Health Care Assistant (HCA) is an umbrella term used to describe support workers who assist individuals with physical and mental disabilities, providing holistic care for patients in a variety of settings. Common titles used include Healthcare Support Worker, Clinical Support Worker or Nursing Auxiliaries (National Health Service Careers, 2011). According to Chaboyer et al (1998) these differing labels have ‘obscured rather than clarified’ the role in healthcare, but the introduction of National Vocational Qualification (NVQ) training programme has allowed the HCA role to develop, setting a new standard of care delivery. HCAs, by definition, do not require statutory professional registration for practice, though many hold various qualifications. HCAs perform a range of tasks under the delegation and guidance of qualified healthcare professionals (RCN, 2009) and documentation of competencies are important as the qualified health professional is accountable for the tasks delegated. However HCAs are accountable for their actions, working within their level of competency and having the knowledge of when to seek professional guidance (RCN,2009). HCAs should be provided with evidence based protocols and guidelines to assist in this process. EDUCATION Nursing was seen as a function that was provided by women, viewed as a natural nurturing job, performed out of compassion and desire to help others. Nursing was “untaught” and instinctive, No training is evident, but based on observations and experience. Nursing care was performed without formal education and by people directed by more experienced nurses. EDUCATION NVQ’s were introduced into the health service in 1992.Levels 1 to 3 were introduced to monitor the development and competency of HCAs in health care settings..NVQ’s are awarded on the foundation of an individuals ability to perform duties at consistently high levels in a practice setting (Roberts, 1994).The NVQ training programme provides an opportunity to establish a career path and access pre registration nurse training (Radcliffe, 2002). NVQ level 3 enables HCAs to access the ‘Higher Education in Health Care Nursing Support Worker Education’.. Wanless (2002) predicted an additional 74,000 HCAs, on top of the existing 350,000, would be required over the next 20 years. This was reinforced in the document ‘Designed for Life’ (WAG, 2005) which offered a vision of a way forward in health and social care in Wales in the 21 st Century. HCAs have progressed from being an under valued ‘nonprogressive resource’, to a skilled role increasingly recognised in healthcare. The NHS seeks to utilize staff resources and skills through role expansion/redesign, an important development is that of the Assistant Practitioner (APs). APs are ‘higher level’ support workers complementing the work of registered professionals, working across professional groups (NHS Modernisation Agency, 2003). REFERENCES Chaboyer W et al (1998) Unlicensed assistive personnel in the critical unit: what is their role? International Journal of Nursing Practice. 4, 4, Changing Workforce Programme (2003) Developing support worker roles in rehabilitation in intermediate care services. London: NHS Modernisation Agency Kershaw B (1989) Project 2000.Identifying the nurse support worker. Nursing Standard. 3, 52, National Health Service.NHS Careers in Detail: Healthcare assistants/auxiliary nurses. [Accessed May 17th 2011] NHS Careers: Assistant Practitioners: May 18th 2011] NHS Training Authority (1987) Support Workers to Nurses, Midwives and Health Visitors: The Role, Selection and Training of Support Worker sand the Way Forward.London, NHSTA. Radcliffe M (2002) Here, capable, abundant. Nursing Times. 98, 8, Royal College of Nursing (2004). Your life and work as a nurse. RCN Magazine. Spring, Royal College of Nursing (2007). RCN Policy Unit Briefing 11/2007: The regulation of healthcare support workers. London: Royal College of Nursing (2009). [Accessed May20th 2011] Roberts I (1994) The healthcare assistant: professional supporter or budget necessity? International journal of Health Care Assurance. 7, 6, Thornley C (2000) A question of competence? Re –evaluating the roles of the nursing auxiliary and health care assistant in the NHS. Journal of Clinical Nursing. 9, 3, United Kingdom Central Council for Nursing. Midwifery and Health Visiting (1986) Project 2000: A New Preparation for Practice. London, UKCC Wanless, D. (2002) Securing our Future Health: Taking a Long-Term View. The Final Report. London: Department of Health Welsh Assembly Government (2005) Designed for Life: Creating World Class Health and Social Care for Wales in the 21 st Century. The Strategic Unit, Welsh Assembly Government. Welsh Assembly Government (2010) Setting the Direction: Primary and Community Services Strategic Delivery Programme. Cardiff, Welsh Assembly Government. Welsh Assembly Government (2011) Code of Conduct for Health Care Support Workers in Waleswww.wales.nhs.uk:[Accessed May20th 2011] Development of the HCA role originates from the Crimean War ( ) This was the first time ‘nurses’ aides, as then called, were recognised as members of the nursing team. Florence Nightingale acknowledged their value, and considered them to be assistants to trained nurses, working with them under direct supervision (Kershaw 1989). Nursing aides main roles were performing tasks such as personal care (washing and dressing), social care (feeding, communicating) General Practices have also seen the introduction of HCAs. This has developed to meet the growing demands of patients and evolving requirements of the healthcare system. A recent review of training programmes for HCAs provides some idea of the scope and development of their role in general practice. The range of tasks undertaken by HCAs in primary care varies and can include :- New patient registration, all physiological measurements, phlebotomy, spirometry, Health Promotion, assisting minor operations. In 2000 the Royal College of Nursing (RCN, 2004) reached a decision that HCAs with NVQ level 3 or above would be eligible to join the largest professional union for nursing in the UK. The National Health Service (NHS) was founded in In 1955 the term ‘nursing auxiliary’ was used and this role was given formal recognition in the healthcare setting (Thornley2000). In 1984 the United Kingdom Central Council (UKCC) undertook a review and reform of nurse education and training (Roberts 1994). The reform highlighted staffing problems, because student nurses became supernumerary. In response the UKCC introduced a new category of support worker – the HCA. The UKCC (1986) expected HCAs to ‘assist qualified nurses’. PAST PRESENT FUTURE RCN Presently trained HCAs/ APs are not professionally regulated. However, all have a responsibility regarding patient related activities, assuming a legal duty of care and accountability under civil law for their actions. Due to the responsibility of the HCAs/APs current duties, it has led to requests for urgent policy attention for the regulation of these staff (RCN, 2007) has finally seen the introduction of the ‘’Code of Conduct for Health Care Support Workers in Wales’,setting out the standards of conduct, behaviour and attitude required of all HCAs/APs..The document provides a comprehensive summary of expectations of HCAs/APs and the responsibilities of NHS employers in supporting HCAs/APs ensuring that the highest quality patient centered care is maintained. (WAG, 2011) EDUCATION Education training for this role is envisaged to be transferable, credible and work based. The training for the APs role has not been standardised. Various ways to prepare for the role can be achieved through : NVQ qualification gained through work-based training Higher Education Diploma, gained through part- time study, Foundation degree, gained through part-time study. In order to support work based learning trainee APs are assigned a clinical mentor By 1987 it was evident that there was a lack of understanding and definition of the role of the HCA.To clarify the HCAs future the National Health Service Training Authority (NHSTA, 1987) proposed that ‘support workers’ – a generic term – would perform specific clinical procedures resulting in a direct link with the patients. In 1988 the UKCC recognized that HCAs were helping to overcome staffing problems. In 1990 The NHS and Community Care Act introduced the HCA within the community nursing team to assist with domiciliary visits /bathing services, resulting in expanding the role and further integration into the NHS. Setting the Direction (WAG, 2010) advocates a paradigm view to community based care, opening up professional opportunities for HCAs.