Memorandum submitted by the Council of Deans and Heads (PAC 00-01/115)
Evidence from the Council of Deans and Heads of UK University Faculties for Nursing, Midwifery, and Health Visiting to the House of Commons Public Accounts Committee meeting on 4 April 2001
1.1 The Council of the Deans has 70 member Universities and is the principal source in higher education of collective views on all matters relating to education and research for Nurses, Midwives and Health Visitors. It aims to respond dynamically to the changes in the professions, and wider developments in health services and higher education.
1.2 The Council welcomes the National Audit Office Report "Educating and training the future health professional workforce for England" and has valued the wide consultations with both individual university faculties and representative bodies that have taken place during the study. The report is a clear analysis of a complex system involving a number of stakeholders.
1.3 The education and training of nurses and allied health professionals has undergone continued dynamic change, particularly since the integration into higher education in the 1990s. The tenor of this report reflects the success of these developments. This is also demonstrated by the subject overview report recently published by the Quality Assurance Agency for Higher Education, which is referred to below.
2. PARTNERSHIP BETWEEN THE NHS AND HIGHER EDUCATION
2.1 The Council welcomes the emphasis throughout the report of the need for enhanced collaboration and partnership between the NHS and Higher Education Institutions to deliver high quality education and training, particularly in clinical placements. We have been concerned at the wide variation in the nature and effectiveness of the relationships between Consortia and Higher Education Institutions (HEIs) across the country. We welcome the observations in paragraph 4.7 that "the Department of Health acknowledges that it will be important for the new Confederations to actively seek to build good working relationships with their management teams and the HEIs", and that " developing effective partnerships requires good working relationships at the operational level".
2.2 We note the several references in the report to the need for the new Confederations to apply criteria and guidelines consistently to facilitate effective partnership working. However, we believe there will need to be clear leadership from the Department to ensure that the unhelpful variation in relationships which occurred with different Consortia is not replicated with Confederations.
We welcome the recommendation 9 for Confederations to work with HEIs to "develop and implement joint strategies to address the problems in arranging good quality practice placements", and recommendation 12 for Confederations "to implement and build on the new joint guidance on providing and managing practice placements, and to seek to spread good practice in this area". These recommendations should be considered alongside the conclusions of the "Subject Overview ReportNursing" recently published by the Quality Assurance Agency (QAA) (1), which include in paragraph 54b "However there is an increasing difficulty in finding adequate diversity and quality of practice experience to meet the recent growth in commissioned numbers".
The provision of sufficient placement opportunities and the continued enhancement of student learning experiences in practice placements are high priorities, which need the full commitment of the NHS as well as Higher Education.
3. CONTRACTING FOR EDUCATION AND TRAINING
3.1 The Council welcomes the recommendations 10/11 that "more collaboration should be introduced into the contracting process", and that there should be longer term contracts; also that the Department should "reconsider the guidance on contracting and the extent to which the move towards better partnership working will need to be reflected". We also welcome the recommendation 11 of a move towards "a common generic pricing approach for core elements with flexibility for local variations such as geographical location, accommodation, and staffing differentials".
3.2 The Council agrees with the NAO that there are a number of historical and structural factors which have contributed to the variations in price per student, including the effect of competitive tendering. However, we note the NAO's observation that, while there is wide variation at the extremes, the variation around the mean for half the contracts is relatively small.
3.3 The Council would strongly support a move away from competitive tendering towards the joint development by Higher Education and the NHS of benchmark core prices. We would support such a common generic pricing approach, providing flexibility is retained for the local variations taking into account cost differences that may depend on geography, accommodation, travel etc.
3.4 The Council notes the finding that the contribution to institution overheads in NHS funded contracts is much less than for non-NHS funded contracts. This will clearly limit any further reduction in the price per student in contracts.
4. CAPITAL DEVELOPMENT
4.1 The Council notes the observation in the Key Findings that "many HEIs believe that if they are to continue to expand student numbers there will need to be investment in the capital infrastructure". We also note that recommendation 11 states that the Department of Health "needs to examine the policy governing contracts especially on the treatment of capital development and research in contracts".
We believe that further capital investment is required to sustain the quality of education and training, and to cope with the expansion of student numbers now being commissioned.
