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 working in broader "pathways" such as mental health and long-term care.

Unions are saying that 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 take 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 Unite professional officer Rita Newland said the move would cause "massive change" based on "very little evidence". She said: "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. Its consultation response says: "It was felt that there was insufficient emphasis placed on innovation, leadership and management.

"This must be addressed 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 had focused on illness "rather than living independently with a long-term condition".

This would have to be reworded in light of the Darzi review, the response says.

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