Short-staffed employers in England may end up paying off fees for nurses who train in Wales to tempt them over the border to work for them soon after they graduate, according to the chair of a new group representing Welsh university nursing departments.
Professor Ceri Phillips, who heads up the newly-established Council of Deans of Health for Wales, said this was a possibility due to new rules in Wales that mean student nurses in receipt of a bursary must work in the country for at least two years after graduating - or pay back at least £25,500.
At the end of last year the Welsh government announced it would retain bursaries for nursing courses in 2017-18 - unlike in England, where they have been scrapped from this autumn – as long as nurses complied with the two-year tie in.
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Professor Phillips said that while it was too early to predict the full impact, the new rules could mean employers in England end up paying off fees.
“It may be some employing agencies within England may say ‘we’ll buy you out of NHS Wales and pay your bursary off ourselves’ - if there are recruitment issues which mean that may be something they would want to use as an incentive,” he told Nursing Times.
Part of the reason for the tie-in was to ensure prospective nurses from England did not flock to Wales for free tuition, “depriving Welsh students of opportunities and depriving NHS Wales of its future workforce,” he said.
”Employing agencies within England may say ‘we’ll buy you out of NHS Wales and pay your bursary off ourselves’ if there are recruitment issues”
Professor Ceri Phillips
He said there was some evidence people from England were being attracted to courses in Wales because of the bursary.
Data from the the Universities and Colleges Admissions Service on applications for healthcare programmes this year had shown a decline overall but “the decline in Wales is certainly less than the decline in England”, said Professor Phillips.
However, he said it was a possibility the new rules in Wales might also deter some applicants.
“Some might think ‘I might take the risk, it’s three years down the road and things may change’. Others may say ‘no way am I going to do that’. It is too early to predict,” he said.
Student bursaries in Wales have not been confirmed beyond 2017-18, due to expected changes following recommendations from a wider review of higher education funding in Wales by Professor Sir Ian Diamond, which advocated a means-tested mix of grants and loans.
Professor Phillips told Nursing Times this change would have “consequences” for recruitment to nursing programmes but “I don’t think these would be extreme”.
”There are discussion between the health boards and the universities to see if there is way where they could directly commission places”
Professor Ceri Phillips
“With the mean-testing of potential students, many who apply for our professional programmes would be entitled to greater than the minimum subsidy anyway so at worst they will have a partial bursary,” he said.
Meanwhile Professor Phillips, who is head of the college of human and health sciences at Swansea University, also revealed Welsh health boards were talking to universities directly about commissioning extra nurse training places to deal with shortages.
This raises the possibility of more Welsh universities offering fee-pay nursing courses. Wrexham Glyndwr University in north Wales recently became the first to offer a fee-paying undergraduate nursing degree, working with five NHS trusts in England.
“There are discussions between the health boards and the universities to see if there is a way where they could directly commission places from the universities in addition to the numbers the commissioners in Wales give us,” said Professor Phillips.
“The extent to which they would be fee-paying has yet to be determined,” he said.
The new Council of Deans for Wales group, which held its first meeting earlier this week, includes all six Welsh universities providing training and research opportunities to nurses, midwives and allied health professionals. The group replaces the former Cyngor group of Welsh health faculties.
”We [those working in nursing education] have got be more proactive, we have got to be involved [in government policies]”
Professor Ceri Phillips
Professor Phillips admitted that in recent years universities in Wales had perhaps not fought hard enough to ensure the voice of professional nurse education and training was heard at the highest levels.
“We have got be more proactive, we have got to be involved, we have got to be in the government’s face as it were – in the nicest possible way,” he said.
This was particularly important in the light of forthcoming changes to the commissioning of health education, when a new body – Health Education Wales – launches in April next year to oversee both medical and non-medical education.
“The intention of this body is to ensure that the education of healthcare professionals in the future meets the needs and the demands of the healthcare services and not simply regurgitate traditional, existing professions and roles and grades,” said Professor Phillips.
He said it was time to adopt a more sophisticated approach to commissioning training places.
“The commissioners have taken very much a ‘well you had so many midwives last year, how many more do you need next year’ approach. It has been done on a geographical basis, it’s been driven by budgets rather than by need and demand,” he said.
“What has happened to date is that the commissioners have taken the numbers the health boards in Wales have given them, looked at that and divided by the amount of money they have got and allocated student numbers to each of the universities,” he explained.
”[If Wales were to introduce nursing associates] I would like to think we would do it on the basis of evidence and not on the whim of a politician”
Professor Ceri Phillips
“I think that’s outdated and short-sighted and I would hope we can be more involved in looking to see where adjustments can be made to give greater benefit to the service in the future,” he added.
When it comes to developing new roles he said it seemed unlikely Wales would follow in the footsteps of England and introduce nursing associates.
“There is a view [among the profession] that we have already got healthcare support workers and what we need to do is provide them with greater opportunities to develop within their own particular grading structure, as well as giving them the opportunity to develop into registrants,” he said.
However, he said that if nursing associates were found to be of benefit then “that is something we can’t ignore”.
“However, I would like to think we would do it on the basis of evidence and not on the whim of a politician or a professional body,” he added.
Meanwhile Professor Phillips said new nurse training standards – and those for prescribing and medicines management - currently published for consultation by the Nursing and Midwifery Council had “caused some consternation” in the university sector in Wales but were generally seen as “an opportunity and a challenge rather than a threat”.
“We need to ensure that when the standards come on board, we’re ready, we’re equipped and can provide students with a deal which ensures they get registration and become highly qualified, highly skilled professionals,” he said.