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'Regulating the healthcare support workforce – what problem are we trying to resolve?'


In response to the recent coverage on the need to introduce the statutory regulation of healthcare support workers, Dean Royles, director of the NHS Employers organisation, provides a different perspective.

Healthcare support workers perform an amazing role in delivering care in support of a regulated healthcare team. They are a hugely important part of the workforce and their roles have a direct impact on the experience patients have of the care they receive. 

There is a lot of discussion about whether they should be subject to statutory regulation, alongside other parts of the workforce. The most fundamental question we need to be clear about is what problem we are trying to fix? We also need to realistic with the public and patients about what regulation can do.

Protecting patients is of paramount importance to employers. Employers support a system of regulation that provides public protection and complements the responsibilities they have as employers to recruit, train, supervise and appraise staff appropriately and which enables them to assure their boards on issues of quality of care and patient safety. Sometimes patients do not receive the highest standard of care or they are not treated with the dignity or compassion expected. This needs addressing from the root if we are to ensure we instil real change for patients.

We must remember that regulation only ever considers minimum standards and the NHS must strive to achieve more than just the basics. It can have unintended consequences that could restrict the flexibility required within the workforce to meet the needs of patients. We also need to be clear that regulation cannot capture the friendly tone of a doctor or the simple effort a nurse makes to ensure his or her patients are as comfortable as possible in their hospital beds.

The 2010 National Nursing Research Unit report Moving forward with healthcare support worker regulation (1) stated that ‘it proved not possible to demonstrate unequivocally that an unregulated support workforce presents a risk to public safety and that this risk would be prevented by regulation.’ However we do know there is compelling evidence (2) showing clear links between high levels of staff engagement and overall organisational effectiveness.

The best employers engage with their staff.

The needs of patients appear two fold, both to ensure patient safety is at the core of the organisation’s culture and to drive up the quality of patient experience, and these responsibilities sit firmly with the employer. 

The NHS Employment Check Standards provide employers with a consistent approach to checks on all staff, including healthcare assistants. All NHS organisations use the checks when recruiting staff to ensure they meet all the relevant legal and mandated policy requirements. However assurance is not a one off check and needs to be accompanied by other processes and, more importantly, a way of working.

We have five priority areas for employers. When reviewing practices against the expectations of the service, this can provide assurance of the competence of the whole workforce.

  1. Recruitment
  2. Supervision
  3. Continuing Professional Development
  4. Clear standards and expectations (to ensure individuals do not operate beyond their scope of competence)
  5. Appraisal

These need to be underpinned by four behavioural areas which will drive forward any positive change:

  1. Strong leadership
  2. Environment where staff are happy to raise concerns
  3. Staff engagement driving service delivery
  4. Effective team working and a team ethos to delivering care

The majority of healthcare support workers provide excellent care. They are caring, well trained and appropriately educated. They have been the backbone of the NHS and remain an essential part of the patient experience where care and compassion matter most. Regulatory bodies, national standards and codes of conduct have a positive role in the healthcare system but they do not necessarily drive up standards of care or provide the solution to all problems.

Healthcare support workers have a critical role in delivering care and influencing the patient experience. You can’t regulate for a smile and a kind word.

Dean Royles is the director of NHS Employers


Readers' comments (3)

  • Absolutely right: I agree wholeheartedly with the author of this piece. I’d rather the vast sums of money that would be required to register these HCA’s was spent on actually training them or used to ensure adequate nurse/patient ratios. Registering is not the way to go with HCA’s, but ensuring employers train their staff appropriately is.

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  • michael stone

    As I have just posted elsewhere:

    The solution to this HCA things is simple - keep it 'local' but enforced, and use the equivalent of a Pilot's Log Book.

    Give every HCA the equivalent of a 'log book' in which brief details of 'certified training' are listed (this would need to be recorded electronically, but could also exist as a physical copy). So if an HCA is trained in taking blood, the nurse (or whoever) trained the HCA, and 'certified the HCA as competent' records the new competency, and the nurse's name as the trainer/certifier, in this 'log book'. You do NOT include things such as 'a caring attitude' !

    Any other person, who wishes to know what a given HCA is deemed able to do, can simply check the 'log book'.

    Ruddy simple !!!! Why do people make these things, so complicated ?

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  • "Regulatory bodies, national standards and codes of conduct have a positive role in the healthcare system but they do not necessarily drive up standards of care..". Really? Why do they exist then? HCA's spend far more time with patients than any of the so-called professions and yet there is no way to set minimum national standards for them. The present system is not working, and occasionally catatrophically fails (Winterbourne View anyone?). Regulate and regulate now.

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