Resolution: Should nursing support workers be regulated?

This resolution was passed by voting members at Congress 2024 

The context for regulation of health and care professionals is currently going through a period of reform.

The Department of Health and Social Care (2023) has published draft new legislation that will allow the regulation of anaesthesia and physician associates. This legislation acts as a template for the future vision of professional regulation. We are expecting similar legislation to be published for nursing.

Mandatory regulation and core standards of education provide confidence to patients and assurance to registered nurses that any nursing support worker (NSW) has a core level of knowledge and skills that will be applicable in all care settings, underpinned by a clear and consistent regulatory structure if concerns are raised about performance or conduct. It also provides a standardised framework for education and conduct and a career pathway.

In England, the nursing associate (NA) role was launched in 2017 and the Nursing and Midwifery Council (NMC) opened the new part of its register in 2019. However, other nursing support roles are not regulated.

In Wales, there is a requirement to be registered but there are currently unregulated staff including health care support workers (HCSW) at bands 3 and 4. The Chief Nursing Officer (CNO) is reviewing the HCSW role within nursing and midwifery teams and exploring development opportunities and role clarity. In January 2024, the Welsh government issued a written statement with a decision to request, at UK level, an “Order in Council” changing UK legislation and allowing the NMC for the first time to introduce and regulate nursing associates in NHS Wales.

In Scotland, individuals working within social care are required to complete their registration. The CNO has recently launched a national framework for HCSWs. Alongside this is a resource toolkit has been developed to support NHS boards implement the framework.

In Northern Ireland, the Department of Health (2018) have issued guidance with a wide range of resources looking to strengthen the role of nursing assistants in NI HSC Trusts.  

Mandatory regulation, enshrined in law and underpinned by core standards, could provide a safer platform to ensure that their skills and knowledge are used safely and effectively to ensure that there is clear statutory oversight. The introduction of mandatory regulation and core education standards can provide assurance that the right level of education and training has been obtained carry out the duties they are routinely expected to perform.

The reading list for this debate is available here.

References:

Department for Health (2018) Standards for Nursing Assistants and associated resources. Available at: https://www.health-ni.gov.uk/publications/standards-nursing-assistants-and-associated-resources 

Department of Health and Social Care (2023) Regulating anaesthesia associates and physician associates. Available at: https://www.gov.uk/government/consultations/regulating-anaesthesia-associates-and-physician-associates/regulating-anaesthesia-associates-and-physician-associates 

Morgan, E. (2024) Written statement: Policy Intent for introduction of a regulated band 4 nursing role for the NHS in Wales, subject to the necessary UK legislative amendments. Available at: https://www.gov.wales/written-statement-policy-intent-introduction-regulated-band-4-nursing-role-nhs-wales-subject 

NHS Education for Scotland (2022) Development and education framework for level 2-4 Nursing, Midwifery ad Allied Health Professional (NMAHP) Healthcare Support Workers. Available at: https://learn.nes.nhs.scot/65220 

NHS Education for Scotland (2022) Implementation toolkit. Available at: https://learn.nes.nhs.scot/39970#toolkit 

Nursing and Midwifery Council (2023) We regulate nursing associates. Available at: https://www.nmc.org.uk/about-us/our-role/who-we-regulate/nursing-associates/