SF: The MNC document talked about five set clinical pathways for nursing careers to follow in future, but the NHS Next Stage Review describes eight – which model will you follow?
JS: We’ve not definitely agreed on the five pathways because clearly the next stage review talks about eight and we need to have more conversations about whether it’s three, five, eight.
We’ve had lots of correspondence and comments through the consultation and otherwise about the number of pathways and the benefits of more or less pathways, so I think there’s more discussion to be had about which the right ones may be.
And secondly we would need to put in some transition arrangements for nurses who are already in practice. If we do move to a more structured pathway approach, we would need to work through what that might look like with the NHS as well as the regulator.
SF: So, essentially you are happy you have enough support to go forward with a pathway system but with a lot of things that still need to be decided and sorted out?
JS: Yes, the purpose of the consultation was not to produce the detail. We’ve a long history of having no particular structured pathways. We’ve got other examples in community nursing – health visiting, district nursing – but for lots of nurses you kind of end up where you end up, which is quite different to medicine and allied health professional careers so there’s more work to be done.
SF: So there are many uncertainties and challenges – identified in the original proposal document – that still remain?
Yes, I think there are. We’ve now got the next stage review, so we’ve got the context better mapped out, and we’ve also got a bit of a mandate in this document to go forward.
The part of choosing this approach was that the profession said, you know, go forward slowly, make sure whatever we do is in the right direction and I think it will unfold as we take the work forward. There wasn’t an appetite for a what I call a big bang – kind of like we’re here today and gone tomorrow.
I think that’s right because there are many advantages to the system that we have currently but generally – certainly when we did the initial careers work – lots of nurses were saying, they register and then they can’t really look anywhere to know how their career might progress if they were in a particular specialty or looking after a particular patient group – that’s what they were after, rather than a very rigid sort of structured approach that brings its own problems with it.
SF: How easy will it be for nurses to transfer between pathways?
JS: The theory would be that it wouldn’t be too difficult. What we want to try and establish in each of the pathways is a series of knowledge, skills and capabilities, and that some of those – for example communication skills – will be generic across all the pathways.
They will obviously be transferable but some of the specialist skills will mean if you want to transfer from long-term conditions to critical care then you may well need some additional teaching and training. But we want to generate a system that is flexible enough for people to swap if they want to or patients or the service needs them to – and that you don’t have to go back to the bottom of the pathway from being quite senior in one.
SF: What’s the next stage?
JS: I think the next stage is take four or five areas and work out the best way to take them forward, particularly around how we start to develop what the pathways might look like.
There are one or two models internationally of structured careers once nurses qualify but we are really, I think, leading the way, so it’s important to go forward but not at a pace that leaves you with a system that is then the worst in the world.
SF: So there is no set timeline for the next set of details?
JS: No, I don’t think so. We’ve got the mandate, we’ve got the next stage review output and I think it’s now a question of sitting down and working out some of that detail.
Interview with Steve Ford