Department of Health and Social Care
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New proposals to ensure care and compassion in the NHS and in social care

Better fundamental training and certificate for healthcare assistants and support workers to raise status and quality of caring profession.

All healthcare assistants and social care support workers should undergo the same basic training, based on the best practice that already exists in the system, and must get a standard ‘Certificate of Fundamental Care’ before they can care for people unsupervised, according to a new independent report published yesterday.

The independent Cavendish Review, carried out in the wake of the Francis Inquiry into Mid-Staffordshire NHS Foundation Trust, makes a number of recommendations on how the training and support of healthcare assistants who work in hospitals and social care support workers who are employed in care homes and people’s own homes can be strengthened to ensure they provide care to the highest standard.

Healthcare assistants and social care support workers provide some of the most personal and fundamental care to people when they are ill or help people with long term conditions to live as independently as possible in their own home. This may include turning people in bed so they do not get pressure sores, helping people to eat and wash, to get out of bed and to get dressed. Such care should be done by competent professionals who treat people with compassion and dignity. But the review finds that the quality of training and support that care workers receive in the NHS and social care system currently varies between organisations.

The recommendations it makes include:

  • Common training standards across health and social care, along with a new ‘Certificate of Fundamental Care’, written in language that is meaningful to patients and the public. For the first time, this would link healthcare assistant training to nurse training.

  • The opportunity for talented care workers to progress into nursing and social care through the creation of a ‘Higher Certificate of Fundamental Care’. This will ensure they have a route to progress in their careers and an opportunity to use their vocational experience of working as healthcare assistant to enter the nursing profession.

  • HEE, with Skills for Health and Skills for Care, should develop proposals for a rigorous system of quality assurance for training and qualifications, which links to funding outcomes, so that money is not wasted on ineffective courses.

  • Healthcare assistants should be allowed to use the title ‘Nursing Assistant’ on completion of the Certificate of Fundamental Care to improve clarity and communication between staff and patients, enhance the status of support workers and reduce the number of job titles - which currently stands at more than 60.

  • The Nursing and Midwifery Council should make caring experience a prerequisite to starting a nursing degree and review the contribution of vocational experience towards degrees.

  • Trusts should empower Directors of Nursing to take full responsibility for the recruitment, training and management of Healthcare Assistants. Employers should also be supported to test the values, attitudes and aptitude of future staff for caring at the recruitment stage.

  • The legal processes for challenging poor performance should be reviewed so that employers can be more effective in identifying and removing any unsatisfactory staff.

Camilla Cavendish, author of the review, said:

There are more care assistants than nurses working in England. Many of us will rely on them at some point in our lives, in particular in old age, and we need them to be as good as they can possibly be – especially as some support workers are carrying out procedures which used to be done by nurses, even doctors.

I have seen many examples of excellent and skilled care, but I have been struck by how disconnected the systems are. The airline industry figured out 30 years ago that the most junior staff could be a critical link in the passenger safety chain. Patient safety in the NHS and social care depends on recognising the contribution of support workers, valuing and training them as part of a team.

For people to get the best care, there must be less complexity and duplication and a greater focus on ensuring that support staff are treated with the seriousness they deserve – for some of them are the most caring of all.

Welcoming the review’s publication, the Health Secretary Jeremy Hunt said:

We are determined to build a compassionate health and social care system – one where people are always treated as individuals, with kindness and respect.

I am very grateful to Camilla Cavendish for the work she has put into this review. It rightly highlights some of the best practices on the frontline – where staff with the right values have been recruited and offered the training and support to do their jobs not just competently but also with compassion. But it also shines a light on how disconnected the health and social care systems can be and the stark variations in training that staff receive.

The review was produced following visits to hospitals and care homes, meetings with nurses, domiciliary care workers, healthcare assistants and care home staff across the country. The recommendations draw on the experience of a wide number of people and organisations, including those who use these services, the staff that provide this care, leaders and supervisors, as well as employers.

The Government will provide a formal response to the Review, along with its response to the Francis Report, in the autumn.

Notes to editors

Camilla Cavendish is the Associate Editor at The Sunday Times. She was chosen to lead the review to provide a fresh perspective on the key issues of valuing and supporting health and social care assistants and because of her strong personal and professional interest in this area.

The review considered questions around 5 key areas:

  1. Recruitment
  2. Training and Development
  3. Leadership, management and supervision
  4. Engagement and support
  5. Public confidence and assurance

In May, Health Minister Dr Dan Poulter announced a wide ranging series of measures to improve the training, values and education of all NHS staff over the next two years and beyond. The measures were published in the Government’s mandate to Health Education England, a new arms-length body set up to give NHS training and education unprecedented focus and importance.

It included proposals for recruitment to all NHS-funded training to be based on values and behaviours as well as technical and academic skills by March 2015; a plan to support the progression of healthcare assistants into nursing by autumn 2014, and to establish minimum training standards for healthcare assistants by spring 2014.

The Department of Health also announced a major commitment to better integrate and health and social care services, so that they focus on the needs of individuals, their families and carers in May.

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