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Evaluation puts aspirant student care pilots in positive light

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A controversial trial scheme to get aspiring nurses to work as healthcare assistants before embarking on degrees has opened up the profession to new people and helped trusts tackle staff shortages, say evaluators.

Initial findings from the Health Education England scheme, show it has opened the door to “a whole new pool of potential nurses”, said project evaluation lead Professor Mary Lovegrove.

“What we have found is that we have opened up a new pool of potential recruits for nursing”

Mary Lovegrove

However, some participants feel 12 months is too long, she revealed during a session on the pilot’s progress so far at Health Education England’s first annual conference in London last week.

“Some people are quite keen to do 12 months but some are champing at the bit after four, five, six months to start their nursing degrees and thinking 12 months is too long,” she told delegates.

She said the scheme, which has attracted hundreds of applicants in some areas, had encouraged new people to think about a nursing career.

“What we have found is that we have opened up a new pool of potential recruits for nursing,” she said. “Simply because a number of people we’ll have recruited into the system may not have had the opportunity to test whether they would like to be a nurse or not.

“Many are quite experienced people with life experience but may have had a family or be bringing up a family. It may be that the education opportunities weren’t there for them or they saw it as a financial risk for them to step into something they didn’t know whether they wanted to do.”

The fact the scheme accepts people with little or no previous care experience was a factor.  Some applicants had tried to become HCAs before but been told they needed care experience first.

The fact people like that were now successfully working as HCAs had made some organisations think again about their recruitment policies for those posts, said Professor Lovegrove.

London South Bank University

Mary Lovegrove

Six of England’s 13 local education and training boards (LETBs) signed up to take part in the pilot. In total 162 people were recruited to take up vacant healthcare assistant jobs from September last year with 142 still in post.

Most are working in acute trusts with a handful in community and mental health settings.

Professor Lovegrove said some people had dropped out for various reasons, including the fact the experience was not what they expected and because they wanted to stay as HCAs.

“They may think ‘actually I don’t feel nursing is the career for me at this stage’, and want to stay as an HCA because it suits them and they are enjoying it,” she said.

A second cohort of around 100 participants was due to start this spring, with five out of the six original LETBs involved. A further two cohorts will embark on the scheme in the autumn and next spring.

One issue that had emerged was a risk of confusion over participants’ role and status with some being described as “students”.

“People have started to refer to participants as students and participants have referred to themselves as students and this is an unfortunate falling into use of the term,” said Professor Lovegrove.

“The effect once people are perceived as students when they are not is they start to think like students and behave like students and start to complain about having to do night shifts and get up in the morning and saying things like they want to be doing what first year students are doing.”

Health Education England

HEE conference 2014

Recommendations from the pilot, which is being overseen by a steering group that includes England’s chief nursing officer Jane Cummings and other nursing leaders, could inform a wider roll-out of the scheme.

Evaluation will include gathering the views of participants, their mentors and supervisors, nurses in charge of wards where they worked, nursing managers and higher education institutions where they apply to do degrees, said Professor Lovegrove.

An economic analysis is also being carried out to assess the cost-effectiveness of the scheme compared to other approaches.

The Department of Health is also funding a longitudinal study from September 2014 to September 2018.

“It was never the intention for this to be for thousands of pre-registration nursing students”

Mary Lovegrove

Professor Lovegrove said the real test would be whether participants completed their degrees and progressed into nursing. “It will be interesting to see whether these people stay the course,” she said.

“That will be the test for me if we have about 200 going in, if they will all stay the course when we might have expected 10% attrition or if that was very low. If they stay the course that will be quite an important message.”

One of the benefits of scheme was that it had helped trusts tackle staff shortages that were putting teams under pressure.

“It has enable some organisations to be fully staffed where they hadn’t been able to before in terms of ratios of qualified nurses and HCAs,” said Professor Lovegrove.

The idea that aspiring nurses should gain first-hand experience of caring before doing a nursing degree was one of the recommendations of the Francis report.

The government has said it would like all prospective nurses to do up to a year of work experience.

But Professor Lovegrove said it was never the intention for all nurses to go down this particular route.

“It was never the intention for this to be for thousands of pre-registration nursing students,” she said.

There was concern the scheme would heap even more work on the shoulder of existing nurses. However, Professor Lovegrove said the feedback from ward sisters had been positive.

NHS national director for quality Ian Cumming

“At this point in time not one has said ‘I can’t manage this’,” she said.

Earlier Health Education England chief executive Professor Ian Cumming said some who had initially described the scheme as “totally wrong” had changed their minds once they had seen it in action.

“They have now stood on public platforms and said ‘We were wrong – this is good’,” he told the conference.

Royal College of Nursing chief executive and general secretary Peter Carter famously described the scheme as “having more holes than a Swiss cheese”.

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