Healthcare assistant survey 2018 Findings summary Background There are more than 400,000 healthcare assistants (HCAs) and clinical support workers in the UK, who work alongside nurses and other health professionals in the NHS. In 2016, UNISON conducted a survey of nearly 2,000 HCAs across the UK, with the majority working in hospitals, as well as in mental health, the community and GP practices. It highlighted how HCAs were carrying out a number of clinical tasks previously carried out by nurses, such as heart checks (ECGs). These tasks should be supervised, but staff shortages meant this was not happening. The objective of the 2018 survey was to return to some of the key issues identified in UNISON s previous survey. With the NHS under increasing pressure due to underfunding, staff shortages and increased demand, UNISON set out to gain an accurate picture of working in the NHS from one of the largest groups of frontline staff. The workplace The majority of respondents worked in an acute/general hospital 59% The next most popular workplaces were mental health 20% and community health 13% 45% of respondents listed their job title as healthcare assistant, while the rest had a variety of titles to describe their clinical support role Nearly 60% of respondents stated they were paid on band 2 of Agenda for Change (AfC) where the typical basic salary scale goes up to around 18,000 a year, and a third stated they were paid at band 3 ( up to around 20,000 a year) Workplace issues More than half of the respondents (51%) reported performing tasks that they had not received proper training for, with 9% stating this occurred daily. Are you ever asked to perform tasks which you have not received proper training for? Never 49% 896 Less than once a 16% 292 Once a or more 13% 247 Once a week or more 13% 233 Every day 9% 173 Some of the more frequent tasks were wound dressing (done by 42%), stoma care (35%) and administering medication (18%). If you are asked to perform tasks which you haven t had proper training, what kinds of tasks? (Tick all that apply) Wound dressing 42% 397 Taking blood samples 6% 57
Blood sugar monitoring 19% 174 Catheterisation 4% 37 Venpuncture 3% 32 Cannulation 3% 26 Carrying out an ECG 21% 198 Stoma care 35% 324 Administering 18% 167 medication Other 31% 292 Nearly two thirds of respondents (63%) said they performed clinical tasks without proper supervision, 27% stated this occurred daily. As a support worker you should work under the supervision of a nurse, doctor or other clinical professional. With this in mind, how often are you left to perform clinical tasks without adequate supervision? Never 37% 681 Less than once a 12% 219 Once a or more 11% 207 Once a week or more 13% 235 Every day 27% 489 Nearly three quarters of respondents (74%) said they picked up extra work to ease the pressure on unfilled registered nursing and clinical professional posts, with 19% of respondents saying this happened every day. How often are you picking up extra work to cover for unfilled registered nursing or other clinical professional posts in your workplace? Never 26% 481 Less than once a 13% 229 Once a or more 17% 319 Once a week or more 25% 462 Every day 19% 340 Staff have big concerns over patient safety, 27% of respondents reported feeling not very confident and 12% said they were not confident at all about patient safety. Due to the current way you are expected to work, how confident are you that the patients you care for are safe? Very confident 22% 371 Fairly confident 36% 611 Not very confident 27% 457 Not confident at all 12% 202 Don t know/unsure 3% 52 Comparing winter 2016/17 with winter 2017/18 Overview The survey also looked at whether a lack of adequate training, supervision, and/or covering for unfilled posts was more of a problem this winter than the previous one.
