Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more


Lord Willis: 'It’s unacceptable that support workers are not regulated'


We must address a number of profound challenges to improve care, says Lord Willis

In 1860 the first Nightingale training school for nurses was opened at St Thomas’ Hospital in London. It set standards in nursing care across the globe and 150 years later the UK is still setting standards by which the world’s very best nursing care can be judged. The fact that the Willis Commission made 29 recommendations to a range of stakeholders about nursing education is testimony to the continued belief that improved nursing care equates to improved patient outcomes. However, simply moving to a graduate-educated workforce will not in itself deliver what the nursing profession, employers and patients want - we must address a number of profound challenges.

At the heart of “graduateness” must be a recognition that tomorrow’s nurses will increasingly have advanced specialist roles, leading teams, diagnosing care requirements and prescribing. They will also need to contribute to research to effect better care.
In a healthcare system where the vast majority of patients will be supported in the community, often in their own homes, educating individuals and families to self-care will be fundamental to the role of the registered nurse. Securing “quality with compassion” in a rapidly changing system is perhaps the greatest challenge the nursing profession has ever faced.


‘It is not satisfactory that no data is available on what training support staff receive, what roles they carry out and how competent they are to do the tasks’

Indeed, it was because of this enhanced leadership role the commission report put such an emphasis on the training and regulation of the growing army of healthcare support workers. Growing at a rate of 6% a year, in 2011 the number of healthcare support workers increased by 24,000 since 2001 and, given the current financial restraints, this growth is likely to continue to accelerate.

It is not satisfactory that no data is available on what training support staff receive, what roles they carry out and how competent they are to do the tasks. That conclusion is not to undermine the commitment of healthcare support workers, but to emphasise that they and their patients or clients deserve better. It is simply unacceptable that staff whose competence is neither regulated or inspected are looking after the essential needs of some of the nation’s most vulnerable individuals.

It is equally unacceptable that registered nurses, some immediately following qualifying, must take responsibility for supervising colleagues whose competency they cannot reply upon. If the modern healthcare workforce is to be re-defined, it must be on the basis of patient need and nursing and care worker competence.

However, it would be foolhardy to believe that training and regulating healthcare workers will by itself improve patient outcomes. Research evidence of the association between nurse staffing levels and patient outcomes presented to the commission was truly compelling.

The best-staffed NHS trusts have significantly lower mortality rates and reduced risk of complications. One only needs to look at the experience of Mid Staffordshire Foundation Trust to see that the negative effects of inadequate staffing can be striking.
We need both registered nurses and registered healthcare support workers, but each must have their roles and competencies clearly defined.

Finally, leading this inquiry has been truly inspiring. The dedication, intellect, compassion and altruism that shone through the multitude of submissions and presentation has been humbling, and the desire to go on seeking improvements, despite the huge challenges facing the service, is testimony to all concerned.

Lord Willis is chair of the Willis Commission on nursing education


Readers' comments (2)

  • there are qualified nurses, including senior bands, who have very low standards and who I would not want looking after me or my relatives.

    you cannot expect HCAs to deliver high quality care if they witness poor care by the qualified staff.

    Unsuitable or offensive? Report this comment

  • I agree, I wouldnt want any staff of any grade, qualification or experience near me or any of myrelatives + friends if their standards were low and dangerous.
    I'm not sure if/when NMC will introduce having names of suspended / struck off registrants, even if its just accessible to registered authorities / employing organisations, but ideally in its present format being generally viewable in its basic form on the NMC public site.
    Same should be applied to all working in extended healthcare professions. Would you like to receive care from a struck off registrant who then works as an unregulated HCA/MCA or general carer/helper? I wouldn't.

    Training + standards can be standardised and promoted for regulated staff. Also continuing support, development, updates and staffing levels/mixes should be addressed. It may not entirely remove poor practice, but hopefully substantially reduce it.

    If people see poor quality of care, help them to improve. If they've not got capacity to learn, change + improve, report them. Hopefully they'll get more support, change of roles or jobs to something they are good at to support their colleagues.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.