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Unison calls for formal HCA registration

  • 14 Comments

Unison is calling for the formal registration of healthcare assistants and national minimum competencies.

The union, which represents 100,000 HCAs, says the lack of formal registration sees widespread injustice in pay, training and scope for advancement.

Unison will unveil its own draft set of core competencies and specialist extras for areas including acute and mental health at its HCA conference in September.

Unison head of nursing Gail Adams said the study funded by the National Institute for Health Research made the case for change in the sector.

She told Nursing Times: “There needs to be a decision over the core elements of an induction programme.

“HCAs experience a postcode lottery depending on whether they work for a good organisation. More often than not they have had to fight for every piece of training they have received.”

She said Unison’s research found the Agenda for Change programme had led to HCAs in mental health being paid at band 3 while those in the acute sector were at band 2 - with no apparent justification in terms of skills or experience.

She said cutbacks would mean trusts having to look again at their skill mix, but she stressed the dangers of doing that without a thorough examination of HCA skills.

Mid Staffs has taught us that you can’t substitute HCAs for nurses without doing a full skill mix review,” Ms Adams said.

“Unless we address the induction programme then people won’t be confident in delegation. They need an understanding of what they can do and, more importantly, what they can’t.”

The NIHR research found the poor definition of HCA roles left nurses anxious over how much they could delegate to them.

A survey of 689 nurses said their main concern with regard to HCAs was accountability, as Nursing and Midwifery Council rules say a nurse is responsible for a task they have delegated to an HCA.

One nurse told the researchers: “Now everybody’s thinking you’ve got to protect your registration. Because at the end of the day, if you’re working with an HCA and they go off and do something that they shouldn’t do and it comes back to bite you, you can’t say well I didn’t do it, because actually you’re supposed to be supervising the healthcare.”

A further problem for nurses was the perception that some HCAs were overambitious and overestimated their abilities, and sought to extend their role “to the neglect of core care activities”.

Survey responses revealed that, while nurses thought the most important tasks for HCAs were bathing, feeding and bed making, HCAs themselves ranked taking patient observations as one of the tasks they most enjoyed.

But the report said tensions between nurses and HCAs should not be exaggerated.

A survey question asking if nurses felt HCAs on their shift were a burden found most did not. But another asking if they were confident HCAs fully understood what they were doing on the ward elicited an ambivalent response - indicating nurses were not always confident.

  • 14 Comments

Readers' comments (14)

  • As an Auxiliary Nurse working in the Ophthalmology Dept out Patients. I feel some Nursing Staff support me to move forward, where some are afraid that I will take over.
    But for me the most important issues here is , if you’re signed off competence any task, this means you’re able to work along side a Nurse compatible without any issues occurring.

    I believe as an Auxiliary Nurses/ HealthCare Assistants we should have a registration number likes the trained staff, but only for those who have gained their NVQ II, III.

    I have fought for a number of years for my Band 3 until I want to my unions (RCN) and they took up my case, which I won, even though I was doing the same job for a number of years.

    Nurses should not be afraid because while the Auxiliary Nurse / HealthCare Assistants who have competence to prove they able to do the task, they should be doing or dealing with other Patient etc, or go on further training.


    So please let Auxiliary Nurses/ HealthCare Assistants who wished to move forward let them and please support them.

    Also my other concern is different trust have different policy for their Auxiliary Nurses/ HealthCare Assistants. We should all work to the same policies.

    I have notice when I go on conference some Auxiliary Nurses /Health care Assistants are able to install drops in Patients eyes to dilate, do sack wash out etc.

    In my trust I am not able to do the above, how some Trust allows the above and some not.

    Parbinder Kaur

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  • I manage a large team that includes many Health care Assistants or Band 3's. On the whole the care they provide is excellent and I fully support formal registration in recognition of their hard work and dedication. Formal registration should include adherence to a code of professional conduct. As well as being valuable members of the team some HCA's in my team are bully's, harrass others and do not share the ideals, values and beliefs that I believe should be inherent in most nurses. Adherence to a code of conduct would help me and the HR department manage these "nurses" out of the organisation.

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  • Absolutely agree that HCA's should be regulated and registered in the same way Nurses are, especially band 2 and upwards.

    The current situation were Nurses are still responsible for delegating tasks that a HCA performs is unworkable.

