17. Return to SENs?

Matter for discussion submitted by the RCN Bedfordshire Branch

That this meeting of RCN Congress discusses whether the introduction of the support worker/assistant practitioner is a return to the State Enrolled Nurse

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Progress report

Submitted by: Bedfordshire Branch
Council lead and committee assigned: Sue Fern, Nursing Practice and Policy Committee
Committee decision: Existing work addresses this issue
Members involved: Juliet Muzawazi, Bedfordshire Branch

Final summary update at May 2012

This was a matter for discussion and did not call for any specific action by the RCN. However, the RCN is already undertaking work which focuses on the role of health care support workers (HCSWs), such as health care assistants (HCAs) and assistant practitioners (APs).

The RCN has consistently campaigned to introduce a mandatory register for HCSWs including APs. The campaign included calling for amendments to the Health and Social Care Bill in the House of Lords, calling for mandatory regulation of all HCSWs rather than the Government’s proposed system of voluntary regulation. This work was supported by Baroness Emerton.

The RCN will also be involved in the proposed development of minimum standards of education for HCSWs.

A briefing paper on the role differences and boundaries of HCAs, APs and registered nurses has been produced, and is available on the RCN website.

Debate report

Juliet Muzawezi from the Bedfordshire branch asked Congress delegates to consider the position of support workers and assistant practitioners in the workforce today. She asked if they were taking on the role previously undertaken by state enrolled nurses (SENs).

Juliet questioned whether support workers should be regulated – highlighting that mandatory codes were introduced in Wales and Scotland in January 2011 and that a recent report by the Nursing and Midwifery Council had concluded that there was a need for regulation. She also asked if assistant practitioners were getting a fair deal and expressed concern that they might be used for cheap labour.

Roger Milligan argued that the RCN must be the voice of assistant practitioners and Philip McCaffery said that SENs were ‘sadly missed’ but that nursing created the muddle as the workforce had been so keen to get rid of enrolled nurses – keen for them to convert to RGN status.
Kathryn Newton said that registered nurses needed to guard their profession and not let financial decisions dictate the work which different groups of staff undertake. Her view was echoed by Bethann Siviter who said she was unwilling to allow people to take nursing roles from nurses, because they are a cheaper option.

Paul Irving said that not everyone wanted to become a Director of Nursing as he argued that there was a place for a second level nurse in today’s workforce. Angela Russell received great support from the delegates when she said: “I’m trained, qualified and competent in my nursing practice. I’m committed to the health and well being of my patients. However I’m not regulated or registered. I and other assistant practitioners would welcome the protection and recognition that this registration would provide.”

The assistant practitioner (AP) role has developed considerably since it was first introduced in the North West of England in 2002 to provide greater flexibility within the nursing team and deliver improved service to those patients requiring care from several disciplines - such as nurses and allied health professionals.

While no form of regulation for health care support workers (HCSWs) currently exists in England, in Scotland mandatory codes and standards for HCSWs were introduced in January 2011. The employer-led regulation consists of a code of conduct for HCSWs, a code of practice for employers, and mandatory induction standards.

A code of conduct for HCSWs and a code of practice for employers were introduced in Wales in January 2011. The RCN in Wales has called for the regulation of HCSWs in its Welsh Assembly 2011 election campaign Nursing Matters.

As yet, there appears to be very few APs operating in Northern Ireland’s integrated health and social care system.

In 2010 the Nursing and Midwifery Council (NMC) commissioned research into the regulation of HCSWs and concluded there is a need to consider regulation of the AP role, either as a second level nurse or senior HCSW (Griffiths and Robinson, 2010). The NMC report recommended further work on six key areas:

Further reports are awaited and the RCN is involved in discussions between the NMC and key stakeholders on these matters. The RCN has already issued a position statement (Policy briefing 06/09) on the AP role, and the RCN HCA adviser has commissioned a short scoping project which was completed in November 2010.

References and further reading

Griffiths P and Robinson S (2010) Moving forward with healthcare support workforce regulation: a scoping review: evidence, questions, risks and options, London: National Nursing Research Unit, King’s College London. Available at:
www.nmc-uk.org/Documents/Research%20papers/NNRU%20report%20into%20the%20regulation%20of%20HCSWs%20July%202010.PDF (Accessed 8/2/11) (Web)

Skills for Health (2009) Core standards for assistant practitioners, Bristol: Skills for Health. Available at: www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/Core-Standards-for-APs.ashx
 (Accessed 8/2/11)(Web)

Spilsbury K, Stuttard L, Adamson J, Atkin J, Borglin G, McCaughan D, McKenna H, Wakefield A and Carr-Hill R (2009) Mapping the introduction of assistant practitioner roles in acute NHS (hospital) trusts in England, Journal of Nursing Management, 17(5), pp 615-626.