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Next steps in HCA work for nursing students plan unveiled

Around 200 students on paid placements will test out controversial government plans to require future nurses to spend up to a year working as a healthcare assistant before starting their degree.

A 16-member steering group, including several high profile nurses, has also been announced to oversee pilot schemes for the plan, which includes several outspoken critics of the idea.

The pilots are scheduled to begin in the autumn, as revealed in April by Nursing Times.

The idea was the central proposal in the government’s response to the Mid Staffordshire Foundation Trust Public Inquiry report.

While Robert Francis QC’s report had recommended students spend at least three months working on the direct care of patients before their degree course, the government expanded it to up to year.

The idea drew largely unfavourable responses from nurse commentators and unions. Royal College of Nursing chief executive and general secretary Peter Carter invoked a public row with the government over the idea last month when he described the policy as having “more holes than a Swiss cheese”.

Earlier this month, the Council of Deans of Health published a paper claiming the proposals should come with a “serious health warning” for the NHS, with “potentially serious unintended consequences” for the role of HCAs, mentorship of students and patient safety.

It argued that focusing on the year after a newly-qualified nurse joined the profession “may be far more significant” than the year before a student joined their course.

However, student nurses themselves appear divided. A Nursing Times survey of over 1,400 students in April found 42% thought it was a good idea and the same percentage that it was a bad idea.

The national steering group announced yesterday by Health Education England will be chaired by Sir Stephen Moss, a former nurse and manager, who is currently a non-executive director at Derby Hospitals Foundation Trust. His most high profile role was as turnaround chair of Mid Staffordshire Foundation Trust from August 2009 until January 2012.

The group also includes leaders from the RCN, Unison, the Nursing and Midwifery Council and the Department of Health.

It will oversee the pilot programme to “see how best to take forward these proposals and assess the most appropriate timescale”, Health Education England said in a statement. The group will also be responsible for evaluation in areas, including the ability to test for values and behaviours and reductions in attrition rates.

The statement added that the pilots were “likely to involve up to 200 nursing students on paid placements across the country from this autumn”.

Professor Ian Cumming, chief executive of Health Education England, said: “The healthcare experience will allow students to understand whether nursing and hands-on care is right for them.

“It should be hard to be a nurse – a vocation, a real desire, not just something you accept as second best so you can do a degree course.”

Sir Stephen Moss, Chair of the steering group, said: “I am delighted to have been asked to chair the steering group for this important piece of work.”

He added: “It is vitally important that we deliver skilled patient care, with kindness and compassion, and piloting this pre-degree experience will enable us to test out the effectiveness of exposing potential students to front line care and professional values at an early stage, before their formal degree programme.

“Of one thing I am certain, that is that things cannot stay as they are. We owe it to those we serve to continually seek new and innovative ways to meet their needs.”

Steering Group members:

  • Sir Stephen Moss (Chair), Non-executive director, Derby Hospitals NHS Foundation Trust
  • Lisa Bayliss-Pratt (Vice-chair and project director), Director of Nursing, Health Education England
  • Jo Lenaghan, Director of Strategy, Health Education England
  • Jane Cummings, Chief Nursing Officer, NHS England
  • Viv Bennett, Director of Nursing, Department of Health and Public Health England
  • Peter Blythin, Director of Nursing, NHS Trust Development Authority
  • Peter Carter, Chief Executive and General Secretary, Royal College of Nursing
  • Gail Adams, Head of Nursing, UNISON
  • Ieuan Ellis, Chair, Council of Deans of Health
  • Dame Christine Beasley, Chair, North Central and East London, Local Education and Training Boards
  • Dean Royles, Chief Executive, NHS Employers
  • Mark Newbold, Chief Executive, Heart of England NHS Foundation Trust, CEO Provider
  • Sally Brearley, Chair, Nursing and Care Quality Forum
  • Jackie Smith/Judith Ellis, Nursing and Midwifery Council
  • Ann Farenden, Care Quality Commission
  • Alan Robson, Deputy Director of Workforce Development Strategy, Department of Health


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Readers' comments (27)

  • 'Steering Group' and what about representatives from the 'shop floor'? A Nursing Student or newly qualified nurses??

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  • michael stone

    This could very possibly end in tears - I'm not sure who will be doing the crying, but quite possibly someone will be reduced to anguished tearfulness, over this one !

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  • or even a patient?!

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  • It will be a hard job removing the poor practice habits that these potential students will pick up while working as HCA's for a year. The message is coming through very clearly that those in high places obviously believe that there is NO difference between Student Nurses studying to become Registered Nurses and HCA's. It is because of this ill conceived belief that Student Nurses are not qualifying with the required skills as they are being counted in the Ward numbers while in practice and are not being given the opportunities to undertake drug rounds, or management of patients/wards. What is needed is a root and branch review of how students are treated while in practice.

