Following the Francis report into care failings in Mid Staffordshire, there is debate within nursing about the regulation of healthcare assistants (HCAs).
Nurses are divided on this issue. On the one hand, our brilliant, often highly skilled, unregulated workforce provides a service to support nursing care, without which many parts of the NHS would be unable to function.
On the other hand, the standard of preparation for the role is highly variable; career pathways lack clarity and HCAs do not subscribe to a professional code of conduct. This is extraordinary when you consider they provide the most intimate of care to the most vulnerable of patients, including our frail elderly population.
One argument for regulation being unnecessary is that HCAs deliver nursing care under the supervision of nurses, who ultimately take responsibility for the work delivered by this part of the unregulated workforce. In hospitals, where nurses, doctors and allied health professionals work in teams in the same environment, it is likely HCAs will work under the direct supervision of a nurse and can call on their assistance when help is needed with patient care; their day to day work is immediately visible to the team.
However, in the community, HCAs are at their least visible and their least directly supervised. They need to be skilled and competent practitioners to be able to deliver care in patients' homes at a very long arm's length from the supervising nurse. The argument about close supervision just does not hold in the community, where there is huge support for their regulation, both to provide recognition of their skills and competence - and protection for the public.
The QNI has campaigned for the past two years on this issue and welcomes Francis' recommendations. I have heard it posed that we cannot afford to regulate this section of the workforce; I ask however, with a growing older, frail and vulnerable population, increasingly reliant on care delivered by HCAs, how can we afford not to?