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Nursing courses face axe at London universities


England’s biggest funder of adult nurse training has decided to cut places by nearly a quarter, leaving the future of some of the best known nursing courses in doubt.

NHS London’s decision to cut the number studying adult nursing each year from 2,000 to 1,580 and ask the capital’s nine nursing schools to tender to win training work could result in the closure of several courses.

A document produced by the strategic health authority in June and obtained by Nursing Times said: “Re-shaping the market, that includes some [higher education institutions] not continuing as providers, would allow the highest performing organisation to operate more sustainably.”

According to NHS London’s latest published ratings, the University of Greenwich is its highest performer. King’s College was among the four training providers given a “low amber” rating - the lowest score awarded.

The document said NHS London had tried to reduce adult nursing training numbers this year but it would have led to the closure of some universities’ nursing departments.

The report also said it was responding to an anticipated reduction in its non-medical training budget of 15% “over the next three to four years”.

NHS London said the move was prompted by quality fears. Its official announcement of the plans did not mention the budget cuts.

Speaking to Nursing Times, London’s chief nurse professor Trish Morris-Thompson said the move was “in response to concerns from the nursing profession about the quality of the product coming out of the HEIs”.

“Nurses were graduating who weren’t employable, there were issues around literacy, numeracy and attitude,” she said.

“We want to drive up the quality of training to make sure they can contribute to the workforce and are employable.”

The Royal College of Nursing’s operation manager for London Nora Flanagan said: “We wouldn’t disagree with the issues around quality, but we are concerned about the speed at which this is being done.”

She demanded guarantees that people who applied for a course at a university that was then de-selected were given a place elsewhere.

Professor Ieuan Ellis, chair of Council of Deans of Health, said the plan to bring in new contracts by September 2012 was “destabilising and fails to recognise the impact it will have on students applying to courses for 2012 entry”.

He said London deans had urged NHS London to defer implementation until 2013.

“It is disappointing that the NHSL decision to continue with the current timetable for 2012 implementation has not been communicated to universities in London prior to the statement being released,” he said.

A disproportionate number of nurses are trained in the capital’s teaching hospitals before moving elsewhere to work. A recent National Nursing Research Unit report said only 55% of nurses trained in London still worked there three years later - the lowest proportion of any English region.

Professor Jim Buchan, a nursing academic at Queen Margaret University, Edinburgh, said: “In the past London has been an engine of growth for other parts of the UK - nurses go there for specialist or pre-registration training. The question then is if London is going to reduce its training numbers will there be a knock-on effect on the whole of the NHS? The answer is yes.”

NHS London has said the current rate of adult nurses qualifying would lead to an oversupply of 6,000 by 2015 - 25% more than required.

But it intends to increase the number of nurses working with children, health visitors and midwives.

London’s reduction is the first announced by a strategic health authority since an RCN study in July found training cuts could reduce the workforce by 28% within 10 years. The college warned poor workforce planning could lead to “a return to quick-fix overseas recruitment, downgrading the current workforce and crude substitution between registered and non-registered roles”.


Readers' comments (21)

  • Well well, I think that the HEIs and also the NMC need to listen to the commissioners a little more.

    There is an arrogance in the profession at this level.
    Whilst I often challenge the conflict of interest that the RCN has as trade union and also as a professional association in this instance they are absolutely right.

    They have spent a lot of members money looking at Dignity and other issues.

    We only have to look at all the media reports about the quality of practice around at the moment.

    The education of nurses and the way they are regulated needs to significantly improve otherwise it is a lost profession. We are already on a steep downhill slope.
    Doctors seem to make suggestions for better practice these days - not nurses. Look at the Dignity poster that they developed for Continence and Older People.

    I could go on.

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  • This surely indicates a need to review the whole of nurse education and maybe look at re-introducing hospital based education, as was offerred up until project 2000 and the move into universities. Then there was real ownership of students by their respective hospitals and pride from the students themselves for the hospitals they were trained in. There are a number of lecturers in universities training our future workforce, who have themselves not been in clinical practice for a number of years. Surely we should now question this and look to providing clinically current pre regsitration programmes, taught by those with the appropriate skills? May be we should return to clinical tutors and schools of nursing?

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  • "NHS London said the move was prompted by quality fears. Its official announcement of the plans did not mention the budget cuts.

    Speaking to Nursing Times, London’s chief nurse professor Trish Morris-Thompson said the move was “in response to concerns from the nursing profession about the quality of the product coming out of the HEIs”.

    We have to take that at face value, but it does seem strange given the context of budget cuts. However, lets discuss the quality issues.

    1) The NHS has to remember that it is at least 50% responsible for the quality of students and their employability. So if their are 'attitude' problems both the HEI and the NHS has to address it. HEIs rely on mentors and now sign off mentors to ensure students are fit for practice.

    2) Literacy and Numeracy: always issues given the wide entry gate HEIs often have to adopt to get the numbers in. No other profession would put up with the low level of entry requirments. Dealing with literacy and numeracy is an argument for keeping education in HEIs and not transferring them to hospitals who will be even less well equipped to deal with this issue.

