Care Bill [HL]

Baroness Jolly Excerpts

Monday 10th June 2013 Lords Chamber

[Lord Patel]

My Lords, I have added my name to both these amendments in the names of the noble Baroness, Lady Emerton, and the noble Lord, Lord Willis of Knaresborough, and I strongly support the principles behind both. The key issue here is that a training curriculum should be developed by the Nursing and Midwifery Council, as the amendment says. In a way—to pre-empt the Minister regarding what the Cavendish review might recommend—whatever the review recommends will have to be taken on board by whoever develops the curriculum. Although the Cavendish review is not defunct, the principles of this amendment are not based on what it might say. Presumably the review will focus on the necessity for training and the kind of training that support and healthcare workers should have. These amendments put a duty on Health Education England to make sure that a curriculum is developed.

The other important point is that the training should be mandatory—not the training curriculum but the training—and the employers must ensure that they employ only those who, having been trained, hold a certificate showing that they have completed it. It is just the same as I would have to do when seeking employment at a hospital. I would have to produce a degree certificate from a university proving that I have been trained as a doctor before they will employ me. It would be an offence to do otherwise. The amendment does not provide for a penalty but that issue will have to be addressed. Although “register” might be the wrong word, the implication is that the employer should be obliged to keep a list of all the healthcare support workers in its employment who have completed the mandatory training and hold a certificate.

The completion of training and the holding of a certificate are the key issues. As nobody can be employed unless they have done that, the care for patients will be safer. The process will define the competencies of these people. It will define what further development they have to go through professionally to be able to do other tasks. It will also make the life of the supervisor easier as they will know what competencies these people have and they will not delegate to them tasks which are beyond their competencies. In that respect, these amendments fulfil all the requirements that the Francis report and several other reports have alluded to—the need to make sure that we have a fully trained and competent workforce which delivers front-line healthcare. I hope that the noble Earl takes the amendments in that spirit.

[Baroness Jolly]

My Lords, I want to add quickly to what has been said by the noble Lord, Lord Patel, and the noble Baroness, Lady Emerton. I very much support what they said. What I can add over and above that is that the amendment in the name of my noble friend Lord Willis, Amendment 23A, refers to,

“working directly with patients or clients”,

so it works not only in a health context but in a care context.

I will declare my mother—as the noble Lord, Lord Campbell-Savours, did his—as an interest. She is a lady who I visit regularly and is well over 90. Somebody comes to see her in her home every day—for the most part they are very nice young women—but I have no idea where they come from or what training they have. Amendment 23A would give me confidence that they have been trained and are certificated. Furthermore, these people tend to be quite a mobile population. If their certificates were to follow them from one establishment to the next, it would give the next establishment confidence that their training had been delivered to the right standard and that, all other things being equal, it is appropriate to employ them. That adds weight to Amendment 23A.

[Lord Campbell-Savours]

In speaking to a previous amendment, my noble friend Lord Hunt produced the explanation, which I am sure is true, that the reason that the Government are being tardy in the area of registration, which is obviously linked to training, is money. I argue that it is actually more costly not to act in this area than to ignore the problems that inevitably arise where there is an untrained workforce in an area where life and death are of critical importance. I do not exaggerate.

I think I have said before in health debates that I probably spend more time in bed on hospital wards than a large number of noble Lords put together. I have seen all kinds of things in hospitals over the years. You never say a word because you are grateful that you are there. You cannot complain. You watch. When you are an MP or a Member of this place you watch with a view to one day perhaps being able to raise what you have seen in a forum where people might actually listen and deal with it. There are many people who leave hospitals today and do not say a word. If they are cured and feel better, they feel grateful, even though they have seen things that they know are wrong.

I argue that many of the problems that arise on hospital wards arise as a result of insufficient training of healthcare assistants. They are in the low-paid sector of the social care and the acute hospital worlds. Many are on the national minimum wage. I will have to do a little more work on vetting and barring. I must admit that I do not know a lot about that. However, it seems to me that somehow people are allowed to enter into this sector who should not be there. I have seen them at work over the years.

