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Investigation: Many HCAs start work on wards without training


A quarter of trusts allow healthcare assistants to start work on the wards without undergoing any training for the job, an investigation has found.

Senior nursing figures described the finding as “shocking” and “worrying”, coming a year after the Francis report highlighted the impact of poorly trained, unregistered nursing staff on patient care.

All hospital trusts were asked how many hours training their HCAs had done before their first shift. Of the 104 that responded, 26 said HCAs were not required to have any formal training before starting.

Of these, 12 did not expect HCAs to have any formal training beyond being mentored on the ward or being given supernumerary status – usually for about two weeks.

Five said their HCAs always had an induction, but received no specific training in their support role. Three trusts stressed they encouraged ward managers to organise training for new HCAs as soon as possible.

One acute trust nursing director said even if new recruits had previous care experience, managers could not be sure of the quality of any training. She said: “Trust induction is usually just a box ticking exercise that all staff go through. To just employ somebody off the street without any training is truly shocking.”

Royal College of Nursing head of policy Howard Catton said it was “worrying and surprising” that some trusts were still not ensuring HCAs received training before starting on wards, given the focus on the issue over the past year.

Howard Catton

He said evidence on the quality of preceptorship for newly qualified nurses suggested other staff had too little time to properly supervise them, which raised questions about whether mentoring and supernumerary status were appropriate for HCAs.

There were also marked variations between trusts where HCAs were expected to attend some formal training, the investigation by Nursing Times’ sister title HSJ found.

Time ranged from one hour and an induction at Mid Yorkshire Hospitals Trust – although its HCAs work alongside a mentor – to three weeks at Southport and Ormskirk Hospital Trust, North Tees and Hartlepool Foundation Trust, Northampton General Hospital Trust and Great Ormond Street Hospital for Children Foundation Trust.

Last February Robert Francis QC called for the full regulation of HCAs. The government has consistently rejected the idea and instead commissioned Sunday Times journalist Camilla Cavendish to review HCA training and supervision.

Her report, published in July, uncovered a lack of “compulsory and consistent” training and recommended the introduction of a national certificate of fundamental care that all staff should complete before working unsupervised.

The idea was backed by ministers and Health Education England has been asked to lead its development.



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Readers' comments (21)

  • Yet more damning evidence of the willingness of "directors of nursing" and nurse "mangers" in general to deliberately expose patients to significant risk.

    These people need removing from the register.

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  • Absolutely. There are many fantastic, caring and conscientious HCA's out there who slog their guts out on a daily basis for a modest salary. This isn't a dig at them, but like Jenny has rightly identified, many HCAs are being asked to perform tasks for which they've not had any training whatsoever. It's not the HCAs fault, it's Trust management who must be held accountable if things go wrong.

    Trust must make sure that HCAs are appropriately trained before they're allowed anywhere near patients.

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  • This is what needs sorting out before revamped revalidation proposals for qualified nurses.

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  • Anonymous | 6-Feb-2014 12:26 pm

    Completely agree. Revalidation for nurses is more about the shortcomings of the NMC than its registrants

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  • michael stone

    Although I'm not convinced about HCA 'registration', there definitely should be a system of compulsory 'induction training' in place.

    Mentoring/shadowing/helping and then some sort of assessment of basic competence, as a minimum.

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  • I am a HCA and I had no formal training before I started this job and had no care experience at all!
    On my first day I was shown the basics by one of my fellow HCA's, I shadowed her for two weeks and that was as far as my training went.
    I strongly agree there should be a system in place or a course that new healthcare assistants could attend, after all peoples life's and private information are at risk!

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  • Possibly more shocking that this is news now, this has been going on for years. Sadly when Enrolled Nurses were phased out, formally trained carers (without management responsibility) effectively disappeared. Whilst NVQs were meant to provide HCAs the training they needed few staff in the clinical environment have the time to train people from scratch. Most training is now on the cheap with little face to face training, e.g. for annual updates. You get what you pay for, and for some it is just a job, so the chances of people doing extra to learn in their own time.

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  • Project 2000 is directly to blame for the situation we now find ourselves in: the creation of 'one level of nurse' [sic] (we now have now have four levels instead of two) meant that those who did the majority of the 'basic nursing care' were spirited away into classroom (in the case of students) or into blue dresses and a huge void was created which had to be filled. The HCA was born.

    Unlike Auxiliaries (who had to spend time in the classroom learning the basics), HCAs were often recruited from domestic staff and were put to work immediately on the wards and had to learn as they went.

    Thinking of the skill mix now compared to that of 20 years ago when it was at least 80% qualified to 20% unqualified, who then would've believed that 'progress' would make the converse true?

    HCAs do vital work, but I think even they would recognise that they need even a couple of weeks learning how to wash, dress and change a bed together with other aspects of nursing craft before they're let loose on the public. The NHS would be so much the better for it!

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  • This is just another example of exploitation of HCA's. The NHS and Government expect the service to run on untrained personnel on the cheap. Physicians Assistance (Dr's on the cheap just because they can't do certain things), HCA's (untrained nurses), Phlebotamists (task orientated blood takers, who can only do simple tasks and vital blood tests go untaken if bleeding a patient is beyond their remit), Nurse night practitioners (cheap and minimally trained Dr replacements). More nursing posts are being replaced by HCA's and then we treat them like this. More pressure put on ward staff to train them as well. I agree that if you are going to call them 'trained HCA's' why not bring back a SEN type qualification? It worked before. Then they would also perhaps have a more protracted pathway to registration if they so wished. Sadly it is all about money not quality or workforce recognition or appreciation.

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  • The reason we cannot bring back the EN is because it devalues Nursing as a whole. Their limitations are frank and obvious and it steals away the fact that we are a professional class, not merely trained units. Already nursing education is at least a year too short, woefully redundant in regards to teaching the science of the human body and saddled with culturally redundant baggage from five decades ago.
    yes. Nursing (NOT healthcare) assistants ought to have valid hospital based training, but they are OUR assistants. If yours are poorly trained, you cannot blame anybody but yourselves for utterly abandoning them.
    The reason why many don't do well is because the profession as a whole still uses redundant self descriptions such as 'caring' rather than recognising that we do a scientific job, and a scientific job only. Thusly our NA's ought to be lectured in the same fashion. Nursing is a science. It is not a caring vocation. Nor was it ever one. And simply insisting that despite the evidence that it is betrays new graduates into accepting outdated social mores as fact.
    to care is a human trait. Care or don't care, the outcome on your patients is zero if you actually do what you are obliged to do properly and with skill and intellect.

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