Developing healthcare support workers

Art & science leading better care series: 5 Developing healthcare support workers Brown J, McMurray J (2014) Developing healthcare support workers. Nursing Standard. 29, 13, 44-51. Date of submission: May 12 2014; date of acceptance: September 23 2014. Abstract This article the fifth in a series of seven, describes the measures taken by one health board in Scotland to enhance nursing and midwifery leadership. In NHS Lanarkshire, the Leading Better Care Programme was implemented locally by engaging all members of the nursing and midwifery teams, including healthcare support workers (HCSWs). This article discusses how NHS Lanarkshire is developing its HCSW workforce in response to recommendations in the Final Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry and other relevant national initiatives. HCSWs provide vital care to patients, but are unregulated and, at present, there are no UK-wide agreed standards for training and development. The article includes an overview of a scoping exercise to identify training and development undertaken by HCSWs. Authors Jacqueline Brown and Julia McMurray Practice development facilitators, NMAHP Practice Development Centre, NHS Lanarkshire, Hamilton, Scotland. Correspondence to: jacqueline.brown@lanarkshire.scot.nhs.uk Keywords Healthcare assistant, healthcare support worker, leadership, Leading Better Care, NHS Education for Scotland, nursing care, nursing leadership Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software. Online For related articles visit the archive and search using the keywords above. Guidelines on writing for publication are available at: rcnpublishing.com/r/author-guidelines WHEN LEADING BETTER CARE, the national approach taken in Scotland to enhance nursing and midwifery leadership (The Scottish Government 2008), was implemented locally at NHS Lanarkshire, it involved a commitment to engaging with all members of the nursing and midwifery teams, including healthcare support workers (HCSWs). Kessler et al (2010) remind us that HCSWs have a distinctive contribution to make to patient care. This article describes the initiatives taken at NHS Lanarkshire to demonstrate to the HCSW workforce that its role is highly valued in the organisation. The article begins with an overview of HSCW development in Scotland. The outcome of a scoping exercise undertaken locally at NHS Lanarkshire with HCSWs is outlined. Finally, the development and evaluation of two HCSW conferences held during 2013 are presented. Background The Final Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013) reinforced several issues previously raised in the literature concerning HCSWs. Namely, that this staff group deliver much of the intimate care for vulnerable patients, sometimes with little or no supervision, and that there are no minimum standards of training or competence (Kessler et al 2010). Since the Mid Staffordshire NHS Foundation Trust public inquiry, there have been calls for greater consistency in the qualifications for HCSWs, clearer role boundaries and improved development pathways (Lintern 2013). HCSWs do not feel appreciated and can at times feel pressured to perform tasks they are not competent to do (Glasper 2013). This is a concern since many have extended their roles, often taking over tasks previously carried out by registered nurses or doctors, for example taking blood samples and carrying out electrocardiograms. Glasper (2013) also identified that registered nurses may be unsure what they can delegate to a HCSW because there is no mandatory or uniform training for this staff group. Bressler et al (2013) showed that better 44 november 26 :: vol 29 no 13 :: 2014 NURSING STANDARD / RCN PUBLISHING

training could improve staff morale and the quality of patient care. These findings were reflected in another competence-based pathway, developed by Colfar et al (2013) to support, assist and encourage HCSWs to improve their knowledge and skills, and provide compassionate and safe patient-centred care. Francis (2013) called for a national code of conduct and national standards of training for HCSWs, reiterating a plea from the Royal College of Nursing (RCN) (2009) to introduce mandatory training and regulation for HCSWs in England. Following this, The Cavendish Review (Department of Health (DH) 2013 proposed that new common training standards should be introduced to improve patient care and recommended that all HCSWs should obtain a standard certificate of fundamental care before delivering care unsupervised. Healthcare support worker development in Scotland NHS Education for Scotland (NES) had been developing a national approach and guidance to support and develop HCSW roles in nursing, midwifery and allied health professions (NMAHP) at levels 2-4 of the Career Framework for Health (Skills for Health 2014). A Guide to Healthcare Support Worker Education and Role Development (NES 2010a) was published to provide health boards with recommendations