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Voluntary regulation of HCAs 'inherently weak'


The voluntary regulation of healthcare assistants is an “inherently weak” idea that would leave patients at risk, the Royal College of Nursing has warned.

Training standards and a new code of conduct for HCAs are currently being finalised by Skills for Health and will be presented to the Department of Health in January.

Skills for Health was commissioned by the government to produce the standards and it is expected they will form the basis of a future voluntary system of regulation.

But in a policy document critiquing the proposals, the college describes the government’s favoured approach of “assured voluntary regulation” as “inherently weak”.

It argues that only a mandatory register can protect patients and assure nurses that HCAs have a core level of competence.

The document claims a voluntary system would do nothing to prevent “poorly performing or dangerous support workers” from moving between employers and risks creating confusion among employers and HCAs themselves.

It questions why voluntary regulation is considered acceptable when many HCAs carry out tasks that were previously carried out by registered nurses.

The college has been a long standing supporter of the need for mandatory HCA regulation but until now has not openly criticised voluntary regulation itself.  

RCN chief executive and general secretary Peter Carter said: “With voluntary regulation, there is a serious danger that those healthcare support workers who represent the most significant risk may be the least likely to be on a register, and may then be able to move between employers without sanction or any monitoring.

“A consistent, mandatory system of regulation is the only way to ensure that concerns about performance and conduct are tackled.”

However, health minister Earl Howe recently suggested the government had not completely rejected mandatory regulation.

He told the House of Lords the government’s “mind was open” on the issue, though he said there would need to be a “good, evidence-based case before proceeding with mandatory regulation”.

The government is also waiting for the outcome of the Francis report into Mid Staffordshire Foundation Trust, which is expected to include recommendation on the issue early next year. 


Readers' comments (15)

  • Tiger Girl

    andy | 20-Dec-2012 11:13 pm

    You seem a little cynical - and you are the second person to have pointed out that there would be problem with the skill set, because different HCAs do different things.

    There should be recognised career progression for HCAs, and that probably involves recognised attainments that are transferable - but registration/regulation is a bit different from recognition of a growing, or indeed basic level, skillset, isn't it ?

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  • Tiger Girl | 21-Dec-2012 2:00 pm

    I agree that registration is different from skill sets, and there should be career progression and recognition of their skills.
    HCA should have mandatory regulation, with a statutory and mandatory skills and training, then continuation training, updates and career options/pathways.
    It should ensure patients and staff are protected through accountability, responsibility and competency in one's own role.
    Regulation (of any staff) is no guarantee that people won't be at risk, but should help reduce risks.

    Skills and knowledge attained are very much transferable from one area into another. There maybe particular skills + knowledge that would be useful for HCAs who would like to develop. Some HCAs can also take bloods and canulate much better than some doctors and nurses. Others are very knowledgeable with wounds and dressings. HCAs are valuable members of the team looking after patients, and like everyone requires support and development.

    However, if there isn't enough staff (or resources) to look after patients, or if staff aren't working with the right attitude, then inherently there will be risks that can be avoided.

    Voluntary regulation doesnt appear to be working too well in the finance, media or political arenas.

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  • michael stone

    andy | 21-Dec-2012 5:10 pm

    'However, if there isn't enough staff (or resources) to look after patients, or if staff aren't working with the right attitude, then inherently there will be risks that can be avoided.'

    Indeed - but I still wonder whether 'national registration' is the answer to the HCA issue: I think a national registration scheme would set the attainment level so low, as to be fairly pointless - I think a universal requirement to assess the skills of HCAs using known measures, and a committment to allowing HCAs to develop increasing skill sets would work better.

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  • I think we have been here before, although perhaps no one studies nursing history now.
    In the fifties they recognised a need for more practical trained nurses and started the Enrolled Nurse training. Initially those with sufficient experience were awarded the qualification, e.g. I had an aunt who worked as a nurse in the war and was given this qualification on that basis. Otherwise it was two years training. Later people decided there should not be two levels of nurses and it was abandoned.
    They say what goes around comes around. But with qualified nurses taking over more and more of what was once only a doctor's prerogative, something needs to fill the gap that they leave.

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  • michael stone

    Anonymous | 26-Dec-2012 10:14 am

    'But with qualified nurses taking over more and more of what was once only a doctor's prerogative, something needs to fill the gap that they leave.'

    That has been discussed on this site before. Nurses do now do things which once doctors would have done, and it seems to me that HCAs were intended to fill some fo the less-skilled tasks 'left vacant' by nurses now performing new tasks - but it seems (HCAs taking blood, etc) that this is a bit like a conveyor belt, with nurses and also HCAs gradually starting to perform 'more complex' tasks.

    So, HCAs cannot, it appears, be thought of as not requiring a level of expertise, and that required level is apparently increasing over time ?

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