• NHS Improvement yet to decide whether nurse associates will be counted as registered nurses in Carter care hours metric
  • New drive on pressure ulcers will see top performances paired with worst

NHS Improvement has not yet decided how to count nursing associates as part of a proposed high-profile staffing efficiency metric, HSJ has been told.

The nursing associate role is being developed by Health Education England, and 2,000 people are due to begin training for it in January.

Some have raised concern that quality could be compromised if the new staff, who will be employed on Agenda for Change band four, are substituted for registered nurses.

NHS Improvement is currently developing an indicator, called “care hours per patient day”, which was recommended in the Carter review of NHS efficiency.

It has been confirmed that this measure will split care provided by registered nurses from un-registered healthcare assistants.

NHS Improvement chief nurse Ruth May, in an interview with HSJ, said: “I imagine that [associates will be counted separately from registered nurses] but I am not going to pre-judge it”.

Mark Radford, NHS Improvement’s recently-appointed director of nursing improvement, told HSJ: “No decision has yet been made about where nurse associates will sit.”

Asked about the nursing associate role in general, Ms May: “I do support the introduction of the role, they have the potential to add value to our whole clinical workforce.

“But I also want to make sure it is recognised that registered nurses are the backbone to what clinical care is being given. I accept though because of the introduction of the nursing associates there is some work we need to do around the clarity of the registered nurse in some of those settings.”

She also said: “I feel passionately these new nurse associates need to be regulated, without any doubt.”

Documents leaked to HSJ last month showed HEE was expecting nurse associates to be able to work independently of nurses and be capable of calculating and administering controlled drugs, a role usually reserved for qualified nurses.

Research across 137 acute trusts between 2009 and 2011 found trusts that employed more healthcare assistants per bed had an increased risk of mortality.

New drive on pressure ulcers

NHS Improvement has launched a new drive to help reduce the number of avoidable pressure ulcers across the NHS.

The regulator was expected to publish a new resource for trusts today to help standardise reporting of pressure ulcers, with advice on making improvements and sharing best practice.

The 15 best performing organisations from around the country will partner with the worst performers to try and accelerate improvements with a new national advisory board led by Cathy Winfield, chief nurse at Derby Teaching Hospitals Foundation Trust.

Mark Radford, former chief nurse at University Hospitals Coventry and Warwickshire, who has recently joined NHSI as its director for nursing improvement, told HSJ the new drive was to help trusts better “measure and improve” care to prevent and manage pressure ulcers.

He said NHSI would look to standardise approaches for reporting, reviewing the evidence and carrying out root cause analysis investigations: “We are going to take the top 15 organisations that deliver substantial improvements around pressure ulcers and align them with those that have been more challenged with a strong focus on community and hospice sectors. We are looking a lot at pathways and how people transition between care settings.”

Ruth May, NHSI nursing director, added: “People have done extremely well to reduce pressure ulcers but we need to do to make sure we are taking the next step forward and widen it across other sectors and across the whole of England.”