NHS trusts could be required to provide far more formalised education and training for qualified nurses under radical proposals outlined to HSJ ahead of a major review next year.

In an exclusive interview, Lord Willis, the chair of the Shape of Caring Review into nursing education and training, suggested nurses’ university education should become more generalist. More detailed and specialist training should be moved into their first years of their NHS careers.

Lord Willis

The current education system for nurses will not be fit for purpose in the next 10-15 years, Lord Willis said

Lord Willis also hinted that he may recommend changes to long term career paths and how education and training is provided to nurses in order to support this.

He also suggested ways of improving the training of healthcare assistants and a requirement for nursing students to have experience of care before starting their university degrees. This was one of a number of recommendations from the Francis inquiry.

Lord Willis added that without changes, the education system for nurses would no longer be fit for purpose over the next 10-15 years.

He revealed his thoughts ahead of the review, established by Health Education England and the Nursing and Midwifery Council last year.

The final report is due to be published in February.

Currently, nurses pick one of four specialisms to study at university: adult, paediatrics, mental health or learning, and disability.

Once qualified, most then complete a short “preceptorship” within the first six months of employment.

Lord Willis said he was exploring “whether there should be a greater element of generalism, with preceptorship being the start of the specialist process”.

Unlike junior doctors, Lord Willis said nurses would fully qualify after university, but added: “They might do two years of really detailed rigorous general nursing and then begin their specialism in the final year and run that on into preceptorship and that becomes a really live part of the education process. That is my thinking at the moment.”

He criticised the current lack of a structured career path for nurses describing it as like “snakes and ladders” with no clear paths or milestones. Nurses must instead rely on “luck and judgment” to progress in their careers, he said.

Lord Willis said the review would not define those pathways but would recommend work is done by HEE to achieve this.

He also repeated concerns over nurse mentoring, adding that his fears had been “reinforced” by evidence to the review.

He hinted the review might suggest a more formal role for nurse mentors.

“I remain convinced that mentoring needs to be streamlined and further professionalised; a key role in any organisation with recognised status. I don’t buy that everyone can be a mentor,” he said.

On requiring nursing students to work for a year as an HCA - currently being piloted, Lord Willis suggested this was not realistic: “I have my own views on this and I think a year is too much because it is not financially sustainable.

“We are looking at a flexible system.

“The bottom line is no one should begin a nursing degree who does not have a relevant amount of prior experience but there can be flexibility about how you exhibit that.”

He said he hoped his review would tackle “silo working” which evidence to the review suggested was often the result of reluctant employer organisations rather than a reluctant workforce, he said.

The review would also examine whether the independent sector could play a greater role in the education of nurses and the need for universities to improve their training to achieve consistent quality.

He suggested the report’s title could be “Raising the Bar”, adding this would be his key theme: “It’s not acceptable for employers to say this is too difficult because we have found people out there who are doing it.

“I have been genuinely staggered by the amount of innovation that is going on right across the country which, if replicated, would make a profound difference to the quality of care that we give and the quality of experience for staff giving that care. Those two things go hand in hand.”