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Exclusive: Lord Willis reveals thoughts on nurse education reform


A major review of nursing education and training looks set to recommend that future student nurses undertake care experience before starting their degrees, but that a whole year is too long.

The requirement, expected to form part of the Shape of Caring Review’s final recommendations next year, would probably be more flexible than a controversial government pilot scheme where future students spend up to a year working as healthcare assistants.

The review was set up in May by Health Education England and the Nursing and Midwifery Council to examine standards of pre- and post-registration nurse education and training. It is due to report its findings in February.

“The bottom line is no one should begin a nursing degree who does not have a relevant amount of prior experience”

Phil Willis

In an exclusive interview, the review’s chair Lord Phil Willis told Nursing Times that his final report would include a recommendation about “prior experience” for student nurses, but he suggested he was yet to finalise what it would be.  

“There will be a recommendation about prior experience, and I have moved over and back on this,” he said. “I think a year is too much, because I don’t think it is financially sustainable to deliver. But what the public demand – and which as a minimum patients should demand – is that nobody works with a patient without appropriate training and experience.

“We are looking at a flexible system, [the] bottom line [is that] no one should begin a nursing degree who does not have a relevant amount of prior experience, but there can be flexibility about how you exhibit that,” he added.

Health Education England is currently running a series of pre-nursing experience pilot schemes, in which prospective students “up to a year on the frontline” prior to starting their degree. The pilot was sparked by the government’s initial response to the Francis inquiry in 2013.   

Lord Willis also reiterated themes discussed at the chief nursing officer for England’s summit in November, where it was suggested student education should initially be more generalist in order to break down “silos” between specialisms.

Lord Willis

Lord Willis of Knaresborough

Currently, nurses pick one of four specialisms to study at university – adult, paediatrics, mental health or learning, and disability.

Lord Willis told Nursing Times he was exploring “whether there should be a greater element of generalism, with preceptorship being the start of the specialist process”.

“They [students] might do two years of really detailed rigorous general nursing and then begin their specialism in the final year and run that on into preceptorship,” he said.

Meanwhile, the Liberal Democrat peer criticised the current lack of a structured career path for nurses, describing it as like “snakes and ladders” with no clear paths or milestones.

Nurses must instead rely on “luck and judgment” to progress in their careers, he said.

He also repeated concerns over nurse mentoring, adding that his fears had been “reinforced” by evidence given to the review. He hinted that he might suggest a more formal role for nurse mentors, rather than the current situation where it is a duty expected of the majority.

“I remain convinced that mentoring needs to be streamlined and further professionalised; a key role in any organisation with recognised status. I don’t buy that everyone can be a mentor,” he said.

“In 10 or 15 years, unless we change, it will not be fit for purpose”

Lord Willis

The review would also examine whether the independent sector could play a greater role in the education of nurses and the need for universities to improve their training to achieve consistent quality.

Speaking generally about the state of nurse education at present, he said: “Nurse training is pretty good and there isn’t much you would criticise apart from the fact there has been a greater call for standardisation.”

“It is certainly fit for purpose in 2014 but in 10 or 15 years, unless we change, it will not be,” he warned. “Raising the bar is really important.”

He added: “I have been genuinely staggered by the amount of innovation that is going on right across the country which, if replicated, would make a profound difference to the quality of care that we give and the quality of experience for staff giving that care.”


Readers' comments (14)

  • I agree with this new change as it will give people an insight into the whole caring experience which is not as one seems to find it. Until you have not had the experience you will never know what it is like until you have been "thrown in the deep end".

    However, in terms of experience it may be difficult to find due to the volume of staff and patients on the ward, as well as this all trusts have their own way of recruiting people, some may be more willing than others to take people on for experience.

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  • This is fine as long it is paid and not voluntary.

    Maybe the focus could be taken away from nurses and this idea be implemented into training of Doctors, OTs, Physios etc. There is often a lack of understanding of the care delivery demands under which qualified and unqualified staff operate every day.

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  • Couldn't there be a program to let prospective nurses volunteer at a trust one day a week during their sixth form years? That way they could build up their experience in Year 12 so that by Year 13 they were able to help out on wards as 'Volunteer HCA'. Just thinking that I would not have wanted to undertake a full year out of my life to prove that I could be a nurse when members of the medical, radiological profession don't also have to.

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  • Fantastic ideas, we in the Nursing Homes Secor have been advocating this system for years and will support it 100%.

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  • Hmm - not sure I agree with Lord Willis.
    1. Nurse Education is not fit for purpose now - you only have to read reports from the Ombudsman, Patients Association etc...
    2. You need three years to develop generalist skills - particularly now that nurse education is 50:50 theory and practice.
    It took me three years to feel confident in generalist skills and that was working in practice virtually all the time.

    Come on Lord Willis - can't you see the warning signs now that you are being paid to do a second review as the first was not at all adequate.

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  • Why would prospective Children's nurses want to or need to work on Adult wards? If this proposal goes ahead those people wanting to work with sick children may decide not to apply for training. This would be disastrous.

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  • A good idea as long as it is paid work and productive.It may then stop students hitting the wards on placement and suddenly realizing it is not Holby.What would be better would be if when training they were told that whenthey qualify they will actually work and not just be pen pushers with all the work done by care assistants.
    Another huge point would be to sort out the entry qualifications....some uni,s want 3 B,s at A Level and some will take 2 D,s,or even worse a mismatch of diploma,s and Btec,s or access etc...i am not saying good exams make a good nurse but lets have an even standard of entry.

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  • Good that Lord Willis has found lots of innovation in nurse education but it angers me that nurses are always singled out for special treatment. Post-Francis, nursing was the only professional group to be punished.... The other members of 'multidisciplinary' team just walk away.

    So, why is it just nurses who need pre-course exposure to patient care? Why not for doctors, Physios, midwives, radiographers etc....
    I actually think it is a good idea as along as it is planned, well-structured and evidence-based i.e what type of pre-course patient experience will really help potential health care professionals understand clinical care for the patient group they wish to work with?

    If this is to become a mandatory requirement, the NHS needs to think long and hard about how it can be offered - and not put people off clinical careers.

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  • As usual, the big stick is being waved at nurses as the core of all the woes of the health service. Appropriate selection for degree programmes, which in my opinion is quite rigorous in most institutions should be maintained and enhanced. I've interviewed prospective students for nursing degree courses and they have ranged from keen and interested individuals who obviously researched their potential career options, did appropriate volunteer work etc to some applicants who did none of the above and applied to nursing seemingly as an afterthought. As a previous post suggested why are these recommendations not being applied to all healthcare professionals?

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  • Nursing education is just like any other professional education . what is the need of a pre-training when students are exposed to sufficient practicum during training?

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