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Nursing education should be freed from NHS control G eorge C astledine, U n iv e rsity of C en tral E ngland in B irm ingham
urse education is currently un der the strict control and direc tion of the NHS Personnel Direc torate. How long it will continue to be so is under review. In January 1989, the Government published Education and Training: Working Paper 10 (Department of Health, 1989a) which set out its in tentions for the future relationship between the NHS and higher educa tion in England. This working paper was one of a series concerned with the implementation of the White Pa per Working for Patients (Depart ment of Health, 1989b) which intro duced a programme of radical organizational change into the NHS. These changes have resulted in lo cal fund-holding by GPs and trust status for some hospital and com munity services. The full effects of the changes are yet to hit us; the em phasis on cutbacks in some services will probably lead to a reduction in qualified nursing staff and profes sional nursing care. The Government appears to be committed to a regional strategy, which is closely linked to local workforce requirements and tightly
N
Professor Castledine is Head of Nursing and Community Health at the University of Cen tral England in Birmingham, Perry Barr, Birmingham B42 2SU.
726
specified professional training pro grammes. This is generally referred to as ‘employer-led training’ and at tempts to create distinctive forms of managerial control over professional education. In some areas professional domi nance has been reduced to simple competencies or tasks which lowerskilled workers can perform. The creation of healthcare assistants and their list of nominated tasks is an at tempt to achieve this in nursing. Limited funding, competencies and contracts have become the levers with which professional education and development are controlled. Nursing is still a very young and vulnerable profession whose educa tional needs and course content are often misunderstood or ignored by those in power within the NHS. It has been a tough battle to establish nursing education in higher educa tion and the full benefits of this are still to be gained.
Higher education The first diploma in community nursing was established at the Uni versity of Manchester in 1959. This was the first time a nursing subject had been taught at a university in the UK. The course’s objective was a closer integration of nursing the ory and practice. A year later there followed an in tegrated degree and registration pro gramme for nurses at the University of Edinburgh. Nine years later, the University of Manchester approved the first UK university bachelor of nursing degree. Following these in itial developments there is now a considerable amount of university nursing education at both pre- and postregistration level throughout the UK. Cox (1992), at a recent Interna tional Sociological Association con ference, stated:
‘H igher education offers professional status, intellectual autonom y, a re search base and a framework for con tinuing professional education towards academic and internationally recogniz ed postgraduate qualifications.’
The government seems set on en couraging a cultural change in the UK which knocks education and challenges professional competence and control. This contrasts some what with its higher education pol icy which emphasizes access, flexi bility, openness and national initia tives in higher education.
Government control There is certainly no harm in re viewing the role of professionals but the use of managers, finance officers and personnel specialists for this purpose suggests that the govern ment has no intention of increasing autonomy or relinquishing power and financial control over specialist and expert practice. I believe the most secure and sen sible position for all nursing educa tion is in higher education, for the following reasons: • The NHS is in the midst of a ma jor shakeup because of the re forms to service delivery which are creating great uncertainty, and is therefore not well placed to manage more changes. It has a poor track record on the quality of education and opportunities for nurses. Many nurses leave during their training and many qualified nurses now find it im possible to get any form of sup port for continuing education. • If higher education was allocated the funds, these could be ring fenced for nursing education as they presently are for medical education. • Clinical placements and supervi sion of students would be more
British Journal of Nursing, 1992, Voi l,N o 14 Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
Nursing education should come outside NHS control
realistic and rigorously reviewed. Money would follow the students and be allocated to those wards and community placements that demonstrate a willingness to fol low educational objectives and a desire to be involved in student placements. Higher education is funded not only by the Govern ment but also by private industr ies and private healthcare agenc ies. Labour markets and courses are national not regional, and this is especially so for the more specialist areas of nursing care. • Allowing managers the predomi nant say in education would nar row and limit the scope of nurs ing practice and innovation. • Nursing students gain from being educated alongside students on
e ft
