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1. An evaluation of a competency tool
(Niche) to develop nursing assistants
N
HS Grampian, like many areas of Britain, is
heading for a demographic time bomb (Dobson,
2007). The population in Scotland is growing
older and the number of people aged over 85
years is projected to rise by nearly 75% by 2025 (Scottish
Government, 2006). This will have an effect on all health
boards’ ability to care for the increasingly growing older
population, which will incorporate multi-faceted disease
processes. In terms of workforce planning, there will be a
need to reconsider the ways in which these demands are met.
This is especially true in Aberdeenshire, where it is predicted
that by 2024, 77% of the population will be over working
age (NHS Grampian, 2007).This, in turn, also puts pressure
on the labour market, as there are less young people to draw
into the health-care workforce.
Therefore,it would seem appropriate to be creative in how
care is arranged to meet needs. This may involve breaking
down traditional boundaries of who delivers what kind
of care and in turn creating new innovative roles (Scottish
Executive, 1999; Scottish Government, 2003; 2004; 2006).
Health-care assistants may need to develop new roles
to help meet these demands. This pilot considered a
Katrina Whittingham
new competency framework, Niche (National Incremental
Competencies in Healthcare Education) as an alternative to
the Scottish Vocational Qualifications, as a way to develop
this part of the workforce.
NICHE
Niche was developed in NHS Greater Glasgow in 2000
and is widely used in a variety of Health Boards throughout
Scotland (Greater Glasgow, Highland, Tayside, Lothian, and
Ayrshire and Arran).Traditionally, it is used when new staff
are inducted, then as an incremental development tool year-
on-year for non-registered health-care assistants. In NHS
Grampian, the pilot was planned to enhance or develop the
roles of existing staff, not for new recruits.
Niche has five core themes, which must be completed
by all candidates and which are directly related to the core
dimensions of the NHS Knowledge and Skills Framework
(Scottish Executive, 2004), the tool that will form part of
all NHS staff’s performance reviews. These are detailed in
Figure 1. In addition there is a wide selection of basic and
enhanced competencies, which have been mapped to the
National Occupational Standards and the NHS Knowledge
and Skills Framework.
Intended outcomes
The aim of the pilot was to test a competency framework
(Niche) in practice, to see whether it could meet the needs
of the clinical area and enable health-care assistants to
demonstrate competence in new diverse roles. The pilot
aimed to develop the role of 20 health-care assistants in six
distinct clinical areas in NHS Grampian. The clinical areas
were selected with the assistance of the workforce planning
team using a Telford study (Croft, 2006), which identified
areas were there was potential to further develop the health-
care assistants’ competencies.
Literature review
Over 15 million people in the UK currently have a
long-term condition, and as the number of older people
is rising across the UK, this number will only increase
(Scottish Government, 2006). However, in order to meet
this increasing demand, there is political recognition of
the need to change the way health-care has traditionally
been delivered (Scottish Executive, 1999; Scottish
Government, 2006).
A range of policy initiatives currently exist that aim to
increase the numbers of health-care assistants and develop
their traditional role (Skills for Health, 2007). However, in
690 British Journal of Nursing, 2009,Vol 18, No 11
Katrina Whittingham is Professional Development Facilitator,
Professional and Practice Development, NHS Grampian
Accepted for publication:April 2009
Abstract
As UK society changes, with people living longer and with
chronic conditions, and less people available of working age to
provide nursing care, there is a need to re-think how health-
care is organized and delivered. This is likely to have an affect
on the non-registered component of the health-care workforce.
However, if patient safety is to be maintained, it is paramount
that the competence of individuals taking on roles that were
carried out by trained staff must be ensured. This pilot study
of a competency tool, National Incremental Competencies in
Healthcare Education (Niche), demonstrated that individuals
could expand or change their role as a result of completing
the educational package. The evaluation aims to examine the
usefulness of this competency tool in preparing nursing assistants
to take on new roles and meet patients’ needs.
Key words: Practice development n Non-registered staff
n Role development n Workforce planning

2. practice there is a lack of consistency in health-care assistant
development and there is a need to clarify their educational
requirements, responsibilities and accountability (NHS
Education for Scotland (NES), 2007). At present, this staff
group are not subject to any form of statutory regulation.
A national pilot for health-care assistant regulation is
currently underway in three NHS Board areas in Scotland
(NES, 2007).
The educational preparation of health-care
professionals has reflected this need for change, moving
from an ‘education system with a one size fits all
approach, struggling to balance academic and practical
learning’ (NES, 2001), to a more flexible principle-based
curriculum that is built around patient pathways, and
interdisciplinary learning.
