Tanis Hand, HCA Adviser

The RCN believes all HCAs and APs should be regulated in the interests of public protection and is committed to supporting steps towards mandatory regulation
This has been a major policy position for the
RCN for many years

The work of the HCA and AP brings them into intimate contact with vulnerable patients and therefore raises significant issues for patient safety and public protection. ( RCN 2004)
It is generally accepted by both the wider health team and HCSWs that regulation is necessary. (DH 2006)
(RCN 2009)

The register
Education
Competence
Performance management
Setting standards
Quality assurance i.e. public protection

Education and training
Code of conduct
Role definition
Career development
Recognition and value to the role

Professionally-led
(statutory)
Employer-led
Voluntary registration

Protects professional boundaries
Lists those entitled to practice
Protects professional title
Establishes professional standards for practice
Controls admission and removal from professional register

Independence of the professional body
Able to set and enforce standards separate from local employment context
Could be costly for registrant
Large potential numbers
Who would register
HCAs & APs in various disciplines or cross-discipline workers?

NHS Scotland: From 1 Jan 2011 has established:
Mandatory induction standards for HCSW
Code of conduct for HCSWs
Code of practice for employers
(n.b. covers Bands 1-4 and only NHS)
NHS Wales: From 20 Jan 2011 has established
“assurance codes”:
Code of conduct for HCSWs
Code of practice for employers
(n.b. Also only NHS)

Employers can hold relevant information on individual HCAs and APs
Would enable regulation of
HCAs/APs working across disciplines
Mobile workforce – difficulty tracking
HCAs/APs as they move around
Hard to develop a model to cover all employers
Consistency issues across different employers

Reducing regulation is a key priority for Coalition government
Aim: to drive up standards ... to improve serviceusers’ experience
... through a system of “assured voluntary registration”
“Enabling Excellence” (DH 2011)
A command paper is issued by the Government and presented to Parliament as conveying information or decisions that the
Government think should be drawn to attention of Parliament

CHRE (Council for regulatory excellence) would become the national accrediting body for unregulated health professionals UK-wide
CHRE would set standards against which the voluntary registers will be judged
Existing statutory regulatory bodies would be given powers to establish voluntary registers
(funded by those who choose to join the registers)
Voluntary registrants would not be subject to full statutory regulation

Flexible, more
“proportionate approach”
May assist public seeking care from selfemployed practitioners to choose those on voluntary register
Regulation will be avoided by some
Removal from register would not be very meaningful
Employers are not compelled to employ staff from registers
There will still be a cost to register

House of Commons 2011a
HCSWs should be regulated
Registration with a regulatory body should be mandatory, and a distinction must be made between regular HCSWs and APs
APs perform more invasive, higher-risk procedures and should therefore be regulated differently than other support workers

Regulation must not just be about fitness to practice but must also focus on induction, standardised training and education.
There must be a mechanism in place to deal with
HCSWs who do not perform to standard, and there is currently no such mechanism.
(House of Commons Health Committee 14.06.11)

House of Commons
Health Committee
_________________________
Annual accountability hearing with the
Nursing and Midwifery
Council
_________________
Seventh Report of Session
2010–12
Report, together with formal minutes, oral and written evidence
Health Select Committee
26 July 2011
(House of Commons 2011b)

(HOC 2011b)
Voluntary registration ... would “be avoided by the people about whom there is most concern.” The recent scandal at
Winterboune View in Bristol underlines the issues around registration of healthcare assistants
The Committee believes that HCSWs should be regulated, not necessarily in an identical manner to nurses and midwives but there should be a regulatory framework that is not voluntary

(HOC 2011b)
The Committee endorses mandatory statutory regulation of healthcare assistants and support workers and we believe that this is the only approach which maximises public protection.
The NMC needs to make significant improvements in the conduct of its existing core functions (such as in how it manages fitness to practise cases) before powers to register these groups are handed to it.

We absolutely support the recommendation for a system of mandatory, not voluntary regulation of healthcare assistants. The RCN has been calling for mandatory regulation for some time and we believe there is a public protection issue, particularly around care of the elderly and as witnessed in recent cases such as Winterbourne View.
We are now committed to working with the NMC about how to make this a reality.

RCN 2004 The future nurse: The future for professional regulation. RCN, London
DH 2006 The regulation of the non-medical healthcare professions - A review by the Department of Health www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/
@en/documents/digitalasset/dh_4137295.pdf
RCN 2009 The Assistant Practitioner Role: a Policy Discussion
Paper. Policy briefing 06/2009. RCN, London.
DH 2011 Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care
Workers. Department of Health, Leeds.

HOC 2011a Health Committee 14.6.11: MPs question the professional regulators for doctors and nurses www.parliament.uk/business/committees/committees-az/commons-select/health-committee/news/news---gmc-and-nmcev/
HOC 2001b Health Committee 26.7.11: Seventh Report:
Annual accountability hearing with the Nursing and Midwifery
Council www.publications.parliament.uk/pa/cm201012/cmselect/cmhe alth/1428/142802.htm

hca@rcn.org.uk