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