Fears over patient safety amid plans to ‘water down’ training for nurses

‘If these plans go ahead, it will put the public at more risk’

District nurses work alone, often seeing patients with highly complex needs (AFP via Getty)

Plans to simplify specialist nurse training across the UK pose “huge risks” to patient safety, health leaders have warned.

Nursing leaders are united in opposition against proposals by the Nursing and Midwifery Council (NMC) to ostensibly simplify the qualification process.

They warn the watchdog is moving away from its core function – to protect the public – with a “reductionist” approach to the training of nurses working with the most at-risk groups.

One NHS trust chief said the plans would leave bosses unable to be certain that nurses possessed the skills required to care for patients’ safely.

Matthew Winn, chief executive of Cambridgeshire Community Services Trust, said community nursing teams were the cornerstone of support for the most vulnerable in society.

He said: “The changes being proposed by the Nursing and Midwifery Council will lead to a watering down of the educational and training standards of these specialist professionals. If courses are developed unilaterally by universities, as an employer I will have no idea if the district nurse is competent to undertake the role I am recruiting them to do.”

Mr Winn, who is also a director of community health at NHS England, said: “All of this points to a worrying drift to reduce the importance of training people to be expert clinicians in care at home settings and will have a detrimental impact on the quality of care and support we are able to offer local people.”

The NMC has already rowed back on initial plans to ditch specialist qualifications entirely for district nurses, community mental health nurses, GP nurses, children’s nurses and learning disability nurses.

It originally wanted just one generic qualification for all nurses working in the community, but was forced into a retreat after all four UK chief nurses intervened, making it clear they could not back such a move.

But the regulator has pressed ahead with proposals to have only generic standards across the five specialisms, leaving all of the knowledge and skills for the specific qualifications for universities to decide themselves. It will even allow universities to choose how long the courses should be and how much time nurses should spend on placements.

The Royal College of Nursing’s professional committee chair, Rachel Hollis, told The Independent: “It’s really important that the public are able to feel confident in who it is that is delivering care for them and how they’ve been trained to do that. I don’t think it’s an intention to dumb down, but I think that that could be an unintended consequence of the proposals as they currently stand.”

She added: “The needs of children being looked after in a community setting are very different to the needs of adults being looked after in a community setting. If you don’t distinguish between the competencies and skills and knowledge that are required for each of those various specialist areas then you risk having nurses who don’t have the specific skills. There’s a risk that the nurses may be less able than nurses today.

“The NMC has a very clear role to protect the public. We, as the RCN, want to ensure they fulfil that role and we’ll do everything that we can to influence this current consultation, making clear what our concerns are. We would hope that the NMC will listen to these concerns.”

The proposals have united nursing organisations in opposition, with eight organisations, including the Royal College of Nursing and Queen’s Nursing Institute (QNI), writing to the regulator earlier this year urging it to reconsider.

One leading patient safety expert, Professor Alison Leary, resigned from the NMC’s steering committee last month because of concerns for the safety of patients.

The NMC has denied its plans are a risk to safety, and said it is considering the response to its consultation ahead of a final decision to be made later this year.

There are around 19,000 nurses working across the UK with a specialist community qualification, and while it is not a requirement, it is seen as the gold standard among roles such as district nurses, who make up the majority of those on the NMC register.

Critics say the plans will lead to a variation in skills across the country and could lead to less capable nurses being deployed in future.

Nursing leaders are worried the regulator appears to have assumed all five specialisms can be treated the same, despite the different jobs and varied work they undertake.

This means a district nurse looking after elderly patients in their own home has the same standards as a community mental health nurse or a nurse working with learning-disabled children.

In a letter to the NMC, the Queen’s Nursing Institute – which represents community nurses – said the proposals were “highly reductionist and seek to diminish the essence of community nursing practice to its most basic constituents.”

It added this would “increase risks of suboptimal or poor care for people in homes and communities. The potential for harm to arise in these services and settings is arguably greater than in a hospital setting.”

Crystal Oldman, chief executive of the QNI, added: “There are some huge risks to patient safety in all of this.

“There would, for example, be no set standard across the country for what you need to know and understand as a district nurse. As a member of the public, what your district nurse coming to you or your loved one needs to know and be able to do may be very different where you live, compared to say 100 miles away.”

She added: “It’s creating a situation in which there is a risk to public protection and patient safety, and it doesn’t have to be this way. Why is the NMC continuing to do this when all the experts in community nursing and education are saying don’t?”

Sharon White, a school nurse and chief executive of the School and Public Health Nurses Association, warned school nursing services had already been cut by 30 per cent since 2015, and after Covid would be needed more than ever.

She said: “If we don’t have very clear high standards for nurses working with our school-aged children, we’re going to fail the children. We won’t have the right skills, we won’t have the right education, the right quality and we won’t be able to deliver on supporting and improving the dire state of our children’s health and well-being, which is on a very downward trajectory.”

She added that the NMC appeared to be moving away from its core role of protecting the public, saying: “If these standards go ahead, it will put the public at more risk. I am so concerned about how the NMC is operating. Whenever we’ve tried to communicate and have conversations we’ve been very firmly put back in our box. They’ve been very abrupt in their responses and very intolerant.

“As a nurse I don’t feel they are working to support my profession, help me to practice safely or protect the public.”

So far, more than 2,300 responses have been submitted to the NMC, one of the highest response rates it has ever had.

Andrea Sutcliffe, chief executive at the NMC, said: “These essential standards for community nurses are 15 years out of date and it is vital that we have fit-for-purpose standards that recognise the huge changes over that time.

“We want the standards to reflect the expert skills, complexity, responsibility and diversity of modern nursing practice in the community.

“There are strong views about what our standards should be and I’m pleased this debate has resulted in thousands of responses to our consultation.

“We’re now looking forward to reviewing all of these comments and suggestions, working in coproduction with our key partners and experts.

“Together, I’m confident we will shape a final set of standards that will be much improved and will strengthen the role of nursing in the community to improve public safety – now and for the future.”