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Health Care Assistants
1.30 pm
Helen Jones (Warrington, North): I am grateful for this opportunity to discuss the role of health care assistants in the national health service. I do so confident in the knowledge that the Government are committed to the modernisation of our health service and to making it once again the best in the world.
Part of that modernisation is our commitment to supporting and valuing our staff. In that context, we hear much about doctors and nurses, and rightly so, because no one underestimates their dedication and skill. However, other members of staff are also an important part of the health care team; without them our national health service could not function. Those include the category known as health care assistants or, in some trusts, support workers.
The confusion of names is in itself significant. Over the years, we have failed to value the skills and input of those workers and to provide a clear definition of their roles and career path. Some trusts call them health care assistants, whatever their role. Others distinguish between health care assistants and nursing assistants. Some trusts have incorporated the old nursing auxiliary grades into their health care assistants' schemes, while others have yet to make progress on that.
Even more confusingly, some trusts have a health care assistant grade, but still designate some of the staff within that grade as nursing auxiliaries. We do not know exactly how far that integration has gone. In a parliamentary answer to me on 9 February about the number of trusts that have incorporated nursing auxiliaries into their health care assistant grades, my hon. Friend the Minister said:
That is profoundly damaging to the teamwork that we want to support and encourage within the health service and, ultimately, it is also detrimental to patient care. The problem goes back a number of years: when the grade was introduced, no proper assessment was made of the skills on offer or the way to enhance and use those skills. We did not set down proper qualification levels for the differing roles that health care assistants can perform, or the roles that should be subject to direct nursing supervision.
Although I say "we", this Government were not in power then, and the problems have been inherent from the beginning. That grade of health care worker began to be
introduced along with the changes in nurse education in Project 2000 and, as the role of student nurses on the wards diminished, the then Conservative Government promoted the use of that new grade, which they later called health care assistant. However, from the start there was no consensus on how the job should be defined. The nursing "professionalisers", if I may call them that without wishing to be derogatory, wanted the role to be strictly defined and clearly differentiated from nursing.
In their National Health Service and Community Care Act 1990, the previous Government explicitly linked the introduction of health care assistants with the freedom for trusts to set pay locally. They then encouraged the use of that grade through a series of initiatives on re-profiling and skill mix, but without a national agreement on the qualifications that should be attached to the different roles or the proper skill mix that should be used in hospitals. As a result, there is a wide variation between different trusts. Job titles are interchanged and the boundaries of the different roles are becoming increasingly blurred. We do not even know for sure how many health care assistants there are. The Department of Health's statistical bulletins distinguish between health care assistants and support workers on the ground that the latter work mainly in the hotel and property areas. It is almost impossible to maintain that distinction in practice.
The Health Service Report survey to which I referred earlier looked at the roles undertaken by health care assistants in different trusts and found that they varied widely. They range from direct patient care to technical support in radiography and phlebotomy to clerical duties and housekeeping duties on hospital wards. Anecdotal evidence from health care assistants themselves, and a survey done by the public sector union, Unison, shows that that is still the case. The majority of respondents to that survey said that their work involved aspects of patient care and that substantial minorities were engaged in a wide range of other duties such as taking blood, plastering, assisting new mothers with breast feeding--the list could go on endlessly.
The job descriptions that the trusts gave Health Service Report on that occasion are revealing because they show that the role has not been clearly defined. For example, Bolton hospital NHS trust defined the role of an HCA grade 1 as being a
There are even wide variations in the number of health care assistants employed by different trusts. I discovered from a parliamentary answer to me on 7 May last year that 13.3 per cent. of the work force of my local hospital--I know that it is concerned about this--are classified as health care assistants, whereas only 9.3 per cent. of the work force of Wirral hospital NHS trust, which is not far away, is so classified. That means either that we are getting the figures wrong or that there is no consensus
about the role that those workers should perform or the proper skill mix on hospital wards. It cannot be that one hospital simply needs many more cleaners and housekeeping staff than another.
It is time that we put an end to that confusion and looked clearly at the skills and competencies needed for health care assistants to perform their different roles. The previous Government said that that would be done through national vocational qualifications, but we do not know how far that system has been put into practice. When I asked, the Department of Health told me, as it frequently does, that that information was not available centrally.