for Scotland-wide agreed skills, educational requirements and training requirements for all HCSWs, linked to the Knowledge and Skills Framework (RCN 2014). The document included role definitions and parameters highlighting the education, training and development needs associated with each role, linking this to the Scottish Credit and Qualifications Framework (SCQF 2006). Subsequently a chief executive s letter was issued by the Scottish Government (2010), which introduced the Mandatory Induction Standards (The Scottish Government 2009a), Code of Conduct for Healthcare Support Workers (The Scottish Government 2009b), and Code of Practice for Employers of Healthcare Support Workers in Scotland (The Scottish Government 2009c), which applied to all new staff employed in NHS Scotland. From December 2010, NHS organisations in Scotland were required to only directly recruit as HCSWs those who commit to achieving the induction standards (The Scottish Government 2009c) and to complying with the Code of Conduct for Healthcare Support Workers (The Scottish Government 2009b). An online resource providing guidance and educational resources for clinical and non-clinical HCSW roles was also launched (NES 2010b). In May 2011, NES conducted a survey of HCSWs in NHS Scotland, the main findings of which are presented in Box 1. Role development at NHS Lanarkshire Approximately 1,500 of the 12,000 staff at NHS Lanarkshire are HCSWs employed in a clinical role, generally in band 2 to band 4 posts, in acute and primary care settings. This group of staff are responsible for delivering most patient care and are BOX 1 Main findings from the national survey of clinical healthcare support workers (HCSWs) 1. Who responded to the survey? A total of 17.8% of all clinical HCSWs in NHS Scotland responded to the survey. 84% of the sample were in Agenda for Change pay bands 2 and 3. The average age of respondents was 44.7 years, with 67% aged between 40 and 60 years. 2. Previous and current level of study 12% of the sample was studying for a qualification, with Scottish Vocational Qualifications (SVQs) at levels 2 and 3 being the most common. A further 5% completed a qualification in the previous 12 months. One in six HCSWs had no formal qualifications, while most had qualifications commonly Standard Grades the Scottish equivalent of the General Certificate of Education. More than one quarter of the sample had SVQ levels 1 and 2 and one fifth had SVQ levels 3 and 4 qualifications. There was wide disparity across health boards in terms of the number of HCSWs who were studying. There were differences regarding who paid for learning: 74% of support workers in nursing teams had their studies fully paid for by employers, compared with 41% of support workers in allied health professional teams. 3. Learning at and for work 83% of the sample had recent Key Skills and Knowledge/Personal Development Plan discussions. 41% of the sample reported no training in the previous year. 63% of HCSWs agreed that their manager supported them to learn. There was a strong preference for learning supported by a colleague or trainer and delivered as close to the workplace as possible. Computer-based learning was not liked by many, but was acknowledged as a learning need. 4. What changes would make a difference to HCSWs? 32% of HCSWs wanted to see changes in how training was delivered; a further 31% were not sure. Time and financial support for training were cited as common barriers to learning. 32% of HCSWs would like to see changes, including more time to study, more hands-on training and more regular training being offered. Training should be more practical, hands-on and skills based. Gaps were identified in clinical, communication and computer skills. (Adapted from NHS Education for Scotland 2011) NURSING STANDARD / RCN PUBLISHING november 26 :: vol 29 no 13 :: 2014 45

Art & science leading better care series: 5 on the whole non-registered, except for example in audiology services where band 4 hearing aid dispensers are registered with the Health and Care Professions Council. NHS Lanarkshire HCSW roles by job family at bands 1-4 are shown in Table 1. Since 2000, NHS Lanarkshire has provided development opportunities for HCSWs through Scottish and National Vocational Qualifications levels 2 and 3, delivered initially in collaboration with local colleges and, since 2006, by the HCSW development team in the NMAHP Practice Development Centre, an accredited SVQ centre. In addition, a Vital Signs course was developed in 2004 to support HCSWs in performing clinical observations using a competence-based framework. The competence-based training was developed to ensure the HCSWs record observations correctly and can identify the deteriorating patient and make sure their observations are acted on. Enhancing the HCSWs role in clinical observation is taking place across the UK (Smith et al 2006, Lees 2011). Lees (2011) reported that HCSWs could perform patient observations, but require a method of