Healthcare assistants in bands 3 and 4 should be independently regulated and trained to at least an NVQ level 3, according to the Willis Commission on nursing education.
The commission, led by Liberal Democrat peer Lord Willis, recommended that a planned programme of regulation should begin with the mandatory registration of all staff who delivered patient care at Agenda for Change bands 3-4.
Nurses should also supervise and delegate work to HCAs who should have clearly defined roles, in the interests of patient safety, the commission said in its final report on Monday.
The independent group of experts was set up by the Royal College of Nursing in April to examine pre-registration nursing education and related issues. It published interim findings in September.
In its final report the commission warned that the quality of “many practice learning experiences” urgently needed improvement and there must be dedicated time for mentorship. It also said full-year preceptorship programmes for newly qualified nurses must become the norm.
In addition, the commission said the regulation and inspection of education providers must be streamlined to avoid duplication, and called for the culture of healthcare provider organisations to be routinely assessed.
The commission also concluded there was no evidence the move to all-degree entry nursing in England – already introduced in Scotland and Wales – would have a negative impact on patient care.
However, it said that, as part of an all-graduate workforce, nurses must be given the ability to continually develop their knowledge and expertise similar to the medical profession with a corresponding academic career structure put in place.
Lord Willis said there was “absolutely no evidence” degree trained nurses were “less caring or compassionate”.
He added: “The notion nurses can be educated in a silo, and that following registration they are the finished article, could not be further from the truth.
“Nursing education thrives when all staff, from medics to healthcare assistants, are constantly having their skills refreshed and updated. We hope policy-makers, employers, universities and professional bodies recognise and act on this challenge.”
Peter Carter, chief executive and general secretary of the RCN, said he was reassured the commission had “put beyond all doubt” the nursing workforce needed to be educated to degree level.
He said: “There is a great deal in this report which we need to work on alongside the government, regulators and individual employers, and we are committing to work on these immediately ourselves, and to campaign strongly for others to do so too.
“We note Lord Willis’ calls to nurses and their organisations to stand up and be counted, in order to restore professional pride and leadership. Where we can provide solutions to the problems Lord Willis identifies, we will do so. We will also play our part in making sure that patients, families and other professions are confident in the direction that the nursing profession is taking.”
Jane Cummings, chief nursing officer at the new NHS Commissioning Board, said: “This is a comprehensive and useful report - I agree absolutely that nursing is about leading as well as caring.
“Many of the recommendations are already included in the draft vision for nursing, midwifery and care-givers. It is an important time for the profession - we will review the report in detail, working closely with Health Education England.”
Health minister Norman Lamb added: “This is a really valuable initiative. I am very grateful to Lord Willis for the work he and his colleagues have undertaken. Lord Willis and his commission are absolutely right to say that nurses must lead as well as care.
“Nursing is one of the prime minister’s priorities and the government will review these recommendations carefully. Nursing is a demanding career that deserves respect - we want to encourage nurses to take advantage of the increasing leadership opportunities which are opening up for them in the changing NHS.”
However, Dean Royles, director of the NHS Employers organisation, said the commission’s conclusions needed to be looked at it in the “context of the real challenges that NHS employers are facing on a daily basis”.
He said: “I understand the move to make nursing an all-graduate profession. However, it is essential that we continue to value the fantastic contribution of the many nurses that qualified through a different route. They are the backbone of the NHS and will continue to be so for years to come. We must value their fantastic work and we cannot let them be seen as second class carers.
Mr Royles added: “I recognise the call to regulate HCAs but I am not sure what problem mandatory regulation is trying to fix. You can’t regulate for a smile and comforting words when dignity is required. Regulation does not guarantee compassion. Let’s not confuse being unregulated with being untrained.
“This is the sort of view that undermines the great work and commitment of our HCAs. I believe that the significant costs associated with regulation would be better spent on recruitment, improved training and supervision, and mentoring for newly qualified HCAs.”