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Lords reject compulsory register for HCAs


Members of the House of Lords have rejected calls to make the regulation of healthcare assistants compulsory.

The existing wording of the health and social care bill provides for the establishment of a voluntary register for HCAs. However, during a debate on the bill yesterday, Baroness Masham of Ilton tabled an amendment calling for registration to be mandatory.

She said: “Healthcare assistants and assistant practitioners are carrying out more and more of what are seen as nursing procedures. It is not always possible to supervise them on a busy ward or in somebody’s own home. Surely there should be a mandatory register accompanied by a programme of basic standardised training.

“A voluntary register is likely to be too weak and in any event it will be avoided by the very people about whom there is most concern,” she said.

The amendment received some support, including from Lord Hunt, the former health minister and former chair of the National Patient Safety Agency.

However, government health spokeswoman Baroness Northover rejected it, saying there was not enough evidence that mandatory regulation was necessary to protect patients.

She added: “Compulsory statutory regulation… is not a panacea. It is no substitute for good leadership at every level and proper and visible management of health and social care services.”

The Lords will have one more chance to consider the amendment when the bill goes to its next stage.


Readers' comments (6)

  • Shameful.

    The government health spokeswoman rejected it, saying "there was not enough evidence that mandatory regulation was necessary to protect patients." and “Compulsory statutory regulation… is not a panacea. It is no substitute for good leadership at every level and proper and visible management of health and social care services.”

    How much evidence does the government need? This decision is more about the Government obsession with reducing regulation than any serious consideration of the health needs of patients.

    This appears to be an evidence-free government

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  • what does the house of lords have to do with it? surely it is a question for the healthcare professions themselves.

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  • tinkerbell

    Anonymous | 21-Dec-2011 1:14 pm

    I was wondering exactly the same, but then realised that they always put things to the Lords when they want to faff about a bit longer and delay anything.

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  • Totaly agree with what has been said previously, what is this government doing just leave it to the people in the know best is the health care professions and stop interferring and dragging their feet. Havent they got enough evidence re the exposed situations lately.

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  • Re Anonymous and tinkerbell- govt law has to be cleared by the Lords- its part of our British constitution. It is a safeguard against the govt just passing anything they want to so its nothing to do with either 'govt obsession' or 'wanting to put things off and faff about'.
    Its not the end of things- the debate must go on as we all know that regulating against struck off nurses still working as HCAs and making them more accountable has got to be good thing.
    Time will tell, but I wish more people who know what they are doing had a say. Unfortunately some of the health care professionals have their own personal agendas so it cant just be down to them, although I agree that more of HC Profs having a say in something as important as this.
    Lets also get the skill mix straightened out then there would be more supervison of untrained and unregulated staff!

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  • Re: Health Care Assistants (HCAs) do need to be regulated.

    Whilst the Government’s plans to introduce a new minimum standard of training for HCAs is a small start in the right direction (reported in The Time 8th November 2011); it falls seriously short in terms of providing a system that assures and maximises public protection for patients and the public. Further it is not good for HCAs, themselves, as it will mean that many current HCAs will have a lesser standard of training then others, and does not address how misconduct should be addressed. The regulation of HCAs is long overdue. I feel this view is well supported by the general public, professional bodies like the RCN and nurses, as well as by Baroness Emerton who is trying to ensure that HCAs are regulated.

    As many people will be aware regulating those staff who support a professional is not uncommon - professions like accountancy and the legal profession do it to ensure clear standards of education and practice are set for these groups. It is recognised as a proven way to assure someone is fit for purpose and practice in their particular field. Over the past few years ‘we’ have had various reports into poor care in both health and social care organisations. One of the factors contributing to these scandals is the failure to assure HCAs are properly trained, supervise and regulated. I acknowledge there are many good HCAs out there and that it is often posited that employer systems are in place to manage such staff, but whilst processes like appraisal policies exist in health care they are often not used or not used effectively, and it is clear that on many occasions HCAs are not being supervised by qualified nurses – often because they are too busy managing a busy ward and cannot keep an eye on everything.

    There has been a call for the return of the State Enrolled Nurse (SEN). From my experience in regulation, this could be a very practical solution in dealing with the non-regulated Health Care Assistant (HCA). The Nursing & Midwifery Council is the largest UK health professions regulator and would be in a good position to take on this responsibility – it has the mechanism in place to record and register care assistants and has extensive experience of setting professional standards for this area of practice. I, also, understand that when the legislation was put in place to create the NMC the register for SENs was not closed. In effect the NMC can still register SENs (albeit they are currently called Enrolled Nurses and the NMC may want to consider a new title).

    There are many nurses currently on this part of the NMC’s register (level 2) who did not covert to becoming level 1 registered nurse in the 1990s. The NMC would need to set up-to-date education & practice standards for HCAs being admitted to the enrolled nurse part of the register and the proposed Government’s new minimum standards might be a starting point. Producing the HCAs trainings standards should be done in close co-operation with health and social care providers e.g. NHS Trusts, education institutions with experience in training nurses, and importantly in consultation with the public. Whilst this will not solve all the ‘ bed side’ problems that have occurred in health and socials organisations recently, it would assure that there were ‘enforceable’ national standards for education and training, as well as for conduct and performance of HCAs. This would provide a UK register of care assistants and would ensure a regulator body had the power to remove those who were not fit to practice. A simple amendment to the current Health and Social care bill could enable this to happen.

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