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MPs call for mandatory HCA regulation


Healthcare assistants should be subject to compulsory regulation similar to nurses, an influential group of MPs has said.

The Commons’ health select committee said mandatory regulation of the 300,000 HCAs that work in the health service was the only way to “provide the best assurance to patients”.

In its latest report, the committee welcomed the government’s move to develop voluntary registration, a code of conduct and training standards for HCAs, which was announced in November.

But it said the training and development of HCAs must be kept under review, and the voluntary register should lead to mandatory regulation in time.

Unions have consistently called for mandatory HCA regulation. But the government has remained opposed to the idea as has the Council for Healthcare Regulatory Excellence, which oversees the Nursing and Midwifery Council and other health workforce regulators.

The report – Education, Training and Workforce Planning – said: “We note the government has announced arrangements for the voluntary registration of healthcare assistants.

“However, the requirements of this key element of the workforce for training and professional development must be kept under review. In the longer run, only independent professional regulation will provide the best assurance to patients.”

Overall, the report acknowledged the existing system for planning and training the future NHS workforce needed overhauling. But it warned that the government’s plans to do so were currently “unclear and lack crucial detail”.

MPs welcomed moves to create bodies, such as Health Education England and Local Education and Training Boards. But they said the government urgently needed to give more “clarity” about how they would function, prior to them taking over control of budgets in April 2013.

They questioned how Health Education England would be held to account and how it would work with the local boards. The report said: “It is unsatisfactory that so much about the boards still remains vague and indeterminate.”

It also called for more “precision” on how postgraduate deaneries will operate in the new system.

Committee chair Stephen Dorrell said: “The government urgently needs to provide more clear and detailed information about how these bodies will operate and work together in the new system.

“We are concerned about this apparent lack of urgency and we believe that failure to address these issues quickly will lead to risk for patients and confusion for staff.”

In addition, the government “must act to safeguard” the NHS £5bn training budget against “raiding” by strategic health authorities, the committee said.

It noted that this had occurred in the past and SHAs might be tempted to do so again due to increasing financial pressures.

Royal College of Nursing chief executive and general secretary Peter Carter, said: “The report makes clear that voluntary regulation for healthcare assistants will not be enough in the long run and urges the government to keep it under review.

“The RCN has long been calling for mandatory regulation for healthcare assistants as we believe it is vital to patient safety and reducing the current variability in the training they receive.”

He added the RCN had “serious concerns” medical education would dominate the role of Health Education England, adding: “The fear is that in a few years we will be facing a real shortage of nurses.”

Dean Royles, director of the NHS Employers, which represents trusts, repeated his opposition to the mandatory regulation of HCAs, arguing that it would not drive up standards by itself.

He said: “We should work on areas that we know will give big patient improvements like recruitment, culture, leadership, standards and training before we embark on mandatory regulation.”

Responding to the report, public health minister Anne Milton said: “This report welcomes our plans to change the current education and training system to make it clearer, fairer and with a greater focus on quality.

“We are now moving ahead to reform the education and training system…and we will be setting out details of their remit and how they will operate. We know that this detail will make sure that our plans deliver the change we want to see.”


Readers' comments (32)

  • HCA's are assistants who work under the direction and supervision of Professional health care providers.

    What is the imposition of another expensive regulatory "Quango" meant to achieve ?

    I have no problem with the concept of identifying minimal training objectives for HCA's and Health Care Organisations could be held accountable by the CQC for ensuring any such training was indeed being provided.

    Normal employer lead disciplinary processes should be more than adequate to ensure patient safety in the event of a rogue HCA being identified!

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  • Sorry JRT but I don’t agree. Currently there is no benchmark for HCA’s training. Someone in one Trust may have an excellent program of training while another may only have the basics or less.

    There is no need for another “Quango”. They could be covered by existing bodies like the NMC or HPC.

    As for “rogue HCA’s”, there is nothing stopping a person who has been sacked getting another job as there is no regulatory body to take them off the register.

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  • Stuart McLauchlan | 23-May-2012 2:40 pm

    if they have been sacked they won't get references and if it is for reasons of safety to patients it will be on their records

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  • Toby Ornottoby

    About time too. Since HCAs have now become de facto SENs they must be regulated as such and be professionally accountable. It is not the job of RNs to monitor HCAs professional standards in the same way that it is not the job of local managers to regulate the professional standards of Registered Nurses.

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  • The dangers of this proposal have not been fuly understood---once you regulate/register health care asisstants they will be able to be used by employers as cheaper nurses eg its like the return of the enrolled nurse via the back door

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  • of course HCAs should be regulated, what argument could there possibly be against it. Gone are the days when staff could use the excuse 'I am not responsible, you are the trained nurse'.

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  • Toby Ornottoby

    edouard dunnachie | 23-May-2012 3:20 pm

    "---once you regulate/register health care asisstants they will be able to be used by employers as cheaper nurses eg its like the return of the enrolled nurse via the back door"

    I fully agree... but it's too late to complain now because it has already happened. The reality is that trained HCAs are the new SENs. As such they have to be regulated just as the old enrolled nurses were. It is NOT the RNs job to be held accountable for the professional standards of the HCAs.

    Present day managers are already using HCAs as "cheap" Registered Nurses just as their predecessors did with SENs back in the 60's 70's and 80's.

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  • Well it will be a good excuse for the NMC to get even more money into it's coffers.
    With thousands of HCAs being regulated by them, will they need to charge them the same as RNs to pay for all the ftp etc hearings?.

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  • Toby Ornottoby

    I did say "Since HCAs have now become de facto SENs they must be regulated as such and be professionally accountable."

    I didn't say that the "regulatory body" necessarily needed to be the NMC. I wouldn't wish that shower of money-grubbing incompetents on any section of the nursing community - let alone my worst enemy.

    At least allow the HCAs the 'chance' to have their affairs managed by a professional body that might actually give a "bowel movement" about their well being!

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  • As a " not so old EN ( level 2 RN ) " I hope at 45, training in 1986, I have to say that HCA's are most definitely NOT the EN or SEN as previously commented !

    The difference is, we were/ are a REGISTERED NURSE. We undertook 2 years of Nurse Training,as a Pupil Nurse, which was Hospital based training, alongside the level 1 students because that was the nurse training at the time. We sat exams and practical assessments throughout training, sat our hospital finals and then state finals. On passing Registered at the UKCC now NMC on part 2 of the Register.
    The Registration of course means we are regulated AND accountable . I understand that HCA staff undertake many of the duties that the true EN role encompassed but please understand we were/ still are a REGISTERED NURSE.

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