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”
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”.