The changing role of the healthcare assistant

Headnote

Abstract

Background This article analyses the changes made to the role of the healthcare assistant (HCA) in the British healthcare system and identifies when and why these changes occurred. The main influences on the role of HCAs, from the time of Florence Nightingale through to the present day, are discussed.

Conclusion The role of the HCA has progressed from being an undervalued 'dead-end' job, to a skilled role that is recognised nationwide. However, the future of the HCA role is uncertain.

Key words

* Education: vocational qualifications

* Healthcare assistants

These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.

THE DEVELOPMENT of the role of healthcare assistant (HCA) from its origins during the Crimean War (1854-1856) is traced in Box 1. This was the first time that 'nurses' aides', as they were then called, were recognised as members of the nursing team. Florence Nightingale acknowledged their value and considered them to be assistants to trained nurses, working closely with them under direct supervision (Kershaw 1989). They continued to be used and the concept of unqualified aides came under scrutiny. The Health Care Act of 1919 attempted to define a boundary between unqualified assistants who were fit to practise and those who were not (Witz 1992). However, the act failed and in 1955 the nursing auxiliary was given formal recognition in the healthcare setting (Thornley 2000). This constituted part of 'grade dilution', the state redefining grade boundaries, to allow the use of cheap labour in place of more expensive grades (Thornley 1996). The nursing auxiliary's role expanded rapidly, particularly at times of staff shortages (Abel-Smith 1960, Dingwall et al 1988, Stacey 1988).

From its inception, the HCA's role remained largely undeveloped until 1984, at which point the UKCC undertook a review and reform of nurse education and training (Roberts 1994). This was the beginning of Project 2000 which was launched in 1986, making the emphasis on nurse education more academic than experiential and moving nurse education from hospitals to institutes of higher education. Training for enrolled nurses (ENs) and first level RGNs was stopped and nursing students gained supernumerary status (Roberts 1994, UKCC 1986).

As a result of the reforms of the...