Exclusive: Concerns have been raised that healthcare assistants are being asked to work ‘beyond’ their capabilities and training within a community nursing team in Cornwall.
Staff working within Cornwall Partnership NHS Foundation Trust have sounded the alarm over the release of a new ‘clinical skills and career framework’ which they say requires unregistered staff to take on significant new responsibilities, without any warning.
The trust told Nursing in Practice that the document was ‘in draft’ and ‘being reviewed following feedback’. It also said it was in line with ‘national policy’ and had been developed ‘in discussion and continued engagement with colleagues’.
But staff working at the trust have said it was originally sent out to staff, via a district nurse lead, without prior consultation.
Michael Wincott, a Band 5 community nurse and Royal College of Nursing (RCN) representative, is one of the nurses who was left concerned after seeing the framework.
Mr Wincott’s main concerns were with the framework’s proposal that Band 3 staff could delegate insulin as part of glucose blood monitoring, although the delegation would only be given as part of community visits only.
He also expressed alarm at Band 3 staff being able to deliver ‘compression/hosiery application,’ as outlined in the document, which specifies that non-registered staff must be ‘delegated by a registered practitioner’ in this area.
Another change that Mr Wincott objected to, was the framework’s suggestion that ‘urinary catheterisation in adults’ could now also be completed by staff of a Band 3 and above.
Mr Wincott claimed these were examples ‘additional roles and responsibilities to which an unregistered healthcare worker should not be subjected to’.
‘Those tasks are risky and there are red flags and when you’re doing these tasks, I would not want a band three to have to make a judgement… when they’re untrained, or not sufficiently trained, to pick up on those red flags,’ he told Nursing in Practice.
‘If someone is unwell and they’ve suddenly got a different blood sugar to normal, I would expect a registered nursing associate or registered nurse to know whether to escalate or whether to come back – I would not expect a healthcare support worker to do that.’
Mr Wincott added that he was already aware of some staff taking on work outside their usual scope prior to the framework being published.
He also outlined the long-term struggle to recruit community nurses in Cornwall, with vacancies having ‘either no applicants or inappropriate applicants who are not qualified for the role,’ with
Mr Wincott said he was ‘disappointed and concerned’ that the framework was ‘released prior to consultation with staff-side representatives’.
It is understood that a meeting will be held at the trust on Thursday to discuss the document. Attendees will include union and trust representatives.
Donna Mackinnon, a healthcare assistant who works alongside Mr Wincott in the trust, told Nursing in Practice, that the document feels like an effort to cut-costs, without providing the necessary training and support for staff.
‘The worry is that this is kind of beyond our paygrade… beyond our working remit,’ she said.
‘If I wanted to do that kind of training, I would have gone on to do my nursing training and I think it kind of degrades the new people who have done their nursing training.
‘I think that from us, we just feel like it’s another way for the trust to save money by utilising us to do the skills, but we don’t necessarily want to do that type of training and want that responsibility.’
She added that the nature of community care means staff are often working alone or in small groups, meaning even if ‘there’s always somebody on the end of the phone,’ the responsibility is always down to the individual.
Ms Mackinnon says that ‘nobody’s actually spoken to us about the new framework at all’, and that she has received no updates on how or whether healthcare assistants will be trained to take on any additional duties.
She believed that ‘if the pay grade and the training was right’ then some healthcare assistants may be open to taking on new responsibilities, but only after changes have been made and all staff have been consulted.
Concerns around the substitution of registered nurses has been widespread in recent months and was at the centre of a discussion at this year’s RCN Congress.
An RCN spokesperson said: ‘What we are seeing in Cornwall is repeated across the country.
‘There are simply not enough registered nurses working in the community, meaning patients waiting longer for care and often care being left undone.
‘In some cases, we have seen healthcare assistants and other nursing support workers employed to visit patients. While these roles are an important part of the workforce, they must not be asked to carry out roles outside of their competencies.’
They warned that substitution of registered nurses with less qualified and unregistered staff ‘puts patient care at risk’.
‘Particularly where patients are treated at home by staff working alone it must be provided by someone with the right level of skills,’ the spokesperson added.
‘Unlike an acute setting, there is not always backup assistance when needed.’
In response to the concerns raised, Cornwall Partnership NHS Trust said the framework ‘is in draft and is being reviewed following feedback’.
‘We employ a variety of colleagues who work across a range of community services and teams. They are a vital part of our trust, and we value the work they do which enables us to provide care at home or close to home.
‘We have developed the Community Nursing Community Skills Career Framework over the past 18 months in discussion and continued engagement with colleagues.’
According to the trust, in line with ‘national policy’, the framework seeks to: provide clarity on roles and expectations; support a competent capable workforce; and promote equitable access to continuing professional development and career progression.
‘Overall, the framework will underpin the quality of care and ensure we make the best use of our resources, of which our people are the most important and valuable,’ the trust added.
‘This is in line with our strategy to develop our colleagues and increase their skills so we can continue to deliver the services our patients deserve.’
