Thursday, 25 July 2013

A brief history of nursing and why HCAs are being hung out to dry by those responsible.









When the NHS was once a service one of the doctor’s who we now report on was admitted as a child to a ward and was given a little booklet to read that explained who was what on the ward where they were then billoted. They read with interest about the different uniforms that were worn, the different “skill sets” and “skill mixes” to use today’s Party speak and which then existed. It was as follows:

Dark blue = sister = top dog on the ward or senior SRN (State Registered Nurse) with experience +/- extra qualifications

Purple/purple white stripes = staff nurse = SRN = 3 years training with minimum qualifications to get trained

Green/green white stripes = SEN = State Enrolled Nurse = 2 years training with minimum qualifications less than those for an SRN.

Nursing auxillary = yellow uniform = not well qualified but did general duties under the supervision of either an SEN and/or an SRN.

Simples but that was before the Party reformed for the better this simple hierarchy whereby different people had different levels of skill and different jobs but worked together to provide a service to the patient (customer).

Over the years the Party and senior nurses have decided that they are now “professionals”, which they already had been but were no longer and some described as, and sorry for the grunt word, sh*t shovellers as some used to refer to themselves as. Times howevr have changed but now all nurses are now chiefs and “practitioners in their own right” and none are Indians.

Using the comprehensive education system as its model nursing seniors have decided that no one is too thick to fail even though with the decline in the UK population it was at one point predicted that in the later part of the 20th century in a projected year that there would not be enough academically qualified women to meet the numbers required to be SRNs let alone anything less qualified due to the falling birth rate and increasing numbers of elderly who would need care.

Easy problem to fix for thick managers lower the standards. All SENs became SRNs with a conversion course and introduce the likes of Project 2000 and the NHS University et al.

So someone in the Party(s) realized that if every nurse is now a chief they cost more. The current TriPartite healthcare policy is a privatization model whereby quality care = care on the cheap as their care model is that profit comes before true patient care.

So training all previously cheaper SENs to become SRNs will have increased costs and left a gap in the nursing workforce (sorry sh*t shovellers) which needed to be filled on the cheap hence the creation of the HCA (Health Care Assistant) the former Nursing Auxillary.

So on the wards the team trained on you would have:

A Sister
An SRN or two
An SEN or two
And a nursing auxillary or two.

Excellent idea until you also coincide these changes with the widespread introduction of the failures of the comprehensive school system called NHS managers. They think nurses big numbers HCAs little numbers. Using their hands and feet to count which is hard work for some who would have to take their shoes off to count to 24 NHS managers realized that employing lots of HCAs instead of more expensive highly trained SRNs meant they could do their sums without running out of hands and feet.

Enter stage left Staffordshire where no NHS manager will ever be wrong for Staffordshire is a “system failure” not a maffs failure for trying care on the cheap but the options they adopted to reduce healthcare costs and therefore quality is part of the cause.

So now a ward will have:

Possibly a sister more likely a ward manager
Maybe one possibly two SRNs
No SENs
And loads and loads of HCAs = cheap unqualified labour.


A former much missed nurse blogger who has departed these healthcare deficiency shores for hopefully something approaching first world care commented on the role of “kids” in providing hands on care at the expense of quality patient care. You should read some of her posts which show the problems which despite Francis are still there.

So the solution is now let us the politicians, who are unaccountable architects of any healthcare system, now "train" the HCAs, not the managers who were the implimentors of any NHS “system failure”. Neither the politician or the manager were responsible it was all the doing of the evil unqualified HCAs so let's get 'em.

Let us in effect (collaboratively buzz word here comrades) reinvent nursing and give HCAs 2 years training as we used to do for SENs and do it dumbland style. So Nicholson “I have regerts but I did it my way” will be happy you cannot believe it but he is still there to paper over his cracks before walking away Jock free sorry to continue the reforms and so 2 years training is a reform for the better to correct a wrong comrades.

Let us take SENs and reinvent them as HCAs and provide what existed previously as now “more qualified” and therefore “better” individuals by “training” less able people to replace that was there before. This is not new concept think out of hours care for GPs, NHS 111 etc.

The former SENs who were often practical not intellectual nurses often ensured that wards ran smoothly despite some of the SRNs. SENs at least had some basic educational qualifications in contrast to the new breed of HCAs who will now no doubt graduate with a (polytechnic) degree after two years in a mortar board and gown in contrast to a qualification and real time hands on experience of patient care that the SENs once had.

If they are all chiefs who do you get to be Indians? Oh we forgot the HCA and so repeat the cycle . . . and what will you get at some point?

The next Staffordshire bull something . . .

Praise be to the Party for once again ignoring history. Where have they all been since 1947? More qualifications for the most junior and least able of staff will not eradicate the failures of those who create and manage the problem.

PS as we decided to publish this the first victims of what will become the night(s) of the Nicholson long knifes were named. Two guards at the Staffordshire concentration camp have been punished for following the orders of those who have no professional regulation or standards. There will we are sure be more.

3 comments:

GrumpyRN said...

I find myself in a strange situation here. I really want to 'rip you a new one' for doing the usual nurse bashing by doctors, but I kind of agree with you. I too remember those days with sister at the top.
I will take issue with you on one thing. I was an EN and did a conversion to RGN (Scotland, different qualification) and it was anything but simple, it took me longer than my EN training to complete.

When they introduced the market system you set up a system that inevitably meant people became secondary to profits. Managers do not understand that patients require highly trained and educated people to look after them. All they see is, as you say, shit shovellers. I still get asked why do I need a degree as I only do what the doctors tell me. I blame TV for this for showing the physician as nurse.

However, back to the point. When trying to maximise profit then you get rid of the larger pay packets and again as you say "HCA's little numbers". I have said this before many times, accountants decide nurse staffing levels.
As far as I remember we have been saving money for 20 years - every year we are told to 'save' or 'cut back'. When does this stop?

Where were the medical staff at Stafford? Where was the senior consultants who should be overseeing their departments? Are they the next ones to be pulled up for a failure of duty? As far as I can see they complained about a shortage of nurses but did bugger all about it.

The nurses who were struck off yesterday are part of a witch hunt and are the first of the scapegoats. They got caught up in the management culture and appear to have forgotten their nursing roots. I wonder if this is because the only way for nurses to advance is to become managers?

One last thing, I have been in a few hospitals up here and can honestly say that I have never seen what you describe - a preponderance of HCA's on the wards. Are we better? I doubt it. What we do have is a government who told Westminster that we do not want the market system and we have been left alone to get on with our jobs without a makeover every few years. Yes, I know we have problems and we are far from perfect - but I sincerely hope that a Stafford could not happen here.

Anonymous said...

You hit the nail on the head.

Militant Medical Nurse

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