Select Committee on Health Appendices to the Minutes of Evidence


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.


Medical Staffing

  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 courses;

    —  adoption of proactive measures to increase participation rates amongst ethnic minorities and lower socio-economic groups;

    —  involvement of institutions not currently engaged in teaching medical students;

    —  expansion of community-based clinical experience, reflecting the changing patterns and loci of health care delivery;

    —  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 transfer—in terms of enrichment of education and training, clinical practice and clinical research—are 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 improve.

    —  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 PAMs.

    —  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.

November 1998

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