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HCA regulation cannot be based on pay band alone


For the past 15 years we have talked about the regulation of healthcare assistants and other staff groups. Over that time, we have had a change of government, we’ve introduced devolution, implemented Agenda for Change - but we still have not delivered for HCAs.

Many people and organisations have now taken up the call for regulation. Most recently, we welcomed proposals in the Prime Minster’s Commission on the Future of Nursing and Midwifery for HCAs and support workers to be regulated.

But, at UNISON, we are actively talking to HCAs and asking them what they want. We know that our HCA members feel strongly about regulation both in terms of pubic protection and also in relation to the standards they work to.

‘It is not for nurses to determine what the regulatory structure for healthcare assistants should be, in the same way that doctors should not determine what nurses do’

Having been in nursing for all of my working life, I have seen at first hand how important HCAs have become to patients. Sadly, I have also witnessed some organisations simply expecting them to take on ever more demanding roles and responsibilities, but without being given the pay and training to reflect this.

HCAs are taking on ever more challenging roles to improve patient care and the patient experience. However, they face a postcode lottery. The good organisations get it right but, all too often HCAs have to beg for training and, at the first sign of financial difficulties, their training is the first to be hit.

The truth is that if regulation were an easy option, it would have been introduced some time ago - but it isn’t.
Because there are no national standards for HCAs, organisations have introduced their own. This has led to a lack of consistency and a situation where, if a HCA moves to another organisation, they are back at the bottom, and have to train again.

The RCN is now supporting UNISON’s call to regulate HCAs. However, it has suggested that this should start with the new assistant practitioner role at band 4.

UNISON believes that effective public protection must be at the heart of any new regulatory system. Such a system cannot be based on a member of staff’s pay band or job title alone - there are huge variations in the roles and responsibilities of HCAs.

Pay bands, too, vary significantly within and between organisations, with some assistant practitioners being paid at band 2.

If we add in the complexity of Skills for Health - with parts of the NHS discussing competencies based on knowledge levels not pay bands - the situation becomes more difficult. This promises to create even more confusion, because there are considerable variations in roles as well as in how much they pay.

UNISON has more than 100,000 HCA members, so we are well placed to find out directly from them how they see regulation working in the future.

It is not for nurses and midwives to determine what the regulatory structure for HCAs should be, in the same way that doctors should not determine what nurses and midwives do.

HCAs are more than willing and capable of developing their own set of recommendations. UNISON is working on a number of areas that we believe will help the process.

First, the new vetting and barring legislation will require staff to register with the independent safeguarding authority. Staff will need a Criminal Records Bureau check and ISA registration, which begs the question - how much public protection could be delivered by this process alone?

In looking at the wider role of healthcare support workers, might this level of protection be sufficient for some staff? Do we really want or should we expect HCAs to register with both the ISA and a professional regulator?

Second, UNISON is working with our HCA forum to develop a set of minimum national competencies that reflect the national pay structures in healthcare.

Our HCAs believe that the current situation is a mess. They are not clear what the parameters of their roles are - if any - and their nursing colleagues do not know either. The lack of clarity means that nurses and midwives are uncertain about what they are able to delegate.

HCAs in community settings work in greater isolation. We need to look not only at what HCAs and others do but also where they work. It is reasonable to say that those who work in the acute sector have quicker access to support if they need it than those who work in the community. Because of this, we need a regulatory framework that is risk based and proportionate.

UNISON is developing national minimum competencies that are designed to work across health and social care. These competencies will reflect national pay structures and become a benchmark against other systems in social care.

We will continue our work to shape a regulatory framework for HCAs and will be launching our consultation in the summer.

UNISON is the home of the nursing and midwifery family; we are in the best place to help to shape this future workforce. We are the voice of the healthcare team.

Gail Adams is head of nursing at UNISON


Readers' comments (5)

  • I dont think this is something for unison alone to decide, RCN also represents the interests of HCA's.

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  • I agree with the previous comment. Surely the employing trusts holds the responsibility for staff advancement in the absence of anyone else?

    I have recently qualified as a Nurse (adult) in a London foundation trust and can say my most rewarding and productive placements(both primary and secondary care) where wards that had high functioning HCA's . Some like A&E design workbooks and training that encourages and supports their HCA's development, while those that don't carry out the same thing often informally. Unfortunately I found that the wards which had no or little provision to help HCA's develop their skills, where the one's who's nursing team suffered high absenteeism and low moral because they were ALWAYS working at their limit. Quite scandalous that for all the other DoH initiative and campaigns, the needs of HCA's have been left to one side considering the difference they can and do make.

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  • without highly dedicated hard working HCA's the NHS would grind to a complete halt!!! and that is a FACT!

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  • I qualified as an Assistant practitioner in Jan 2009, before that I was a community HCA with 19 years under my belt.
    Why... is this discussion of regulating HCA & AP's being dragged on for to long, surely those that be, can foretell the state of the future NHS.
    Personally I would say the best approach is to recognise & appreciate that without the 2, 3 & 4 bands there would be no NHS. As for the clarity of the roles of HCA, I think this will continue to be the case, "because nobody really knows what they want them to do in the first place", abit like the new role of an Assistant practitioner, let's give them 2 years of training i.e. "let's through everything at them" & "oh" then we can think later, about what we can do with them, [clearly logically thought through]. Come on NHS let's get your act together, support, regulate & Nationally train up HCA & AP's to do what will be needed to sustain the future of the Health Service.
    I have always loved my job & still do, even after all the changes I have witnessed over the 21 years in-service, but like others, I to want clarityof my role, is that to much to ask.

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  • How can Qualify Nurse said that HCA's put patients life at risk. As qualify what do they do to help the HCA as for them they are not good. But let me tell you that HCA is more vigilance than the qualify as in most cases Qualify apart from doing medication and paper works and ward round and review do not do anything else. HCA are the only peoples who spend more times and attend to their needs all the time. I am very sad to hear qualify nurse to put HCA down..................

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