Full HCA registration 'inevitable', says care review author

Camilla Cavendish, a Care Quality Commission board member and associate editor of The Sunday Times, led a review into the training standards of care assistants in 2013. She also told HSJ the CQC would need to be “rigorous” in its approach to overseeing new HCA standards that come into effect next month.

Ms Cavendish, who was asked to undertake her review after the public inquiry into poor care at Mid Staffordshire Foundation Trust, said a new government must tackle the risks to patient safety from the lack of checks in place for HCAs in health and social care.

Health Education England has drawn up 15 standards HCAs should achieve over 12 weeks, which should be delivered by NHS trusts and social care employers as part of their induction.

The standards, which make up the care certificate, are designed to deliver a national minimum level of training for HCAs and cover areas such as fluids and nutrition, privacy and dignity, patient handling, and infection prevention.

While considered to be best practice by HEE, achieving the care certificate has not been made a compulsory requirement by the government.

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Speaking ahead of the certificate’s launch on 1 April, Ms Cavendish said she believed the standards were a “real move forward”, but added: “I would never pretend the care certificate is ever going to solve every single problem.”

Asked whether she agreed with Lord Willis, who earlier this month called on HEE to make the care certificate mandatory, she said she did agree with him but added: “You can have any numbers of pieces of paper; what matters is the care that people are actually getting.

“The CQC is saying it will expect providers to have trained their staff using the care certificate and the CQC needs to rigorously pursue that. We need to ensure CQC inspectors are trained on this and ask the right questions when they go in.”

On registration of HCAs - one of only nine recommendations from 290 in the Francis report rejected by the government - Ms Cavendish said it was important not to overestimate the safety net this could provide.

“The fact that nurses are registered and theoretically accountable to the [Nursing and Midwifery Council] has not saved patients from appalling care at the hands of nurses,” she said. Registration of HCAs would be a “huge bureaucratic task which would not necessarily create the utopia some of its advocates think it would”, she added.

HCAs would ultimately need to become part of a total registered nursing workforce, Ms Cavendish argued. “The dividing lines are artificial and we have ended up accidentally with two tribes of people trained in different silos. I actually think we need to move to a situation where there is one registered workforce and in the end that is probably inevitable.”

She said a future government “absolutely” needed to address the systemic gaps that could allow HCAs who have been disciplined or are guilty of misconduct to move between employers in health and social care.

“There have been proposals for some time now for skills passports, references and ways to check up on people. It is completely critical and until we can do that we can never reassure patients or do what the staff themselves want, which is to make sure no one who is underperforming can reappear somewhere else. We don’t have that at the moment.”