In the Midst of Life

ageing:
     
To separate education from service by conferring supernumerary status on students and creating bursaries in place of training salaries.
To create a single register that would do away with the Enrolled Nurse grade, and to simplify the designation of first-year student nurses.
To establish a new clinical grade of support staff, essentially to replace junior nurses and enrolled nurses, whose function would be fulfilled by these aides.
     
    ‘Toseparate education from service’. Herein lies the rub. Nurses need higher education, but they also need practical training in bedside nursing. A thousand and one tiny details, some so small they are barely perceptible, are involved in basic nursing care, and these details have to be learned; they are not obvious to the casual observer or to someone who thinks they could just do the job.
    The second reform dealt with the proposal to do away with the State Enrolled Nurse (SEN) qualification. Nursing staff had always had assistant nurses or auxiliaries to help them. The Voluntary Aid Detachments (VADs) in the military hospitals of the First World War are just one example. Later in the century, the SEN received a training approved by the Royal College of Nursing (RCN) that was essentially the same as the first year of student nursing. The course appealed mainly to married women who had family commitments, who enjoyed nursing but did not want responsibility. I worked with several and, as a ward sister, knew that an SEN was a great asset, providing stability and continuity on a ward. Also, she was often a mother figure to nervous young students, doctors as well as nurses. But Project 2000 looked ahead to a single register of graduate nurses, in which a second grade of enrolled nurses had no part.
    When I read the words ‘To establish a new clinical grade of support staff,’ I was unclear what this might mean, but assumed it could easily be found out. Two months later, after an exhaustive study of professional papers and government reports, after rushing around all over the country interviewing people, I am still unclear, and get the impression that everyone else is, too!
    Let’s start with the name or title for these support workers. My researches produced about twenty different names. When I told this to a spokesman for the RCN, he laughed: ‘Over the history of the RCN we have come up with 295 different names for support staff, and there may be more.’
    From the inception of Project 2000, statutory powers enabled the UKCC to phase out the apprenticeship approach in favour of more academic training. Nurses started to leave the wards, and that was when carers came in. It was the first time the word ‘carer’ hadbeen used as a job description. Hitherto, they would have been called auxiliaries, assistants, or one of the 295 options. By the 1990s, the title Health Care Assistant (HCA) became accepted, and this seems likely to stick.
    In my capacity as an ordinary person, or ‘Everyman’, seeking to get to grips with this revolution in healthcare provision, I studied a great many documents, Government Reports, professional reviews, websites and journals distributed for public information by the Care Quality Commission (CQC, formerly known as the Healthcare Review Body). Whilst the area is muddy and changing all the time, the following is taken from my researches and is accurate at the time of writing:
    Question (from ‘Everyman’):
So who does the basic nursing these days?
    Answer (information gleaned from CQC documents):
Health Care Assistants.
    Q
: And who trains them – the RCN?
    A:
No. The employer, the Trusts, the NHS Training Authority, the care home, the agency or an independent hospital.
    Q
: What training could the Trust give, for example?
    A:
This can vary. Some trusts offer up to six weeks induction and training, whilst others provide two weeks of support for new Health Care Assistants.
    Q
: What training would a private hospital, clinic or care home give?
    A:
There is no national standard, and on the whole it is very little, a couple of days at most. However, all health care workers must show the Criminal Records Bureau clearance, and complete a brief induction.
    Dear Heaven, it can’t be true! And we had fifteen months’ training in basic nursing.
    I have two nieces who are health care assistants. One of them told me that she had worked with disabled children, and decided to change to geriatric nursing. She said, ‘So the agency sent me on half a