The Atlas of Shared Learning

Case study

Small Changes, Big Impact – Healthcare assistant development in a tissue viability clinic

Leading change

The Community Tissue Viability team’s healthcare assistants within Bradford District Care NHS Foundation Trust identified an opportunity to develop the healthcare support assistant role to offer a more personalised, flexible service to patients, carers and their families. The developments have led to improved outcomes, experiences and use of resources within community services as well as across the Trust more widely.

Where to look

Health Education England’s Shape of Caring review (2015) identified that care assistants, be they in health or social care settings, are a vital part of delivering frontline compassionate care. They provide approximately 60 percent of hands-on care, yet unfortunately can have at times variable or little access to development both professionally or personally. The report recommends that these roles should be a significant focus for investment moving forwards as they play an important role in patient safety and wellbeing.

The Community Tissue Viability team service manager and team leaders at Bradford District Care identified unwarranted variation in the provision of education, training and extended roles for healthcare assistants to develop their skillset. Supported by the Shape of Caring recommendations, a programme of work was developed to address this.

What to change

A review of service delivery undertaken by the leads and in collaboration with the team’s healthcare assistants (HCA’s) identified:

  • Increased numbers of referrals into the service;
  • Increasing acuity of patients referred;
  • An emerging need to work more flexibly for patients both in their own homes and within the clinics held by the service;
  • A need to remain focused on high quality personalised care;
  • Capacity, capability and a willingness within the healthcare assistant staff to extend their skills and expertise.

An agreed programme of clinical skill development for the healthcare assistants was developed to address unwarranted variation:

  • Applying compression bandaging (including Chronic Oedema bandaging);
  • Running of clinics with Band 6 overseeing;
  • Providing care to a specific cohort of patients identified by the agreed pathways of care within the organisation;
  • Actively participating in Doppler assessments & the care management plan.

How to change

The community tissue viability team leaders developed a comprehensive programme plan including the specific educational needs of healthcare assistants and this was agreed with senior colleagues at the Trust. The plan included a focus on the following areas:

  • Theoretical and practical training provided by Tissue Viability clinical leads in participating with Doppler assessments & wound management;
  • Practical training and support with bandaging regimes – including Chronic Oedema and Lymphoedema;
  • Support with the aetiology of wounds/dressing regimes and recognising early deterioration.

Each of the identified areas of education and development had a six-week competency framework requiring sign off by a Tissue Viability Nurse (TVN) once achieved, which was evaluated by the senior nurse manager for the department.

To support the practice of the newly up-skilled HCAs, a framework of support was developed which included a registered nurse ensuring they undertook initial patient assessments and a registered nurse presence in all treatment clinics to offer support, advice and guidance where needed. The registered nurses within the team also work directly with the HCAs every third treatment clinic at all locations across the Trust.

Adding value

Better outcomes – This programme of work has increased the knowledge and skills for the healthcare assistants within the Tissue Viability team using their talents and expertise to maximise their impact for patients in practice. The clinic sessions offered by the team have been increased, with increased flexibility and frequency where required and this has led to reduced waiting times within the service. The empowered healthcare assistants – with enhanced skillsets – have supported the team to be increasingly centred on delivering high value, high quality, personalised care with a focus on the experience of care for each patient using the service.

Better experience – The feedback from healthcare assistants about the new ways of working in the team has been very positive. This is also true in terms of patient, carer and family feedback as well as staff. This has been evidenced in the Trust’s friends and family test as well as through anecdotal feedback received by the team. The increased continuity of care they offer is particularly celebrated as well as staff reporting more time to support individuals, families and communities to equip them to make informed choices and manage their own health.

Better use of resources – The tissue viability nurses have had increased time available for other aspects of patient care. The new flexible service offered to patients means an increased number can be seen in their own home where appropriate. The programme has also resulted in a more cost-effective service by providing focused patient care using a triage and allocation system to ensure the right resources are allocated early.

Challenges and lessons learnt for implementation

It is important to consider the significant benefits for all members of the team to have the opportunity to develop their skills. Developing staff is key to leading an enthusiastic and dedicated team and should be given enough time and careful consideration.

The uncertainty of change can be challenging, but by encouraging the discussion and consideration of the change with staff, early myths can be debunked and support gathered.

Support of wider nursing teams, senior managers and other key stakeholders must be given time and resources before launching the new way of working/programme of change as it’s difficult to bring people on board later in the stages of change.

Flexibility is a must. However, it is essential to ensure your programme remains focused on its goals and the positive impacts it will have for patients and staff.

Due to the success of the programme, the Tissue Viability Operational are rolling out healthcare assistant led clinics (overseen by the tissue viability nurses) to support further staff development. A bespoke package of support for local District Nursing teams doing home visits is also underway to ensure compression hosiery treatments remain optimal.

Find out more

For more information contact:

  • Rebecca Rae – Tissue Viability Operational Lead, Bradford District Care Foundation Trust,
  • Claire web – Tissue Viability Operational Lead, Bradford District Care Foundation Trust,