Why do cuts in training places for nurses matter?

Deans WelcomeFiona Ross, Dean of the Faculty of Health, Social Care and Education, gives her thoughts about the recent reduction in training places for nurses in London, the political context of education commissioning and the impact on care quality for the future.

“Everyone has a view about nursing – it has lost its way, it is too academic, nurses have the wrong attitude and lack compassion. Many argue that nurses do not need degrees and that universities are responsible for producing nurses ’not fit for purpose’.

“These opinions are often based on a nostalgic view of the past that does not take account of the contemporary context of healthcare, the need for thinking, as well as respectful, practitioners or the partnership model used by the NHS to commission educational programmes from universities. Perhaps, more importantly, what is missing in the current debate on nursing is, while concerns around the quality of care mount, we are seeing simultaneous cuts in the non-medical training budget of 15 per cent over three years, resulting in annual reductions in training places for nurses and other health professionals. These cuts have been applied more deeply in areas defined as having an over supply, notably adult nurses and physiotherapists, which is ironic as it these professionals who play a key role in the quality of care, particularly in relation to older people and rehabilitation.

“What is the link between the debate on poor quality and the cuts in training places? I have three observations to make in what is, undoubtedly, a complex area. First, there is growing evidence that higher levels of qualified nursing staff are linked to better patient outcomes. David Cameron’s recent exhortation for nurses to do hourly ward rounds is to be welcomed. It is a basic tenet of nursing to observe, be in touch with the concerns, needs and recovery of patients. Hourly ward rounds, however, will be much easier to put in place, and maintain, in better staffed areas such as paediatrics and acute/intensive care areas, than in care of the elderly wards, where there may be only one qualified nurse for 26 patients. In such wards, without additional resources, hard-pressed nurses looking after patients with multiple morbidities and probably some level of confusion, as well as managing constant demands and interruptions would mean other things never get done.

“The second response to this debate is to counter the view nurses are getting the wrong sort of training in universities. Universities provide education for health professions in partnership with service users and employers. Students spend half their time in clinical practice. Employers and, in some universities, members of the public (service users) take part in interviewing prospective students. NHS commissioners have robust contract management systems, which penalise universities for failing to meet targets such as recruitment and attrition, and, in some cases, publish league tables of university performance. Therefore if nurses are being prepared, who are not suitable for the healthcare workforce, employers need to accept their part in this and work within constructive and respectful relationships with universities to shape the solutions for the future.

“This leads to my final point about the current political context of education commissioning. Driven by the need to make cost reductions, the commissioner of healthcare training in London (NHS London) has been running a competitive tender for nursing and physiotherapy education programmes, open to any qualified provider (existing university providers and new players such as private institutions). This unfolding ‘experiment’ has arguably received little attention in the higher education press, which is surprising, because the size of the contracts and the impact in terms of the effect on university budgets could lead to new entries into the market, institutional instability amongst existing providers and uncertainty for students, practitioners and employers.

“It takes three years to train a nurse. Cuts in training places today mean we are storing up problems for the future and possibly a re-run of the cycle initiated by the cuts made under Margaret Thatcher, which resulted in growth in cheaper, unqualified and unregulated healthcare assistants, acute shortages of qualified staff leading to ward closures and hospital managers recruiting/poaching nurses from parts of the developing world. If we care about the quality of healthcare, particularly for older people, it matters that we pay attention to the politics of commissioning nursing and health professional education.”

Professor Fiona Ross
Dean, Faculty of Health, Social Care and Education