gaining competence to ensure patient safety. There are other courses at NHS Lanarkshire, developed in collaboration with local further and higher educational establishments for HCSWs, including dementia care, higher national certificates providing access to year two of pre-registration nurse education, and Open University courses. In response to the results of the NMAHP HCSW survey (NES 2011) (Box 1), the HCSW development team, which is part of the Practice Development Centre team, developed, delivered and continue to evaluate two half-day courses for HCSWs: Promote Effective Communication in a Healthcare Environment and Delivering Care with Dignity. This latter course incorporates TABLE 1 Number of NHS Lanarkshire healthcare support worker post-holders by job family at bands 1-4 Job family Bands 1-4 Allied health professions 155 Healthcare sciences 158 Medical and dental support 90 Nursing and midwifery 1,526 Other therapeutic 46 Personal and social care 8 Total 1,983 the Code of Conduct for Healthcare Support Workers (The Scottish Government 2009b), locally developed Caring and Compassionate Practice guidelines (NHS Lanarkshire 2009), and NHS Lanarkshire organisational values (NHS Lanarkshire 2014). Following the publication of the Mid Staffordshire NHS Foundation Trust public inquiry, the NMAHP Practice Development Centre team undertook an evaluation to identify existing provision at NHS Lanarkshire and what more could be done locally to meet the report s recommendations in relation to HCSWs. Through the Leading Better Care collaborative (McGuire and Ray 2014), two pieces of work were agreed. The first was a scoping exercise to discover what qualifications HCSWs in the workplace had, what training they had undertaken recently and what training they felt would help them improve the care they deliver to patients. The second was to host a conference for HCSWs at NHS Lanarkshire focusing on their role in the organisation. The collective aims of these events were to: Consider how well trained and qualified the workforce is. Engage with a cross-section of HCSWs. Consider with them how patient care and experience could be improved. Ensure the HCSWs heard about learning opportunities and considered how best they could use these opportunities. The motivation for this work was to ensure that HCSWs and the wider NMAHP group recognised the major contribution of HCSWs to patient care and how important education and training are to them. As outlined in The Cavendish Review (DH 2013): If the NHS wants to improve patient care, it should see healthcare assistants as a critical, strategic resource. The scoping exercise The scoping exercise was undertaken to identify the existing qualifications and training needs for NMAHP support workers throughout NHS Lanarkshire. This was performed between February and May 2013. It was important to include an accurate cross-section of HCSWs; therefore, questionnaires were distributed to HCSWs who worked in acute, primary care, midwifery, and cottage and associated hospitals. Approximately, one third of all nursing and midwifery HCSWs employed by NHS Lanarkshire (n = 552) were sent a questionnaire; 255 were returned. The 46% return rate means that caution is required in relation to the survey s representativeness. 46 november 26 :: vol 29 no 13 :: 2014 NURSING STANDARD / RCN PUBLISHING

Respondents area of practice and pay band are shown in Table 2 and respondents qualifications are shown in Table 3. As Tables 2 and 3 show, 76% of HCSWs working at band 2 who completed the questionnaire had attained an SVQ level 2, while 39% of band 3 HCSWs had gained an SVQ level 3. The Vital Signs course had been running for several years, but only 88 (35%) HCSWs had attended this training, even though this is a skill widely undertaken by HCSWs at NHS Lanarkshire. Since 2011, the Practice Development Centre has offered the course Promote Effective Communication in a Healthcare Environment and, since 2012, Delivering Care with Dignity, but the results of the scoping exercise made it clear that attendances were low, at just over 1% and just under 12% respectively. These figures were noteworthy given that poor communication and concerns around the variance in provision of dignified care for patients and relatives were central findings of in the Mid Staffordshire NHS Foundation Trust public inquiry (Francis 2013). TABLE 2 Area of practice and pay band of survey respondents Area of practice Band 2 Band 3 Band 4 Total* Acute care 129 16 6 151 Primary care 48 51 1 100 Total 177 67 7 251 Four people did not identify their pay band TABLE 3 Qualifications of survey respondents Course Base Band 2 Band 3 Band 4 Total Mandatory induction standards Acute care 3 0 0 3 (NHS Education for Scotland 2010b) Primary care 4 0 0 4 Total 7 0 0 7 Higher National Certificate (HNC) Acute care 4 2 0 6 Primary care 5 6 0 11 Total 9 8 0 17 Scottish Vocational Qualification Acute care 103 11 0 114 (SVQ) level 2 Primary care 31 21 0 52 Total 134 32 0 166 SVQ level 3 Acute care 12 6 0 18 Primary care 5 20 1 26 Total 17 26 1 44 Vital Signs Acute care 50 6 3 59 Primary care 15 14 0 29 Total 65 20 3 88 Promote Effective Communication Acute care 0 0 0 0 in a Healthcare Environment Primary care 0 3 0 3 Total 0 3 0 3 Delivering Care with Dignity Acute care 18 2 0 20 Primary care 7 3 0 10 Total 25 5 0 30 National Nursery Examination Board Acute care 0 0 6 6 (NNEB) Primary care 0 0 0 0 Total 0 0 6 6 NURSING STANDARD / RCN PUBLISHING november 26 :: vol 29 no 13 :: 2014 47

