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Make care certificate compulsory for HCAs, says Cavendish


New training standards for healthcare assistants should be made mandatory as a step towards “inevitable” full registration of the care workforce, according to the author of a major review.

The next government must tackle the risks to patient safety from the lack of checks in place for HCAs, said Camilla Cavendish, who led a review into the training standards of care assistants in 2013 in the wake of the Francis report.

Ms Cavendish, associate editor of The Sunday Times, was speaking ahead of the introduction of HCA standards that came into effect on 1 April and which are based around the new Care Certificate.


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Health Education England has drawn up 15 standards HCAs should achieve over 12 weeks, which should be delivered by NHS trusts and social care employers as part of their induction.

“We have ended up accidentally with two tribes of people trained in different silos”

Camilla Cavendish

The standards, completion of which contribute towards gaining the certificate, are designed to deliver a national minimum level of training for HCAs. They cover basic areas such as fluids and nutrition, privacy and dignity, patient handling, and infection prevention.

Achieving the care certificate is considered to be best practice by Health Education England and the Care Quality Commission will check on its implementation during inspections. However, it has not been made a compulsory requirement by the government.

Ms Cavendish said she agreed with comments made by Lord Willis earlier this month, in which he called on Health Education England to make the care certificate mandatory.

She described the standards and certificate as a “real move forward”, but acknowledged that they were not going to “solve every single problem”. HCAs could have “any numbers of pieces of paper”, she said, but what mattered was the “care that people are actually getting”.

On the full registration of HCAs – one of the recommendations in the Francis report that was rejected by the government – Ms Cavendish said it was important not to overestimate the safety net this could provide.


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She noted that the fact nurses were registered and accountable to the Nursing and Midwifery Council had “not saved patients from appalling care” at Mid Staffordshire Foundation Trust.

Registration of HCAs would be a “huge bureaucratic task which would not necessarily create the utopia some of its advocates think it would”, she added.

However, despite this, she argued that HCAs would ultimately need to become part of a total registered nursing workforce.

“The dividing lines are artificial and we have ended up accidentally with two tribes of people trained in different silos,” she said. “I actually think we need to move to a situation where there is one registered workforce and in the end that is probably inevitable.”

Ms Cavendish added that a future government “absolutely” needed to address the systemic gaps that could allow HCAs who had been disciplined or were guilty of misconduct to move freely between employers without being identified.

“There have been proposals for some time now for skills passports, references and ways to check up on people,” she said.

“It is completely critical, and until we can do that we can never reassure patients or do what the staff themselves want, which is to make sure no one who is underperforming can reappear somewhere else,” she said. “We don’t have that at the moment.”


Readers' comments (23)

  • HCSW

    I've got a mixed feelings about that. Just a one important message from the article, 'noted that the fact nurses were registered and accountable to the Nursing and Midwifery Council had “not saved patients from appalling care”'. Even now trusts have tools to remove poor quality HCA from their workforce. Why do I have to be up to date with all, 23 mandatory trainings? POVA, DBS...Why was the NVQ2 in Health Care invented for? That should be the minimum requirement, not just a registration with the another impotent quango

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  • I've been saying HCA's need to be on the register like registered nurses and THEY SHOULD BE STRUCK OFF!! if found guilty of poor care etc and NOT allowed to work in the care profession again!! If they were on a register any struck off HCA's would be highlighted to NEW employers saving vulnerable patients they may try to care for again. I know of many unsavory HCA's who have police records etc for physical abuse, drugs, theft etc and they should NOT be allowed to care for vulnerable people, period. They can have folders full of certs BUT without a caring heart/attitude this can place vulnerable people at risk..

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  • Do HCA'S NEED ALL THAT , Try paying them more especially in private care ,,, where no unsocial hours are paid........

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  • great idea also maybe they could be paid better for all the extra they have to do!!!!!!

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  • michael stone

    This is a bit complicated: I agree that paying HCAs more would help, but I very strongly agree that somehow HCAs whose 'attitude is awful' should be kept out of healthcare, and I think that training and career progression should be available for HCAs.

    There will probably be a difference between 'what seems to make sense' and what actually happens, here: as is true for so many things.

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  • No one will take responsibility and that is why we have to have all these organisations that are making loads of money

    .Its just a way to make money off the back of something else.Most managers get the jitters about having to tell someone that their performance is poor and the're in the wrong job because when we were busy filling in lots and lots and lots and lots of forms and shuffling bits of paper about someone came along and removed our spines and replaced them with a piece of string! SO NOW we haven't got the guts to say " your work is very poor,you don't arrive on time,your on the sick more than you are at work,you are useless and you are unkind "

    Why would anyone employ someone with a record ???Is it because we are constantly being fed this ridiculous idea that you cant discriminate between someone who has got a police record and someone who hasent ????We are all so regulated now because we've dodged making decisions for years,we've only got our selves to blame for that....Oh no hang on......Its a blame free culture so everything's okay !

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  • Be careful what you wish for: a registered HCA will quite quickly become a Registered Nursing Assistant then in a few years time they'll drop the 'assistant' part and hey presto you've got band 2 and 3's doing the work of 5's and 6's.

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  • anon 31-mar-2015 4:40 pm
    ok to anon above. well this is history because when you was put to work with agency nurse they didn't know what to do
    that's the reson why band 3 did everything exept give the drugs out and now they have got rid of them for doing a good job as H C S W was the nurses back up?

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  • We have to be carful as there are so many different types of HCA's i.e hospital HCA's, care home HCA's and GP surgery HCA's they all have different roles, some are more hands on with patient care, i do agree with increasing the pay grading seems to be different grades for each role. I do agree there should be some kind of register, not to sure how it will work though.

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  • I feel there should definitely be a form of regulated training but I can imagine with the variety of roles it may not be so easy. It does worry me though that it will be the employer who signs for the competence of the staff member, how many managers will sign staff off who probably shouldn't be just because they will struggle with staffing levels if they don't?!!

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