Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Regulation of HCA not a top priority for the NHS

  • 36 Comments

The chief executive of the NHS has dismissed calls from two of the country’s most senior nurses for healthcare assistants to be regulated, saying “nurses would say that wouldn’t they?”.

During his evidence to the Mid Staffordshire Foundation Trust public inquiry last week Sir David Nicholson was asked to respond to the comments, widely reported in the national media, from Royal College of Nursing chief executive Peter Carter and Nursing and Midwifery Council boss Dickon Weir-Hughes.

Professor Weir-Hughes warned the country was heading for a “ghastly national disaster” without regulation.

Sir David said: “I’m not convinced that spending a huge amount of time and effort in [creating] the registration organisation, as opposed to putting the effort into training and education, might be a better way forward. And, of course, the nursing profession would say all of that, wouldn’t they?”

The inquiry is examining why appalling standards of care at the trust went unnoticed for so long and is considering whether regulating HCAs could help improve standards in future.

However, Sir David told the inquiry regulating such a huge and diverse workforce, whose roles ranged from “housekeeping to the direct care of patients”, was a complex task and was not of “top importance” at the moment when the NHS was going through major reform and financial challenge.

Inquiry chairman Robert Francis QC questioned his priorities, asking what could be more important than ensuring that the people “charged with feeding and providing basic care to our most vulnerable patients are fit and proper people to do that?”

Sir David said training and education was more important than regulation.

We have a NEW website just for student nurses, with everything from the usual site at a discounted price plus more. Take a look now at www.studentnursingtimes.net and subscribe for just 70p a week.

  • 36 Comments

Readers' comments (36)

  • " the nursing profession would say all of that, wouldn’t they?”

    The arrogant prat!!!!

    Unsuitable or offensive? Report this comment

  • I agree with Mike !!

    Unsuitable or offensive? Report this comment

  • well actually Sir David Nicholson, not all nurses are saying it so do not patronise us.

    I suppose "spending a huge amount" on anything isn't going to be "top importance". . . but being chief executive of the NHS he would say that, wouldn't he?

    Unsuitable or offensive? Report this comment

  • michael stone

    Sir David said training and education was more important than regulation.

    Nobody has yet commented on that - but you are probably all nurses. The above is fundamentally right - but, unless people are regulated, nobody checks up on the quality of the training and education. THAT is why you need the regulation, to make sure HCAs are trained properly - and, to establish who 'higher up the food chain' is to be BLAMED if their training is inadequate !

    I'm not 100% sure if nurses would say it - I don't think Carter wants the RCN to have any involvement in the process, as HCAs are not nurses. But clearly nurses must support the training of HCAs if the HCAs are involved in care.

    Unsuitable or offensive? Report this comment

  • David Nicholson's comments are astonishing. He counterposes "major reform" and "financial challenge" to regulation of HCAs as if they inhabit different universes.

    David Nicholson and his predecessors have driven grade mix often without any serious consideration as to whether the financial savings have been made without compromising standards of care.

    Now the chickens have come home to roost he appears to want to duck the issue (if you'll excuse a bad pun).

    Michaelm Stone is right. Training and education will only be taken seriously for HCA with the advent of regulation.

    Unsuitable or offensive? Report this comment

  • Am I surprised, NO. Why does he not have the guts to say it straight He does not see the improvement of patient care and safety a priority over saving money

    Unsuitable or offensive? Report this comment

  • John Howes

    At a time when the answer of many Chief Executives as to who does what with patient care is you get a bigger bang for your bucks with HCA's.

    The problem however, is that most employers will tell you that the Registered Nurse is accountable for supervising their performance; that said, the absence of regulation means for the most part the training is not subject to scrutiny and when the effluvia hits the fan it will not be the Chief Exec who will be in the spread zone!

    It will, in all certainty be a scapegoat who has; a) not been involved in the training, b)may be the most junior RN on shift and c)be the body offered to the NMC rather than the Chief Nurse, Matron or Ward Manager ( we called the Ward Sisters once) who will have assured anyone who doesn't have to deliver care that all is well.

    Unsuitable or offensive? Report this comment

  • Can anyone give me some advice - I work with HCAs who frequently do not carry out the tasks they are given at handover, when confronted they just say "I'm not doing it, you do it". Most of the qualified staff just do all the work and leave them to sit around because we need the numbers. HCAs were supposed to lighten our load but they've just increased mine.
    I would welcome registration and training because then we might attract people who actually want to do the work.

