Examination of Witnesses (Questions 160-179)
WEDNESDAY 4 APRIL 2001
SIR JOHN BOURN, KCB, MR GLENN HULL, MR NIGEL CRISP AND SIR BRIAN FENDER
160. You have got 6,000 more over the last year, so you are expecting to be full, so to speak, in three years' time with the current rate of recruitment and training?
(Mr Crisp) Let me put it another way. We have started all that but I would not necessarily predict that we will get 6,000 in each of the next three years.
161. What is your prediction for when you will meet your target and have all of the available places full?
(Mr Crisp) My prediction is that we will meet the 20,000 before the target we have set.
162. The target you have set is 2004?
(Mr Crisp) That is right.
163. And at that time you will still presumably have this number of training places?
(Mr Crisp) Yes.
164. You have only recently been training the extra people you need to make up the number that are leaving.
(Mr Crisp) That is right.
165. Are you suddenly going to have to reduce the number of training places again in order not to find you are training people for whom you do not have employment?
(Mr Crisp) The point I wanted to make separately is that we will always have a number of vacancies because nurses turn over, so we will need to allow for a proper level of friction in the system. But the point is that we have done the workforce model for the targets in the NHS Plan that apply to 2004 but the NHS Plan is a ten-year plan and we expect to see within the plan further expansion after 2004.
166. So the 20,000 that you are trying to fill is up to 2004?
(Mr Crisp) That is right.
167. What you are saying is you are expanding beyond that?
(Mr Crisp) That is subject to any future Government and the decisions it will make on spending.
168. Are you saying that if a future Government does not continue to expand the number of nurses needed you will after 2004 find yourself training considerably more nurses than there are places for? That is what you appear to be saying.
(Mr Crisp) It depends on the policy of the future Government as to whether it is expanding or contracting.
169. If the Government decides after 2004 to keep the number of nurse places where it is in 2004 then am I right it saying that you will at that point be training a lot more nurses than you will have places for?
(Mr Crisp) Not necessarily. If you continue that over a number of years the answer is yes, but the other point is that that is not the only thing that it will eat into. It will eat into, first of all, the vacancy rate, secondly, it will eat into the amount of agency nursing we use and, thirdly, it will eat into international recruitment.
170. Most of the agency nurses are people who have been trained through the NHS anyway, as you have already said, so if you eat into the number of agency nurses you are using that simply means that fewer people will want to go from the NHS training into agency nursing because there will not be so many agency jobs for them.
(Mr Crisp) I think that is probably the case. I think one also needs to look at whether agency nurses are working more than 40 hours a week in terms of the work they are doing to get the calculation right.
171. So what will happen is that those NHS nurses who are also those working for an agency to make a bit more money will no longer find that they have that overtime available to them?
(Mr Crisp) If there is not the demand in the system for nurses then a number of things would give and one would be agency work. But perhaps the first thing that would give is international recruitment, bearing in mind we have very deliberately gone out for strong international recruitment at the moment. It is the point I made to one of your colleagues here, Mr Campbell, that we are trying to maintain and develop the service at the same time as we are growing our own staff, and if some of the short-term measures such as international recruitment fall over the time then that is another sensible thing to have happen.
172. Mr Burns may find that there are no more of his nurses available for deportation after that. Can I turn to figure 5 on page 25. I still have not quite understood. I am not sure you have really given us an answer as to why there are such big differences between different institutions here.
(Sir Brian Fender) As we said, the two major factors which would influence the attrition rate would be the average age of the cohort and their qualifications. There may be other factors. I am simply picking out two strong influences on the attrition rate. In practice this period when the NAO Report was done was a rather turbulent period as far as entry into nursing education was concerned. The Colleges of Nursing had been transposed into universities and colleges and the evidence that I have got (because I have looked at some of these high attrition rates) is that the present level is much lower, that in fact there is evidence of success on the ground of attrition improving, particularly these high attrition rates. I can give you specific examples if you like.
173. That still has not answered the question as to why they are different for different institutions That is an overall picture you are giving us. Why are some so much better than others?
(Sir Brian Fender) The mixture of students, the make-up of the student body will vary from institution to institution depending where the institution is perhaps, so not all
174. Why should it vary in terms of what qualifications and what level of people they are taking on?
(Sir Brian Fender) The truth of the matter is that the variation of qualifications between institutions is quite high.
175. So some institutions are taking people a lot less qualified than others?
(Sir Brian Fender) That is so, yes.
176. Is that something you are happy with? I would have thought that if you were finding that those institutions taking less well qualified students were getting a much higher attrition rate then maybe you ought to be saying something about it.
(Sir Brian Fender) You can turn it round the other way and say, yes, the probability of not completing is higher if your entry qualifications are lower but nonetheless even with relatively low qualifications, taking into account this broader question of experience of students, the proportion completing is high.
177. We are still wasting a lot more money potentially.
(Sir Brian Fender) Every student who does not complete is a loss in one sense in personal terms
178. Let me put it in this way to you: is it not sensible that we should set some sort of national level? Either it is right that we should go for high qualifications and only getting a ten per cent attrition rate or it is right that we should set low qualifications and be prepared to put up with a 33 attrition rate. To say that it does not matter and that each institution can choose what it goes forsurely there must be an optimum position between those two in which you are getting best value for money?
(Sir Brian Fender) Clearly if you raised the qualifications too high you would not have enough nurses. If you make the qualifications too low then you will have a high drop-out rate and a loss of money. Indeed, what you see is a system which is not yet optimised because one would like to cut the attrition rates, but a system which is delivering students, it has delivered the growth, it has delivered the quality of education, it has delivered satisfactory nurses.
179. It may have done that overall but what I am suggesting to you is that it cannot be right to go both for an attrition rate which is high and take people in with low qualifications because then you give the maximum number of people the chance and you get more people into nursing, and that it is right for other institutions to go for a much higher qualification rate because that brings down the attrition rate. There must be, surely, an optimum level of qualifications in order to minimise the attrition rate but get the right number of people into nursing?
(Sir Brian Fender) I think we are perhaps over-simplifying it. There are two major influences on completion. There are a lot of things which can be done in terms of individual support which will help the attrition rate and lead to more nurses completing. There are some lessons to be learned in the non-nursing area. We give institutions extra money in order to ensure that students from low participating backgrounds, which tend to have lower qualifications, do have that extra support which makes them more likely to continue. We are doing a lot of work in this way on trying to identify the factors which help students sustain their courses and complete and we will go on doing that.