Education chiefs have questioned claims in the NHS Long Term Plan that “well-qualified” student nurse applicants are being rejected a place on a course because some universities are setting the bar too high.
Brian Webster-Henderson, chair of the Council of Deans of Health, which represents faculties of nursing, midwifery and allied health professions, said members feared the situation had been “misrepresented”.
The 10-year plan for the NHS in England was released this month and highlighted ambitions to increase the number of student nurses because there were currently not enough in training to meet demand.
Despite the shortfalls, the plan noted that there were still nearly two applicants for each nursing degree place offered, claiming 14,000 people in the UK were not accepted onto courses in 2018.
“At a time of staff shortage across the NHS it is – to say the least – paradoxical that many thousands of highly motivated and well-qualified applicants who want to join the health service are being turned away”, it said.
The plan went on to state that some universities had entry requirements that were higher than necessary. It said: “A number of higher education institutions (HEIs) have entry tariffs well above the levels set by other HEIs and deemed to meet appropriate standards by the Nursing and Midwifery Council.”
In a wide-ranging, exclusive interview with Nursing Times, Professor Webster-Henderson said the council and its members were “surprised” to read this, and they would be digging deeper into the claims.
“We were quite surprised to see that in the plan and many of our members were anxious that it misrepresented the higher education system in England,” he said.
“Many of our members were anxious that it misrepresented the higher education system in England”
Professor Webster-Henderson highlighted that the “biggest challenge” for universities was around applicants not having adequate levels of maths and English. “This goes beyond a university issue, it’s around a schooling issue,” he noted.
He added that universities were working to find “creative solutions” to this problem, such as employing tutors in these subjects. The 14,000 figure quoted in the plan “needed some analysis”, Professor Webster-Henderson said.
He said: “We absolutely know we get more applicants for children’s nursing than there ever would be places, and therefore some of that data will be representing where we are at maximum capacity because of placements anyway.
“It’s not an easy figure to understand but because it’s been made publicly we are committed to working with colleagues to really look at the data and see what that tariff situation is,” he added.
Professor Webster-Henderson has been a leading voice against cuts to continuous professional development. The budget fell by 60% in two years from £205m in 2015 to £83.49m in 2017. He, therefore, welcomed the commitment in the long-term plan to reinvest in CPD.
The document appeared to include an acknowledgement from leaders that previous shortfalls in this area had affected staff retention.
It said: “Many of those leaving the NHS would remain if they were offered improved development opportunities and more control over their working lives.”
“Many of those leaving the NHS would remain if they were offered improved development opportunities”
Professor Webster-Henderson said he “really switched on to that comment”.
Increases in CPD were “absolutely required to support service quality, training capacity and staff retention”, he warned.
“Roles are changing and becoming a registered nurse is probably the start of the journey not the end point,” said Professor Webster-Henderson.
“We are in a place in our country that we will need many more advanced nurse practitioners, many more people that can work across health and social care, and many people that will need to change their scope of practice, you can only do that through investment,” he said.
“I do believe if we increase not just the financial amount but the opportunities available we could change the shape of the workforce quite significantly with our partners,” he added.
The long-term plan promised to increase the number of people studying learning disabilities and mental health nursing by 4,000 by 2023-24 through the introduction of “earn and learn” support premiums.
The offer is being targeted at mature students who have traditionally been more attracted to these specialisms but have declined in numbers since the removal of the bursary.
“Equity and equality are going to be really more important issues – that’s my concern”
Professor Webster-Henderson said it was “great” to see leaders finding carrots to hold up to entice people into these problem areas, but he raised concern about the potential impact on adult and children’s nursing.
“The risk to this is that in trying to incentive to those areas it could be at the behest of other fields of nursing,” he said.
“You could get students who feel that it’s quite unfair that there’s a mechanism in two fields and not in the other two,” he said. “Equity and equality are going to be really more important issues – that’s my concern.”
He also highlighted that the premium idea did not take into account the fact that the challenges were not the same across England and that some areas were finding it far more difficult to recruit these students than others.
