1. History The position of Health Care Assistant (HCA) began during the Crimean War of 1854-56. Their role was as a part of the nursing team and was given the title of ‘nurse’s aides’. Florence Nightingale saw their value and regarded them as assistants to, and working with, the trained nurses (Kershaw 1989).The role of nurse’s aide continued until the Health Care Act of 1919 tried to define the boundaries between nursing staff who were trained and those that were not (Witz 1992). The Act failed and it was not until 1955 that the role of ‘nursing auxiliary’ became formally recognised. This was a move by the state to allow the use of cheap labour (‘grade dilution’) to replace some of the more expensive grades (Thornley 1996). The use of auxiliary nursing staff expanded thereafter, especially in periods of staff shortage. The role of the auxiliary nurse, or HCA changed after the 1984 review by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC). This was called Project 2000 and looked at nurse education and training. Project 2000 was launched in 1986 and defined the role of the HCA as assisting trained nurses in patient care. It became clear by 1987 that the interventions had failed to define boundaries and the HCA’s role was defined as assisting trained nurses. Modernisation In 2005 the Welsh Assembly Government (WAG) set forward their vision for health care in Wales. This was called ‘Design for Life’ (WAG, 2005) and was designed to make the Welsh health service the best in the world. This was to be achieved by both the health service and patients working together to prevent poor health and to give the patient better control over his or her health. Under this proposal the role of the HCA was to contribute to the quality of direct patient care, they were to become highly skilled members of the health care team and to be able to understand the holistic nature of patients’ needs. The role was changing and a new title of Health Care Support Worker (HCSW) was introduced and The Wanless Report (WAG, 2003) proposed that they would become ‘the eyes and ears of the service’. ‘Setting the Direction’ (WAG, 2010a) sets out the vision that HCSWs will work with other multi-disciplinary teams to deliver patient centred care in the community and understand their needs and promote independence. Within this strategy the HCSW has an opportunity to expand and develop their role. References Cox C (2010) Responsibility and accountability: Nursing Management 17:3:18-20 June 2010 Howard, S (2009) Chapter 1: How we learn and how we can help others to learn in Hinchcliffe, S (2009) (Ed) The Practitioner as teacher (4th Edition) Churchill Livingstone Elsevier Edinburgh. Kershaw B (1989) Project 2000. Identifying the nurse support worker. Nursing Standard.3, 52.40-43 Thornley C (1996) Segmentation and Inequality in the workforce: re-evaluating the evaluation of skills. In Crompton R al (Ends) Changing Forms of Employment: Organisation, Skills Gender. London, Routledge. Welsh Assembly Government (2003) The Review of Health and Social Care in Wales: The report of the project team advised by Derek Wanless, Cardiff: Welsh Assembly Government Welsh Assembly Government (2005) Design for Life, Cardiff: Welsh Assembly Government Welsh Assembly Government (2010a) Setting the Direction, Cardiff: Welsh Assembly Government Welsh Assembly Government (2010b) All Wales Guidelines for Delegation, National Leadership and Innovation Agency for Health (NLIAH), NHS Wales. Welsh Assembly Government (2011) The Code of Conduct for Health Care Support Workers in Wales. Cardiff: Welsh Assembly Government. Witz A (1992) Professionals and Patriarchy. London, Routledge. photo name Florence Nightingale Delegation Greater demands are being made on the health services; the need to delegate, assign and supervise will be important competencies for the HCSW (WAG, 2010b). Delegation ensures that patients obtain prompt and appropriate care, staff time is effective, work shared evenly, all staff will feel part of the team, productivity is improved and the health care services achieve better results. Models of nursing and protocols are focusing on the care that is being given outside the hospital setting. The HCSW needs to gain the experience and training to undertake tasks safely and effectively while following clear competences and working with the supervision and support of trained members of staff. The All Wales Guidelines for Delegation (WAG, 2010b) allow the Welsh Health Service to create a standard and consistent approach for effective delegation. An important part of the Nursing Support Worker Education is being mentored in the workplace. However, mentors can make the experience negative as well as positive; they must ensure that they take the time to enable students to grow and develop their knowledge. Facilitation in the workplace from mentorship enables the support worker to develop their professional experiences. Giving support to other fellow workers by mentoring new starters by sharing knowledge and reflecting on activities builds a good working relationship (Howard, 2009). Code of Conduct A new Welsh Code of Conduct for HCSWs (WAG, 2011) is being implemented to ensure that people using the services of the National Health Service receive a consistent, high quality, safe and effective service. HCSWs must always be accountable by ensuring they can always answer for their actions and have a responsibility to undertake the task of ensuring the well being of all persons using services and that they are free from harm. The Code of Conduct applies to all HCSW whether they deliver direct or indirect care. They have to give quality of care by updating their knowledge and skills (Cox, 2010). There will be a modernisation of the workforce to ensure that NHS Wales provides a better quality and safe environment for patients. A new development and education programme for HCSWs, the Health Care Support Worker Course in Level 4 Higher Education, will enhance the level of service to patients and help the HCSW in working toward a professional career. The HCSW’s future is changing but, through training and development, they will continue to deliver a high quality of care and continue to take their place in the frontline of the Health Service. From the Crimea to the Code of Conduct 09045856