NES (2001) also recognizes the need for a career structure
with an increased number of health-care assistants working
as part of multidisciplinary teams.
Ramprogus and O’Brien (2002) expressed a need to
develop the health-care assistants within the NHS in a more
formal way, as they found that to date their development
was delivered in a sporadic non-systematic fashion.
Hancock et al (2005) considered the impact of educating
health-care assistants and how prepared they were for
newly developed roles – the outcomes were positive in
terms of skill and knowledge development, increased
confidence, initiative and a more holistic approach to care.
Similar results in terms of increased levels of confidence
and the desire to undertake further study were found in
other studies (Fearfull, 1990; Day, 1993). However, these
studies and others (Pratt, 1999; Dunlop, 2001, Sutherland
and Whittingham, 2005) also reported negative aspects of
completing vocational competence-based frameworks in
extremely busy clinical environments, where health-care
assistants had to compete with a multitude of demands in
order to be assessed as competent.
When breaking down traditional role boundaries in health-
care delivery there must be clarity as to where the health-
care assistant’s role ends and the registered nurse’s begins.
Hopkins et al (2007) recommend that clear job descriptions
are written with absolute clarity on lines of responsibility and
accountability. In addition, Hopkins et al (2007) recommend
an accurate record of assessed competence is kept and
maintained by the health-care assistant.
All staff within the area where the development is
taking place should be encouraged to ‘have a voice’ in the
project to ensure ownership within the area. Otherwise,
as found by McGloin and Knowles (2005) suspicions and
anxieties arise around professional lines of accountability
and responsibility.This is further supported by Bowman et
al (2003) and Storey (1991) who state that the increasing
use of health-care assistants has led some qualified nurses to
believe that a diluted skill-mix could have a negative impact
on the quality of care delivered.
Ramprogus and O’Brien (2002) and Gray (2003) also
found that some nurses were reluctant to allow health-care
assistants to take on tasks that they considered to be their
own work. However,Warr’s (1988) study found that in fact
health-care assistants who had completed a competency
WORKFORCE DEVELOPMENT
British Journal of Nursing, 2009,Vol 18, No 11 691
based framework provided higher standards of care than their
registered nursing counterparts.
In order to successfully develop roles of health-care assistants,
Ashby (2003) suggests that there should be designated co-
ordinator responsible for facilitating training, development
and role progression.
Background to the evaluation
Recruitment and programme design
The pilot was carried out as part of the role of two
professional development facilitators (one whole time
equivalent), who work in Professional and Practice
Development Unit (PPDU). The facilitators approached
the manager in each of the selected areas who decided
whether to recruit a small number or all of the health-care
assistants in their clinical area. The facilitators discussed
how the roles of the health-care assistants could be
enhanced, or changed, to better meet the needs of their
client group, enhance team work and meet individual
personal development plans. Each ward manager decided
on specific areas of development on which to focus for
the purpose of the pilot and the facilitator provided advice
on grouping different competencies together, for example,
urinalysis/catheter removal or diabetes management and
blood glucose monitoring.Table 1 details the topics
selected by managers in each area.
In addition to the core themes, managers were able to
design the programme around a large selection of practice-
based competencies (a selection of which are included in
Table 1). Each clinical area designed their own programme to
meet their specified service need.The structure of the Niche
competency framework allows for this degree of flexibility.
Communication
Equality and
diversity
Health, safety
and security
Service
improvement
and quality
Personal and
people
development
Niche
core
competencies
Figure 1.The five core competencies of the Niche tool.

3. Induction
On consultation with the ward managers, there was a view
that evening classes (6–8pm) would free-up staff to attend
the induction sessions. Therefore, four two-hour sessions
were planned and delivered in November 2006,then again in
January 2007 for the Aberdeen-based participants. Assessors
received a half-day’s preparation for their role as they must be
deemed competent to assess pre-registration nursing students
in order to assess on this programme.
Separate sessions were delivered locally.The topics covered
on the induction were:
n An Introduction to Niche as a competency framework
n How to use a portfolio
n Accountability and responsibility
n Ethics
n How to search for evidence using a PC.