4.2 The QAA Overview report (1) includes the comment (paragraph 44) "Where accommodation has been purpose designed, reports suggest that students benefit form an enhanced learning environment. However, the more usual picture is one of students studying on split sites where the quality of accommodation is variable . . . 26 per cent of reports highlight the use of accommodation that is not appropriate for the teaching activity taking place . . . Increased student numbers have compounded accommodation deficits in some provision".
4.3 We believe there is an urgent need for the Department to review the policy on the provision of capital, and to move to much longer contracts which would enable capital provision to be funded over the period of an extended contract.
5. QUALITY MONITORING
5.1 The Council notes the observation on page 33 of the report that most Consortia management teams are generally content with the overall performance of their higher education institution. However, paragraphs 3.16 to 3.20 describe the detailed monitoring procedures involved. These, together with the recent QAA subject review round have imposed very considerable time and cost pressures on nursing departments.
5.2 The Council has seen the recent announcement from the Secretary of State for Education that "We have invited HEFCE to discuss with QAA, Universities UK and SCOP ways to further reduce the subject review load while still providing reliable public information for students, employers and others" (3). The announcement proposes that departments that achieved good scores in the current round of subject reviews should be exempt from external review in the next round. The Council notes that 77 per cent of nursing departments meet the criterion for this exemption.
5.3 In the light of these developments, and the success of nursing and allied health profession departments in recent reviews, we ask the NHS to revisit its current proposed contract with the QAA for future quality assurance, to move towards the "lighter touch" that is proposed for successful departments in other disciplines.
6.1 The council welcomes the recommendation 11 that the NHS and HEIs should build on the existing work of the Department of Health and Higher Education Funding Council for England (HEFCE) taskforce on Research in Nursing and allied Health Professions in developing strategies for attracting sufficient research funding to the HEIs involved in health professional education and training.
6.2 Research and scholarly activity in nursing are essential to support education and training, and to ensure the continued development of the profession and nursing practice.
6.3 The Department of Health document "Towards a strategy for nursing research and development" (2) refers to the "confusion" as to whether Education and Training Levy funds can be used to support research. We are aware of considerable differences across Consortia and Regions on the extent and approach to the use of this funding stream for research related activity. The Council would welcome a clear commitment and recognition from the Department that research and scholarly activity are essential to support the education of health professionals, and thus that they should be supported from Education and Training Levy funding.
6.4 There has been very considerable development of nursing research since the colleges integrated into the universities between 1992 and 1996. However, there remains a need to develop the capacity and capability to undertake high quality research in both nursing and the allied health professions. We urge the Department of Health to establish a specific funding stream for this purpose.
7. STUDENT ACHIEVEMENT
7.1 The Council welcomes the discussion on student attrition on health courses and the recommendation that the NHS and HEIs need to agree guidance to facilitate the collection of consistent information on attrition that recognises the scope for stepping on and off programmes. The Council looks forward to being involved in that discussion.
7.2 The reasons for student attrition, and its variations across the country, are many and complex. They include the different experiences in clinical placements, often reflecting local staffing pressures in the health services. The Council is aware of, and the report refers to, a number of studies on this issue. The Council will seek to be an avenue for the exchange of information and good practice in this area. However, the report also acknowledges that average "attrition rates are slightly lower than for students elsewhere in higher education, and that the proportion of students completing programmes have improved over time" (paragraph 2.37).
8. EXCHANGE OF GOOD PRACTICE
8.1 The Council notes and welcomes the many examples of good practice highlighted in the report. It also notes and endorses the views of HEIs reported in paragraph 4.11 that competitive tendering has inhibited the exchange of good practice in the sector. The Council believes that the growing emphasis on longer term collaborative relationships will facilitate the exchange of good practice, and we will endeavour to accelerate this process through our own meetings and conferences.
(1) Subject Overview Report Nursing 1998 to 2000 (QO11/2000), Quality Assurance Agency, March 2001.
(2) Towards a strategy for nursing research and developmentproposals for action, Department of Health, 2000.
(3) Blunkett proposes 40 per cent reduction in University assessments. Department for Education and Employment press notice 21 March 2001.
Council of Deans of UK University Faculties for Nursing, Midwifery and Health Visiting
29 March 2001