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Francis report: HCAs should face regulation


Healthcare support workers should be subject to regulation by the Nursing and Midwifery Council in one of 290 recommendations from the Mid Staffordshire Foundation Trust public inquiry.

Inquiry chair Robert Francis QC said HCAs should not allowed to deliver personal care to patients in any healthcare setting without first being registered.

He has also demanded a national code of conduct and a national set of standards for training of HCAs who he said should also be clearly identified and distinguishable from a registered nurse.

In his report, which makes a total of 290 recommendations, Robert Francis QC said the Nursing and Midwifery Council should be in charge of regulating the HCA workforce but he also called on the Department of Health to launch a nationwide system to “protect patients”.

It should be a national entry-level requirement for student nurses to spend a minimum period of time, at least three months, working on direct care of patients. A satisfactory completion of this should be a pre-condition for continuing training, Mr Francis argues.

The report also calls for nursing students to be recruited based on values with “constant support and incentivisation” for nurses, “which values the work they do.”

Mr Francis says nurse education should be reviewed to ensure sufficient practical elements that ensure trainees have a “consistent standard” and he suggests the NMC should develop an “aptitude test” for student nurses.

He also calls for the Department of Health and the NMC to develop the idea of a Responsible Officer for Nursing, and for a system of annual revalidation similar to doctors to be created with nurses having to demonstrate key skills and knowledge and include feedback from patients.

Ward nurse managers should not be office bound and should know about care plans for each patient, Robert Francis said. They should be visible to patients and staff alike and act as a role model and mentor to other nurses.

A key recommendation was for each patient to be allocated for each shift a key nurse responsible for their care and this nurse should be present at every interaction between the patient and the doctor.

Mr Francis also backed the use of a cultural barometer on wards and backed further efforts to develop a tool for assessing the needs for minimum staffing on wards.


Readers' comments (31)

  • tinkerbell

    Good man Robert Francis. Tell it like it is QC.

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  • tinkerbell

    who regulates the managers?

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  • Any person who is involved in the direct care of patients must be regulated. By being regulated, we have codes of conduct and regulations to abide by which are there to protect everyone. At the moment, anybody can be employed as an HCA without any training. Suitable training and regulation of HCA's is the only way we can provide a high standard of care across the board where everyone is accountable for their actions. Regulation of HCA's can't come soon enough.

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  • tinkerbell, simple . . . noone regulates the managers. Whilst there is a lot of good stuff in this report, Mr Francis QC has not had the guts to go that far!!

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  • Bill Rollings | 6-Feb-2013 2:44 pm

    if all of the recommendations are implemented, which it looks as though there is a good chance they will be, and with the government and the opposition on the NHS, patients' and nurses side, it looks as if they won't get away with nearly as much any more. Everybody will see to that. Besides, more power is being handed to clinicians and patients and their families and to those who lodge complaints or blow the whistle.

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  • Susan Markham

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  • Removed due to offensive content. Please refer to this site's terms and conditions before posting further:<br/>

  • Susan Markham

    tinkerbell | 6-Feb-2013 12:45 pm

    "who regulates the managers?"

    Indeed Tink. Just another reason why the good intentions of this report will eventually come to naught.

    Common sense 101 - don't leave the lunatics in charge of the asylum.

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  • you can susan and tink regulate managers you can do everything? i would be very happy after 28 years of direct care just wash, feed, toliet,listen,our patient that is the most rewarding post no paperwork! i wouldn't thank you for a post as a nurse people ask me if i was a nurse and why i didn't do my training i said I AM NOT STUPIED i could see this coming many years ago it only needs a couple off kids to start a fire oh well?

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  • Susan Markham

    Anonymous | 6-Feb-2013 5:35 pm

    Exactly! I am a Registered Nurse not a frigging administrator.

    I started my nursing career back in 1974 and my goal was to become a State Registered Nurse who cared for the health of patients. I didn't sign up to become a quasi-doctor or manager... but that is what the formation of Health Trusts (originally formed under Thatcher's “Sainsbury Report” in the 80's) forced me to become.

    Hehehehe... fortunately I resisted joining the club and I turned down many offers of promotion.

    You were very wise my friend to recognize your competency and to stick to it. Not that many people have your courage and fortitude.... BTW... I DID!

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  • The spelling and grammar posted above by many is a prime example why nursing needs to raise its standards. It is not about being a 'semi-doctor' - as technology and treatments progress so should nursing. I, for one, believe that these regulations cannot come soon enough; and probably could be more stringent.

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