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Voluntary regulation of HCAs 'inherently weak'

The voluntary regulation of healthcare assistants is an “inherently weak” idea that would leave patients at risk, the Royal College of Nursing has warned.

Training standards and a new code of conduct for HCAs are currently being finalised by Skills for Health and will be presented to the Department of Health in January.

Skills for Health was commissioned by the government to produce the standards and it is expected they will form the basis of a future voluntary system of regulation.

But in a policy document critiquing the proposals, the college describes the government’s favoured approach of “assured voluntary regulation” as “inherently weak”.

It argues that only a mandatory register can protect patients and assure nurses that HCAs have a core level of competence.

The document claims a voluntary system would do nothing to prevent “poorly performing or dangerous support workers” from moving between employers and risks creating confusion among employers and HCAs themselves.

It questions why voluntary regulation is considered acceptable when many HCAs carry out tasks that were previously carried out by registered nurses.

The college has been a long standing supporter of the need for mandatory HCA regulation but until now has not openly criticised voluntary regulation itself.  

RCN chief executive and general secretary Peter Carter said: “With voluntary regulation, there is a serious danger that those healthcare support workers who represent the most significant risk may be the least likely to be on a register, and may then be able to move between employers without sanction or any monitoring.

“A consistent, mandatory system of regulation is the only way to ensure that concerns about performance and conduct are tackled.”

However, health minister Earl Howe recently suggested the government had not completely rejected mandatory regulation.

He told the House of Lords the government’s “mind was open” on the issue, though he said there would need to be a “good, evidence-based case before proceeding with mandatory regulation”.

The government is also waiting for the outcome of the Francis report into Mid Staffordshire Foundation Trust, which is expected to include recommendation on the issue early next year. 

Readers' comments (15)

  • Registration itself will not reduce risk to patients. We have seen over and over again cases of incompetent "registered" professionals causing harm to patients -
    What is needed in appropriate training,assessment, supervision and expectations of HCA's Too often these staff are left without this.
    If they were to registered who would pay as they would be most definitely a cost for this?

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  • Having worked as a HCA for over 20 years, I would welcome the registeration of HCA's. As I feel it would have a positive impact on the quality and care provided and expected ,in our hospitals throughout the country.

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  • Florence

    I would welcome mandatory regulation for HCA'S. The role has altered dramatically in recent years. Regulation will provide protection for Patients, RGN'S and HCA'S themselves. It will also ensure a firmer framework for training and education will need to be in place to ensure that HCA'S are equipped for the roles they are carrying out now.
    Without the support of the HCA'S in our department our RGN'S would find our role much more challenging.

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  • Isn't there an issue regarding the tasks HCAs perform - do these not vary widely according to the enviroment the HCA is working in, and wouldn't a register of skills be either so 'limited in scope' as to be pretty pointless, or else so extensive that too much training would be required ?

    However, perhaps some sort of 'modular' certification - grouping related tasks into modules - might be possible, where the individual modules were nationally standardised, and where competence in a particular module could therefore lead to confidence on the part of both HCAs and supervising staff ? More modules could be 'passed' as experience was gained.

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  • another way of not paying for something

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  • Voluntary regulation is as much use as a chocolate teapot. There again the NMC is too but at these times of financial pressures it is unlikely that voluntary measures will be enough.

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  • for registration to be effective obviously relevant criteria would have to be met and assessed regularly to ensure skills are kept up to date and registrants are able to demonstrate and give proof of safe practice at all times in order to maintain their registration.

    In the interests of safety and quality of any care delivered to patients registration after a period of relevant training should be obligatory. this would obviously result in higher costs to the NHS as a more highly trained and qualified staff can and must demand a higher salary on line with their skills and experience. However, a greater investment would probably be a sound and more cost effective one than continuing to muddle along under the current highly inconsistent and often unsatisfactory system.

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  • Well voluntary or mandatory, HCAs will need some form of regulation, ready for when all the Registered Nurses have gone or been made redundant.

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  • a couple years back, I had a chat with the NMC in one of their seminars; the gist of it was that they'd love to have HCAs registered, due to the extra income they'd get, however didn't want the administration of having to process the numbers of staff out there - and there are loads of HCAs in the country.
    Once there's a register, there will then have to be agreed standards to what skills and competencies each grade must have and maintain. This can be very difficult as different areas would require different skill sets. I also got the feeling what some organisations want are mindless drones doing anything and everything, with as little training and investment as they can get away with, not only with HCAs but for nurses too.

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  • sorry, that's someone in the NMC (not the whole of the NMC) ;)

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  • Tiger Girl

    andy | 20-Dec-2012 11:13 pm

    You seem a little cynical - and you are the second person to have pointed out that there would be problem with the skill set, because different HCAs do different things.

    There should be recognised career progression for HCAs, and that probably involves recognised attainments that are transferable - but registration/regulation is a bit different from recognition of a growing, or indeed basic level, skillset, isn't it ?

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  • Tiger Girl | 21-Dec-2012 2:00 pm

    I agree that registration is different from skill sets, and there should be career progression and recognition of their skills.
    HCA should have mandatory regulation, with a statutory and mandatory skills and training, then continuation training, updates and career options/pathways.
    It should ensure patients and staff are protected through accountability, responsibility and competency in one's own role.
    Regulation (of any staff) is no guarantee that people won't be at risk, but should help reduce risks.

    Skills and knowledge attained are very much transferable from one area into another. There maybe particular skills + knowledge that would be useful for HCAs who would like to develop. Some HCAs can also take bloods and canulate much better than some doctors and nurses. Others are very knowledgeable with wounds and dressings. HCAs are valuable members of the team looking after patients, and like everyone requires support and development.

    However, if there isn't enough staff (or resources) to look after patients, or if staff aren't working with the right attitude, then inherently there will be risks that can be avoided.

    Voluntary regulation doesnt appear to be working too well in the finance, media or political arenas.

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  • michael stone

    andy | 21-Dec-2012 5:10 pm

    'However, if there isn't enough staff (or resources) to look after patients, or if staff aren't working with the right attitude, then inherently there will be risks that can be avoided.'

    Indeed - but I still wonder whether 'national registration' is the answer to the HCA issue: I think a national registration scheme would set the attainment level so low, as to be fairly pointless - I think a universal requirement to assess the skills of HCAs using known measures, and a committment to allowing HCAs to develop increasing skill sets would work better.

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  • I think we have been here before, although perhaps no one studies nursing history now.
    In the fifties they recognised a need for more practical trained nurses and started the Enrolled Nurse training. Initially those with sufficient experience were awarded the qualification, e.g. I had an aunt who worked as a nurse in the war and was given this qualification on that basis. Otherwise it was two years training. Later people decided there should not be two levels of nurses and it was abandoned.
    They say what goes around comes around. But with qualified nurses taking over more and more of what was once only a doctor's prerogative, something needs to fill the gap that they leave.

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  • michael stone

    Anonymous | 26-Dec-2012 10:14 am

    'But with qualified nurses taking over more and more of what was once only a doctor's prerogative, something needs to fill the gap that they leave.'

    That has been discussed on this site before. Nurses do now do things which once doctors would have done, and it seems to me that HCAs were intended to fill some fo the less-skilled tasks 'left vacant' by nurses now performing new tasks - but it seems (HCAs taking blood, etc) that this is a bit like a conveyor belt, with nurses and also HCAs gradually starting to perform 'more complex' tasks.

    So, HCAs cannot, it appears, be thought of as not requiring a level of expertise, and that required level is apparently increasing over time ?

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