Mixed response to UK call for student nurses to first work as HCAS

1 April 2013

A pilot of student nurses working first as health care assistants could be underway in the United Kingdom before the end of year despite major reservations from nursing leaders.

The policy initiative was announced in late March by the British government as one of its responses to the long awaited Francis Report into a National Health Service (NHS) trust.

The Francis Report was the culmination of a two year inquiry into lessons to be learned for patient care from the failings of the Mid Staffordshire NHS Trust late last decade.*

The report recommended that student nurses spend at least three months working on direct patient care under nurse supervision as a pre-entry requirement to nursing school but the government stepped this up to students being required to spend up to a year working as health care assistants (HCAs) as a prerequisite for getting NHS funding for their degrees. “This will ensure the people who become nurses have the right values and understand their role,” said Health Secretary Jeremy Hunt.

The Royal College of Nursing said it had “urgent questions” about the proposal for student nurses to first spend a year working as an HCA with the UK having about 18,000 nursing students start training each year.

“Who will train, employ and monitor tens of thousands of these support workers? How can the Government deliver this radical change to nurse training on a cost-neutral basis? And how will we ensure that the supply of nurses does not become restricted?” said the College’s chief executive Peter Carter.

The Council of Deans of Health, representing British nursing schools, also expressed concern with chair Ieuan Ellis saying an influx of trainees could add more pressure onto existing staff.

“Prospective students spending up to a year working as a healthcare assistant will place an over-stretched health service and its staff under even greater pressure, putting more unqualified people on the wards.”

“If this is piloted and evaluated then we will engage with it, but we are clear that if this becomes a blanket provision it will risk patient safety rather than protect it. This is the wrong answer to the wrong question.”

HCA regulation
Meanwhile a Francis Report recommendation that HCAs should be regulated by the Nursing and Midwifery Council was not taken up by the Government.

Instead it issued a code of conduct and minimum training standards for the unregulated workforce.

Royal College of Nursing CEO Peter Carter said compulsory registration was a “crucial” Francis report recommendation and was deeply concerned registration had been dismissed by the government.

He pointed to a survey recently carried out by the British Journal of Healthcare Assistants which found the vast majority of HCAs supported compulsory registration and said it was clear HCAs took delivering safe patient care “very seriously’.

 *Mid Staffordshire NHS Foundation Trust Public Inquiry chair Robert Francis said the trust’s ignoring of warning signs and putting “corporate self interest and cost control ahead of patients and their safety” lead to “appalling and unnecessary suffering of hundreds of people” including elderly and vulnerable patients left “unwashed, unfed and without fluids”. In his report, released in February, he said there had been a “lack of care, compassion, humanity and leadership” and made 290 recommendations designed to change the culture and ensure patients came first.  The full report can be read at: www.midstaffspublicinquiry.com

An analysis of the Francis report by NZNO and its implications for nursing in New Zealand can be read at: bit.ly/14u31gW