other health and non-health-related courses. There is a danger of marginalizing healthcare stu dents and denying them a full higher education experience. Re search has shown that of all the benefits to be gained from mov ing nursing education into higher education, the greatest benefit is the value to the students them selves, i.e. they are socialized into nursing as a lifetime commitment and given a professional identity. • The NHS has a very poor record of workforce planning, even in today’s relatively stable condi tions. Similar experience of em ployer-led training in industry suggests that, when faced with the immediate budgetary problems, enterprises find if difficult to in
vest in long-term future training. • Finally, a less closely coupled sys tem with a more autonomous education sector would offer a stronger basis for the professional nursing education required by the changing healthcare systems of the next decade. Securing nurse education under the control of the NHS Personnel Directorate was, as Tom Bolger said recently at our nursing debate on the subject, ‘Like entrusting a Rottweiler with babysitting’, 1 Cox D (1992) Working Paper 10 — Profes sional Education in Transition. Unpub lished paper presented to the International Sociological Association Conference, Lei cester, April 21—23 1992 Department of Health (1989a) Education and Training: Working Paper 10. Cmnd 555. HMSO, London. Department of Health (1989b) Working for Patients. HMSO, London
British Journal of Nursing in association with
The N ightingale & G uy's College of health presents
I N N O V A T I O N S IN C L IN IC A L P R A C T IC E R o b e n s S u it e L e c tu re T h e a tr e , G u y 's T o w e r , G u y 's H o s p ita l, L o n d o n 1 2 -1 3 F e b ru a ry 1993
The British Journal of Nursing in association with The Nightingale and Guy's College of health are organising this major two-day national event. The conference promises to be a highly educational and topical event with eminent speakers and an excellent programme. The topics for discussion will include: • • • • • • • • •
Innovations in Clinical Practice Implementing the Patient's Charter Approaches to care delivery The Nurse Practitioner Nurse Prescribing Accountability Auditing Clinical Practice — focus on standards and quality Planning your career in Nursing Career Pathways
For further inform ation please contact Jackie Grasso, Assistant Conference Manager, Mark Allen International Conferences, Croxted Mews, 286A-288 Croxted Road, London SE24 9BY. Tel: 081-671 7521. Fax: 081-671 7327.
British Journal of Nursing, 1992,Vol l,N o 14
727
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
Nursing education should be freed from NHS control G eorge C astledine, U n iv e rsity of C en tral E ngland in B irm ingham
urse education is currently un der the strict control and direc tion of the NHS Personnel Direc torate. How long it will continue to be so is under review. In January 1989, the Government published Education and Training: Working Paper 10 (Department of Health, 1989a) which set out its in tentions for the future relationship between the NHS and higher educa tion in England. This working paper was one of a series concerned with the implementation of the White Pa per Working for Patients (Depart ment of Health, 1989b) which intro duced a programme of radical organizational change into the NHS. These changes have resulted in lo cal fund-holding by GPs and trust status for some hospital and com munity services. The full effects of the changes are yet to hit us; the em phasis on cutbacks in some services will probably lead to a reduction in qualified nursing staff and profes sional nursing care. The Government appears to be committed to a regional strategy, which is closely linked to local workforce requirements and tightly
N
Professor Castledine is Head of Nursing and Community Health at the University of Cen tral England in Birmingham, Perry Barr, Birmingham B42 2SU.
726
specified professional training pro grammes. This is generally referred to as ‘employer-led training’ and at tempts to create distinctive forms of managerial control over professional education. In some areas professional domi nance has been reduced to simple competencies or tasks which lowerskilled workers can perform. The creation of healthcare assistants and their list of nominated tasks is an at tempt to achieve this in nursing. Limited funding, competencies and contracts have become the levers with which professional education and development are controlled. Nursing is still a very young and vulnerable profession whose educa tional needs and course content are often misunderstood or ignored by those in power within the NHS. It has been a tough battle to establish nursing education in higher educa tion and the full benefits of this are still to be gained.
Higher education The first diploma in community nursing was established at the Uni versity of Manchester in 1959. This was the first time a nursing subject had been taught at a university in the UK. The course’s objective was a closer integration of nursing the ory and practice. A year later there followed an in tegrated degree and registration pro gramme for nurses at the University of Edinburgh. Nine years later, the University of Manchester approved the first UK university bachelor of nursing degree. Following these in itial developments there is now a considerable amount of university nursing education at both pre- and postregistration level throughout the UK. Cox (1992), at a recent Interna tional Sociological Association con ference, stated:
‘H igher education offers professional status, intellectual autonom y, a re search base and a framework for con tinuing professional education towards academic and internationally recogniz ed postgraduate qualifications.’
