management support to enable them to deliver good care.

As a local involvement network member recently told us: “Patients tell us about their many positive experiences of nursing. They do sometimes complain about things like not being able to reach a bell but they are generally sympathetic to nurses’ and healthcare assistants’ busy working schedules and seldom want to complain.”

Events at Mid Staffordshire Trust have shown us the limits of regulation: it did not stop poor care. What does protect patients is professionalism: nurses and other staff living by their codes of conduct and performance. That includes delegating responsibly, supervising effectively and being supported by management to do this well. The Nursing and Midwifery Council’s guidance on delegation is helpful.

“We are not aware of any data that shows HCAs are causing serious harm”

Healthcare is heavily regulated and controlled. Employers in England are regulated by the Care Quality Commission and must ensure that they recruit the right people and make sure they have the right training and skills. If they do not comply with these regulations, they should be referred to the CQC so that it can take action, using enforcement powers if necessary.

All employers conduct Criminal Records Bureau checks, review Independent Safeguarding Authority records and can perform checks with the NMC. The nursing regulator circulates a list of names of people who have been struck off to directors of nursing and could make it easier still by publishing those names on its website for all to see - as we have asked them to do. Other health professional regulators already do this.

A quick look at one nursing agency supplying temporary staff shows they are regulated by CQC, accredited by two bodies, approved by the Information Commissioner, ISO 9001 registered and EXOR health and safety accredited to gold standard; it also offers professional indemnity insurance, provides mandatory training and has clinical governance systems. Staff then work in an organisation that has its own assurance systems, too.

Add to this the role of commissioners and of regulated professionals in supervising staff, and we already have a comprehensive (and expensive) system of checks and balances in place.

The public has a right to expect its money in this regard is well spent before being asked to spend another £70m a year on regulating support staff. Statutory regulation is neither quick nor cheap to set up and, if that money is available, it could be put to better use in ensuring the right skill mix on wards or supporting education.

In our paper Right-Touch Regulation, we explain that regulation must be based on an assessment of actual harm, not possible risk, and it should be proportionate to the problem it is trying to solve.

We must also take care to ensure that we have correctly identified the problem in the first place. We are not aware of any data that shows HCAs are causing serious harm.

If nurses are concerned that employers are using lower-paid staff in preference to nurses to do things they used to do, then regulating HCAs may well increase that trend. This could have far-reaching, unintended consequences.

We do not think HCAs need statutory regulation. We do think nurses and HCAs should be properly supported at work to give the best care possible.

Christine Braithwaite is director of policy and external relations at the Council for Healthcare Regulatory Excellence


Readers' comments (4)

  • I cannot dispute the facts that Christine has stated however, working in the private sector is a very different kettle of fish to the NHS, unfortunately.
    In my experience, a high percentage of HCA's working in care homes see their employment as just a job to pay bills. They do not see themselves in the same context as hospital HCA's, despite the lengths we go to to train them, encourage them to do further studies, give them responsibilities etc. We try and teach them about accountability but only a few acknowledge what they're taught.
    We dismiss people for under performing but care homes are so desperate for staff that they find new employment in other homes with no problem.
    The reason I'd like to see a regulatory body for HCA's is to help us employers give them an identity, a greater feeling of self esteem, and the belief that they do an important job that has career prospects. It's not just about weeding out the bad but helping to encourage the good is vital.

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  • michael stone

    The person who will eventually oversee a voluntary register for HCAs, and myself, both agree about the pragmatic answer to this issue.

    It is about having a very clear local-level policy, which makes it obvious who is responsible for 'certifying' the competence of HCAs to do the things they are asked to do - who, further up the command chain, gets blamed if an HCA is tasked with soemthing outside of their competence level (when the HCA is unaware of that).

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  • As a helpful addition to Christine Braithwaite's comments, in order for the Independent Safeguarding Authority to make fair, thorough and transparent decisions about who should be barred from working/volunteering with these groups, it needs to receive referrals from employers where they believe (often after their own disciplinary processes) that an employee has harmed or there is a risk of harm of a child or vulnerable adult.

    Therefore, a nurse who has been barred from working with children and/or vulnerable adults is breaking the law if they work (or seek to work) with these groups. An organisation which knowingly employs someone who is barred is also breaking the law.

    It’s vitally important that employers and organisations are aware of their safeguarding responsibilities, so that we can all work together to help prevent the abuse of the most vulnerable members of our society.

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  • Yes they do. But given your job title I would not expect you to understand that.

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