HSJ’s round-up of Monday’s must read stories and talking points

The future of nursing?

Leaked documents seen by HSJ reveal for the first time what Health Education England expects the new band four nursing associates to be able to do. And for those familiar with the evidence around nurse staffing and patient safety they could make frightening reading.

The internal documents say nurse associates will be expected to work independently of qualified nurses and will be expected to calculate drug doses safely, as well as administer medication, including controlled drugs, without direct supervision of nurses.

Critics of the nurse associate role, which is supposed to be aimed at creating a career framework for band two and three healthcare assistants, say it will be used and viewed as nursing on the cheap – a substitute for registered nurses.

The role is being developed in the absence of evidence and in the face of mounting research that shows a link between substituting nurses for non-nurses and an increase in mortality and harm.

There is a case to be made for an enhanced band four healthcare assistant role, but allowing them to calculate and administer controlled drugs risks undermining nurses and could be a tempting option for trusts faced with pressure to reduce their paybill and a paucity of qualified staff.

There is a worrying lack of discussion around safeguarding nurse numbers in the NHS and ensuring nurse associates are not used inappropriately.


Hartlepool borough council has become the latest local authority to publish its patch’s sustainability and transformation plan (the fourth out of 44).

Key elements of the Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby STP include consolidating specialist hospital services on two sites and creating a string of multispecialty community providers. It aims to make more than £260m of efficiency savings.

Buddies forever

More change is afoot in the West Midlands. The latest plan is to set up a chain (or “foundation group”) to solidify the “buddying” arrangement that has existed between South Warwickshire Foundation Trust and Wye Valley Trust while the latter has been in special measures.

Wye Valley is about to come out of special measures, so it seems safe to assume the relationship has been productive. NHS Improvement certainly seems to harbour that belief, and is understood to have made it clear that a chain is the only option it will support.

The new chain is partly controversial because it does not have universal backing. Not everyone who might have expected to know in Wye Valley did – and it appears the board has been presented with a solution and told nothing else will do. So late last week we were treated to the spectacle of the local MP Jesse Norman raising some pretty reasonable points about the lack of consultation, and asking sensible questions about the operating model for the chain.

This was avoidable: note that Mr Norman was not saying the arrangement is a bad idea – he’s mostly angry that he and other local players were kept in the dark.

South Warwickshire is a logical partner for Wye Valley. Both are acute and community providers, based around small county towns with dispersed rural populations.

South Warwickshire is a high performing organisation – it’s one of the few trusts in the country hitting both finance and key performance targets, and its success challenges the idea that smaller trusts can’t stand on their own. It hasn’t yet been accredited to run a chain, though that will presumably be a formality if NHSI wants it to happen.