My Lords, I sincerely thank every noble Lord who has spoken in the debate and engaged with these regulations so thoroughly. It has been a really important discussion about not just the new role of nursing associate but its impact on the overall health and care workforce. I am very grateful to all corners of the House for the broad welcome, albeit with questions and conditions, for the creation of this role.
I want to deal up front with the urgency of these regulations. I agree that there has been an element of rush, and I think we are all agreed on the requirement for it. But like all overnight successes, this has been a long time brewing, as the noble Lord, Lord Willis, pointed out. A lot of work has been done, and I salute, along with all noble Lords, the many people at the
RCN, the NMC and others who have contributed to this, and the many people behind the scenes. It is quite right to acknowledge them. No doubt there is more work to come.
The primary debate, or part of it, revolved around the distinction between the nurse role and the nursing associate role. It is very important to be clear, as I hope I was in my speaking note, that these are distinct professions. They may all be part of the same family—there is a certain amount of semantics involved here—but they are distinct professions, which will be regulated distinctly, albeit in a joined-up way through the same regulator, which is quite right. The NMC is currently consulting on standards of proficiency. The department, with all the necessary arm’s-length bodies and others, will develop guidance for that separate profession. While nursing associates can inevitably support nurses, doctors and others, they will not just be the handmaidens to others, in the evocative phrase of the noble Lord, Lord Clark. They will be professionals in their own right.
It is also worth pointing out that, in the consultation going on at the moment on standards and proficiency, the NMC is also looking at the code of conduct and amendments to it. That consultation ends on 2 July so, again, I warmly encourage all noble Lords to contribute to that, because some of the ideas set out today could have an important role in getting that right.
The noble Baroness, Lady Thornton, asked about the financial risks involved in setting up the courses—making sure that they are properly constituted and so on. My department has a memorandum of understanding in place with the NMC to keep the costs of the set-up within agreed cost parameters. The costs of accrediting nursing associate courses are met from the annual registration fees paid by the NMC’s registrants. Therefore, the financial modelling has been investigated and we understand what we need to stick to.
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I, along with the rest of the House, congratulate the noble Lord, Lord Willis, on his role in helping to bring the nursing associate position into being. He made a very good point about it being a role that will help us to get the most out of our highly skilled registered nursing profession. The introduction of skilled teaching assistants into the education profession involved work that could be done by teachers. However, as teaching became not just a graduate profession but, in many cases, a master’s graduate profession, the introduction of that role helped to unlock the skills of the teaching workforce and provided a balance with clearly delineated boundaries—although arguably education could do with more delineation—and that is what we are aiming for by going through this route.
The noble Lord asked about the apprenticeship route. The apprenticeship courses under consideration for nursing associates are level 5 and they will be about creating transferable skills. The pilot schemes are not NMC-approved but, once nursing associate training is on a full statutory footing, the schemes will have to be NMC-approved. The order ensures that the only way for nursing associates trained in England to join the register is by holding an NMC-approved nursing associate qualification. I can also tell the noble Lord that the
NMC will need to approve higher education institutes or education providers wishing to deliver nursing associate training once it is the regulator, so I hope that provides reassurance.
Several noble Lords asked about overseas applications. Again, it is important to distinguish between overseas citizens already resident in this country and those currently resident abroad. The noble Earl, Lord Listowel, made an important point about not wanting a system that relies on taking skilled individuals, in particular, out of developing countries, although we have to acknowledge that we currently allow for that in some cases. Clearly, it is important to have comparable qualifications and to pass a language test. Our future relationship with the European Union and mutual recognition of professional qualifications and so on will determine what that looks like for that particular group. However, we are clear that, once the NMC opens its register, overseas applicants who can demonstrate that they meet the standards will be able to join it. It is of course about maintaining those high standards throughout.
Noble Lords were right to comment on the absence of the devolved Administrations in taking forward this route. That of course is their right and prerogative. This route has been designed to meet the specific needs of the English health and care workforce. We have had very positive discussions and relationships with the devolved Administrations in developing this role. They intend to see how it develops and is implemented before making a decision about whether to implement it in their own countries. I can confirm that it would require a further order if they wanted to extend the regulation of the role into Scotland, Wales or Northern Ireland. I would be amazed if they wanted to introduce this kind of role on a formal basis without any kind of regulations, and I am certain that that is something we would not want to see happen and would strongly argue against.
The noble Baroness, Lady Watkins, who speaks with great experience in the area of nursing, quite rightly pointed out that this is a good route for people without qualifications to enter the nursing family, to coin a phrase. I am sure she will have seen the NMC briefing, which has a rather wonderful quotation from a nursing associate trainee at the Cheshire and Wirral NHS trust about what it has enabled her to do. She clearly has that aspiration in the long run and that is fantastic. However, equally, it is right that, when she takes those qualifications, she will gain a qualification and be a professional in her own right.
The noble Lord, Lord Clark, was right to put the Government under scrutiny, as he always does, and to ask several incisive questions. He made a point about potential conflicts, but that is in the nature of the beast. It is worth saying that the consultation responses included 203 from individuals working in the NHS or in healthcare delivery. The responses were not separately coded for nurses, although perhaps in retrospect they should have been. This was to make sure that we were talking not just to the institutions, because they can have a vested interest. Having all these professions under a single regulatory framework but as separate professions is the right way to balance those issues.
On the number of nursing associates in training, about 2,000 are on the pilot scheme. The intention is for that to rise to 5,000 in training and then 7,500 the year after. That is just for nursing associates; we are not talking about nursing. On who pays the training cost, this is absolutely intended to be an apprentice route—a level 5 foundation course. The apprenticeship levy therefore comes into play as a source of funding.
The noble Earl, Lord Listowel, talked about health visitors. I do not believe that there is any specific impact on health visitors. I absolutely agree about their importance in the early years of a child’s life, and indeed for their parents. I do not think there is any direct impact, but I will double-check and write to him.
The noble Baroness, Lady Jolly, made a very interesting point about this being particularly attractive in areas where it is hard to recruit. In one way it solves one problem, but it serves only to highlight another: if these are not substitutes, which they are not, that does not mean that we have necessarily solved the nursing shortage in rural areas. It is important that we keep those issues distinct.