The vision of nursing degree apprenticeships as a realistic and sustainable route into the nursing profession is just a “mirage”, according to MPs who say there are currently “too many obstacles” in the way of making them work.
A report by the education committee warns that the uptake of nursing degree apprenticeships has been far too slow with no more than 30 people starting training through the scheme last year.
“Nursing degree apprenticeships are trapped in a tangle of regulation”
It concluded there was “no evidence” to show how the government intended to meet a target of 400 nursing associates progressing to degree apprenticeships from 2019.
“The idea that degree apprenticeships are a realistic route into the profession is currently a mirage,” said committee chair, Robert Halfon, an MP and former apprenticeships minister. “Ambitious targets are simply not going to be met.”
He added that the inquiry had uncovered “huge difficulties” in the delivery of apprenticeship schemes.
These include concerns about the costs and a lack of nurses to provide supervision, with universities and employers having to navigate a “maze of bureaucracy” in order to get schemes up and running.
Robert Halfon MP
“There is currently little incentive for the NHS to spend precious time and resource building nursing apprenticeships,” said the committee’s report, which highlighted the need for greater flexibility especially when it came to use of funding from the apprenticeship levy.
Controversially the committee also suggested the need for more flexibility on supernumerary status for apprentices while working in health and care settings and called for other options to be explored.
Meanwhile, it also called for the creation of a new postgraduate apprenticeship to allow registered nurses to further their careers.
The committee’s inquiry, which heard evidence from bodies including the Royal College of Nursing, Council of Deans of Health and Nursing and Midwifery Council, follows concern about the very low numbers embarking on nursing degree apprenticeships, first announced by the government in November 2016.
At the time, the government envisaged 1,000 people starting a nursing degree apprenticeship each year as part of its ambition to expand the number of apprenticeships in the NHS from 20,000 to 100,000 by 2020.
But despite these ambitious targets initial provision was small. According to the committee’s report there were no more than 30 starters across two universities – Anglia Ruskin and the Open University.
“Restrictions on the use of the levy act as a serious disincentive to the development of nurse apprentices”
However, neither of these universities were among the four allocated funding by the Higher Education Funding Council for England to develop nursing degree apprenticeships ahead of their launch.
Since April 2017 the NMC has approved 19 nursing degree apprenticeship programmes, the report states, with 61 providers currently approved to offer nursing degrees.
However, the committee warned apprenticeships would never become a viable route into nursing unless some major barriers were addressed.
One issue is the fact the NMC requires apprentices to have supernumerary status so they can experience nursing practice with no responsibility for patients.
This means they cannot be included in staffing figures or calculations and so employers must backfill posts at a cost of between £7.88 to £10.15 per hour, which was deterring trusts from establishing apprenticeship schemes, the committee was told.
While the committee said it understood the reasoning behind supernumerary status, it suggested there may be alternatives.
In written evidence provided to the inquiry the NMC, which is currently consulting on whether nursing associates needs to be supernumerary, said it would be open to exploring the options.
“We urge the NMC to apply any safe and effective flexibility to supernumerary status to nursing degree apprentices in addition to nursing associates,” said the report.
Another key stumbling block identified by the committee was a lack of flexibility in the way NHS trusts were able to use money obtained through the apprenticeship levy.
This lack of flexibility was a major source of frustration to employers and meant apprenticeships were “a very expensive way of training a nurse,” chief executive of NHS Employers Danny Mortimer told the inquiry.
The levy was designed to cover the cost of an apprentice doing off-the-job training for 20% of their contracted hours. However, NMC requirements mean nursing degree apprentices must spend 50% of their hours on off-the-job training.
The fact employers must pay apprentice salaries and backfill salaries means it costs around £35,000 extra per apprentice per year for four years – a cost cash-strapped employers were struggling to meet.
The committee urged the government to relax it rules on use of the apprenticeship levy and said the NHS should be allowed to use it to backfill costs of apprentices and the government should double the amount of time in which employers must spend levy funds to 48 months.
It also heard concerns from universities that funding for providers of apprenticeships could be reduced making them “unaffordable to deliver”.
Currently universities can charge employers up to £27,000 to deliver a four-year nursing degree apprenticeship.
“The idea that degree apprenticeships are a realistic route into the profession is a mirage”
The committee called on the Institute for Apprenticeships, which sets funding bands, to ensure funding for nursing degree apprenticeships remained at a minimum of £27,000 and to consider increasing it.
Another problem flagged up during the inquiry was a lack of nurses able to supervise and mentor apprentices in part due to a nationwide shortage of nursing staff.
The committee suggested employers should be able to use the apprenticeship levy to develop the necessary infrastructure to support nursing degree apprenticeships including training nurses in supervision and providing protected time for them to do that training.
It also welcomed suggestions that the apprenticeship level could be used to fund continuing professional development in the form of higher level apprenticeships.
Chief executive of Health Education England Professor Ian Cumming told the inquiry there was no reason why the levy could not be used to help a registered nurse become an advanced clinical practitioner via a level 7 apprenticeship programme.
The committee said more postgraduate level 7 apprenticeships for nurses should be created “to enable them to further their careers and develop specialisms”.
It said the government should provide funding for a trailblazer group to develop these apprenticeships.
Overall, Mr Halfon said not enough attention had been paid to adapting apprenticeships to meet the needs of the NHS and he said the Department for Education was guilty of a “lack of imagination and foresight”.
“Ministers must now recognise the uniqueness of the health service’s position and allow flexibility in the use of the apprenticeship levy so these apprenticeships can be made to work for both the employer and students,” he said.
The report highlights the fact the number of applications for nursing degrees has fallen by a third since the government scrapped nursing bursaries in 2017.
The committee said it was particularly concerned by a fall in the number of applications from mature students.
Mr Halfon said apprenticeships could provide a route into nursing for those put off by the cost of degrees.
“While on their own they will not solve the nursing workforce crisis, no-one should be prevented from undertaking a nursing degree apprenticeship due to lack of availability,” he said.
The Royal College of Nursing said it welcomed the idea of apprenticeships if they were properly resourced and implemented safely.
However, Anne Corrin, head of professional development and learning at the RCN, said the education committee report showed nursing degrees remained “the fastest and safest way to educate, train and recruit the nurses we so desperately need”.
“Nursing degree apprenticeships are trapped in a tangle of regulation that offers cash-strapped employers little incentive to run schemes and recruit apprentices,” she added. “Take up is very low.”
She said the RCN supported recommendations in the report that sought to address these issues but stressed the body was concerned about any attempt to alter students’ learning status.
“The RCN is clear that the government must commit to maintaining supernumerary status for nursing apprentices, so that they are not counted in staffing numbers,” she said.
“Supernumerary status is vital if apprenticeships are to provide the safe route into nursing that patients deserve,” she added.
Responding to the report, Mr Mortimer said NHS employers remained committed to using the apprenticeship route to develop future nurses
“However, as the committee points out, the current restrictions on the use of the levy act as a serious disincentive to the development of nurse apprentices,” he added.
“In common with other major employers, the NHS needs to see reform of the apprenticeship levy to enable it to deliver the government’s apprenticeship agenda,” Mr Mortimer said.
The Department of Education said it would consider the committee’s recommendations and respond in due course.
Apprenticeships and skills minister Anne Milton added: “We are continuing to work with the health service to make sure the NHS is fully supported to recruit more apprentices.”