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Health Care Support Worker Regulation: will ideology trump safety?

March 4, 2013

During the course of his investigations into failures of care at Stafford Hospital, Robert Francis QC heard a number of very heavyweight witnesses express conflicting opinions concerning the desirability of compulsory regulation of Health Care Support Workers (HCSWs). Sir David Nicholson ‘questioned whether regulation was necessary. He pointed out the large numbers involved, and suggested that creating a regulatory system from scratch was not likely to be a top priority at the present time. He felt that focusing on training was likely to be a more beneficial use of available resources’ (Ch 23, para 114). Dame Christine Beasley ‘expressed strong disagreement with the arguments in favour of compulsory regulation for all HCSWs. She thought it was disproportionate in terms of patient safety and cost’ (Ch 23, para 115). On the other hand, Francis noted that ‘The Royal College of Nursing favours regulation of support workers’ (ch 23, para 122) and Sir Stephen Moss ‘strongly supported regulation [because] …anybody that could cause a patient some harm, looking at it negatively, ought to be tightly controlled by regulation or by a set of standards that they live and work by….(Ch 23, para 124).

One cannot disagree that the case for some kind of register of HCSWs is a persuasive one. So persuasive, in fact, that Francis himself came down in favour (recommendation 209). Obviously, the public has a right to be protected from individuals who by their actions have rendered themselves unfit for employment in the care sector. Even a limited form of registration which functioned, in effect, as little more than a blacklist, would go some way towards restoring confidence. Yet despite this, the government remains unconvinced. In Commons debate on the day the Francis Report was published, David Cameron said that ‘Robert Francis’s idea of proper training standards [for HCSWs] needs to be looked at. I tend to agree with that. The issue of registration is more complicated and potentially more bureaucratic. We will certainly look at it, but I think that needs some close examination.’ (Hansard, 6th February 2013, column 302).

Reading between the lines, this aspect of the Francis report is, for the government, all a bit of a nuisance. Apart from the financial implications of setting up a new regulatory body against a background of widely-reported shortcomings in the one we already have – the Nursing and Midwifery Council – it is also ideologically problematic. An acceptance of Francis’s proposal that a new ‘national uniform description of [HCSWs] should be established’ (Ch 23, para 142, my italics) would go against the grain of current policy-making, with its emphasis on the break-up of national public-sector pay scales in favour of locally-agreed arrangements on pay and conditions and concomitant locally-agreed standards and job descriptions.

Hovering above all this is the Health and Social Care Act, due to take effect in April. As Polly Toynbee recently commented in The Guardian: Commercialisation and competition is written into [the act’s] key section 75, opening up virtually all the NHS to public tender in a market supervised by Monitor’. The imposition of rigid national frameworks is obviously unhelpful (to say the least) to the competitive market economy in health that the government is now apparently on course to deliver. Their formal response to the Francis Report will reveal whether safety trumps ideology .

Francis, R (2013): Report of the Mid Staffordshire Foundation Trust Public Enquiry; London; The Stationary Office.

Toynbee, Polly (2013): The Lib Dems must not stand for any more lies over the NHS; The Guardian; 22-02-2013

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