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NHS trusts turning to healthcare assistants to ‘plug nursing shortfall’


Healthcare assistants now account for almost three in 10 of all nursing team roles in NHS trusts in England and their numbers are increasing at nearly four times the rate of registered nurses, according to a new study.

The analysis by BPP University’s school of nursing, based on data obtained through Freedom of Information requests, shows 29% of nursing and nursing support roles are now filled by HCAs.

“It’s inevitable that hospital trusts will look to other sources for their staffing requirements”

Lynne Gell

In some regions the proportion is higher, with HCAs accounting for 35% of care roles in the East Midlands.

In all, 195 NHS trusts across England, including acute, mental health and community trusts, responded to the request for information.

The data shows that in the two years between December 2015 to December 2017 nurse numbers at those trusts remained virtually unchanged, increasing slightly from 270,725 to 272,476 – a rise of 0.5%

In comparison, HCA numbers shot up much more rapidly from 103,797 in 2015 to 110,450 in 2017 – a rise of 6.5%.

However, some areas saw a much sharper increase. In London, where HCAs have historically made up a smaller proportion of the nursing care workforce, HCA numbers rose by 18%.

The analysis suggests that for each additional nurse taken on in those two years, trusts hired about four HCAs on average although there were wide variations between regions.

“We have to think more imaginatively about routes into healthcare”

Lynne Gell

Professor Lynne Gell, dean of BPP University’s school of nursing, said the figures showed NHS trusts were having to think flexibly about their recruitment needs.

“Maintaining the status quo is not an option. As demands for care rise inexorably and the supply of nurses struggles to keep pace with that demand, it’s inevitable that hospital trusts will look to other sources for their staffing requirements,” she said.

“HCAs are already a crucial element in care provision – and that role looks set to increase in the future,” she added.

Mental health trusts were found to have the biggest proportion of HCAs accounting for 34% of nursing care roles.

A breakdown according to type of trust shows HCA numbers increased substantially in acute trusts between 2015 to 2017 – by 8.5% – while nurse numbers rose by just 1%.

In mental health trusts, HCA numbers increased 3.5% compared to 1.5% for nurses. In community trusts, HCA numbers declined by 3.5% alongside a big 9% drop in nurse numbers.

Although the analysis showed nursing numbers had stayed relatively stable between 2015 to 2017, it flagged up separate figures from the NHS showing a worrying rise in nurse vacancies.

The stats show nurse vacancies rose by 21% during the same period to more than 34,000, increasing by up to 48% in some regions.

“Men are almost twice as likely to become HCAs as they are nurses”

Lynne Gell

Professor Gell, who is a registered nurse and nursing lecturer, said trusts were struggling to replace nurses leaving the profession at the same time as grappling with rising demand.

“There are 2,200 more emergency admissions per day than there were five years ago, 31% more diagnostic tests, while delays due to waiting for available home care have more than doubled in that time,” she said.

“We won’t solve our care staffing needs by standing still,” she said. “We have to think more imaginatively about routes into healthcare and attracting and training more people.”

BPP is a private university specialising in professional courses including nursing degrees and nursing degree apprenticeships and apprenticeships for HCAs and nursing associates.

Professor Gell maintained apprenticeships were a promising area for development and that BPP had seen increased interest from NHS trusts.

The analysis, which compared the gender profile of nursing and HCA employees, also suggested trusts could do more to attract men into nursing, she said.

While the proportion of male nurses had not really changed over the two years, remaining at around 11%, the proportion of male HCAs increased by 6% with men now making up 18% of the HCA workforce.

lynne gell

lynne gell

Lynne Gell

Some regions had witnessed particularly large changes to their gender profile, with the percentage of male HCAs increasing by 10.5% in the North West and by 33.5% in North, Central and East London.

Numbers of male nurses have stayed flat for a decade yet “there is no intrinsic reason why this should be so”, said Professor Gell.

“According to our analysis, men are almost twice as likely to become HCAs as they are nurses, while some trusts seem to be far better attracting men into those roles than others,” she said.

She added: “Clearly, if we could tempt as many men into nursing as there are in HCA roles, for instance, or if all trusts were equally successful at recruiting male carers, then we may go some way to meeting our staffing needs.”


Readers' comments (4)

  • The problem is they are not regulated, they are not accountable, for actions and or omissions.
    We have in our trust a few good health care assistants but there are others where you have to check up on avery task you ask of them. If I didt check on every task my patients would be at risk of neglect and even harm.
    And I’m sure I won’t be the only person with such negative comments.

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  • How about doing something about why nurses are leaving, and also why trusts can't recruit? But no, we ll fill the gap with unqualified, unregulated staff, and stick them in a nurse's uniform. I've worked with some excellent hcas, but I've also worked with some who couldn't even take a blood pressure with an electronic sphyg, or wash a patient.

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  • Wouldnt it have been far better for HCA's to undergo a thorough 6 month training rather than waste resources on the ridiculous nurse associate role that seems an utter waste of money. I have asked on numerous occasions how the associate will be incorporated onto a ward with Band 5 nurses and HCAs and nobody can tell me.

    The nursing code has changed meaning that as Band 5 nurses we have responsibility for any task we delegate to a Nurse Associate . How on earth can we delegate without knowing their competency or role. At least with HCA's we know the limitations.

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  • I agree with above,they are not accountable and it’s very difficult to rely on some of them to do a proper job.
    Reasons for the rise is also for safe staffing levels which have been introduced, plus the acuity of patients have increased. There is also a lot of specialising of patients one to one supervision is an increasing necessity due to dementia falls risk etc.

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