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Nurse dressing 3

Building the first comprehensive picture of NHS England's Healthcare Support Workers

Work led by Professor Ian Kessler of King’s Business School has made a significant contribution to improving the skills of over 150,000 healthcare support workers who provide the majority of routine bedside care in the NHS. His work informed the creation of the first ever National Strategy for Healthcare Support Worker Training and Development published in 2015, as well a more recent review.

Unregulated and unregistered Healthcare Support Workers have been a feature of the NHS since its inception, but by the late 1990s had taken on an increased share of bedside care as changes in treatment meant nursing roles became more technical and managerial. Given their importance to patient care Professor Kessler explored how Healthcare Support Workers are trained, deployed and developed, and how they interact with patients and colleagues.

Between 2007 and 2009 he conducted interviews and focus groups with over 250 Healthcare Assistants, nurses and recently discharged patients as well as a larger scale survey. This was supplemented with 275 hours of non-participant observation on 11 hospital wards.

You see more of the healthcare assistant, so the relationship does develop differently. I think sometimes the patients can see the support workers as actually doing more for them than the trained staff.– A patient in Professor Ian Kessler’s study explains the crucial part Healthcare Support Workers play in bedside care.

While the championing of Healthcare Support Workers in some individual workplaces was found to help ensure they were effectively utilised, their nurse colleagues were often wary and unsure of the part Healthcare Support Workers should play in the team as a whole. Professor Kessler also identified a general lack of best-practice sharing between healthcare providers which meant that these issues were not being addressed consistently.

‘Talent for care’

These findings influenced Health Education England’s 2015 strategy for the training of Health Support Workers in NHS England: ‘Talent for Care’, and in mid-2016 Professor Kessler were invited to evaluate the strategy’s initial impact. His examination of 20 healthcare settings and a survey of healthcare providers in NHS England found that the strategy was already gaining considerable traction.

Often for the first time, Healthcare Support Worker training and development were being considered at board level, prompting changes in practice designed to increase recruitment, provide more structured training opportunities, and allow career progression into more advanced Healthcare Support Worker roles.

There was also widespread adoption of specific actions recommended by the Talent for Care strategy including more robust induction programmes for Healthcare Support Workers, the development of formal competency frameworks for HSWs; and the establishment of secondment schemes for HSWs to train as registered nurses.

Professor Kessler and colleagues have also conducted a review of Talent for Care in the light of more recent policy shifts, including the government’s encouragement of apprenticeship training in the NHS and the development of a new, registered advanced support role. The result has been the development of an apprenticeship career pathway for Health Support Workers which allowed them to progress into registered nursing. Recent data suggested that there are now around 4,000 individuals on the different stages of this apprenticeship pathway.

In this story

Ian Kessler

Ian Kessler

Professor of Public Policy and Management