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What are the issues facing healthcare assistants in today's climate?

  • 6 Comments

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.

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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.

The cuts

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?

  • 6 Comments

Readers' comments (6)

  • No national core standards for HCAs-nonsense-abide by the CQC Quality and Safety Outcomes as everyone involved in care delivery should be doing. Regarding HCA registration and other issues they need to become more proactive and the first step is for some who are so motivated to form a national professional association from which lobbying platforms can be launched-Coparitevely recent example shows this to be the road to registration etc.

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  • The problem facing the NHS in England is that PFI debts are starting to cripple the NHS in England.
    Scotland's NHS is independent and remains true to the founding principles.
    As the Govt's own figures show, the total public sector expenditure in Scotland is equivalent to 9.3% of total UK public spending. However, Scottish public sector revenue is 9.6% of the UK's total public sector revenue.
    Independence for Scotland will therefore mean the public sector will be protected - indeed it is needed to protect our public services from the Tory cuts we are seeing in England.

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  • MeThinks

    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.'

    I had to go an check who the author was, because this piece seemed so lucidly descriptive - it turned out to be Jenni.

    But I'm not sure the thoughts she put down, above, are consistent - she had already highlighted that HCAs vary enormously in both competence and role, and it is the HCAs who are doing more complex tasks unsupervised (or, if you wish, unsupported) who arguably need 'statutory regulation': that makes the issue of regulation tricky, because it looks like overkill for some HCAs, but necessary for others ?

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  • Although I agree where the core statement's in this article the debate is becoming rather tiresome. There are good and bad staff both on and off the nursing register.

    Registration for HCA's is frankly a long way off in my opinion with current government reform. Recruiting the NMC, whilst able to do the task at hand: would be disastrous as it appears to lack opaque management and competence currently.

    Which also raises the question who would fund HCA registration. There needs to be a fine balance of ensuring that public safety is paramount and not fleecing non-registered nursing staff -because someone somewhere realised how much money could be made out of non-registered nursing staff having to pay fees and be on a register.

    I think personally a lot of the problem is managers are too unwilling to root out low performing staff for fear of reprisal. Mangers should be supported to do this in a fair an open manner: where an individual feels they are being persecuted by their manager another manager unlinked to the area should take on the management of the case.

    I also read about the 360 tool today in NT I think this should be mandatory for all staff, it sound's fantastic as long as it is not used vindictively and people are honest. Although their is a possibility people will only say nice things about colleagues, hoping to have nice things said back which would be rather un-constructive.

    This tool could also be developed as a questionnaire and send to patients once they have been sent home and asked to comment on the performance of staff. (I often here patients say their unwilling to complain: or at least imply they feel they will be treated differently if they do) no matter how much reassurance you give that they won't.

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  • as an hca in the nhs,i take blood,do ecgs,check controlled drugs and am being asked to take the canulation course and all this for a band 2 pay,apparently i should do these things for job satisfaction !!!

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  • It is essential that the correct HCA's are recruited in the first instance. Many of us older nurses have born the brunt of the HCA who has been in post for 25years, on the same ward, goes to parties with the Ward Manager and ends up working with student nurses but using them as a pair of hands and not as a Registered Nurse in the making. This is wrong. Students have their own agenda for their placement and learning outcomes shold be identified at the time of joining the ward or dept.I really do not believe that HCA's have a clue that we as RN's are responsible for what they do and say to clients.If mobile phones were left in lockers more nursing care could be administered.Some brilliant HCA's sone dinosaurs.

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