Health care assistants themselves report wide variations in training practices. They often feel that the qualifications that they gain are not given the recognition that they deserve.
It would be folly to allow that situation to continue, because those staff have a great deal to contribute to our health service. Many of them are mature women with considerable caring experience to offer us, but if we want a modern and committed NHS work force, we must allow all staff to acquire the skills that they need and to benefit from a sensible pay and career structure.
I hope that I have shown through my remarks that those people are often front-line staff who have a great deal of contact with patients. It is vital that people who are ill and in hospital receive good nursing and medical care, but equally important to patients are the people who keep them clean and comfortable, who help them to eat if they are too weak to do so by themselves and who will even sit and chat and share a joke for a while. Those roles are often and increasingly performed by health care assistants, as well as by nurses, and it is time that we put their job on a proper footing.
We should move forward to arrive at a national framework of pay and employment, after consultation with all the various interested parties. I realise that that cannot be done quickly, but we should be moving in that direction. We should set down clearly the qualifications and the competencies needed for the different roles that health care assistants perform. It simply cannot be right that someone can move from cleaning the ward one minute to direct patient care the next, without us specifying the skills or the qualifications that they have to have to do that. That is not in the interests of patients and is not tenable.
We also must have clarity on training. We should move to a national system linked to NVQs and move away from the system of in-house competencies, which some trusts have been using. That system disadvantages staff and is not fair to patients. Staff have the right to equal treatment, wherever they work in the NHS, and patients have a right to expect the same standard of care, wherever they are being treated.
I am pleased, too, that the Government have introduced proposals to allow health care assistants to train as nurses without any loss of pay. I hope that we will expand that system, because many of those people, most of whom are women, have valuable skills to offer. Many of them could not train as nurses when they were younger for various reasons--often because of family responsibilities. I hope that we will value them and allow them to move forward, but if we are to achieve that we must underpin it with sensible career progression through the various grades of health care assistant grade 2.
I want to discuss the question of supervision and regulation. I hope that I have shown that many health care workers switch roles and are often involved in patient care. We need to set clear skill levels and qualifications for those roles and we also need to look carefully at which of those tasks ought to be supervised by qualified nurses and which ought not. Although it is often reported, it is unfair to leave staff working on the ward unsupervised when there are not enough staff on duty--or when the ward is pushed--and then move them back to other duties, and tell them that they cannot work unsupervised, when there are plenty of staff available. That is unfair to staff and to patients.
I strongly believe that we must have some form of regulation. I was pleased that the JM Consulting report on the regulation of nurses, midwives and health visitors mentioned health care assistants. No one wants to introduce a system that is too bureaucratic, but it cannot be right to leave vulnerable people in hospital when there are not proper checks on the staff who are dealing with them. Nor can it be right that, in extreme cases, someone can be struck off the nursing register, but can get a job as a health care assistant dealing with vulnerable people.
"No figures are kept centrally."---[Official Report, 9 February 1999; Vol. 325, c. 168.]
That is confusing enough, but the position becomes even more bizarre when we look at the different pay scales on offer and the often confusing employment contract status of many of those staff. A survey done for Health Service Report a couple of years ago showed wide variations between trusts, and the position has altered little since then. Some trusts have three grades for their health care assistants; some have only two; and some use a single grade to cover a range of roles from housekeeping duties to direct patient care. Some have training grades while others do not. In some trusts, paid progression depends entirely on the length of service, whereas in others it is linked to performance factors. Indeed, it is possible to have staff doing exactly the same job on different rates of pay within the same trust because some staff retain the old Whitley Council contracts while others are on locally negotiated contracts.
"combination of direct patient care, technical, clerical and housekeeping duties".
It did not help that it then went on to define the role of an HCA grade 2 in exactly the same way. Warrington hospital NHS trust, which is my local hospital, said that the work of what it calls a support carer 1 was "basic carer duties" and the role of a support carer 2 was "extended carer duties". That is as clear as mud to me and, I assume, to everybody else. In practice, it means that workers are switched between different roles, depending on staffing on the wards at any particular time.
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