The Evolving Role of the Healthcare Assistant and its Implications for Regulation in the Republic of Ireland – A Case Study Approach

Glackin, Patrick (2016) The Evolving Role of the Healthcare Assistant and its Implications for Regulation in the Republic of Ireland – A Case Study Approach. Doctoral thesis, Northumbria University.

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Abstract

Healthcare assistants (HCAs) have been a longstanding feature of the Irish health service workforce albeit under different guises such as nursing auxiliary or nursing aide. However, concerns have been growing about this workforce since scandals in the UK (Winterbourne View and Mid-Staffordshire) and Ireland (Aras Attracta) reported appalling standards of care being administered by unregulated care assistant staff members to vulnerable adults in residential settings. Whilst recognising these concerns and acknowledging that the role continues to evolve and grow in significance from a policy perspective no proposal has being posited for the professional regulation for this occupational group. The purpose of this study is to explore the changing role of Healthcare Assistants in Ireland and to consider the potential need for professional regulation in the public interest.

This thesis makes use of two central theories proposed to explain the pattern and motivation of professional regulation in healthcare, public interest theory and public choice theory.

An explorative in-depth case study approach combining a number of different data-gathering methods, including focus groups with HCAs, semi-structured interviews with senior managers and other key stakeholders and document analysis, was adopted. The findings reveal the existence of a three tiered HCA workforce – qualified, part qualified and unqualified that is a source of confusion at the interface between HCAs and registered nurses for delegated tasks and subsequently viewed as a risk to patient safety.

This study makes a valuable contribution to a neglected area of knowledge by presenting for the first time the views of HCAs and senior managers regarding professional regulation for the evolving HCA workforce in Ireland. The study also makes a valuable contribution to practice by developing a series of recommendations regarding regulation and governance of the HCA workforce.

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