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Regulation of HCA not a top priority for the NHS


The chief executive of the NHS has dismissed calls from two of the country’s most senior nurses for healthcare assistants to be regulated, saying “nurses would say that wouldn’t they?”.

During his evidence to the Mid Staffordshire Foundation Trust public inquiry last week Sir David Nicholson was asked to respond to the comments, widely reported in the national media, from Royal College of Nursing chief executive Peter Carter and Nursing and Midwifery Council boss Dickon Weir-Hughes.

Professor Weir-Hughes warned the country was heading for a “ghastly national disaster” without regulation.

Sir David said: “I’m not convinced that spending a huge amount of time and effort in [creating] the registration organisation, as opposed to putting the effort into training and education, might be a better way forward. And, of course, the nursing profession would say all of that, wouldn’t they?”

The inquiry is examining why appalling standards of care at the trust went unnoticed for so long and is considering whether regulating HCAs could help improve standards in future.

However, Sir David told the inquiry regulating such a huge and diverse workforce, whose roles ranged from “housekeeping to the direct care of patients”, was a complex task and was not of “top importance” at the moment when the NHS was going through major reform and financial challenge.

Inquiry chairman Robert Francis QC questioned his priorities, asking what could be more important than ensuring that the people “charged with feeding and providing basic care to our most vulnerable patients are fit and proper people to do that?”

Sir David said training and education was more important than regulation.

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Readers' comments (36)

  • tinkerbell

    Correct me if i'm wrong, but as a qualified nurse am i not accountable for the HCW's working my shift. If they go off and get something horribly wrong without my knowledge am i still accountable? If so then they should be regulated and accept accountability. I do not have eyes in my backside and i am not all knowing. The majority of HCW's i work with are great but there are some that no matter how much training or education they are given, and they have been given it believe me, will just go off and 'do their own thing' and this is the same for some qualified staff also. People are people qualified or unqualified. People who work with vulnerable people should all be regulated, responsble and accountable in their own right and not have the buck passed on to the nurse in charge, unless he/she is also culpable.We have already had a tragedy at our place a few years ago. I never want one on my shift because i was not aware what was going on and then have to attend an enquiry where i am the nurse that is accountable because when the proverbial hits the fan it will be your arse that is dragged over the coals have no doubt about that.

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  • John Howes-You are Soooooooo right and what an arrogant shit Sir David Nicholson sounds.
    Of course everything is always nurses fault becuase we are superhuman and can produce miracles and overcome any little obstacles like the mad systems in which we are required to work -well we could if we were truly vocational as the Daily Mail would say.

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  • michael stone

    Anonymous | 1-Oct-2011 10:56 am

    tinkerbell | 30-Sep-2011 9:50 pm

    Everyone - including nurses - should make it plain that they are willing to be blamed for their own mistakes, but not for the mistakes of other people.

    If individual nurses are expected by management to somehow supervise 6 unqualified HCAs, and you reckon that is impossible, then as a unit an entire hospitals nursing staff should complain to management about it: and also copy in the DH and RCN.

    Not just mutter between yourselves !

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  • David Nicholson is absolutely right with regard to the regulation of HCA’s: it certainly isn’t a priority and, in reality, would be little more than a list of names and wouldn’t guarantee the safety of one single patient. I totally agree with Nicholson’s remarks regarding training and surely the priority is for each employer to ensure that HCA’s in their employ have the necessary skills and training to undertake the tasks that they’re given.

    I have no idea how many HCA’s there are working in the UK, but I’m sure that we’re talking in the millions here. Can you imagine the cost, can you imagine how large such an organisation would be? Logistically, it is impossible.

    Just thinking where I work, we have some HCA’s who are basically limited to topping-up and tidying the sluice whereas others are able to cannulate and do ECG’s. How could you regulate such a diverse workforce? The answer is, you can’t! If you include everyone that is involved in patient care then the register becomes meaningless, if you only allow those with a NVQ, then you exclude those who are probably most in need of support and training. If you limit the HCA register to these Associate Practitioners then I believe this will negatively impact on the primacy of the Registered Nurse and will ultimately lead to our employers favouring the cheaper alternative!

