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

Hospitals to replace nursing posts with lower paid assistants


A number of NHS hospitals are planning to replace an increasing number of trained nurses with cheaper, unregistered ‘nurses’ paid at a lower rate.

Leeds Teaching Hospital and East Kent Hospitals University Foundation are among those trusts known to be making or planning such changes.

The chief executive of another hospital trust, who did not want to be named because staff have not yet been informed, said the nurse “swap” was in response to financial pressures and a shortage of experienced band five nurses.

The increased use of electronic monitoring of patients meant it was now possible to replace registered nurses with healthcare assistants, the source added.

A spokesman for Sheffield Teaching Hospitals Foundation Trust told Nursing Times it uses “band four nurses who have reached a higher level of competence and experience who at times fulfil some of the roles previously carried out by band five registered nurses”.

He said: “In these areas we developed the roles primarily as a response to specific recruitment difficulties and the roles are supported by very specific training programmes.”

Foundation chief nurse Hilary Scholefield added: “We have not used band four posts to replace band five registered nurses in order to make financial savings; in fact it is the absolute contrary.

“Band four posts were introduced in our hospitals more than six years ago and this is now a well embedded formal programme of education and training which has enhanced, not detracted from the 70/30 skill mix of our nursing workforce. It has not impacted on the number of registered nurses we have.”

Unison head of nursing Gail Adams said: “This is not like for like work. You can’t swap band four for band five staff. We have seen the effects of these cuts in Mid Staffordshire and Maidstone and Tunbridge Wells. There has been no discussion of this at a national level.”

A spokesman for Leeds Teaching Hospitals said “a major trust-wide organisational development programme with workforce modernisation at its heart” would include “exploring the potential of new roles to support our registered workforce”.

The trust’s Unison branch secretary Sharon Hamilton – herself a band five nurse – said staff had not been informed of any plans to increase the numbers of band four staff. Asked if she agreed electronic patient monitoring meant there was more scope to use lower qualified staff Ms Hamilton said: “It’s OK having a machine that bleeps but if the patient starts changing colour then it’s only a person who can see that.”

Earlier this month a Nursing Times survey revealed many nurses felt the increased use of patient observation technology made it less likely staff would spot signs of patient deterioration (news, page 1, 13 October).

A review of ward staffing levels and skill mix at East Kent, seen by Nursing Times, states nursing’s transition to being an all graduate entry profession by 2012 could mean fewer nurses, but a greater proportion of leadership roles.

It anticipates a “major expansion in the number of people required to work at assistant and associate practitioner role”, which is paid at band four. It describes this role as delivering “protocol-based clinical care that had previously been within the remit of registered professionals”. Meanwhile, a number of band five nurses at the foundation trust will be moved into band six positions, to take on ward management tasks.

Director of NHS Employers Sian Thomas said such changes were “exactly what Agenda for Change” was for and the knowledge and skills framework could be used to measure the skills appropriate for any new role. “The tools are already there to change the career ladder,” she said. “It’s right where we have qualified registered practitioners to have them doing jobs they are qualified to do”

Ms Thomas said responses to the NHS staff survey indicated that up to one in three nurses felt they were doing jobs that were below their knowledge and skill level, suggesting scope for substitution with lower skilled staff.

Royal College of Nursing head of employment relations Josie Irwin said she feared such changes were “financially driven” but she would not object if they were on the basis of a proper evaluation of clinical needs and staff engagement.

Ultimately, the “test” was whether changes to the nursing profession and skill mix made a positive different to patient care, she added.


Readers' comments (70)

  • Further to my comments I intended to state that through this system we have supported a considerable number of HCA's to futher their careers by undertaking nurse, ODP and paramedic training and they are out there working as Band 6's and beyond. Thus giving people who are unsure of their career pathway to make decisions as to their future and become fulfilled as they are maximising their potential.

    Unsuitable or offensive? Report this comment

  • why do nurses talk about HCA'S as if they are brainless we are not all the same as nurses I think nurses work very hard they have one of the most stressfull jobs they could have.
    we are there to help and if we are competent at what we do it must be a help we are not trying to take over its the management that is trying to save money not us doing more then we should.
    myself i would register all (trained) hca's that wont to take on more responsibilities.