A computer suite was used for these classes so that the
candidate’s could learn to use a personal computer in
order to search for evidence. By the end of the induction
period all candidates had an email address and access
to the NHS e-library. At their penultimate session, all
candidates were asked to produce two 500 word essays
on the subjects of ethics, accountability and responsibility,
ideally by the end of the induction process (if not during
completion of the programme). The candidates were
given the marking scheme which would be used to mark
their essays, and floppy discs to save their essays onto.The
essays were double marked by both facilitators of the
programme and participants were given written/verbal
feedback. The principles of responsibility, accountability
and ethics underpin the development process within
the Niche philosophy. The programme is designed to
enable candidates to gain knowledge and competence
in these areas that will then inform the rest of their
development and ensure patient safety with absolute
clarity on responsibility/accountability.
At the end of the induction process, the candidates
requested further contact with the facilitators, to ensure they
stayed ‘on track’ and to receive peer support. Although the
candidates were encouraged to learn in a self-directed, adult
learner style (Rogers, 1981; Knowles, 1984; Race, 2001),
there appeared to be a need for a facilitated medium and
experiential co-operation with peers (Heron, 2000). Six
weekly evening meetings were planned in Aberdeen where
attendance was voluntary.
In the workplace
The candidates and assessors then commenced the course
back in their normal workplace. The facilitators met with
theWard Manager/Team Leader, or whoever was responsible
for overseeing the programme in each area on a six-weekly
basis.These meeting were to check on progress, re-motivate
the candidates if progress was slow,and generally facilitate the
programme (Race, 2001).
Methodology
The methods used formed an action research study
of workforce development. Advice was sought from
NHS Grampian’s Ethics committee, however, no
692 British Journal of Nursing, 2009,Vol 18, No 11
Table 1. Topics chosen by each manager
Acute rehab Rehabilitation Medical From the
(Woodend Hospital, Self-care Diabetes well- HCA
Aberdeen) Exercise being establishment,
Practice Blood glucose one of each,
Post monitoring applied for the
Orthopaedic Urinalysis course and were
Progression Catheter interviewed and
Mobility and gait removal selected by the
Dressing Temperature ward manager
Practice Pulse
Seating Blood pressure
Feeding Simple
Transfers dressings
Night Nurse Blood glucose monitoring Two HCAs
Practitioner Service Diabetes Well-being employed on a
(Aberdeen Royal Laboratory results temporary basis
Infirmary) Venepuncture to take part in the
Cannulation pilot.
Requesting blood for X match
Bladder scanning
Male catheterization
12-lead ECGs
Respiratory Escorting Patients with Two – selected by
(Aberdeen Royal intravenous fluids the ward
Infirmary) Escorting patients with a chest manager
drain
Diabetes well-being
Blood glucose monitoring
Peak flow measuring
Acute Medical Oxygen Saturation Five, all HCAs
Admissions Unit Measuring and recording in the area
(Aberdeen Royal respirations
Infirmary) Escorting a patient with oxygen
therapy
Escorting a patient with
intravenous fluids
Escorting and transferring
patients
Blood glucose monitoring
Diabetes well-being
Hourly urine volumes
Out-patients Core only Seven, all
Department HCAs
in the area
Out of hours Removal of a wound dressing Two, all HCAs
Service, Weekend Simple dressings in the area
Team Assisting with a clinical procedure
(Primary Care)
How many
candidates and
Type of enhanced method of
Clinical area competencies selection

4. formal submission was required as this was a workforce
development study. As the study formed part of an
academic piece of work, ethical approval was sought from
Robert Gordon’s University.
All ward managers/senior nurses who were responsible
for the Niche pilot in their area were invited to attend
an evaluation day 11 months into the 12-month pilot.
Candidates and assessors also attended a two-hour session
to ascertain their views. Semi-structured focus group
discussion took place where key points were scripted
for further thematic analysis. In addition, everyone
who attended the evaluation events all completed an
individual questionnaire.
Results
Managers re-considered the drivers they had initially
identified (Figure 2), then discussed whether the pilot had
met their expectations.
Patient/service need
There was a general view held by the managers present
at the evaluation events that there was an improvement in
patient care delivery as a result of being involved in the
pilot. Eighteen individual questionnaires were returned
(five managers, five assessors, and eight candidates),
seventeen (89%) of these stated that the healthcare
assistants’ ability to provide patient care had increased
due to being involved in the Niche pilot. The two who
felt there had not been a change were candidates who
felt they had already provided a high standard and the
Niche programme had not affected this. There was an
overwhelming sense of a deepening of knowledge among
health-care assistants as well as an increased awareness of
accountability. This in turn led to increased confidence
among managers in delegating duties, with an greater
assurance that the health-care assistant was competent.
Managers’ comments included:
‘Patients get their required care quicker.’