    3) Critical thinking: HEIs have been facing pressure for bums on seats and the above mentioned wide entry gate in addition to a focus more and more on competencies and skills at the expense of critical thinking. A move back to hospital 'training' would lead to a further dumbing down of the currculum, squeezing out critical thinking in the rush for vocational competence. This is not an argument of 'either or', we need both critical thinking and vocational competence to meet the challenges of modern global health care issues. Medical colleagues have accepted the need for a critical thinking discipline (Sociology) which would be under threat in a move to hospital 'training'.

    4) The 'good old days' are a myth, 'learning from nelly' often resulted in ritualistic practice without an evidence base and certainly did not foster critical thought.

    5) HEIs need support to help the development of kindness, cleanliness and competence in addition to critical thinking, the NHS must get its own house in order in some organisations in this regard.

    6) Nursing is as much (if not more) a cognitive discipline (or should be) as a 'hands on' one. Indeed without cognitive development, which lecturers are more than capable of developing, nursing is in danger of reducing down to the lowest common denominator of ritualistic oractice overseen by our educated colleagues - doctors.

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  • I agree with Benny.

    It has to be remembered that whilst there is a problem with the CONTENT of many of the courses, student Nurses still spent approximately 50% of their time on the wards, 'learning' on the job' so to speak, so it must be qualified whether they are questioning the quality of Nurses coming through the system, or the quality of the course content here. Personally I believe that there has been far too much focus on 'fluff' subjects in HEI's as of late, in the rush to compare themselves with other degrees rather than celebrating being a discipline in our own right, too much content has been included that has little or nothing to do with Nursing, whilst Nursing skills and clinical theory has been diluted. This balance needs to be addressed so the majority of the course is made up of practical clinical skills, clinical theory in pathophysiology, A&P, etc etc, and the course NEEDS to be standardised across all HEI's. However saying that, the old caveat of 'it was better in my day' and calling for the reintroduction of hospital based training is a false economy as hospital based training is not great at the moment either with the quality of student placements needing to be addressed too, there are far too many students who are simply used as extra hands for the HCA's rather than being taught valuable clinical and Nursing skills, and many other problems besides. Both of these issues need addressing.

    I also agree with Benny in the fact that as a degree profession, a higher standard for selection must be demanded for entry now. What other similar profession would not demand at the very least GCSE's in the basics, Maths and English for example, or demand A levels, preferably but not limited to a similar field? This simply ensures that those who also show and develop the caring and compassionate traits that are essential to our profession can also deal with the increased academic requirements of Nursing.

    However, there are other issues here. Whilst I think that there are issues at the moment where the numbers of Nurses qualifying cannot get jobs because the posts are not available, that does not mean the short sighted plan of cutting training posts should be made a priority. That will simply lead to a future Nursing shortage. They should instead focus on creating posts for the already qualified Nurses and those who will be coming through in the future.

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  • benny goodman | 6-Sep-2011 5:18 pm

    "4) The 'good old days' are a myth.."

    I wish that I could completely agree with you. Unfortunately, your statement isn't quite true. As a Nurse who trained in the 'good old days' and worked through my Nursing degree and Masters, I am desperate for Nurses to be trained and treated like the autonomous practitioners we should be.

    Quality of care is influenced greatly by so many factors including resources and staffing levels, and it has become rather easy to lay the blame for poor care at the feet of Nurses alone. However, whilst we aspire to better things, there is an undeniable truth that something has gone wrong with the way we train our Nurses. It is a mistake to dismiss the training of old, as it is to advocate it's return 'as it was'. The answer lies somewhere in between.

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  • Goodness me, the old argument of which training and education was/is best. STOP this now and embrace the best of both worlds. The so called 'good old days are a myth', they are not, they happened.

    Anonymous | 6-Sep-2011 6:40 pm
    I have to agree with your comments

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  • Intellectual discussion at its best.

    Something remains good about the 'good old days', not myth, I suppose.

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  • Anonymous | 7-Sep-2011 0:18 am to be fair you are right. There are good and bad points about both ways and as the anon above you says, the answer probably lies in between the two.

    I think the bigger issue here is being missed though. As I said earlier, this will have serious repercussions in the future when there is a shortage of good, qualified Nurses, this constant short sighted approach to training and recruitment completely baffles me.

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  • Dear Mike
    I am no politician and in my simplistic and humble view, this myopic approach applies not only to nurse training, which is serious enough, but to the whole of the NHS and anything else the successive governments are concerned with - they are too scared to spend money but not in the least afraid of wasting it - are pledging money taxpayers money to all and sundry, some of which they have not yet even collected!

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  • Anonymous | 7-Sep-2011 1:16 pm I absolutely agree. It is the whole paradigm of government, and the country as a whole that is the problem.

    The fact is, the money is there to spend on a first class system of public services in this country, but as you say, the government just do not want to spend that money on public services, instead those funds get spread out all over the place and wasted.

    There needs to be an instilled paradigm that the public services in this country, teaching, policing, the NHS, etc are WORTH spending the vast amounts of money on that they inevitably cost.

    This also applies to the training and recruitment/retention of the staff. We should quite simply have one of the best Nurse education systems in the world, we should have a strong and robust, universal system that brings through enough Nurses to maintain a world class Nursing workforce without there being problems with no jobs, recruitment/retention or dealing with high quotas for foreign applicants.

    Instead, what we have at the moment is a ridiculous system where enough Nurses are qualifying, but there are no jobs there for them despite the fact that EVERY ward/department is dangerously understaffed, so there is inevitably a high level of home grown brain drain and disillusionment.

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