Exclusive: 'Cost neutral' Francis policy has cost £2.5m

The flagship policy was championed by health secretary Jeremy Hunt as part of the government’s initial response to the Francis report. It followed Robert Francis QC’s recommendation that all aspiring nurses have at least three months’ hands on experience.

However, it was met with almost universal opposition from senior nursing figures who felt mandating a year’s experience for all new recruits was excessive, would undermine the existing HCA workforce and be logistically extremely difficult for providers to organise without costing more money.

The Department of Health response, published a year ago, said the scheme must be “tested and implemented carefully to ensure that it is neutral in terms of costs”.

However, figures obtained by HSJ under freedom of information legislation show Health Education England spent £1.9m on the first cohort of 165 HCAs, equivalent to more than £11,000 each. They started work between September and December.

More than 80 per cent of this was paid to NHS providers to subsidise the salaries paid to HCAs on the scheme, many of whom are additional to trusts’ nursing establishment. In addition HEE has provided funding for recruitment, mentorship, and management costs to providers, universities and local education and training boards.

An additional £646,000 has been budgeted for two further cohorts of about 80 participants during 2014-15.

If the scheme was extended in the same way across all 19,206 nursing undergraduate places commissioned for 2014-15, the figures suggest it could cost more than £225m for the year. It could mean every NHS provider taking on about 80 HCAs.

University Hospitals Birmingham Foundation Trust has been paid £182,360 for its first cohort of 23 HCAs. This covers half the individuals’ salaries and more than £15,000 to cover management costs, recruitment and workshops for trainees.

Its director of nursing Philip Norman said HEE’s funding had “got [the scheme] off the ground” but without it, “we would have a view as a trust there’s still value in it for recruits without care experience”.

Mr Norman said between taking on 20- 30 HCAs was in line with trust’s natural turnover and unlikely to displace existing HCAs.

Chesterfield Royal Foundation Trust currently has a cohort of 10 aspiring nurses going through the scheme and has received £119,918. As well as standard HCA training, those on the scheme also receive half a day each month of additional support with a band 7 nurse.

The trust’s director of nursing Lynn Andrews told HSJ she believed taking part in the scheme would mean more aspiring nurses consider Chesterfield as a place to work, at a time of a national nursing shortage.

HEE hopes the scheme will reduce attrition rates from nursing courses, which have reached as high as 25 per cent over the past decade, and therefore offset the costs of the scheme.

A spokeswoman said: “An economic evaluation is looking at costs and potential benefits of doing this. Cost neutrality doesn’t mean no cost. There may well be gains, for example, in terms of improved retention and reduced attrition.”

The Department of Health is commissioning an evaluation of the pilots, and a DH spokeswoman said all aspects of them would be evaluated before any decision to extend them nationally.