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Next steps in HCA work for nursing students plan unveiled


Around 200 students on paid placements will test out controversial government plans to require future nurses to spend up to a year working as a healthcare assistant before starting their degree.

A 16-member steering group, including several high profile nurses, has also been announced to oversee pilot schemes for the plan, which includes several outspoken critics of the idea.

The pilots are scheduled to begin in the autumn, as revealed in April by Nursing Times.

The idea was the central proposal in the government’s response to the Mid Staffordshire Foundation Trust Public Inquiry report.

While Robert Francis QC’s report had recommended students spend at least three months working on the direct care of patients before their degree course, the government expanded it to up to year.

The idea drew largely unfavourable responses from nurse commentators and unions. Royal College of Nursing chief executive and general secretary Peter Carter invoked a public row with the government over the idea last month when he described the policy as having “more holes than a Swiss cheese”.

Earlier this month, the Council of Deans of Health published a paper claiming the proposals should come with a “serious health warning” for the NHS, with “potentially serious unintended consequences” for the role of HCAs, mentorship of students and patient safety.

It argued that focusing on the year after a newly-qualified nurse joined the profession “may be far more significant” than the year before a student joined their course.

However, student nurses themselves appear divided. A Nursing Times survey of over 1,400 students in April found 42% thought it was a good idea and the same percentage that it was a bad idea.

The national steering group announced yesterday by Health Education England will be chaired by Sir Stephen Moss, a former nurse and manager, who is currently a non-executive director at Derby Hospitals Foundation Trust. His most high profile role was as turnaround chair of Mid Staffordshire Foundation Trust from August 2009 until January 2012.

The group also includes leaders from the RCN, Unison, the Nursing and Midwifery Council and the Department of Health.

It will oversee the pilot programme to “see how best to take forward these proposals and assess the most appropriate timescale”, Health Education England said in a statement. The group will also be responsible for evaluation in areas, including the ability to test for values and behaviours and reductions in attrition rates.

The statement added that the pilots were “likely to involve up to 200 nursing students on paid placements across the country from this autumn”.

Professor Ian Cumming, chief executive of Health Education England, said: “The healthcare experience will allow students to understand whether nursing and hands-on care is right for them.

“It should be hard to be a nurse – a vocation, a real desire, not just something you accept as second best so you can do a degree course.”

Sir Stephen Moss, Chair of the steering group, said: “I am delighted to have been asked to chair the steering group for this important piece of work.”

He added: “It is vitally important that we deliver skilled patient care, with kindness and compassion, and piloting this pre-degree experience will enable us to test out the effectiveness of exposing potential students to front line care and professional values at an early stage, before their formal degree programme.

“Of one thing I am certain, that is that things cannot stay as they are. We owe it to those we serve to continually seek new and innovative ways to meet their needs.”

Steering Group members:

  • Sir Stephen Moss (Chair), Non-executive director, Derby Hospitals NHS Foundation Trust
  • Lisa Bayliss-Pratt (Vice-chair and project director), Director of Nursing, Health Education England
  • Jo Lenaghan, Director of Strategy, Health Education England
  • Jane Cummings, Chief Nursing Officer, NHS England
  • Viv Bennett, Director of Nursing, Department of Health and Public Health England
  • Peter Blythin, Director of Nursing, NHS Trust Development Authority
  • Peter Carter, Chief Executive and General Secretary, Royal College of Nursing
  • Gail Adams, Head of Nursing, UNISON
  • Ieuan Ellis, Chair, Council of Deans of Health
  • Dame Christine Beasley, Chair, North Central and East London, Local Education and Training Boards
  • Dean Royles, Chief Executive, NHS Employers
  • Mark Newbold, Chief Executive, Heart of England NHS Foundation Trust, CEO Provider
  • Sally Brearley, Chair, Nursing and Care Quality Forum
  • Jackie Smith/Judith Ellis, Nursing and Midwifery Council
  • Ann Farenden, Care Quality Commission
  • Alan Robson, Deputy Director of Workforce Development Strategy, Department of Health


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Readers' comments (27)

  • 'Steering Group' and what about representatives from the 'shop floor'? A Nursing Student or newly qualified nurses??

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  • michael stone

    This could very possibly end in tears - I'm not sure who will be doing the crying, but quite possibly someone will be reduced to anguished tearfulness, over this one !

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  • or even a patient?!

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  • It will be a hard job removing the poor practice habits that these potential students will pick up while working as HCA's for a year. The message is coming through very clearly that those in high places obviously believe that there is NO difference between Student Nurses studying to become Registered Nurses and HCA's. It is because of this ill conceived belief that Student Nurses are not qualifying with the required skills as they are being counted in the Ward numbers while in practice and are not being given the opportunities to undertake drug rounds, or management of patients/wards. What is needed is a root and branch review of how students are treated while in practice.

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  • I would like to see the Steering Group, work as HCAs, giving direct patient care for 2 solid months. To refresh their skills + perspective of frontline care, as well as gaining contemporary experiences of what is required from staff currently (not a few years ago) - or are they 'too posh to wash' ;o)

    If working as a HCA for xx months before a nursing programme (for those who want to become registered nurses) is paid at the correct rate, of course students (especially younger students) would love to earn a bit of money before the tough programme of juggling clinical work and academic studies takes over their lives. It might be a bit tougher for those who has changed careers. However if undersupervised, undersupported, or received inadequate training, it is easy to pick up bad habits which is then much harder to retrain someone whose spent a year reinforcing poor practice. All of which isn't good for patients care.

    Most student nurses are currently working 50% clinical practice:50% academic work, equating to about 1.5 years hands-on work by the time they qualify, on top of which, some work extra shifts as HCAs due to the needing more money to survive on (otherwise they'll quit the course, at any stage of their programme)

    When student nurses are being used as an extra pair of hands, the quality of their learning is fair poorer than when properly supported / supervised by registered mentors. When appropriate, a combination of getting stuck in and taking a step back + being able to see and reflect on their own + other staffs clinical practices is much better for a students' development.

    Respecting everyone, patients, relatives, all levels of staff is one of the things will help to improve practice all round.

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  • who's bad habits may i ask! dont forget students are under the instruction of matron, ward managers,sr, sn come on!

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  • Who is going to be mentoring these HCAs??!! By the sounds of the previous commentator, there is no one fit to do so....never mind anyone who is going to have the time!

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  • no! to much paperwork!!!!!!!!!!!!!

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  • Speaking from my own experience, I wholeheartedly agree with what anonymous said at 12.30. We're not learning to become nurses, we're already working as HCA's while on placement. We're allocated mentors who are staff nurses, but the reality is that the majority in my experience do use us as HCA's instead because they are so stretched and unsupported themselves and have no time or energy to teach us.

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  • Does Professor Cumming have an evidence base to support his assertion that students currently enrol in nurse education 'as second best so you can do a degree course'? I have never met a student who has done this and in the unlikely event I ever did they would not remain a student for long! I fear Prof. C. would fail his degree if he used unsupported assumptions like this in his work.

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