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Healthcare assistant experience in nurse training

Royal College of Nursing (RCN) chief executive and general secretary Peter Carter has already provoked a public row with the government over its recent proposals that all nurses be required to work as healthcare assistants (HCAs) for at least a year in order to complete their training.  

Mr Carter described the policy as having “more holes than a Swiss cheese,” and 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.

Under the government's proposals, nurses will have to work as HCAs for at least a year in order to secure funding and go on to complete their nurse training.

In reply to the Francis report released just over two months ago, Health Secretary Jeremy Hunt said the rules would apply to any nurse who seeks NHS funding for their degree.

He said that the scheme would “ensure that people who become nurses have the right and understand their roles.”

After an introductory pilot scheme, the government hopes that the new rules will “promote frontline caring experience and values, as well as academic strength”. 

Around 200 students on paid placements will test out controversial government plans and 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 as early as this autumn, and although 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 have expanded it to up to year.

The national steering group will be chaired by Sir Stephen Moss, a former nurse and manager, who is currently a non-executive director at Derby Hospitals Foundation Trust and 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” according to Health Education England.

Professor Ian Cumming chief executive of Health Education England, which will be responsible for overseeing the schemes implementation, has said he believes that the healthcare experience gained working for a year as an HCA 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,” he said.

Sir Stephen Moss meanwhile has said that it is “vitally important that we deliver skilled patient care, with kindness and compassion.”

“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.”

A recent Nursing in Practice Facebook poll revealed that nearly 70 per cent of respondents disagreed with the government's proposals.

Commenting on the poll, HCA Natasha Neal said: “What makes the government think there would be enough HCA jobs available to supply the high number of student nurses with? 

“There is already a shortage of jobs and many HCAs stay in the role for a number of years without doing their nurse training,” she added.

Meanwhile Jasmine Davies questioned those that did not have time to work as a HCA because they already worked as unpaid full-time carers.  

“Everyone's experience in nursing is unique, however I'm guessing the NHS will now not fund your course because of this. I do agree that experience is needed for the course but to work as a HCA is going a bit too far.”

And nurse Danielle Aimee Trow labelled the government's proposals as “ridiculous”.

“I can see a massive nurse shortage happening. I felt I was a glorified HCA during my first two years of training anyway.”

The proposal has been heavily criticised and the Council of Deans of Health has warned that it could also prove dangerous.

Professor Ieuan Ellis, chair of the council said: “Prospective students spending up to a year working as a healthcare assistant will place an over-stretched health service and its staff under even greater pressure, putting more unqualified people on the wards.

“We are clear that if this becomes a blanket provision it will risk patient safety rather than protect it. This is the wrong answer to the wrong question.”

Meanwhile RCN head of policy Howard Catton told Nursing in Practice that there were a significant number of questions about how the proposal would work in practice.

“Will people who come into nursing who already have caring experience be required to do this... and how will people be funded to do this?” he asked.

“There is also a question about how many extra HCA posts would need to be created. If you look at the number of people applying to train as nurses at any one time, does that mean the NHS would need to create that number of HCA posts?”

Around 18,000 nursing students began a degree programme last year. The RCN estimates paying them all a typical HCA salary would cost at least £250 million. However, the government has stated the programme should be cost neutral.

“If you're a trust and you're paying these students, how are you going to fund a significant increase in your HCA workforce? You'd have to cut back on your existing HCAs,” Mr Catton said.

And others have questioned why nursing students have been singled out for HCA training and not their medical counterparts.  

With 198,000 applications to student nursing places in 2012, Professor Ellis has also warned that prospective students spending up to a year working as a healthcare assistant “will place an over-stretched health service and its staff under even greater pressure, putting more unqualified people on the wards.”

As with many of the government's NHS proposals, the devil will be in the detail, and it will be important to see what comes out of both the work of the steering group and the pilots.

However, one nurse responding anonymously to the Nursing in Practice poll had this to say about the idea: “Why aren't student teachers being made to work as classroom assistants for at least a year to get experience working with small groups of children? Or why don't doctors have to work as nurses so they understand the nurses role more? 

“These are all stupid ideas, that's why - a classroom assistant isn't a teacher, a nurse isn't a doctor, and a HCA isn't a nurse.   

“Making student nurses work as HCAs is not in any way going to improve their nursing abilities... this country is run by complete and utter morons.”