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NHS Improvement devising nursing associate safeguard to avoid ‘cheaper, less skilled workforce’

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Safety measures to ensure the introduction of nursing associates does not result in a diluted nurse workforce are being drawn up by regulator NHS Improvement, the body’s senior staff have revealed today.

A safeguard mechanism is being devised by the regulator’s chief nurse, who also said today that nursing associates will be counted separately from nurses under a new metric being used to calculate staffing levels.

“Ruth [May] and colleagues are working on a safeguard that makes sure there isn’t a dilution”

Jim Mackey

In an exclusive interview with Nursing Times’ sister title Health Service Journal, NHS Improvement’s chief executive also indicated that previous comments he had made over the summer – suggesting employers should not have gone beyond one nurse to every eight patients – were incorrect.

“There is evidence for that, absolutely; I might have said that slightly wrong,” he said, adding that NHS Improvement’s job was to make sure staffing was “optimised, but that we don’t cross the line” of becoming unsafe.

The regulator would “provide a floor that people can’t go beneath… because the evidence is they haven’t always got that right,” he said.

“I want to see evidence that what they are planning to do at the end of is better than what they are doing now”

Jim Mackey

Mr Mackey said the regulator would take steps to protect registered nurse staffing levels alongside the introduction of nursing associates, the new “bridging” role between healthcare assistants and nurses that will be trained through a two-year programme from January.

He said NHS Improvement’s executive director of nursing, Dr Ruth May, was developing a safeguard mechanism to achieve this.

“Ruth and colleagues are working on a safeguard that makes sure there isn’t a dilution, so that this isn’t interpreted that you can get away with a cheaper, less skilled workforce,” he said.

NHS Improvement needed “to be a safeguard in this process”, he said, adding: “This is all about increasing the amount of clinical resource devoted to patients rather than diluting it.”

His comments echo those of chief nursing officer for England Jane Cummings, who last month pledged to support trust directors of nursing if they are put under pressure to replace registered nurses with nursing associates.

Meanwhile, in response to discussion on social media today, NHS Improvement’s Dr May revealed that nursing associates would also be separated out from nurses and healthcare assistants when NHS employers count staffing levels using a new nursing metric.

The care hours per patient day (CHPPD) metric, being introduced this year across NHS hospitals and due to be extended to other settings, initially attracted criticism because it was thought that support workers and nurses would be grouped together when using it to calculate required staffing levels. It was later clarified that HCAs and nurses would be broken down separately.

In today’s interview, Mr Mackey also said that new proposals being drawn up to improve services in local areas – known as sustainability and transformation plans (STPs) – would be subject to NHSI checks on safety.

His comments follow the publication of some draft STPs, such as those for Buckingham, Oxfordshire and Berkshire West, and also Nottinghamshire, which envisage the “reduction of nursing grade input” and more use of “generic support workers”.

“I want some basic assurance and I want to see evidence that what they are planning to do at the end of it is better than what they are doing now. We should be kicking the tyres – that is part of our job,” said Mr Mackey in relation to STPs.

He said workforce was not prominent enough in many STPs. More so than finances and emergency department performance, staffing was “the thing that really keeps [NHS leaders] awake at night”, therefore “let’s put it centre stage”, he said.

“There needs to be a kind of safety [check] on let’s not cross any de minimus standards,” he said. “I am the accounting officer for NHS trusts, I am responsible for the safety in a lot of these places.”


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