Universities have called for an urgent review of “short-sighted” cuts to funding for the ongoing professional development of nurses and midwives, amid fears less money for training will harm care.
All but one of the 13 Local Education and Training Boards (LETBs) in England have cut funding for continuing professional development (CPD) in 2016-17, with cuts of 40-45% in some areas, according to a report published today by the Council of Deans of Health.
“These cuts are difficult for universities, but will have a far greater impact on the NHS”
It follows Health Education England’s decision to reduce workforce development funding to LETBs by almost half, claimed the report, which said the cuts to CPD could harm plans to improve and re-shape NHS services.
The cuts may also mean fewer post-registration training programmes on offer, with universities forced to drop courses and lay-off staff, warned the report.
Meanwhile, a lack of funding to train practice mentors was already hitting pre-registration training and risked hampering plans to expand the nursing workforce and tackle widespread staffing shortages, it added.
However, HEE has described the report’s claims as “misleading”, stressing it is mainly up to employers to fund and support CPD activities, rather than itself.
The report, which is based on interviews with university deans, stated that the constant evolution of treatments and technology, as well as rapidly-changing roles for healthcare staff, meant ongoing education and training was essential to ensure safe, effective care.
While funding for the ongoing training of doctors has been protected, the money available for CPD for nurses, midwives and AHPs has been slashed, it claimed.
“The Council of Deans report is a misleading portrayal of the extent of HEE’s involvement in CPD”
According to the report, HEE funds some CPD activities through its allocation to LETBs. The boards either provide trusts with an overall CPD budget that they then use to commission universities to deliver education and training, or spend the funding directly with universities under Learning Beyond Registration contracts.
Examples of courses currently funded via HEE’s CPD budget include diploma level courses in diabetes care and leg ulcer management, degree-level programmes in advanced renal nursing, prescribing, postgraduate courses in cancer and palliative care, and stand-alone modules in topics such as managing critically ill patients, and autonomous nursing practice in A&E.
“For 2016-17, such funding in England has been the subject of deep cuts of up to 45%, often without much warning and with little evidence of strategic planning at national level,” said the report written by Professor David Greatbatch.
It is based on in-depth interviews conducted in May and June this year with 11 university deans who lead faculties that provide CPD courses, encompassing contracts with all 13 LETBs.
Cuts to CPD funding in 2016-17 reported by the universities range from 12% in the East Midlands to 45% in the North East (see table below).
“Without continuing training and education, it’s hard to see how nursing staff can be expected to keep up with changes”
All the institutions that took part in the Council of Deans review said they had been told there were plans for further significant cuts in 2017-18, leading some to consider pulling out of CPD altogether – with the exception of mentorship courses.
Other problems highlighted in the report included “the reluctance of some trusts to release staff for CPD”, which could mean unused funding being “clawed back”.
While the cuts will hit universities, the report claimed that the biggest impact would be on the NHS workforce and the health service’s ability to meet key goals.
“Given the profound changes that are expected to nursing, midwifery and AHP roles, as demand for services grows and patient needs and service configurations change, this transformation is at risk without investment in education and training,” said the report.
“CPD is also equally important for sustaining core NHS services, such as A&E and intensive care, where specialist and advanced practice knowledge and skills are required for staff to be able to deliver safe, up to date care,” it added.
The report said there was already evidence significant cuts to mentorship budgets were damaging mentorship training, which is key to plans to expand pre-registration nursing courses and address nurse staffing shortages in coming years.
“The government’s strategic priorities and these funding decisions simply do not add up” stated the report – titled A false economy: Cuts to Continuing Professional Development funding for nurses, midwives and Allied Health Professionals in England.
Professor Dame Jessica Corner, chair of the Council of Deans of Health, described the cuts as “short-sighted”.
“We urgently need more joined-up thinking about funding for education and training for these professions,” she said.
“There is a clear gap between the government’s strategies to transform services by deploying nurses, midwives and AHPs in new roles and these short-sighted cuts,” said Dame Jessica.
“These cuts are difficult for universities, but will have a far greater impact on the NHS and its ability to deliver its own objectives,” she added.
The Council of Deans of Health called on the government to recognise the funding gap and initiate a “national strategic discussion” to address it.
A key concern raised by university deans was the contrast between CPD and career pathways for doctors and other professions like nursing.
“Despite the intention when HEE was created that it would take a multi-professional approach to funding allocations and redirect resources where necessary, this aspiration has not been delivered,” noted the report.
The report was described as “very worrying” by the Royal College of Midwives, which said cutting funding for workforce development and training “simply makes no sense”.
Stephanie Aiken, deputy director of nursing at the Royal College of Nursing, said: “Patient care is transforming at a rapid pace, and without continuing training and education, it’s hard to see how nursing staff can be expected to keep up with these changes.
Fears raised over deep cuts to CPD funding for nursing staff
“This report highlights yet another case of cuts without thought for the impact on staff and patients,” she said. “Funding for training and development has been cut almost by half, yet the strategy for the health service and the care it delivers has not adapted to reflect this loss.
“If the government wants to achieve the goal of safe and up to date care, it needs to provide the funding for training, development and education – it’s that simple,” said Ms Aiken.
“The progress and innovation we’ve seen in healthcare has been astounding, but it will be wasted if nursing staff cannot access specialist education to put this into practice,” she added.
However, HEE said the document was “misleading” when it came to the body’s involvement in, and its responsibility for, CPD.
“The Council of Deans report is a misleading portrayal of the extent of HEE’s involvement in CPD, which is primarily an employer responsibility,” said Rob Smith, the body’s director of strategy and planning.
Fears raised over deep cuts to CPD funding for nursing staff
“HEE does not, and never has had a specific allocation for general CPD for the NHS workforce,” he said. “The report also fails to recognise the far greater investment that all NHS employers make in the development of their own staff.
“The report refers to our workforce development fund that covers a broad range of investment based on local NHS priorities, some of which has supported specific CPD programmes in addition to employers’ own CPD primary responsibility, but this is not and never has been a CPD-specific budget,” he added.
Mr Smith said HEE was using its allocated budget from government to fund additional university places and “prioritise investment in the future workforce”, as this was the body’s primary remit.
“We are also making strategic investments in areas, such as nurse associates, in order to meet NHS priorities locally and nationally,” he said. “These priorities were previously supported by the Council of Deans and we assume still are.”
|LETB||Reported CPD cuts in 2016-2017||Reductions in LETB Workforce Dev funding, 2016-2017|
|East of England||25-30%||50.3%|
|Kent, Surrey and Sussex||33%||Not available|
|North Central and East London||25-30%/40%||Not available|
|North West London||30%||Not available|
|South West||c. the same as last year but up to 50% cuts to mentorship||44.1%|
|Thames Valley||30%||Not available|
|Wessex||c. the same as last year||46.6%|
|Yorkshire and the Humber||40%||Not available|
- Cuts to CPD funding by LETBs in England as reported by universities. Figures for the reduced workforce development allocation are from LETBs’ board papers, where available.