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Regulate HCAs now, warns review

  • 118 Comments

There is an urgent need to regulate assistant practitioners because they are being increasingly used as substitutes for registered nurses, a major review has warned.

The review, carried out by the National Nursing Research Unit for the Nursing and Midwifery Council, says there are strong patient safety grounds for regulating all healthcare assistants.

But the report authors said there was a particularly “urgent need” to regulate HCAs working in band 4 assistant practitioner roles as they are used as a “substitute” for nurses rather than as a supporting and supervised role, as originally intended.

“A decision needs to be made as to whether this [regulation] should be as a senior support worker or as a second level qualified nurse,” the report states, before further decisions about assistant regulation can be made.

There have been long standing arguments over which body or organisation should be responsible for HCA regulation. The review recommends that the task should be led by the NMC as a large percentage of the assistant workforce is allied to nursing.

NMC chief executive and registrar Dickon Weir-Hughes said the report “makes clear the risks associated with patient safety if healthcare support workers continue to remain unregulated”. The report says the lack of regulation poses a risk to the public and there is a strong case that safety would be improved by its introduction - although it is “not possible to demonstrate unequivocally”.

It says the lack of regulation means it is hard for employers to check if new HCAs have previously been dismissed for poor misconduct. There is also evidence of HCAs undertaking tasks they are not trained to do in anunsupervised setting.

The review rejects a voluntary,employer led model of assistantregulation - such as that piloted in Scotland - on public safety grounds.

However, Nursing Times understands a voluntary system could be a likely first step.

The Department of Health’s arm’s length bodies review, published last week, proposed to extend the remit of theCouncil for Healthcare Regulatory Excellence, which oversees the NMC. Its new role will allow it to set standardsfor and provide quality assurance of “voluntary registers” held by regulators and professional bodies.

CHRE chief executive Harry Cayton told Nursing Times a register would be “easier to create” for HCAs than full blown regulation and could be a first step towards a more formal system.

Responding to the NNRU review, Royal College of Nursing policy director Howard Catton said: “The report presents an overwhelming care for moving ahead with the regulation of HCAs on the grounds of patient safety, quality and professional practice.”

Unison assistant national officer Jennifer West welcomed the review but warned that how HCA regulation was funded remained a major issue. She said: “It must be remembered that they are on a lower pay band to other nursing professionals. This must be taken into account when setting regulation fees and making decisions about who should pay them.”

Professor Weir-Hughes told Nursing Times earlier this year that he was “single minded” about ensuring HCAs were regulated nationally.

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  • 118 Comments

Readers' comments (118)

  • wow it has come to light! so where would i stand i have extended clinical skills and my discription is a higher clinical support worker on band 3? yes i know i am a h c a with extended role but i know people do the same as me but are band 4 and get put with newly qualified for goodness sake who is the superviser in the mixed skills

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  • This has to be a contender for the no s**t sherlock award! (And there have been a lot of them lately!)

    Not only should HCA's be regulated and accountable in the same way a Staff Nurse is, but they should have their duties and roles limited as at the moment they are in no way trained, educated or qualified enough to perform a lot of the tasks they are being asked to do. This is wrong.

    If a Staff Nurse wants to perform at a higher level for example, then seperate qualifications in prescribing (amongst others for example) must be undertaken before they can do that, a HCA's NVQ does not compare to that level of qual, and even then we are still highly regulated, HCA's are not.

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  • If the NMC takes HCAs under their wing I will burn my registration card and leave the U.K. There should be no unqualified (RN) staff working in U.K. hospitals.

    And Mike the NMC can't even pull a finger out to regulate 'advanced' practice in qualified staff, so your way off the mark with the comment about 'highly regulated'.

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  • Definitely needs to be some sort of control of HCAs. Have just left a job where very good HCA who has been operating in a role that should be filled by a staff nurse. She is unauthorised to be in charge so cannot legally be left on her own but because she has been there so long and has learnt to do extended role functions she is unhappy to be left the more mundane tasks eg cleaning.Essentially this devalues the role of the staff nurse who is meant to be her supervisor . The problem is the HCA has gone as far as she possibly can but the staff nurse who could use this as a developmental position is undermined and no one stays in the job for long as a result.
    As a result of this experience I am against HCAs being given extended roles - they should have to go through full training as we did

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  • It is important to recognise the value of HCA's. Regulation may be one way forward. For those of us who have been around for a while - I can see this eventually emerging as the re-introduction of the State Enrolled Nurse (no doubt they would think of some other name, to avoid the embarrassment of having got rid of the title in the first place). SEN's were incredibly valuable part of the workforcee that should never have gone.

