Nurses will become mere “handmaidens” who lack leadership skills under planned changes to nursing careers, unions have warned.

The Department of Health’s consultation on post-registration nursing careers, which ended last Friday, proposed moving away from early specialisation, with nurses instead working in five shorter term “pathways” such as mental health and long-term care.

Unions are saying this will de-skill nurses, replacing specialised roles such as district nurses and health visitors with cheaper care that is more difficult to measure.

The consultation response from trade union Unite says the changes risk turning nurses into “jack of all trades and master of none”.

It says: “The proposed model appears to be taking the nurse back to a time when they fulfilled a handmaiden role because they merely responded to workload need.”

The aim of the pathways is to simplify the nursing career framework and make skills more transferable.

But Rita Newland, professional officer at Unite, said the move would cause “massive change” based on “very little evidence”.

She toldHSJ: “At the moment, specialist practitioners are educated to at least Msc level. These people have the ability to work to a much higher level, see the bigger picture, and think critically.

“If these changes go ahead, they won’t get the specialist knowledge and skills, just short-term training.”

Unison has also expressed concern at the plans. Its consultation response says: “It was felt that there was insufficient emphasis placed on innovation, leadership and management.

“It is essential that this is addressed as the framework develops, or we could risk losing the ground that nurses have made.”

It is difficult to see where some parts of the profession, such as those who work in NHS Direct, would fit into the new framework, it says.

Members had felt that the language of the consultation, which is part of Modernising Nursing Careers, had focused on illness “rather than living independently with a long term condition”.

This would have to be re-worded in light of the Darzi review, the response says.