Art & science leading better care series: 5 Staff were also asked about their attendance at mandatory training and 76% of HCSWs surveyed had undertaken at least one course or study day in the previous two years. However, attendance was variable, with less than 50% having completed moving and handling, basic life support (BLS) or fire lectures in the past two years, all of which are mandatory at NHS Lanarkshire. One of the limitations of the survey was that the questions should have been subdivided to show what training had been carried out online and what had been by attendance at a study day. This information is important, especially for training that has to be completed in two parts. For example BLS participants must complete an online module before attending the practical session, and therefore there was no way of knowing if the full training has been completed. A further question concerned training needs. Most courses and training that HCSWs have identified as desirable are consistent with what is already available and pertinent to their job role, including dementia, palliative care, phlebotomy, information technology training, dressings, stroke care, SVQ levels 2 and 3, Vital Signs, Promote Effective Communication in a Healthcare Environment and Delivering Care with Dignity. These findings were indicative of Kessler et al s (2010) research, which showed that many HCSWs displayed an enthusiasm for in-role development. Conferences Following the review of the survey results, the executive director of NMAHP in NHS Lanarkshire proposed holding a conference for HCSWs. The objectives were to: Share current good practice. Raise awareness of local initiatives and policies. Highlight the educational opportunities available. Provide the opportunity for networking with other HCSWs from different disciplines and clinical areas. The support of the executive director reflects the concept that good leadership must be visible, receptive, insightful and outward looking (Francis 2013). It was also a step forward in closing the perceived gap between management and clinical staff. Staff at the NMAHP Practice Development Centre were asked to organise the conference, which brought a cross-section of HCSWs together in terms of location and job description to consider how patient care and experience could be improved, to hear about learning opportunities and to think about how best to use these. The conference programme involved a combination of speakers and several discussions to encourage HCSWs to participate and share their views. Several HCSWs were also invited and supported as speakers; they then acted as role models for their peers and had opportunities to share good practice. Each HCSW was given a pack containing the conference programme, a copy of the Code of Conduct for Healthcare Support Workers (The Scottish Government 2009b), a leaflet with a sample of the training available at NHS Lanarkshire for HCSWs, and booklets with information about Caring and Compassionate Practice (NHS Lanarkshire 2009), Make Every Moment Count (Care Inspectorate 2013), and Raising Care Concerns (NHS Lanarkshire 2013). The first speaker at the May 2013 conference was the executive director of NMAHPs at NHS Lanarkshire, who spoke from a professional and a personal point of view. Next, two HCSWs discussed the good practice they shared responsibility for in their workplace. Then a discussion about the concept of being brilliant in the workplace took place. The next speaker was a member of the public who related his experience of the care his sister received in hospital, and how it affected her and the family as a whole. This story reflected research findings that it is important to engage patients and relatives in decision making in everyday care to promote dignity and relationship-centred care (Nicholson et al 2010). Involving families means a shift from doing for to doing with and encourages holistic treatment of the patient as he or she wishes to be treated. According to Warren (2012), this can help decrease the length of hospital stay and improve patient satisfaction. After lunch the director of the NMAHP Practice Development Centre delivered a motivational speech emphasising how all staff have a role in improving care. She introduced several HCSWs who spoke about various aspects of their roles and the different types of training they had undertaken. Members of the audience were then asked to complete a personal action plan, which was distributed with the aim of following up 20% of delegates (random selection) six weeks after the conference to ascertain who had completed their action plan and whether assistance was needed to do so. Immediate post-conference evaluation The director of the Practice Development Centre delivered feedback from the first conference to an NMAHP senior leaders symposium the following day. This included an overview of 48 november 26 :: vol 29 no 13 :: 2014 NURSING STANDARD / RCN PUBLISHING