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  • i work as a senior health care asistant in norfolk, i totally agree we should be registered, as i can cannulate, venepuncture and catherize male and female patients, which are invasive procedures. we are all accountable for our actions as regards our jobs, so i totally agree we should definately be registered

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  • I work as an HCA and I would support the idea of registration.
    How can it be fair or workable for trained nurses to be expected to delegate and supervise the work we do on top of their own with THEIR registration on the line if we make mistakes?

    Add to this the benefits of having our own registration so that we can use it as part of our progression path and show the skills we have.
    It would also help us to gain better recognition of our role and our skills. As others have stated, HCA's are gaining competencies for invasive procedures and are expected to perform them.
    It is all too easy for people without responsibility to endanger another persons registration by cutting corners, what do THEY have to lose?
    If we want to advance ourselves and our reputations within healthcare we need to take the responsibility into our hands and get registered as professionals in our own right. We could also then have a case for getting protection for the title 'Healthcare Assistant' to prevent other carers from using it outside the hospital environment.
    Don't get me wrong, carers in rest homes and nursing homes do a great and well-needed job but they do not do what we do.

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  • I am in full agreement of regulation for Health Care Support Workers and Assistant Practitioners. However, I feel within a regulatory framework there will need to be commitment to the undertaking of a Mandatory Induction Training Schedule, with protected study time to attend.

    There will also be a benefit to having defined core standards, an accountability framework which provides structure and accountability to the role, for the Assistant Practitioner and Health Care support worker and a clear progressional route.

    With these components, I feel the regulatory framework will give clarity around the roles and competencies of these workers both for employers and colleagues and provide a standardised platform from which to develop other skills and attitudes, towards the development of an accountable and competent worker.

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  • D Wright

    HORRAHH! I agree entirely that HCS's or HCSW should be regulated, supported and respected as valuable members of the health care team.
    They need to feel valued and rewarded as such. As nurses we rely so much on this part of the work force, they provide, as one comment stated, invasive and nurse like procedures, regulation / registration is the next step to professionalism.
    But I do think there should be clear guidelines. My example would be (and no disrespect intended at all) that HCA’s in many nursing homes for example, receive a very limited training package but don the same title as HCA.
    The HCA in the hospital or GP surgery performs to a very high standard and indeed receives a different training package, yet retain the same title and low wage, I have observed many people’s views of HCA’s, as a menial and unprofessional workforce of mainly ‘women in service’, it’s awful I know, but unfortunately many still believe this to be true!!
    Perhaps we need to differentiate the title, I don’t know, is going back to the Enrolled Nurse a better more professional title?

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  • D Wright, I absolutely agree with you but we have to remember that there is also a place for the HCA who does not have any training or quals, who does perform the basic tasks such as feeding and bed making.

    Apologies for repeating myself as I said this in another post, but I believe in a three tier system that is fully accountable at each stage, and very distinct and seperate in the tasks each tier can perform.

    The basic care such as feeds, washes, bed making etc, performed by HCA's at band 2, which would not require education/qualifications/training.

    Low level clinical tasks performed by HCA's who are fully trained in those tasks (with formal, recognised qualifications) and fully accountable. This way these tasks (which can still be performed by Staff Nurses) can be delegated safely and correctly. This can also be used as a way for someone without formal education/qualifications to get onto the degree (full completion of which would depend on personal and individual ability)

    And finally, mid/high level clinical tasks, care/ward management etc performed by fully qualified staff Nurses, specialists and beyond.

    This type of ranking system works very very well within the military and many other institiutions and perhaps our own profession can learn from this, without the constant blurring of lines and roles. Like I said earlier, this would also work well without stopping any upward mobility for those with the intelligence/skill and ambition to achieve extra qualifications. At the very least it will serve to protect us professionally as each level of staff, from HCA to specialist would know their exact role and job description and stick to that, without people wanting to 'do more than they should' or management constantly expecting people to do more and more within their roles, without extra pay, status or more importantly protection if anything goes pear shaped.

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  • Of course HCA's need and should have their own framework, support and regulation, whoever thought they shouldn't?! They are faced with the same issues we are as nurses like pay, conditions, training, support, status, professional scope issues. Just the fact that management and governments have been planning to shift the skill mix towards a more heavily weighted HCA proportion for years should indicate the need for this.

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  • Phase them out over a decade. Train them up as nurses or goodbye. No more untrained/ barely educated staff looking after sick, vulnerable people.

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