In the Midst of Life (30 page)

A:
This will depend on the organisation. In theory, a nurse on the staff should train and monitor care assistants. But, in practice, this is unreliable because some employers will take a carer after a day’s induction and there may be
no
nurse available to offer further training. There can be a wide difference between the training and supervision of care assistants in NHS hospitals and those employed privately.

Q
: If the private establishment has no nurse to train potential carers, who does train them?

A:
National Care Training Providers.

Q
: And what training do they offer?

A:
Telephone help throughout the day.

Q:
So is it seriously proposed that basic nursing can be learned by telephone?

A:
It is a telephone support line.

Q
: Is this support line open at night?

A:
No. Care assistants also have one-to-one contact with a specially trained NVQ Care Assessor.

Q
: How often is one-to-one contact available?

A:
By appointment, when it can be arranged.

I have mentioned my two nieces who are HCAs. The younger one is on NVQ Level 3, and her elder sister is on Level 4. I asked the younger why she did not take the Level 4 qualification. She replied: ‘I don’t see the point. I wouldn’t earn any more.’

‘But it says here in the syllabus that you would.’

‘It may say that, but I wouldn’t get it.’

‘What do you earn now?’

About £5.40 an hour. It might be
£$.70
– I’m not sure.’

Her
sister interrupted: ‘I was on £5 something an hour for years and years, even after I passed Levels 2, 3 and 4; it made no difference to the pay But now I get £8 something an hour because I have worked there for a long time. That makes a big difference.’

My nieces both work in nursing care homes, one in Reading, the other in Plymouth. I asked them why they did the work for such a pitiful wage. They replied, almost in unison, one echoing or agreeing with the other:

‘Because I love it.’

‘It is deeply satisfying.’

‘I love knowing that I have made a difference to some old person’s life who might be lonely or unhappy.’

‘At the end of the day, or night as it might be, you feel you have done something worthwhile.’

‘It’s very 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:

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, and
working 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 decisions are made by government think tanks, by teams of professors at the British Medical Association, by ethics committees consisting of philosophers and theologians and senior judges. But having come to their conclusions, and issued their reports, they can walk away from the problem. They don’t have to do the work. The work is left to care assistants, who receive barely a living wage for work that is arduous and demanding, and for whom the strain can sometimes be insupportable.

We are a rich nation, and like all rich nations we need a subculture of underprivileged people to do the dirty work that we would not want to see our sons and daughters doing. Much of the work of care assistants falls into this category, and they are the ones who will look after us in our old age. It is worth remembering that, when our faculties, our senses, our mobility and our organs
fail us, health care assistants will be more important to us, and have far more power over us than doctors.

Let me end this chapter by reproducing some of the NVQ introductory literature, which can be obtained online. It is addressed to prospective health care assistant candidates at the initial entry level:

The contempt with which this hedonistic society looks upon simple virtues is reflected in the pay reward. We offer care assistants £11,000 a year: that is £5.70 an hour, with no guaranteed sick pay, holiday pay or maternity leave, and no guaranteed pension.

Would you, the reader, do it? Could you? Would you advise your son or daughter to become a health care assistant?

The year was 1968, and I was night sister of a small provincial hospital. I walked into the ward, and there he was – Dr Conrad Hyem. We recognised each other instantly, though it had been many years since the night in Poplar when we parted. No doubt we had both changed. I was a married woman in my thirties with two children. And he? Well, he was very much changed. He looked frail, sitting up in a hospital bed, breathing with difficulty a bluish tinge around his nose and lips, and an anxious look in his eyes. The ward was quiet after the daytime bustle, and peaceful. A single light glowed above the bed of the frail old man suffering from congestive heart failure. I went over to him, sat on the edge of the bed, and took his hand. He squeezed it, and a crinkle in the corners of his eyes showed his pleasure.

‘Jenny Lee,’ he whispered, ‘after all these years … I have not forgotten you. How could I? And now you come to me when I am dying. You are thrice welcome. What a happy chance.’ He sighed with contentment, and squeezed my hand again, such a weak little squeeze. ‘A happy chance.’ He looked up and smiled once more.

The effort to speak had made him breathless, and he leaned back on the pillows panting, shallow breaths, his nostrils dilated with the effort to take in more air. An oxygen cylinder was beside his bed, and I turned it on and placed the mask over his face. He breathed the life-giving gas for a few minutes, and then pushed it away. I adjusted his pillows, and he leaned back comfortably and closed his eyes. I whispered: ‘I must go round the wards and see my other patients, but I will come back; be assured of that.’ He nodded and smiled and patted my hand. ‘Jenny Lee,’ he whispered, ‘a happy chance.’

*

A
hospital is a lovely place to work in at night. Staff is reduced to about ten per cent of the number required during the day and there are no routine admissions or discharges, no routine surgery, no moving of patients to special departments for treatment, few telephone calls. All is quiet. I refer here to the general wards of a hospital, and
not
accident and emergency, where day can blend into night, and night is usually more hectic than day.

I went quietly around the hospital, taking the night report from each nurse in charge, seeing a patient here or there, checking a drug, adjusting some treatment, mentally noting this or that to be checked on the next night round, and then returned to the male medical ward, where I sat in the office reading Dr Hyem’s notes. Congestive heart failure was the diagnosis. Long-term diabetes, for which condition I had treated him in the first place, had caused generalised atheroma of the arterial circulation (atheroma – from the Greek for ‘porridge’). Just as a plumber may say, ‘Your central heating won’t work because the pipes are all furred up,’ so it is with the circulation. The arteries become congested and the heart, which is the central pump, gets weaker and cannot work properly.