Nursing is one of the most admirable of all professions. I was very lucky, in my 35 years as a doctor, to work with some extraordinarily gifted nurses. They were knowledgeable, dedicated and hardworking, of course; but, on top of this, they had compassion, empathy, common sense and a 360-degree awareness of what was going on around them. And grace under pressure. It is not easy to keep your cool when several people at once are asking you questions, one or more phones are ringing, and you are reassuring a patient about to undergo an operation, trying to keep the drug round to time and making sure the medical team knows what is going on.

But there are some nurses who are simply not up to the job. And there are wards where leadership is lacking. Patient information gets lost, practices are sloppy and patients, treated with inappropriate familiarity, call in vain for bedpans. The staff appear too busy to care, and spend more time chatting to each other than talking with anxious patients.

The Patients Association receives many complaints of such inadequate, and sometimes outright negligent, treatment. Its report Patients not Numbers, People not Statistics, published in August, documented appalling cases of mistreatment.

A speech given yesterday by Ann Keen, the Health Minister, announcing a measure that would “raise the quality of patient care” should therefore be welcomed. But the measure she described may not have been precisely what the patient ordered. By 2013 anyone wishing to be a nurse will have to take a degree course lasting up to four years.

The reasons given for this — the most radical change in nurse trainingsince the NHS was founded — are not entirely persuasive or encouraging. It is designed “to raise the status of nursing”. This, alas, is a story that we have heard many times before to justify reforms in the profession but it no longer seems relevant. The ghost of the nurse as “the doctor’s handmaiden” has long since been exorcised — not least because an increasing proportion of nurses are male and the medical profession as a whole is becoming increasingly female. In many cases, nurses are the leaders of the multidisciplinary team.

Christine Beasley, the Chief Nursing Officer, has argued that, as more young people than ever are studying for a degree, this will make nursing more attractive. The logic of this escapes me. A four-year course may put off individuals who have all the necessary qualities for nursing either because they do not feel academically inclined or because they may not wish to accumulate large debts. Besides, one would hope that people would enter nursing because they are motivated to care for others rather than because they want to enter a degree course.

It has also been argued by the Department of Health that graduates would “be able to deal more readily with increasingly complex care in an increasingly challenging health and social care system”. It is not at all clear that the difference between a degree course and the existing diploma will necessarily equip nurses to function better. The kind of multitasking I referred to requires quite different qualities. At any rate, I would like to see the evidence that the 75 per cent of nurses who currently lack degrees are less capable than the remainder who have them.

Many nurses have successfully extended their roles — acting as specialists in different contexts — without a degree. They have simply had additional training as required. I have a particular reason for being grateful to specialist epilepsy nurses who vastly improved the care I was able to give to older patients with seizures. Most simply took on the extra training. Requiring all nurses to have a degree seems to be a blunt instrument for enabling some nurses to acquire new skills and take on new roles. There is no reason why some nurses should not choose to proceed to a degree after they have acquired a diploma.

There is, however, a deeper concern about the proposal. It will not address the failures of basic care that all of us have witnessed when visiting the bedsides of friends and relatives in hospital. Indeed, it may exacerbate the problem.

The emphasis on the academic aspects of nursing, rather than practical skills and the deeply humane activity of hands-on care, may constitute a kind of “dumbing up”. Focusing on more abstract and theoretical issues, which a degree course, as opposed to vocational training, would require, might diminish the commitment to basic nursing — a fear captured in the much used phrase: “too posh to wash”. This is dangerous, particularly at a time when such care is undervalued — though not by those who receive it. One could be forgiven for thinking that the rewards and prestige of nursing rise in proportion to the distance from the bedside.

Already, we are seeing core nursing activities handed over to healthcare assistants who require only an NVQ or similar qualification. Such individuals are often deeply caring and highly skilled but it cannot be good for patients to have their nursing care divided between yet more professionals — or an iron wall erected between different aspects of nursing. Experienced nurses know that they are often able to learn much more about the patient’s needs and indeed his or her condition during the course of giving a blanket bath than through a structured interview in which many boxes are ticked.

We are told that there will be “a consultation process”. However, as is customary, the main outcomes have already been decided. Though the consultation will run until the end of April, the standards will be finalised only a few months later and the first new programmes will start in the autumn of 2011.

One can only hope that this latest development in nurse training will not simply place more distance between nurses and the patients who need their care. Ann Keen’s talk of providing “new nurses with the decision-making skills they need to make a high-level judgment in the transformed NHS” doesn’t awaken the expectation that the reforms will do much for the lonely, frightened, thirsty patient sitting in a pool of urine. My concern for such a patient is not exactly disinterested. One day it will be me. Or you.

Raymond Tallis was Professor of Geriatric Medicine at the University of Manchester and author of Hippocratic Oaths: Medicine and Its Discontents

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