As we kick off our week-long special on healthcare assistants, Unison’s head of nursing Gail Adams, reveals just what the challenges are for this branch of the profession
Healthcare assistants constitute a massive proportion of Unison’s membership, with just over 110,000 healthcare assistant members and another 150,000 in social care
The lack of standards
The main issue facing healthcare assistants is that there are no national core standards, and that there is a huge variation in what they’re allowed to do and where they are allowed to do it. Some people perform advanced practitioner duties when they are a band 2, and yet they should be paid band 4. It’s so inconsistent – often what an HCA is allowed to do is dependent on who they are working with because some supervisors and nurses are prepared to delegate and others are not. Registrants are also uncertain about what they can and can not delegate, and they can feel guilty about delegating their work to someone who is only being paid as a band 2.
The disparity of remuneration can also undermine this profession, which has also been affected by downbanding.
Tension between nurses and healthcare assistants
There is no doubt that the introduction of healthcare assistants taking on greater nursing tasks has created tension between the two groups and has been seen to erode the professional standing of nurses. However, I am quite certain that we had the same rows with doctors 80 years ago, when nurses started taking on the roles that were traditionally performed by doctors.
Lack of professional identity
There is also a huge variation in what they are called and what they wear – patients have no understanding of who is caring for them. Their perception is that anyone who lays a hand on them is a nurse, and we know that isn’t true.
HCAs feel a level of frustration around the whole thing – they feel they are giving 120% – and don’t always feel valued as part of their team, or by their organisation because of way they are paid and way they are treated.
Our philosophy is that every member of the healthcare team is vital. We expect the whole team to work together – and bring their different skillsets to the care of patients.
We do see examples of good practice where this is happening – but what I haven’t found yet is an organisation that has got this systematically sorted across the whole service. We will go into orthopaedics at one hospital, say, and it will be fabulous – then we will walk into another area and it will be a different story. I liken it to having a hip replacement – you can do something in one site that fixes the pain and have no problem. But at some point you may need further treatment. And it may be right at a given time, but it will continue to need updating.
Some of the cuts are starting to hit now – and we know that in times of economic hardship bands 1 to 4 get less training. Also, we know that nurses are losing jobs to HCAs – it’s something we discuss in our nursing and midwifery group. So this is going to further compound the problem if their training needs are being neglected and they are taking on more nursing duties.
I am not suggesting that only nurses can do everything – managers should look at what the patient group is, how patients present and what the interaction is. This can reveal what roles nurses can undertake and what role HCAs can perform. For example, it may well be that you need someone with a patient the whole time – but that person does not necessarily need to be a nurse.
Where tensions exist is often where an HR director or manager comes in and drives through reorganisation based on money, it doesn’t work. Nurses feel frustrated when they feel all efficiency savings are money driven, and this can fuel tensions that may not necessarily exist otherwise.
Regulation for HCAs
Healthcare assistants should be able to be in control of their own future. We want statutory regulation for this group of staff, with a code of conduct and core competences. But what we have said to the Department of Health, is that we don’t want this to be a project that is done to HCAs – we want them to be a genuine partner and to have an adult discussion around role.
In terms of introducing regulation to ensure public protection, it’s clear we need to regulate those HCAs that are working in isolation, managing their own caseload, going into an older person’s home and who have little or no access to supervision because their registered nurse colleague is 30 miles away running her own caseload. These are the biggest risk to public protection. Whereas, in hospital, if something goes wrong, you can call for help – you don’t have that luxury when working alone in someone’s home.
The opportunities for HCAs
Let’s also acknowledge and recognise and celebrate the role we were doing
In 1984 when I worked in South London Hospital for Women – HCAs did nothing but make beds. As nursing can go up to be a clinical nurse specialist, take on advanced roles, offer prescribing, manage their own clinics and carry out minor procedures, isn’t it great that our HCA colleagues have the opportunity to increase their roles and responsibilities?