The education of our nursing workforce is poised to hit the headlines once again when evidence is presented to the Education Select Committee, to understand why nursing degree apprenticeships are not taking off.
There are many misconceptions around the nursing degree apprenticeship route; the quality of the training isn’t as good, they don’t have the same amount of practical experience, they reduce access to nursing for mature students. However, these are unfounded.
Fundamentally, whatever the route, every nurse must be trained to the same degree of quality and measured by the same outcomes and standards.
”The cost of covering staff when they are training is a major concern for a lot of trusts”
As the largest provider of health and social care education in England, Sheffield Hallam University fully supports the degree apprenticeship agenda.
Since 2015 we have invested considerably in expanding the availability of high-quality apprenticeship provision for local and national employers in a range of sectors.
Within health and social care, this includes membership of a number of trailblazer groups across the allied health professions and nursing.
While Sheffield Hallam does not currently offer the registered nurse degree apprenticeship, we have everything in place to, if and when demand materialises.
There are a number of reasons why it hasn’t just yet, which explains the lack of progress made towards the government’s target.
The cost of covering staff when they are training is a major concern for a lot of trusts who are already facing many financial constraints.
The Nursing and Midwifery Council has maintained its requirement for registered nurse apprentices, to complete the course as set out in the standards for education. This means that they must spend 50% of their time in practice and 50% studying theory as a student, which equates to 2,300 hours on placement in a supernumerary status.
These requirements mean that apprentices are only available to work as a full time member of staff in their substantive employed post for 38.5 out of 192 working weeks during their four-year apprenticeship.
The 80% ‘off-the-job’ time, when the apprentice would be in an education setting, would have to be backfilled by the employer to maintain a safe and suitable service. This remains a financially unattractive prospect.
I understand that the Nursing and Midwifery Council has recently indicated it will drop the requirement for the apprentice to be supernumerary for the 2,300 hours, a change which we would welcome as it will significantly reduce the burden on employers.
However, even with this change apprentices will still be ‘off-the-job’ for 50% of the time, presenting the challenge of backfilling - a requirement which cannot be met through apprenticeship levy funds.
Another issue is the direct loss of income due to rules around the work placement tariff. Universities pay healthcare providers to place full-time healthcare degree students through this tariff.
However, under current regulations apprentices do not qualify for this tariff to be paid. As there are a finite number of practice placements, health trusts would lose tariff income if they used placement capacity for apprentices over full-time degree students.
Furthermore, anyone undertaking a nursing apprenticeship will be studying for 48 months, which is longer than the traditional three-year undergraduate degree or two-year pre-registration nursing masters. So, under the present rules, it will take longer for a healthcare provider to benefit from a qualified apprentice than a qualified undergraduate. This represents another disincentive for trusts.
The end-point assessment (EPA) rules also present a problem. It was designed to enable universities that deliver nursing apprenticeships to modify their current degree programmes, rather than undergo the lengthy process needed to validate a new course.
However, once an apprentice has achieved their award in nursing, be that at BSc or master’s level, they are eligible to register as a nurse irrespective of whether they complete the EPA or not. Within the current rules, there is a financial penalty of 20% for the provider if students fail to complete their apprenticeship (around £5,400) – which includes a penalty for failing to complete the EPA.
Many universities will view this risk to funding as unacceptable. The potential level of non-completions would have a major impact on the institution’s overall completion rates, which, in turn would affect their Education and Skills Funding Agency contract. These factors are yet another risk associated with providing registered nurse degree apprenticeships.
”Financial, regulatory and practical factors combine to make this lower skilled route a more attractive short-term fix for employers”
Finally, the introduction of the nursing associate higher apprenticeship and the anticipated Nursing and Midwifery Council regulation of this route has had an impact. The former is a two-year programme and, unlike the registered nurse degree apprenticeship route, there is currently no requirement for supernumerary status or any particular split in practice and theory time.
The aforementioned financial, regulatory and practical factors combine to make this lower skilled route a more attractive short-term fix for employers. The numbers already indicate that the NHS will see a significant boost in regulated nursing workforce via this route, albeit not of registered nurses.
By early 2019 the number of trainees on the nursing associate higher apprenticeship route will be close to, if not in excess of, those which the government aimed to have on the registered nurse degree apprenticeship within one year of its launch.
However, while the registered nurse degree apprenticeship route is unattractive for trusts, universities and indeed potential students in its present form, the principle is sound. As outlined, some simple reforms to remove these barriers could reverse this trend.
Universities such as Sheffield Hallam, a national leader in creating innovative and real-world solutions for tackling today’s health and wellbeing challenges, are ready to play our part to help supply the NHS with its next generation of registered nurses.
Toni Schwarz is deputy dean, Faculty of Health and Wellbeing, Sheffield Hallam University