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'How can costly student scheme be justified?'

So surprise, surprise, the government’s plan to make all would-be nurses spend a year working as a healthcare assistant before entering a nursing course is proving a costly experiment.

Our story on page 2 reveals the pilot for just 165 potential students is costing around £11,000 a head. If that was scaled up across the nearly 20,000 students expected to start their training this year, it would cost the NHS £225m.

So let’s just get this straight. The government can’t afford to give all nurses even a 1% pay rise - in effect cutting their salaries every year. And yet it does have money to spend on schemes that are unproven, untested and likely to be unworkable on a larger scale.

Health Education England’s response that the “cost-neutral” plan “doesn’t mean no cost” is laughable. The organisation suggests there may be other benefits - in terms of recruitment and retention. There would have to be some mighty advantages to outweigh the £225m price tag.

The government can’t afford to give nurses more than a 1% pay rise. And yet it does have money to spend on schemes that are unproven, untested and may be unworkable

When the government announced the scheme last year, chief executive and general secretary of the Royal College of Nursing Peter Carter said the idea had “more holes than Swiss cheese”. Perhaps the government should have heeded his words. Because it’s proving to be also pretty expensive Swiss cheese.

It’s a fantastic idea to ensure that students have hands-on experience of clinical care before they start their training. But most universities already look for that sort of interest, knowledge and enthusiasm in potential students. Does the government really need to formalise it such an extravagant way?

HEE suggests the scheme may reduce university attrition rates but that has yet to be proved. And I suspect lots of factors make drop-out high. Since student nurses tend to be a bit older than most undergraduates, cost, family commitments and time pressures will all play their part. So I’d imagine adding a year’s work experience will make attrition over the four years higher rather than lower.

I doubt very much attrition rates are high because nurses suddenly realise that they will have to touch patients and clear up some bodily fluids. In most cases, it is time spent with patients that is the very reason that nurses choose the profession.

The government is doing this because it wants to show it’s placing emphasis on compassion in nursing. Well compassion cuts both ways. How about paying nurses a decent wage instead of wasting money on flights of fancy that seem to bring nothing but cost at a time when we are constantly told the NHS can ill afford to do anything?

Jenni Middleton, editor Follow me on Twitter @nursingtimesed

Readers' comments (11)

  • Well said Jenny! this idea is again the government reacting on on whim and not thinking long term. The issues with the NHS today surround short term solutions rather than long term planning and sustainability. we will never get long term planning if the NHS remains party political and can change direction at every election!

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  • Here, here.

    However as I was unable to secure a HCA post before I started my training I do see some benefit in this idea. I was not 100% sure I could cope with the realities of basic care (day 1's bed bath of a morbidly obese, doubly incontinent stroke victim proved that I could).

    You could achieve the same effect by putting students straight on a 6 week basic care placement, after a brief induction and preparation period. Make this a trial period of the course - fail to demonstrate compassion and a caring attitude and your out. You could over subscribe the courses knowing you would have a certain amount of attrition in the first couple of months. This would be a lot cheaper and ensure all students had proper exposure to the realities of care early on.

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  • tinkerbell

    Anything can be justified when you have no moral compass!

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  • Great editorial Jenni,

    Money is so easily wasted and I don't see either how this scheme will affect the attrition rate, as, you state, there are many reasons for this.
    Use the money to give nurses a pay-rise in recognition of the role.

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  • Can I make just one comment?

    Proper staff levels?

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  • Anonymous | 27-Mar-2014 11:23 am

    what a nerve! How did you dare? or should one say 'How dare you'!

    well done, lets keep it simple.

    far safer, and probably far more cost effective too in the long run, than all of this perpetual prevarication we are witnessing.


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  • The problem is that universities are churning out all of these highly qualified (on paper) nurses who lack even the most basic nursing skills. Trusts are having to spend more and more time and money on inducting these people into the workplace and going over ground that should've been covered on the course.

    Until nursing courses are refreshed to include more hands-on and technical skills this is expenditure that will just have to be swallowed.

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  • Money would be better spend on undergraduate nursing courses. Greater tutor to student to ratio an more simulation.

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  • "compassion cuts both ways" that`s exactly what i think , the path of compassion include carers and patients. very well said jenny

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  • To Anon (27 Mar, 7.57 am)
    Your comment, whilst not sounding very supportive to student nurses, does have a ring of truth about it.

    I do agree that student nurses need to get more hands on as early into the course as possible. I gained a diploma but I wasn't technically skilled on qualifying. However, the needs of the service you find yourself working in dictates the level of skill you need.

    Whatever training you receive, you will never be able to learn everything in that time. There is no such thing as a generic nurse who can go anywhere and do anything. I have met lot of hospital nurses coming out into the community who flounder. And who could just walk into ITU and just get to work?

    It's all part of nursing's rich tapestry - the widely different roles we each undertake, the opportunities to learn and develop as we move through our career.

    I can't see how working as a HCA for a year could benefit a student nurse. After all, how much time do we spend giving "care" and how much time do we spend giving meds, inserting catheters, educating, training, planning, mentoring, trouble-shooting etc etc.

    There needs to be more balance between learning how to care, giving that care and developing into a nurse who can manage all aspects of that care.

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  • Anonymous | 31-Mar-2014 3:00 pm

    It was a dig at the upper echelons of nurse education who seem to think that a BSc is the answer to all the ills in nursing, not the Student Nurses themselves.

    I too qualified with a diploma. My course differed in content from the current model in that for the first few weeks we were taught the basics of nursing: how to wash and dress a patient, how to change a bed, how to put someone onto a bed pan, how to feed a patient, how to perform last offices etc., etc. That grounding in the basics meant that we could function on our first placement onward.

    In college, we had to demonstrate we could set up a drip, administer medicines, calculate drugs doses, open sterile packs - a whole series of practical skills that we then had to practise on placement and be signed off as competent having completed each task at least three times each year.

    You're right that no course could ever prepare a student for everything the world of work will throw at them, but there are some fundamental skills and knowledge that they should possess on qualifying.

    In the clamour for an all degree progression, current courses are leaving out the basic fundamentals hence the need for student to work a year as a HCA.

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