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The RCN believes all health care assistants (HCAs) and assistant practitioners (APs) should be regulated in the interests of public safety and is committed to supporting steps towards mandatory regulation. This has been a major policy position for the RCN for many years and campaigning for regulation continues to be a priority for the organisation going forward.

Westminster government response to the Francis Inquiry

On 19 November 2013 the Westminster government issued its formal response to the Francis inquiry, which included the responses to the recommendations about health care support workers (HCSWs).

Recommendations for regulation of HCSWs were not accepted. However, the government intends to achieve the intention behind this by ensuring that organisations have ‘the right staff with the right skills to deliver care in a safe way’. They have also stated that they will keep the situation under review, and have commissioned the Professional Standards Authority for Health and Social Care to produce advice on how employers can be more effective in managing the dismissal of unsatisfactory staff. Reference is also made to the disclosure and barring service and the importance of effective delegation and supervision from registered nurses, alongside the right training for HCSWs to do the job.

Health Education England has been asked to work with Skills for Health, Skills for Care and other stakeholders (including the RCN) to develop a “Care Certificate”. This will include guidance around actions to take if a support worker no longer meets the standards required by the care certificate.

The code of conduct produced earlier this year by Skills for Health and Skills for Care will be reviewed.

In addition, the Chief Nursing Officer has been asked to lead the work around the identification of support workers. When the Secretary of State for Health Jeremy Hunt delivered his statement to the House of Commons on 19 Nov 2013 he mentioned that HCAs in hospitals will be called nursing assistants “to better illustrate the pathway to nursing”.

What happens now?

Health Education England has already set up a Cavendish Reference group which includes the RCN and many other stakeholders, with the purpose of developing the standards for the proposed Care Certificate. The work is at a very early stage and this page will be updated as it progresses.

Cavendish Review

The Cavendish Review is  available on the gov.uk website.

RCN work on regulation

The RCN has published various policy papers setting out its position on regulation. See the RCN work on regulation section for more information and details of member research about the perceived benefits of regulating health care assistants.

If you would like to contribute your own views on the issue please contact hca@rcn.org.uk

The regulation agenda forms an important part of the RCN’s This is Nursing initiative, along with training and education to ensure HCAs and APs are competent for their roles. Find out more about This is Nursing here.

Promoting good employment practice

In 2011 assurance codes were developed in Scotland and Wales to promote high quality care for patients and good standards of practice for all staff. These codes can be accessed as examples of good practice wherever in the UK you are employed. Many organisations have developed similar codes and guidelines.


NHS Education for Scotland have developed the health care support workers toolkit which includes the Scottish government's mandatory induction standards for health care support workers (HCSWs), a code of conduct for HCSWs and a code of practice for employers in Scotland. Mandatory induction standards have been in place since 2011.  Although the overall picture remains constant, with the HCSW code of conduct and induction standards in use for HCSWs in the NHS, in Scotland the Scottish Social Services Council (SSSC) currently require all their HCAs to be on a register (which is paid for by the HCAs) and they are now considering moving onto a fitness to practice model. For more information please visit the SSSC website.  


code of practice (PDF 533KB) has been developed for NHS Wales employers as well as a code of conduct for health care support workers (PDF 692KB). Principles of induction standards for health care support workers (PDF 90KB) have also been produced. A national steering group has been established to develop a career framework for health care support workers in NHS Wales.

Northern Ireland

In Northern Ireland the health and social care services are integrated. The Regulation and Quality Improvement Authority (RQIA) registers and inspects a wide range of services delivered by HSC bodies and independent sector providers. There is no mandatory regulatory process for individual support workers. However, the Northern Ireland Social Care Council is now regulating all social care assistants, including those working within nursing homes. See more information.

In Northern Ireland, the RCN continues to lobby to ensure that HCAs are appropriately regulated alongside their registered nurse colleagues. It opposes the registration of HCAs with the Northern Ireland Social Care Council as it does not believe that this is in the public interest.