Plans for widespread changes to the way nurses and care assistants are trained are underway, with new standards for a senior healthcare assistant “bridging” role due to be piloted next year.
Student nurses could also in the future have a reduced number of placements during undergraduate training, but be assigned a caseload of patients to follow for longer as they access care across a range of settings.
“There’s an opportunity here to see if there is a core caring role we can have national standards around”
A move away from one to one mentoring for student nurses is also being considered in a bid to decrease the large amount of nurse mentors and ensure undergraduates learn from only those who are considered to be “quality educators”.
The “bridging” role was proposed earlier this year by a major review of nursing education and training, which identified a gap in career development between HCAs and registered nurses.
The Shape of Caring review, chaired by Lord Willis of Knaresborough, recommended national workforce planning body Health Education England look into the position, and also whether those that had completed the training for it could then be fast-tracked through a nurse degree.
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Up to a 1,000 HCAs are expected to take part in testing competencies for the senior HCA position at around 30 sites in England during 2016.
In an interview with Nursing Times, HEE’s nursing director Lisa Bayliss-Pratt said the core competencies were expected to cover those required for holistic care.
“This role needs to be seen as forward thinking and be seen as part of the future, not the past”
It would be different to the kind of work carried out by senior HCAs already employed in some organisations – usually at Agenda for Change band 4 level and known as assistant practitioners – which often addressed a specific skills gap within the trust, such as phlebotomy.
Opportunities to “bolt on” additional therapy skills were also being considered, said Ms Bayliss-Pratt. “When I’ve spoken to many directors of nursing, if you look at the frailty pathway of an older person for example, actually they don’t just need nursing care – they also need therapeutic interventions.
“There’s an opportunity here to see if there is a core caring role we can have national standards around, and then bolt on competencies to enable people to give basic occupational therapy advice, basic chest physiotherapy to help alleviate an older person’s breathing problems, and exercises to help people become more mobile,” she said.
Due to the range of proposed competencies and skills, until the piloting had been completed it was still undecided as to whether or not the role should be registered with the Nursing and Midwifery Council, she said.
Physician associates – a new support role for doctors imported from the US – are not regulated and “yet if you think about the interventions they do and the way they work they seem to be incredibly successful”, she noted.
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Ms Bayliss-Pratt also stressed the proposed role would not be equivalent to a state enrolled nurse – phased out during the 1990s – because trainees would need to meet a set of nationally agreed competencies.
Trainees would also be provided with “clear progression points” along the way and the role would not be a “default” for those who failed to gain a registered nurse qualification, as the SEN was, she said.
“This role needs to be seen as forward thinking and be seen as part of the future, not the past,” she said. “The SEN role was about bedside nursing but didn’t have an academic component. This would have an academic component.”
Discussion around the need for the return of an SEN-style role has increased noticeably in recent months, were especially prevalent in the run-up to May’s general election.
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Ms Bayliss-Pratt said HEE was looking at a work-based learning programme that would be around two years in length for entry level care assistants, but those already working in nursing support roles would be able to complete it in less time.
As previously reported by Nursing Times, the body is also investigating how those HCAs who have achieved the core competencies for the bridging role would then be able to complete a nursing degree in less than the usual three years.
When asked by Nursing Times how HEE would fund the senior care assistant training and whether it would commission course places as it does with universities for nursing degrees, Ms Bayliss-Pratt said it was too early to say.
“What we do know is we can’t afford not to invest in our nurses and care workforce”
However, she did confirm that plans were being made “in line with the anticipation that we won’t have as much money” following the government’s next spending review in November.
Concerns have been raised that HEE budget will no longer be ring-fenced following the government announcement , which will set out savings it needs to help eliminate the national budget deficit by 2019-20.
“What we do know is we can’t afford not to invest in our nurses and care workforce,” added Ms Bayliss-Pratt. “However bad the hit is, we are trying to come up with solutions, opportunities and return on investment.”
She was appointed as director of nursing at Health Education England in 2012 and in this role she is responsible for leading national policy, workforce planning, and multi-professional education and training commissioning for the non-medical healthcare workforce.
Key achievements include establishing the Shape of Caring Review, development and piloting of pre-degree care experience for aspirant nurses and leading the ‘return to practice’ initiative.
She is a trustee of the Foundation of Nursing Studies.