I will not name the hospital, but I remember being on a ward where they needed to put strapping across my chest to do an ECG. It was around 1 am or 2 am. A healthcare assistant brought five machines to my bed. The first four machines all appeared not to work. The healthcare assistant then found a junior doctor on the ward. It turned out that the healthcare assistant just did not know how to use the ECG machines. They had not been trained properly. Think of the loss of time involved; of my frustration at 2 am, or whatever time it was—it is several years back now—at having to wait while all this was going on. There was also disruption for the patients in the beds to each side. They could not sleep because of the commotion. They knew that something was happening. The lights were off. There was only a light at the end of the ward where the nurses sit. The curtains were pulled around the bed. People kept going back and forth trying to find out why this piece of equipment was not working. In the end the problem was solved.

I think that there are many areas not only in social care but also in the private social care sector where little things that are of immense importance to patients could be dealt with if only the healthcare assistants available actually knew what they were doing and understood the importance of what they were doing to an individual patient. I shall refer to just a few of these areas. We have heard of food out of reach. I have seen that repeatedly in hospitals. I have seen it in other settings as well. An elderly person may be trying to get hold of something but they cannot communicate. They can only wait for someone to turn up. That person will not be a nurse, because the nurses are invariably sitting behind a desk trying to sort out the huge amount of paperwork that they have to deal with, or a doctor, because the doctors are running back and forth. Their problem may be the jug of water, the uncomfortable bed, the extra pillow, the extra blanket to keep warm, the dirt on the floor, the fact that they have not been cleaned or, if they manage to get to the toilet, the toilet not being properly cleaned. Many people might say that that is down to ward management, but the fact is that everyone on the ward is under pressure and very often it is not the nurse or the ward leader who is held responsible, but the poor young woman or man who is paid very little money who is taking the brunt of the anger of the patient. I do not think that that is good enough. I very strongly support these amendments as their purpose is to tackle the problem of the quality of care that is given by people who are hands-on in the ward.

We have talked about standards. I think that communication is extremely important. I have been on wards where the patient could not talk to the healthcare assistant because the healthcare assistant could not speak English. Can you imagine the frustration of the ill patient who cannot communicate with the healthcare worker because they do not understand what the patient is saying? I think that it is essential that language, and the ability to communicate through language, is a part of the training programme, to ensure that we are not bringing in, particularly from the banks and agencies, people who should not be on the ward. Some of them are, in my view, a danger to patients.

I think that there should certainly be training for healthcare assistants in nutritional requirements and why nutrition is important. As the noble Baroness, Lady Emerton, said, it is necessary not just to say to someone that this is what they must do; they must also understand why they are doing it and the significance of that to the patient. There should also be training in ward hygiene and training in the use of equipment. There should be training in how to take blood pressure. On one occasion I had my blood pressure taken by a person who did not know where the tube had to come out of the arm strap. I had to tell that person that it was on the wrong way. I have been in Parliament; of course I could tell them. What about the patients who do not know how to take blood pressure and may well get a wrong reading? That must change.

There should be training in the need to ensure that bedding is fresh and clean and on the turning of patients. Patient turning is very important on a hospital ward, as the Minister must know. However, it is very often the case that healthcare assistants have not been adequately trained in the way that a patient is turned on the bed. There must also be training in ward hygiene and in the standards required of a hospital loo. I have been in hospitals where the loos have been filthy. You would not think that there would be such filth in a hospital in the British National Health Service—things still in the bowl, floors not cleaned. I am not exaggerating. It is going on within the NHS.

A colleague and good friend in the House of Commons, Ann Clwyd, is doing some work on complaints, as the Minister will know. I go to her office regularly as we work in some of the same areas. I obviously cannot be involved in the work that she is doing on behalf of the Executive, but I do know about the speeches that she is giving in the House of Commons, involving personal testimony coming in from all over the country. She has read to the Commons from some of the letters she has received—not hundreds but, as the Minister will be aware, thousands—underlining all the complaints about the NHS. She has almost become the national clearing house for complaints. Many of those complaints are not about sophisticated areas of healthcare in hospitals. They are about very elementary things with which, with a little bit of thought, a healthcare assistant or a nurse could deal if only they had been properly trained in that area.

We know that the trade unions, particularly Unison, have made their voice very clear on this issue. They want training and registration. I understand that that is the position of the RCN. Most of the health service organisations want it and many healthcare assistants recognise the value of it. The Minister may not concede today but I plead with him to go back to his department and tell some of the civil servants who work with him on these matters that something has to change. I do not believe that this sort of laissez-faire attitude to this sector of healthcare is the answer. It is for Ministers in this Government to take action now and resolve the problem. There is a crisis and it has to be resolved.