Dermatology nurse practitioner Jill Peters has been trying for five years to access paediatric training via Suffolk PCT, but to no avail. In addition to being limited by the strategic health authority (SHA) to one college, which does not offer the course, there is no one to cover her current role.
Ms Peters’ situation is not unusual. Deficits across the NHS, coupled with the removal of ringfencing from training budgets, has seen SHAs using money allocated for training to plug holes in finances. And in 2006–2007 they cut backfill money for acute trusts
Community nursing courses were hit particularly hard. Recruitment suffered and many courses were cut. The fact that most are full-time for one year made them more vulnerable than part-time courses.
For Ms Peters, backfill is an ongoing problem. ‘I’m often in a stand-alone role, so there aren’t other nurses around who can backfill.’
Not only that, but around two years ago, the PCT cut its training budget. ‘Mandatory training came in as the only thing you are able to do unless you negotiate it with your manager and there is a clinical need or a service need for training to take place,’ Ms Peters explains.
More recently, East of England SHA chose to allocate each trust to a particular college. Previously, nurses could attend courses across the patch. Ms Peters says the PCT’s provider arm was ‘horrified’ by this decision because the previous system had been used to access the most appropriate courses. The PCT is now looking at which courses aren’t provided locally but are required for service development and provision, and how they might be funded.
Ms Peters had planned to attend a paediatric course but it was cancelled by the local college and because of the SHA deal she cannot go elsewhere. The PCT is looking into whether it can leapfrog the SHA’s decision and find another venue. ‘Then they would look at how much it costs, the time involved and the fact there’s no backfill for the service,’ she says.
Ms Peters is an adult-trained dermatology nurse but treats children with eczema, using support from community paediatric nurses and a GP with a diploma in paediatrics.
‘Some people could argue that I shouldn’t, but then you’re denying children and their families access to dermatology care,’ she says. ‘I’ve done odd days on paediatrics but I feel I need something slightly more structured to underpin what I do.’
Even before the SHA’s decision it was difficult to find the right course. ‘It’s all about the higher education places putting the courses together that are needed by nurses. There’s always been an under-availability of paediatric modules because it’s very hard to take a whole year out. Who runs my service when I’m gone?’
If Ms Peters does get on a course, it is likely to be part-time for six months. Her manager agrees it is important but it still needs to fit in with her clinical workload. ‘I’m going to have to cancel something, whatever I do, to be able to attend,’ she says.
As for other training, the amount of study leave Ms Peters receives is negotiated and sometimes she attends courses in her own time. Her manager does recognise that she works in a specialist area and needs to attend national conferences to keep clinically updated, so this year she went to a dermatology conference and prescribing conference. ‘I was actually given the time slot of the day to go but I funded my travel.’ In February she will use her own time to attend a one-day course on dermascopy.
Nurses in acute settings are also increasingly using their own time for training. One senior A&E sister and nurse practitioner, who spoke to NT but wished to remain anonymous, did two master’s-level modules of an advanced nurse practitioner course in 2005. ‘I was given a choice of whether they paid for the course and gave me some study time, or I could have all of the time but pay for the course myself,’ she says. She opted for the former, topping it up with some of her own time.
The idea behind the course was to enable her to fast-track more complex cases, such as fractured neck of femur and asthma. But her skills have been under-utilised in these cases because she has been pulled back into her previous role when other nurses go on courses.
She says financial pressures at the hospital have caused the training situation to deteriorate. ‘I’ve seen a big change in the last five years. If we’re busy in A&E, our study days have to come last because we have to see to the patients first.’
Staff sickness is another reason study days are forfeited. ‘You have to call people back from their management day or their study day because you can’t cover the place safely without the skill mix. So it’s not always about numbers,’ she points out.
The department reached a crisis point and was losing nurses, who said during exit interviews that it was because they felt their training needs were not supported.
Across the NHS the training infrastructure could become permanently damaged, says Paul Turner, executive officer for the Council of Deans of Health. Universities may cut staff but find it difficult to recruit when demand for training returns. ‘You can’t just switch education on and off like that,’ he says. ‘Education is not a simple supply chain.’
Sue Howard, education adviser at the RCN, says the future of the sector depends on organisations working together to plan training. Training needs will be greater in the community and just providing more of the same isn’t the answer.
‘There’s an awful lot of shift at the moment to care closer to home, so services need to be developed to meet that,’ she says. ‘And they won’t be unless the trusts and the providers of education get together and decide what it is they both want and need.’
But commissioners do not have clinical backgrounds and don’t always appreciate what skills and knowledge are required, says Ms Peters. ‘They want delivery, they want “how many patients can you see per pound”. I think that’s a pressure all of us are facing, wherever you work in the NHS.’
Effects of training cuts
Study days being cut on busy days and when staff are sick
Nurses quitting because their training needs are not supported
Nurses expected to train doctors but haven’t been trained themselves
Nurses using their own time to do courses
Nurses unable to use new skills acquired in training because they must cover for other nurses to go on courses
Clinics cut so nurses can attend training, because there is no one to cover
Staff quitting because their training needs are not supported
Community nursing courses cut, making it difficult to shift care out of hospital
Nurses using their own time to do courses
Some nurses treating children without having received paediatric training
Time Out For Training: Campaign aims
To persuade trusts to guarantee sufficient training time is set aside for both career progression and patient safety
To compel the government to bring back ringfencing of training budgets
To persuade SHAs to guarantee that education funds are spent only on training
To raise awareness of the importance for the profession, those in the NHS and the wider public of post-registration training for nurses
To secure guarantees for sufficient backfill to cover the training requirements of nurses
To support nurses in lobbying trusts and government on their training needs