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Bill presents 'missed opportunity' to regulate HCAs


Hopes that healthcare assistants could be placed on a statutory register to improve patient safety have been dashed by the Health and Social Care Bill, Nursing Times has been told.

The bill has confirmed that the government wants HCAs to be regulated through voluntary registers, despite calls for a formal system similar to the Nursing and Midwifery Council’s register of qualified nurses.

The legislation allows the Council for Healthcare Regulatory Excellence, which oversees regulatory bodies such as the NMC and the Health Professions Council, to accredit voluntary registers that would be held by the regulators.

An impact assessment accompanying the bill says anyone on a voluntary register “will meet specified standards of training and competence”.

CHRE chief executive Harry Cayton said the bill signalled the end of attempts to create a statutory register for HCAs. He said: “It’s not going to happen because it’s expensive and probably not necessary in terms of protection of the public.”

But critics have said that a voluntary register could allow professionals who pose a real danger to patients to drop below the radar.

Unison head of nursing Gail Adams said the bill was a “missed opportunity”. She said: “The government’s intention is that there is no more statutory regulation. We continue to feel that HCAs do need regulation due to public protection issues.”

An NMC spokeswoman said: “We will continue to work with partner organisations to scope the various options that may be available to us around this important issue.

“In the meantime, a key priority for us is to revise our guidance on delegation of tasks by registered nurses or midwives.”

Meanwhile, a CHRE progress report, published last week on the NMC’s performance in its fitness to practise function, has found “significant improvements”, following previous heavy criticism of its poor handling and slowness in dealing with cases.

However, the CHRE is “still concerned about the seriousness of the amount and nature of the improvements that the NMC has to make”, which include “cultural changes” and better administration of hearings.

The NMC spokeswoman said: “We are confident that we will continue to make excellent progress in the coming year.”



Readers' comments (6)

  • It would be more expensive as regulation would probably mean ensuring every HCA has proper training for allocated tasks and would ensure they are not being asked to step outside their role. I am lucky enough to be working in a practice that makes me have accredited training for all my tasks and would have welcomed the move for the protection of my role, the nurses roles and the health authorites themselves when errors are made, unfortunately I think this debate will just run and run.

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  • I for one and pleased to see that there is no statutory regulation of HCA's.

    Supporters of this approach need to be extremely careful about what it is they are seeking.

    I was concerned to read that critics are already saying that in not having stautory regulation, that this, "could allow professionals who pose a real danger to patients to drop below the radar".

    As far as l am aware, all "professionals" involved with health care are covered by statutory regulations. Does this mean that critics, are now saying that HCA's are "professional".

    My understanding is that they are not required to undertake a statutory training, so therfore cannot be referred to as professional.

    This is not meant to impune the value or commitment to the role of HCA's or indeed others who contribute to the care and welfare of people who require healthcare such as porters and domestic staff.

    Gail Adams of Unison is quite right to raise the, "public protection issues", but as far as l am aware HCA's are not accountable in law for their actions or omissions. They are protected under the employers vicarious liability, or am l out of date?

    My real worry is that there is a clear indication that we are returning to a two teir system of nursing. I saw the abuse of the role of State Enrolled Nurses in the past, and can see the same thing happening now.

    Currently, the principle responsibility rests with the employer to ensure public safety, this is then delgated to the professionals to provide on a day to day basis. If this is not enough to give the protection needed, then we really are in trouble.

    Healthcare professionals will always need support from well trained and responsible staff, who for whatever reason have not undergone the statutory training that is required for the various professions. This should not require them to be come under the umberella of requiring stautory regulations.

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  • I would like to know more about this 'missed opportunity' to regulate HCA's. I dont actually agree with the current HCA role in hospitals at all. They are now, for want of formal accrediation doing most of the of SEN role and in my humble opinion they should be accredited to this role and thus regulated.
    It isn't the act of regulation in itself, its about recognised training and accrediation.
    For goodness sake, an HCA can be expected to do: ECGs, catheterise, venopuncture, canulate, carry out all observatrions including Neuro obs, replace dressings.. the list is endless. What are they then NOT doing that the SEN DID do?
    If you want qualified staff, then train and qualify them and then regulate them. If you dont want this, then dont bother to try and regulate as what is it that you are actually regulating? Oh yes.... that would be unqualified staff on crap wages!

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  • SEN were / are (if any are left) registered nurses, they gained a qualification that put them on the register in the same way as other nurses who had competed nurse training. Despite what tasks they may or may not do HCAs have not completed nurse training.

    In that respect the role of the HCA is open to greater abuse than the SEN.

    I agree with anonymous 1/2 11.22 in that I am not sure whether regulation is the right way forward.

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  • I agree with you. HCAs have NOT had formal nurse training. BUT they are expected to carry out a huge percentage of what the trained SEN did (or does in some cases). My issue is that if HCAs are to be regulated then they absolutely have to be FULLY trained, the costs are prohibitive in doing this. So we continue to abuse HCAs by expecting theme to undertake the very tasks that SENs took 2 years to qualify to do!

    But the assistant practitioners at Band 4 do a 2 year foundation degree and they are still not registered. So, why then
    does the Gov't not upgrade by further training the Ass. Pract. to SEN?

    HCAs do have a valuable role. But what about Safeguarding? If HCAs are poorly trained (and some get next to no trg at all) yet qualified nurses are still having them carry out the taks that should be effected by a qualified nurse, what does this then say about the qualified nurses allowing this to happen?

    So, poo-poo the registration for HCAs. But stand up for 'qualified' HCAs (perhaps as band 4's).

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  • I agree with the last posting re regulating Assistant Practitioners. I qualified as an AP three years ago following a two year FdSc course. I practice outside the scope of an HCA, am expected to do the same role (with the exception of the drug rounds) as an RGN, have to regularly prove competence in the skills I perform many of which the RGNs are not trained to carry out. I completely understand that we have not done the same training as the RGNs but the fact is that much of our work now is the same and I feel that we have been abandoned in a new role and are working in grey areas with little support.

    I understand that there are local policies and protocols which, so long as we follow them to the letter, ensure good consistent, knowledge based practice and would be used to our defence in a legal situation. However' the issue in our Trust and in other professional guidelines is that the references are either for HCAs or RGNs and APs fall somewhere between but are never mentioned.

    The crux is that we are expected by our job descriptions and supported by appropriate training to demonstrate increasingly higher levels of knowledge and proficiency but have a very dubious safety net beneath us.

    Is this fair to the RGNs we are working with, our patients and indeed ourselves? Surely regulation would protect and maintain the standards within our role, iron out much of the ambiguity and give APs a status.

    I'm sure this subject will rumble on until, if ever, it is resolved. I don't think we should have to fight for regulation it should be insisted on by the Health bosses. As for prohibitive costs, surely most HCAs hold at least an NVQ level 2 anyway and if regulation highlighted those places whose training opportunities were too inadequate to gain recognition for their staff it would force owners of those establishments to face the consequences of cutting corners. This would raise standards to levels that could be understood on a national basis. Instead we have a situation where an HCA could have walked straight off the street with no experience or have recieved a sound knowledge based training and years of work in care under his/her belt. How would a patient/ client know?

    For the cost of administration there could be a transitional register for those undertaking agreed training programmes and a permanent register for those holding a national qualification with compulsory updating of skills. HCAs should be required to have a minimum of NVQ2 and APs should have an FdSc. I also think that a "passport" linked to this would indicate level of knowledge and skills at any one time and could be used as evidence of competence. ODPs are regulated by the HPC -why not APs at least?

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