‘Assistance with rehabilitation is available to
patients out of hours.’
‘The Niche candidate recognizes changes in a
patient’s condition and acts upon it.’
‘Trained staff are being assisted more.’
‘The course allowed trained staff to be devolved
elsewhere.’
Knowledge/skills enhancement
Those present were asked which knowledge and skills had
been enhanced and how (see Table 2).
Education
Those present were asked who provided the background
education to support the competence development. These
included:
n PPDU facilitators
n Mentors
n Colleagues (occupational therapists and physiotherapists)
n Specialist nurses
n Team leaders
n Self-directed learning searching online for evidence.
Time for learning, developing and being assessed
was a consensus issue to all involved. As found in
previous studies (Pratt, 199; Dunlop, 2001; Sutherland and
Whittingham, 2005), vocational workplace development
can tend to be squeezed into an already busy work
schedule. All who attended the evaluation events felt that
the pilot would have benefited from a protected learning
time agreement.
Involving key stakeholders
At the outset of the pilot, ward managers and team leaders
were asked to identify key stakeholders who could influence
the pilot. At evaluation they were then asked: ‘Who had
influenced a change in care delivery as part of the pilot?’Their
responses included positive and negative influences (Figure 3).
Those present at the evaluation day felt that the nursing
mentors had to re-motivate the health-care assistants when
they became disheartened by fitting the Niche programme
into very busy care delivery schedules.Comments were made
by several candidates and assessors on the appropriateness of
senior nurses being appointed as mentors as this creates
difficulties when they are in charge of an area. Both groups
(candidates and assessors) felt it would be more appropriate
for less senior nurses to be assessors. Specific comments were
made by several candidates on the accessibility and excellent
support the candidates received from newly qualified staff
nurse development programme nurses. Generally, the ward
managers and team leaders present self-assessed themselves as
influential in moving this change forward.
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British Journal of Nursing, 2009,Vol 18, No 11 693
Knowledge
and
skills
enhancement
Patient
and
service
need
Involving
key
stakeholdeers
Accountability
Governance Education
Figure 2.The drivers initially identified by managers.

5. Some positive comments were fed back from patients, in
particular in relation to the weekend dressings clinic run
by the out of hours service. Patients commented that they
waited less time to receive their treatment when the health-
care assistants were fully involved in the clinic.
Views were expressed about negativity from the allied
health professional mentors, some of whom appeared
reluctant to become involved in the programme.There was
a degree of anxiety about devolving traditional occupational
therapy and physiotherapy duties and apprehension about
the need to protect the role of their own assistants. However,
by the end of the pilot, the allied health professional
mentors appeared enthused by the programme and were
keen to support their candidate to achieve completion of
the programme. Some senior trained nurses appeared to feel
threatened by the devolving of duties that were traditionally
carried out by registered practitioners – a feeling that has
been found in other studies (Storey, 2002; Bowman et al,
2003, McGloin and Knowles, 2005).
One ward manager felt that she did not receive enough
physical support to allow additional staff cover to be booked
for Niche participants’ study time.
The PPDU Facilitators were viewed as positive
influencers within the pilot, in terms of regularly (six-
weekly) meetings with the ward manager/team leaders,
which were held to facilitate the process. However, both
facilitators, worked on a part-time basis and were not
solely dedicated to the project – therefore their ability to
meet needs as they occurred (for example, someone at the
end of a phone) meant that at times there was insufficient
support for the pilot areas.
Governance and accountability
Those present were asked ‘How was patient safety assured
during the Niche pilot’ and the following answers were
provided:
n Close supervision
n Direct instruction
n Discussion
n Health-care assistants were taught theory before practice
n Patient permission sought
n Feedback
n Following flowcharts developed in specific areas
n Following NHS Grampian Guidelines and Best Practice
Statements.
The Niche programme induction also focuses on
developing the candidate’s awareness of accountability and
responsibility, as recommended in the evidence (NMC,
2006; Hopkins et al, 2007).Those present at the evaluation
felt strongly that the candidates had an increased knowledge
and awareness of their own accountability. Candidates
expressed a view that from a governance perspective their
achievement of competence should be recognized in order
for staff and patients to accept that it was appropriate for a
health-care assistant who had been deemed competent to
carry out duties, which would have previously been the
domain of a registered nurse. They made suggestions that
recognition could be in the form of a different title, badge,
or poster in the clinical area.
Ward managers/team leaders were asked if the Niche
programme had led to ‘significant’ role changes, which
would require a new job description. Only the acute medical
assessment unit, the night nurse practitioner service and the
rehabilitation service felt that the job roles had undergone
significant enough change to warrant a new job description.
