Health and Social Care Bill

My Lords, the amendment concerns the power to register healthcare support workers in England. I shall try to be brief, as we had a long and thorough debate on this matter on Report and I have studied the Minister's response to my amendment at that stage. I have had protracted discussions between Report and now with the noble Earl and officials, and I thank them most sincerely for the time and effort they have put into trying to meet my requests. Healthcare support workers form a very large part of the workforce, whether they are in the employment of NHS hospitals, community services or local authority services, providing care in people's homes, or in the large number of nursing and residential care homes. We should not forget the role played by social workers, which often overlaps with the role of healthcare support workers, and vice versa. Many noble Lords have said in previous debates that large numbers of support workers provide high-quality care, and they have received some training in order to do that. It is not likely that this large number of support workers will decrease with a growth in demand from the rapidly expanding number of elderly, frail and vulnerable people who require high-quality care. However, it is also not possible to expect a magic wand—that is, the Government—to provide training overnight for everybody at once. Therefore, it is reasonable to find a way forward that provides a direction of travel that satisfies patients, the public, the professions and employers that the issue is being addressed as a matter of urgency within the economic situation in which we find ourselves. I shall briefly address each item covered by the amendment. The Minister has indicated that Skills for Care and Skills for Health will be producing an assured training programme, prepared with professional inputs, that will, following consultation, be available for implementation in 2013. This will entitle successful candidates to be entered on the voluntary register if they so wish. I am aware, and pleased, that the Minister has also agreed that work should proceed on reviewing the research on ratios of registered to unregistered personnel, and that the supervision of work delegated to registrants is vital. However, realistically, in some communities and hospital situations it is not possible for there to be close scrutiny of support workers' performance. The recent report published by Which? clearly demonstrates neglect in the delivery of care to patients and in their safety. Clearly, the Government need a means of early identification of the failings in the delivery of care. While the training programmes are being developed, perhaps we could ask, through the Minister, that registered nurses and midwives are reminded of their responsibility and accountability, that they have to assure themselves of the competences of individual support workers before delegating a task, and that, once a task has been delegated, it must be supervised. Where that proves impossible because of insufficient registered nurses and midwives, immediate action should be taken by a registered nurse to report to his or her manager and the employers should take action on the level of care that can be delivered in that situation. That will safeguard the safety and quality of care to patients. I now turn to the second subsection of the proposed new clause. It is recommended that the next logical step would be to aim for the training of support workers to be mandatory. So far discussions on making the training of healthcare support workers mandatory has not found favour with Her Majesty's Government. Many Peers indicated, on Report, the importance of all healthcare support workers receiving mandatory training and that it should be regulated. Although it is recognised that that could not be arrived at tomorrow, if Her Majesty's Government could agree that the training programmes will be mandatory at a date to be determined for implementation, I am sure that the patients, the public and certainly the professions of nursing, midwifery and social care would be satisfied. Subsection (3) of the proposed new clause requires the Secretary of State to develop a code of conduct for all employees whether they are entered on the register or just providing care. That includes the employees not just in the NHS hospitals but also in local authorities. That would provide clear guidance for employers as well as employees and should assist in ensuring that competences, where lacking, are made good by training modules or by withdrawing the person who does not have the skills or the competences. Without such controls of clearly defined competences being included for practising healthcare support workers and the correct delegation and supervision by registrants, it will be impossible to ensure the high-quality, safe, compassionate care that patients and clients deserve or indeed Her Majesty's Government aim to provide. I hope that the Minister will feel able to provide a positive response to this request. Subsection (4) requires Her Majesty's Government to carry out a strategic review within three years, as the Minister undertook to do on Report, about whether statutory regulation of support workers is necessary in the light of progress with the proposed training programmes and the introduction of the voluntary register. Perhaps I may suggest that the review of the research on improving the ratios of registered nurses and midwives is also included in this review so that a holistic view can be gained of the future shape of the workforce required to deliver high-quality, safe and compassionate care, with the result of improved clinical outcomes that are cost-effective and of cost benefit. I beg to move.