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Exclusive: fears raised over HCA apprenticeship schemes


Concerns have been raised that teenage apprentices are increasingly carrying out tasks normally done by healthcare assistants, sometimes with insufficient training and supervision.    

These include key tasks such as care of deceased patients and recording key clinical observations such as blood pressure and oxygen saturation levels. They are also helping patients to use toilets, assisting with feeding and liaising with relatives.

Use of apprentices in the NHS has been growing, with around 8,000 places during 2012-13. Although the apprenticeship schemes can cover a range of roles, including admin, Nursing Times has identified a number of trusts using or advertising for HCA apprentices.

Homerton University Hospital Foundation Trust in London is advertising for 10 HCA apprentices, while James Paget University Hospitals Foundation Trust is looking for one apprentice to work on a rehab ward on a salary of £109 a week. Norfolk Community Health and Care Trust is also advertising for HCA apprentices.

Gloucester Hospitals Foundation Trust has 34 apprentices already working on its wards, after launching a scheme in September last year.

However, a healthcare assistant who works alongside apprentices at the trust contacted Nursing Times with concerns that their training and supervision was not sufficient.

“Some are under 18, so you’re asking teenagers to be at cardiac arrests and to lay out dead patients, it’s wrong,” they said. “One teenager was on a respiratory ward and she was asked to lay a patient out and freaked.

“They are doing the exact same job as me, but they’re only paying them £9,000 a year. That’s £6,000 less than a HCA, for the exact same job,” they added. “But they haven’t had the training and in some cases [are left] on their own.”

“In my opinion it is a way of cutting the staff budget and it totally undermines us. They are not bad kids to be honest, but it’s just cheap labour.”

The trust refuted the claims and insisted all of its apprentices, which include one 16-year-old and four 17-year-olds, were under constant supervision.

Maggie Arnold, the trust’s director of nursing, said: “Our apprentices are supervised at all times as well as having a mentor within the trust. They also learn a great deal by working on the job and this necessarily involves assisting in the provision of individualised, planned patient care.”

The trust said apprentices received a two-day induction plus a protected study day each month.

A spokesman for Norfolk Community Health and Care Trust said its apprentices had extensive training for three months before working under “continuous” supervision. He added: “Apprentices work alongside the trust’s qualified staff, but do not replace these roles.”

The NHS Employers organisation and the national skills council Skills for Health are working with the government to increase the number of apprentices in the health sector.

Skills for Health has developed a framework to guide trusts in what tasks apprentices can do and issues certificates at the end of their placement.

The framework does not discuss which areas of direct patient care that apprentices should be allowed to do but neither does it state those that they should not be engaged in.

However, the document says:  “Apprenticeships are one of the many ways in which employers within the health sector are seeking to address… increasing pressures. Support workers tend to have delegated responsibility for a range of tasks which enables the professionally qualified staff – eg nurses, doctors, allied health professionals – to fulfil their own roles more effectively.”

Angelo Varetto, head of apprenticeships at Skills for Health, said apprentices should have a minimum of 670 hours of learning in 12 months and should not be left unsupervised.

“The expectation is they would have someone with them to make sure they are doing the job properly,” he said. “We would not expect them to be working alone.

“Apprentices and particularly young people should not be put in those types of situations and shouldn’t be asked to do things like that,” he added.

However, the introduction of HCA apprentices prompted concerns from the Royal College of Nursing.

RCN head of policy Howard Catton said it “could mark the next stage of evolution in terms of skill mix dilution” among the nursing workforce.

He said there was nothing wrong with the idea of apprenticeships, but they needed to be properly structured and constituted.

“If there are cases where this is not happening, it raises big questions about whether these schemes should be called apprenticeships at all,” he said.

Mr Catton added: “For a registered nurse to delegate any task under these circumstances could be inappropriate and raise patient safety issues. The nurse would need to be extremely careful as they could put their registration in jeopardy.”

He urged nurses with concerns over the use of HCA apprentices to raise them with their line manager.

Professor Ieuan Ellis, chair of the council of Deans of Health, added: “Patient safety must be paramount. It is unacceptable both to patients and apprentices if they are required to work beyond their skills or experience, and without close supervision.”

A spokesman for the Nursing and Midwifery Council warned nurses they needed to be mindful of its code of conduct.

“Registrants need to satisfy themselves that delegation is appropriate in a given situation,” he said.

A spokesman for NHS Employers said: “These staff bring fresh skills and positivity to the NHS and their growing numbers are widely recognised as good for patient care – helping ensure quality, dignified care in the future.”

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 (22)

  • I am a senior HCA in an emergency department. I am fully up date and trained with the relevant skills but when I first started this job 6 years ago. I was thrown in at the deep end. Within 2 weeks of being in the department I was allocated to work in Resus and take part in a Cardiac Arrest. Yes I had CPR training the week before but only wished I could have just watched on that particular day to see how Resus runs and what happens when a blue call arrives. There is a big difference in doing CPR on a dummy to doing it on a real patient. I was totally distressed that day as the patient did not survive and I was made to prepare the body for viewing along side a qualified nurse. All I wanted to do at the time was go outside for air. The good thing that came out of this was I pressed my manager to put me on an ILS training course whish she did. 6 years on with loads of training in different areas and certificates to show I am fully confident and competent in what I do but I agree more support is needed for new HCA's just starting out.

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  • Isn't that what HCAs are doing in most places too?

    Just to paraphrase the first paragraph,

    "increasingly carrying out tasks normally done by qualified nurses, often with insufficient training and supervision."

    It's care by the cheapest bidder! You don't need skill, education, qualifications or experience, there will always be someone beneath you without any of that who managers can get to do your job for less money. Little things like quality of care don't matter.

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  • michael stone

    This is interesting, considering that a common criticism is that there is no formal requirement for HCAs to be adequately trained !

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  • Nursing will be destroyed whilst we all sit and moan....

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  • Maggie Arnold Director of Nursing Glouc“Our apprentices are supervised at all times as well as having a mentor within the trust. They also learn a great deal by working on the job and this necessarily involves assisting in the provision of individualised, planned patient care.”
    So who is supervising, mentoring and working with the Students of Nursing?

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  • If this is correct, management should hang their heads in shame as should the government.

    Why on earth anybody wants to train as a nurse these days is beyond me. What is the point other than to shoulder the blame when the inevitable outcome of inadequate training of staff is the Mid Staffs scenario.

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  • tinkerbell

    cheaper unregulated staff, no accountability, what could possibly go wrong? Suits the private sector ideology to make a profit at the expense of quality of care without any accountability to the patient other than to their share holders. This is what it appears is to take the place of what was our nhs.

    Like the bankers no accountability but this time it is peoples lives they are playing with where they put profit before safety.

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  • Tinkerbell, I agree with your comments, with great sadness

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  • What is an apprentice? - what are they learning to be - an HCA? a student nurse?. You become an apprentice to learn a skill, not get dumped on as cheapo labour.

    Sorry to disagree with some people but HCAs and student nurses will inevitably witness emergencies and cardiac arrests. It is part of the job and there will always be a 'first time' for everyone, sometimes all the staff on duty have to get involved, we can't guarantee that there are enough people at the time so that staff can just observe, that is why employers insist on BLS training.

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  • so, inevitably, if a RN delegates a task to someone inappropriately then their registration is at risk. if staff are moved to wards inappropriately or expected to work with inappropriate staffing levels or skill mix whose 'registration' or job is at risk? - let me guess, no-ones.

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