Nursing and Midwifery (Amendment) Order 2018

Lord O'Shaughnessy Excerpts

Monday 25th June 2018 Lords Chamber

Moved by

[Lord O'Shaughnessy]

That the draft Order laid before the House on 17 May be approved.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, today we are debating legislation that puts in place provisions to regulate the nursing associate role in England.

Health Education England’s Shape of Caring review made a series of recommendations to strengthen the capacity and skills of the nursing and caring workforce. The report identified strong support from employers, managers and staff in the health and social care sectors for a new nursing support role that would act as a bridge between the unregulated care assistant workforce and the registered nursing workforce. Health Education England undertook a public consultation on introducing the nursing associate role in England. The majority of respondents, a large proportion of whom were registered nurses, supported the new role, and there was strong support for it to be regulated.

Nursing associates will have their own defined role, augmenting and supporting the work of nurses in carrying out critical functions. They will deliver hands-on care, enabling registered nurses to spend more time using their specialist skills to focus on clinical duties and take more of a lead in decisions on patient care. We do not expect nursing associates to be primary assessors of care, but they will monitor the condition and health needs of those in their care and be able to recognise when it is necessary to refer to others for reassessment.

Although this new role will open a new career pathway into the nursing profession, I reassure all noble Lords that nursing associates are not substitute nurses. We want more not fewer nurses, which is why in October 2017 the Government announced a 25% increase in funded training posts for nurses to ensure that the NHS meets current and future nursing workforce needs.

It is vital that the right safeguards are in place. The Government’s view is that the most appropriate way to achieve this is through statutory regulation. This will support employers to use the role to its full potential and help ensure patient protection.

First, the effects of the proposed amendments to the Nursing and Midwifery Order 2001 are to give statutory responsibility to the Nursing and Midwifery Council to regulate the nursing associate profession in England. Secondly, they are to extend the NMC’s current powers and duties contained in the order to nursing associates, in particular the key functions of: registration of nursing associates in England; setting standards of proficiency, education and training and continuing professional development and conduct for nursing associates in England; approving nursing associate programmes in England; operating fitness-to-practise procedures in respect of nursing associates; and recognising Scottish, Northern Irish, Welsh, European Economic Area and international qualifications for the purpose of registration to the nursing associate part of the register.

Thirdly, this order amends the offence provisions in the Nursing and Midwifery Order. These amendments provide that a person commits an offence when falsely claiming to be on the nursing associate part of the register, falsely claiming to hold a nursing associate qualification or using the title “nursing associate” when not entitled to. The offences have been drafted to reflect that nursing associates will be regulated in England only.

Fourthly, the order makes provisions that allow admission to the register for those who have completed or commenced their training by 26 July 2019 through the pilot courses being run by Health Education England or an apprenticeship route. Fifthly, it excludes nursing associates from being given temporary prescribing rights in a time of national emergency, such as a pandemic flu outbreak. Sixthly, the order also removes the screener provisions from the Nursing and Midwifery Order 2001, as these are now redundant. Seventhly, it makes consequential amendments to the Nursing and Midwifery Council’s rules and to other legislation.

Finally, the order closes sub-part 2 of the nurses’ part of the register by amending the Order in Council which determines the parts of the NMC’s register and the titles which may be used by persons included in the register.

These are important changes to the governing legislation of the Nursing and Midwifery Council which introduce the nursing associate role into regulation. Employers have told us that they need a more flexible workforce to keep pace with developments in treatments and interventions. This role will enrich the skill mix available to employers within multidisciplinary teams and support the increase of nurse numbers by providing a clear pathway into the nursing profession.

Once the order comes into force, it is proposed that the Nursing and Midwifery Council will open the new nursing associate register in January 2019. I beg to move.

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[Baroness Jolly (LD)]

My Lords, my contribution will be very short, as noble Lords have already said everything. We, too, welcome the role of the nursing associate. I commend the work of my noble friend Lord Willis of Knaresborough in making this happen and say to him that he can have the Front Bench if he is happy to take all that goes with it.

