'We want to see that our caring workforce has the right skills'
With another healthcare review under way, Shaun Lintern talks to its chair Lord Willis to find out its aims and clarify how it will differ from others recently carried out.
Nurses must have the skills and expertise to meet future expectations of both patients and the NHS, according to the man leading the latest review of education and training standards for nursing staff.
In an in-depth interview with Nursing Times, Lord Phil Willis, chair of the Shape of Caring Review, has highlighted why he believes the work is necessary and the areas he wants it to focus on.
The review was established in May by Health Education England and the Nursing and Midwifery Council to recommend changes to pre- and post-registration training for nurses and also the training of healthcare assistants.
“My fear is that suddenly there will be this great move to close hospitals and we will find we don’t have the staff”
Though primarily set up to look at England, the other UK governments have also registered their interest in the review’s eventual recommendations.
However, some have questioned why the review is needed, coming so soon after the NMC’s review of pre-registration education standards, last year’s array of government-commissioned reports on the NHS and the Royal College of Nursing’s own Willis Commission on Nursing Education.
Why another review is needed
In explanation, Lord Willis said that rather than focusing on the current situation – as other recent reports have trended to do – his review was looking forward to the needs of the future, especially the fact that more care will be delivered in community settings.
He said: “The fundamental thing we all want to see is that the whole of our caring workforce have the appropriate skills to manage patient and public expectations of care over the next couple of decades – and that is what this review is looking at.
“It’s not looking at solving today’s problems, it’s looking ahead five, 10 or 15 years to ensure that, as the NHS changes and as care patterns change, we have a workforce of nurses and HCAs who are appropriately trained to meet those needs,” he said.
In contrast to the view often aired in the national media, he insisted the principle cause of care failings did not lie with the move to all-graduate nursing, suggesting that his review will not recommend a row-back from this position.
“There is a huge misconception that somehow, because we are educating people to higher standards with a whole graduate nursing workforce, that they are more interested in academia than caring,” he said. “I totally refute that.”
“What we are going to end up with is a consolidation of existing recommendations and a framework within which training can take place”
However, he did call for variations in quality between university courses to be tackled, saying that Health Education England needed to use its ability as the commissioner of training places to demand higher standards.
Lord Willis reinforced the need for better pre-registration education by highlighting that changes in the way services were being delivered would present further technical challenges for the nursing profession in future.
“The whole shift we are going to see over the next 5 or 10 years is going to be a shift into other settings, more community and domiciliary settings,” he said. “The question my review has got to do is ask: are the skills we are teaching and training our nurses and care assistants appropriate for that change.”
He warned: “My fear is that suddenly there will be this great move to close hospitals and we will find we don’t have the staff.”
Noting the work by others on the subject, Lord Willis said it was important his review did not “re-run the plethora” of recent reports into nursing, which he said contained “enough recommendations to last us a long time”.
“What we now need is actually a translation of those into a programme of action,” he said. “To start re-visiting these things is wasting everybody’s time and, to be honest, I’ve got better things to do.
“What we are going to end up with is a consolidation of existing recommendations and a framework within which training can take place,” he told Nursing Times.
Key subject areas for the review
The Liberal Democrat peer identified some of the key areas he would consider, including a certificate of training for HCAs, expanding the numbers of apprenticeships available, the continuing professional development of qualified nurses, and the quality of training placements for students.
Regarding placements, he said: “How do you ensure a consistency of standards within a variable setting – that the student going in to a care home gets that same quality of training as in accident and emergency or theatres, for example? That’s a real challenge and I am hoping the review will throw up answers.”
He stressed his opposition to the status quo where all nurses could become mentors, a position he made clear in his earlier commission on nurse education, which was carried out for the RCN in 2012.
“I hold to that view – although I will test it again during the review – because I think the mentor could be the real catalyst to actually make sure we up the game in terms of standards,” he said.
“We don’t have enough mentors for students, and when a mentor has a total workload and mentoring is an added extra, quite frankly I don’t see how that can work. This is not a criticism of mentors, this is saying to them: you are being asked to do much.”
As reported by Nursing Times in June, Lord Willis has particular concerns around the provision of post-registration training for nurses, arguing that the NHS did not “take the whole process of continuing professional development as seriously as it should do”.
“Nurses, by hook or by crook, do develop new techniques, but the system should not rely on that,” he said.
“When you think how fast the world of healthcare is changing, to say someone after three years of training as a registered nurse is somehow a finished article without any mandatory requirement to update is wrong,” he added.
Lord Willis hinted that he might recommend some form of continuing programme of education, possibly similar to the foundation programme for junior doctors, with nurses getting competencies signed off over a much longer period of time.
“The view that all CPD means going away or coming off duty is very outdated idea. Quite often good CPD is giving people time to work with their peers in order to develop new skills, but to do it consciously rather than some form of osmosis,” he said.
“That is a challenge for organisations, but one you can’t simply say because we haven’t got the resource we shouldn’t do this,” he said.
Funding problems for CPD was especially acute from 2005-08, when hundreds of millions of pounds were siphoned from the former Multi-Professional Education and Training budget by strategic health authorities facing deficits – leading Nursing Times to launch its Time Out for Training campaign.
Some of the CPD concerns highlighted by Lord Willis could theoretically be improved by the NMC’s new system of revalidation, which will introduce a series of regular checks on competence and learning activity from December 2015.
He said he supported the move to revalidation, but only if it led to a form of appraisal, which meant post-graduate training needs were met. He added: “Revalidation as a tick box, which leads to no tangible improvement in a nurse’s skill set is something I think we can do without.”
The review is due to publish its findings by spring next year, just months before the general election – and therefore at risk of being forgotten or ignored by a new administration.
Lord Willis accepted the timescale was “tight”, but said he hoped to produce a report that was “politically acceptable across the piste”.
What is the Shape of Caring Review
The Shape of Caring Review is chaired by Lord Willis of Knaresborough. It was launched in May 2014 and is due to produce a final report by January 2015.
The review will recommend reforms designed to ensure that nurses and healthcare assistants receive high quality education and training, which in turn supports high quality patient care.
It will bring together findings from recent major reviews such as those by Sir Robert Francis, Camilla Cavendish, and Professor Don Berwick, as well as Lord Willis’ previous work for the RCN.
For more information visit the Health Education England website