“It’s not an equally distributed problem so that then creates another issue about incentivising in a system that is geographically different,” said Professor Webster-Henderson, an adult and mental health nurse by background.
“That market at some point will slow down considerably and then you will find that universities are also having to push”
The 10-year NHS blueprint also vowed to continue to invest in the growth of nursing apprenticeships. However, Professor Webster-Henderson said the government was unlikely to hit targets for both nurse degree and nursing associate apprenticeship uptake without changes to the funding system.
There has been widespread concern from the health sector that the rules around the use of the apprenticeship levy are too rigid because it can only cover training and not associated costs to host trusts.
Professor Webster-Henderson said many of the council’s NHS partners struggled to cover the cost of “backfill” staff to stand in for apprentices during their protected learning time or while they had supernumerary status.
This issue was raised in a damning education committee report into nursing apprenticeships released last year and which the Council of Deans of Health submitted evidence to.
The government has since committed to carrying out a review into the operation of the apprenticeship levy, but NHS England will not be providing evidence to it until 2020.
To date, the nursing associate role has primarily been opened up to people who are already working in the NHS as a healthcare assistant. Professor Webster-Henderson noted that this pool of workers would at some point dry up and it may fall to universities to find people to fill the spaces.
He said: “The market that that is currently pulling from I would imagine tends to people already in the health system, nursing assistants, healthcare support workers, whatever we call them in the organisation.
“That market at some point will slow down considerably and then you will find that universities are also having to push recruitment to that route, which some of them are doing already,” he said.
“The biggest way to get people into the workforce is the three-year route or a short postgraduate route”
While welcoming the introduction of new routes into nursing, Professor Webster-Henderson said they were a slow way to increasing workforce numbers compared to the traditional university pathway.
He told Nursing Times: “My view absolutely and the view on the council is that the biggest way to get people into the workforce is the three-year route or a short postgraduate route but absolutely we warmly welcome the diversity of routes in and most of our members are actively engaging in that agenda.”
The long-term plan made no mention of bursaries or the nurse degree funding model in general, suggesting no imminent change to the controversial loans system.
The government axed bursaries in 2016 for people studying nursing under the reasoning that it would lift the cap on the number of students universities could take on.
However, the change led to a 32% decline in applications over the following two years, with the drop in applications from mature students even more extreme at 40%.
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Professor Webster-Henderson said the situation could have been different if the council’s request for a “sustained” recruitment campaign to coincide with the reforms and boost the image of nursing had been met.
“Recruitment is a huge issue for nurse education,” he said. “In some areas it’s really buoyant and since the system of capping numbers has changed some universities are really able to increase the amount of students they are taking and working in partnership with the NHS and local providers.
“Some areas are really struggling to recruit targets…partly because of the change in the funding [but] I think it’s more than that. I think it’s partly due to the image of nursing in parts of the country,” he told Nursing Times.
“The council absolutely pushed for a national and sustained recruitment campaign for nursing, midwifery and allied health professionals at the time of the changes to the funding system and that didn’t happen and I think that was a huge issue for us,” he noted.
“Our council members think that a maintenance grant would be a valuable thing for nursing students”
He said the council wanted to see a maintenance grant introduced for nursing students to help cover their living costs, highlighting that trainee nurses were under particular financial pressure due to clinical placement requirements.
“Our council members think that a maintenance grant would be a valuable thing for nursing students because they work 45 weeks across the year,” Professor Webster-Henderson told Nursing Times.
“Our students and universities also tell us that the biggest challenges to someone doing nursing is cost of standard of living,” he said.
Professor Webster-Henderson acknowledged that student nurses were able to get reimbursed for costs such as travel to their placement but added that under the current system they could have to wait up to 12 weeks to get the money back.
He spoke to Nursing Times during the Council of Deans of Health’s annual conference last week. In an earlier story focused on one part of the interview, he claimed that senior nurses were not considering a career in academia because they will get better pay working for the NHS.