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Regulation of HCA not a top priority for the NHS

  • 36 Comments

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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  • 36 Comments

Readers' comments (36)

  • michael stone

    Anonymous | 7-Oct-2011 8:53 pm

    We are not talking about insubordination - we are talking about, HCAs being asked to perform tasks outside of their competence levels.

    Anonymous | 7-Oct-2011 7:35 pm

    'whenever i ask for an explanation, i'm told that because i'm an hca i wouldn't understand the answer'

    That isn't very acceptable - it is sheer rudeness - but doubtless if you asked a nurse, that was the answer, and you pressed it, the nurse would say 'I don't have the time to explain it in enough detail, for you to be able to understand it'. But it strikes me, that as an HCA you are being subjected to offensive behaviour - mind you, it strikes me that everyone reckons somebody is being offensive towards them !

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  • @ mike | 7-Oct-2011 11:50 pm

    "Delegation
    If the nurse or midwife is delegating care to another professional, health care support staff, carer or relative, they must delegate effectively and are accountable for the appropriateness of the delegation. The code requires that nurses and midwives must
    establish that anyone they delegate to is able to carry out their instructions confirm that the outcome of any delegated task meets required standards make sure that everyone they are responsible for is supervised and supported."

    http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/

    so, if the task is within the training, skills and competency of the hca, the task has been made clear to the hca, yet when the nurse checks that the task has been completed to the required standard finds that the hca has "done their own thing," the nurse is NOT accountable for the hca "doing their own thing," the hca is, and should be disciplined appropriately.

    of course, if the nurse doesn't check that the task has been completed to the required standard, the hca's "own thing" results in a poor outcome and litigation, then the nurse is accountable for their own failure to follow through.

    mike, perhaps there isn't enough in the entire nhs training budget to teach you what you don't want to learn, ie. your own code of conduct.

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  • michael stone

    Anonymous | 9-Oct-2011 9:47 am



    Isn't your:

    'The code requires that nurses and midwives must establish that anyone they delegate to is able to carry out their instructions'

    what is being discussed here ? Isn't this discussion, about who is responsible for training the HCAs and checking their competences ? From what I can see, most nurses will say 'well, I don't have THE TIME to do that' !

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  • @ mike | 7-Oct-2011 11:50 pm

    "Delegation
    If the nurse or midwife is delegating care to another professional, health care support staff, carer or relative, they must delegate effectively and are accountable for the appropriateness of the delegation. The code requires that nurses and midwives must
    establish that anyone they delegate to is able to carry out their instructions confirm that the outcome of any delegated task meets required standards make sure that everyone they are responsible for is supervised and supported."

    http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/

    so, if the task is within the training, skills and competency of the hca, the task has been made clear to the hca, yet when the nurse checks that the task has been completed to the required standard finds that the hca has "done their own thing," the nurse is NOT accountable for the hca "doing their own thing," the hca is, and should be disciplined appropriately.

    of course, if the nurse doesn't check that the task has been completed to the required standard, the hca's "own thing" results in a poor outcome and litigation, then the nurse is accountable for their own failure to follow through.

    mike, perhaps there isn't enough in the entire nhs training budget to teach you what you don't want to learn, ie. your own code of conduct.

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  • There is a piece in today's Time's on page 18,

    Harry Cayton, CE of the CHRE which will (eventually) oversee a voluntary register for HCAs, wants to mirror an approach adopted by Scotland, by using a 'binding code of practice':

    'Under a scheme in Scotland, new HCAs must sign a code of conduct. In return, managers promise to make sure their workers are competent and properly trained. "It's low cost, high responsibility. The people nearest the problem are most responsible for solving the problem", Mr Cayton said. He also said "It's about who's in charge of that care or ward".'

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  • HCA are the backbone of nursing care the registered nurse supplies the drugs and iv's and does not give much time and care to the patients..the problem with regestering HCW would give nurses an eccuse to do even less contact with patient puting even more work onto the HCA

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