The other areas felt there had been a valued change in the
roles, but that the level of responsibility the health-care
assistants had not changed.
Ward managers/team leaders also expressed concerns in
that they would like to be able to further develop their
health-care assistants, but due to financial constraints had a
limited capacity to create Band 3/4 (Scottish Executive,2004)
in their set staffing budgets.
Structure
There were opinions expressed by all who took part that
the pilot lacked a clear structure. The structure had been
too flexible, allowing for variation in support at local levels
and at individual manager’s discretion. For example, one
area gave four hours protected learning time per month,
whereas all the others did not receive any. Those present
Table 2. How knowledge and skills were enhanced
• Vital signs • Shadowing
• Escorting patients with intravenous fluids • Mentors support and guidance
• Escorting a patient with oxygen therapy • Development nurses’
• Escorting patients with a chest drain support and guidance
• Holistic diabetes care • Personal experience (brought the
• Blood glucose monitoring skills, learned the background
• Urinalysis knowledge)
• Catheter removal • Practice (supervised until
• Laboratory results competent)
• Venepuncture • Policies
• Cannulation • Intranet and internet
• Requesting blood for X match
• Bladder scanning
• Male catheterization
• Peak flow measuring
• Oxygen saturation
• Measuring and recording respirations
• Escorting and transferring patients
• Hourly urine volumes
• Removal of a wound dressing
• Simple dressings
• Assisting with a clinical procedure
• Rehabilitation skills
• Admission assessment
• Cross infection
• Local human resource policies
Skills Methods
Positive Influences Negative Influences
Nursing mentors Allied health professional
mentors
Ward manager/team leaders Senior trained nurses
Patients Senior nursing managers
PPDU facilitator PPDU facilitator
Figure 3. Positive and negative influences on change.
694 British Journal of Nursing, 2009,Vol 18, No 11

6. felt there should be a timetable set for progression through
the programme, with at least four hours protected learning
time with a mentor every month.
A basic computer skills course, in this case provided
by NHS Grampian IT support, should be integral to the
induction process for all candidates. In terms of the course
content, there were views expressed that there had also
been too much flexibility, with one area concentrating on
achieving two enhanced competencies, whereas as in other
areas, up to nine enhanced competencies were targeted.
Attrition
Of the initial 20 candidates only three left the programme –
two to take the HNC route onto nurse education, and one to
take up an access to nursing place.This is similar to findings in
other studies (Fearfull, 1990; Swiattwiczak, 1990; Day, 1993,
Sutherland and Whittingham, 2005). Views were expressed
that this programme had provided an ideal framework to gain
entry into further education
Discussion
The pilot demonstrated that the Niche framework provides a
wide range and depth of potential areas to develop this staff
group (Table 1).This is merely a snapshot of what could be
potentially available, as the types of enhanced competencies
in the Niche programme have increased since the outset of
the pilot.The competencies are practice-based and responsive
to the ever-changing NHS. The programme is based on
national occupational standards and is completely mapped
to the NHS Knowledge and Skills Framework (Scottish
Executive, 2004).
The pilot demonstrated that in most cases, candidates
develop in a self-directed, adult learner mode (Rogers,
1981; Knowles, 1984; Race, 2001), with only the
rehabilitation role requiring protected time-out. The
role of the health-care assistant in the rehabilitation
area underwent the most significant change compared
to others in the pilot (who were enhancing their skills
within the nursing discipline) and the health-care
assistant was able to break down professional boundaries
(Scottish Executive, 1999; Scottish Government, 2006)
to better meet patient need, continuing rehabilitation
activities out of hours.
However, the mentoring of a health-care assistant role by
an allied health professional mentor presented challenges
to all involved. The allied health professional mentors
required additional support from the PPDU facilitator to
assess the competencies at the level expected for the Niche
programme. On reflection, had the allied health professional
mentors been involved more with the ward manager from
the outset in designing the programme, there may have been
an increased sense of ownership and this may have been less
challenging. As the pilot reached completion, this became
much less challenging, with the allied health professional
mentors actively participating in the programme. The
health-care assistant required protected learning time with
the occupational therapist and physiotherapist, whereas
others in the pilot worked as normal with a registered nurse
to gain competence.
The programme would appear to be a cost effective way to
develop staff, however, it is not without its downfalls, as there
appears to be a need for a structured programme with in-
built protected learning time, if it were to be continued.