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  • Anonymous | 3-Aug-2010 10:47am:

    You seem to be a bit confused about what you want here. Okay, apart from the fact that the NMC are pretty useless and yes they have faffed about with technicalities, do you believe for one second that if a qualified staff Nurse with advanced practice quals messes up they would not be dragged in front of the NMC? Don't think so. That is why we are still highly regulated regardless of technicality. Second of all do you want HCA's to be registered or not? You say you would tear up your card if they were accountable and regulated, but then say they should not be working if they are unqualified, which is exactly what is happening now?

    Anonymous | 3-Aug-2010 11:15 am:

    I absolutely agree! Yes there are limited basic roles a HCA can perform, and they should be trained, qualified and regulated for these tasks. However, the term Health Care ASSISTANT is a bit of a clue, there will always be a need for the most basic of tasks (such as bedmaking, washes) to be performed by unqualified staff to assist the qualified staff. If they want to do the job of a qualified Nurse, they should become a qualified Nurse, if they are able, not everyone is.

    Anonymous | 3-Aug-2010 11:54 am:

    Here we go again, before anyone gets started here noone is having a go at HCA's or 'not recognising their valuable contribution'! For crying out loud. It is the same thing in every one of these discussions. HCA's do perform a vital function, of course they do, but at the end of the day they are not qualified staff and should not be performing tasks that they are not educated/trained in, qualified to do, or accountable for. It is as simple as that.

    The SEN is already here, albeit in a different guise of band 4's. However their training and qualification is still not up to standard for the tasks they are being asked to perform, and they are still not accountable for their actions. Both of these are wrong and need to be rectified.

    IF these things are done, then I believe this will be a good thing for a HCA to expand and grow in their profession, either leaving it at that or using it to see if they want/are capable of becoming a qualified Nurse, in which case (providing they have the necessary academic and skill requirements to do the course) they can go on to do their training.

    But that still does not mean that a HCA should not be accountable in the same way a staff Nurse is for their actions.

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  • This article seems to have caused some inflamatory responces.There seems to be a lot of confusion about regulation, registation and qualified. As I understand it the drive is towards regulation of HCA's not registation, so don't go tearing up your registation cards yet. In any case this debate has been going on for years without any sign of an outcome.

    As a trainee AP I support regulation. There is so much confusion about the role. We are qualified for the skills we perform, we are assessed by national standards, supervised and work in line with protocols. Any HCA performing tasks and skills that they have not been trained to do and competent to perform should be aware that they are also accountable as much as any nurse that delegates these tasks.


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  • yes i do think there is some need for some kind of regulations ! There has to be reprocussions of actions!

    At my place of work they have taken on a lady as a HCA who has NO qualifications at all ! no NVQ's or anything ?????

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  • Anonymous | 3-Aug-2010 3:23 pm, there have been a number of threads on the same topic so they all tend to get spillover arguments I think.

    I have to disagree with you about HCA's being accountable though, they are simply NOT as accountable as a staff Nurse is. If a Nurse delegates a task to a HCA, it is the staff Nurse, not the HCA who will be held to account and face disciplinary action by the NMC.

    And I am sorry band 4 HCA's are simply NOT educated and qualified to the level they SHOULD be, to perform clinical tasks such as take an ECG for example. A band 5 staff Nurse IS, and I know many who still struggle with the reading of an ECG, how can a band 3 or 4 with less education and training be expected to manage? I think most of those clinical tasks should be solely the realm of band 5 and above.


    Anonymous | 3-Aug-2010 4:51 pm, that is what a HCA should be. You do not need qualifications to be a HCA, that is why they perform the basic tasks such as washes, bedmaking, teas, etc. Those who go on to get qualifications or have them beforehand perform at a higher level, band 4 and above.

    I would like to reiterate there is nothing wrong with any level and all levels are needed to form the whole, but it must be an imperative that each band stay within the competencies of their role.

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  • I have just completed a foundation degree to become an assistant practitioner, I have completed competencies in venepuncture , ecg's and several other tasks. All mentored and signed off by qualified staff and assessors. I work as a Band 4 on my ward . I work within my competency but under three senior staff members who no longer have competencies in venepuncture or ecgs or catherisation . They are Band 6 & 7. We also have newly qualified nurses on the ward who don't have the competencies either so when the need arises it is the Band 4 's who have the skill and come to the aid of the patients. I could carry on and convert to qualified status but I want to work with patients not paperwork .

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