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NHS failing to make the most of nursing support staff


The NHS is failing to make the most of skilled support staff to improve efficiency and address widespread shortages of registered nurses, according to a new report.

Too often competent healthcare workers who could take on relatively complex tasks and free up nurses’ time are held back due to a lack of training and because their abilities are under-estimated, said the report from the body Skills for Health.


The document said the NHS could boost productivity, save money and improve care by helping more support workers realise their potential.

However, the Royal College of Nursing, which has just published its own policy paper on support workers, stressed they cannot be used a substitute for qualified nurses.

“There needs to be greater clarity around support worker roles and wider understanding that every job is important and worthwhile”

Ian Wheeler

The Skills for Health document claims the current “hourglass” structure of the workforce – with many skilled, relatively well-paid and highly trusted staff at the top, many low-skilled, low-paid and low-trust roles at the bottom but few in the middle – is hampering progress.

A key issue is a lack of high quality intermediate roles such as assistant practitioner jobs, it concluded. It said workers struggled to make the “leap” from band 4 to 5, yet many have potential that is not being realised.

Meanwhile, a related paper, published by Skills for Health in January, found that for every 1% of activities shifted from band 5 to 4 staff, a total of £100m could be saved across the health sector.

“The relatively high number of support workers qualified at level 4 and above signals that there is capacity for these workers to undertake complex activities,” said the new document.

But it added there was confusion about such roles, which can be viewed with suspicion by nurses.

Nurses may be unaware of what the difference is between an assistant practitioner role and a healthcare assistant, which “can lead to resentment and anxiety”, all round.

The report argued enhanced support roles have many advantages and have been shown to benefit both patients and hard-pressed nursing staff.

“If such roles are created they can go a long way to addressing the shortages and difficulty in the recruiting of registered staff being experienced at present, it will lead to improved productivity and will be more cost effective,” said the report.

“This is by no means suggesting that somehow professions need to feel threatened by such developments or that quality of care will be compromised,” it said.

“Evidence from the experience of the creation/deployment of such roles actually suggests the opposite in that the quality of care and patient satisfaction increases and the jobs of professional staff tend to be less stressful.”

“The responsibility for the overall nursing care of the patient and clinical decision-making lies with the registered nurse”

RCN briefing paper

While trusts do offer opportunities for support workers to develop their skills, the authors said simply providing training was not enough. Such workers should be held in greater esteem and given the chance to progress through intermediate roles and into higher bands.

“There needs to be greater clarity around support worker roles and wider understanding that every job is important and worthwhile,” said Ian Wheeler, head of research at Skills for Health.

“It is only by understanding the contribution and value of the support worker role that the sector will be able to realise its potential in terms of productivity and efficiency,” he added.

The RCN’s policy paper, published this week, also highlighted the need for development programmes and a structured career path for support workers.

However, it also made a clear distinction between the roles of registered nurse and support worker.

“Whilst there are a wide range of activities that can be undertaken by appropriately trained and competent support workers, the responsibility for the overall nursing care of the patient and clinical decision-making lies with the registered nurse, and this is not something that can be substituted by a healthcare support worker or assistant practitioner,” it said.

NHS chief executive Simon Stevens recently called for “new career ladders between care assistant and graduate nursing roles”.

In its briefing paper, the RCN made it clear it did not want to see the return of second level registered nurse roles and that nursing “should remain an all graduate profession”.


Readers' comments (17)

  • michael stone

    This is something which I suspect will become more prominent. There is already the an emphasis on the two 'themes' of 'nudging the public to keep themselves healthier' (don't smoke, don't over-eat, etc), and of 'community involvement in healthcare (more involvement of community and charities, etc, in things the NHS once did more-or-less on its own).

    I think it likely that more things falling to HCAs [to perform], and a push for it to be made easier for 'senior HCAs' to become nurses, is something to be expected.

