'Health care is changing and we must respond'

One trust already has mixed tasks for staff, reports Nicholas Timmins

Kingston NHS Trust in Surrey has already taken the first steps towards the new support worker - employing dozens of "team assistants" in its 140-bed medical unit.

The change has involved not just substituting the skills of nurses for trained-up cleaners, porters and maintenance staff, but a wholesale switch to what Susan Legg, the trust's director of nursing, calls "patient-focused care".

The unit has its own X-ray and pathology on site. Qualified nurses lead the teams with assistants already undertaking tasks from traditional cleaning and portering, to maintenance, toileting and bathing patients, helping them with mobility using exercises prescribed by physiotherapists, taking blood for tests and undertaking other care traditionally provided by professional staff. A radiographer has been trained to assist doctors with endoscopies - the use of fibre-optic cameras inside the body - a task usually done by technicians or nurses. Nurses now insert the cannulas for drips and can re-site them without calling junior doctors out.

The unit's heaviest cleaning, portering and maintenance is still done by "unit stewards". But they too are trained to help feed, wash and toilet patients. The idea that this endangers patients and risks infection is dismissed by Miss Legg. "In the past we have had nurses empty bed pans and then change dressings," she says. "There is no difference between that and cleaning a toilet. It is about proper infection control and we train people in that."

Team assistants may be cheaper to employ than fully qualified nurses, but Ms Legg insists the exercise is "driven by quality of care" - based on patient needs and "competence-based training". Growing numbers of services are delivered without the patient having to travel round the hospital. Time spent in meetings, on paperwork and in waiting for qualified staff is reduced. It no longer takes five forms to get a light bulb changed.

The NHS, Ms Legg added, "has never had all qualified staff. We have had nursing auxiliaries for years. But this provides individuals with the chance of a far more satisfying and flexible job. Some have already gone on to do their nurse training. Health care is changing, and we must respond".