the conference in terms of its purpose, format, main outputs, immediate feedback from participants and main messages to emerge from their participation. The HCSWs immediate feedback was overwhelmingly positive: they enjoyed the day, the learning it offered and the appreciation shown to them. Many commented on their evaluation forms that they left the conference inspired to be brilliant in their work. Since the first HCSW conference was successful, it was decided to repeat it six months later in October 2013. The most important messages from the May and October HCSW conferences were: HCSWs enjoyed the conference and felt listened to. HCSWs wish to be known as assistants they want their job role to be part of their title, for example nursing assistant, physiotherapist assistant. HCSWs know they make a difference to patient care and experience. HCSWs require senior charge nurses and team leaders to reconsider their role and how best they can work as part of the NMAHP team. HCSWs wish to be recognised and valued at ward, department or team level for what they do. HCSWs want to learn about the job and as much as possible on the job. HCSWs have more opportunity to be supervised by registered staff. One of the objectives of the conference was to inform HCSWs about local initiatives and policies. The local guidance on Raising Care Concerns (NHS Lanarkshire 2013) was highlighted, with reassurance given that their concerns about patient care or experience would be heard and followed through. This reflects information available on the National Whistleblowing Helpline (DH 2011). Following the conference, one of the delegates contacted a senior leader to discuss concerns about patient care in a clinical area. This triggered an investigation that resulted in reassurance on patient safety and wellbeing in that area, and highlighted the need to address the attitudes, behaviours and practices of some members of staff. This follow-up action demonstrated the pivotal importance of HCSWs to patient care and experience, reflecting NHS Scotland s value of promoting a culture of openness, honesty and responsibility, and showed how HCSWs may at times need encouragement and support to raise challenging issues. Evaluation of the conferences An important outcome measure in the evaluation was the effect that the conference had on the HCSWs practice and how they felt they had improved the care they deliver to patients. Russell et al (2011) suggests that evidence gathered by effective and appropriate measurement and evaluation helps to achieve this. Six weeks after the conferences had taken place, 24 (20%) personal action plans completed by the HCSWs were randomly selected for follow-up. Five HCSWs were visited in their clinical areas; two were followed up by telephone; and the remaining 17 by email. Only one person had not completed the first section on their personal action plan, Personal commitment to improving care and experience. Comments relating to this included: Took a step back and reviewed my communication with patients, which I have improved, to try and make patients feel more at ease. More aware of my communication with patients. Patients seem to appreciate this. Provide more support to inexperienced staff now. Involving staff nurses more to assist with personal patient care. More aware of my own good practice. After I attended the HCSW conference, I found that I was more attentive with the patients, listened to them and helped them with any problems that they had while in the ward. With regard to the second section of their action plan, Personal commitment to improving my learning, half of the group had fully completed it, one quarter had partially completed it and the other quarter had not completed it. Comments included: Need support to access HCSW toolkit. Department too busy for me to have opportunity to shadow colleagues. Think more positively and have provided feedback to line manager. Two courses completed recently. Kept up to date with my Learn Pro [an online system that provides access to a variety of training programmes] and spoken to my manager about applying for my SVQ2. I shared with my colleagues the experience of the conference that I attended. I also attended two courses which have helped me improve the care I give to my patients. Sampling only 20% of NHS Lanarkshire s HCSW workforce may not be fully representative of the whole and does not allow for generalisation of these results. On reflection, the sample size should have been larger to give a more comprehensive and robust viewpoint. NURSING STANDARD / RCN PUBLISHING november 26 :: vol 29 no 13 :: 2014 49