The extremely low attrition rates and progression of all
who left the pilot demonstrates that this programme could
act as a catalyst to motivate career progression into nurse
education for this staff group. Furthermore, the expansive
catalogue of enhanced competencies available would appear
to have the ability to facilitate the creation of more enhanced
roles,such as senior health-care support workers or specialised
health-care support workers.
However, there is a need for recognition of achievement
of competence in terms or job role/banding, title, or pay
progression if motivation to become involved in future
developments is to be encouraged.
Limitations
Several limitations to the pilot were identified:
n The pilot hoped to represent the diversity of care provided
in NHS Grampian, however, as Chalmers Hospital in Banff
was unable to be involved, rural health-care provision was
not represented
n Staff reported that patients were positive about the role
development within the pilot, however, no patient views
were specifically sought or recorded
n The evaluation only considered the views of those who
attended the evaluation events, therefore, the views of those
who did not attend were not recorded
n The pilot took place during turbulent times within the
NHS. Staff within NHS Grampian were being banded as
a result of the job evaluation strand of Agenda for Change
(Scottish Government, 2004). Banding of most of the
Niche candidates, at Band 2, with no immediate prospect
of re-banding led to discontent and low motivation to
complete the programme
n The pilot was facilitated by two part-time professional
development facilitators, who had other areas of
responsibility within their post. However, nine months
into the pilot, one facilitator changed post, leaving a
0.4 whole time equivalent facilitator to oversee the
pilot. This meant clinical areas were less supported as
the pilot progressed. As suggested by Ashby (2002,) to
ensure a systematic approach to the development of
health-care assistant roles, there should be a designated
coordinator who would be responsible for their overall
role development and training.
Conclusion
The demographics of society in the NHS Grampian area
and the UK as a whole is changing as people are living
longer, with increases in chronic illness. If health-care is to
meet these ever-increasing demands, the ways in which it is
currently delivered will have to be creatively developed, as far
as possible within existing manpower resources.
This pilot demonstrated that the roles of health-
care assistants, could be enhanced by using the Niche
competencies. It is crucial that health-care assistants develop
competence in new clinical skills and that this development is
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British Journal of Nursing, 2009,Vol 18, No 11 695

7. underpinned with clear lines of accountability (NMC, 2006;
Hopkins et al, 2007). From this pilot, the Niche programme
appears to be able facilitate this process safely, in terms of
professionalism and vicarious liability. It is anticipated this
pilot will be an influential factor on how NHS Grampian
will respond to these needs and the development potential
of health-care assistants.
Possible areas for further work or study
Further work that is being considered within NHS
Grampian:
n Consider new job roles/bands/titles for those who have
completed the Niche competency framework
n Extend the pilot to other areas where there are:
a) issues with recruiting and retaining health-care assistants
b)potential to develop the established staffing structure
with more enhanced health-care assistants in place
c)Consider if Niche could have the potential to facilitate
the development of Band 3 and 4 health-care assistants.
n Learn lessons from the pilot in terms of engaging all
involved in the planning process; providing a more
structured approach to the programme; selecting less senior
mentors; and providing a more consistent approach to
protected learning time across all areas
n Consider how the Niche programme fits to the current
SVQ provision within NHS Grampian
n Appoint a dedicated Facilitator to oversee the development
of this staff group
n An investigation of the expansive roles health-care assistants
have at a national level, considering their titles, banding and
potential career progression
n Formulation of a clear career pathway for health-care
assistants at a national level, for adaptation locally. BJN
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KEY POINTS
n Demographic changes in Scotland are fuelling a need for change in workforce
planning and care organization.
n As society changes in the UK, with people living longer and with
chronic conditions, and with less people available of working age to
provide nursing care, there is a need to re-think how care is organized
and delivered.
n However, it is paramount to ensure the competence of individuals taking
on roles that were carried out by trained staff if patient safety is to be
maintained.
n This pilot study of a competency tool, National Incremental
Competencies in Healthcare Education (Niche) demonstrates that
individuals can expand or change their role as a result of completing the
education package.
n This pilot considered the development of new support roles in practice,
in line with service need and the Knowledge and Skills Framework (KSF),
(Scottish Executive, 2004).
n The article evaluates the Niche competency tool in a variety of practical
settings and aims to inform on the usefulness of this competency tool in
preparing health-care assistants for new roles.
n It is anticipated this pilot will be an influential factor on how NHS Grampian
will respond to these needs and the development potential of healthcare
assistants.
696 British Journal of Nursing, 2009,Vol 18, No 11