Anne Marie Lee, Chairperson, Alliance of Health Care Assistants in Ireland.

Planning a career path for healthcare assistants

Irish nursing grew out of the charitable works of middle-class gentlewomen who visited the sick poor in their own homes.

Following on from this came the founding of the Sisters of Mercy and the Irish Sisters of Charity in the first half of the 1800s and the setting up of St Vincent’s and the Mater Hospitals for the sick poor.

Women who worked as nurses were untrained; the requirement for employment as a nurse in hospitals was that they be of good character and able to read and write. Formal nurse training began in the Dublin hospitals in the 1870s.

In the past all Irish nurse training was in the apprenticeship system. So, many weeks were spent on the wards under the supervision of registered nurses and a lesser number of weeks were spend in the classroom.

It was while working in a hospital in Edinburgh in 1970 that I came across the first university trained nurses on placement in the hospital. In the late 1960s nurse training in Scotland was transferred to the universities and it wasn’t until 1996 that Ireland caught up and introduced the diploma in nursing which was followed quickly by the degree.

According to the University of Edinburgh: “In 1972, Edinburgh University established the first chair of Nursing Studies in Europe, appointing Margaret Scott Wright as the first incumbent. The chair was created in line with the recommendations of the Briggs Report (1971) which strongly supported university-level nurse education, arguing that an academic setting was vital both for developing professional knowledge and for training cadres of graduates with leadership qualities.”

To accommodate this change in nurse training and the temporary gap in new staff coming on stream that was created in the Irish healthcare system, suitably qualified nurses were recruited from abroad and healthcare assistants began to be employed in greater numbers.

On graduating and with some experience on the wards, these new nurses had a higher level of knowledge and competence in healthcare than those trained in the apprenticeship system. This has left a gap in the service which is being filled to a certain extent by healthcare assistants, however, there is much room for improvement.

In all disciplines in healthcare there is a history of improvement and development. It is now the turn of healthcare assistants (HCAs) to be afforded this privilege.

There is room for career development in this discipline. Currently there is no statuary requirement for training for HCAs, many do not have any formal training qualification for the tasks they are expected to carry out. All healthcare assistants should have statutory training qualifications. We must have a national standard of training and registration for all HCAs.

The Alliance of Health Care Assistants, ( the representative body for HCAs suggests a three-step career path.

A reformed QQI Level 5 ‘Healthcare Support’ eight module training course with work placements. At this level the HCAs will be qualified to carry out personal and social care with the care recipients in all branches of healthcare.

There will be registration with a national written scope and code of practice at this level. HCAs may choose to remain at this level and their contribution is essential to the delivery of the service.

They will continue to work to the registered practitioner.

The HCA will complete a two-year apprenticeship program in addition to their level 5 award from which they will acquire knowledge skills and competencies required to work autonomously and deliver a defined range of clinical skills. They will be in a position to train the students studying at level one and may take responsibility for a team of HCAs in their workplace.

This apprenticeship course has been approved and written and is currently with QQI for validation. It will commence later this year.

Those qualifying at level two will be called Advanced Healthcare Assistant Practitioners (AHAP); they will work to the registered practitioner and be accountable for their own practice. The registered nurse can delegate a defined range of clinical tasks to this AHAP. They will be regulated with a national scope and code of practice. AHAPs may choose to remain at this level.

The HCA can choose the path they want to take. They will have the option of attending further education in the form of a degree in social, community, or nursing care. They could also attend a management programme.

In order to meet the ERSI predicted increase in demand for healthcare services to 2030 due to the ageing demographic in Ireland, it may be necessary to set up through private and public collaboration, small residential units in each locality on a not-for-profit basis to house older people. There will would be eight to ten residents in each unit. These people may be frail elderly, have dementia or Parkinson’s disease or other conditions which do not need nursing care but render the people unsafe to live on their own.

It is envisioned that these units be managed by an AHAP working with a team of HCAs. They could be overseen in groups of five or six units by a lay manager who would hire staff, deal with purchasing, salaries, insurance and overall supervision of the units.

In these residential care homes, the residents would be entitled to visits from the public health nurse (PHN) and the community nursing team, ancillary healthcare workers and alternative practitioners. The community care services would attend these units in the same way as they attend families in their own homes however, they would be able to achieve economies of scale by meeting each resident on the same day.

It would be essential that these residencies would be based in a person’s own community to ensure continuity of relationships and activities. Residents would be able to come and go as they please, have their own car and use the services as they need them.

It would provide residents with the comfort that they know there is somebody to call on if they get into difficulty. This plan or one similar to it must happen, to meet the required level of elderly healthcare services required in Ireland.

The healthcare assistant is vital to the provision of these services.

Healthcare assistants provide a unique mix of social and clinical care to care recipients. Nurses with their four years of academic training will be required to operate at the upper end of their scope of practice in the public hospital system, for which they have been trained, to meet the demands of the public health service.

The current combination of low pay rates and lack of status is making it very difficult to recruit and retain HCAs in the service. It is essential that as a nation we correct this immediately by valuing the role of the healthcare assistant and the creation of a career path that we would recommend to our children.

The Alliance of Health Care Assistants in Ireland are holding their second conference in the Kingsley Hotel Cork on 29 February, which is open to the public and at which the above issues will be debated.

Tickets through All healthcare assistants and support workers are welcome to attend.