Wednesday, 10 July 2013

Healthcare Assistants

From The BBC:

There is no minimum standard of training for healthcare assistants before they can work unsupervised, an independent report has found.(1)

Some were doing tasks usually performed by doctors or nurses, such as taking blood.(2) The Cavendish Review was set up by the government to study the role of healthcare assistants (HCAs) in England after the Stafford Hospital scandal.

HCAs provide basic care in hospitals, care homes and at home. They should go through a universal training system and gain accreditation before they can work unsupervised, the report said.(3) Currently, there is no consistent qualification or training for HCAs, with employers deciding for themselves what training is needed.(4)...

There are more than 1.3 million frontline staff who are not registered nurses, according to the Cavendish Review. They provide some of the most personal and fundamental care such as turning people in bed so they do not get pressure sores, helping people to eat and wash and to get out of bed and get dressed. But the review says the quality of training and support that care workers receive in the NHS and social care system varies between organisations and, in some cases, is lacking.(4)

It calls for a new Certificate of Fundamental Care for fully-fledged HCAs - a qualification that would link HCA training to nurse training, making it easier for staff to progress up the career ladder should they wish to. All new recruits would need to obtain the certificate and existing HCAs would need to prove they had the equivalent training.(5) And in recognition of the important job HCAs do, they should be called Nursing Assistants.(6)

Journalist Camilla Cavendish, author of the review, said: "Patient safety in the NHS and social care depends on recognising the contribution of support workers, valuing and training them as part of a team. For people to get the best care, there must be less complexity and duplication and a greater focus on ensuring that support staff are treated with the seriousness they deserve - for some of them are the most caring of all."(7)

Peter Carter, of the Royal College of Nursing, was concerned that without mandatory regulation there would be a danger that any staff who were found to be unsuitable could move from one employer to another unchecked. "The priority must now be to underpin the recommendations made by Camilla Cavendish in the regulatory structure which governs care," he said.(8)

Christina McAnea, of Unison, said that in some hospitals HCA's have been treated as "cheap labour".(9) "Common training standards across health and social care are long overdue and welcome."(10)
1. They're assistants. The whole point of an assistant is that they are people working for someone else, rather than people with responsibilities. You tell them to do something, they do it. But if they screw up, you, the person in charge of them take it in the can.

2. Yes, because they're assistants to doctors and nurses. Who can show them to do something, and have to take responsibility for their work. And actually, taking blood isn't brain surgery.

3. Great, so instead of hiring someone with a reasonably active brain and getting them to work by a nurse or doctor showing them the ropes in some basic care, we're now going to have an accreditation scheme, driving up costs.

4. How much training does someone need in turning a patient or feeding them? Millions of parents seem to be able to manage this.

5. Right, so that means not only spending money training new recruits, but also certifying existing recruits. What's that going to cost?

6. Someone now has to go through every piece of documentation and change it. No more healthcare gets done, no more pay to nurses, just some more bureaucracy.

7. None of this means that these people will be more valued. If a doctor looks down on someone who turns the patients, they're still going to look down on the accredited people who turn the patients.

8. Well, yes. Once you get people with accreditation, they'll need a union to try to raise the salary of them.

9. Which is exactly what they are, and they only exist because we made nurses more expensive by turning it into a degree-level job, resulting in the workaround of creating HCAs. If we make the HCAs more expensive, we're going to have to create a new job like Nursing Dogsbody.

10. No, they aren't. Not for assistants doing feeding and turning patients. You want flexible people who can do what nurses and doctors tell them to.


Mark Wadsworth said...

It's the same drivel as the government saying that all nursery staff should be educated to degree level or something. Barriers to entry, quangocracy, inspectorates, red tape. Lovely.

Morgan Charles said...

"So, Ms Cavendish, that's a good report you did, how would you like to be the chair of the new Healthcare Accreditation Agency on £75,000 a year? It won't involve much, in fact you will be able to keep your current job as a journalist, if you like."

Mark Wadsworth said...

MC, yippee, that's your first comment in ages that I didn't have to retrieve from spam.

paulc156 said...

To be fair when listening to a very committed HCA this morning on the Today prog' it seems to me there is an issue here which you too easily dismiss.
It's not simply a matter of 'anyone can turn a patient', to do so in a way that minimises risks of bed sores does take some training.
Nor is it just trivial stuff like 'turning a patient' but also changing dressings for example which itself is not something that HCA's are taught to do but nevertheless are required to do when no one else is around to do it.
When attending patients they are often the only option for the patient since there will be no nurse or doctor at the patients home or in the care home who can carry out the task.

You could argue [you have] that nurses shouldn't be required to train to such high standards in the first place but that does seem to fly in the face of evidence suggesting the job of caring for patients in hospitals is now much more technically demanding than in the days of Hattie Jacques and a better educated nursing staff is no bad thing so long as it doesn't come at the expense of a 'caring' attitude.

Morgan Charles said...

"MC, yippee, that's your first comment in ages that I didn't have to retrieve from spam."

Spoke too soon!

