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It’s common sense, innit?

April 23, 2015

This week: more flesh on the bones of Labour’s election pledge to recruit an extra 20,000 nurses to NHS England in the next five years. Unfortunately, the result was less rippling thoroughbred champing at the bit and more tired old nag headed for the knacker’s yard.

On the plus side, Labour is to be congratulated for being the only major party to have come out with policies specifically about nursing. On the minus side, you’ve got to be concerned that Shadow Health Secretary Andy Burnham’s plan to expand the nursing workforce, though praiseworthy in itself, will come the price of prioritising quantity over quality. And in an ‘exclusive‘ in the Sunday Express last weekend, those fears appeared to be confirmed from Mr Burnham’s own mouth.

Although lengthy, his words are worth quoting in full. “Because nursing has become a degree profession and then with the changes to the way higher education is funded” he said “young people, who perhaps even a generation ago would have aspired to become nurses…now cannot see a way through for them any more…There are thousands of young people…on zero-hours contracts, often being paid less than the minimum wage, receiving minimum training and probably feeling completely undervalued and forgotten. I want to give [them] a route into the NHS, so we will be talking about fast-track apprenticeships for people working in care…to move up into these new nursing posts”.

Now I don’t know about you, but I can’t make much sense of this. First of all because it has no basis in reality. When Mr Burnham warns that ‘young people’ are being put off nursing because it is all-degree and because of ‘changes to the way higher education is funded’, what planet is he on, exactly? Is he aware that 30,000 people applied unsuccessfully for places on UK nursing courses last year? Or is he conveniently ignoring it because it doesn’t fit his policy agenda?

There is absolutely no evidence that degree nursing is deterring applicants. In fact – the reverse is true: all UK nursing degrees are heavily over-subscribed. But Mr Burnham’s words contain strong hints that his party is seeking an alternative to degree education as an entry portal to nursing. It doesn’t matter that this analysis flies in the face of all the evidence about graduate nurses and patient outcomes; it doesn’t matter that it would apparently be forced onto the profession without any debate whatsoever; it doesn’t matter that yet again nursing is insulted by the implication that it is not worthy of being a degree subject. It doesn’t matter because – to borrow a cliché beloved of bar room bores the world over – it’s common sense, innit?

And it doesn’t even end there. This ‘army’ of new nurses will, in Mr Burnham’s words, be exclusively ‘homegrown’ or – to revert to the Sunday Express‘s more unambiguous language – ‘British’. So if you were a young EU national, resident in this country and contributing to society for the last few years by working as a health care assistant, you would be presumably be denied a place on the new scheme. I’d like to see a Labour administration defend that one in court.

Ladies and gentlemen, I could understand (not condone) if this bilge was being spouted by the likes of Nigel Farage. But this is not UKIP – we now seem to be in a position where even the so-called ‘electable’ parties feel it’s perfectly legitimate to use nursing as a vehicle for peddling a toxic mix of anti-intellectual (only fast-track apprenticeship nurses, we are told, will be capable of ‘chang[ing] the way care is provided’) misogynistic, xenophobic populism at the expense of clear and incontrovertible evidence. Nursing, in other words, is yet again being reduced to political football. It makes me sick – and I’m an instinctive left-leaning voter.

In the Sunday Express article, Andy Burnham was silent on the specifics of how students undertaking his ‘fast-track apprenticeships’ would be funded (centrally, by Health Education England? Or locally, by individual trusts?) but the concept of apprenticeship generally implies financial remuneration in return for a level of participation in the workforce. So one interpretation of these new plans is that they’re nothing but a quick, cheap and untested way to recruit extra pairs of hands.

Of course, some students have argued that payment for time spent on placement (at least at National Minimum Wage rates) would represent a way out of the current student funding morass. Morally – given that student labour does make significant contributions to patient care – acknowledgement of this in the form of financial recompense seems fair. But the break with supernumerary status would be important ideologically, and would need to be supported by firm guidelines on what students should, and should not, be expected to do on placement.

Far more likely, in my opinion – and pace Andy Burnham – is that bursaries will be allowed to wither on the vine. Students undertaking standard nursing degrees will increasingly be expected to save the NHS money by funding themselves via the student loans system. It’s already happening at University of Bolton and – crucially – it does not appear to have put applicants off. But where the alternative is a (possibly) less financially-painful apprenticeship, what would you do?

Currently, the only way for a UK nurse to join the UK Nursing and Midwifery Council register is by successfully completing a degree course run by an approved institution. Any change to that would require a change in the law. In this respect, Mr Burnham’s plans leave many questions unanswered: would the apprenticeship also be a degree? Would it lead to one? If so, what would be the status of the nurse who had completed the apprenticeship but not the degree? Would it mean a return to two-tier nursing? Most importantly, would it mean a dumbing down of nurse education by the back door and with no debate? And how would that benefit patients?

  1. We HAVE a two-tier system. The first tier is a registered nurse, educated and qualified to do the role. The second tier is manned by Health Care Assistants, unqualified, often uneducated and unregulated. Like it or not, HCAs do the majority of nursing care in many organisations. This is not going to go away.

    Only yesterday I was talking to a Practice Nurse Facilitator who has now been told to teach HCAs to cannulate, catheterise, monitor blood sugars and manage intravenous fluids. Excuse me, but I thought this was what qualified nurses are supposed to do. You won’t need nurses if HCAs are upskilled in this way – and still all unregulated.

    Our profession needs to wake up before it ceases to exist. It’s about time we paid some attention to our mistakes over the past 20 years and did some proper analysis and synthesis – a natural thing to do for a graduate profession, surely. I don’t think people really want to know how bad things have become, how toxic the health service is and how it will implode if we carry on in the current system.

  2. Hi Barbara. I completely agree that ‘professional drift’ has quite scandalously allowed invasive procedures that were once the exclusive province of regulated staff, to pass down the food chain so that they are now routinely performed by staff against whom patients have no regulatory protection. And while I believe there are genuine difficulties – given the low status of many jobs in the care sector and the consequent tendency of workers to drift in and out of them – with introducing retrospective regulation for care staff, the roll-out of the new ‘Care Certificate’ could have provided a starting point. That it has not done so is a huge missed opportunity.

    I sometimes think that what wards need most is a new grade of staff to take on admin work – referrals, bed management, ordering, answering the telephone, chasing transport and all the stuff that seems to take up increasing quantities of nursing time but is not actually nursing. For nurses, what is particularly frustrating about all this stuff is that they are told by managers that they have to prioritise it over ‘real’ nursing.

    I also agree with you that self-interrogation and reflection is the one of the hallmarks of a graduate profession. So maybe there is little point in nursing being a graduate profession if it is never going to be allowed to come up with its own solutions to its own problems, but rather, is always going to be handed political ‘solutions’ by people who have no understanding of what those problems are.

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