Art & science leading better care series: 5 Current developments within NHS Lanarkshire Written feedback and reports from the conferences were delivered to the senior charge nurses on each of the acute sites at their team meetings and by email to delegates at the conference. This provided an ideal opportunity to highlight how some of the HCSWs felt regarding poor communication and lack of recognition or respect for their role. These views resonated with those outlined in The Cavendish Review (DH 2013). Conference feedback indicated that HCSWs wanted to feel part of the team and have access to appropriate training the scoping questionnaire had raised issues around access to mandatory training. This information was used to update and revise the strategy for developing HSCWs, which is linked to the Learning Strategy 2012-2015 (NHS Lanarkshire 2012). The strategy therefore reflects the roles and pay bands recommended in NES guidance (NES 2010a). It also identifies the recruitment and selection processes, and the lifelong learning framework at the organisation. Another important feature of the strategy is the outline of the main responsibilities of the senior charge nurse or team leader, the NMAHP support worker and that of the Practice Development Centre in relation to HCSW development. This updated version of the strategy emphasises five areas (NHS Lanarkshire 2012): The pivotal importance and value of NMAHP support workers to patient care and experience. The need to strengthen recruitment and selection. The need to ensure job titles on identification badges are more readily understood by patients and the public, and that management and direction is at all times provided by registered NMAHPs. More focus on induction, participation in mandatory learning and the use of the Code of Conduct for Healthcare Support Workers (The Scottish Government 2009b). The tailoring of learning to better match local need and circumstance under the reinforced leadership responsibility of the senior charge nurse or team leader. In response to feedback from the conference and its follow up, all development and training opportunities for HCSWs are now advertised through team leaders or charge nurses at a local level to increase awareness and uptake of the courses. It also means that HCSWs have the name of a person they can contact for further information about role development. Other developments are enhancing support for the HCSW workforce. Recruitment and selection to such roles now involve competency-based interviews (Cerinus and Shannon 2014). The Practice Development Centre team has developed an induction day for HCSWs new to the organisation; the day complements the corporate induction session that all new employees have to attend, and will be evaluated and revised as required. According to NES (2010c), a well-planned induction programme can help new HCSWs to feel valued, inform them about the boundaries of their role and provide a foundation for personal development, therefore making public protection and patient safety a priority. In addition, the team is re-emphasising the Code of Conduct for Healthcare Support Workers (The Scottish Government 2009b) to all HCSWs in NHS Lanarkshire. In conjunction with this work, the University of the West of Scotland has incorporated the mandatory induction standards into the ongoing achievement record for first-year nursing students. Francis (2013) indicated that HCSWs should be clearly identifiable and distinguishable from registered nurses. The Cavendish Review (DH 2013) recommended that employers should allow HCSWs to use the title nursing assistant on completion of the certificate of fundamental care. HCSWs at NHS Lanarkshire had raised similar views at the conferences and a proposal to change their title is being pursued at an organisational level. The applicability of the findings of the more recently published Developing People for Health and Healthcare. The Talent for Care consultation in England (Health Education England 2014), alongside the recommendations from The Cavendish Review (DH 2013), are currently under discussion. Conclusion The Final Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013) indicated that a change in the culture of the NHS is required and that leaders need to support and value their staff to ensure they are delivering safe, patient-centred care. The mechanisms used at one Scottish health board have been highlighted in this article, including a scoping exercise undertaken to identify existing qualifications and training needs for the HCSWs throughout NHS Lanarkshire. This information provided a snapshot of how much learning and development the HCSWs had undertaken in 50 november 26 :: vol 29 no 13 :: 2014 NURSING STANDARD / RCN PUBLISHING

