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1.46 pm
The Minister of State, Department of Health (Mr. John Denham): I congratulate my hon. Friend the Member for Warrington, North (Helen Jones) on obtaining the time for this important debate. It is clear from her speech that she has taken an interest in the subject for a long time and knows a great deal about it. Making the most of the contributions of all staff, including the valuable work carried out by health care assistants, is absolutely integral to our ability to deliver the ambitious programme for modernising the national health service and to meeting the increasing expectations of patients and staff.
We need health care staff to be adaptable and responsive, and able to work effectively within teams where role boundaries are flexible. Health care assistants are an invaluable and important part of the NHS. As my hon. Friend has said, they make an important contribution to the direct care of patients as well as supporting a range of health professionals in a wide variety of ways.
There is no fixed definition of what a health care assistant is or does. The latest figures show that there are almost 18,000 health care assistants and almost 67,000
support staff employed in the NHS. The majority of health care assistants work in trusts and many work with the elderly. A significant number work with vulnerable adults, such as those with psychiatric illnesses or learning difficulties. Others work with mothers and babies, with children, or in the community.
Support staff work to provide essentials such as ensuring the cleanliness of the hospital environment, and food and drink for patients. The term "health care assistant" has also developed as an umbrella term for a variety of staff groups. Those include staff whose work is supervised by chiropodists, occupational therapists, physiotherapists, radiographers and speech and language therapists.
For statistical purposes, the guidance on occupation codes used in our census of NHS staff defines health care assistants as support staff who are trained, or who are undertaking training, in job-related competencies through national vocational qualifications or other local training. In the service itself, the term "health care assistant" is often used interchangeably with titles used for other staff who undertake similar roles and provide similar support, for example health care support workers, nursing auxiliaries and nursing assistants.
Ultimately, the responsibility for determining the job role of a health care assistant lies with the employer. Different skills and different levels of skills will be needed in different working and clinical environments. We feel that local managers need to be able to provide the right sort of services for their locality and a rigid definition would restrict their ability to meet local service needs.
Similarly, it is a matter for employers to provide the necessary training and resources to enable staff to undertake their duties. We are aware that many NHS employers use local and national frameworks to train their health care assistants. Many use NVQs, or their component occupational standards, to specify the competence and performance outcomes of health care assistants in the workplace. Those standards provide a measure of quality and enable clear specification of the roles and responsibilities of staff. The attainment of NVQs is supported by on-the-job training and assessment, as well as off-the-job training. The latter is provided either directly by the employer or by an education provider.
The national health service executive has, for some time, supported the use of NVQs and occupational standards. It did so in 1995 and in subsequent education and training guidance issued to the NHS. That approach has been reinforced by the approach taken in the first human resource framework for the NHS, "Working Together", which we published last September. One of the aims of the framework is to make the NHS a better place to work in. Developing the commitment and skills of staff, including health care assistants, will be one way of achieving that. The House should not underestimate our commitment to strengthening the role of human resources in the national health service, ensuring that we are a good employer, and ensuring that we can develop the skills of our staff. That means that NHS employers will increasingly have better human resources planning, and better development plans for individual members of staff.
As my hon. Friend said, some health care assistants will wish to make progress in their NHS careers. Recognition of the skills and experience of such staff provides them with increasing opportunities to gain entry to programmes leading to professional qualifications, particularly nursing qualifications. Education consortiums are working with higher education institutions to open up nursing careers to as wide a range of people as possible, including existing NHS staff such as health care assistants. As has been said, we have already opened a route whereby NHS employers can second health care assistants on to pre-registration nursing diploma courses. That allows local education consortiums to fund up to 80 per cent of an employee's salary--up to a certain limit--with the employer funding the remainder.
That new approach has proved to be of considerable interest in the service. Therefore, as part of the £50 million nurse recruitment plan announced in September by my predecessor, my right hon. Friend the Member for Darlington (Mr. Milburn), up to 200 additional secondments have been funded this year, with up to 1,000 additional places being made available over the next three years. The package also includes measures to provide non-means-tested bursaries for enrolled nurses who wish to return to work and convert to first-level registration, and an expansion of part-time and flexible pre-registration nursing and midwifery diploma programmes.
There are also a number of local schemes established by the NHS, which recruit health care assistants, support them in the achievement of level-three national vocational qualifications in care or modern apprenticeships, and, using the funding that I have described, second them to nursing diploma programmes. I understand that in my hon. Friend's constituency such a scheme is operated jointly between Warrington and Halton NHS trusts and the north and mid-Cheshire training and enterprise council.
