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Scottish staff guidelines create a ‘patient safety issue’ and ‘exploitation’, says workforce expert

Scottish staff guidelines create a ‘patient safety issue’ and ‘exploitation’, says workforce expert

Non-registered professionals and assistant practitioners (APs) will be able to carry out assessment and evaluation of care under a new framework that has been described as ‘exploitation’ of support workers and risking patient safety.

The Development and Education Framework for Level 2-4 NMAHP Healthcare Support Workers, published by NHS Education for Scotland (NES), makes significant changes to the role of APs, including allowing them to carry out work previously reserved for registered nurses.

Under NMC regulation, non-registered professionals were only able to carry out the delivery and monitoring steps of the nursing process, while assessment and evaluation of care should always be carried out by a registered nurse.

However, under the new Scottish framework the role of an AP has been extended to include carrying out ‘routine elements of an individual’s assessment, treatment or intervention following protocols and evidence-based practice.’

The changes were endorsed in a tweet by Alex McMahon, Scotland’s chief nursing officer, who said ‘this is really good and important work’.

A Scottish Government spokesperson said: ‘The Development and Education Framework for Bands 2-4 nursing, midwifery and allied health professional Health Care Support Workers (HCSWs) formalises and standardises the required skills for HCSWs and provides a structured development pathway to support the continuing professional development of this group of staff who are an integral part of the NHS workforce.

‘The framework – which was developed in consultation with key stakeholders, including the RCN, education providers and health boards – is robust and provides safeguards as HCSWs must demonstrate appropriate knowledge, skills and behaviours, appropriate to their Band, before engaging in the skills of assessment and evaluation, therefore ensuring that the public are protected and registered healthcare professionals are able to safely delegate.’

Professor Alison Leary, professor of healthcare and workforce modelling at London Southbank University, said that the change amounted to allowing unregistered professionals to carry out nursing assessments.

Although Professor Leary said that support workers are very important, ‘we know that registered nurses have a big impact on patient safety. We also know that missed, delayed or uncoordinated care where there isn’t a care plan is one of the most cited concerns for coroners in prevention of future death notices.

‘It is important to have nursing assessment and care properly planned, and then others can help deliver care.’

Furthermore, Professor Leary said that ‘asking support workers to take on the assessment of care is not only a patient safety risk but is exploitation, they are not paid to take on that level of responsibility.’

Despite offering an improved pay offer for NHS staff, Scotland is facing an acute workforce crisis. Recent analysis from Nuffield Trust showed that one in 9 Scottish nurses had exited the NHS over the last year.

Scotland has since racked up an agency staff bill of £92m in 2021-22, almost double the total spend of the previous year. Professor Leary suggests that this could have lead to NHS Scotland looking for ‘the most hands for the least money’

However, ‘safe staffing is more than just numbers,’ Professor Leary told Nursing in Practice, ‘it’s about skill and who can do what kind of work, and when that isn’t right we know that outcomes can be catastrophic for patients.’

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