    Unsuitable or offensive? Report this comment

  • Steve Williams

    Omigosh... here’s yet another example of the Victorian parodies like - The Rt. Hon. Sir Joseph Porter, KCB, singing "When I Was A Lad" from H.M.S. Pinafore...

    http://www.youtube.com/watch?v=TpJ_IAUs8nI

    Sir David Nicholson? Sir Doctor Peter Carter O.B.E? Lord Professor Weir-Hughes? Who are these self-ego-masturbators?

    When was the last time that any of these jolly Jack-Tars went to sea?

    Do they really get paid in millions for spouting this "nonsense" while dedicated Nurses in the UK are being institutionally abused?

    Too many experts up there on the “Poop-deck” and not enough hard-working “hands on-the-deck” for my liking!

    Unsuitable or offensive? Report this comment

  • Steve, I always preferred A British Tar ... ;D

    Anonymous | 30-Sep-2011 4:52 pm well said I absolutely agree.

    Unsuitable or offensive? Report this comment

  • tinkerbell

    Correct me if i'm wrong, but as a qualified nurse am i not accountable for the HCW's working my shift. If they go off and get something horribly wrong without my knowledge am i still accountable? If so then they should be regulated and accept accountability. I do not have eyes in my backside and i am not all knowing. The majority of HCW's i work with are great but there are some that no matter how much training or education they are given, and they have been given it believe me, will just go off and 'do their own thing' and this is the same for some qualified staff also. People are people qualified or unqualified. People who work with vulnerable people should all be regulated, responsble and accountable in their own right and not have the buck passed on to the nurse in charge, unless he/she is also culpable.We have already had a tragedy at our place a few years ago. I never want one on my shift because i was not aware what was going on and then have to attend an enquiry where i am the nurse that is accountable because when the proverbial hits the fan it will be your arse that is dragged over the coals have no doubt about that.

    Unsuitable or offensive? Report this comment

  • John Howes-You are Soooooooo right and what an arrogant shit Sir David Nicholson sounds.
    Of course everything is always nurses fault becuase we are superhuman and can produce miracles and overcome any little obstacles like the mad systems in which we are required to work -well we could if we were truly vocational as the Daily Mail would say.

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 1-Oct-2011 10:56 am

    tinkerbell | 30-Sep-2011 9:50 pm

    Everyone - including nurses - should make it plain that they are willing to be blamed for their own mistakes, but not for the mistakes of other people.

    If individual nurses are expected by management to somehow supervise 6 unqualified HCAs, and you reckon that is impossible, then as a unit an entire hospitals nursing staff should complain to management about it: and also copy in the DH and RCN.

    Not just mutter between yourselves !

    Unsuitable or offensive? Report this comment

  • David Nicholson is absolutely right with regard to the regulation of HCA’s: it certainly isn’t a priority and, in reality, would be little more than a list of names and wouldn’t guarantee the safety of one single patient. I totally agree with Nicholson’s remarks regarding training and surely the priority is for each employer to ensure that HCA’s in their employ have the necessary skills and training to undertake the tasks that they’re given.

    I have no idea how many HCA’s there are working in the UK, but I’m sure that we’re talking in the millions here. Can you imagine the cost, can you imagine how large such an organisation would be? Logistically, it is impossible.

    Just thinking where I work, we have some HCA’s who are basically limited to topping-up and tidying the sluice whereas others are able to cannulate and do ECG’s. How could you regulate such a diverse workforce? The answer is, you can’t! If you include everyone that is involved in patient care then the register becomes meaningless, if you only allow those with a NVQ, then you exclude those who are probably most in need of support and training. If you limit the HCA register to these Associate Practitioners then I believe this will negatively impact on the primacy of the Registered Nurse and will ultimately lead to our employers favouring the cheaper alternative!

    The situation we now find ourselves in is largely due to the UKCC and Project 2000. Think back to the eighties: hands on care was provided by a regulated and highly-trained workforce, they were called Enrolled Nurses. The wards were also full of Student Nurses who weren’t supernumerary and learned on the job. There were some Auxiliaries, but in the hospital I worked, they had to do 6 weeks in school to learn the basics before they were allowed anywhere near a patient.

