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Willis Commission calls for regulation of HCAs and supports all-degree nursing

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.”

Readers' comments (9)

  • Hurrah! At last the powers that be have recognised that band 3 and 4 nursing assistants should be regulated and have a minimum standard of education! And the fact that they have gone that step further and recognised that just because someone is educated to degree level doesn't mean that they are devoid of compassion. I was starting to think that I was an exception to the rule, being compassionate AND holding a degree, when reading some of the negative comments on here!!

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  • Why only band 3 and 4, why can't the band 2 hca's be regulated. Everyone that works in health-care should be properly trained in their jobs.

    I'd like to have my skills refreshed and updated, trouble is I am no longer prepared to come in for a study day (which is often cancelled when you turn up) on my day off.

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  • Anonymous | 5-Nov-2012 9:50 am

    Anonymous | 5-Nov-2012 9:57 am

    I suppose they had to have an initial cut-off point to get some HCAs regulated first, then later possibly think about regulating bands 1+2. When I used to be a bank hca, I was in band 1 - yeah anothery way of keeping wages down. But when on bank work, all study days are on your day off - however we claimed back and got paid for mandatory study days. It was suggested by the bank office, otherwise people would do it in their own time.

    I'm not clear what Mr Royles is trying to say - does he mean, there are financial implications to ensure all regulated staff receives regular and up-to-date training, which would cost an organisation money and time, so that patients are cared for by adequately trained staff with dignity and compassion. I sometimes think on various my travel and meetings around work, that senior managers and directors can also show all staff a bit more compassion and dignity, and to lead by example and indicate they know how hard it really is with staff directly involved with patient care with all the ongoing cuts in resources and to morale. If there's any fewer junior grade staff, sooner or later we might see the executive team having to roll-up their sleeves to help out to deliver basic care - something I like to see politicians do more when they do their media visits, rather than just parading to their entourage and acting all important. That'll be the day when all politicians get seconded to show how 'big-society works' working 2 x 12.5hr shifts in a front-line role, maybe once every other month in different departments/services. Then at least they can say 'we're in it (a-bit) together'. ;o)

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  • It could be a lot of people think that having degrees make people too academic and not practical. Education and training has moved on - or it should be, in that all training and development should cater for people with all sorts of teaching and learning styles. Courses can be redesigned to facilitate less 'academic' types (who might get very anxious at the thought of book-work) to be encouraged to develop critical analysis, thinking and reasoning about why certain things are done and why other things are no longer done. Certainly more practical skills and linking theories into practice will definitely help.

    As far as I know, currently most nursing courses are nearly 50:50 academic work in uni and clinical placements. It is also expected that for every hour academic lesson taught, students should spend about triple that in self-directed study, to get the best out of their learning.

    On top of that, with financial difficulties, some students also have to work a paid part time job (with restricted hours) to make ends meet - and people wonder why attrition rates are still high.

    There is an element that being caring and compassionate that comes naturally, and possibly not taught. However all people can be nurtured to become more caring and compassionate with excellent role models, to show how things are done at uni and on clinical placements. You don't need to smile to maintain a patient's dignity, privacy and high quality of standards of care but smiling does certainly help with most things and very good for avoiding conflict situations and relieving anxiety.

    Even the most compassionate person can sooner or later break down with on-going stress and eroding working conditions which should be there to support staff to look after our patients.

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  • I am a nursing assistant band three and have worked with a lot of nurses who I am proud to call my colleagues and some I would rather have not had to work with.young nurses can get so tied up in paper work and that makes it look as if they don't care enough.perhaps like social workers nurse students should have a year in the field learning the basics of personal care and communication skills . This would make the practical nurse training easier to absorb and seem more relevant .

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  • Training HCA's will not solve the problems
    created by poor skill-mix and an overall lack of RN's

    Regulation should not be seen as a panacea for all ills. It will be expensive and the NMC is not equipped to manage a huge number of non qualified care assistant "registrants" Yet another "Quango" would probably have to be set up to manage the task.

    It would be easy for Trust HR to share information about people who have been dismissed as being ill suited to working as a care assistant thus preventing "job hopping"

    As RN's you will remain accountable for the well being of your patients and for any task(s) which you delegate to care assists.

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  • This cracks me up. Essentially back to a two-tier system. Some things never change. The pay is still rubbish and the conditions are worse. But at least nurses are too busy in-fighting about degree v non-degree, to bother actually fighting for decent terms and conditions for themselves, and better conditions for their patients.

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  • I think everyone who works giving care to patients should be regulated i.e is from band 1 up and should be sent on training and updates as required by their banding. However the argument about degree nurses and diploma nurses is silly. I did a diploma in nursing 12 years ago with students who were doing the degree we all had the same assignments, placements etc the only difference was thedegree students had to do a dissertation and us diploma students did not. I have no problem with nursing now becoming an all degree course my concern is that they are some nurses who lack compassion, have no real interest in patients etc. this goes for diploma,degree nurses and even HCAs these are the type of people that need to be shifted out of the NHS.

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  • Had you asked me a few years ago I would never have agreed with this BUT now that I am working in a team which has more HCAs than qualified nurses, I have to agree that HCAs need regulation, but across all bands. And once formally regulated, HCAs will be able to ask for decent pay rises and get them, not be doing the work of registered nurses for little reward. However, this would effectively a return to the 2 tier system of nursing, instead of RGN and EN we just have RG/RN and HCA. Nothing changes really does it?!

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