The government seems set on en couraging a cultural change in the UK which knocks education and challenges professional competence and control. This contrasts some what with its higher education pol icy which emphasizes access, flexi bility, openness and national initia tives in higher education.
Government control There is certainly no harm in re viewing the role of professionals but the use of managers, finance officers and personnel specialists for this purpose suggests that the govern ment has no intention of increasing autonomy or relinquishing power and financial control over specialist and expert practice. I believe the most secure and sen sible position for all nursing educa tion is in higher education, for the following reasons: • The NHS is in the midst of a ma jor shakeup because of the re forms to service delivery which are creating great uncertainty, and is therefore not well placed to manage more changes. It has a poor track record on the quality of education and opportunities for nurses. Many nurses leave during their training and many qualified nurses now find it im possible to get any form of sup port for continuing education. • If higher education was allocated the funds, these could be ring fenced for nursing education as they presently are for medical education. • Clinical placements and supervi sion of students would be more
British Journal of Nursing, 1992, Voi l,N o 14 Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
Nursing education should come outside NHS control
realistic and rigorously reviewed. Money would follow the students and be allocated to those wards and community placements that demonstrate a willingness to fol low educational objectives and a desire to be involved in student placements. Higher education is funded not only by the Govern ment but also by private industr ies and private healthcare agenc ies. Labour markets and courses are national not regional, and this is especially so for the more specialist areas of nursing care. • Allowing managers the predomi nant say in education would nar row and limit the scope of nurs ing practice and innovation. • Nursing students gain from being educated alongside students on
e ft
other health and non-health-related courses. There is a danger of marginalizing healthcare stu dents and denying them a full higher education experience. Re search has shown that of all the benefits to be gained from mov ing nursing education into higher education, the greatest benefit is the value to the students them selves, i.e. they are socialized into nursing as a lifetime commitment and given a professional identity. • The NHS has a very poor record of workforce planning, even in today’s relatively stable condi tions. Similar experience of em ployer-led training in industry suggests that, when faced with the immediate budgetary problems, enterprises find if difficult to in
vest in long-term future training. • Finally, a less closely coupled sys tem with a more autonomous education sector would offer a stronger basis for the professional nursing education required by the changing healthcare systems of the next decade. Securing nurse education under the control of the NHS Personnel Directorate was, as Tom Bolger said recently at our nursing debate on the subject, ‘Like entrusting a Rottweiler with babysitting’, 1 Cox D (1992) Working Paper 10 — Profes sional Education in Transition. Unpub lished paper presented to the International Sociological Association Conference, Lei cester, April 21—23 1992 Department of Health (1989a) Education and Training: Working Paper 10. Cmnd 555. HMSO, London. Department of Health (1989b) Working for Patients. HMSO, London
British Journal of Nursing in association with
The N ightingale & G uy's College of health presents
I N N O V A T I O N S IN C L IN IC A L P R A C T IC E R o b e n s S u it e L e c tu re T h e a tr e , G u y 's T o w e r , G u y 's H o s p ita l, L o n d o n 1 2 -1 3 F e b ru a ry 1993
The British Journal of Nursing in association with The Nightingale and Guy's College of health are organising this major two-day national event. The conference promises to be a highly educational and topical event with eminent speakers and an excellent programme. The topics for discussion will include: • • • • • • • • •
Innovations in Clinical Practice Implementing the Patient's Charter Approaches to care delivery The Nurse Practitioner Nurse Prescribing Accountability Auditing Clinical Practice — focus on standards and quality Planning your career in Nursing Career Pathways
For further inform ation please contact Jackie Grasso, Assistant Conference Manager, Mark Allen International Conferences, Croxted Mews, 286A-288 Croxted Road, London SE24 9BY. Tel: 081-671 7521. Fax: 081-671 7327.
British Journal of Nursing, 1992,Vol l,N o 14
727
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
