Health and Social Care Bill

Lord Patel Excerpts

Monday 19th March 2012 Lords Chamber

[Lord Turnberg]

My Lords, I rise to speak briefly, because much of what I might have said has already been said by the noble Baroness, Lady Cumberlege. I, too, am very grateful for the way that the noble Earl has listened to us and spoken and written to us with helpful comments, which I hope that he will reiterate today. I just want to make one point about the research undertaken by the current HPA. It is directed predominantly to infectious disease and bacterial and viral infections. In that area, it is really world-beating. Recently, two of its members of staff have been elected fellows of the Academy of Medical Sciences, which is quite an achievement. The idea that it should do all this research in academic research partnerships with universities is unhelpful. Although collaboration and co-operation with university departments is enormously valuable, it should not be a precondition that it should be able to do research only in collaboration with universities. I hope that the noble Earl will be able to nail that problem.

[Lord Patel]

My Lords, I shall speak very briefly. I spoke at length in Committee and on Report and I shall not repeat what I said. Other noble Lords have referred to the key issues. If Public Health England is to be a strong, high-profile, public health national organisation, it needs strong governance. It also needs the independent ability to bid for research funds, as the HPA currently does, as has been highlighted, both nationally and internationally. At the Report stage, I referred to the fact that the HPA currently gets a significant amount of contract research income from NIH. It is no easy task to get money from NIH for research. If it is forbidden to do that, and, as the noble Lord, Lord Turnberg, said, is allowed to do research only with academic institutions, and not independently, that will be wrong. I hope that the noble Earl, who has listened to the arguments in the meetings we have had, will be able to alleviate those anxieties.

[Lord Beecham]

My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Cumberlege, on the enormous effort that she has put in to moving the Government’s position somewhat although, as she says, in the view of some of us, not quite far enough.

The noble Baroness, Lady Jolly, referred to a degree of separation. I would rather that we had six degrees of separation; I think that we will probably have to settle for the current single degree of separation. That is slightly unfortunate, because, as other noble Lords have stressed, the question of independence of the organisation is crucial. In moving the amendment, the noble Baroness, Lady Cumberlege, raised that issue and mentioned the Civil Service code and the possible inhibitions on employees of Public Health England and what was the Health Protection Agency in giving that advice independently and openly.

Bearing in mind the discussions that we had earlier this afternoon about the relationship between civil servants and Ministers, I hope that the noble Earl will address that, if not today in his reply then subsequently, to explain how that relationship will work and to confirm the complete independence of members of staff in advising not only Ministers but, as the noble Baroness said, the public. I reinforce the points made by other noble Lords. I think we got a verbal assurance from the Minister last time, but I would like it fully explained that the research capacity of the organisation will be maintained.

The amendment is slightly more modest than originally proposed by the noble Baroness, and even more modest than some of us would have liked. For the life of me, I cannot see why the noble Earl should not be able to accept it. If he is not prepared to do that, perhaps he will explain why. At the very least, I hope that he gives the assurances and undertakings that the noble Baroness has sought and that we can take forward this part of the Bill, which in turn complements the best part of the Bill, which relates to public health in general.

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[Baroness Emerton]

My Lords, the amendment concerns the power to register healthcare support workers in England. I shall try to be brief, as we had a long and thorough debate on this matter on Report and I have studied the Minister’s response to my amendment at that stage. I have had protracted discussions between Report and now with the noble Earl and officials, and I thank them most sincerely for the time and effort they have put into trying to meet my requests.

Healthcare support workers form a very large part of the workforce, whether they are in the employment of NHS hospitals, community services or local authority services, providing care in people’s homes, or in the large number of nursing and residential care homes. We should not forget the role played by social workers, which often overlaps with the role of healthcare support workers, and vice versa.

Many noble Lords have said in previous debates that large numbers of support workers provide high-quality care, and they have received some training in order to do that. It is not likely that this large number of support workers will decrease with a growth in demand from the rapidly expanding number of elderly, frail and vulnerable people who require high-quality care. However, it is also not possible to expect a magic wand—that is, the Government—to provide training overnight for everybody at once. Therefore, it is reasonable to find a way forward that provides a direction of travel that satisfies patients, the public, the professions and employers that the issue is being addressed as a matter of urgency within the economic situation in which we find ourselves.

I shall briefly address each item covered by the amendment. The Minister has indicated that Skills for Care and Skills for Health will be producing an assured training programme, prepared with professional inputs, that will, following consultation, be available for implementation in 2013. This will entitle successful candidates to be entered on the voluntary register if they so wish.

I am aware, and pleased, that the Minister has also agreed that work should proceed on reviewing the research on ratios of registered to unregistered personnel, and that the supervision of work delegated to registrants is vital. However, realistically, in some communities and hospital situations it is not possible for there to be close scrutiny of support workers’ performance. The recent report published by Which? clearly demonstrates neglect in the delivery of care to patients and in their safety. Clearly, the Government need a means of early identification of the failings in the delivery of care.

