Memorandum by CVCP (SR 64)
CVCP speaks on behalf of the UK Universities,
which are now responsible (in partnership with the NHS) for all
pre-registration education and training for medicine, dentistry,
nursing and all the other health professions. In the case of nursing,
the transfer of education provision from the NHS to the university
sector has only very recently been completed.
University staff make a major contribution to
clinical research, patient care and NHS Continuing Professional
Development. They are also a major source of clinical leadership
and expert advice at local and national level.
We welcome the integration of the health professional
education into the higher education sector. Universities are uniquely
well placed to provide an educational environment in which the
skills that will be required of health professionals in the twenty-first
century can be developed. These skills include the evidence-based
approach to clinical practice, team working, and the development
of inter-professional approaches to patient care.
FUTURE NHS STAFFING
REQUIREMENTS: CVCP PRIORITIES
The following paragraph represents the joint
views of CVCP and the Council of Heads of Medical Schools (CHMS).
The two bodies made strong joint representations to the Medical
Workforce Standing Advisory Committee for an increase in medical
student numbers to meet the increasing demand for health care
professionals and to limit the high level of NHS dependence on
overseas doctors. CVCP and CHMS welcomed the Government's acknowledgement
of the need for an increase, and the post-CSR announcement that
the annual medical student intake is to be increased by 1,000
in a phased programme stretching to 2005. This expansion will
strengthen the impetus that has already been generated for the
development of new approaches to the structure and delivery of
undergraduate medical education.
These approaches include:
development of accelerated undergraduate
medical courses and new access routes into pre-clinical and clinical
adoption of proactive measures to
increase participation rates amongst ethnic minorities and lower
involvement of institutions not currently
engaged in teaching medical students;
expansion of community-based clinical
experience, reflecting the changing patterns and loci of health
further development of team approaches
and inter-professional working within the curriculum; and
an increased curricular emphasis
on health promotion and illness prevention.
CVCP and CHMS are in consultation with the Department
of Health on the development of criteria for the allocation of
the additional medical student numbers between institutions. The
implementation of the MWSAC recommendations must be fully funded
for quality to be maintained. This echoes the concerns expressed
in the Independent Report of the Task Force on Clinical Academic
Careers chaired by Sir Rex Richards (1997), which concluded that
the current pressure on clinical academic staff and facilities
was such that any expansion in student numbers requires a commensurate
increase in resources.
Nursing and the Professions Allied to Medicine
The recent completion of the transfer of all
pre-registration nursing courses to the university sector represents
a major cultural and organisation change for all the parties involved.
The schools of nursing have new partners within their faculties
and universities and also new contractual partners in the NHS.
The potential benefits of the transferin terms of enrichment
of education and training, clinical practice and clinical researchare
vast. It offers the prospect of a broader professional training
for nursing, both initial training and post qualifying, by drawing
on a wider range of staff. This need not compromise the need to
acquire specific nursing skills but it exposes student nurses
to contact with other health professionals and to people with
other skills (such as management and social science) which are
highly relevant to the practice of nursing. This makes it possible
to produce nurses who are educated to understand the broader context
of their work, to show initiative and to adapt to changing circumstances.
It paves the way for the development of inter-professional education
involving nurses and other health professionals.
However, the new structure needs time to stabilise
and new relationships need time to develop and blossom. A period
of consolidation is essential. The areas of opportunity and the
matters of concern, which are highlighted below, should be considered
in this context:
Universities and the NHS education
consortia with which they contract must work to develop a long-term
partnership in place of a crude purchaser/provider relationship.
This is necessary because it recognises the changed environment
of nursing education (as above). Only in a relationship based
on partnership can the potential of the move into HE be realised
fully. There must equally be a partnership approach between the
Universities and the Professional and Statutory Bodies, on the
basis of recognising the proper function of each.
The image of the nursing profession
needs to be enhanced if recruitment and retention rates are to
The near parity of applicants and
training places for nursing training at sub-degree level means
that the application process (unlike that for medicine, dentistry
and the PAMs) does not put students' motivation to the test. This
may be one factor contributing to the high drop-out rates for
nursing*, which are markedly higher than for medicine and the
CVCP is working with the NHS Executive
and individual universities to share and disseminate good practice
in recruitment and to develop family-friendly modes of course
delivery. More account needs to be taken of APEL (Accredited Prior
Experiential Learning) in this context.
The expansion of skills required
of nurses and other health professionals in the twenty-first century
and the development of a team approach must be reflected in the
training these groups receive. The requirement is not just for
multi-skilled teams but also for multi-skilled individuals. Vice-Chancellors
recognise their responsibility to exercise leadership in promoting
the inter-departmental and inter-faculty approach required to
realise these requirements.
* An important caveat is the present confusion
about the basis of current calculations of drop out and completion
rates, which often fail to take account of different modes of
study and their effect on the length of courses. CVCP wishes to
work with the Funding Councils and the NHS Executive to establish
an agreed methodology.