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Nursing associates should be regulated 'without restricting role flexibility'

  • 5 Comments

Nursing associates should be regulated but in a way that does not restrict the flexibility of the role, a leading think-tank has concluded as it publishes a report on upskilling the non-medical NHS workforce.

Regulation of nursing associates would provide confidence in the role for other staff and ensure more investment in its training, according to the Nuffield Trust.

“We do support regulation but with the caveat that it needs to be in a more supportive way”

Candace Imison

The government’s new role is designed to bridge the gap between healthcare assistants and registered nurses, and is expected to sit at band 4 within the Agenda for Change payscale for NHS organisations. Consultation on the role recently closed.

In its report commissioned by NHS Employers – called Reshaping the workforce to deliver the care patients need – the Nuffield Trust found “many” of the people it interviewed called for band 4 staff to be regulated.

However, it also noted the risk of regulation was that it could “reduce the potential flexibility of this workforce and, given the limits of regulation, not provide the safeguards looked for”.

“We are interested in understanding how that blended approach can still mean standards that we expect”

Danny Mortimer

Speaking at the launch of the report, its author and Nuffield Trust’s director of policy Candace Imison, said: “In our response to the consultation around the nursing associate role we have clarified that we do support regulation, but with the caveat that it needs to be in a more supportive way.”

She noted one of the benefits of regulation was that it could increase funding for training the new nursing associate role, which sits within the historically “underinvested” support workforce.

“In work that I’ve done previously we’ve talked about the inverse training role, where essentially you have masses of the training budget going to a very small percentage of the most senior staff, and the most junior staff get a paltry amount of investment.

“So hopefully regulation would drive a shift in the other direction,” said Ms Imison.

Candace Imison

Candace Imison cutout

Candace Imison

But she said it would be “crucial” for a regulatory framework to be set up in way that “does not totally limit what your staff can do”.

Meanwhile, Danny Mortimer, chief executive of NHS Employers, said “on balance” regulation of current band 4 assistant practitioners in nursing could help to develop the NHS workforce.

He noted its wider benefit across the registered workforce was that it provided standards and also confidence to change the scope of people’s practice in response to evolving patient needs.

“So people can operate to their licence and if necessary their licence to practise can be changed and evolved based on technology and the needs of our patients and regulation gives us the confidence to do that,” he said.

The Nuffield Trust report lays out a series of recommendations for NHS organisations to redevelop their current workforce by extending their staff’s skills and responsibilities, which it said was in some cases due to shortages.

When asked how this could be achieved without posing a risk to patient safety due to registered nurses being substituted with HCAs, Ms Imison said the report addressed this “head on”.

She noted that the report highlighted evidence showing healthcare support workers could not safely substitute for nurses in acute settings.

Danny Mortimer cut out masthead

Danny Mortimer cut out masthead

Danny Mortimer

Mr Mortimer said NHS Employers accepted evidence that showed the “present configuration” of the support workforce could not be used to replace registered nurses.

“But we are clearly also talking about developing a different blend colleagues to work in the NHS. And we are interested in understanding how that blended approach can still mean safety standards and quality standards that we expect,” he said.

“So how does a nursing associate fit as part of that blended approach? How does it sit alongside the trained nurse role, how do other professions sit alongside the trained nurse role? And we do think there is more to do there?” he added.

Publication of the consultation results on the nursing associate role, which is being led by Health Education England, is expected in the coming weeks.

HEE recently told Nursing Times that findings from the consultation had shown “strong support” for regulation of the role.

  • 5 Comments

Readers' comments (5)

  • Nobody in a professional health service should be permitted to provide nursing or any care to patients without adequate regulation and supervision and the appropriate qualifications for their role. Without this it doesn't not permit safe care or consistent quality of service.

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  • Absolutely...well said.

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  • If there is to be no restriction of role, whatever is the point of regulation? Without restriction of roles, anything can be tackled, any lack of supervision by registered practitioners enabled. Anything goes!

    Unregulated staff are no better than ineffective regulation which is hamstrung by such rules. Why bother regulating or training then?
    Public protection looks as if it'll be the first thing to be discarded.

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  • If there is to be no restriction of role, whatever is the point of regulation? Without restriction of roles, anything can be tackled, any lack of supervision by registered practitioners enabled. Anything goes!

    Unregulated staff are no better than ineffective regulation which is hamstrung by such rules. Why bother regulating or training then?
    Public protection looks as if it'll be the first thing to be discarded.

    Unsuitable or offensive? Report this comment

  • Is this not just the "Enrolled Nurse" reborn. I was originally an Enrolled Nurse as I wanted to be a practical bedside nurse and not a Sister. However was forced to undertake Conversion course as I was finding I was doing a registered nurses job but without the financial recognition, hope this doesnt happen to the Assosciate nurses!

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