Back in 2005 healthcare assistants received their 15 minutes of fame after health secretary Patricia Hewitt spoke of an ‘army of unsung heroes’ delivering outstanding care on a daily basis.
She was so impressed with what she saw in a morning spent working ‘undercover’ with a maternity support worker at a London hospital that she pledged £60m of funding for continuing education and training.
Of course, the role of the HCA is certainly not new – they have been supporting nurses since the time of Florence Nightingale.
But in recent years, their place within the NHS has undergone a real transformation.
Working in care homes, hospitals, mental health, in the community and the GP surgery, they are at the coal face of patient care and the NHS would simply crumble without them.
In hospitals HCAs may work on the general ward taking blood pressures, helping patients to eat or wash, making and changing bedding; in outpatients helping to run the clinics; or in specialist units such as renal dialysis.
But that’s just the beginning of the story. Other areas of healthcare that might not immediately spring to mind when considering the work of HCAs include podiatry, occupational therapy, orthotics, dietetics, physiotherapy, radiography, and speech and language therapy.
In primary care, the introduction of the new GP contract in 2004 brought with it a raft of changes in the daily working of the healthcare team. Nurses became more specialised and started to run their own clinics for long-term conditions, opening up a world of new possibilities for the HCA.
Under the guidance of the general practice team HCAs can take on a wide range of tasks including phlebotomy, ECGs, weight management, smoking cessation and administering flu vaccinations. In fact the role is so varied and dependent on their area they work in it can be hard to explain to potential new recruits what HCAs do.
An important distinction between the role of the HCA and nurse is that, although much of their care may overlap, the nurses are largely responsible for assessing and delivering care themselves, whereas HCAs have work delegated to them.
But in the hospital ward, patients who need help getting to the bathroom, or to have a blood pressure or temperature measurement taken will not necessarily realise or care about the distinction. They simply care whether they are receiving good care from someone who takes the time to listen to them and any concerns they may have.
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One of the most rewarding aspects of working as a HCA can be building up a rapport with patients, allowing them to confide in you or for you to reassure them of an aspect of their care.
Alanzo Smith, a HCA on a male acute mental health ward in St Ann’s Hospital in Haringay, London, says the relationships HCAs can build with their patients is by far the most rewarding part of the job.
‘It can be quite challenging but seeing them get well and being discharged is a really good feeling,’ he says.
‘We do arrange time to have one-to-one chats with most of them.’
In addition to the routine caring jobs on the ward, Alanzo is in charge of organising activities, such as table tennis or pool.
These social therapies are important to service users – they are seen as part of their therapy and can make an immense difference to their recovery and are an opportunity to socialise. They can also reduce dependence on medication to manage their condition.
And HCAs often act as the go-between, feeding the relevant information back to the rest of the healthcare team.
As crucial members of the healthcare team HCAs work on the same shift or rota systems as other healthcare professionals.
However, many can have flexible working arrangements, particularly due to the wide variety of areas HCAs can work in.
The exact daily tasks required of the job depend on the specialty. For example, in a maternity service, HCAs will help the midwives, support mothers as they learn to care for their babies, breastfeed and become independent, assist in running classes for new parents, as well as undertaking clinical duties of taking blood pressures and helping out on the wards. They often also have a caseload of new mothers who they visit at home to support as necessary.
Peter Nzekwe, a HCA in the outpatients department for the North West London Hospitals Trust describes a typical day: ‘I help the doctors, sit down with patients and also take blood and do minor dressings. I’m the link between the doctor and the patient.
‘We also look for missing notes, make sure all the information is up to date, call porters if they are needed and help patients find their way between departments.’
He adds: ‘Patients see you as someone they can talk to – they can just be lonely and bored. It gives me real joy to put a smile on a patient’s face.’
Anyone thinking of becoming a HCA would perhaps benefit from doing some voluntary or part-time work first to get an idea of what would be expected of them.
Some work can be messy and challenging and can involve dealing with vulnerable, distressed, demanding or even mentally unwell patients. Good communication skills are vital for HCAs, as they are dealing with intimate situations and patients will welcome being able to open up to them.
Although the role of the HCA is more embedded in the NHS than it ever has been there are still barriers to overcome.
This includes obtaining appropriate training and being fully integrated in the rest of the healthcare team. Some HCAs talk of being excluded from staff meetings or not being listened to by management.
Alanzo adds: ‘Qualified nurses do leave us to get on with stuff while they do paperwork. I’d like to see them muck in a bit more.’
One perk of the job, however is if you are not happy or supported where you are there is a huge amount of opportunities in the NHS for HCAs – it’s just a case of being brave enough to make the change.