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Eluned Morgan, Minister for Health and Social Services

First published:
19 January 2024
Last updated:

Today I am announcing my intention to introduce a regulated band 4 nursing role for the NHS in Wales, subject to the necessary UK legislative amendments. This decision is based on the biggest and most impactful review of nursing in Wales since the introduction of the graduate nurse in 2004.

Last year I commissioned a project to explore the options and opportunities to inform a policy position and recommendations for the future of the band 4 nursing workforce across NHS Wales. The aim being to consider whether a registered and regulated band 4 role would be desirable, appropriate and of value within NHS Wales. The work is intrinsically linked to the Welsh Government National Workforce Implementation Plan: Addressing NHS Wales Workforce Challenges, published in February 2023. 

The project has involved a comprehensive review of literature, evidence gathering and extensive stakeholder engagement followed by the production of a report.  A key finding demonstrates that despite considerable work over a decade to standardise Health Care Support Worker development, there remains significant under-utilisation of the band 4 role and an inconsistent approach to its implementation across NHS Wales. 

A fundamental outcome of the project confirms that clinical and academic stakeholders across Wales want the band 4 role in nursing to be regulated to provide increased public protection and a reduction in risk, along with consistency in terms of professional and educational standards. This approach will mirror work undertaken in NHS England with the introduction of their band 4 Registered Nursing Associate role. The Registered Nursing Associate has been described as the best model of widening access into nursing in England and provides the opportunity for new, educated members of the nursing workforce to bridge the gap between Health Care Support Workers and Registered Nurses.

The report includes 20 recommendations divided between Welsh Government, Health Education and Improvement Wales, health boards and NHS trusts to action and I have accepted all the recommendations in full.

Legislative amendments to the Nursing and Midwifery Order (2001) are required to introduce the Registered Nursing Associate role into Wales. These are powers reserved by the UK Government. I have notified formally the Nursing and Midwifery Council so that my decision can be factored into its imminent regulatory reform programme. I have also asked Welsh Government officials to liaise with counterparts in the UK Department of Health and Social Care in relation to this matter.

Over the coming weeks the full project report will be published, and later this year we will undertake public consultation on developing the parameters of practice for the new role in Wales.

This is a momentous decision for nursing and is vitally important for the quality and safety of care provided to patients as well as improving patient outcomes.