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  • Agree with all you say Michael and as long as it is managed safely that is fine. Interestingly when I was working for the OU (I retired in 2013) from 2009 to 2013 we worked hard to develop a decent Assistant Practitioner Programme which included all the Essential Skills outlined for the first year of a nursing degree plus some really excellent and thorough underpinning learning - this was in the form of a Foundation degree. I know that some were used in England but I was working in Wales but trying to get the NHS in Wales to look at this programme was so so difficult. Local university loyalties was usually the problem but none of the other universities offered an online course with work based learning assessment at the time. Absolute value for money and what quality!! We had some brilliant tutors who were NHS based too.
    Sadly lots of vested interests and professional tribalism stopped this from being used throughout Wales and probably elsewhere in the UK. Healthcare support workers want to continue working whilst they learn.

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  • Sorry but the Assistant Practitioner post for me was a total waste of my time! I should have just done the Nursing Degree! Held back, no supported and no understanding what the role was about from members of staff I worked with.. 2 yrs at uni for the FDSc to be told I was an NVQ4!!! Now left the post and was able to APL the credits so another 2 yrs at uni now so in effect taken 4 yrs to get my NSBc.. The nursing shortage and recruiting from abroad is an issue but I think they should be seconding good healthcare assistants with lots of experience into nursing!! No one invests in hca's at all in this country!!

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  • Now that a registered nurse qualification is a degree course and the government are planning to loan trainee nurses the money to qualify I don't think it is a great job to be in. I assume that as less qualified nurses are going to be available to the NHS more tasks will fall within a HCA job description. What was wrong with the enrolled nurse job it gets the work done and costs less?

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  • I agree with anon 16 oct 5.57 there are loads of really good hcas that don't have the qualifications to get into uni but would make brilliant trained nurses, they are good on the ward but as hcas there is so much they are not allowed to do leaving vast quantities of work for the often only trained nurse on duty in their area .Good hcas are worth their weight in gold and should be treated as such ,if they want to train and have support from their manager to do so please help them , home grown good quality staff are what we need.

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  • You can delegate the task, but not the responsibility...if HCA,s are to be utilised to spread the load (and the cost) then someone needs to have a word with the NMC...I don't really want 'unregistered' individuals practice resting on my long as the trust/NHS/employer steps up to the mark with training etc. and issues such as vicarious liability are considered...which means HCA's are 'accountable' for their (own) acts and omissions and not me as Matron/Manager/Team Leader...I am not being a dinosaur just a realist....

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  • Whilst I don't disagree with the basic ideas being laid out here, I am fearful that this debate detracts from the major problems we currently face. Answering the current shortage of nurses by inventing intermediate roles is playing straight into the hands of the politicians and civil servants who would like nothing better than to be handed a "get out of jail" card. Give them a cheaper solution than training more nurses and paying nurses better and they'll most certainly take it!

    Just sayin' :-)

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  • I was a higher clinical support worker at the top stage of my band a lot of my skills not even the band 5 and 6 could perform beginning of January 2015 I was down graded this was to a band 2 the was no choice in the matter it was to save money for the trust?
    then they brought in nurses from abroad
    and agency nurses to replace BUT! all these nurses didn't want to do the skills to replace me so patients are waiting for time that someone can do the tasks in that day before they can go home if not they have to wait a day or time longer in hospital until they can go home so know? we have work streached nurses or not enough, patients waiting for longer times for discharges, and trained H C S W to a very high level of compedents to strip them of there skills that cost the N H S
    to train the though a universite hospital for nurses at about £3000 what makes sense.!!!!!!

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  • We simply need someone to do the "nursing" duties. Nurses are so "highly trained" these days that they don't want to do the mundane chores associated with nursing - but someone needs to do said chores. Having staff to do the unworthy tasks frees up university trained nurses to do all those "life saving" chores and to work in all the high dependency areas, where their skills are so badly needed.

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  • some of the comments are delusional

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