Time out for training
Why campaign on training?
For nearly three years, financial crisis in the NHS has resulted in many ill effects for nurses. Jobs have been lost, others continue to be frozen and those who remain in post have suffered because of the demands of working in a skeletal workforce.
However, it is not just these issues that are burdening the profession. The long-term issue of nurses’ continuing professional development (CPD) has also been put at risk, as strategic health authorities (SHAs) continue to raid funds that were previously ringfenced for post-registration training.
The result, according to a Nursing Times survey of 3,814 staff, published this week, is that one in two nurses do not feel that they have access to adequate training to progress in their career. What’s more, this situation is making one in five feel angry and one in 10 ready to quit their jobs.
For this reason, NT launches its Time Out for Training campaign this week – with the end goal of ensuring both time and money are ringfenced for vital post-registration nurse training.
As RCN education adviser Sue Howard says of the current situation: ‘How, in terms of workforce planning, can you plan for future healthcare if you have no funding for what staff are going to need to develop them? It is a nonsense.’
The story so far: funding raids
So how did we arrive at this point? It all began in the 2005–2006 financial year when money set aside for training, provided by the government and supposedly ringfenced at the time, became budgets to plunder for SHAs desperate to claw back some of their exponential deficits.
The raids were to little avail, since SHA debts contributed to an NHS overspend of £536m by the end of 2005–2006.
The Council of Deans of Health brought the situation to the attention of the profession in July 2006 after it presented evidence to MPs on the then health select committee, who were holding an enquiry into NHS workforce planning.
The council’s research eventually revealed that in total more than £135m was top-sliced by the SHAs from the total Multi-Professional Education and Training (MPET) budget. This money is provided to SHAs to pay for all non-medical training, both for pre and post-registration nurses, and amounted to a total of £3.92bn in 2005–2006.
Evidence demonstrating the impact of the first round of budget raiding was revealed throughout the year, as NT reported.
A number of hospital trusts, including Cambridge University Hospitals NHS Trust and Mid Yorkshire Hospitals NHS Trust, then began to cancel non-mandatory training indefinitely for thousands of nurses, saying there was not enough funding available to provide it.
The 2006 NHS Staff Survey found that 79% of staff had experienced difficulty in accessing training in 2005. And shortly after chief nursing officer for England Chris Beasley had warned nurses that they faced their toughest year yet, 60 universities axed post-registration courses.
Ministers fail to act: ringfencing removed
A statement that summer by Lord Warner, the then health minister, served
to compound the situation.
Responding to a call from the Council of Deans of Health, which demanded that MPET cash would not be topsliced and diverted to other areas again in 2006–2007, Lord Warner said that trusts would receive MPET funding as part of their total allocations and would be free to use it as they saw fit.
This effectively removed ringfencing of the funds and gave SHAs carte blanche to continue in the same vein.
Ms Howard said of the government’s approach to training at the time: ‘On one hand you are saying we have got to have a robust workforce and on the other you are reducing the amount of money available for education – and the two do not match.
‘When it is dealt with in a short-term way it is not so much a ripple effect, it is more like a tidal wave.’
Unions and academics were furious with Lord Warner’s 2006 statement and predicted an inevitable deterioration in training. They were right.
The effect of the cuts
A total of £357.6m was diverted from MPET funding by SHAs to other areas in 2006–2007. Moreover, the number of commissions for post-registration courses at universities fell by 10%.
Again, evidence of the impact was seen across the nursing profession – no more so than in February 2007, when Unite/CPHVA discovered that the number of health visitor training places in England had been cut by 40% in 2006.
In the same month Unison blamed deficit plugging for preventing staff from accessing training opportunities after it was revealed that the Knowledge and Skills Framework was being sidelined because NHS reorganisation was taking priority.
Mandatory training, including manual handling, fire training and emergency first aid, which trusts have to carry out under the Health and Safety Act 1974, has also suffered during the last three years.
A report by the National Audit Office in July 2006 found that 30% of permanent nurses and 70% of bank nurses were failing to receive the mandatory training required.
Figures released by the Healthcare Commission (HCC) in the same month revealed that 10% of trusts admitted they had had significant lapses in mandatory training during the course of that year.
Ms Howard says: ‘Mandatory training should be sacrosanct; they need to make sure it is safe and sound. The feedback we have is anecdotal but in certain areas it is still not as it should be.’
Julie Dalphinis, clinical learning environment lead (west), NHS East of England, says that the HCC has had a big impact on mandatory training because of its monitoring system but she warns that trusts will have to become more innovative to provide all of the necessary requirements given the current climate.
While she agrees that education funding should be ringfenced, Ms Dalphinis says nurses need to shoulder some responsibility for the current situation because some have not taken advantage of the courses on offer or have not completed their studies.
She says: ‘Trusts pay universities for training courses up front, so if they do not manage to fill places the university gets to keep the money.
‘Trusts get wrapped on the knuckles but the effect in the long term is that SHAs will say “they have not been using 15% of the money, so what does it matter if we topslice it anyway?”’
Last July the RCN’s annual employment survey, which was published shortly before leading nursing universities laid off almost 100 lecturers because of a drop in post-registration training, summed up the mood.
The survey found nurse morale to be at its lowest level for 10 years and that one cause was the lack of time available for training.
It revealed that the amount of time set aside for qualified nurses to train has declined from 11 days a year in 2005 to only seven in 2007.
The survey, which covered 9,000 RCN members, also found that internationally recruited nurses were worse off, with levels of participation in CPD falling from six days in 2005 to three in 2007.
Following the survey the RCN signed a joint statement, along with other leading healthcare unions including the Royal College of Midwives, calling on employers to provide all healthcare staff with a minimum of six days of protected time for their CPD.
