In the Midst of Life

rewarding work.’
    I looked at them with deep respect. I have always loved them both, but had no idea of the depth of their vocational commitment and unselfishness. Sue, the older sister, is a very thoughtful and impressive woman. She is a Jehovah’s Witness, which is a life-affirming religion, and she bubbles with laughter half the time, and radiates warmth, kindness and compassion, which she says, in a large part, has come from her faith. She sees it as God’s commandment that she should be a Witness by working for those in need. I am sure she would work for nothing if she did not have bills to pay.
    I sent this chapter to them both for approval and had a letter in reply from Sue containing the following paragraph:
    I have chatted with Jayne and we are both of the same mind, that maybe we gave you an unfair description of our training, which I must make clear is always ongoing throughout our working life in the units we are employed in. There are always updates in line with CQC and care standards. We are not nurses but care assistants who provide a vital role in the physical and emotional care of the people who for one reasonor another find themselves in care homes or day centres such as ours.
     
    This is the ideal standard, expressed by two ideal care assistants, and I know it to be true; the CQC, with support and advice from the RCN, is all the time striving to improve standards through on-going training. However, the stark fact is that a huge number of people working in private hospitals, clinics and nursing care homes have no training whatsoever, and do not stay long enough in the job to benefit from the training that may be on offer.
    Nursing Care Home Managers are supposed to employ only people with NVQ Level 3 qualifications. However, a survey conducted for the End of Life Care report, issued by the National Audit Office in November 2008 (p.6, sub para 15) found that fewer than five per cent of nursing care home staff had this minimum qualification. Why, then, are they employed? The reason is because the managers are desperate for staff. They must have someone to cover the varying shifts over twenty-four hours, and night duty is the hardest to get anyone for. They could not function if they insisted on this Level 3 qualification.
    An NVQ seems to be the minimum qualification that is obtainable. But it can be bypassed altogether. Agencies offer a bit of training that amounts to shadowing another carer for a few hours, and this is accepted as enough for someone to get a job.
    It seems to me that care assistants fall into one of three categories:
    1. Those who are wholly and selflessly dedicated.
    2. Those who enjoy looking after people, but don’t want responsibility.
    3. Those who can’t get any other job.
    The last comment is certainly not meant in a derogatory way. A great many of those in the third group are newly arrived immigrants from middle European countries (the former communist bloc) who need a work permit to stay in the country, and who can get one by signing up to take the NVQ Healthcare at Level 1, andworking in a care home. Many of these boys and girls are very good indeed, and I have met them. They are young, bursting with life and happiness, not afraid of hard work or getting their hands dirty. Also, having been brought up in a culture that does not exclude the old from family life, they are gentle and understanding.
    In 2013, it will be mandatory for all newly recruited nurses to have a degree. It will not be possible to enter the nursing profession by any other door. Suddenly it is upon us –
health care assistants will be the most significant workforce in hospitals and care homes.
At present, it is estimated that there are over 700,000 practising HCAs in the UK, but, as they are not registered or regulated, the number is not really known. Their training has been insufficient, to say the very least, yet they will be the ones who do the basic bedside nursing that is the foundation of nursing care, as anyone who has suffered long-term illness or debility will tell you. It is also, for this reason, the most noble.
    Doctors come and go, but nurses or care assistants are always there. All the high-tech, multi-drug paraphernalia in the world is as nothing beside the human need for human touch and contact – which is what good bedside nursing is all about.
    We can prolong life for decades, and resuscitation is fast becoming the norm, and all these people will have to be looked after. The