A short post this morning to draw attention to Professor Tony Butterworth’s Playing our Part review, this being something which occupied me towards the start of last week. With the support of the Foundation of Nursing Studies Tony is conducting a review of mental health nursing, by mental health nurses. I made the trip to the (very plush) King’s Fund headquarters in London’s Cavendish Square on Monday, where FoNs is currently in residence, to join an educators’ group discussing responses to a series of questions Tony had set for us in advance. The questions were of a type always easier to ask than to answer (‘how do you prepare students to uniquely become mental health nurses?’, and ‘do you think that students should be exposed to some form of basic psychosocial education skills at undergraduate level?’ being two examples). We talked lots about the interpersonal aspects of nursing, and the enduring importance of relational work, but also about the roles that mental health nurses fulfil in managing the system and coordinating care. I’ll be keeping an eye on the Playing our Part blog over the coming weeks as Tony continues his tour through the UK, meeting groups of nurses to draw out their views and experiences. The final report, as I understand it, is due to appear towards the end of the year.
Elsewhere I’ve been working with co-conspirators to fine-tune next week’s #AfterWhitchurch ESRC Festival of Social Science event at Chapter in Cardiff. I’ll have to post something uniquely about that once we’re done.
In this post I’ll largely confine myself to some thoughts on the mental health workforce and on the place of nurses within this. Yesterday’s discussions in this area exercised MHNAUK members greatly. Proposed changes to the occupational mix to be found within mental health services, debates over nursing numbers and safe staffing, and new arrangments for the funding of education have the potential to trigger significant turbulence in an already-complex system of care. MHNAUK members rightly identified how the appearance of a new associate nurse role, sitting in between health care support workers and registered nurses, will trigger unrest. This is always the case when professional jurisdictions come under pressure (see here and here for papers I have co-written which expand on this point). In this current case, some registered nurses will see new associates as a threat to their hard-won jurisdiction. At a time when nurses are pressing for safe staffing, some are likely to argue that the introduction of associates will also open the door to role substitution and eventual reductions in numbers of registered nurses, thereby threatening both quality and safety.
Should associate nurses appear, we can be certain that plenty of inter-occupational jostling will take place as support workers, associates and registered nurses (amongst others) negotiate their relative positions and assert control over areas of work. In this regard, abstract descriptions of the tasks which new associates will (and will not) be permitted to carry out will provide only the most limited of guides. Differentiations between who does what will inevitably be hammered out in the workplace.
And what of the cross-UK implications for all of this, given that the Department of Health’s associate nurse announcement is for England only? To me it is unclear how new associates will be regulated, or how transferable their future qualifications might be should any wish to move to, say, Wales. Across the four countries of the UK important differences are appearing in the ways people are prepared for health care practice, and in the funding of this. Student nurses will pay fees in England from next year, but student nurses in Scotland will not and will continue to receive a bursary. Here in Wales (unless I’ve been asleep and have missed a piece of essential news), we will need to wait until after our forthcoming Assembly elections and the formation of a new Welsh Government for an announcement on future financial arrangments for nursing education. Perhaps we’ll hear more about the shape of the future Welsh NHS workforce then, too.