Onboarding, retention and career development

Effective processes are needed to rapidly induct HCSWs into an organisation and equip them with the knowledge, skills and confidence to provide high-quality care quickly. An enhanced onboarding process may be useful to consider. It is also essential that your recruitment strategy and your onboarding, education and training processes include and communicate ways to retain your HCSWs and ‘grow your own’ workforce by supporting people to further their career in the NHS. A clear pathway for progression from HCSW roles through to registered nurses and midwives should be developed and made clear to potential recruits and existing staff. You should also ensure there are career development opportunities in place for those who wish to remain in HCSW roles.

Enhanced induction and the Care Certificate

The Care Certificate is designed to be used at the very beginning of an HCSW’s career as part of their onboarding, induction and training. It is aimed at equipping HCSWs with the knowledge, skills and confidence they need to feel safe and supported at work, and to enable them to provide safe and compassionate patient care. This improves health outcomes and the experience of both patients and the multidisciplinary care team; which in turn improves early attrition and retention.

Accelerated Care Certificate delivery model

HEE has worked collaboratively with the system to develop content to support an accelerated delivery model of the Care Certificate in 4-6 weeks (traditionally 12) via a blended learning approach. In partnership with eLearning for Health, HEE has also created a refreshed and rebranded landing page and animation for audiences new to healthcare. This introduces the Care Certificate and supports an accelerated delivery model.


Skills for care: The organisation Skills for Care has produced a range of resources to support implementation of the Care Certificate. This now includes new resources, to contextualise some of the Care Certificate standards to different working situations, including learning disability, mental health, dementia and lone working roles.

Reducing HCSW attrition

Being an HCSW can be challenging. Ensuring people feel supported and safe to undertake their role to the best of their ability is a critical part of reducing attrition and to improving the experience of patients and staff. Building resilience is imperative; making sure HCSWs feel supported and confident in their role is crucial.

A main driver of retention is staff having access to ongoing learning and development opportunities in addition to ongoing supervision. It is therefore important to consider not only how to recruit innovatively, but how to retain and support HCSWs in their new roles and reduce early attrition through your induction and education and training processes.

Case study: Frimley Health NHS Foundation Trust. To ensure that HCSWs had a thorough induction process and that there were clear pathways for progression between Bands 2 and 4 for HCSWs, Frimley Health developed a robust six-day induction process, taking place over six months, using a blended learning model to deliver the programme.

Key features include:

  • Fundamentals of care delivery to begin supporting patients in the first two days
  • A focus on communication, including handover and the importance of both verbal and non-verbal behaviours, dementia, safeguarding and an e-learning module on falls
  • HCSWs are inducted together which is an important element of the programme as it helps to foster peer support amongst HCSWs
  • HCSWs are buddied up with someone on the ward they belong to and undertake a period of supernumerary training for two weeks
  • Four weeks after starting the programme, HCSWs undertake a fourth day of induction, which covers additional skills that will help them in different settings, including ECGs, palliative care, diabetes, pain and mobility
  • Eight weeks after joining the trust, HCSWs come back and undertake an e-learning review and action learning sets to ensure their
    knowledge and skills are embedded
  • Four to six months after joining the trust, HCSWs undertake a study date focused on deteriorating patients. This whole process ensures
    that for the first six months a HCSW is in the trust they have several learning opportunities.
  • Induction days for new starters to the trust are run every two weeks as part of the programme.

Find out more about this case study on the FutureNHS platform.

HCSW career development and pathways for progression

It is important to think about career development opportunities for those that wish to develop within their role while remaining as a HCSW and staff that would like to progress over time to become a registered nurse or midwife.

A clear pathway for progression, as well as education and training opportunities, should be developed and mapped out for both instances,
then made clear to potential, new and existing staff. This will support individuals to maximise their potential in HCSW roles and also develop
a ‘grow your own’ model that will help build an organisation’s nursing workforce.

Organising regular discussions with staff to ensure there are opportunities to participate in improvement activity, or supervision of junior colleagues are just two ways to support HCSWs’ development within their role. A shared decision-making council can be an effective model for this kind of engagement.

Case study: University Hospitals of Leicester NHS Trust. UHL has developed a pastoral support package to help their HCSWs early on in their career and to help manage the practical realities of the role. Band 3 healthcare assistants (HCAs) support new HCSWs to omplete the Care Certificate and assist those who need extra help.

The trust has a buddy programme from the first day of clinical practice. HCSWs will have someone waiting to meet and greet them on their first day, and can then learn their way around the ward. Band 3 HCAs gain an understanding of the HCSWs and their skills, knowledge and experience. This enables them to identify which career pathways are most suited to their colleagues.

UHL is also in the process of running development days 12 weeks after HCSWs finish their induction process. It is being led by Band 3 HCAs with space for the previous cohort of HCSWS to come back and attend a session. The day incorporates ward manager feedback for each candidate and a strong element of peer support through their own reflective scenarios that they have encountered in practice.

The development and education team talk to the HCSWs about the different NHS career pathways and opportunities available to them both inside and outside of the HCSW role.

Find out more about this work on the FutureNHS platform.

Case study: Imperial College Healthcare NHS Trust. Imperial identified a need to increase their awareness and understanding of the skills and educational attainment of HCSWs coming into the trust. There was also a delay in the completion of the Care Certificate due to staff not having participation documents signed off in a timely manner.

A Band 4 associate educator role was developed to focus on HCSWs’ training and education. The aim was to train an appropriate member of staff to fully understand and support the HCSW role, and introduce a culture of education and learning for HCSWs with two posts covering the whole trust.

It is intended that the post holder will support the trust nursing directorate’s education team to further build on and articulate the development opportunities for HCSWs, by helping to champion and co-ordinate the development of HCSWs who are new to the trust and to the care environment.

Find out more about this case study on the FutureNHS platform.

Next sections in this guidance

Download this guidance as a PDF: Attracting people into healthcare support worker roles – A practical guide to developing your healthcare support worker workforce.