Anne Marie Lee RPHN, Chairperson Alliance of Health Care Assistants.

A vision for healthcare assistants

Many informative articles have been written in various newspapers about the state of the health services, the pay and working conditions of doctors and nurses.

However very little is ever written about the group of healthcare assistants who are the unsung heroes of the care services. Healthcare assistants provide a unique blend of personal and social care services.

We know from an ERSI report on the demand for healthcare to 2030 that the ageing demographic in Ireland is going to lead to a significant increase in demand for healthcare services.

Nobody is talking about how this tsunami in demand is going to be met. With families dispersed all over the world, who is going to care for the aging population?

In its current form, the HSE will not have the budgets to meet the increase in demand. Ireland needs to take this issue seriously and to start planning for the future care needs of the nation.

Planners need to reserve sites in each community for low dependency sheltered living accommodation. This would help meet the Government’s object of getting older people to release their larger properties back to the market in favour of sheltered accommodation.

Developers need to be mandated to provide space for sheltered accommodation in each community. These low dependency units could be run by healthcare assistants providing a significant increase in care services and freeing up other facilities including hospitals to take on higher dependency care recipients. These units could then be linked to residential care centres with step-up care services.

30 years

Healthcare assistants have been employed in this country for almost thirty years. They began to be employed in greater numbers in the mid ‘90s when nurse training moved into the universities. The nursing apprenticeship system no longer existed.

This was also the time when active recruitment of nurses from other countries began. Twenty years later, we have staff from around the world and there still is a chronic shortage of staff.


80,000 in Ireland

In Ireland we have up to 80,000 healthcare assistants, trained and untrained, working in all sectors of the health services. They are a hidden asset that can be tapped to help meet the future care needs of this country with the right planning, resources and management.

We must look to them, value them, encourage them to play a greater, more educated and competent part in the care sector.

A higher trained healthcare assistant with clinical skills could be the means of releasing older people from hospital to be cared for in their own homes. They would still work with the registered nurse who could assess the patients and delegate a range of clinical tasks as required.

In Europe a study showed that 60 per cent of the activities in a nurse’s role with the right training and education could be carried out by a competent qualified healthcare assistant.

Currently the Health Information and Quality Authority (HIQA) has no prescription for a national standard of mandatory training for healthcare assistants, that is left up to the employer and his/her requirements.

Healthcare assistants carry out all the hands-on tasks with the care recipient yet they have no status in the national system. There is no regulatory body and their scope of practice has not been defined. All of these factors are inhibiting the expansion of the role of the healthcare assistant which is required to meet the increase in demand for care services.


The Alliance of Health Care Assistants (AHCAI) came into being in 2015 and hopes to change this status quo. It is an organisation for healthcare assistants founded by a small group of healthcare assistants, and laypeople who valued the care they received when family members were in need.

Healthcare assistants make up 50 per cent of the board of directors and 50 per cent of the executive council.

The AHCAI are working to raise the profile of the healthcare assistant and create a career path and lobbying for regulation for this discipline, so it can stand shoulder to shoulder in recognition and respect with other disciplines in the healthcare sector.

AHCAI represents healthcare assistants in all sectors of the service. It is a not-for-profit company and registered charity. AHCAI is involved with an industry-led consortium of private healthcare providers and Griffith College - the coordinating provider - in preparing a two year apprenticeship program at Higher Certificate level 6, for healthcare assistants.

It is an industry-led apprenticeship during which healthcare assistants will acquire a greater knowledge of health and illness, work autonomously and become competent in a range of clinical and social care skills to assist the registered nurse.

The proposal was accepted by the Apprenticeship Council and announced, alongside twenty or so other apprenticeships, by the Minister for Education Richard Bruton on 8 December 2017. The course will begin early in 2020.


The next step in the process is to seek regulation for this higher-grade of healthcare assistant so that they will have a national scope and code of practice and ethics. The higher-grade healthcare assistants will be responsible for their own practice. All this is coming about in consultation with healthcare assistants rather than having decisions made about them without them.

Looking into the future, AHCAI intends to seek a national standard of training registration for existing level 5 qualified healthcare assistant and regulation for higher certificate healthcare assistant.

This in fact, is creating a career path for the discipline of the healthcare assistant. It is intended that this discipline will become attractive to school leavers.

When healthcare assistants were first employed in numbers, they were distinguished from home helps by the fact that their duties were ‘hands on’ tasks for the care recipient, showering, dressing, feeding etc., while home helps carried out domestic tasks, cooking, cleaning, shopping. The work has become blended in the past ten years.

Healthcare assistants are, in some cases, being offered multitask contracts, where they can be requested to work with the care recipient or carry out housekeeping tasks. This practice is not ideal as it can lead to a lack of infection prevention and control.

AHCAI keeps healthcare assistants informed through Facebook and Twitter. They offer free CPD courses on the members section of the website for which a certificate of course completion is issued.

Their first conference was held in Dublin last February and their second conference will be held in the Kingsley Hotel, Cork city in February 2020. Tickets cost €10 and will be available from Eventbrite at a later date.

The theme will be Working to Build a Better Future for Healthcare Assistants. The alliance aims to be the voice of the healthcare assistant, uniting them and assisting them in forming a career path, raising their status through training and regulation/registration and having them recognised as a valued discipline in the health service.

Visit for more information.