Evaluation of the roll out of the Care Certificate in Islington community education provider network

Background: The rise of support workers
Support workers have nearly always worked alongside qualified nurses. In the past student and auxiliary nurses have carried out a great deal of the direct patient work (Allen, 2001) but today much of that work is done by a growing number of Health Care Support Workers (HCSWs), also known as Health Care Assistants (HCAs). The health service has relied on these workers partly for demographic reasons, when it has been difficult to recruit enough nurses, but more obviously because these workers are not only cheaper to employ, but quicker and cheaper to train (Traynor, 2013). It was the combination of the new higher level training for nurses brought in by Project 2000 (National Audit Office, 1992) in the 1990s and a government concerned with reducing healthcare costs that led to a policy and managerial focus on ‘skill-mix’ (Car-Hill et al., 1992) and the rise of the support worker. Since then the role of support workers has received much policy attention. Reports which have examined their work have found variability and flexibility in their use, ambiguity in the attitudes of nurses towards them (Kessler et al., 2010) and unevenness in their preparation for practice (NHS Education for Scotland, 2010).

A report commissioned by HENCEL and produced on behalf of Middlesex University, School of Health and Education