The first pilot of the government’s plan to make student nurses work as a healthcare assistant for a year before starting their degree could be up and running by the autumn, Nursing Times has learnt.
The controversial plan, widely trailed by national newspapers, was one of the key announcements made by the government last week in its initial response to the Mid Staffordshire Foundation Trust Public Inquiry report.
Ian Cumming, chief executive of Health Education England, the body that will be in charge of running the pilot schemes for the plan, told Nursing Times the “initial thinking” was the pre-entry experience would be for “up to a year” and different periods of time would be piloted.
Professor Cumming said ideally HEE would like participants to have three paid placements working as HCAs in a hospital, out in the community and a third setting of their own choosing. It had not “ruled anything in or out”, in terms of what could count as experience, he said. But HEE would want to ensure individuals were properly supervised and “learning and developing” during the placement.
“Our views at the moment are we need to start relatively small with two or three geographical locations,” Professor Cummings added. He said the first pilot could be up and running by the autumn and would most likely involve a small number of NHS organisations and their academic providers.
The proposal followed a recommendation in the Francis report that there should be a national entry-level requirement for student nurses to spend a “minimum period of time, at least three months, working on the direct care of patients under the supervision of a registered nurse”.
But Professor Cumming said the idea had “come from a variety of sources”, including feedback from students that they would have welcomed the opportunity to have understood more about patient care before embarking on their courses.
He also said it could be a way of reducing the “significant number” of nursing students who drop out in their first year “because they realise it’s not for them” – as well as being a way of assessing an individual’s values and behaviours “before spending tens of thousands of pounds on their education”.
But the proposal has been heavily criticised by the Council of Deans of Health, which warned it could prove dangerous.
Professor Ieuan Ellis, chair of the council said: “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.”
The Royal College of Nursing and Unison will be invited to join a steering group along with educators and other interested parties. However, both expressed significant reservations last week.
RCN head of policy Howard Catton said: “There is an issue about the message it sends. The healthcare support workforce is hugely valuable in its own right: it’s not a supply chain to produce the future generation of nurses.”
Around 18,000 nursing students began a degree programme last year. The RCN estimates paying them all a typical HCA salary would cost at least £250m. However, the government has stated the programme should be cost neutral.
“If you’re a trust and you’re paying these students, how are you going to fund a significant increase in your HCA workforce? You’d have to cut back on your existing HCAs,” Mr Catton said.
Unison national officer Monica Hirst also warned the impact of the policy could be to take jobs away from HCAs. “Why are they singling out nurses and not medical students or radiographers? I don’t think there is anything to be gained from this,” she said.
However, the proposal gained backing among some senior nurses.
Katherine Fenton, director of nursing and University College London Hospital, said: “I fully support this proposal and believe it will provide invaluable insight for students as they embark on their healthcare career.”
Cheryl Etches, chief nurse at the Royal Wolverhampton Hospitals NHS Trust, added: “Many people commence training for a healthcare profession only to find the reality of their clinical placements a shock and sometimes, sadly, decide healthcare isn’t the right choice for them.
“Potential healthcare workers of the future could benefit from exposure to the real healthcare environment before committing to a healthcare career and its associated training.”
Sign our Speak Out Safely petition to support a transparent and open NHS. We are calling on the government to implement recommendations from the Francis report that will increase protection for staff who raise concerns about patient care.