    What we really need is a minimum Registered Nurse to patient ratio as this really is the only way to guarantee high quality care. Even a very high nurse to patient ratio would be cheaper than introducing a register for HCA’s. I caution colleagues to be very careful in what they wish for with regard to registering HCA’s


    Unsuitable or offensive? Report this comment

  • Anonymous | 1-Oct-2011 8:24 pm, you are wrong, you can regulate the workforce very easily. Nurses are regulated with a variety of roles and skills, and this is done quite easily.

    Also, as you say, there are a lot of HCAs out there working vastly outside what their role should be. Regulation would specifically define that role, and it would stop trusts from abusing staff in this way, using HCAs to perform tasks and roles they are not fully trained for just to save money.

    I do agree with you however in the fact that a full QUALIFIED Nurse/patient ratio is needed.

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 1-Oct-2011 8:24 pm

    see my post above:

    THAT is why you need the regulation, to make sure HCAs are trained properly - and, to establish who 'higher up the food chain' is to be BLAMED if their training is inadequate !

    Whether or not you need a national regulatory body, is a different question. But if the senior nurse on a ward is supposed to be responisble for training & regulation of the HCA's on it, fine, provided everyone understands and accepts that.

    It is the clarity of responsibility, which matters. You can't blame anyone for incompetently performing a task they are not adequately trained for, if they themself do not understand that is the case - but if an HCA damages a patient, you need to know who does get the blame.

    Unsuitable or offensive? Report this comment

  • Mike and Michael,

    I’ve given my previous comments a lot of thought, but I still stand by earlier assertion that the regulation of HCA’s isn’t a priority. Individual employers taking responsibility for the staff in their employ ensuring that they are appropriately trained for the tasks which they are being asked to perform is, however, a priority. I’m not against HCA’s having their own register, but I think colleagues are placing too much emphasis on HCA‘s ‘being registered’ when its not the register that offers protection, but the training one has to do in order to become registered is.

    There a 660,000 nurses and midwives registered with the NMC, of which 350,896 work in the NHS in England - in hospitals and community services (not including GP practice staff) (NHS IC, 2011). It is relatively easy to regulate them as in order to call yourself a nurse or a midwife you have had to have completed a NMC approved training course which has minimum levels of attainment. The NMC register itself is not what protects patients, it is the training an individual undertakes to gain and maintain their registration with the NMC that affords patient protection.

    I’ve been unable to uncover the finite number of HCA’s in the UK, but it appears that there are 273,328 working in the NHS in England in hospitals and community services and there are 6,700 working in GP practices. There are in excess of 24,000 care homes registered within the UK so I think it is acceptable to assume we are dealing with an extremely large workforce at least as large as that on the NMC‘s books.

    Unlike their qualified colleagues, HCA’s have not had to meet any minimum requirements in order to become a HCA therefore there is no base in which to start from. You could say anyone wishing to work as a HCA has to have completed at least NVQ level II, but I know of someone who was able to complete her entire NVQ using a Dictaphone, so one wonders the true value of such a qualification. I could go on ad nauseum, but placing someone on a register does solve anything. Rather than the government spending however many £million on setting up such as register, I’d rather the money was spent on establishing proper nurse/patient ratios.


    Unsuitable or offensive? Report this comment

  • Yes, Its all about money - again!! Regulation would help define the HCA role and therefore, support patient care/safety - but is that a priiority for the 'powers that be?' - it doesn't seem so to me.

    I agree with others though that an improvement in qualified staff/patient ratio is needed to improve patient care - this also would enable nurses to carry out their job effectively and safely.

    Unsuitable or offensive? Report this comment

  • tinkerbell

    of course it is not a 'top priority'. The dismantling of the NHS is the top priority. Staff patient/ratio is not a top priority either, most wards are closing in my speciality. The top priority is 'cuts, cuts, cuts, making money and getting rid of nurses and pensions. We are just a fly in the ointment. Dire times!

    Unsuitable or offensive? Report this comment

  • To my thinking an employer of HCA's should make sure that they have had the right training for what they are expected to do when they are on the ward, so that nurses know that all HCA's have the same basic knowledge, and know what tasks they can carry out without worrying if the HCA might drop them in it!
    It's the employer that should make sure the HCA is fit for purpose, and not nursing staff taking the rap when they are not!

