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Healthcare assistant regulation plans 'too weak'

Plans for a voluntary system of registration for health care assistants have been attacked as being too weak to significantly improve patient safety.

A government plan, drawn up in response to growing national concern over safety standards, would see HCAs who have completed basic care training being allowed to opt-in to a voluntary register.

But it is not yet known where the register would sit, and there are no plans yet to monitor standards or a fitness-to-practise system.

The proposals would see a code of conduct introduced, with training standards roughly equivalent to an NVQ level two introduced for entry-level staff.

Nursing Times understands ministers have rejected calls to introduce statutory regulation of HCAs because regulation costs would fall on the often low-paid assistants and it would be difficult to determine who should regulate them.

The news comes in the wake of a string of care scandals uncovered by bodies including the Care Quality Commission and as research shows HCAs increasingly taking over from nurses in supplying many care tasks.

A Department of Health source said ministers were “concerned” about HCA standards and had asked for “urgent action to be taken”.

However, Royal College of Nursing head of policy Howard Catton said their plan “absolutely doesn’t go far enough”.

He told Nursing Times: “What we have seen over recent weeks is a growing and powerful consensus for some kind of regulation for HCAs. The government and the Council for Healthcare Regulatory Excellence are the only two bodies saying they don’t want to move to a statutory approach.

“This plan absolutely doesn’t go far enough and is too weak. A voluntary approach is too weak and won’t maximise patient safety.”

An Oxford University study last year found individual HCAs did twice as much direct care as nurses.

Co-author Ian Kessler said: “Codes of conduct and recommended core training are all very well but without any meaningful form of enforcement, trust and individual compliance becomes problematic, as does tracking individuals who might have left a trust under a cloud and popped up elsewhere.

“How will any of this be enforced?”

Professor Kessler’s research showed nurses were concerned about them being accountable for the HCAs they delegated tasks to.

James Buchan, of the School of Health Sciences at Queen Margaret University, Edinburgh, said: “The question of who would pay for regulating a large and sector transient workforce was always going to be in the mind of government, particularly at this time of cost-containment. Regulation of HCAs would have contributed to patient safety but was going to be a complex challenge, even at the best of times.”

Gail Adams, Unison’s head of nursing, said: “We continue to support statutory registration, as we have done for more than 10 years.

“But I am confident that this work is a step on the road, anything that increases the standardisation across the sector is going in the right direction.”

She predicted the inquiry into care standards at Mid Staffordshire Foundation Trust would “something absolutely definitive on this issue”.

At the moment there is no standardised qualification or registration for HCAs working in the NHS.

The government said it anticipated the work would be completed by September 2012 with the new standards available from 2013.

The DH has approached Skills for Care and Skills for Health, which represent employers on training issues, to draw up the code of conduct and training standards.

Skills for Health’s director of standards and qualifications Anne Eaton said discussions were at an early stage but the entry-level standard would likely include health and safety and communication skills, with higher standards for band-three HCAs whose work involved blood pressure measurement, basic dressings and helping with the administration of medication.

Readers' comments (86)

  • michael stone

    I may be missing something here.

    My 'instinct' is that originally HCAs were not really supposed to be involved in any patient care which might be dangerous, and were supposed to be supervised by nurses. So, extensive regulation of HCAs would have seemed unnecessary.

    But now that nurses are 'moving upwards and onwards', it seems to me that HCAs are getting involved in more areas of patient care, so they seem to be slowly moving towards the role once filled by the most junior nurses (was that SENs ?).

    Circles, comes to mind, here !

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  • SEN's had completed a 2 year training and came under statutory regulation so no comparison there with HCA's. When SEN's were around, there were also nursing auxiliaries on the wards. The comment nurses 'moving upwards and onwards' is misleading. The reason HCA's are getting more involved is that there are more of them employed instead of trained staff. Cheaper option. If HCA's are to be allowed to provide care for patients, and a lot of it is delivered unsupervised due to staffing levels, then they must be regulated and responsible for their actions.

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  • michael stone

    Anonymous | 14-Nov-2011 2:04 pm

    'If HCA's are to be allowed to provide care for patients, and a lot of it is delivered unsupervised due to staffing levels, then they must be regulated and responsible for their actions.'

    I do of course agree with that, but are not HCAs currently supposed to be under the supervision of nurses ?

    I do, of course, take your 'they are cheaper' point - it all seems a bit 'muddled', to me.

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  • Yes, HCA's are supposed to be under the supervision of nurses but in practice it is very difficult to achieve. One or two trained nurses per shift, full ward of maybe 30 patients, how on earth can there be adequate supervision. Some HCA's are excellent, highlighting problems to the nurse in charge, some, sadly are not. In an ideal world the supervision would be in place, in reality due to managment replacing qualified staff with unqualified staff due to cost it is not. Nurses have no control over this situation and unfortunately are left to 'carry the can' if things go wrong.

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  • It is important that we retain the focus on employment practices. Employment checks have an essential role in providing assurance to employers, staff, patients and the public of the competence of the workforce but it is arguably organisational and clinical leadership that will drive improvements in the quality of care.

    NHS Employers work on staff engagement shows clear links between high levels of staff engagement and organisational effectiveness. The best employers use the employment check processes and underpin these with a way of working.

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  • why dont we forget it all ?and let trained nurses do the lot? that means no csw's no hca's then nurses can wash people, toilet them, feed them, give tablets and injections, take b p's , bm's, check skin areas document, food drinks about patient
    and so on and so on yes you can do it all
    why was we created??????

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  • Anonymous | 14-Nov-2011 9:14 pm

    Why you were created? Is that a religious question, or are you being churlish and petulant?

