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Unlocking talent
The role of the nursing associate

Organisations across England are being urged to offer opportunities for apprentices, but how can this be done in the social care sector, and what are the benefits? Professor David Sines from Health Education England explores the role of the nursing associate and the goals it aims to achieve.

In 2018, Skills for Care published The State of the Adult Social Care Sector and Workforce in England. A range of key issues were identified regarding challenges faced by a dynamic social care workforce facing increasingly complex local populations.

The report noted that the Department of Health and Social Care would be bringing forward a Green Paper, which would inform the design of a national strategy for the care workforce. This strategy would be put together using workforce intelligence sources and evidence from national and regional policy makers.

However, the Green Paper has not (as yet) appeared, but in the meantime Skills for Care and Health Education England are working together to co-design local workforce solutions. These will reflect the changing nature of our care systems in England as they continue to become more and more integrated.

Emergent workforce solutions require the future-proofing of both the supply and the design of flexible career progression pathways for care workers.

The aim is to enable staff to acquire greater confidence and ability, and to support them to apply their skills across a range of health and social care settings. It will also provide innovative solutions to enable the whole of the care workforce to reach their full potential.

User demand, personalisation, new technology, pharmaceutical advances and longevity amongst the population are among the reasons a new approach to workforce design and delivery is required. Not to mention Government’s commitment to introducing integrated health and social care systems that are supported by the development and deployment of well-trained care staff across a range of local services.

At the centre of this vision for the creation of a more closely aligned health and social care workforce is the need to reduce dependence on the in-patient healthcare system and to develop new ways of working with an aging population; a population that presents with increasingly complex health and social care needs and which rightfully stakes its claim to be actively engaged in the design and delivery of the care and support that it requires.

Filling the gaps

In 2015, Health Education England’s Shape of Caring review identified a gap in support workers’ skills and knowledge and confirmed the need to develop a workforce which was more ‘community and public health-focused’.

The report acknowledged that health and social care assistants made an essential contribution to the care sector in England, but advised that there had been underinvestment in providing local access to training and development to ensure that staff were ‘working to high, consistent standards wherever they work’.

Skills for Care’s 2018 State of Care report agreed that staff should be able to access training to develop the right values, skills and knowledge to enable them to provide high quality care and support.

Evidence of the appetite for additional training and career development possessed by members of the social care workforce has been confirmed by Skills for Care who have reported that approximately 50% of care workers held a relevant adult social care qualification at Level 2 or higher, whilst 37% had engaged with the Care Certificate.

Skills for Care and Health Education England have been investing significantly to design new career pathways and work-based learning opportunities in the social care and health sectors. Part of this is developing new apprenticeships that are available to current and aspiring social care staff.

Apprenticeship routes enable employers to work alongside education providers to offer training for their workforce against approved, benchmarked performance standards.

The training leads to the award of a nationally-recognised vocational qualification which evidences proficiency to practise. The nursing associate apprenticeship provides one such example of how employers can work with education partners to co-design and deliver workplace learning solutions.

What is a nursing associate?

Following the 2015 Shape of Caring review, Government announced the introduction of the new role of a nursing associate. The person in this role would be trained to work across a range of health and social care settings.

The aim was to increase the competence and skills of a new cohort of trained and regulated care workers. They would be equipped with the knowledge and skills to support people with highly complex needs, including those with long-term health conditions, learning disabilities and cognitive/mental health disorders.

The first ‘test site’ nursing associate programmes commenced in 2016/17, followed by national roll out in England in 2017. The Nursing and Midwifery Council has been responsible for regulating and admitting qualified nursing associates to a designated part of its Register since February 2019.

With the ongoing radical change required by health and social care agencies and the necessity to deliver greater levels of out-of-hospital care, this new role was needed to support people at home, in care homes – with and without nursing – and in hospital. The nursing associate offers a nationally-approved ‘higher skill set’ than that provided for care workers currently.

The nursing associate programme is delivered as a full-time Level 5 Apprenticeship as an ‘earn and learn’ programme over two-year period. It enables the trainee to be educated with the knowledge and skills required to provide high-quality, person-centred care.

The training is provided in the same way as any other apprenticeship model to foundation degree or equivalent – in partnership with a designated university on a day release basis.

Trainees acquire knowledge and both practical and critical thinking skills to enable them to make a substantive contribution to social and health care assessment and delivery.

Apprentice nursing associates spend 50% of their two-year training programme working and learning in their home base (including residential, community and homecare settings). The remainder is spent on day release attending their university programme and gaining as much experience as possible in different health and care settings.

The role offers greater flexibility to the social care workforce in terms of career development and should provide opportunities for staff who are unsure of their educational ability, but still wish to advance their careers with their current employer.

From an employer point of view, apprenticeships can enhance the competence, capability and capacity of your staff so they are better equipped to respond to the needs of people using your service. Staff may be more satisfied knowing that there is a career path for them, and this could help your recruitment and retention figures.

The future of nursing associates

In 2017, 2,000 trainees were recruited to the nursing associate programme within 35 health and care test sites.

Key findings to date suggest that current trainees have been motivated by a desire to improve the quality of care and safety for service users and have shown themselves to be highly motivated and conscientious learners who are keen to build on their experience of working in care and health settings.

University leads and employers have reported a consistently high level of enthusiasm and commitment shown by trainees and have noted a relatively low attrition rate of 7% (Traverse, 2018).

Our social care landscape is changing in response to the complex needs and demands placed upon it by our local populations.

New workforce solutions are required to bridge the gap that currently exists between our health and social care systems.

The nursing associate is a regulated role, but it is shaped and adapted to the needs of local employers and service users. As such, it is a ‘facility independent’ role, requiring practitioners to function lawfully within their defined scope of practice.

This new role is set to make a significant contribution, not only to enhancing opportunities for flexible career progression for members of the social care workforce, but also in providing greater assurance to members of the public with regard to the safety and effectiveness of the care that they receive.

Professor David Sines CBE PhD is Strategic Advisor to Health Education England (London). Email:

How have you used apprentices in your organisation? Have you engaged with the nursing associate role? Leave a comment below to share your thoughts and experiences and feed-back on this feature.


Health Education England (March, 2015) The Shape of Caring review (‘Raising the Bar’), (Chair Lord Willis), London.

Skills for Care (September, 2018) The State of the Adult Social Care Workforce, London.

Traverse (July, 2018) Evaluation of Introduction of Nursing Associates Phase 1 Report for Health Education England, London.

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