    Unsuitable or offensive? Report this comment

  • I haven't got time to read all the responses because I am on the shop floor and not the higher echelons of power, so I apologise for any repetition, but shame on Sir David if these comments were reported correctly. It doesn't matter what status you are - we should ALL be regulated with everything that entails if we are looking after vulnerable people. How does it make any difference if you are an unqualified or qualified carer? The person on the receiving end just wants a good service. It is actually discriminative NOT to be. If I was a conscientious HCA I would WANT to be regulated.

    Unsuitable or offensive? Report this comment

  • tinkerbell

    Anonymous | 3-Oct-2011 6:05 pm

    Well said you. End of.

    Unsuitable or offensive? Report this comment

  • I am really concerned about regulating a workforce who are neither trained to a certain standard or hold any responsibility. As nurses we should be protecting our professional standards and abilities and not be campaigning for this. HCA's are already allowed to be members of the RCN and now the RCN want to make them full members. THEY ARE NOT NURSES! i hear so many saying "there is no difference" "we are all the same" etc. We are not. Doctors, Dentists, Radiographers etc would never allow it - so why do we?

    Unsuitable or offensive? Report this comment

  • If the top nobs looked and corrected all the waste that occurs in the NHS they would have money to regulate the HCA's properly and not just with Mickey Mouse NVQ's. ANY idiot ccan come in off the street from any country and become an HCA and 'care' for the moster vulnerable. It is shameful.
    Start with millions of wasted unused medication. Heating on in hospitals with windows and doors wide open. A dozen secretaries when half the amount would do. Over-salaried NHS bosses etc....

    Unsuitable or offensive? Report this comment

  • Yes I agree the same goes for an RN who may be struck off the register and begin work as an HCA. If people would actually listen AND hear that the Healthcare Assistants WANT to be registered/regulated for the safety of patients. These members of staff where I am employed are trained to a very high standard, doing more and more clinical and bedside roles of an RN i.e. cannulations, taking bloods, changing enteral feeds, ECG's, catheterisations, manual BP's, evaluations, even scrub and assisting surgeons.The Only duties they dont do are IV's and drug rounds. Not all are useless skivvies, majority are educated human beings.

    Unsuitable or offensive? Report this comment

  • Well Said Louis!

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 2-Oct-2011 3:03 pm

    You are rigidly equating 'regulated' with a regulatory body such as the NMC.

    All I am saying, is the rules 'about who is responsible for the competence of the HCAs on any particular ward' must be CLEAR !

    Call it 'local-level but defined' regulation, if you wish to - but if an HCA makes a mistake because of inadequate training, that is not down to the HCA unless the HCA has been told to not attempt such a task - patients need to know who is culpable, in that situation. And if it is to be the nurses on the ward, those nurses need to know that, and also to be in charge of HCA training and tasking.

    It is about COMPETENCE and CLARITY.

    Unsuitable or offensive? Report this comment

  • i'm an hca. before the man from the glucose meter company came to the ward and trained me, nurses never asked me to use the meter. after the training, i used the meter nearly every day. before the charge nurse elected me for two day phlebotomy training, i was never asked to take bloods. after the training i was asked to take bloods more often than the nurses. explain why do hca's need a regulatory body so that nurses can take their responsibilities seriously and manage the ward workload and skill mix properly? whenever i ask for an explanation, i'm told that because i'm an hca i wouldn't understand the answer, but i've been involved in management in non-medical settings, so perhaps it's because nobody has yet given me a rational and coherent account. as for de-registered nurses becoming hca's, surely if they pass their crb checks their experience should be welcomed. i currently work with a couple of nurse degree drop outs and they make damn good hca's.

    Unsuitable or offensive? Report this comment

  • @ tinkerbell | 30-Sep-2011 9:50 pm

    surely, in ANY profession, if the person in charge asks a subordinate to carry out a task within their job description, and that subordinate "does their own thing" that would be a disciplinary matter. depending on the frequency or severity of the insubordination it may be a dismissal matter. i know this has happened to hca's, so the nursing profession is not somehow different to other professions in this regard. why is it that you, and the majority of respondants on this thread, are unable to understand the basics of management and delegation? is it a training issue? perhaps the money spent on creating an hca professional body would be better spent teaching nurses how to delegate.

