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Nurses have reiterated longstanding demands for the regulation of healthcare assistants (HCAs) and other non-registered nursing staff.
At the Royal College of Nursing (RCN) annual congress for 2024, which is taking place this week in Newport, members voted overwhelmingly in favour of a motion asking the union to lobby the government on regulating the nursing support workforce.
“RCN has long called for regulation of the nursing and healthcare support workforce in the interests of public protection and public safety”
Rachel Hollis
HCAs, sometimes referred to by other titles such as nursing support workers or healthcare support workers, are normally on Agenda for Change bands 2 or 3, and are not currently regulated by the Nursing and Midwifery Council (NMC).
The NMC, since 2019, has regulated the band 4 nursing associate role in England and the Welsh Government is now seeking to have a similar band 4 regulated role in Wales.
However, while demands for HCAs to be regulated have persisted for over a decade, the NMC is yet to take the idea forward.
Motion proposer Kevin Morley, an HCA himself, said regulation would allow for the support workforce to have standardised education and core standards, similar to that of regulated clinicians, which in turn would protect both staff and patients.
Rachel Hollis, an RCN member from Yorkshire and chair of the RCN professional nursing committee, said the regulation of nursing associates was a “step forward”, but that it “only emphasised” the need to extend regulation to other parts of the nursing support workforce.
“RCN has long called for regulation of the nursing and healthcare support workforce in the interests of public protection and public safety,” said Ms Hollis.
“Others have echoed that call, but the complexity of regulation over such a large and increasingly diverse workforce has left the issue in the ‘too difficult’ pile, when it comes to regulatory reform.”
She said the lack of regulation had led to inconsistent education and training of HCAs across the country, and claimed this meant registered nurses who rely on support from them, and patients, were put at risk.
London nurse Sammi Colman highlighted that the work-based nature of their training could result in HCAs lacking the core competencies to safely move between different care settings or specialties.
Similarly, Sharon Mitchel, who trains support workers at her trust in the South East of England, said that, currently, there was huge variation in the quality of training for this part of the nursing workforce.
“[HCAs] in my trust are fabulous, because I train them, but I have healthcare assistants come in from other areas, other organisations, who think they are trained, until they come to mine – then they know what training really means,” she said.
“You need to know, as nurses, that the people working alongside you know what they are doing. How do you really know? You trust that they do.”
Regulation of this workforce, Ms Mitchel said, would mean nurses could have more assurance that support workers had the right competencies.
“Nurses put so much trust in us [as HCAs]; it’s lovely, but surely you worry about your PIN. We need to be registered, so you can be assured that we are there to help you,” she added.
HCA member Tracie Culpitt said regulation could help prevent the workforce from being asked to perform tasks they were unqualified for.
She said: “There is no quality assurance pathway.
“With a standardised structure, with regards to regulation, I feel this would promote team working, but most importantly explicit individual responsibility for patient safety and welfare, and protection when HCAs are asked to undertake activities not part of their remit.”
Tracie Culpitt speaking at the debate
Recent industrial action across England, particularly the North West of England, highlighted frustration from the nursing support workforce about performing duties above their pay grade.
Dawn Marr, at the RCN debate, said this increasingly common practise was further cause for bringing support workers under the NMC’s list of regulated roles.
She said it would be a “vital step” towards a more trustworthy and efficient healthcare system.
No RCN speakers aired opposition to the motion. However, member Lyndsey Curtis-Dawson said any regulation of support workers should be done “carefully”.
She explained: “As a registered nurse, I have to pay £120 each year [to the NMC] for the privilege of practising my profession.
“What we need to ensure, in a financial crisis, is that this doesn’t detrimentally financially impact our [HCAs].
“We need to be very careful with this. We don’t want to say [to HCAs], ‘You have been doing this for years, you’re amazing but actually we will come in and regulate you now because what you’re doing isn’t good enough.’”
She further questioned who would regulate the nursing support workforce in social care.
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