One of the significant current discussions in healthcare since the Francis Report, concerns the regulation and training of Healthcare Assistants. Healthcare Assistants (HCAs), also known as Healthcare Support Workers, work in a wide variety of healthcare settings from GP surgeries and clinics to acute hospital wards. There are 1.3 million of them working in front-line care roles in the UK (DoH, 2013). These workers are currently unregulated and at present there is no compulsory role-specific training. HCAs are legally permitted to carry out most clinical tasks of a Registered Nurse, however, there is no definitive list stating what tasks they can or cannot undertake. This paper will attempt to demonstrate that there is an urgent need for HCA regulation and standardised training. It has been divided into four parts. The first part deals with the arguments for HCA regulation, the second with the hurdles that regulation would bring and the last part will attempt to draw some concussions and recommendations.
In response the Francis Report (Francis, 2013), published in February 2013, which highlighted poor care and management at the Mid-Staffordshire NHS Trust, the Independent Cavendish Review made recommendations regarding the recruitment, training and regulation of HCAs. The Cavendish Review (DoH, 2013) concluded that HCA training varies greatly between NHS trusts. This is particularly concerning when the core of patient care is now being carried out by HCAs rather than Nurses (Kessler, 2012). There also exists ambiguity surrounding what tasks HCAs are allowed to carry out. This poses significant risks to patients, nursing staff and HCAs themselves. The Nursing and Midwifery Council state that;
‘A nurse or midwife should only delegate an aspect of care to a person who has had appropriate training and whom they deem competent to perform the task … they must be assured that the person to whom they have delegated (the delegatee) fully understands the nature of the delegated task … The delegatee should know their limitations and when to seek advice from the appropriate professional in the event that circumstances change’ (NMC, 2013)
This guidance is not sufficiently robust. For example; if a HCA states that they are confident and able to carry out a clinical procedure there is the danger that things can go wrong and even though the Nurse is still responsible for the overall care of their patients, by accepting a delegated task the HCA then becomes legally accountable for their actions. If the HCA is not sufficiently competent to carry out the task there is the potential not only for the patient to be harmed but for the HCA to face criminal proceedings; which would be unfair when taking into account they may not have had appropriate training and may have felt pressured to carry out the tasks in a busy clinical environment. When working with unfamiliar staff, agency workers for example, Registered Nurses have no way of reliably checking a HCA’s...