Expanding Vaccine Roles for Health Care Support Workers

Training Requirements and Employer Responsibilities

Healthcare Support Workers (HCSW’s) are integral to the success of immunisation programmes, especially in meeting the growing demand for vaccines. However, their expanded responsibilities must align with proper training, competency, and governance. This blog focuses on the essential training requirements for HCSWs and the employer’s role in ensuring patient safety and compliance.

Training Requirements for HCSWs

Comprehensive training is critical to ensuring HCSW’s are equipped to administer vaccines safely and effectively. A key guiding document is the PHE (2015) National Minimum Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers

This framework specifies the foundational requirements for HCSWs who administer the following vaccines:

Live Attenuated Influenza Vaccine (LAIV) for children.
Inactivated Influenza vaccine
Shingles Vaccine
Pneumococcal Vaccine

The curriculum provides a structured approach to immunisation training, ensuring that HCSWs acquire the necessary knowledge and practical skills to deliver these vaccines confidently and competently.

While the PHE guidance focuses on the vaccines listed above, many organisations expanded the scope of HCSWs during the COVID-19 pandemic. For other vaccines such as Covid-19 or the new RSV vaccine, practices must ensure that HCSWs:

Receive specific training for each vaccine.
Are assessed for competency before administration.
Work under clear governance and supervision frameworks.

“The RCN does not support HCAs administering other vaccines. These include the remainder of the childhood vaccination programme or travel vaccines. This is due to the clinical decision-making involved.”

Employer Responsibilities

Employers play a pivotal role in enabling HCSWs to take on expanded responsibilities. Below are the key areas of responsibility:

1. Competency Assessment

Employers must:

Ensure HCSWs complete immunisation training as per the PHE standards or equivalent.
Conduct competency assessments, with regular re-evaluations to maintain standards.

The Royal College of Nursing (RCN 2022) provide an Immunisation Knowledge and Skill Competence Assessment tool. Employers should ensure that the HCSW has a completed and signed competency assessment for each vaccine they are administering.

2. Governance and Policy

Organisations must develop and document clear policies, including:

Which vaccines HCSWs are authorised to administer under a Patient Specific Direction.
Supervision arrangements to ensure a registered practitioner is available on site for advice.
Local governance protocols for safe vaccine administration.

3. Supervision and Support

Employers must guarantee that:

A registered healthcare professional is on-site for supervision, guidance and support.
HCSWs can escalate any concerns or questions to their supervisors.

4. Insurance and Legal Safeguards

Employers must:

Provide indemnity insurance for HCSWs administering vaccines.
Ensure compliance with regulatory standards and professional guidance (e.g., RCN, CQC).

5. Ongoing Professional Development

Invest in continuous learning opportunities for HCSWs, including:

Annual refresher courses on immunisation updates.
Access to resources on new vaccines or immunisation protocols.

For further information it is recommended that employers and practitioners review the RCN Guidance (2019) on HCSW’s administering vaccines

The RCN recognises that nursing teams are key to the safe and effective administration of large numbers of vaccinations to those who need them.

This guidance has been developed as a resource and framework for health care support workers who undertake vaccinations as part of their role.

Common FAQ’s on HCSW vaccination roles

Can HCSWs Only Administer Vaccines Listed in the PHE 2015 Guidance ?

The PHE 2015 National Minimum Standards specifically address training for influenza, shingles, pneumococcal, and LAIV vaccines. However, this does not mean HCSWs are restricted to these vaccines. Provided they are:

Appropriately trained and deemed competent in the vaccines they are administering.
Supported by a PSD, HCSWs can administer a broader range of vaccines based on local governance arrangements.

What About RCN Guidance?

While the RCN supports HCAs administering specific vaccines, such as nasal influenza for children, their recommendations are not enforceable policies. The ultimate decision lies with the employing organisation, if safety, training, and competency requirements are met.

The following questions should be asked before the activity is delegated to the HCSW:

Is delegation in the best interest of the patient
Has a risk assessment been undertaken
Has the HCSW been appropriately trained and assessed as competent to perform the role
Does the HCSW consider themselves competent and confident to perform the role
Is adequate support and supervision available on site
Are robust protocols in place so that the HCSW is not required to make a stand-alone clinical judgement

Can a HCSW give vaccines under a Patient Group Direction (PGD)?

No: In any case involving administration of a medicine, an unregistered support worker may only administer under a PSD or National Protocol (Flu and Covid-19 Vaccines) and may NOT work under a PGD.

HCSW administering vaccines should always be supervised by registered healthcare professional. Ensuring that any questions or issues that may arise during vaccine administration can be addressed promptly by practitioner with the appropriate clinical expertise.

In conclusion

As the vaccination programme expands and roles of HCSW evolves it is important that employers and practitioners keep informed about the regulations and guidance and that HCSW’s only work within their professional scope of practice and sphere of competence.

Employers must adapt by providing additional training and robust governance to support HCSWs in expanded roles. They must ensure that training programmes align with the latest standards, governance frameworks are clear, and support systems are in place. By doing so, they not only enhance patient care but also empower their workforce to play a greater role in meeting public health demands.