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Exclusive: HCA pilot for potential nursing students could be set up by autumn

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.”


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Readers' comments (60)

  • The only way to keep this cost neutral is to replace existing HCA positions with these potential recruits. And the point of the exercise is to give experience to inexperienced workers and to weed out those unsuitable for healthcare. So the assumption is that we'll be replacing experienced and suitable HCAs with people we expect at least some proportion of (could be up to a third judging by student attrition rates) are NOT suitable to work in healthcare and do NOT have the benefit of experience in their work. And this is meant to be helping...
    Thing is, educators are already highly aware of the value of frontline experience when they come to select their intake and with the ratio of candidates to available places as it is, they can afford to choose those people who've made the effort to get some experience as it is. Putting it on some kind of statutory basis, however it gets run, won't make much difference, if any. Also note that in typically Tory fashion you can simply buy your way past the requirement with money by foregoing the funding contribution to the course.

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  • This is yet another facile, unworkable idea from this bunch of government thugs. It does nothing to address the issues facing the NHS. Rather it deflects the blame away from where it lies and abdicates responsibility for fixing it. F*****g disgraceful. Absolute bar stewards.

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  • I don't think this is a bad idea, purely because I view my experience in health to be a brilliant foundation to build my degree around plus I know this job isn't right for everyone.


    I am starting my degree in September and I have six years experience as a HCA how does this affect me? Or even current HCA's who want the opportunity to go in to nursing. Do I/them have to do another year?

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  • Anonymous | 2-Apr-2013 2:39 pm

    What about all the HCAs who won't to remain HCAs? What will happen to their jobs? There is no extra money for this. It is a stupid idea based on the erroneous premise that all the ills of the NHS are the fault of uncaring nurses. Anyone who goes along with this is merely perpetuating that point of view. The government has very cleverly made nurses the scapegoats for their criminal policies. It would appear that the common man has fallen for it.

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  • I think this is a great idea. I worked as a carer for 6 months before I started my degree and it gave me a great base in patient care skills.
    Unfortunately a minority of students lack care and compassion. I do bank shifts as a HCA when I'm not on placements and have had students say they "outrank" me and refused to do "basic" tasks. Being a nurse is all about caring and mucking in as part of a team to give great care. Hopefully this will get rid of the students who are just there to get a free degree and not care for patients. I'm sure committed students will jump at the chance to learn more as I know quite a few currently feel we don't get enough ward exposure

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  • How will these hca's be "properly supervised, learn and develop"?? When as a profession we're struggling to mentor and support our own students and newly qualified staff??

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  • what will happen to HCA who want to remain as HCA?

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  • Undoubtedly it is helpful to gain as much hands on experience as possible as a student nurse. However, student nurses may learn bad habits before they even start their degree if the quality of support and training isn't good for potential students when they become HCAs,

    Before becoming a student I worked as an HCA in the community setting (many students already do this). I had virtually no training except informal support from other care assistants. I hardly interacted with the registered nurses on a day to day basis due to their workload. Some places give great training to their HCAs but I don't think we can guarantee that everywhere without regulation for HCAs.

    Secondly I think the main issue for compassion in care is not student nurse training. Burnt out tired nurses are less compassionate. Minimum nurse patient ratios and good emotional support for nurses requiring it would do a lot more to help.

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  • Anonymous | 3-Apr-2013 2:21 pm

    Not one student raised a single concern in Mid Staffs. So-called 'burnt out', 'tired' and according to you, 'less compassionate' nurses did raise concerns.

    When I was a student, we went out on strike for better conditions. What have you done? Be careful where you aim that pointy little finger.

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  • Maybe it's also time that we insisted all those totally prejudiced and ill-informed 'health correspondents' in the media and governing bodies worked on the wards before spouting their 'outrage'. Why can't student nurses just go back to the old training system of spending their first year working on general wards, care of the elderly and psych - at the end of which you knew if you were suitable for the job, if not, goodbye training.

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  • Hmmm. Where is the time to supervise all these pre-nursing HCAs (who seem to be expecting much attention from RNs) going to be found?

    Most nursing students have some form of HCA experience prior to commencement of training. So there is nothing new here. It doesn't need to be a year. It doesn't need to be formalised and we shouldn't be falling for this latest pointless stunt from the government.

    Nurses do not lack compassion. They lack time, numbers and resources. As for the student nurse who thinks that burnt-out tired nurses are less compassionate, you have an incredible amount to learn. One hopes that you learn it very quickly.

