Healthcare assistants are a vital part of the team and they must have clear roles, says Stephen Dorrell
Healthcare assistants are the undervalued part of the healthcare workforce. They are often young, receive low pay and little training, but are expected to deal on a routine basis with major crises in their patients’ lives.
Furthermore, despite the challenging nature of their work, they are expected to deliver care that is judged against similar professional standards to those that apply to all the caring professions.
Not surprisingly these expectations are not always met.
We would all like our families to receive caring and sympathetic support and our objective should be to ensure that HCAs deliver a standard of care that meets those expectations, and is accountable through a proper professional structure.
That uncontroversial thought often leads people to call for the immediate introduction of a regulatory structure for HCAs.
There are several reasons why I do not believe this is the right approach.
“The immediate priority should be to ensure there is greater clarity around the roles that can be fulfilled by HCAs and the training needed to fulfil them effectively”
First, at a time when the medical profession is only now, finally, biting the bullet of revalidation, and it is widely recognised that the Nursing and Midwifery Council also needs to raise its game, the priority should be to make existing professional regulatory structures, including revalidation and re-registration, work more effectively. Otherwise there is a danger that widening the scope of regulation to include HCAs would be a political response - a distraction that makes observers feel better but leaves the underlying issues untouched.
Second, the argument that there needs to be a regulatory structure for HCAs implies they currently provide unregulated care. That is misleading both because all employers of HCAs are themselves regulated by the Care Quality Commission, and because HCAs work as part of a clinical team, and the nurses and doctors working with them have a professional obligation to “raise concerns” if they believe care does not meet proper professional standards.
Third, and most importantly, the call for a regulatory regime for HCAs puts the cart before the horse. The purpose of regulation in healthcare is to ensure nurses and doctors apply both proven standards of technical competence and clear ethical standards. These standards are codified and the individual is required to undergo initial and in-service training and review to ensure they are understood and applied. The hard edge of professionalism is that the individual’s right to practise is withdrawn if these standards are not met.
All this requires certainty about what is expected. It is hard to see how withdrawal by a regulator of an HCA’s right to practise could comply with the normal principles of justice in the absence of these certainties.
The immediate priority should be to ensure there is greater clarity around the roles that can be fulfilled by HCAs and the training needed to fulfil them effectively.
This is part of a much wider issue, as the roles of individuals within the care team continue to change to reflect the changing needs of patients. Medical advance has enabled more patients to live longer but, increasingly, they need support to allow them to enjoy their longer lives. These changing needs have led to more emphasis on better qualified nurses, but also to a developing need for caring support.
That is the requirement being met by HCAs. They are a vital part of the team, and need to be recognised within the regulatory and training structure. But before we grant the power to deny an HCA the right to work to a regulator, we owe patients and HCAs an obligation to clarify just what role we expect them to fulfil and ensure they receive the training that allows them to do it. Otherwise we are writing headlines, not policy.
Stephen Dorrell is chair of the House of Commons health select committee