Care Bill [HL]

Baroness Greengross Excerpts

Monday 10th June 2013 Lords Chamber

Moved by

[Baroness Greengross]

16: After Clause 85, insert the following new Clause—
“Regulation of healthcare and care assistants
(1) HEE shall establish and maintain a register of qualified healthcare assistants and care assistants.
(2) HEE shall, from time to time—
(a) establish the standards of proficiency necessary for admission to the register being the standards it considers necessary for safe and effective practice under the register; and(b) prescribe the requirements to be met as to evidence of good health and good character in order to satisfy HEE that an applicant is capable of safe and effective practice as a healthcare assistant or care assistant.(3) Regulations may prescribe—
(a) access to the register;(b) the process of application to and acceptance on the register;(c) the process of registration and readmission;(d) deemed registration of EEA health care assistants and care assistants;(e) lapse of registration;(f) approved qualifications;(g) EEA qualifications; and(h) fitness to practice under the register.(4) HEE shall, before carrying out duties prescribed in subsections (1) and (2), consult—
(a) the Secretary of State;(b) the Care Quality Commission;(c) such other persons, or other persons of such a description, as may be prescribed; and(d) any other person it considers appropriate.(5) “A healthcare assistant” is an individual who provides personal care for the health service, but who is not—
(a) a carer as defined under this Act;(b) a healthcare worker currently registered with the General Medical Council or Nursing and Midwifery Council; or(c) any other healthcare worker as may be prescribed. (6) A “care assistant” is an individual who provides personal care for the purposes of adult social care, but who is not—
(a) a carer as defined under this Act;(b) a healthcare worker currently registered with the General Medical Council or Nursing and Midwifery Council; or(c) any other healthcare worker as may be prescribed.(7) “Adult social care”—
(a) includes all forms of personal care and other practical assistance for individuals who, by reason of age, illness, disability, pregnancy, childbirth, dependence on alcohol or drugs, or any other similar circumstances, are in need of such care or other assistance, but(b) does not include anything provided by an establishment or agency for which Her Majesty’s Chief Inspector of Education, Children’s Services and Skills is the registration authority under section 5 of the Care Standards Act 2000.”

[Baroness Greengross]

My Lords, I bring this amendment before the Committee because, as we all know, there are huge numbers of very frail people, usually older people, often with multiple conditions, in our hospitals and care homes, and indeed in the community now. The numbers are growing. For all sorts of reasons—I think that some of them could be tracked back to the European working time directive—nurses are doing more and more complex tasks in the care that they provide, some of it electronic, that very often removes them from the day-to-day care of some of these very frail people. The same applies in care homes. The care that is provided is very often not provided by qualified nurses but by healthcare assistants or care assistants. There are many of those people who are fantastically caring. They have a natural ability to relate to the patients that they deal with or the residents in care homes. However, a lot of the dreadful cases that we read about in the newspapers take place because unqualified and unregistered care assistants are looking after people without the necessary training and without the necessary standard of care being insisted upon. This is extremely worrying.

We have heard a lot about dehydration or malnutrition and about a lack of dignity and respect. That is terrible, whoever is providing the care, but it is even worse somehow if the care is provided by people who are neither registered nor trained adequately and cannot be blamed for the fact that complex and difficult care situations are thrust upon them and they are landed with residents that they do not know how to care for adequately.

The amendment asks HEE to establish and maintain a register of qualified healthcare assistants and care assistants. If we could get there, we would then begin to have a remedy for some of the awful cases that we read about. We would know that people were fit to practise under the register and that there would likely be fewer cases of what can, unfortunately, amount to abuse.

When this system goes wrong in our country, we often learn that it is due to people who are not trained, qualified or registered being given enormous responsibilities. I would be pleased to know if the Minister agrees with me that this amendment would be of enormous benefit to patients and residents.

--- Later in debate ---

[Earl Howe]

I conclude by saying to the noble Baroness, Lady Greengross, that I hope she takes some encouragement from the work that is in train, and that she agrees with me that it is right to take stock after we see the recommendations flowing from the Cavendish review later in the year. No doubt that can inform our deliberations on Report. I hope that, in the mean time, she will feel able to withdraw the amendment.

[Baroness Greengross]

My Lords, I thank all noble Lords who have spoken for accepting that the principle that I was arguing about is correct and that there is a need for something to be done. I think we all recognise that, too often, people receive rather poor care. It is very hard to pin down what is going on because we do not have the mechanism to do so.

I also thank the noble Baroness, Lady Cumberlege, for saying that the principle of what I said was right. I thank the noble Baroness, Lady Browning, and all noble Lords who have spoken for agreeing that something really needs to be done. In my rather simplistic way of looking at things, I think that training leads to a qualification that will lead to a registration. It is as simple as that. Getting the training right would eventually lead to a professional approach of which people could be more proud and which would give them the self-respect that they need and, in the majority of cases, deserve. That would also give us the knowledge that, when things go wrong, there is a mechanism that will stop them from getting worse.

I also agree with the Minister that the Cavendish review could be the way forward and perhaps this is pre-empting something that we will have to wait a while to achieve. I feel very strongly that this has gone on for far too long; the anxieties are really great and something must be done. I hope I can work with my noble friend Lady Emerton so that somehow we can speed things up a little. In the mean time, I thank the Minister for his comments and beg leave to withdraw the amendment.

Amendment 16 withdrawn.