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EXCLUSIVE: Low paid staff offered route to top clinical jobs

HSJ has discovered thousands of lower-paid NHS support staff could be given a path into top clinical jobs after Health Education England revealed plans to redirect part of the service’s training budget.

The education and training body will develop in-service training for staff working in bands 1-4 of the Agenda for Change pay framework. It plans to roll out national minimum training standards for all workers in bands 1-4, not just healthcare assistants, as had previously been indicated. The independent sector will also be included in this training expansion.

Medical tray with syringe, pills and water

Band 1-4 staff will be able to pursue careers as doctors or nurses

HEE will seek changes to the way education and training is provided to allow staff in these bands to progress into professional careers as doctors or nurses, beyond band 4. This could include the creation of part-time degrees, which could be up and running as soon as September 2014.

New clinical roles could be developed as part of the creation of a more flexible workforce. An example of this approach is the use of midwifery support workers, who work alongside trained midwives in the East of England at lower cost and are recognised by the Royal College of Midwives.

HEE will work with provider trusts and its 13 local education and training boards to encourage a greater emphasis on continuing professional development within bands 1-4.

The boards will need to deliver the strategy from their existing education and training budget. Stephen Welfare, managing director of the East of England LETB and national lead for the strategy, said: “I don’t think it’s possible for us to talk about safe staffing levels if we don’t also have properly trained clinical support workers.”

He said workers in bands 1-4 made up 40 per cent of the NHS’s 1.7 million workforce and were responsible for an estimated 60 per cent of patient contact, but received just 5 per cent of the education and training budget.

Mr Welfare said significant investment in bands 1-4 “would build trust and confidence in the group”. He said the strategy would take a five to 10 year view of workforce development. “We need to make sure we invest more and that this group is given the priority that they deserve,” he added.

Staff in bands 1-4 include healthcare assistants, porters, domestic support workers and a range of non-clinical jobs such as finance assistants, receptionists and medical secretaries. They earn between £14,294 and £22,016.

Readers' comments (12)

  • About time.

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  • Jenny Dalloway

    Absolutely agree - sooner the better.

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  • Err..
    Skills escalator
    Learning Accounts

    Must be a different wheel we have just reinvented.

    Fully support this work but only wish we could embed some of these initiatives.

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  • What could possibly go wrong?

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  • Once had a young patient who was bored with his career choice as an accountant. Fair enough. Told me he was thinking of training as a podiatrist so he could be a 'consultant surgeon like you in 3 to 4 years'. On suggesting he try medical school first, then surgical training in the time-honoured way, he asked me why. My reply was so that you can look your auntie or uncle in the eye and say you are competent. He had never thought of that - he thought it was just managers and NHS patients he would have to bluff............

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  • Mike Jackson

    This is great news that HEE is to give some priority and encourage targetting funding to the development of this pre-professional group. Yes there have been previous initiatives and Agenda for Change was designed to provide for such pathways and development of new and flexible roles. But many employers have yet to realise the potential of staff in Bands 1-4 and spend too little of their training monies on this significant section of the NHS workforce. Employer engagement in LETBs provides a new opportunity to embed this straegy. Trade unions should also be engaged to ensure they become partners not obstacles to such developments.

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  • Let's train people properly. We used to. We had Level 2 nurses, SENs, for instance. Now we have support workers; that's not a real title, it tells patients, family and carers nothing and provides no clarity about role, function or responsibility.

    Quote from article:
    “I don’t think it’s possible for us to talk about safe staffing levels if we don’t also have properly trained clinical support workers.” Agreed. But strangely I believe the response to safe staffing has to be properly trained professionals.

    We have some crazy thinking going on. Trusts are openly talking about sacking doctors and nurses and HEE is planning to train up lower graded staff. How exactly are these two strategies going to raise standards and provide safe staffing levels? (Answers MUST be written on something larger than the back of a postcard).

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  • My GP practice seems to be ahead of the field. I noticed they're replaced their qualified RN practice nurses with HCAs. I wasn't impressed - I'd come for a vaccination. I put my coat back on and left smartish.

    There was a time when people giving any kind of medicine had to know about the patient's condition, contraindications etc, plus how to cope if anything went amiss. I just didn't feel safe.

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  • I worked closely with both HCAs and SENs during the transition period. It was on an acute trauma and surgical ward in a big DGH. Both groups of staff were caring for acutely ill post operative patients.

    The ENs were able to explain why they did particular physiological observations and what they were looking for. They told me what the possible changes in the patient's condition might be and how they could spot them. I felt they were safe bedside practitioners on the whole.

    In contract, the HCAs started collecting their physiological data from the top of the observations chart and they worked their way through to the bottom conscientiously enough, but they understood nothing about physiology and hadn't the least idea what it all meant and how the data they collected linked together to indicate the patient's condition and changes over time.

    Frankly, I was scared! I would hate to have a loved one cared for like this. It's not about doing the tasks alone, it's about understanding what's going on.

    A machine to monitor patients is as good as its internal algorithms. People are much the same, just warmer to touch...

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  • It is annoying that we have to keep remaking the argument for learning and skills investment for Bands 1-4 ( Learning Accounts/JiF/nurse secondment scheme etc) but it seems we must. I think Stephen Welfare deserves recognition for reasserting this agenda.He has been a consistent supporter of learning for support staff over the years.Rightly so.Better trained support staff =better care outcomes and done in the right way improves team working and makes better use of the shrinking pot of money we have available.
    In terms of Assistant Practitioners, there is much work and modelling going on to show how their roles can be enhanced and care delivered safely under the supervision of a registered practitioner and using agreed protocols.There is no excuse for not increasing their numbers across most care settings but there is a lot of professional anxiety.This needs to be recognised and met.Professional organisations and unions have a key role in leading this challenge and it would hugely help if Camilla Cavendish were at least to argue in favour of regulation of qualified APs.

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  • All for training, but how is it that someone with no qualificiations as a band 2 could become a doctor when universities are turning away people with 4 A* A levels??

    Seems like hyperbole to me and unfair to the incredibly bright and dedicated young people that get turned away.

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  • Can't disagree with this, it's the latest in a long line of such initiatives. The mod squad were pushing workforce transformation initiatives such as this many moons ago, and others before that.

    The problem tends to be that these are 'top down' and employers don't always buy into them, for various reasons. Can a 'bottom up' approach from Trusts buy into the concept in a way they haven't done so yet ?

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