    The situation we now find ourselves in is largely due to the UKCC and Project 2000. Think back to the eighties: hands on care was provided by a regulated and highly-trained workforce, they were called Enrolled Nurses. The wards were also full of Student Nurses who weren’t supernumerary and learned on the job. There were some Auxiliaries, but in the hospital I worked, they had to do 6 weeks in school to learn the basics before they were allowed anywhere near a patient.

    What we really need is a minimum Registered Nurse to patient ratio as this really is the only way to guarantee high quality care. Even a very high nurse to patient ratio would be cheaper than introducing a register for HCA’s. I caution colleagues to be very careful in what they wish for with regard to registering HCA’s

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  • Anonymous | 1-Oct-2011 8:24 pm, you are wrong, you can regulate the workforce very easily. Nurses are regulated with a variety of roles and skills, and this is done quite easily.

    Also, as you say, there are a lot of HCAs out there working vastly outside what their role should be. Regulation would specifically define that role, and it would stop trusts from abusing staff in this way, using HCAs to perform tasks and roles they are not fully trained for just to save money.

    I do agree with you however in the fact that a full QUALIFIED Nurse/patient ratio is needed.

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  • michael stone

    Anonymous | 1-Oct-2011 8:24 pm

    see my post above:

    THAT is why you need the regulation, to make sure HCAs are trained properly - and, to establish who 'higher up the food chain' is to be BLAMED if their training is inadequate !

    Whether or not you need a national regulatory body, is a different question. But if the senior nurse on a ward is supposed to be responisble for training & regulation of the HCA's on it, fine, provided everyone understands and accepts that.

    It is the clarity of responsibility, which matters. You can't blame anyone for incompetently performing a task they are not adequately trained for, if they themself do not understand that is the case - but if an HCA damages a patient, you need to know who does get the blame.

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  • Mike and Michael,

    I’ve given my previous comments a lot of thought, but I still stand by earlier assertion that the regulation of HCA’s isn’t a priority. Individual employers taking responsibility for the staff in their employ ensuring that they are appropriately trained for the tasks which they are being asked to perform is, however, a priority. I’m not against HCA’s having their own register, but I think colleagues are placing too much emphasis on HCA‘s ‘being registered’ when its not the register that offers protection, but the training one has to do in order to become registered is.

    There a 660,000 nurses and midwives registered with the NMC, of which 350,896 work in the NHS in England - in hospitals and community services (not including GP practice staff) (NHS IC, 2011). It is relatively easy to regulate them as in order to call yourself a nurse or a midwife you have had to have completed a NMC approved training course which has minimum levels of attainment. The NMC register itself is not what protects patients, it is the training an individual undertakes to gain and maintain their registration with the NMC that affords patient protection.

    I’ve been unable to uncover the finite number of HCA’s in the UK, but it appears that there are 273,328 working in the NHS in England in hospitals and community services and there are 6,700 working in GP practices. There are in excess of 24,000 care homes registered within the UK so I think it is acceptable to assume we are dealing with an extremely large workforce at least as large as that on the NMC‘s books.

    Unlike their qualified colleagues, HCA’s have not had to meet any minimum requirements in order to become a HCA therefore there is no base in which to start from. You could say anyone wishing to work as a HCA has to have completed at least NVQ level II, but I know of someone who was able to complete her entire NVQ using a Dictaphone, so one wonders the true value of such a qualification. I could go on ad nauseum, but placing someone on a register does solve anything. Rather than the government spending however many £million on setting up such as register, I’d rather the money was spent on establishing proper nurse/patient ratios.

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  • Yes, Its all about money - again!! Regulation would help define the HCA role and therefore, support patient care/safety - but is that a priiority for the 'powers that be?' - it doesn't seem so to me.

    I agree with others though that an improvement in qualified staff/patient ratio is needed to improve patient care - this also would enable nurses to carry out their job effectively and safely.

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  • tinkerbell

    of course it is not a 'top priority'. The dismantling of the NHS is the top priority. Staff patient/ratio is not a top priority either, most wards are closing in my speciality. The top priority is 'cuts, cuts, cuts, making money and getting rid of nurses and pensions. We are just a fly in the ointment. Dire times!

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  • To my thinking an employer of HCA's should make sure that they have had the right training for what they are expected to do when they are on the ward, so that nurses know that all HCA's have the same basic knowledge, and know what tasks they can carry out without worrying if the HCA might drop them in it!
    It's the employer that should make sure the HCA is fit for purpose, and not nursing staff taking the rap when they are not!

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