Health education – managing the risks

Professor Steve West, Vice-Chancellor of the University of the West of England, reflects on the Comprehensive Spending Review (CSR) and how this could impact on nursing and allied healthcare provision. This is part of a series of blogs, where key players in Bristol’s health sector write about a health related subject of their choice. If you want to contribute, email [email protected].

We have now had two weeks to reflect on the Government’s Green Paper, ‘Fulfilling our Potential: Teaching Excellence, Social Mobility and Student Choice’, published on 6 November.

The Government’s recognition of the vital role universities play in driving economic growth and boosting productivity in the UK was of course very welcome. As a University that places a strong emphasis on widening participation and the employability of our graduates, the paper’s focus on these key areas was again positively received.

The changes set out for consultation will certainly have a significant impact across the higher education sector over the coming years.

However, it is important to note that much of the detail was not included in the paper. As always, this will be where the interest lies. I look forward to working with the Government over the coming months as this develops.

In contrast to the Green Paper, the Comprehensive Spending Review (CSR) sets out quite specific changes that will have a major impact on nursing and allied health provision.

The changes announced today are welcome, however given the potential implications on the shape of the future nursing and healthcare workforce, it is absolutely critical that we recognise and mitigate the significant risks that arise whenever there is major reform and change.

Changes to student funding

We learnt today that instead of continuing to be funded to study by the Department for Health, nursing, midwifery and allied health students will, from 2017/18, be treated the same as all other degree students, funding their studies by taking out fee and maintenance loans through the Student Loan Company. The financial rationale for the changes is of course clear and it is positive that the artificial cap on student numbers for nursing will be lifted through this change, increasing the training places available (the change in funding arrangements means student numbers will no-longer be controlled by the NHS). There are, however, very significant risks that will need to be worked through as this major change is implemented.

Maintaining quality

In particular, as the future nursing and healthcare workforce is opened up to market forces, close attention will need to be paid to ensuring that the profession is sufficiently diverse and attractive to encourage students to want to study in these areas. This is essential if we are to achieve the required increase in workforce numbers forecast by the NHS, whilst maintaining the quality of applicants. The profession needs to attract candidates with the right qualifications, attributes, motivations and values for healthcare practice, supported by high quality education, meeting the standards and requirements for registration through degree award.

In relation to the latter point, as we move to the new arrangements proposed today, it will be essential that a sufficient number of quality work placements are available to support students to develop the skills, knowledge and attributes required of graduate practitioners delivering high quality patient care. In this field real and simulated practice is vital.

Improving retention

We know that the retention of staff has been a big problem for the NHS for some time. The skilled workforce has often been lured away by the private sector or temporary staffing agencies – who are perversely capitalising on shortfalls in NHS staffing. Often this can happen just a few years after graduating. Clearly this places a huge burden on NHS finances – with a limited return on investment.

In light of the above, there is a major opportunity for the government to support the NHS by offering some sort of incentive on the loans for graduates on condition that they stay and work within the NHS for a defined period of time. This approach would ensure the investment via the Student Loans Company is retained within the NHS and the public sector and would recognise the significant public service and benefit delivered by health and social care practitioners.

Preventing skill shortages

We know from data published by the Higher Education Statistics Agency (HESA) that over the last 10 years the numbers of over 26 year olds studying at university has declined by 23 per cent. The University and Colleges Admissions Service also showed that mature students, were deterred when £9k fees were introduced in 2012; seeing a drop of 5% of over 21s in that year. We also know that four in ten mature students come from disadvantaged or low participation backgrounds. It is these mature students that make up some 60 per cent of the nursing cohort. It is absolutely critical that we don’t accelerate the decline in mature students and lose this talent and numbers from the future workforce. This is a big risk for us all and we must build in appropriate safeguards and explain the changes very carefully to potential students.

This challenge is particularly pronounced in specialist areas, which are often less attractive to 18 year old students. For example, at the University of the West of England we have been able to meet key skill gaps in vital NHS services where it has traditionally been difficult to recruit – like mental health, radiotherapy and learning disabilities – by appealing to mature students, who may also have caring responsibilities. Yet, past experience shows that these are the potential students who are most likely to be put off by the changes that are emerging.

It is clearly essential that we work together to create the right conditions to recruit and retain the very best students we can for the future nursing and healthcare workforce. We need to ensure prospective students understand the changes and the benefits of the new funding approach. It is clear that if we are to meet the additional 10,000 nurses required over the course of this parliament, universities, healthcare providers, commissioners and government are going to need to work together in innovative and creative ways to recruit, retain and energise the future workforce.

The NHS needs a strong, capable and committed workforce to sustain it through the challenges ahead, as demands for healthcare and cost pressures continue to grow. We need to recognise the public value and public good delivered by the nursing and healthcare profession. Importantly, as these changes are implemented we need to be very alive to the risks, redoubling our efforts to make the profession as attractive as possible so we pull in the talented individuals that make the NHS the celebrated institution that it is – which ultimately serves to benefit us all.