The government’s ambitious target for recruiting more health visitors has driven the training and mentor system close to breaking point, practice teachers have warned.
An investigation by Nursing Times has uncovered mounting pressure to maintain standards while training students to meet a key government target to boost health visitor numbers, and growing concerns of the limited support available to inexperienced newly-qualifieds.
“Unless you put some protection around practice teachers, it’s not sustainable in the long-term”
Anonymous practice teacher
The government introduced its Health Visitor Implantation Plan in 2011 to create 4,200 more staff by April 2015. But practice teachers told Nursing Times that since then they had been asked to move away from the traditional model of 1:1 training and instead must support many more students.
In some places, this meant they were now responsible for up to 10 students at a time, often with no reduced caseload. Experienced practice teachers have warned of “burn out” as a result.
The larger ratio has been made possible by students being supervised by either experienced health visitors acting as mentors, or trainee practice teachers, who then reported back to practice teachers for sign off.
A Nursing and Midwifery Council circular distributed in 2011 suggested this “long-armed” model of training was acceptable, but that “professional judgement” was required to decide on how many students could be allocated per teacher.
Concerns have been raised that a similar arms-length approach to training may now be taken to fast-track new district nurses into short-staffed community settings.
“As practice teachers we have been sold down the line really, in that we just got more and more,” said one practice teacher from a trust in the north west of England who has supported up to five students at a time and asked not to be named.
“We have been caught between the NMC guidance, which was very flimsy and left open to compromise, and trying to maintain standards,” she told Nursing Times.
“There is always a concern where practice teachers have to carry a full, or near to full, caseload”
She and other teachers said the increasing numbers were not the only problem, but that the government’s target had also resulted in a swell of students entering training straight from their undergraduate degree nursing programmes.
This meant recent trainees were often inexperienced and less sure if health visiting suited them, compared to previous intakes that would have usually spent time in practice beforehand.
Students have been “more difficult to handle,” according to the practice teacher, who has 20 years’ experience. She said: “Even where we have had students that weren’t doing particularly well it became more and more difficult to fail them because the targets were there.”
She added that it was also “very stressful” trying to maintain standards within her own caseload, which was not reduced. It was concerning that trusts have viewed the implementation plan as a success and are now discussing whether to use a similar model of training for district nurses, she told Nursing Times.
“Unless you put some protection around practice teachers, it’s not sustainable in the long-term. You can do this for the short-term over a few years but now everyone is burnt-out,” she added.
Sarah Morton, a health visitor practice teacher at Cambridgeshire and Peterborough Foundation Trust, said it had been an “extraordinarily hard few years” since the implementation plan was introduced.
“I know I’m not alone in saying it has been enormously hard work, emotionally and practically and in terms of organisation,” she said.
While her trust had supported staff to adapt to new models of training, other organisations had not, she said, warning that mentors were also often not seeing their caseloads reduced.
“I’m not alone in saying it has been enormously hard work, emotionally and practically”
Meanwhile, another practice teacher who has been in post for two years – and also asked not to be named – claimed she and her colleagues had been “inundated” with students. She said her “real worry” was that there were not enough experienced health visitors available to deliver “vital” preceptorship programmes for the vast number of newly qualified students.
Helen Donovan, the Royal College of Nursing’s professional lead for public health nursing, said: “The thing people are concerned about is that there is a gap – there are a few very experienced health visitors in the system and then you’ve got a lot of newly qualified health visitors.”
Ms Donovan said the government’s implementation plan had been managed better in some trusts than others, but said this “patchy” training provision had always been a problem.
“There is always a concern where practice teachers have to carry a full, or near to full, caseload as well. In theory they should have a reduced caseload but we know that that doesn’t happen across the board,” she said.
“What we are interested to know is have the new models got benefits and what is their impact on student learning”
Preliminary findings from UK-wide research into the impact of the new models of health visitor training has found some instances where a practice teacher was supporting up to 10 students.
The research – which is looking at 45 higher education institutions and their student placements – has so far shown a wide variation in how far the teacher’s caseload is reduced.
“What we are interested to know is have the new models – which we have been forced to use because there were so many students – got benefits and what is their impact on student learning and ultimately service delivery,” said lead researcher Mary Malone, head of post graduate taught programmes at King’s College London’s Florence Nightingale Faculty of Nursing and Midwifery.
“We need to watch the numbers of students to practice teachers, but we do need to look at not just ratios, but the support in place for everyone who has students, and the extent to which learning opportunities are opened up or closed down,” said Ms Malone.
Unite professional officer Dave Munday said the union had consistently highlighted problems with the high ratio of students to practice teachers.
“With the end of the implementation plan at the end of March, it is important to continue investment in practice teachers and we are concerned that the current approach to varying ratios so widely will have a negative impact to this aspiration,” he said.
“It is important to continue investment in practice teachers”
A report published last year by the national workforce body Health Education England noted that practice teachers had raised concerns about maintaining quality with higher ratios of students, and said they believed their caseload should be reduced.
It also stated that large number of additional students since the implementation plan had put “an additional strain on practice teachers and preceptors with a subsequent impact upon student health visitors”.
Asked about the concerns, a Department of Health spokesman said: “We know health visitors and practice teachers play a vital role in giving families the best start in life.
“This is why we are investing more than ever before in the profession and now have 3,890 more health visitors than in 2010, however decisions about student to teacher ratios are best made at a local level,” he said.