Health: Healthcare Assistants

Earl Howe Excerpts

Monday 24th October 2011 Lords Chamber

[Baroness Wall of New Barnet]

To ask Her Majesty’s Government whether they have any plans to regulate healthcare assistants by establishing minimum standards and a code of conduct to ensure the protection of patients.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, there are provisions in the Health and Social Care Bill to enable the Council for Healthcare Regulatory Excellence to establish a process for accrediting voluntary registers for healthcare workers. Assured voluntary registration for healthcare assistants would build on existing safeguards such as the Care Quality Commission’s registration requirements and the vetting and barring scheme, and would include setting national standards for training, conduct and competence for those on the register.

[Baroness Wall of New Barnet]

I thank the noble Earl for his response, but is he aware of the worry and concern he has caused in his comments in the Times this morning? At my hospital, the director of nursing is very concerned that there are many reasons why nurses are reported to the statutory body and some of that can just be that they are not caring properly. The noble Earl’s remarks do not take that into account. Will he also accept, in a positive way, that many healthcare assistants would like to be regulated so that they can assure their patients and themselves that the skills they have and the service they are providing are of the very best?

[Earl Howe]

I agree with the latter part of the noble Baroness’s question in so far as I am quite sure that many healthcare assistants would like to be recognised for their skills. The question is whether statutory regulation or voluntary registration is the best and most proportionate route to achieve that. As regards the first part of her question, I regret the slant that the Times took on my remarks, because if a nurse has been struck off because they are considered to pose a risk to patients, then they must be referred to the Independent Safeguarding Authority, which would have the power to bar them. On the other hand, if a nurse is struck off for, say, misprescribing drugs to patients but is still capable of performing care tasks such as washing and bathing, they could still work as a healthcare assistant under appropriate supervision—depending on the circumstances. So there is no blanket prescription in this area; one has to look at the competencies of the individual and whether they are safe to work with adults.

[Baroness Gardner of Parkes]

My Lords, the same article in the Times referred to people without any experience whatever being appointed as healthcare assistants. While that might be splendid in terms of more people helping in the hospital, is it not important to develop training standards of some level to replace the lost SENs—state-enrolled nurses—and to be sure that these care assistants are reasonably competent in what they are being asked to do?

--- Later in debate ---

[Earl Howe]

I agree with my noble friend and it is why we are proposing a system of assured voluntary registration that would provide those training standards. We need to bear it in mind that the health and social care sectors are already subject to numerous tiers of regulation, including the important requirement on employers who are providing regulated activities to use only people who are appropriately trained and qualified. That means taking up references, having proper induction processes and so on. No national set of arrangements absolves employers of their responsibility to ensure that the people they are employing are suitable for the roles that they are fulfilling.

[Lord Low of Dalston]

My Lords, does not the problem lie with nursing having been made a wholly graduate profession, whereby nurses are taught nothing but theory and not how to nurse people at all? Indeed, I recently heard a nurse on the radio complaining that being asked to minister to the needs of patients was very inconvenient because it got in the way of completing their paperwork. Should it not be the case that nurses are taught the traditional skills of nursing that are directed at meeting patients’ needs, and that if nurses are to be helped by healthcare assistants it is important that the job of nurses is not simply delegated to the kind of untrained people that the noble Baroness, Lady Gardner of Parkes, was talking about?

[Earl Howe]

I can agree in part with what the noble Lord says. I do not agree that the training of nurses is skewed against what one might call the traditional caring activities that we associate with nursing, because my understanding is that the division is around 50:50 between the academic and practical elements of the training. We recognise the important contribution of nurses, not just in the new roles that they have taken on but in the fundamental aspects of care. They have the reach and relationships to improve outcomes and experiences for patients. We are doing our best to support them by various means.

[Baroness Greengross]

My Lords—

[Baroness Thornton]

My Lords, I often take my lead from the noble Baroness, Lady Masham. In an article in the Times today she said that a voluntary register was no cure. This, taken with the confusion created by, I am afraid, the noble Earl’s remarks about struck-off nurses, underlines the point at issue. I ask the Minister: is it really satisfactory that there is a chance that no one would know that a nurse was a struck-off nurse? Is it satisfactory that thousands of nursing care assistants are taking blood and carrying out procedures, but patients cannot know whether they are on a register and properly regulated? That is the problem. The noble Earl needs to think about the kind of juggernaut that is heading towards him on this one.

[Earl Howe]

No, it is not satisfactory that people should not know that a nurse has been struck off and is on the barred list. That is why it is incumbent on employers to make exactly those inquiries when taking on a new employee. As regards patients, the presence or absence of statutory regulation will not change one jot the responsibilities of employers or the responsibility of nurses to delegate appropriately on a ward or in a care home. Unsupervised, unregistered healthcare assistants should not be working without the proper authority and supervision.