I was pleased, as a participant, to receive the final research report from the National Institute for Health Research (NIHR), and King's College London following their survey work into the nursing associate (NA) role (Kessler et al, 2021). The research has been evaluating the role, concentrating on its deployment, use, management and impact, with the methodology including two surveys of nurse directors in NHS trusts (in 2019 and 2020), two NHS trust case studies, and a series of interviews with experts from health and social care.
This research is important for professional debate around workforce planning because, although there have been several studies—Robertson et al (2021) being one of the more recent—into the motivations, experiences, and aspirations of trainee nursing associates, the work from Kessler et al (2021) focuses on the implications of embedding newly qualified NAs into healthcare settings and enables employers to consider the findings to operationalise these roles into care delivery.
The report covered a range of areas; I was interested in the themes around embedding the NA role into various care settings. Having worked in the acute sector in a different part of the country where a large cohort of NAs were trained and employed, I have found in my current trust that the uptake of the role has not been at scale at all.
Kessler et al (2021) reflected that there was variance nationally in the distribution of postholders between care settings with some trusts being ‘keener to run with the role than others.’ Interviews revealed comments such as:
‘We've got some areas in the region where [trainee NAs] have really taken off … and then there's other areas in the region where there seems to be a real reluctance…’
‘Some Trusts … really want to embed the role, and other Trusts that are large Trusts … have four or five in a cohort … [in some] Trusts [… there are] three or four training cohorts of 30 a year. It's very different across the patch.’
There were suggestions that community healthcare trusts were more likely to have band 3 healthcare assistants in place, better able to transition to a new band 4 role, than acute trusts, This may be because of the number of existing support workers in their workforce models at band 3, whereas several acute trusts have ‘cut this band out’.
The financial impact of supporting the training of an NA was raised, particularly in primary and social care. In primary care, the opportunity has now increased through the recent inclusion of the NA in the Additional Roles Reimbursement Scheme (ARRS), from October 2020, providing financial support for the salary costs of trainee NAs:
‘There's going to be a massive increase because why would you not; they're getting a fabulous deal there really, salary paid for two years, apprenticeship levy, HEE funding … It's an amazing role for primary care.’
In relation to social care, despite some growth of interest in the role, take-up has remained weak. Reasons for this include a misunderstanding about the role and a lack of infrastructure to support the trainees, with the costs of supporting the role being a major cause of poor take-up.
‘We've got a pilot running at the moment in the (region), [for] TNAs [trainee NAs] in social care, because they've got the same issue as in primary care. They're lots of small independent businesses, and they might be taking one or two trainees at best, and they're finding the whole navigating the programme difficult.’
The body of evidence regarding both the experience and aspirations of NAs and the experience and views of employers is providing us with an evidence base for workforce strategy. Kessler et al also explored areas such as skill mix, scope of practice and career progression. However, fundamental issues such as affordability, and infrastructure to support the trainees into employment within practice environments that will retain these roles, remain to be fully resolved.
In my own Trust, I think that the context to consider for our relatively low uptake of the role includes significant progress with overseas recruitment and infrastructure to support this, as well as an agreed plan to continue this with continued funding opportunities from NHS England/NHS Improvement. There is still an opportunity, as yet not fully explored, to come together as a system: Kessler et al highlight that place-based partnerships of health and social care employers, providing mutual guidance and support, continue to be important in the development of the NA role.