Strengthening identification of healthcare support workers and nurses
There should be a uniform description of healthcare support workers, with the relationship with currently registered nurses made clear by the title.
- The Cavendish Review (July 2013) recommended that healthcare support workers who complete the proposed Certificate of Fundamental Care should be entitled to use the title "Nursing Assistant," establishing a clear relationship with registered nurses (Review of Healthcare Assistants and Support Workers in NHS and Social Care, Camilla Cavendish, July 2013).
- NHS Supply Chain, in conjunction with NHS England, announced 15 national colourways for clinical roles in September 2023, assigning healthcare assistants a lilac uniform with navy trim, distinct from registered nurses' hospital blue with navy trim (NHS Supply Chain, National Healthcare Uniform, September 2023).
- The Nursing Associate role, regulated by the NMC from January 2019 under the Nursing and Midwifery (Amendment) Order 2018 (SI 2018/838), created a bridging role between HCAs and registered nurses, partially clarifying the relationship between unregistered and registered clinical staff (NMC, Nursing Associates, January 2019).
- No uniform national title for healthcare support workers has been mandated; role titles vary between trusts (e.g. healthcare assistant, healthcare support worker, nursing assistant, clinical support worker), and adoption of the national colourways remains voluntary at trust level.
How was this evidence gathered?
Response
Accepted in Part
Response
Accepted in PartThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
NMC Revalidation launched 1 April 2016 in direct response to Francis Report. All nurses and midwives must revalidate every three years. Replaced the Post-Registration Education and Practice system. Updated NMC Code published March 2015 strengthened requirements around candour and raising concerns.
Care Certificate launched 1 April 2015 as standardised induction training for all new healthcare assistants and social care support workers. Covers 15 standards (updated to 16). Implements recommendations from Cavendish Review (July 2013) and Francis Report on healthcare support worker training.
NMC published updated Code of Professional Standards for nurses and midwives (March 2015). Standard 14 specifically requires nurses and midwives to be open and candid with all service users about all aspects of care, including when mistakes or harm have occurred.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.