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Hard-pressed support workers expected to do nurse tasks ‘without proper training or supervision’, claims union


Healthcare assistants are being expected to do the work of registered nurses without adequate training or proper supervision, according to survey results released by a union.

Nearly two thirds of support workers who responded to the survey – 63% – reported that they were being left to care for patients without enough support from doctors and nurses.

“It’s clear the pressures on them to act as nurse substitutes have increased over the winter”

Sara Gorton

A knock-on effect of this was indicated by 39% of the HCAs saying they did not feel confident that those they were caring for were safe.

The findings are based on a Unison survey of nearly 2,000 HCAs across the UK, with the majority working in hospitals, as well as in mental health, community settings and GP practices.

Around half said they had not received adequate training for performing tasks such as dressing the wounds of patients, giving out medication and changing stoma bags.

The results reflect previous findings from earlier surveys of support workers carried out by Unison.

The union, which held its annual health conference in Brighton this week, also said the findings highlighted how nurse staff shortages were to blame for 74% of HCAs having to take on extra work.

HCAs said the situation had been worse this winter just gone, compared to the year before, with 57% picking up extra work due to nursing or clinical staff shortages.

“We don’t even have time to do our core responsibilities properly, it’s very stressful”


In addition, 41% said they were asked to carry out tasks without adequate training more often than last winter and 37% were asked to perform tasks without supervision more frequently in 2017-18.

On the back of the survey results, Unison said it was calling on the government to address staffing issues so that HCAs felt “properly supported and patients received the care they deserve”.

Unison head of health Sara Gorton said: “Healthcare assistants are being left to fill staffing gaps and do vital tasks without recognition or reward. It’s bad for them and bad for patients.

“It is important these staff receive training for all the extra responsibilities they’re expected to take on,” she said.

“It’s clear the pressures on them to act as nurse substitutes have increased over the winter,” she said. “The government needs to show they value healthcare assistants by investing in their training.”

“Trusts are trying to make use of HCAs, which isn’t necessarily a bad thing, but it can put patients at risk”


A summary of the survey findings, published by the union this evening, also featured anonymous case studies from HCAs.

Nicole, 33, from Greater Manchester, said: “On my first day I was shown how to do tasks like taking pulses and blood pressure by another HCA.

“They said they’d never been properly trained how to do it and weren’t really sure if they were doing it properly,” she said. “HCAs are doing ECGs and taking bloods – that’s a lot of responsibility.”

Meanwhile, Janet, 40, a band 3 maternity support officer from Croydon, said: “Trusts are trying to make use of HCAs, which isn’t necessarily a bad thing, but it can put patients at risk.

“There is a divide at the trust I work for between the people that have worked there a long time and those of us that are newer to the job,” she said. “People who have been in the job longer have received different training that doesn’t cover everything we’re expected to do these days.

sara gorton for story

sara gorton for story

Sara Gorton

“Since I started two years ago, there’s more pressure on us, and we’re taking on more responsibilities,” she said.

Graham, 51, from Bradford said: “There is a lot of pressure from understaffing. I work in a dementia ward. The ratio of patients to staff is very high.

“Sometimes you wonder why patients are being admitted without due regard for the number of staff,” he said. “We don’t even have time to do our core responsibilities properly, it’s very stressful.”

More news from the Unison annual health conference:



Related files

Readers' comments (8)

  • I started as a Auxillary nurse 30 years ago, as we were called then. I qorked on MAU medical assessment unit. We always did regular observation rounds taking B/P's pulses Sats and temps. We also did ECG's on patients. The only thing we wernt allowed to do were Blood sugars. 20 years ago i did my nurse training, and my back ground training and experiences were so helpful, and gave my that sixth sense in spotting a patient that didnt look quite right, and the confidence to liase with doctors and consultants when i needed to report things or be my patients advocate. HCA's are perfectly capable to do obs but must take the job seriously and report things promptly to the nurse, and know the normal levels and when things need attention. It makes the job more interesting and you feel you are making a difference to the patiends welfair and safety

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  • Additional duties such as obs, bloods, BMs and ECGs are all well and good when HCAs are trained properly. The problem isn't the training though it is that the basic care needs for some groups of patients eg acute medicine for the elderly, so high that HCAs are struggling to do these to a high standard, as a result they become more rushed as additional duties are piled on them with the overall effect being reduced standards of care.

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  • Surely it can't be difficult to train HCAs properly?!

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  • Instead of wasting money on training the nurse associates it could be put to better use by a proper training for HCA's.

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  • IT IS NOT A WASTE OF MONEY TRAINING nursing associates!!! I have 30 years experience and am currently at university doing a degree for my band 4 role. I am already a very experienced HCA and I can tell you without them nurses would be LOST!!!!!!!!!!!!!!! ASK any nurse, stop running down investment in training band 2 3 and 4s it is needed desperately and all I say is dont do it, if you are not competent, but every single HCA i have met is more competent than a lot of the nurses and agency nurses that I see!!!!!!!!!!!!!!!!!!!!! and safer...............FACT!! nurse associates and AP,S are people with vast experience who want a better wage for a good job done.

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  • HCA's are extremely well trained and at our trust, a huge amount of money is invested in training, but without common sense, you are wasting your time. Any nurse is happy to show you how to do a task, JUST ASK!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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  • No reduced standards of care at our trust and we have amazing nurses and HCA's I would say the standard of care is higher the more HCA'S you employ! FACT

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  • Surely training is carried out by Unison members , maybe Unison needs to have a word with their members, LACK OF COMMS

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