12. Maintaining standards, safeguarding care
Resolution submitted by the RCN Salisbury and South Wiltshire Branch
That this meeting of RCN Congress requests RCN Council to mount a campaign to get government to establish a national standard for advanced health care assistant training and assessment, with those who reach competence being registered and regulated by a national body independent of employers
Report on this debate
A resolution calling for national standards for advanced health care assistants and their regulation by a national independent body narrowly escaped defeat today in one of the closest votes to be held so far at this year's Congress.
Only 55% of voting delegates were persuaded by the arguments of Derek Blackshaw, a member of the RCN's Salisbury and South Wiltshire branch, who claimed standardising the training and assessment of advanced health care assistants across countries and between employers would offer greater protection to service users and would develop the 'portability' of this group of staff.
'Assessment and validation is so disparate across the country', he said.
Some members, like Bernadette Medcalf of the District Nurses Forum, believed the registration of advanced HCAs would be an important step forward in recognising their responsibilities and skills. The nursing auxiliaries she worked with, she said, carried out routine catheterisation and compression bandaging.
Other members, Paul Phillips from Scotland in particular, wanted registration extended to cover all health care assistants.
A number of delegates expressed concern though that the registration of advanced HCAs would mean a return to second level nursing. Marie Mcateer from Northern Ireland, herself an enrolled nurse for more than 20 years, warned delegates to be careful what they wished for. 'It may come back to haunt us,' she said.
| For | 214 |
55.15% |
|---|---|---|
| Against | 174 |
44.85% |
| Abstain | 29 |
| For | 3 |
7.3% |
|---|---|---|
| Against | 38 |
92.7% |
Background
The number of health care support workers (HCSWs) in the UK has more than doubled since 1997. Alongside a wide variation in HCSW titles, roles, education and training, HCSWs remain unregulated. Working within nursing teams, HCSWs increasingly deliver a substantial proportion of essential patient care, raising potential issues relating to patient safety and public protection. A growing number of HCSWs are operating at assistant practitioner (AP) level (AfC bands 3 and 4, attained or studying for a foundation degree in health), and are responsible for supervising HCSWs at bands 3, 2 and 1.
The RCN believes that HCSWs responsible for the delivery of direct clinical care alongside registered nurses should be professionally regulated by the NMC, and that as a pragmatic first step the NMC should open a voluntary register until primary legislation can be enacted to establish a statutory register. In addition, the RCN believes that as a matter of urgency the NMC, RCN and other key stakeholders should agree a UK-wide shared understanding on the AP title and its role in nursing. As well as mapping current and predicted numbers of APs in nursing, the RCN, NMC and other key stakeholders should also agree details for implementation of AP regulation, including funding arrangements. At the time of writing, the NMC was planning a summit on the regulation of HCSWs in February 2008.
The Scottish Government (Cowie, 2006) is currently leading a regulation pilot study, on behalf of the UK, exploring employer-led regulation of HCSWs in NHS organisations, the results of which will be reported at the close of 2008. The RCN is involved in this project, and consultations on safe recruitment practice, the conduct and practice of HCSWs, and induction for HCSWs all took place in 2006. The induction standards and the code of conduct for health care supporters are being tested currently through pilots within three NHS Scotland Boards.
In Wales, the Welsh Assembly Government is intending to publish a discussion paper on the regulation of HCSWs in February 2008, which will be followed by a formal public consultation. In Northern Ireland, the current void in the UK regulation of HCSWs has led to the General Social Care Council regulating some HCSWs across both social and health care sectors.
This UK-wide issue needs urgent attention at the highest policy levels. It is currently within the remit of existing working groups to implement a White Paper on professional regulation. The RCN (2007) has a clear policy on the professional regulation by the NMC of HCSWs in nursing and is working closely with government health departments and the NMC to this end.
References and further reading
Cowie A (2006) Regulation of healthcare support workers: a national pilot on behalf of the UK, Edinburgh: Scottish Executive Health Department.
Available from: www.healthworkerstandards.scot.nhs.uk/Documents/HealthcareSupportWorkerspilotpres29November2006.pdf (Accessed 30 January 2008) (Internet).
Department of Health (2007) Trust, assurance and safety: the regulation of health professionals in the 21st century, London: Stationery Office (Cm 7013).
Available from: www.dh.gov.uk/en/Publicationsandstatistics
Royal College of Nursing (2007) The regulation of health care support workers, London: RCN. (policy briefing 11/2007) Available from: www.rcn.org.uk/aboutus/policy/projects/future_nurse_future_workforce_project/modernising_nursing_careers (Accessed 30 January 2008) (Internet).