Health Education England (HEE) has now concluded its consultation, “Building capacity to care and capability to treat – a new team member for health and social care” and confirmed that it will be proceeding with plans to introduce nursing associates into the healthcare sector. The new Nursing Associate role is a potentially radical addition to the healthcare sector; reigniting the debate on the blurring of roles and what exactly it means to be a regulated professional.
First announced as a possibility in December 2015, the consultation published its conclusions in May 2016. If that was not a short timeframe within itself, HEE has now declared its intention to introduce the new role into England’s healthcare system by Spring 2017.
The nursing associate role has been described by HEE as having “the potential to transform the nursing and care workforce” by providing a new type of healthcare worker to whom more complex care work can be delegated. It is envisaged that applicants would apply for a nursing associate apprenticeship and foundation degree, with the possibility of further progression to registered nurse qualification via a degree level apprenticeship or shortened degree.
On a day to day basis, nursing associates would work with healthcare assistants and registered nurses, in an enhanced version of the carer role; freeing up nurses to deliver specialised care by allowing them to delegate more complex tasks.
However, the Royal College of Nursing (RCN) has urged caution and pressed for greater clarification. Whilst broadly supportive of more flexible models of care and greater skill mix, the RCN noted that delegating a wider range of complex tasks to non-registered individuals would not alter the fact that nurses would remain ultimately responsible for care and decision making.
Registered nurses have a duty of care and a legal liability to their patients, not only via employment obligations but also under the Nursing and Midwifery Council’s (NMC) Code of Conduct. Delegating tasks without ensuring that those to whom they delegate are competent and appropriately supervised is a breach of the Code. Any such breach could result in disciplinary and regulatory investigation. This accountability would mean nurses remain largely responsible for the supervision of non-registered workers.
The RCN consultation briefing paper also cautioned against a further blurring of the caring roles and concluded by raising the question of statutory regulation for all healthcare workers.
Likewise, the NMC response concluded that “that there is still some way to go in bringing definition to the role” and noted “the strong support in principle for the NMC to regulate the new role. (However) a final decision about regulation needs to be based on evaluation of the proposed scope of practice for nursing associates”.
The Government and the HEE now have to explain exactly how they are intending to distinguish this new role, the required levels of academic learning and frontline practice and how, if at all, these new employees will be regulated. They must also offer guidance on which institutions would be tasked with formulating the academic structures behind the qualification and to what extent training will take place on the frontline or in the classroom. All of this is separate from the significant legislative and political hurdles of how to regulate and who will regulate these new professionals.
With so many upheavals in the current political landscape, numerous significant questions to be answered and the stakes in terms of public confidence set so high, one might suggest that it will be more than the 9 months to Spring 2017 before we see the first nursing associates in the NHS.
