Annual accountability hearing with the Nursing and Midwifery Council - Health Committee Contents

5 The future of regulation

57. Several witnesses to our earlier inquiry into complaints and litigation expressed concerns about care of older people, particularly when they are undergoing treatment in acute hospitals.[67] The Committee has followed this up with the NMC in light of the transition to an all-degree nursing profession by 2013 and the perception that nurses may have "stepped back" from basic nursing care.[68]

58. The NMC told us about the recruitment and retention benefits that have accrued from having an all-degree profession in Wales,[69] where nurse education has been to degree-level since 2004.[70] The NMC also told us that there was "extremely positive" evidence for an all-degree profession from other countries.[71] In written evidence to the Committee they stated:

There is no evidence that a degree level nursing profession leads to diminished standards of basic care in fact quite the opposite. Studies from the USA reveal that a high proportion of degree qualified registered nurses has been associated with lower mortality in surgical units.[72]

59. However, the Committee raised the issue that many basic nursing care tasks that used to be undertaken by registered nurses are now undertaken by healthcare assistants. The NMC estimates that there are 300,000 unregistered healthcare support workers and an unknown number of assistant practitioners currently working in the UK.[73] The NMC has "growing concerns" that healthcare assistants (HCAs) are increasingly working on tasks previously undertaken by registered nurses but remain unregulated. This means that there is little control over entry to employment and no final sanction of removal from a register when competence or conduct are not of a sufficiently high standard.[74]

60. The NMC commissioned a scoping review of HCA registration which found that there is evidence of HCAs taking up work having been dismissed from other roles for misconduct, and that they are undertaking tasks for which they have not been trained. Based on these findings, the report states that a strong case exists for regulating HCAs. Voluntary registration was thought to be too weak as it would "be avoided by the people about whom there is most concern.[75]" The recent scandal at Winterboune View in Bristol underlines the issues around registration of healthcare assistants.

61. In its recent Command Paper on regulation of the healthcare workforce, the Government has stated that statutory regulation of health workers has often been the first rather than the last resort.[76] The Government now proposes to:

[…] enable a system of assured voluntary registration to be developed for professionals and occupational groups which are currently not subject to statutory professional regulation.[77]

62. The Committee notes that under clause 212 of the Health and Social Care Bill that the Government is proposing to give powers to the professional regulators to establish voluntary registers for unregulated professionals and workers.[78] The NMC expressed concerns about this proposed approach.

We believe that health care support workers should be regulated, not necessarily in an identical manner to nurses and midwives but there should be a regulatory framework that is not voluntary. I do not believe that people who are unpleasant want to join voluntary registers, so we believe it should be mandatory.[79]

They went on to tell us about assistant practitioners who undertake complex procedures such as suturing and giving drugs, but are also unregulated. In its written submission to us the Patients Association has endorsed mandatory statutory regulation of healthcare assistants and support workers.[80]

63. As previously mentioned, the Committee has ongoing concerns about the care and treatment of older people both in hospitals and care homes. Of particular concern to the Committee is the lack of regulation of a range of groups who undertake many basic nursing care tasks.

64. The Committee endorses mandatory statutory regulation of healthcare assistants and support workers and we believe that this is the only approach which maximises public protection. The Committee notes that the Government intends to give powers to the relevant regulators to establish voluntary registers for non-regulated professionals and workers, but would urge it to see healthcare assistants, support workers and assistant practitioners as exceptions to this approach who should be subject to mandatory statutory regulation. However, the NMC needs to make significant improvements in the conduct of its existing core functions (such as in how it manages fitness to practise cases) before powers to register these groups are handed to it.

67   Health Committee, Sixth Report of the Session 2010-12, Complaints and Litigation, HC 786-I, Q 1 for example Back

68   Following on from the Darzi review of the NHS, the document "Framing the Nursing and Midwifery Contribution" set out the trajectory for the transition of nursing to a graduate-level profession. The then Health Minister Ann Keen MP announced that the profession would require a degree-level qualification for entry to the register from 2013. Back

69   Q 105 Back

70   Swansea University, "Nursing. An all-graduate profession - the Welsh experience", Back

71   Q 105 Back

72   NMC 02 Back

73   NMC 02 Back

74   Kings College London, Moving forward with healthcare support workforce regulation. A scoping review: evidence, questions, risks options, July 2010 Back

75   Ibid.  Back

76   Cm 8008 Back

77   Ibid. Back

78   Health and Social Care Bill, Clause 212 Back

79   Q 108 Back

80   NMC 06 Back

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Prepared 26 July 2011