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  • anonymous I 14-nov-2011 9:58pm


    dont talk silly! when anything new like skills come on the ward us hca's get asigned to them because trained are to bizzy for supervison or do the job.
    the word created is to make more? ie work
    ?????? so you have insulted yourself

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  • Michael, you are partly right.

    HCA's are there to do the basic care and monitoring, reporting to and supervised by Nurses. But HCA's are constantly being asked to work outside their remit (often in my opinion very, very wrongly) because it is cheaper to make up staff numbers with HCAs than qualified staff, and there are often not enough qualified staff to supervise the rest of the staff fully. Nurses are not moving 'onward and upward' in the sense that we are being removed from our patients, it often just seems that way because there are not enough of us around.

    HCAs NEED to be regulated because of this position we have been put in. But it needs to be all or nothing. Half hearted measures do not work.

    Anonymous | 14-Nov-2011 9:14 pm actually that is what the Australians do, they also employ more than enough Staff Nurses to do just that; so gladly. So lets do what you suggest then eh? Do yourself out of a job, from the sound of your post you wouldn't be a great loss, but hire as many Nurses as is needed to cover a Nurse/patient ratio of 1:4. Remember, we can do your job, many of us used to, but you cannot do ours.

    Dawn. New skills coming onto the ward are automatically assigned to HCA's? Hmm, I think you may be getting a bit confused. Oh, and the word is 'busy'.

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  • Mike

    "Hmm, I think you may be getting a bit confused. Oh, and the word is 'busy'."

    Really?

    Is that what we've come down to? making fun of people's grammar or ability to spell?

    In that case Mike, the word is "nurse" not "Nurse" it is a noun or a verb

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  • mike
    "I will remember that Quote, basic care and be monitored next time no more! no less and if anybody asks i will refer them to you? while your at it check the spelling
    ha! ha!

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  • dawn neale | 15-Nov-2011 9:35 am

    I guess you don't do irony!

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  • dawn neale | 15-Nov-2011 9:35 am

    "dont talk silly!"

    Are you serious? Have you read the absolute codswollop that you churned out?

    Anonymous | 15-Nov-2011 6:18 pm

    Tell you what. Why don't you get a job that doesn't involve working with people? You're not cut out for it.

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  • Geeze, actually Nurse is a title, a prefix added to a name to signify academic and/or professional status and is used as a proper noun, not a common noun, so the correct spelling is Nurse. I do not mind in the slightest the odd typo (I make my own fair share) or mistakes made in haste, but if the poster wants to spout such rubbish as "when anything new like skills come on the ward us hca's get asigned to them because trained are to bizzy for supervison or do the job", thereby comparing their own status as a HCA to that of a Nurse, then I think pointing out their inability to form a grammatical sentence is just, regardless of how sharp or sarcastic the barb may be.

    The current batch of posts by HCAs just shows that full regulation by their own specific body is needed more than ever.

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  • The HCAs I work with are bloody brilliant, and they too support robust regulation of their role. They know that they cannot be used to fill the role of qualified Nurses, and they don't try. We work together and the qualified staff do EVERYTHING that they do. They are there to support the nursing care of our patients, not to replace us.

    You are right Mike. Half-hearted measures will not be enough.

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  • Mike

    It's only a proper noun when the person's name comes after it- the same as doctor

    And I think you'll find that the HCAs on here weren't saying they have the same status as registered nurses, they were merely pointing out that if they stopped doing everything they do now such as obs, hygiene, feeding etc the registered nurses would not be able to cope, they certainly wouldn't have time to fit it themselves.

    If you work on a ward, you are dependent on your HCA colleagues Mike, I think a little more respect and support wouldn't go amiss

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  • michael stone

    mike, your:

    'But HCA's are constantly being asked to work outside their remit'

    Isn't that the point - are not HCAs ACTUALLY being asked to perform 'nursing tasks' ? Isn't that WHY this 'regulation issue' has cropped up ?

    I don't CARE if HCAs carry out 'nursing tasks', provided they have been suitably trained and assessed (which need not involve a national-level register, but which does require something 'formal and enforced'). So long as HCAs are competent, I'm quite happy - but HCAs should not be performing, or being asked to perform, tasks they have not been adequately trained for.

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  • Unfortunately, judging by the attitude of some health care assistants comments here, it is plain why proper regulation is required. I have seen some appalling, lazy HCAs who tried to get out of doing any work, preferring to do a slapdash job to be able to sneak off outside, or into the kitchen for some tea. I have also seen meticulous, caring, dedicated HCAs who worked very hard to make sure patients were comfortable. Everyone who is supposed to work directly with patients to care for their wellbeing whilst in hospital should be regulated and be held accountable for their own actions. I loved one ward I was on placement at but ruled it out as somewhere to work as I didn't want to be responsible for many of the care assistants on the ward as I felt they had an appalling attitude towards patient care and didn't want to be held accountable for their (non) actions.

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  • I'm not sure what to make of all this, having worked as an HCA for the last 15 years !!!! I have worked in hospitals and Dr's surgeries,many time's when arriving on a ward to find 2 trained Nurses on duty who sat and watched me work while they both drank tea !!!!! and i was left to do most of the work !!!! " some "Trained nurse's seem to think we are just "skivvys"
    AND that happened many times.....Most of us "HCA's" take a pride in our work , and it's a shame that we are all branded the same.... Regards From one hard working caring HCA !!!!!

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  • Anonymous | 16-Nov-2011 5:40 pm

    All you have done is reinforced the view that some HCAs just have a big chip on their shoulder!!!!!!...regards from a hard-working RN!!!!!

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