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Health: Healthcare Assistance

Volume 743: debated on Wednesday 13 February 2013


Asked by

To ask Her Majesty’s Government whether they will reconsider the decision not to regulate healthcare assistance in the light of the Health and Care Professions Council’s preliminary finding, published in December 2012, that there are significant shortcomings in a voluntary register.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and refer noble Lords to my interests in the register.

The department notes the Health and Care Professions Council’s findings. Levels of assurance are already in place for healthcare assistants, including supervision by regulated professionals and registration of their employer with the Care Quality Commission. In addition, new training and conduct standards for healthcare assistants will be published shortly. We will review the need for further assurance of healthcare assistants in light of the recommendations of the Francis inquiry.

I am grateful for that response. Does the Minister agree that the significance of the council’s report is that in relation to social care assistants it has concluded that a voluntary register is not sufficient? Does he agree that the same argument applies very much to healthcare assistants? With regard to the Francis inquiry recommendations, will he undertake for the Government to seriously consider reversing their policy on this matter?

My Lords, we have made it clear that each and every one of Robert Francis’s recommendations will be considered extremely carefully, including the recommendation in relation to healthcare assistants. However, it is worth noting that while the Health and Care Professions Council has signalled some potential limitations to a statutory regulator holding a voluntary register, and we take account of that, nevertheless that does not mean that these potential limitations would apply to other organisations wanting to set up a voluntary register. Our view is that that avenue should be explored. The HCPC also flagged up some major limitations in attempting to regulate healthcare assistance. Those messages bear thinking about.

I ask the Minister again—I have asked him this so many times—whether he will ask the Nursing and Midwifery Council to look again at some intermediate training level, which I think is sadly needed since the abolition of the SENs, for which you could qualify without having to have academic university entrance.

My Lords, the policy on nursing is clear: there is general acceptance that nursing should be a graduate profession. The problem with giving responsibility to the NMC for healthcare assistance is that that is not currently within its remit, and I think it would say that it has enough on its plate to deal with, without that added dimension as well.

My Lords, what does the Minister think of the care assistant who posed as a nurse for four years, working in four different surgeries, before she was found out? She did several hundred vaccinations and cancer smears on patients.

That story bears out the importance of employers fulfilling their responsibility to those who are in their care and ensuring that those whom they employ have the competences and skills that are required for the job. I do not want to prejudge that case, but there are systems in place that should ensure that patients are protected. We must deplore cases of this kind but they should not happen—safeguards are already in place.

My Lords, many members of the public find it difficult to understand why healthcare support workers who deal with patients every day are not regulated and registered and do not have to be fully trained in order to take up a job. I, too, am puzzled. Will the Minister tell us whether it is purely a matter of finance?

No, my Lords, it is not purely a matter of finance. Our view is that what really matters in this context is the competence and training of the individual involved. We are not oblivious to the concerns in this area. That is why we have already announced a number of further measures to support healthcare assistants. For example, we have just created an innovation fund of £13 million for the training and education of unregulated health professionals. The Care Quality Commission will undertake a review of inductions for care staff to make sure that nobody can provide unsupervised help without an appropriate level of training, and we have the work currently being done by Skills for Health and Skills for Care. Their report has now been received and embodies suggestions for a code of conduct and induction standards for health and social care workers.

The Minister mentioned supervision. The voluntary register does not necessarily cover the total safety of patients unless they are supervised. There is an issue about the minimum levels of registered nurses who can supervise support workers. When will the Government look at minimum standards for the registered nurses to enable sufficient supervision? The evidence base is that effective care and cost-effective care are reliant on the number of registered nurses who can supervise support workers.

The noble Baroness as ever raises an important issue. She will know that the code of conduct for nurses specifically covers supervision where necessary. My department has instigated a number of measures to support local decision-making to get skill mix profiles right. They include the QIPP programme, which is a key driver for getting the skill mix right through producing tools and programmes in that area. The NHS Institute for Innovation and Improvement supplies case studies and other resources to help NHS provider organisations deliver their QIPP strategies, and NHS employers also deliver guidance and support to help employers better plan their workforce.

My Lords, given that the Care Quality Commission has highlighted the problems of people having too many different carers and of them not arriving at the right time—I can vouch for that; my mother is nearly 94 and has care twice a day—does he agree that managers of rosters need better training to enable them to make much better provision for carers and those they care for?

I agree with my noble friend. It is an extremely important issue. Part of this relates to employers, part of it relates to those who are charged with supervising healthcare assistants, but part relates to induction training. The Prime Minister announced on 4 January that the CQC will undertake a review of induction training for care staff to ensure that nobody can provide unsupervised help without an appropriate level of training.