The new apprenticeship system for nurses risks repeating the mistakes of the past, potentially putting both patients and apprentices at risk, the Royal College of Nursing has warned MPs.
Janet Davies, RCN chief executive and general secretary, told the Commons education select committee on Tuesday that there was clear evidence to support the traditional system of degree-based training.
“We need a whole picture of where we need investment in nursing education”
It was safer, more consistent and more inclusive than the old style apprenticeships through which all nurses were once trained, she claimed.
Under this old system, both registered nurses and state enrolled nurses were paid by their employer and put on the duty rota as part of the team, rather than being supernumerary.
Apprentices had to learn from an inadequate number of fully qualified registered nurses, which reduced both patients’ quality of care, and the quality of the training, said Ms Davies.
This approach to training was phased out following seminal pieces of work on nurse education reform called the Judge Report and Project 2000, which were both carried out in the mid-1980s.
Both concluded that hospital-based apprentice training was unsafe and inefficient, and did not equip nurses with the necessary skills for the future, noted Ms Davies.
“Many of the directors of nursing that we talk to feel the cost of training has just been transferred from the government to employers”
She highlighted that, with more than 40,000 nurse vacancies in England alone, there were fears history could repeat itself with the government’s new apprenticeship scheme.
She said apprenticeships risked putting undue pressure on overstretched NHS services, as they placed the responsibility for training staff on cash-strapped employers, instead of universities.
Giving evidence to the committee, which is carrying out an inquiry into nursing apprenticeships, Ms Davies said: “The big challenge we have is ensuring we’ve got a proper environment where students can be students and where patients can be kept safe.
“Many of the directors of nursing that we talk to feel the cost of training has just been transferred from the government to employers, who are already overstretched,” she said.
“We are currently working in an environment where we have 40,000 registered nursing vacancies,” she said. “These are the people who have to be the mentors and supervisors and their focus has to be providing safe care to their patients.
“It is not chance that we have the level of vacancies that we have. This was because of poor policy, and saving money in the past. Apprenticeships themselves will not fix this. We need a whole picture of where we need investment in nursing education,” Ms Davies told MPs.
She also highlighted to the committee that prior to the scrapping of the bursary that 41% of people on nursing degree programmes were over 25 and that representation of people from local communities and ethnic minority backgrounds was better than the rest of the student population.
“We need to have incentives for people to be able to have a university education as well as people having the opportunity via an apprenticeship,” she said. “Both models need investment not just one over another.”
The RCN leader also warned that the current apprenticeship levy does not cover the full cost of training, leaving struggling health service trusts to pick up the bill.
Ms Davies referred to previous evidence on the issue of the levy that had been given to the influential Commons health select committee.
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She noted that Danny Mortimer, chief executive of NHS Employers, had told the committee that the cost of training was “probably something in the region of £125,000 to £155,000 over the four years of a nursing apprenticeship, and the levy will not capture all that cost”.
The government announced degree apprenticeships in 2016 as a new route into nursing, with an ambition to train up to 1,000 a year. But progress has been slow.
The first wave of nurse apprenticeships began at around four universities in England in September 2017, with a further nine universities also funded to offer courses from September 2018.
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However, the first wave was hindered by delays with getting courses approved by the Nursing and Midwifery Council as well as a number of other factors.
Confusion over the new levy funding system for apprenticeships, the need to support training for new roles like nursing associates, and pressure on clinical placements also contributed to delays.
Members of the Commons’ education select committee highlighted recent media reports that only around 30 apprentices had started training in 2017.
The RCN has set out four key factors it believes must be in place for apprenticeships to work as intended:
- Ensure access to a variety of clinical placements across community, general practice, social care and acute settings to ensure nursing students have the necessary exposure and experience of working in different environments
- Ensure access to safe, effective and appropriate learning environments where nursing apprentices have protected time for learning and access to mentors and assessors. Currently, providers will struggle to meet this requirement due to the unprecedented pressure they are facing
- Protect the supernumerary status of nursing students. Any compromise to supernumerary status of nursing students would compromise patient safety as well undermine nursing students’ learning ability
- Ensure a robust quality assurance process is in place to make sure that patient and learner safety is guaranteed and that there is consistency is the skill, knowledge and abilities of all nursing graduates, whatever route they take into becoming a registered nurse