The RCN's decision to open up its membership to healthcare assistants could see the biggest shake-up in the health trade-union movement in a decade. The controversial proposal was overwhelmingly carried by the annual general meeting in October. But it is strongly opposed by a minority.

It also puts the college on a collision course with Unison, which is the current home for most healthcare and nursing assistants.

RCN assistant general secretary Tom Bolger accepts the college will have to work hard in the next couple of years to placate the 'significant minority'within it who are unhappy with the decision. But he does not believe the expansion of RCN membership should necessarily lead to a head-to-head spat with Unison.

The fact is that many HCAs would never contemplate joining the RCN and others would never wish to join Unison. But he accepts there is still likely to be competition 'for the bunch in the middle'.

However, Ray Rowden believes the bigger danger is that many HCAs - who would only be admitted as associate members in the first instance - will be deterred by the college's elitism.