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Employers reject HCA regulation and creation of 'older person's nurse'


NHS Employers has written to the Department of Health calling on it to reject some of the key recommendations in the Francis report relating to nursing.

The organisation, which represents trusts, sent a letter to the DH yesterday responding to Robert Francis QC’s Mid Staffordshire Foundation Trust Public Inquiry report.

In the letter, NHS Employers argued against the mandatory regulation of healthcare assistants, claiming it was “not an appropriate or proportionate action”. It also warned that minimum training standards for HCAs could become a “tick-box” exercise.

In addition, the letter expressed concern at the prospect of creating a specific older people’s nurse specialist role, arguing that most NHS staff worked with older people rather than a subset.

“We know the changing demographics of the population and we have examples from employers where the youngest person on a hospital ward is 92 years old,” it stated. “We need to be clear that, for most people, working within the health service means working with older people.”

The letter – seen by Nursing Times – was sent to Gavin Larner, the DH director of professional standards, who is leading the team behind the government’s response to the Francis report.

Its contents summarises the views expressed by 180 HR directors and senior HR professionals at six listening workshops from 15-26 February.

However, NHS Employers appeared to accept the arguments for aptitude tests for healthcare students to ensure they had the right values and behaviours.

The letter said: “Funding pre-registration education (fees and bursary), when other non-healthcare courses are paid for by students, appeared to be creating a perverse incentive and driving some people’s behaviour to enter healthcare training courses without the intent to forge a career in healthcare.

“Employers want to be assured that we are properly testing intentions, as well as attributes and fundamental academic abilities, before accepting students onto courses.”

The letter also backed calls for a change in culture around raising concerns and lent support to making ward mangers supernumerary.

“[There is] still an over-riding feeling of needing to be brave to raise concerns for fear of reprisal, despite much good work in this area. Driving a more open and transparent discussion at board, through to ward level, will start to change this,” it stated.

“There was some support for creating ward manager posts, outside of the established numbers,” it added. “For those who had done it, they confirmed it created an initial significant cost pressure but that it helped to provide the oversight and vigilance needed to address events and issues as they happen.

“In the medium to longer term the gains from the initial investment are both financial and better outcomes and experience for patients.”

The government is expected to formally respond next week to Mr Francis’ report, which included 290 recommendations.


Sign our Speak Out Safely petition to support a transparent and open NHS. We are calling on the government to implement recommendations from the Francis report that will increase protection for staff who raise concerns about patient care.


Readers' comments (3)

  • 'it was “not an appropriate or proportionate action”' to ensure that all healthcare staff are appropriately and well-trained to ensure delivery of high quality healthcare for patients, to ensure that there are enough staff to safely look after patients, to ensure frontline staff are properly remunerated for ensuring people's lives come first rather than cost cutting targets, and to ensure that there will be enough well trained and qualified staff in the future to look after everyone.

    Fine if they don't want to help fund pre-registration students to enter into healthcare, I like to see where the next generation of practitioners are going to come from. It will make more sense to pay for a course, where you know you will be properly remunerated, not used and abused, and as a career develops can work with higher levels training, skills and experience without the threat of being downbanded/downgraded like it is with nurses just because those at the top wants to make 'efficiency' savings.

    I'd like to raise a concern that the government and employers are not really interested in patient care, quality or outcomes, other than to save their face and sound like they care; and that they will not ensure healthcare staff directly involved with or supporting patient care are properly paid, trained and supported to do their jobs effectively. Seems that money will always come first.

    Cutting everything back to the minimum, including staffing levels, staff pay and reducing resources, staff training, patient services and treatments feels like it makes it more attractive for big private companies to take over and run the health service for profit for the key shareholders.

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  • Just because the majority of staff work with older patients, doesn't mean they have the expertise to care for them. Many have complex needs to be taken into account, not just what they came into hospital with. I have nursed for 40 years, many years with care of the elderly, and elswhere. My observation has been that they do not always get the care they require on other wards. Not the nurses fault, but lack of expertise.
    Did NHS Employers get every Trust's response before writing to the DH, do we know?

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  • I have heard some nurses say that they only went into nursing because they got paid for 'doing a degree'.

    Do nurses working in any 'specialist' wards (except ITU and theatres) have experience and training in that particular area, do they all have extra training and attend courses so that they can care for their patients properly or are most nurses now just generalists with 'transferrable skills'?

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