Care Bill [HL]

Baroness Emerton Excerpts

Monday 10th June 2013 Lords Chamber

Moved by

[Baroness Emerton]

23: After Clause 86, insert the following new Clause—
“Mandatory training for health and care support workers
(1) HEE must develop a mandatory training curriculum for health and care support workers who are delivering direct care to service users.
(2) For the purposes of subsection (1), a health or care support worker shall be an individual who works in support of health or care professionals and delivers direct care to service users.
(3) In setting the training curriculum set out in subsection (1), HEE must seek to ensure that standards and competencies are developed in conjunction with the Nursing and Midwifery Council and other relevant organisations.
(4) Providers of health or care services must be responsible for ensuring that all health care support workers have completed the mandatory training curriculum in subsection (1).”

[Baroness Emerton]

My Lords, in her absence I thank the noble Baroness, Lady Greengross, for introducing the debate earlier this afternoon on the regulation of healthcare support workers, which opened the discussion leading to the two amendments that are down here. The first is in my name and the second in that of the noble Lord, Lord Willis, who unfortunately is unable to be with us. We wish him a speedy recovery.

I want to make one or two points by way of introduction. First, I would be remiss not to say that the Royal College of Nursing has long called for the mandatory registration and regulation of healthcare support workers. The RCN believes that it is an important part of the registration and regulation process because it has done a tremendous amount of work in talking to both registered nurses and healthcare support workers. It feels that this should be the way forward in the interests of patient safety. However, disappointed as they have been that we could not have regulation, they have moved on and are sympathetic to the amendments that we have laid down.

Mention was made of the disappearance from this setting of enrolled nurses. I went back to look at the case that was made for that disappearance and the end of enrolled nurse training. It happened because the enrolled nurses were being abused and misused by being left in charge of wards and being required to undertake tasks for which they had not been trained or were not being supervised. I have to say that the various skills currently being used by healthcare support workers far exceeds the definition of basic skills. They are doing things that might suggest that they are being abused and misused. I am sure that the House will agree that we need to do something about the situation. The Francis report requested that we look at the registration of support workers.

The question of standards leads into the amendments that we have put down. When a healthcare support worker is under the direction of a registered nurse, that nurse is working to care standards that have been determined by the Nursing and Midwifery Council. It seems sensible that the skills for care should be linked to care standards so that the registered nurse who delegates to the support worker can understand to which standards that support worker has been trained as well as the level of understanding that that support worker should have. I think that I used this example before in a debate on the health Bill, but instead of them just being taught how to carry out a skill such as taking a blood pressure, they should also understand the side effects of a raised or lowered blood pressure and what that means in terms of reporting it to the person who has delegated the task.

That brings me to the amendments we have tabled. If I may, I will move straight to Amendment 23A, which is a more succinct qualification of our first amendment and brings in all the points. It is in the name of the noble Lord, Lord Willis of Knaresborough, and is supported by me and the noble Lord, Lord Patel. The first point of the proposed new clause is that:

“Any individual working directly with patients or clients must be certified to have completed training in basic standards”.

In other words, they must go through training which equips them to have a certificate of qualification.

Secondly:

“The standards, in subsection (1), will be published by Nursing and Midwifery Council and approved by HEE”.

There should be some agreement between the NMC, which is the regulatory body, and Health Education England on subscribing to that.

Thirdly, the amendment states:

“Employers must retain a register”.

Once the support worker has been through the agreed LETB training, which would be delegated to a college of further education, they would reach the basic standard and be on a register and hold a certificate. The additional point in Amendment 23A is that it would be,

“an offence for any employer to employ an individual to work directly with patients or clients who is not registered as holding a certificate of training in basic standards”.

That would get over the point that people could go from one place to another without a valid certificate. We are interested to know how the Minister will respond to the amendment’s proposals on basic training certification in place of registration and regulation. I beg to move.

--- Later in debate ---

[Earl Howe]

I agree with the noble Lord. It would be an interesting exercise. If I can glean relevant facts from the National Health Service Litigation Authority, which is the holder of the corpus of information in this area, I would be glad to share it with noble Lords. We do not dispute that skills are an issue. They clearly are. That is why we have instigated the Cavendish review, but it is important that we set about this in the right way.

The Secretary of State has clearly stated in his mandate to Health Education England that it should work with employers to improve the capability of healthcare assistants. That will include the standards of training that they receive. In developing a strategy and implementation plan to achieve this, Health Education England will build on the Cavendish review, when it is before us, and the work of Skills for Health and Skills for Care on minimum training standards for health and care support workers.

The Government accept that the arrangements for induction, training and performance management of this workforce vary between providers. We do not duck the importance of training and I want to stress that. The Cavendish review has been tasked with reviewing how the training and support of healthcare and care assistants can be strengthened so that they provide safe and compassionate care to all people using health and social care services. The noble Lord, Lord Patel, is right that Amendment 23A and whatever recommendations emerge from the Cavendish review may not necessarily be mutually exclusive. At the same time, it surely makes sense for the Government to look at all these issues in the round before pronouncing one way or the other on prescribing specific arrangements around certification, new criminal offences or whatever the case may be.

I hope the noble Baroness will agree that the Government should be afforded the time to consider any recommendations from the Cavendish review and the respective roles of employers, commissioners, regulators and other bodies before taking further steps. At the same time, I hope that she will feel reassured by what I have said today and that Health Education England and the Government have taken sufficient steps in committing to the training and development of this workforce, and that she will feel able to withdraw her amendment.

[Baroness Emerton]

My Lords, I thank the Minister for his summary and noble Lords who have taken part in this debate. I think there is no doubt in anybody’s mind that this is a very important subject, which we cannot ignore. In his summary, the Minister suggested that the Government need to take this away and look at it. I think that we, too, need to take it away and look at it, and at what the Minister said. Will the Minister tell us when the Cavendish report is to be published? We understood that it was signed off two or three weeks ago, and we need to understand where it fits into the picture with the CQC. I thank the Minister for his comments. I will withdraw the amendment tonight on the basis that I will return to it later in the passage of the Bill. I beg leave to withdraw the amendment.

Amendment 23 withdrawn.