    When, you have done this physically and emotionally punishing job for a couple of decades and still turn up, shift after shift, (burnt-out and tired) to look after people in distress at the worst moments of their lives, when they need you most; and deliver the best of yourself, then you will understand the insult of such a misguided remark.

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  • Anonymous | 3-Apr-2013 7:09 pm

    Very good comment.

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  • tinkerbell

    these government antics are all just a fudge, a cover up and a deflection to throw people off the scent and protect the politicians and government cronies.

    Following the crime of mid staffs no one is to be held accountable but the sub text of all these changes to nursing is that it came about because nurses lack compassion.

    It is a political arse covering campaign, cos' they are going to look out for each other. It's all a pack of lies to protect themselves and make a fast buck whilst at it.

    We all know there are a minority of uncaring nurses, doctors but the majority of staff across the land are kind, caring, decent people working under extreme pressure and still doing a good job despite a lack of staff. Sadly things are going to get a lot worse. I feel sorry for new nurses coming into a profession that is on the ropes.

    There has been an unrelenting propaganda machine in full swing since the torys came into government, because it suits their agenda to privatise the NHS and it suits their agenda to demonise nurses. Nurses have shown themselves to be an easy target because they won't stand up for themselves.

    It also suits them very nicely that nurses are not going to put up any kind of fight against this injustice and the decimation of what was OUR NHS.

    They are a machine, programmed to destroy us because of their tory ideology. The NHS is a thorn in their side and as such so are its staff because they can never turn a profit out of us unless they get rid of most of us and privatise healthcare.

    The rich will get richer and the working class will become poorer and unable to afford healthcare. Same old, same old whenever this shower get into government.

    It no longer matters what you think, or i think or anybody thinks, they are hell bent on destroying, fragmenting and destroying the NHS and they have sadly, very sadly succeeded.

    They don't care if there aren't enough staff and they don't care about the francis recommendations unless it suits their agenda.

    It doesn't matter a jot what any of us think now, it's a done deal and all comment is inconsequential as the nursing profession has demonstrated it is not going to take any action against this onslaught.

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  • What about me that l have 10 years experience in Hospital as a HCA ? Am l going to waste another one year before going to the University. This idea is good for student who has no experience.

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  • tinkerbell | 3-Apr-2013 11:17 pm

    It's all too evident that the government is pushing ahead its own agenda, that nursing is the easiest targets to attack and whose views can be dismissed. Too many people on here and other posting have been attacking each other, not reading posts right or are inaccurate. Nursing training, HCAs, nurses aren't 'the problem' to poor quality + compassionless care.
    Training has been evolving to meet changing needs, even though it would be nice to let some of it bed in and evaluated before more changes. Many newer + prospective students have experience as HCAs, unpaid carers and other roles before applying as competition is fierce for relatively few places available. with all this going on we wonder why they bother applying, that's because they want to make a difference.
    It's the causes leading to stress and burn out that needs to be addressed. Top on the list is not enough staff, not enough skilled staff, not enough support + resources, and constant chipping away at nursing morale.
    Experienced staff can only effectively support + develop less experienced staff + students only when they feel supported themselves too. Can't do it when there's a skeleton crew on the ward. Everybody staff + patients could end up ratty + frustrated.
    Feels like this pilot just wastes time, money and avoids root causes.

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  • tinkerbell

    andy | 4-Apr-2013 11:40 am

    I agree there is a lot of denial and avoidance of root causes going on by people in high places who could really address the root causes but have no genuine motivation to do so.

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  • andy | 4-Apr-2013 11:40 am

    "It's all too evident that the government is pushing ahead its own agenda,..." !!!!!!!!!

    sounds like you haven't taken on
    board the NHS reforms which started at the beginning of April.

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  • The NHS Reforms are essentially the end of the NHS as a public service. The people of England will now be at the mercy of an increasingly fragmented and privatised healthcare system where the shareholder is more important than the patient. If anyone thinks that accountability and responsibility are already problematic concepts, it will be very much worse in a multi-layered, disparate system, where passing the buck will become a sport in itself. The disadvantaged will suffer most. Some people think that this is a good idea.

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  • For the NHS to function adequately under the reforms and provide the highest quality seamless service to patients there needs to be a central organisational framework in place to ensure the coordination of services to patients as well as quality and cost effectiveness. This has probably been overlooked in favour of profit-making, as suggested above, to benefit the share holders. However in order to thrive, businesses have to have competition which relies on their good reputation built up by its customers. Only time will tell the success of such a system applied to health care which hopefully will not cause harm or any single patient to suffer in the meantime.

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  • The NHS is not a business. Patients are not customers.

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