The scheme has three stages. Young people are employed by the trusts, and, in collaboration with the TEC, undergo a two-year modern apprenticeship course. Provided that students secure an NVQ, they are then placed on a nursing diploma course at Chester college, funded by the local education and training consortium at the college. Placements are undertaken at Warrington and Halton NHS trusts, and, on successful completion of their diploma courses, students are guaranteed employment. The scheme is an example of the way in which the NHS, TECs and education providers can work well together, helping individuals to achieve their potential, addressing nursing shortages and helping patients at the same time. Those developments are supported by the Government's wider approach to lifelong learning, which seeks to enable those capable of progressing to do so through education and training opportunities.
More recently, we have published proposals for the modernisation of the NHS pay system in our paper, "Agenda for Change". Our aim is a modern pay system that will enable staff to do their best for patients, working in new ways and breaking down traditional barriers. We want a system that pays fairly and equitably for work done, with career progression based on responsibility, competence and satisfactory performance: a system that will simplify and modernise conditions of service, providing national core conditions and considerable local flexibility.
Our proposals identify people--such as health care assistants--who should have more scope to develop their jobs. Those people will be encouraged to take up training opportunities and secure NVQs. Our proposals for pay reform recognise that, in many cases, employers have created health care assistant posts to provide flexible support for nurses and other staff. Postholders often fulfil a wide variety of different roles. We want to preserve the benefits, while giving staff the security of core terms and pay minimums. "Agenda for Change" sets out the means to do that, recommending a national system with meaningful local flexibility.
We are also committed to working with unions and employers to agree the basis of a national job evaluation framework on which all NHS jobs can be assessed. That will be an essential underpinning to ensure equal pay for work of equal value, and will be relevant to groups performing a wide variety of roles, including health care assistants. Staff should receive equal pay when they are performing the same role; differences should reflect variations in skill, role and responsibility.
The skill mix that an NHS organisation requires locally will depend on a number of factors: the type of services that it delivers, the type of patient who is being treated, and the environment in which patients are treated. NHS organisations must therefore determine the mix of skills, roles and staff that they need at local level. But, although training is available for health care assistants, they cannot be a substitute for professional staff. The current national average ratio between qualified and unqualified staff is more than two to one--about 70:30--although I understand that in my hon. Friend's constituency it is about 60:40, and that the local NHS trust is taking action to define the roles and training needs of its support workers.
It is important for health care assistants to be properly and adequately supervised to ensure the safety of patients in their care, the quality of the care offered, and the accountability of individuals involved in providing care. Support staff should carry out assigned tasks involving direct care in support of, and supervised by, other registered health professionals. Employers also have a role to play: they should ensure that employees are suitably qualified and competent to perform the duties for which they are employed, and that high standards of patient care are maintained at all times.
Concern has been expressed by, among others, my hon. Friend, about the development of the roles undertaken by health care assistants, and it is well known that concern has been expressed in the past about the need for the regulation of support workers. On 9 February, my noble Friend the Under-Secretary of State, Lady Hayman, announced that the Government had accepted most of the recommendations of the body that conducted an independent review of the Nurses, Midwives and Health Visitors Act 1997, whose report was submitted in autumn last year. During extensive consultations, fears were
expressed about the threat to public protection that might be posed by unregulated support workers, including health care assistants. The reviewers recommended, and we have accepted, that a short review should be commissioned to explore the scope and need for regulation. It will be a UK-wide review, and UK health Ministers will want to consider its terms of reference carefully.
The Government have already announced plans to regulate social care staff by setting up a statutory general social care council. The driving force behind the council will be the need to increase the protection of service users, their carers and the general public. Any review of health care assistants will have to take account of the Government's proposals for a general social care council, published in the social services White Paper, "Modernising Social Services".
Systems of professional self-regulation and protection of title play a vital role in ensuring public protection, but flexible role boundaries will help to meet changing health care needs and public expectations. Flexibility provides the scope that is necessary to develop health care teams to meet patient's needs. Well-trained health care assistants, working under the supervision of registered and accountable professionals, make an important contribution to care, and provide the ability to tailor skill mix to patient and service need. Cost-effectiveness and efficiency are maximised by appropriate skill mix. It is inefficient, and a misuse of highly and expensively trained professionals, to let them undertake care tasks that others, with the appropriate training and supervision, could undertake to the required standard.
We must ensure that we have enough nurses to support and supervise our health care assistants. Registered professionals are required to delegate appropriately to support staff, and employers are required to ensure that their staff are competent to undertake the tasks required of them. We must also have enough nurses to provide the treatment and care that patients need. The new human resources framework is a major step forward in our drive to meet those aspirations.
It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
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