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The Cavendish review - some reflections

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Last week, Camilla Cavendish published the report of her review of the role of healthcare assistants and support workers in the NHS and social care.  Abuse and neglect in our care homes and hospitals scandalises us all. Winterbourne View and Mid Staffordshire are just 2 recent examples where lack of respect, compassion and care visited terrible and unnecessary suffering upon the innocent.

The Cavendish review, instigated by the Secretary of State following the findings of the Francis inquiry, seeks to explain why ‘safe, effective and compassionate care’ can sometimes be found wanting. It goes on to propose recommendations to ensure the 1.3 million front line healthcare assistants (HCAs) and support workers feel properly valued and supported to deliver the best quality care.

There are a number of findings that stand out for me. The first is the disconnect Camilla found between NHS and social care systems, the latter “seen as a distant land occupied by a different tribe”. In the context of our ambitions, in respect of integration, it is a sharp reality check. Integration is not just about budgets, systems and structures. It’s also about aligning cultures. Many of the staff in question will be moving between these sectors. We need development of the right shared values and a confidence there will be continuous development of skills, regardless of which sector those assistants are currently employed in.

The second was the need for HCAs to be recognised as a critical resource for the effective delivery of care. Too often, they feel ignored and/or underappreciated. There is a wealth of organisational development research showing that most employees want the same thing. They want to be motivated by a strong sense of purpose. They want to be respected in terms of being trusted to do their job. They want to be encouraged and recognised for their good work. And they want to be treated fairly by employers who recognise their needs and care about their wellbeing. The message from the Cavendish review is that if we want to get the best out of our healthcare assistants and other support workers, we have to invest in them.

A third main conclusion of the review is that HCAs face increasingly challenging tasks, in particular meeting the care needs of the frail elderly (an area we are seeking to address through our engagement on vulnerable older people this summer). This raises the question of whether, collectively, we have adequately addressed the skills challenge in respect of caring for people with complex, multiple conditions, which often include dementia.

It is worth reminding ourselves that the review is not a prelude or call for greater regulation. This was never its remit. Creating and maintaining a culture of compassion, responsibility and supervision is a duty all of us share in the care sector and is a sentiment I wholeheartedly support.

The review makes a number of clear recommendations on this basis, but at its heart is this message:

HCAs and support workers have a need and a right for enhanced, certificated training to raise their status, helping them strive for and achieve higher care standards.

Allied to this is a need:

  • to better support employers to test the values, attitudes and aptitude of potential care workers at recruitment stage
  • to establish common training standards across health and social care, linking healthcare and nurse training for the first time
  • for hospital trusts to empower directors of nursing to take full responsibility for recruitment, training and management of HCAs

Clearly, there are challenges here for us at national level, but at the local level we need to provide consistent, quality care for our citizens. You can’t legislate for compassion but you can raise awareness of the needs and aspirations of both care workers and the people they are there to help. Health and wellbeing boards will continue to drive closer co-operation between health and social care services, and I am sure the Cavendish Review will further galvanise the integration agenda. We need to make high quality care the standard throughout the system. Nothing less will do.

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