We must pay attention to the politics of commissioning nurse education, says Fiona Ross
Everyone has a view about nursing - it has lost its way, it is too academic, nurses have the wrong attitude and lack compassion. Many argue that nurses do not need degrees and that universities are responsible for producing nurses “not fit for purpose”.
What is missing in the current debate on nursing is that, while concerns around the quality of care mount, we are seeing simultaneous cuts in the non-medical training budget of 15% over three years, resulting in annual reductions in training places for nurses and other health professionals.
These cuts have been applied more deeply in areas defined as having an “over supply”, notably adult nurses and physiotherapists, which is ironic as it is these professionals who play a key role in the quality of care, particularly in relation to older people and rehabilitation.
What is the link between the debate on poor quality and the cuts in training places?
First, there is growing evidence that higher levels of qualified nursing staff are linked to better patient outcomes.
The second response to this debate is to counter the view that nurses are getting the wrong sort of training in universities.
“Cuts in training places today mean we are storing up problems for the future”
Universities provide education for health professionals in partnership with service users and employers.
Students spend half their time in clinical practice. Employers and, in some universities, members of the public take part in interviewing prospective students. NHS commissioners have robust contract management systems, which penalise universities for failing to meet targets such as recruitment and attrition, and, in some cases, publish league tables of university performance.
Therefore, if nurses are being prepared who are not suitable for the healthcare workforce, employers need to accept their part in this and work within constructive and respectful relationships with universities to shape solutions for the future.
This leads to my final point about the current political context of education commissioning.
Driven by the need to cut costs, NHS London - which commissions healthcare training in London - has been running a competitive tender for nursing and physiotherapy education programmes. This is open to any qualified provider, which includes existing university providers as well as new players such as private institutions.
This unfolding “experiment” has arguably received little attention in the higher education press. This is surprising, because the size of the contracts and the impact in terms of the effect on university budgets could lead to new entries into the market, institutional instability among existing providers and uncertainty for students, practitioners and employers.
It takes three years to train a nurse. Cuts in training places today mean we are storing up problems for the future and possibly a re-run of the cycle initiated by the cuts made under Margaret Thatcher, which resulted in an increase in cheaper, unqualified and unregulated healthcare assistants, acute shortages of qualified staff leading to ward closures, and hospital managers recruiting/poaching nurses from parts of the developing world.
If we seriously care about the quality of healthcare, particularly for older people in our hospitals, it matters that we
pay attention to the politics of commissioning nursing and health professional education.
Fiona Ross is dean of the Faculty of Health and Social Care Sciences at Kingston University and St George’s, University of London