Exclusive: HCA 'year of care' pilots come with £2.5m price tag
More than £2.5m is being spent on piloting government plans to make aspiring student nurses work as healthcare assistants for a year – despite a commitment it would be cost neutral, Nursing Times has learnt.
Last year, the government controversially announced that it wanted all aspiring nurses to “serve up to a year” as an HCA before gaining entry onto an NHS-funded undergraduate nursing course.
It followed a recommendation in the Francis report into care failings at Mid Staffordshire Foundation Trust, which called for all aspiring nurses to have at least three months hands on experience before starting their degree.
The Francis report
The government’s initial response to the report, published almost exactly a year ago, said the scheme must be “tested and implemented carefully to ensure that it is neutral in terms of costs”.
But figures obtained under the Freedom of Information Act show Health Education England – the body running the pilot scheme for the government – spent £1.9m on the first cohort of 165 HCAs, equivalent to more than £11,000 each.
More than 80% of this was paid to NHS providers to subsidise the salaries paid to HCAs on the scheme, many of whom are additional to the nursing establishment. In addition, HEE has provided £122,000 for recruitment, £105,000 for management costs and other support, and £70,000 to fund mentorship costs.
An additional £646,000 has also been budgeted for two further cohorts during 2014-15.
The total price tag of the scheme would top more than £225m annually if the costs of the first cohort were scaled up across the 19,206 nursing undergraduate places commissioned for next year.
“The level of payments to providers raised questions over how the scheme would work”
When it was announced, the plan was met with almost universal opposition from senior nursing figures. At the time, Royal College of Nursing chief executive and general secretary Peter Carter described the policy idea as having “more holes than Swiss cheese”.
RCN director of nursing and service delivery Janet Davies is a member of the steering group which set overarching principles for the pilots.
She said, while it was to be expected the pilots would have start-up costs, the level of payments to providers raised questions over how the scheme would work if organisations did not get funding for the posts.
“If this was to be rolled out in any significant numbers, then that type of expenditure wouldn’t be sustainable,” she said.
“It’s an awful lot of money to throw at something that most people think is unnecessary”
Another steering group member Sally Brearley, chair of the Prime Minister’s Forum on Nursing Care Quality, noted that the figures suggested it would be “extremely unlikely” the scheme could be cost neutral if fully implemented.
“It’s an awful lot of money to throw at something that most people think is unnecessary and probably counter-productive,” she added.
University Hospitals Birmingham Foundation Trust has been paid £182,360 for its first cohort of 23 aspirant student HCAs. This covers half the salaries for the individuals as well as more than £15,000 to cover management costs, recruitment and running workshops for the trainees.
“It’s not for everyone, there needs to be flexibility”
Director of nursing Philip Norman said: “HEE’s investment has got this off the ground… If that was no longer there I think we would have a view as a trust that there’s still value in it for recruits without care experience. But it’s not for everyone, there needs to be flexibility.”
A key aim of the policy is to reduce attrition rates from nursing courses, which have been as high as 25% over the past decade. HEE hopes this could help offset any costs of the scheme.
Nationally 11.5% of the first cohort have already dropped out of the scheme. In Birmingham three have left but only one left nursing altogether.
“That [individual’s] decision was made within eight weeks,” said Mr Norman. “The bit I’m unsure about is, does it [the scheme] need to be a year?”
Chesterfield Royal Foundation Trust currently has a cohort of 10 aspiring nurses going through the scheme and has received £119,918. As well as standard HCA training, those on the scheme also get half a day a month additional support with a band 7 nurse.
Director of nursing Lynn Andrews said the trust was taking part in the scheme in the hope it would mean more aspiring nurses might consider it as a place to work in future, in the face of a national nursing shortage and a competitive market.
“We will of course evaluate at all aspects of the scheme”
Department of Health
The Department of Health is commissioning an academic evaluation of the pilots, which will track the cohorts until completion of their undergraduate nursing degrees in 2017.
It is also planning to conduct research into the benefit of other types of caring experience for nurses.
A DH spokeswoman said: “We will of course evaluate at all aspects of the scheme, including costs, before we make a decision on whether or not to roll them out nationally.”
A spokeswoman from Health Education England reiterated than an economic evaluation was looking at the “costs and potential benefits” of the scheme.
“Cost neutrality doesn’t mean no cost,” she said. “There may well be gains, for example, in terms of improved retention and reduced attrition. Pilots are evaluating outputs and outcomes not just inputs and processes.”
She added: “The final pilot report including the economic evaluation will be published later this year once the pilot period has completed in September. In addition, a longitudinal study is being conducted to look at the long term impacts of the pilot.”
But Professor Ieuan Ellis, chair of the Council of Deans of Health, said: “Our council position has been clear from the start, that this scheme could not be cost-neutral and was not scalable.
“We need to have a long hard look to see if it is worth further investment”
“Aside from the cost, we also confirmed that almost all nursing students currently entering pre-registration nursing courses will have gained and demonstrated experience of care prior to and as part of the interview and selection process.”
He added: “The pilots are demonstrating that paid work experience as an HCA could be one route for some applicants who are otherwise unable to gain such experience.
“However, at a time when government wants to cut away at the funding for nursing, midwifery and AHP education, we need a focus on the core business of educating the future workforce, not gold-plated work experience programmes for a select few.
“When the economic evaluation of the pilot is complete, we need to have a long hard look to see if it is worth further investment.”