the past two years and resulted in a conference to provide HCSWs with an opportunity to celebrate their successes and share their developments. The immediate feedback has been overwhelmingly positive, establishing the momentum to build on this and enhance patient care and experience NS Acknowledgement Nursing Standard would like to thank Kathleen Duffy, NHS Education for Scotland nursing and midwifery practice educator, Practice Development Centre, NHS Lanarkshire, for developing and co-ordinating the Leading Better Care series of articles. References Bressler K, Molnar M, Brown M, Redfern RE, Swicegood TM (2013) Effects of an advanced nursing assistant education program on job satisfaction, turnover rate, and clinical outcomes. Journal of Gerontological Nursing. 39, 10, 34-43. Care Inspectorate (2013) Make Every Moment Count. tiny.cc/lxwmmx (Last accessed: October 20 2014.) Cerinus M, Shannon M (2014) Improving staff selection processes. Nursing Standard. 29, 10, 37-44. Colfar S, Dey A, Foulkes D, Douglas M (2013) A skills development pathway for HCAs. Nursing Times. 109, 21, 20-21. Department of Health (2011) NHS Whistleblowing Helpline to be Extended to Social Care Staff. tinyurl.com/lw7b8cv Department of Health (2013) The Cavendish Review An Independent Review into Healthcare Assistants and Support Workers in the NHS and Social Care Settings. tiny.cc/62wmmx Francis R (2013) Final Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. www.midstaffspublicinquiry. com/report (Last accessed: Glasper A (2013) Making caring a career: the role of the healthcare assistant. British Journal of Nursing. 22, 17, 1028-1029. Health Education England (2014) Developing People for Health and Healthcare. The Talent for Care. tiny.cc/n7wmmx (Last accessed: Kessler I, Heron P, Dopson S, Magee H, Swain D, Askham J (2010) The Nature and Consequences of Support Workers in a Hospital Setting. Final Report. tiny.cc/iaxmmx Lees L (2011) Unqualified support staff are doing more observations with minimal training. Do standards exist for this work? Nursing Times. 107, 7, 16. Lintern S (2013) Call for Focus on HCA Standards Ahead of Crucial Review. tiny.cc/3hxmmx (Last accessed: October 20 2014.) McGuire C, Ray D (2014) Developing leadership roles in nursing and midwifery. Nursing Standard. 29, 9, 43-49. NHS Education for Scotland (2010a) A Guide to Healthcare Support Worker Education and Role Development. NHS Education for Scotland, Edinburgh. NHS Education for Scotland (2010b) Supporting Induction and Safe Working for All Healthcare Support Workers. www. hcswtoolkit.nes.scot.nhs.uk/ hcsw-standards-and-codes NHS Education for Scotland (2010c) Benefits of a Planned Induction. tiny.cc/aoxmmx (Last accessed: NHS Education for Scotland (2011) NMAHP Healthcare Support Workers Survey: Survey Results September 2011. tiny. cc/1txmmx (Last accessed: NHS Lanarkshire (2009) Caring and Compassionate Practice. tinyurl. com/pp5z98w (Last accessed: NHS Lanarkshire (2012) Learning Strategy 2012-2015. www.nhslanarkshire.org.uk/ publications/documents/ Learning-Strategy-2012-15.pdf NHS Lanarkshire (2013) Raising Care Concerns Do not Turn the Other Way. tiny.cc/73xmmx NHS Lanarkshire (2014) Our Values. www.nhslanarkshire.org.uk/about/ Values/Pages/default.aspx Nicholson C, Flatley M, Wilkinson C (2010) Everybody matters 3: engaging patients and relatives in decision making to promote dignity. Nursing Times. 106, 22, 10-12. Royal College of Nursing (2009) Health Care Assistants Call For Regulation. tiny.cc/6aymmx Royal College of Nursing (2014) Knowledge and Skills Framework. www.rcn.org.uk/support/pay_and_ conditions/agendaforchange/ksf Russell NC, Wallace LM, Ketley D (2011) Evaluation and measurement for improvement in service-level quality improvement initiatives. Health Services Management Research. 24, 4, 182-189. Scottish Credit and Qualifications Framework (2006) Scottish Credit and Qualifications Framework. http://scqf.org.uk/the-framework Skills for Health (2014) Career Frameworks Allied Health Professions (AHP). tiny.cc/0ajqmx Smith J, Roberts R, Fahy S (2006) Use of study days to develop the healthcare assistant role. Nursing Times. 102, 30, 34-35. The Scottish Government (2008) Leading Better Care: Report of the Senior Charge Nurse Review and Clinical Quality Indicators Project. tiny.cc/mdymmx (Last accessed: October 29 2014.) The Scottish Government (2009a) Healthcare Support Workers in Scotland. Mandatory Induction Standards. www.scotland.gov.uk/ Resource/Doc/288863/0088362. pdf (Last accessed: October 29 2014.) The Scottish Government (2009b) Code of Conduct for Healthcare Support Workers. www.scotland.gov.uk/resource/ Doc/288853/0088360.pdf The Scottish Government (2009c) Code of Practice for Employers of Healthcare Support Workers in Scotland. tiny.cc/cfymmx (Last accessed: The Scottish Government (2010) CEL [chief executive s letter] 23 (2010). www.sehd.scot.nhs.uk/ mels/cel2010_23.pdf (Last accessed: Warren N (2012) Involving patient and family advisors in the patient and family-centered care model. MEDSURG Nursing. 21, 4, 233-239. NURSING STANDARD / RCN PUBLISHING november 26 :: vol 29 no 13 :: 2014 51