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Case Study – Royal United Hospital Bath

Upskilling Healthcare Assistant role improves mental health care delivery for patients and reduces Registered Mental Health Nurse agency spend

A significant number of patients requiring acute care at the Royal United Hospitals Bath NHS Foundation Trust (RUH) have complex health needs and a growing number of these extend to Mental Health (MH)challenges, a growing concern for many NHS Trusts.

The senior nursing team at RUH identified that by piloting the upskilling of a cohort of Healthcare Assistants, it would be possible to significantly enhance care for patients with Mental Health needs and potentially reduce the use of Registered Mental Health Nurse (RMN) agency staff.

“It’s amazing to see the change in practice and the movement in understanding patients with mental health needs. The Healthcare Assistants are a delightful group of staff to work with and they have really enjoyed putting their learning into practice. Of course, the change has to continue beyond the end of the life of the project, and from what I’ve seen so far, I’m confident we are seeing change for good.”

Julie Blackman Head of Clinical and Vocational Skills

The RUH recognised that existing options to ensure these patients were looked after by staff with the right skills (RMN agency nurse or nurse special) did not always deliver a timely consistent quality care outcome and that there was a need for competence for staff in support roles.

The RUH worked with Skills for Health to develop a core group of HCAs to support this ambition, utilising the National Occupational Standards to develop a Transferable Role Template. The nine-month project focused on upskilling a cohort of HCAs to support an improvement in care for people with mental health needs and support a reduction in reliance on RMN agency staff. The project aimed to:

  • develop a health care assistant (HCA) band 3 six-month mental health training programme
  • recruit and develop a cohort of band 3 mental health senior HCAs using the programme
  • improve care for patients with mental health needs
  • successfully deploy upskilled specialist HCAs on the achievement of programme
  • develop a nationally transferable role template for a level 3 Mental Health Care Support worker
  • demonstrate cost savings on RMN agency usage
  • a six-month level 3 vocationally based programme was developed
  • a cohort of eight HCAs was recruited and successfully completed the programme


The mid-term qualitative evaluation identified that HCAs have:

  • an increased understanding of mental health issues and the associated behaviours
  • improved thinking strategies and enhanced communication skills
  • increased confidence in approaching and caring for this group of patients able to share knowledge with colleagues
  • increased confidence in challenging team members

The RUH chose to invested in developing HCAs to deliver enhanced care for this group of vulnerable patients. After developing a six-month training programme and devising a transferable role template working with Skills for Health, eight Band 2 HCAs were selected for upskilling in the area of mental health. Recruits came from the HCA pool and three wards. The wards chosen were care of older persons (dementia), gastroenterology (alcohol and substance misuse) and trauma and orthopaedics (dementia and self-harm).

Project leads worked closely with Avon and Wiltshire Mental Health Partnership NHS Trust, the RUH’s Mental Health liaison team, who were keen for the cohort of staff to act as champions for this group of patients, and specialists from within the Trust. The training combined work-based learning, simulation, face to face and self-directed learning plus peer learning. Clinical supervision was provided by the MH liaison team.


By mid-term, the project has been able to identify changed individual behaviours not only among the HCAs but also group behaviour within ward teams, to the benefit of this highly vulnerable patient group. Examples included:

  • HCAs have become mental health champions.
  • Sharing of enhanced knowledge/awareness with others and increased confidence in challenging multidisciplinary team members’ approach to patients with MH needs
  • Recognising that a patient with schizophrenia was agitated and would not stay still when staff wanted to insert a venflon. The HCA intervened, calmed the situation and the patient
  • HCAs role modelling new language with colleagues, sharing knowledge, and identifying risks
  • HCAs reminding registered staff about the timely administering of medication for patients with MH disorders such as dementia
  • Investing more time to listen to patients and talking to them

The project’s mid-term evaluation shows that behaviours have changed, and it’s anticipated that final evaluation, based on group feedback and one to one interview with HCAs and managers, will confirm that these behaviours are becoming embedded in team approaches. The upskilled HCAs are doing things differently with patients since their understanding of MH issues has improved. The cohort has heightened awareness of common mental health problems and their role modelling of changes in behaviour and approach are having a positive impact on colleagues.

The upskilled HCAs have truly become the RUH’s mental health champions. The evaluation continued for a further three months beyond the programme end to monitor the impact and change now the HCAs have completed the programme.

It was informed by data collection from a 12-month period ensuring maximisation of lessons learned and thorough understanding of the project’s impact before proceeding with the next programme.

As the Sector Skills Council for the UK health sector, we support the NHS, independent healthcare providers and voluntary organisations. Our purpose is to help develop solutions that can deliver a skilled and flexible workforce to improve health and healthcare.