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  • I would like to see the Steering Group, work as HCAs, giving direct patient care for 2 solid months. To refresh their skills + perspective of frontline care, as well as gaining contemporary experiences of what is required from staff currently (not a few years ago) - or are they 'too posh to wash' ;o)

    If working as a HCA for xx months before a nursing programme (for those who want to become registered nurses) is paid at the correct rate, of course students (especially younger students) would love to earn a bit of money before the tough programme of juggling clinical work and academic studies takes over their lives. It might be a bit tougher for those who has changed careers. However if undersupervised, undersupported, or received inadequate training, it is easy to pick up bad habits which is then much harder to retrain someone whose spent a year reinforcing poor practice. All of which isn't good for patients care.

    Most student nurses are currently working 50% clinical practice:50% academic work, equating to about 1.5 years hands-on work by the time they qualify, on top of which, some work extra shifts as HCAs due to the needing more money to survive on (otherwise they'll quit the course, at any stage of their programme)

    When student nurses are being used as an extra pair of hands, the quality of their learning is fair poorer than when properly supported / supervised by registered mentors. When appropriate, a combination of getting stuck in and taking a step back + being able to see and reflect on their own + other staffs clinical practices is much better for a students' development.

    Respecting everyone, patients, relatives, all levels of staff is one of the things will help to improve practice all round.

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  • who's bad habits may i ask! dont forget students are under the instruction of matron, ward managers,sr, sn come on!

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  • Who is going to be mentoring these HCAs??!! By the sounds of the previous commentator, there is no one fit to do so....never mind anyone who is going to have the time!

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  • no! to much paperwork!!!!!!!!!!!!!

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  • Speaking from my own experience, I wholeheartedly agree with what anonymous said at 12.30. We're not learning to become nurses, we're already working as HCA's while on placement. We're allocated mentors who are staff nurses, but the reality is that the majority in my experience do use us as HCA's instead because they are so stretched and unsupported themselves and have no time or energy to teach us.

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  • Does Professor Cumming have an evidence base to support his assertion that students currently enrol in nurse education 'as second best so you can do a degree course'? I have never met a student who has done this and in the unlikely event I ever did they would not remain a student for long! I fear Prof. C. would fail his degree if he used unsupported assumptions like this in his work.

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  • Mmm, might be useful experience so let`s see what can be learned from this trial. This will not, however, prevent under-staffing and incompetent bonus-chasing, harm-causing management.
    This is just my opinion. I am waiting to hear managers` opinions. Are any of you reading this ? Would love to hear what you think the problems and solutions are and what you have done to help the health service.
    That`s if you get any time left after sending out countless emails.

    Respect to my colleagues. RNLD `96

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  • What the hell are the RCN and Unison, (who know how stupid, pointless and wasteful this idea is) doing participating in the steering group? This is exactly the problem with these two. Behaving like slightly petulant but easily ignored children is NOT the way to represent nurses and the profession. STOP COLLUDING with this bunch of NHS-hating morons and mount proper opposition to the ministry of feckin' silly ideas.

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  • DH Agent - as if ! | 10-May-2013 12:25 pm

    tears don't work either!

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  • michael stone

    Anonymous | 11-May-2013 12:02 pm

    Oh, I'm not suggesting that the tears will work - simply that I feel some people will be driven to tears over this one !

    I'm still trying to figure out, exactly what does work re improving NHS behaviour/services. Lots of 'counting of things' on its own isn't enough, but that seems to be the only thing the NHS is really keen on.

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  • NHS is not a business

    RGNs and HCAs are two distinct and separate animals. By working as HCAs the assumption is that RGNs don't care but that HCAs do.

    As mentioned above what should happen is that Students are afforded the luxury of not being in the numbers. They should be the shadow. The current 50:50 split of practical and theory would work as it was intended if Students just absorbed - not grafted.

    This can only work if wards are staffed and run well. As we know this is not the case (the staffing more than the running) what do we do? We don't address the problem of understaffing we simply add on and add on layers of other working. Ridiculous and very wrong.

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  • Thought the panto Dame had retired, still got her seat on the gravy train the fat pig.

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  • redpaddys12 | 12-May-2013 3:00 am

    now who is trolling?

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  • redpaddys12 | 12-May-2013 3:00 am

    "Thought the panto Dame had retired......"

    Oh no she didn't!! She's still got the truffle-snorting gear snuffling after public money. She's got to eat, after all.

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  • OK, at least there's a trial...but really.
    I could understand 3 months experience, and anyone wanting to be a nurse would (probably) have some or get some sort of experience in healthcare (HCA most likely) just to get some insight if they really are keen (i know i did).
    Yet again, the Gov takes advice & recommendation and does their own thing!

    I wonder if nurses from other countries look on and think WTF.
    I know i do.

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  • I am greatly concerned about the bad habits or ill informed ways of doing basic care that these students will pick up from carers.
    Please I am not knocking carers.
    I have seen and experienced for myself where carer are not taught or mentored, they just have to get on with it.
    I have always been very concerned that carers with little or no experience are Not Taught and Assessed.
    There is a big need for the ward manager/sister to undertake this teaching and assessment.
    As a professional nurse I want to see more teaching On the Ward for Everyone and sufficient staff to accomodate this to ensure the patients care is maintained.

    I feel that a year is too long and this would put off people wanting to come into nursing.
    Instead another year of study in another field is likely get one a better paid job.

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