Modernising Nursing Careers
In November 2007, the Department of Health began a review of post-registration training. The government is currently consulting on a new framework designed to take forward its Modernising Nursing Careers programme, which would see qualified nurses choose one of five major career pathways.
The framework is something Paul Turner, executive officer at the Council of Deans of Health, thinks may go some way to reversing the decline.Mr Turner says: ‘There needs to be an agreement on a nursing career framework. We want the Modernising Nursing Careers programme to come to fruition so there is a clear nursing careers framework and a link between that framework and flexible post registration provision but also that the funding is both provided and protected.’
Topslicing to continue
Nurses will not find out how much MPET funding was held back in 2007–2008 until the end of this month but the Council of Deans of Health believes that five of the 10 SHAs have again used significant sums of funding intended to pay for nurses’ training and education.
Ms Howard adds: ‘We have got long-term planning for the workforce for what we need in 2015 or 2020 but alongside that we have got short-term funding and if that means that training money has to be ringfenced then so be it.’
Despite a turnaround in NHS finances – a surplus of £510m at the end of 2006–2007 and a predicted £1bn surplus for 2007–2008 – and a promise of an extra 6% towards nurse training for 2008–2009, the situation for post-registration training is still patchy nationally.
Help NT help you
This is why NT is campaigning on behalf of nurses to help you get the vital support you need as professionals to meet the NMC’s requirements, practise safely and stay abreast of developments in your field.
We will be running this campaign both in the magazine and online, where nurses who have struggled to gain the training they deserve are encouraged to contribute their experiences, sign an online petition and lobby the government to bring back the ringfencing of all training budgets.
Staff will also be helped to demand of their trusts that they provide protected training time to cover both mandatory and non-mandatory training each year.
As NT’s survey has revealed this week, more than 85% of nurses feel that training is vital to both their career and the safety of their patients. It’s now up to you to help us ensure that education is once again the cornerstone of nursing practice.
Time out for training: what the campaign hopes to achieve
To persuade trusts to guarantee sufficient training time is set aside
for both career progression and patient safety
To compel the government to bring back ringfencing of training budgets
To persuade SHAs to guarantee that education funds are spent only on training
To raise awareness of the importance to the profession, those in the NHS and the wider public of post-registration training for nurses
To secure guarantees for sufficient backfill to cover the training requirements of nurses
To support nurses in lobbying trusts and government on their training needs
Case Study: 'I cancel mandatory training if I know I won’t get the time back’
Maria Gough, who now works for West Essex PCT, first encountered training problems in 2005, when working for what was then Harlow PCT.
As a nurse working in one of the government’s first pilot walk-in centres in Harlow, Maria claims that money for training was freely available at first.
However, when the pilot came to an end she says that funding for training became more scarce and training was then withheld, despite the funds having already been allocated.
Maria says: ‘I didn’t expect them to give me it all but they refused even study days and tried to put me off by saying I could not do my course as well as my job.
‘It said in my contract that you should be working towards master’s-level education. I was band 7 going on to band 8, so as far as I was concerned I should have been doing it.’
Mandatory training, according to Maria, now a senior nurse practitioner, is still an issue.
‘The last three sessions of mandatory training I have been asked to go to I have cancelled three times, because I refuse to go on things where there is no prospect of me getting the time back.’
Maria, who blames the government and the SHAs for the situation, continues: ‘I think nurses have to be a bit more proactive about this and ask for the opportunities they are entitled to. But a lot of nurses are less experienced so they do not have the confidence to go to their manager and say: “If you do not send me on a training course, which I need to do to carry out my role correctly and a patient dies as a result, then it will be your fault and not mine.”’
In March 2005 Gemma Smith (pictured) decided it was time for a change. She left her job as a district nurse to become a community matron.
Case Study: 'When I asked about master’s education I was told there was no money’
She wanted to progress her career and was interested in the type of further training and education opportunities she believed the role would require. But it quickly became clear there was little scope for her ambitions.
At the time Gemma was working for Adur, Arun and Worthing PCT which merged with four others to become West Sussex PCT in 2006.
Gemma, now an urgent care lead at West Sussex, says: ‘When I asked about securing education around master’s modules I was told there was no money.
‘The money was being spent on educating community matrons without a first degree, even though the requirement of the role was to be working at a master’s level. So the nurses who already had a degree were at a disadvantage.’
Gemma felt frustrated and considered quitting but, determined to succeed, she approached universities herself, eventually won a scholarship and by 2006 convinced her PCT to give her a day off for study each week.
‘It is not fair that you are taken on for these roles and want to give the best possible care to a patient but without the suitable training it almost de-motivates you.’
Gemma adds: ‘There is a different culture here now. We have some fantastic people who are really looking to upskill their workforce.
‘However SHAs do need to stop cutting the training funding. It has created inequity across PCTs and it is that inequity that needs to be addressed.’
CRISIS in nurse training: THE STORY SO FAR
The crisis in post-registration training began in the 2005–2006 financial year. Nurses were refused training after more than £135m was topsliced by all SHAs from the total Multi-Professional Education and Training (MPET) budget of £3.92bn in 2005–2006.The SHAs diverted the money into other areas to ease financial pressures
Budget raiding continued in 2006–2007, with SHAs spending £357.6m of training money on other things
It is still unclear how much has been plundered from the 2007–2008 budgets but the Council of Deans of Health claims that five out of 10 SHAs have spent significant sums
Over the course of three years, thousands of nurses have been denied access to continuing professional development training and post-registration courses have been axed
According to last July’s RCN survey, the number of protected training days given to nurses has fallen from 11 in 2005 to seven in 2007
An NT survey, published this week, finds many nurses are angry about lack of training and one in 10 are ready to quit the profession.