Critics fear plans will shift focus of nursing away from care and compassion

Unions are divided over a Government plan to make nursing an all-degree profession in England within four years. The move, announced by ministers yesterday, is intended to raise standards and improve the quality of healthcare.

But critics say the creation of an "elitist" workforce will distract attention from the basics of nursing, which should focus on care, compassion and treating patients with dignity. There are also concerns about how applicants for nursing – who are older than other students with an average age of 29 – will be able to afford to do a degree.

There are 400,000 nurses in the UK, the largest medical staff group in the NHS, and nursing is already an all-degree profession in Wales and is soon to become one in Scotland. In England all nurses study either for a degree (20 per cent) or a diploma (80 per cent). Both take three years but the degree course contains extra content and is marked at a higher level.

From 2013 all new nurses in England will require a degree in nursing. The courses will have to meet standards set by the Nursing and Midwifery Council (NMC), the professional regulator.

Ann Keen, a health minister, said: "Nurses are the largest single profession within the health service and are critical to the delivery of high-quality care. By bringing in degree-level registration we can ensure new nurses have the best possible start to meet the challenges of tomorrow.

"Degree-level education will provide new nurses with the decision-making skills they need to make high-level judgements in the transformed NHS," she added.

Ms Keen was backed by the Royal College of Nursing (RCN), which described the move as "an important and historic development". Dr Peter Carter, RCN chief executive, said: "All nurses need to put quality care at the centre of what they do, and they also need extensive knowledge, analytical skills and experience to work in a range of settings. Many nursing roles are demanding and involve increasingly advanced levels of practice and clinical knowledge.

"This is not about restricting entry to the nursing profession, in fact we must ensure that the door to nursing continues to be as wide as possible. We need a nurse education system which encourages the best entrants to pursue a career in care."

But two unions, Unison and Unite, said the emphasis on higher academic qualifications could result in a loss of focus on basic care. "The emphasis should be on competence, not on unfounded notions about academic ability," said a Unison spokeswoman.

A spokesman for Unite said: "We believe that individuals who aspire to work in nursing should also have the option of training and development without the absolute requirement of a degree."

The NMC is expected to publish new standards for nursing degrees early in the new year for consultation. Final standards will be published in the autumn of 2010 and universities are expected to start offering the new curriculum from 2011. The Department of Health said the costs would be no higher than the current diploma.

More than a quarter of nurses currently hold a degree, up from 17 per cent in 2002, and 4 per cent hold a postgraduate qualification. A third have a diploma while the remainder trained in the past, before the current qualifications were introduced. The RCN said a key reason why nurses are deterred from studying for a degree is financial. All nurse students have their fees paid but diploma students also receive a non-means-tested bursary of £7,000 to cover living costs. Nurses on degree courses are means-tested like other students so many do not qualify for help.

Gill Robertson, student adviser at the RCN, said: "We want access to a bursary of £12,000 for all nurse students. Wales provided a non-means-tested bursary for all students and they have had no problems with recruitment. We would like to see the same in England.

"The problem for nurse students is that they are on work placements during the holidays. They have a 45-week year so they can't get temporary jobs during the summer. They are also older than the ordinary student with an average age of 29 and a significant number are in their forties and fifties. They need recompense to live."

Christine Beasley, the Government's chief nursing officer, said: "More young people than ever are studying for a degree and this will make nursing more attractive to them. [We] will ensure that new nurses have the support they need to make the transition to confident practitioner.

"This demonstrates our commitment to the NHS Constitution pledge to provide staff with rewarding job training and development opportunities to provide high-quality safe and effective care.

Nursing by degree: How the figures stack up

400,000 Number of nurses in the UK

20% Number of nurses currently studying for a degree (three years)

80% Number of nurses currently studying for a diploma (three years)

29 Average age of new applicants to nursing

100% Number of new nurses required to study for a degree in 2013

£7,000 Current bursary for nursing diploma students; nursing degree students will be means-tested like other students