    Unsuitable or offensive? Report this comment

  • Anonymous | 7-Oct-2011 8:53 pm It seems you don't understand much about delegation, yes the HCA would be disciplined and even sacked, but the Staff Nurse would still be ACCOUNTABLE according to our code. Instead of using the money teaching Nurses how to delegate, it could teach you how to follow orders properly instead?

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 7-Oct-2011 8:53 pm

    We are not talking about insubordination - we are talking about, HCAs being asked to perform tasks outside of their competence levels.

    Anonymous | 7-Oct-2011 7:35 pm

    'whenever i ask for an explanation, i'm told that because i'm an hca i wouldn't understand the answer'

    That isn't very acceptable - it is sheer rudeness - but doubtless if you asked a nurse, that was the answer, and you pressed it, the nurse would say 'I don't have the time to explain it in enough detail, for you to be able to understand it'. But it strikes me, that as an HCA you are being subjected to offensive behaviour - mind you, it strikes me that everyone reckons somebody is being offensive towards them !

    Unsuitable or offensive? Report this comment

  • @ mike | 7-Oct-2011 11:50 pm

    "Delegation
    If the nurse or midwife is delegating care to another professional, health care support staff, carer or relative, they must delegate effectively and are accountable for the appropriateness of the delegation. The code requires that nurses and midwives must
    establish that anyone they delegate to is able to carry out their instructions confirm that the outcome of any delegated task meets required standards make sure that everyone they are responsible for is supervised and supported."

    http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/

    so, if the task is within the training, skills and competency of the hca, the task has been made clear to the hca, yet when the nurse checks that the task has been completed to the required standard finds that the hca has "done their own thing," the nurse is NOT accountable for the hca "doing their own thing," the hca is, and should be disciplined appropriately.

    of course, if the nurse doesn't check that the task has been completed to the required standard, the hca's "own thing" results in a poor outcome and litigation, then the nurse is accountable for their own failure to follow through.

    mike, perhaps there isn't enough in the entire nhs training budget to teach you what you don't want to learn, ie. your own code of conduct.

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 9-Oct-2011 9:47 am



    Isn't your:

    'The code requires that nurses and midwives must establish that anyone they delegate to is able to carry out their instructions'

    what is being discussed here ? Isn't this discussion, about who is responsible for training the HCAs and checking their competences ? From what I can see, most nurses will say 'well, I don't have THE TIME to do that' !

    Unsuitable or offensive? Report this comment

  • @ mike | 7-Oct-2011 11:50 pm

    "Delegation
    If the nurse or midwife is delegating care to another professional, health care support staff, carer or relative, they must delegate effectively and are accountable for the appropriateness of the delegation. The code requires that nurses and midwives must
    establish that anyone they delegate to is able to carry out their instructions confirm that the outcome of any delegated task meets required standards make sure that everyone they are responsible for is supervised and supported."

    http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/

    so, if the task is within the training, skills and competency of the hca, the task has been made clear to the hca, yet when the nurse checks that the task has been completed to the required standard finds that the hca has "done their own thing," the nurse is NOT accountable for the hca "doing their own thing," the hca is, and should be disciplined appropriately.

    of course, if the nurse doesn't check that the task has been completed to the required standard, the hca's "own thing" results in a poor outcome and litigation, then the nurse is accountable for their own failure to follow through.

    mike, perhaps there isn't enough in the entire nhs training budget to teach you what you don't want to learn, ie. your own code of conduct.

    Unsuitable or offensive? Report this comment

  • There is a piece in today's Time's on page 18,

    Harry Cayton, CE of the CHRE which will (eventually) oversee a voluntary register for HCAs, wants to mirror an approach adopted by Scotland, by using a 'binding code of practice':

    'Under a scheme in Scotland, new HCAs must sign a code of conduct. In return, managers promise to make sure their workers are competent and properly trained. "It's low cost, high responsibility. The people nearest the problem are most responsible for solving the problem", Mr Cayton said. He also said "It's about who's in charge of that care or ward".'

    Unsuitable or offensive? Report this comment

  • HCA are the backbone of nursing care the registered nurse supplies the drugs and iv's and does not give much time and care to the patients..the problem with regestering HCW would give nurses an eccuse to do even less contact with patient puting even more work onto the HCA

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.