Morgan Charles said...

paul156, there are very few jobs that can be done without some sort of training, but, as TS point's out, that doesn't mean that there needs to be a whole colossus of accreditation and other bureaucracy involved. What is necessary is that the people in charge have to be responsible (and accountable) for doing two things, firstly find out what experience the recruit has and secondly, give them the necessary training in the first place if they don't have it. All that this sort of bureaucracy is designed to do is absolve the employers of such like HCAs of the responsibillity of carrying out anything other than the most basic of checks, and cover the employers' arses if anything goes wrong. Basically it is another attempt to shove the onus of responsibility down from management to workers.

Mark Wadsworth said...

MC, jeez, the comment was there on the page and then it disappeared again.

The Stigler said...


No-one is saying it's trivial. This stuff has to be done and has to be done well. But does it need a certificate for putting on dressings and turning patients? What's wrong with the people in charge making sure that they can do it right? We have managers in the NHS, lots of them. That's they're job, to make sure the job is done properly.

As for attending patients etc, again, they are ASSISTANTS and I emphasise that word most strongly because an assistant is supposed to assist someone. It might be that they do it, but that should be after the person they are assisting has ensured that they are capable of doing the job, and the person they are assisting should get it in the neck if the person screws up. So, it doesn't need a certification scheme.

With regards to nurses, what has to be understood is that insisting on nurses being degree educated has a cost. It might be that this means nurses are better value. I'm skeptical myself, but certification doesn't come for free. And if you're paying for certification, you'd better be able to explain why you need it in terms of putting a value to improved care for the cost.

paulc156 said...

The Stigler.

The thing with an accreditation is that they get to take it with them. Staff turnover tends to be high so it does minimise the dangers of less able HCA's migrating from job to job.
They also get the advantage of progressing more easily into nursing since the proposal is to link their training with nurse training.

Morgan Charles.
Sure they need training, some seem to get it some don't get adequate training. Perhaps a level playing field is unachievable without 'some' bureaucracy. If they train with nurses I don't see how that would necessitate a new 'layer', maybe just a some more 'trainers' and asessors to monitor the HCA's.

Bob E said...

"With regards to nurses, what has to be understood is that insisting on nurses being degree educated has a cost. It might be that this means nurses are better value".

And it might also mean, and I vaguely recall some quite recent media, politico and "health service professionals" speculating that this end, that "nurses" as a group now have an "such is beneath us highly qualified professionals" attitude towards certain aspects of patient care that was previously seen as the province and raison d'etre of "Angels". Which is one reason for now having Health Care Assistants.

So, looking ahead, is it entirely unreasonable to suppose that if a qualification based accreditation scheme is set up for Health Care Assistants, it won't be long before a new "lowest rung of the profession" springs up to carry out the functions that "professional HCAs" are increasingly disinclined to do, especially because getting HCA accreditation is really just another entry route to getting onto the degree course that leads to becoming a nurse?

Morgan Charles said...

Paul, the important part of the report in the post is: "The Cavendish Review was set up by the government to study the role of healthcare assistants (HCAs) in England after the Stafford Hospital scandal.". That tells you what this is about. It is not about getting better trained HCAs, though that is what it purports to be, it's about preventing managers, doctors and nurses having to take responsibility when things go wrong. Currently it is the managers who recruit the HCAs who have to take responsibility for making sure the HCAs are up to the job and the doctors' and nurses' responsibility to make sure they are not asked to do things which they are not competent to perform. These people are in the firing line when HCAs screw up and they don't want to be, they want the HCAs to be in the firing line. They want to be able to say "the HCA had accreditation, so I could reasonably expect they were up to doing X,Y or Z, which I asked them to do and they got wrong".

DBC Reed said...

Having been in hospital on and off throughout 2012, I have to take issue with your confident statement "We have managers in the NHS ,lots of them. That's their job to make sure the job is done properly." This is naïve in the extreme. My experience ,an update of "How the Poor Die" by George Orwell, was that the Officer Class of consultants & doctors was issuing carefully typed orders and the Other Ranks of nurses and nursing assistants were not taking any notice of them and making it up as they went along , communicating their own ideas by word of mouth. I ended up after an operation with no painkillers, no food and no sleep because the ward was full of nutters ,dumped by private care homes, shouting "I want to die." And their wish often came true as when one guy was taken to the emergency room amidst shouting and panic only for the resuscitation bag to be missing, cue running around and more shouting. To no avail: they could n't find it and he died. The idea that this lot would carefully supervise assistants is ridiculous. There is no supervision. Assistants need to be trained to cope with situations where nobody is telling them exactly what to do. If their every move has to be explained and then checked there is no point in having them in the present chaotic system.
Your introductory statement No 8 is appalling, " Once you get people with accreditation, they'll need a union to raised their salary for them." This is more of the 'we need low paid workers' attitude that led to the controversy over LVT which you represented as having the advantage of lowering wage rates. As should be obvious, low wages lead to low demand which
ultimately affects the employers because low paid workers can't afford to pay for the goods and services provided. This is pretty basic ,you know. We need demand side policy, chucking alot of money at potential customers.
And less of the disapproval of unions: they're doing the employers/capitalists/entrepreneurs a favour by keeping demand up!

Morgan Charles said...

DBC, what you seem to be saying is that, rather than patching the hole in the side of the good ship NHS, we should be training the men at the pumps to pump better.