The Modernization of the Nursing Workforce : Valuing the Healthcare Assistant

The Modernization of the Nursing Workforce: Valuing the healthcare assistant is based on recently completed research exploring the role of healthcare assistants (HCA) in acute hospitals. Whilst a support role working alongside registered nurses has been a longstanding feature of the NHS, the contemporary HCA role has become increasingly central to the process of health service modernization. The role is now assuming even greater importance as the ramifications of financial constraints, restructuring and other pressures on the NHS play out.

The HCA role is unregulated and low paid, but by taking-on direct care tasks from registered nurses, the role has become politically sensitive. The HCA remains a cheap and flexible source of labour, but the unregulated role encourages dilemmas and public scrutiny over risk and patient safety. The book explores how public policy reform of the health service feeds through to impact upon the management and structure of the healthcare workforce. More specifically, the book provides a timely evidence base for the extended and growing use of the HCA role.

The book draws upon a multi-method research design from four geographically located hospital trusts in England, which during a three year period saw over 270 staff interviewed, focus groups and interviews with over 100 patients, some 275 hours of ward-based observation, and detailed survey responses from over 3000 members of staff and hospital patients.

The unusual richness of the data allows a defining examination of who undertakes the HCA role, its shape, nature and diversity, along with the consequences for those with a stake in the role - hospital managers, the assistants themselves, the patients they care for and the nurses they work alongside. Making, The Modernization of the Nursing Workforce: Valuing the healthcare assistant essential reading for health care studies and public management communities, and those charged with training and education policy.

Ian Kessler worked as a research officer at civil service trade union, the Institution of Professional Civil Servants, before becoming a senior lecturer at Bristol and Thames Polytechnics. Joined the University of Oxford in 1990 and has produced a range of publications from research on reward strategies, employee communications, human resource management in the public services and the 'psychological contract' at work. He has been involved in a number research programmes including projects funded by the Economic and Social Research Council on employment relations in the public services and has just completed a three year project funded by the National Institute of Health Research on nurse support roles in secondary healthcare. He has acted as an adviser to the Audit Commission and the National Audit Office, Royal College of Nursing and the Police Federation. He was a Commissioner on the Local Government Pay Commission, 2005.


Paul Heron is a Senior Research Associate at Said Business School. His interest in health services research and, more specifically, the role of support workers in the public sector has been supported by grants from the Economic and Social Research Council and National Institute for Health Research. He has a background in survey based research and an interest in the role of surveys in mixed-methods research.

Sue Dopson is Rhodes Trust Professor of Organisational Behaviour and Faculty Dean at Said Business School. She is also Dean of Green Templeton College, Oxford, and Visiting Professor at the University of Alberta, Canada. She is a noted specialist on the personal and organisational dimensions of leadership and transformational change, especially in the public and healthcare sectors. Sue has been extensively involved in some highly innovative executive development programmes. She teaches on the Oxford Advanced Management and Leadership Programme, the Oxford Strategic Leadership Programme, and Consulting and Coaching for Change, as well as a number of programmes delivered to clients in the Middle East. She has worked closely with organisations ranging from the UK Department of Health to Roche Pharmaceuticals. As a founding director and current member of the Oxford Health Care Management Institute, she is involved in the development of courses for the NHS. She has also worked as a tutor with Centrica