interviews

Tight timetable for nursing associate regulation

Jackie Smith, chief executive at the Nursing and Midwifery Council (NMC), talks to NHE’s David Stevenson about the challenges her organisation faces in setting up regulation for nursing associates, including the very tight timetable.

In December 2015, the government announced a plan to create a new nursing support role. Fast-forward to 2017, and over 1,000 nursing associates will start their training this year in a new role that will sit alongside existing nursing care support workers and fully-qualified registered nurses to deliver hands-on care for patients. 

However, there are still challenges facing the development of the new position which, in late January, the NMC agreed to regulate. Jackie Smith, CEO at the NMC, told NHE that the organisation is well-equipped to regulate nursing associates and this is a positive endorsement of its progress. But the regulation will not be ‘light touch’, as it doesn’t exist. 

“What regulation does, is it allows the NMC to set that standard and be clear about what is expected of individuals who join our register as a nursing associate. From a public protection point of view, regulation is understandable and essential where there is a risk, and clear for all to realise what the expectations are,” said Smith. “It is important that the NMC is regulating this role, but we mustn’t run away with the idea that regulation solves all the problems, because it doesn’t. It is very important that the NMC works with all of those going through the pilot sites at the moment, but also beyond that, when regulation takes effect and individuals get on our register.” 

Professor Ian Cumming, chief executive of Health Education England (HEE), welcomed the NMC’s decision to regulate the new role, and said in a recent HEE board paper: “Following successful recruitment to the first cohort of nurse associate training programmes, we have now embarked on a second cohort of 1,000 trainees, with test sites commencing in April 2017. 

“The grant-funded two-year test site partnership programme across England, with 35 test sites of varying size, location and focus, will train 2,000 trainees by 2019 and involve 61 education providers and 201 employers to date. In total, 24 fast follower test sites involving 115 employer partners across England, with a number in each of the four HEE regions, have been selected to deliver the two-year training programme, in addition to the 11 pilot sites already announced.” 

He added that HEE will continue to work closely with the NMC during the next two years to ensure that the trainee nursing associates within the 35 test sites have a “smooth transition onto the register”.

Prof Cumming explained that he expects test site partnerships to have concrete plans in place to support qualifying nursing associates progress into employment. 

“Partnerships will also need to demonstrate their plans for scalability in the long term to accommodate growth in this area,” he said. “As such, HEE’s monitoring and evaluation of the programme will review employer plans and progress in this area throughout the two-year pilot.” 

Reflecting on the work going forward, Smith told us: “Any worker who is delivering care, whether that is in hospitals or in social care, needs to make sure they have the correct skills and training to deliver to the right standard – that is a major issue here.” 

She reiterated that with regards to nursing associate regulation, the NMC is planning to implement the “full suite of regulation”. 

“We are not talking about ‘light touch’ regulation, because it doesn’t exist,” she said. “This idea that you might just have a register is something that the Professional Standards Authority (PSA) does, not what professional regulators do. 

“We are fundamentally talking about setting the standards, having a code – whether it is the existing code or a separate one. These are significant policy issues that the council will need to debate. We are talking about fitness to practise and we are talking about revalidation. All the things that nurses and midwives on our register currently understand that relate to regulation would apply, but they do need to be debated by the council.” 

The CEO added that there are many reasons why the NMC being the regulator makes sense. For instance, it is easier for career progression, which often gets overlooked, but is essential to this work. The regulator has already indicated that the cost of setting up regulation of nursing associates is in the region of £4m, and the Department of Health (DH) has agreed to fund this work.

“It is, of course, ministers who decided that the role should be regulated,” said Smith. “We are in discussion with the DH at the moment about a business case and about funding for this. But in terms of the immediate next steps, what we have to do is engage with HEE, the pilot sites, and get the standards drafted. 

“There are some really tricky legal issues we need to overcome, because nobody has ever created a new role from scratch. There isn’t a blueprint for saying ‘this is how you do it, it will be quick and easy and won’t cost much’. We are doing this from scratch and we have to make it work, and because they are already going through their training there is an expectation that they will finish by January 2019 and, therefore, be on our register. 

“We have to make sure that everything we do aligns, that we absolutely put public protection first, but that we don’t end up in the position at the end of 2018 where the standards are so high that these people can’t get on the register. We are alive to all the issues and are working closely with everyone to make sure this makes sense.” 

Discussing the tight timescale in order to deliver the regulation, Smith stated that, to a large extent, the NMC is reliant on the DH. 

“They have to change our legislation to create this new role, and changing our legislation, as we all know, takes a long time. It is going to take a minimum of 18 months, and nothing will happen unless legislation moves along quickly and is in place by the end of 2018,” said Smith. “The DH knows what the priorities are, they are used to changing legislation, and they are committed to delivering what is, effectively, the secretary of state’s initiative.” 

Smith reflected that chief nursing officers (CNOs) in the devolved nations have been “very clear about not supporting the concept of nursing associates”. Professor Jane Cummings, the CNO for England, recently tried to allay concerns: “The nursing associate is not a registered nurse and will not replace them, but they will instead have the training and skills to bridge the gap between what a healthcare assistant can do and what a registered nurse is now needed to do. 

“Critics have suggested that this is a cheap replacement for nurses – this is not and must not be the case. This is an opportunity for thousands of talented people to gain the first step on the ladder not just to a job, but to a rewarding lifelong career.” 

Reflecting on the challenges this regulation poses for the NMC, Smith told us: “We want to preserve the status of UK-wide regulation. It is absolutely critical. What we are actually regulating here is a qualification. Scotland, Northern Ireland and Wales can choose not to use nursing associates, but I would hope they don’t stand in the way of regulation applying across the UK. It is terribly, terribly important that that happens. We are working with the DH and all the CNOs to make sure they understand what all the issues are and address them in a sensible way. 

“There is a difference about not supporting the role, and standing in the way of UK-wide regulation. I don’t believe any of the CNOs wish to see an England-only bit of legislation. I’m hoping we can find a way through this, and DH must work with its counterparts in the devolved nations. 

“What we are very clear about is that by allowing us to set the standards for this role, and thinking about what we are doing with the future of nurse standards, it enables us to be clear about the difference between a graduate-registered nurse and the nursing associate. Workforce issues are for someone else, not the NMC.”

FOR MORE INFORMATION

W: www.nmc.org.uk