Tensions between universities and the NHS need ironing out
Universities, like all parts of the public sector, are under pressure from growing demand, falling resources and rising student expectations.
The British public and healthcare managers seem ambivalent about their value. It is right to call universities to account, challenge them about their use of public money, and their value and contribution to society - in this context to workforce development, knowledge transfer and research in nursing. So how does nursing benefit from universities’ relationships and interdependencies with health and social care organisations and the NHS?
Perhaps this is best illustrated by a story. Recently we held a memorial event for Professor Paul Wainwright, a nurse academic leader, ethicist and philosopher. A distinguished figure in his field, he did not fit with the stereotype of a stuffy or remote academic sat in an ivory tower. He had powerful communication skills and could translate and make sense of complex theoretical ideas and research evidence for students and frontline nurses. He was always keen to learn from practitioners and, in turn, offered support, practical insights and inspiration.
At his memorial one chief nurse from a centre of clinical excellence spoke of his role in the leadership development of her nurse consultants, his contribution to ideas for principled/ethical nursing practice in the trust, the supervision of her own doctorate and the support he gave her through an informal mentorship.
There is a danger of generalisation, but I think this illustrates the benefits to the NHS of an academic relationship. These benefits may be intangible, cost little and go unnoticed, but they should not be taken for granted. People like Professor Wainwright can successfully navigate the boundaries between universities and trusts, turning ideas and knowledge into practical offerings and support.
There are threats now to the outward facing role of universities. The Browne review of higher education and student finance, together with the comprehensive spending review, will have a major impact on the culture of universities as they begin to respond to a student led market and perhaps start counting the cost of partnership working that may not be seen to improve the bottom line. Already financial strategies are being repositioned to support portfolio based income streams and variable market led prices, and move away from formulaic block grants and standard tariffs.
What impact will these changes have on the delivery of non-medical education and the value added contribution to nursing? There will be an unwillingness to tolerate sharp and unplanned reductions in education commissioning of the healthcare workforce, which has been a feature of the relationship between the NHS and higher education. Also, we may see some “market exits” from the “business” of healthcare education. As such it is even more important that we pay attention to the relationship universities should have with the NHS and how that relationship might be recalibrated to focus more on value and partnership, and draw on ideas of coproduction to benefit nursing.
In the context of public services coproduction means delivering care in an equal and reciprocal relationship between professionals and service users. There are some lessons here for universities and the NHS, which have long established partnership working, albeit through a purchaser-provider relationship. Often the relationship is one of tension, which can become adversarial rather than mutually supportive. We need to build on these partnerships to develop mutuality, reciprocity and constructive criticism if we are to establish sustainable relationships able to meet student expectations, support clinical mentors and design relevant educational programmes for service needs. Research should evaluate the impact of training interventions on health improvements and the extent to which they can be successful as a lever to improve the quality and productivity of nursing care.
Over the last decade, universities have also made significant strides in providing learning and professional development opportunities for students who would not previously have had access to them. Widening participation has been a successful and progressive policy in the development of a healthcare workforce, which reflects the population’s diversity, and has given students without traditional entry requirements the chance to access and progress within it. However, widening participation does not stop at the point of access; it is followed up with tailored support for students with diverse needs throughout their university career, relying on the specialist expertise to be found within the sector.
Universities are connected to the wider system of healthcare in formal and informal relationships and contribute to workforce development, capacity development and informing the evidence base for nursing care through research. They need to get better at articulating and demonstrating how they add value - doing this through mutually respectful partnerships is a way forward.
Fiona Ross is dean, faculty of health and social care sciences, Kingston University and St George’s, University of London
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