HCAs ‘still invisible’ more than 10 years after major review
A decade after the Cavendish Review into the role of healthcare assistants (HCAs), and other clinical support workers, a new report has highlighted how little has changed.
The 2013 Cavendish Review, commissioned in the fallout of the Mid Staffordshire NHS Foundation Trust Public Inquiry, found that support workers lacked oversight, standardised training, fair recognition, progression and were being deployed inappropriately by employers.
“It is frustrating to see that so many of the issues and challenges I identified 10 years ago still remain”
Camilla Cavendish
The report called for all HCAs to complete a certificate in “fundamental care” before they can look after patients one-to-one in a bid to improve standards and the status of support workers.
It put forward various other recommendations on the way support workers are overseen, trained and recruited, including changing the way poor performance can be reviewed by employers, a new job title for HCAs who complete a ‘higher certificate of fundamental care’ and giving directors of nursing more of a say over the HCA workforce.
Despite the strong recommendations put forward by the Cavendish Review, however, a new report published today (23 July) – a little over 11 years later – found that several 2013 recommendations went unfulfilled, and that many of the same issues persisted to this day.
The new report, led by academics from King’s College London and the University of Exeter, analysed changes in policy since 2013 and surveyed 5,255 clinical support workers employed by the NHS in England.
Mid Staffordshire and the 2013 Cavendish Review
This new report said support staff were still “invisible”, and the survey found that four fifths (80%) of support staff did not feel as though the NHS valued their role and contributions, though most (58%) felt the team they directly worked in did.
Around a quarter (28%) “frequently” considered leaving their jobs, and a third said they did not feel like “full members” of their team at work.
Half of support workers (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.
A care certificate, a chief recommendation in the 2013 review, was implemented. However, only around half of respondents to the survey said they had completed it.
The findings suggested that, since Cavendish, support workers still wanted more support to improve their practice.
One in 10 survey respondents (13%) said they had not been able to access any formal education during their NHS career, and 97% said they would like protected time for continued professional development (CPD).
Most support staff said they lacked information about career progression and wanted support in taking steps towards being a registered healthcare professional.
The survey said only around a third (37%) of HCAs felt “clear” about the tasks they could and could not perform.
Further, it highlighted issues around recruitment; one HCA told the survey that “a lot of people” did not know what to expect when joining a trust as a support worker.
Another said new workers should be given more time to complete the large amount of initial onboarding training, adding that it “puts them off”.
Camilla Cavendish, a journalist who led the 2013 review, said of the new report: “It is frustrating to see that so many of the issues and challenges I identified 10 years ago still remain.
“When the NHS faces acute backlogs and staff shortages, it is vital to maximise the potential of all staff.”
The report concluded: “It is reasonable to say that, whilst some progress has been made in the years since Camilla Cavendish undertook her review… most of the issues she identified are still typical of how this important, diverse, and growing part of the healthcare team experience working in the NHS in 2024.
“Progress for this group of staff has been slow, intermittent, and partial.”
The nine recommendations in the King’s College London report:
- An ‘agenda for action’ to be created to improve recruitment, training, development, deployment and management for support workers in the NHS;
- Senior leaders to be “identified” and given responsibility for the recruitment, deployment and development of support workers;
- Make the care certificate, and other interventions for support workers, mandated, not just a recommendation;
- Require employers to audit the job descriptions of support staff, to make sure they match national standards;
- Review any national NHS job profiles for support staff which have not been recently reviewed;
- Allocate CPD funding for non-registered, as well as registered, clinical staff, protect study time for support staff and otherwise improve the availability of best practice training;
- Require the Care Quality Commission to consider the training, development, voice and management of all staff in inspections including support workers;
- Create a national support worker infrastructure fund. This would be used by employers to improve their training and development systems for support workers;
- Set up a taskforce to address barriers to accessing pre-registration healthcare degrees among those working as a clinical support worker.
Professor Richard Griffin, professor of healthcare management at King’s College Business School and lead report author, said support staff remained an “underutilised resource” and said 2013 was a missed opportunity to address this.
He added: “It should not be missed again.”
Royal College of Nursing deputy chief nurse Lynn Woolsey, similarly, called on the NHS to better support and make use of the support workforce.
“NHS support workers are fundamental to the delivery of services, but in the decade since the Cavendish Review little has been done to improve career progression, access to education or recognition,” said Ms Woolsey.
“The NHS should be making better use of their skills and talents, but this requires investment in their training and development. Failure to do so holds back the NHS and impacts patient care.”
She added: “Rebuilding a broken NHS can only be done when the whole of the nursing workforce is allowed to work to its full potential.
“The report’s recommendations, including on providing ring-fenced funding for continued professional development, creating a national support worker policy agenda and reviewing all job profiles, should be acted upon.”
