Around a decade ago, a key report announced its recommendations on the training and support of healthcare assistants and support workers in NHS and social care.
That report, which contained the findings a review commissioned in the fallout of the Mid Staffordshire NHS Foundation Trust Public Inquiry, was a big deal when it came out in 2013.
“HCAs represent a major workforce resource for the health and social care sector”
The Cavendish Review – as it was known due to its lead author, the journalist Camilla Cavendish – lifted a lid on what was largely, and probably still is, a workforce unrecognised to the public.
Patients may call for a ‘nurse’ but never an ‘HCA’, even though the chances are that it could well be an HCA or other support worker who is providing the bulk of their day-to-day care.
HCAs represent a major workforce resource for the health and social care sector; often doing some of the jobs associated with nursing of the past and often with the experience of years of caring.
And yet, as well as the public, it feels like a workforce of a million plus are largely ignored by the health and care system too, other than to fill rosters and go about their work competently.
They remain unregulated and there has never been any real appetite to change this. Possibly because the Nursing and Midwifery Council has always struggled with its existing register duties.
Likewise, pay and progression, and training and development feel less accessible to this vital group of workers. With that said, Unison has been waging a successful campaign recently to improve HCA pay.
However, the lot of HCAs and other support workers remains somewhat under the radar. And that was where the Cavendish report was supposed to come in. It was supposed to change things.
It found that support workers lacked oversight, standardised training, fair recognition, progression and were being deployed inappropriately by employers.
As a result, it proposed that all HCAs and social care support workers should undergo the same basic training, based on the best practice that already exists in the system, and must get a standard ‘certificate of fundamental care’ before they can care for people unsupervised.
Controversially, certainly at the time, it did not include the question of whether HCAs should be regulated in its terms of reference.
This was despite HCA regulation having been a recommendation of Robert Francis QC’s report from the Mid Staffordshire NHS Foundation Trust Public Inquiry
But, even more controversially, there was little formal response to the findings from the Department of Health and Social Care. Try searching for ‘government response to Cavendish review’. Nothing!
What did happen was that, in May 2014, the Nursing and Midwifery Council and Health Education England officially announced a review into nurse and healthcare assistant education and training.
That’s correct, another review. The resulting Shape of Caring report did, ultimately, lead to the creation of the nursing associate role and the recommend HCA certificate was introduced in 2015.
But a new report, led by King’s College London and the University of Exeter, has analysed changes in policy since 2013 and surveyed 5,255 clinical support workers employed by the NHS in England.
This new report said support staff were still “invisible”, and the survey found that 80% of support staff did not feel as though the NHS valued their role and contributions.
In addition, 28% “frequently” considered leaving their jobs, 53% said they would not recommend their job to others and a large majority felt underpaid.
The survey also asked about progression, education and training – a significant theme of the 2013 review. Only around half of respondents to the survey said they had completed the care certificate.
The findings suggested that, since Cavendish, support workers still want more support to improve their practice, and only 37% of HCAs felt “clear” about the tasks they could and could not perform.
Most said they lacked information about career progression and wanted support in taking steps towards being a registered healthcare professional.
All in all, the conclusion can only be that not much has changed for HCAs and their social care counterparts in the more than 10 years since the Cavendish review.
This feels like a significant missed opportunity. I’m certainly not saying we need another review as, like the experience of HCAs themselves, not enough has changed to warrant one.
But it is clear that support workers need more support themselves to be the best they can be and fulfil their massive potential as part of the health and social care workforce. Now is the time to act.
Steve Ford, editor, Nursing Times