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By engaging with the NHS and its workforce, Oxford research has helped develop new ways of working that increase worker motivation and improve patient experience.

Putting care back on the nhs agenda

Image credit: Shutterstock

You’re in hospital, anxious and uncomfortable. Your doctor comes to visit you at regular intervals, but you see much more of the nursing and support staff. They give you medication, help you to get up and about, help keep you clean, and bring your meals.  They change your dressings, your clothes, your sheets. They’re often the first people you see in the morning, and the last you see at night. But if this scene had taken place before 2013, then some of your carers might well have been the most unregulated, over-stretched and underrepresented groups in the NHS system. A Saïd Business School research team, led by Professor Ian Kessler (now at Kings College London), has successfully worked with stakeholders to change this, improving the quality of care and the position of healthcare assistants in the UK.

Healthcare assistants (HCAs) were often seen as a source of cheap and flexible labour, working long shifts with little or no voice or support. Career development was limited, even basic training was minimal. Professor Kessler and his team have changed that. They spoke extensively to HCAs, nurses and patients, exploring their experiences of HCAs and care work more broadly.  HCAs were asked about their job satisfaction, their motivations, and their everyday challenges. This helped Professor Kessler build up a nationwide picture of HCAs’ experiences, and the findings were alarming.

Whilst their work and support was hugely important to the running of the NHS and patient satisfaction, HCAs were hugely stretched. They frequently had to take over tasks that equally pressured nurses could not deliver, and this increase in their responsibility wasn’t rewarded. Many HCAs reported that they’d originally viewed the role as a stepping stone to formal nursing qualifications, but had become trapped in a system that delivered job specific training and limited career development opportunities. Reform was needed to improve training and to improve morale.

Since 2012 Kessler’s research has fed into policy decisions on these points. It has highlighted these issues in the workforce, and is being used to support policy change at national level. For example, The Cavendish Report of 2013 draws heavily on his research, and recommends the introduction of new training and support for HCAs. These recommendations are currently being implemented, and support mechanisms like Skills for Care and the Royal College of Nursing’s First Steps are designed to improve skills and qualifications for HCAs, as well as to open up their career options. The Report also supported calls within the sector for regulation amongst HCAs. 

HCAs are very much part of the nursing team, and will tell you that they have great job satisfaction from their role - Royal College of Nursing


At the workplace level, the report has triggered organisational change. Trusts are starting to share information about best practice, for example on how to evaluate new recruitment initiatives more effectively. The relationship between HCAs and other staff has improved, by making the remit of the role clearer to staff and patients alike. HCAs can now access higher quality training and support in some Trusts. Oxford University Hospitals has introduced an HCA academy that delivers extended HCA induction and training and has created a role to support further HCA training.

HCAs are starting to get the support and credit they deserve, and Oxford research was critical in drawing policy makers’ attention to the issues that had troubled the system.

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Saïd Business School

Professor Ian Kessler at Kings College London