Recommendation 213

Dismissing unsatisfactory staff following breach of code of conduct

Not accepted - agree with principle
Until such time as the Nursing and Midwifery Council is charged with the recommended regulatory responsibilities, the Department of Health should institute a nationwide system to protect patients and care receivers from harm. This system should be supported by fair due process in relation to employees in this grade who have been dismissed by employers on the grounds of a serious breach of the code of conduct or otherwise being unfit for such a post.

We intend to achieve the intention behind this by ensuring that organisations have the right staff with the right skills to deliver care in a safe way.

We do not believe that regulation of health care assistants and support workers will improve the quality of care. The Nursing and Midwifery Council are an organisation going through a significant change programme focused around delivering their core functions relevant to the regulation of nurses and midwives, and should not be charged with these recommended regulatory responsibilities. In line with the recommendation from the Cavendish Review, the Government has commissioned the Professional Standards Authority for Health and Social Care for advice on how employers can be more effective in managing the dismissal of unsatisfactory staff.

The disclosure and barring service provides a further layer of assurance by helping employers make safer recruitment decisions and prevent unsuitable people working with vulnerable groups.


The Care Quality Commission’s registration requirements state that all providers of regulated activities must ensure that they have the right staff with the right qualifications, competence, skills and experience to undertake tasks to be performed. Where providers fail to comply, the Care Quality Commission has a range of enforcement powers.

The Nursing and Midwifery Council’s Code of Conduct requires nurses and midwives to delegate effectively by ensuring that anyone they delegate to is able to carry out their instructions, that the outcome of the delegated task meets required standards and that the individual delegated to is supervised and supported.

All healthcare assistants and social care support workers should receive consistent high quality training in the fundamental skills of caring, understanding the skills and behaviours needed to deliver good care. That is why the Department of Health is introducing the Care Certificate, which will be a means of ensuring healthcare assistants and social care support workers receive the training and support they need to do their jobs.

Supporting staff can also mean tackling underperformance in a sensitive, fair and robust manner.  We should not shy away from this.  In response to the Professional Standards Authority’s advice to the Secretary of State, NHS Employers and the National Skills Academy for Social Care (Skills for Care) have been commissioned to develop a resource drawing together content on effective performance management and appraisal of staff providing care. This should support health and social care managers in their responsibilities to manage performance, leading to safer, higher quality care. We expect the resource to be launched in April 2015.