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

An ineffectively utilised healthcare resource

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

There is a recurrent theme in the media about the struggling health services in Ireland.

This includes: long waiting lists, people on trollies in A&E, inadequate services for specialist groups such as those with autism, scoliosis, cerebral palsy and others, and greatly reduced respite and day care for those struggling to care for loved ones at home.

This is blamed on the pandemic, a great excuse, but don’t be fooled; the health services in this country were well on their way to a state of disfunction before Covid. Wasn’t that why Sláintecare was set up?

We hear about medical and nursing staff recruitment and retention problems, not only because salaries could be better in the face of a high cost of living, but also because working conditions have been deteriorating as the workload increases for those who have remained in the service; and this is coupled with a certain lack of respect and gratitude all round.

Nationally there are thousands of health care assistants (HCAs) working in all sectors of the health services both public and private.

When nurse education was transferred to the university in 1995, qualified staff had to be found to replace the students who had fulfilled staffing requirements while training in the apprenticeship system. Managers began recruiting trained staff in the Philippines, India and elsewhere.

Around this time HCAs began to be employed in the health service in numbers. Initially they were trained by the nurses with whom they were working.

Later ‘in-house’ training was provided for them until, in more recent years, individual FETAC/QQI Level 5 modules became available.

A directive went out from the Health Information and Quality Authority (HIQA) that all healthcare assistants employed from 2014 should have the FETAC Level 5 Major Award. This directive was withdrawn in 2016 when the new document entitled National Quality Standards for Residential Care Settings for Older People in Ireland was published, replacing the document of the same name produced in 2008.

It is now up to the employer to assess the suitability of the candidate for a job as a healthcare assistant. Could this be regarded as a backward step in the development of a discipline which is crucial to the delivery of the health services nationally?

The Health Care Assistant (HCA) is an asset to nurses and midwives in all sectors of healthcare. There is an opinion that HCAs will be employed in place of the nurse and in truth that is not an unreasonable fear, particularly in the private sector, because HCAs are cheaper to employ.

However, this cannot happen where mandatory ratios are set and monitored for the number of HCAs to nurses and to patients. In taking on the personal and basic nursing care of the patient, the HCA releases the registered nurse/midwife to concentrate on their own role development, to enhance their competencies and expertise to better meet the needs of the patient.

It is now more than twenty five years since HCAs began to be employed in numbers. It is time that an adequate number of HCAs were trained up to a basic level of clinical competencies. This new grade of healthcare worker could implement a greater portion of the patient care plan under the direction of the registered nurse, allowing for a higher number of homecare packages to be rolled out, more patients needing home care to be discharged from hospital and more patients receiving their medical/nursing treatment from their own homes.

It would in time help to relieve the stressful working conditions in hospitals as much of the routine basic clinical care could be carried out by trained HCAs.

The HCA is not a qualified nurse and will not erode the role of the qualified nurse but rather enhance it by improving the working conditions, increasing staff numbers, being a valuable resource in the delivery of care.

Neither will the HCA take away duties from the qualified nurse who would prefer to carry out these duties him or herself.

But the HCA is long enough a part of the health services in this country to have their discipline developed through mandatory training and regulation and the formation of a career path. It is time that the discipline of healthcare assistant was included on the career lists in secondary schools.

It is time we looked carefully at the resources in front of us and come up with ways to better utilise them for the benefit of those to whom we deliver healthcare.