    Unsuitable or offensive? Report this comment

  • No offense to the person who wrote the above post, who I'm sure is a very hard-working care assistant and good at the job they are employed to do, but I have to point out that by it's very nature i.e. below standard spelling, punctuation and grammar, that it illustrates the difference in levels of intelligence and education needed to fulfill the role of a nurse. Nurses are educated to a very high standard, and for very good reason. As we are accountable to the NMC, as previously pointed out, our documentation has to be flawless, our understanding of patient's conditions needs to be accurate and constantly updated with further training and the administration of medications, with all the understanding of correct dosages and possible side-effects must be consistently without error - how could someone with a below-standard level of education possibly fulfill all these tasks? I, for one, am not willing to stand in a coroner's court taking responsibility for a Health Care Assistant who has failed to deliver care to the high standard demaded by a Qualified Nurse, who has been led to believe they can take on the role given to them by penny-pinching senior management and yet who has no professional accountability! Can no-one see he potential dangers of this situation? As the old saying goes - "A little knowledge is a dangerous thing".

    Unsuitable or offensive? Report this comment

  • In the "old" (mid 1970's) days, we had a Senior sister/charge nurse, a junior sister/charge nurse, 3 or 4 staff nurses and a couple of Nursing Assistants per ward. The rest of the staff were students on a 3-4 month placement. The change in training and the loss of student workers caused the need for another grade of staff. Australia started University training before us in the UK and as an interim measure imported loads of UK staff ('I know I was that soldier') before they gradually started cutting numbers of qualified staff and increasing the unqualified.

    Unsuitable or offensive? Report this comment

  • What about swapping chief executive with a cashier from a grocery shop? This would help to maintain a hospital budget too.

    Unsuitable or offensive? Report this comment

  • I agree that is has been going on for many years and the band 4 hca's are extremely good clinically. However they are unable to check or administer medication. I work in a critical care area where medication is not given out on a medicine round, therefore the drugs pile up that the HCA cannot give waiting for the registered nurses to check, adding even more pressure to an already highly stressful job, and there is no accountability on the part of the HCA

    Unsuitable or offensive? Report this comment

  • Hells bells! I'm just about to finish my first year which I've done remarkably well in - maybe I should do a fast track graduate medicine degree (although that would not be my preference)... With a future in nursing looking about as bright as Victoria Beckham I do wonder whether I'm wasting my time. Especially when I go on placement and get blanked by nurses who can't be bothered to mentor me. Some of us students have very respectable CVs and experience and prejudice against us just puts us off! When I have been mentored effectively I have proven to be a very reliable time saving asset to the ward, and the placement has been much more educational and enjoyable!

    Unsuitable or offensive? Report this comment

  • I have worked as a nurse for over 30 years and have witnessed the gradual exodus of trained staff due to overwork and unreasonable expectations.They are given more and more responsibilies taking them further away from the reason they joined the profession in the first place the patient!what was wrong with Enrolled nurses?I was an SEN for 12 years and thoroughly enjoyed it until I was obligated to do my RGN.

    Unsuitable or offensive? Report this comment

  • This is not at all surprising but deeply worrying. Nursing has been continually downgraded with untrained but task orientated staff for many years since the disbanding of SEN's and poor training in Universities leading to poorly equipped trained nurses. If some of the Trusts say that band 4 nurses have higher competencies than band 5 nurses what kind of training is going on for nurses? If this is true then my worries that nurse training is inadequate is also true. Either get Universities to train nurses properly or get training back in the hospitals and experiential not paper based. Competency for HCA's is and should not be the same as training for nurses. Trained nurses should have analytical skills for assessing why something is either normal or abnormal and then do something about it, not just 'doing' a task. This is an excuse to save money not altruism on the part of the Trusts to recognise skills of HCA's. It could also be seen as exploitation of HCA's in order to pay people less to do a 'job'. Nursing used to be based around task allocation and the so-called profession spent a lot of time trying to get away from this and think about whole patient care instead. Nursing should be professional but this illustrates that we are undervalued and have no respect from Managers (many of whom would undoubtedly have no insight and lack competency at anything clinically based,) Can we down grade the Management posts for people who are more competent in lower bands as I suspect there are countless people like this too? I would be very surprised if this happened as all that seems to happen is that the Manager gets and Assistant Manager who then gets an assistant Assitant Manager (and on it goes), because they can't cope.

    Unsuitable or offensive? Report this comment

  • I am a band 5 nurse. I am unfortunately already in a position where I have to supervise and check closely on the work of band 2 staff because quite frankly I cannot rely on the quality of the work they do. I will spare you the details of the experiences I've had. I cannot see how introducing another grade to bridge the gap between bands 2 and 5 is going to help. All it means extra supervision. As a nurse, I do not feel there is any aspect of patient care that is to menial for me to do. What happened to the concept of Total Patient Care.

    Unsuitable or offensive? Report this comment

Show 102050results per page

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.