Role redesign in a modernised NHS: the case of health care assistants

Abstract

This article examines role redesign in the National Health Service (NHS), which has been central to the Labour government's modernisation agenda, focusing on the role of health care assistants (HCAs). Drawing on data from two acute hospital trusts, this article focuses on variation in HCA roles between trusts, indicating that there may not have been a uniform expansion of the HCA role as the government's HR agenda and most commentators suggest. Although the modernisation agenda has curtailed registered nurses' role in direct care, there are significant variations in the degree to which HCAs undertake a ‘relief’, ‘substitute’ or ‘apprentice’ role at trust level. These variations in HCA role stem from distinctive models of the nursing workforce with differing assumptions about the respective roles of registered and non‐registered nurses. The variations in HCA role have important consequences for the prospects for role redesign and HR policy in the NHS.