This analysis therefore excludes those respondents who were not in post last winter, or who were not experiencing these issues. The results show that for the majority of respondents able to make a comparison these issues have persisted and for significant numbers worsened since last winter. Particularly concerning was that nearly 60% of those who picked up extra work due to unfilled nursing vacancies said this was happening more often this winter than during the last one. Performing tasks without adequate training In total 942 respondents were asked to do this, and were able to make a comparison with last winter. Of these 383 (41%) said they were asked to do tasks without adequate training more often this winter than the previous one. A total of 486 (51%) said they were asked at about the same rate. Just 73 (8%) said they were asked less often this winter than last. This winter has seen many reports on the strain of the health service. Can you tell us if, during the period December 2017 January 2018, you have been asked to perform tasks without adequate training, compared to the period December 2016 January 2017... winter? 41% 383 51% 486 8% 73 Performing clinical tasks without adequate supervision In total 924 respondents were asked to do this, and were able to make a comparison with last winter 2016/17. Of these 343 (37%) said they were asked to perform clinical tasks without adequate supervision more often this winter than during the previous one. A total of 517 (56%) said they were asked to at about the same rate. Just 64 (7%) said they were asked less often this winter than during the last one. During the period December 2017 January 2018, have you have been asked to perform clinical tasks without adequate supervision... winter? 37% 343 56% 517 7% 64 Picking up extra work due to unfilled registered nursing/clinical professional posts In total 1,115 respondents said they had done this, and were able to make a comparison with the previous winter. Of these 632 (57%) felt they were picking up extra work due to unfilled registered nursing or clinical professional posts more often this winter than during the previous one. A total of 427 (38%) said they were doing so at about the same rate. Just 56 (5%) said they were doing so less frequently this winter than during the previous one.
During the period December 2017 January 2018, have you picked up extra work due to unfilled registered nursing/clinical professions posts compared to the period of December 2016 January 2017... 57% 632 38% 427 5% 56 Workforce pressures The failure to invest properly in the support workforce continues to be a problem in the NHS, letting down both staff and their patients. In UNISON s 2016 survey, over half of the respondents stated that they felt staffing levels were not adequate in their clinical area. In this latest survey, nearly three quarters said they had to pick up extra work due to staff shortages. The survey results show that the largest factor affecting patients safety and quality of care is staffing levels. The pressures on staffing are putting healthcare assistants in an impossible position pressurised to perform additional tasks but not getting the training or supervision they need to do so safely. Healthcare assistants have a vital role to play in healthcare and many have the potential to train and develop to take on more complex tasks but are not getting the support they need to do so. Some 43% of respondents said they would like to train to become a nurse or other health care professional, but that their employer was not providing them with the support and opportunity to achieve this. The withdrawal of the NHS bursary is also likely to have had an impact on some support staff s desire to train to become registered nurses. The NHS is suffering from an acute shortage of nurses, so it s imperative that action is taken to support healthcare assistants who have the desire and ability to train as nurses. Case studies Abigail, 30, from Glasgow said: If a nurse or higher asks you to do something that you re not trained to do, you don t want to say no, even if it s something you feel uncomfortable with. You find that HCAs are asked to do things like ECGs or disconnecting and connecting infusion lines a lot, even though we re not trained to do it. I don t mind helping out but it can put patients safety at risk. Graham, 51, from Bradford said: There is a lot of pressure from understaffing. I work in a dementia ward and it can affect the level of care you give. The ratio of patients to staff is very high. Sometimes you wonder why patients are being admitted without due regard for the number of staff. We don t even have time to do our core responsibilities properly, it s very stressful.
Nicole, 33, from Greater Manchester said: The trust I work for has got rid of the band 3 salary scale so now band 2 workers are doing band 3 work for less money, which doesn t seem very fair. On my first day I was shown how to do tasks like taking pulses and blood pressure by another HCA. They said they d never been properly trained how to do it and weren t really sure if they were doing it properly. HCAs are doing ECGs and taking bloods, that s a lot of responsibility. Janet, 40, from Croydon said: Trusts are trying to make use of HCAs, which isn t necessarily a bad thing, but it can put patients at risk. I work as a maternity support officer on a band 3. There is a divide at the trust I work for between the people that have worked there a long time and those of us that are newer to the job. People who have been in the job longer have received different training that doesn t cover everything we re expected to do these days. I think people don t want to say they haven t had the training because they don t want to drop down a band, but this means they might not ask the patients the right question or spot the warning signs if a patient is at risk. Since I started two years ago there s more pressure on us, and we re taking on more responsibilities.