The noble Earl, Lord Listowel, made the point about impact. I just make one extra point. In remote locations—I live in Cornwall, but this could account for anywhere far-flung where there are hospitals and health establishments—there will be uptake from healthcare assistants who feel that they cannot leave home to train as a nurse because the distance is too great and they have family responsibilities or other commitments, but they could manage the two-year course. That would be really positive. Nursing associates would then improve in those establishments the quality, but also the skill mix, of nursing teams in areas where it is also particularly difficult to appoint.

I understand the timing of this SI. The noble Lord, Lord Clark of Windermere, said that perhaps there was still stuff to look at. It is really important that it gets on to the statute book, because we will have real live trainee nursing associates who need to register next year. Sadly, we cannot take any more time to do this, but from these Benches we really welcome the role of the nursing associate and the help it will give the NHS.

[Lord O’Shaughnessy]

My Lords, I sincerely thank every noble Lord who has spoken in the debate and engaged with these regulations so thoroughly. It has been a really important discussion about not just the new role of nursing associate but its impact on the overall health and care workforce. I am very grateful to all corners of the House for the broad welcome, albeit with questions and conditions, for the creation of this role.

I want to deal up front with the urgency of these regulations. I agree that there has been an element of rush, and I think we are all agreed on the requirement for it. But like all overnight successes, this has been a long time brewing, as the noble Lord, Lord Willis, pointed out. A lot of work has been done, and I salute, along with all noble Lords, the many people at the RCN, the NMC and others who have contributed to this, and the many people behind the scenes. It is quite right to acknowledge them. No doubt there is more work to come.

The primary debate, or part of it, revolved around the distinction between the nurse role and the nursing associate role. It is very important to be clear, as I hope I was in my speaking note, that these are distinct professions. They may all be part of the same family—there is a certain amount of semantics involved here—but they are distinct professions, which will be regulated distinctly, albeit in a joined-up way through the same regulator, which is quite right. The NMC is currently consulting on standards of proficiency. The department, with all the necessary arm’s-length bodies and others, will develop guidance for that separate profession. While nursing associates can inevitably support nurses, doctors and others, they will not just be the handmaidens to others, in the evocative phrase of the noble Lord, Lord Clark. They will be professionals in their own right.

It is also worth pointing out that, in the consultation going on at the moment on standards and proficiency, the NMC is also looking at the code of conduct and amendments to it. That consultation ends on 2 July so, again, I warmly encourage all noble Lords to contribute to that, because some of the ideas set out today could have an important role in getting that right.

The noble Baroness, Lady Thornton, asked about the financial risks involved in setting up the courses—making sure that they are properly constituted and so on. My department has a memorandum of understanding in place with the NMC to keep the costs of the set-up within agreed cost parameters. The costs of accrediting nursing associate courses are met from the annual registration fees paid by the NMC’s registrants. Therefore, the financial modelling has been investigated and we understand what we need to stick to.

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[Lord Clark of Windermere]

May I press the Minister a little further on the training costs? Is he saying that all students on the nursing associate courses will be apprentices and that no student on the nursing associate course will pay towards the cost of that course?

[Lord O’Shaughnessy]

I thank the noble Lord for that question. My understanding is that the nursing associate is a two-year apprenticeship that provides a level 5 qualification. Therefore, there is currently a consultation about the nature of the role—the balance between work and training and so on—but obviously if it counts as an apprenticeship any organisation providing it can draw down on the apprenticeship levy fund to pay for those training costs. Whether it is in theory possible to train through an alternative route that would involve the paying of fees is something I will need to investigate and write to the noble Lord about. Of course, I will put that letter in the Library. The funding is there and the NHS is paying it. It is not necessarily drawing it down at the moment; this is an opportunity for us, with a course that is tailor-made for apprenticeships, to take advantage of that money to fund the courses.

I hope I have been able to answer noble Lords’ questions. This is an exciting moment in the development of the workforce. It provides an extra gear to the workforce to provide for the ever more complex care needs of our population. This is a good step forward. We are moving quickly and I look forward to working with noble Lords in the coming months to make sure we can put this course and its regulation on a statutory footing, attract many thousands of people into it and welcome a new profession into the health and care family. On that basis I commend the order to the House.

Motion agreed.