While the training programmes are being developed, perhaps we could ask, through the Minister, that registered nurses and midwives are reminded of their responsibility and accountability, that they have to assure themselves of the competences of individual support workers before delegating a task, and that, once a task has been delegated, it must be supervised. Where that proves impossible because of insufficient registered nurses and midwives, immediate action should be taken by a registered nurse to report to his or her manager and the employers should take action on the level of care that can be delivered in that situation. That will safeguard the safety and quality of care to patients.

I now turn to the second subsection of the proposed new clause. It is recommended that the next logical step would be to aim for the training of support workers to be mandatory. So far discussions on making the training of healthcare support workers mandatory has not found favour with Her Majesty’s Government. Many Peers indicated, on Report, the importance of all healthcare support workers receiving mandatory training and that it should be regulated. Although it is recognised that that could not be arrived at tomorrow, if Her Majesty’s Government could agree that the training programmes will be mandatory at a date to be determined for implementation, I am sure that the patients, the public and certainly the professions of nursing, midwifery and social care would be satisfied.

Subsection (3) of the proposed new clause requires the Secretary of State to develop a code of conduct for all employees whether they are entered on the register or just providing care. That includes the employees not just in the NHS hospitals but also in local authorities. That would provide clear guidance for employers as well as employees and should assist in ensuring that competences, where lacking, are made good by training modules or by withdrawing the person who does not have the skills or the competences. Without such controls of clearly defined competences being included for practising healthcare support workers and the correct delegation and supervision by registrants, it will be impossible to ensure the high-quality, safe, compassionate care that patients and clients deserve or indeed Her Majesty’s Government aim to provide. I hope that the Minister will feel able to provide a positive response to this request.

Subsection (4) requires Her Majesty’s Government to carry out a strategic review within three years, as the Minister undertook to do on Report, about whether statutory regulation of support workers is necessary in the light of progress with the proposed training programmes and the introduction of the voluntary register. Perhaps I may suggest that the review of the research on improving the ratios of registered nurses and midwives is also included in this review so that a holistic view can be gained of the future shape of the workforce required to deliver high-quality, safe and compassionate care, with the result of improved clinical outcomes that are cost-effective and of cost benefit. I beg to move.

[Lord Patel]

My Lords, on Report, I spoke strongly in support of the amendment in the name of my noble friend Lady Emerton. I thank the Minister for the many conversations that he has had with my noble friend and myself to try to resolve some of the issues. Like the noble Baroness, I am most appreciative of his readiness to meet and speak with us on many occasions.

We have about 450,000 healthcare support workers and some have had some training and therefore perform the tasks that they are given with fairly good competency. Others do not have any training and they might perform the tasks that they are given at variable levels. We also heard on Report from the noble Lord, Lord MacKenzie, and my noble friend Lady Emerton about the kind of tasks that healthcare support workers currently carry out. They range from simple nursing care or bathing or feeding duties to cannulisation and bladder catheterisation and even more invasive procedures than that. That should confirm to us that there is a need for some kind of standardised training programme that healthcare support workers must undertake so that their competences are assessed and so that they work to those competences. It is not fair that those healthcare support workers who have had some training and are competent to perform their duties have to work alongside others who have not had any training and, therefore, are lacking in competences.

On Report, one of the many things that the Minister agreed to take forward in relation to healthcare support workers, if I quote him correctly, was to try to establish assured voluntary registration, which the Council for Healthcare Regulatory Excellence will run. If we are to have any kind of register, surely ipso facto certain conditions must be satisfied before someone can go on to the register. Logically, that would suggest to me that there must be some form of training. If that is the case, why would we object to having training as a requirement for all new healthcare support workers? I well understand that it is not impossible, but very difficult and expensive, to try to train some 450,000 people who already carry out such tasks. That could be overcome by having a code of conduct imposed on employers; it would be their duty to ensure that whoever they employ has the competencies to do the tasks that they are asked to undertake. It would not be vastly expensive to get 450,000 people trained. Subsection (2) of the proposed new clause refers to “mandatory” training—I use the word “requirement”—for all new healthcare support workers from April 2003 before they go on the assured voluntary register.

I take a slightly different view about whether the register is voluntary or statutory. I know that the word “statutory” to all healthcare workers is important. I am registered by statute to be on the medical register but it is more important that the register has some meaning and that it works. If a voluntary register does not work, it is no good; if a statutory register does not work, it is no good. It is important that people who go on the register are trained and assessed as having those competences. Subsection (4) of the proposed new clause, to which the Minister agreed previously, requires that a review will be carried out for the benefit or otherwise of any kind of register that is established. I hope he will agree to that. I hope that the Minister will be able today to reassure my noble friend Lady Emerton.

I have been very touched by what my noble friend has said in the many conversations that she has had with me. To me, she typifies the attitude of a very caring nurse who is concerned about the poor quality of care seen in daily reports in newspapers; there was also a report yesterday from Which?, to which she alluded. That clearly affects her as a professional nurse. Therefore, I strongly support her amendment.