53. Memorandum submitted by the Royal
College of Nursing
EXECUTIVE SUMMARY
— any proposals to charge nurses, midwives
and health visitors tuition fees would detrimentally affect the
continued recruitment and retention of a diverse workforce. Student
nurses require adequate financial and pastoral support and non-means
tested bursaries should be made available for all nursing students
to bring England into line with the other three countries in the
UK.
— both strong research and good teaching
practice should be recognised, especially where it results in
improving patient care and informing practice.
— appropriate complaints should continue
to be governed by the proper professional regulatory bodies rather
than an independent adjudicator.
TERMS OF
REFERENCE OF
THE COMMITTEE
To examine the proposals in the Government's
White Paper The Future of Higher Education.
INTRODUCTION
With a membership of over 350,000 registered
nurses, midwives, health visitors, nursing students, health care
assistants and nurse cadets, the Royal College of Nursing (RCN)
is the voice of nursing across the UK and the largest professional
union of nursing staff in the world. RCN members work in a variety
of hospital and community settings in the NHS and the independent
sector. The RCN promotes patient and nursing interests on a wide
range of issues by working closely with Government, the UK parliaments
and other national and European political institutions, trade
unions, professional bodies and voluntary organisations.
The RCN strongly believes that high quality
professional education is central to enabling skilled expert nursing
care in order to improve outcomes for patients and staff. A better-educated
nursing workforce, which has equity in terms of opportunities,
will lead to higher standards of patient care and improved health
outcomes. The RCN seeks to ensure that nursing education is recognised
both within the profession and with key external stakeholders
as central to improving the quality of patient care and the health
of the public[32].
CHAPTER 7. FREEDOMS
AND FUNDING
The NHS Plan explicitly acknowledged that the
"biggest problem facing the NHS remains shortage of capacity
in staff and beds"33. The RCN and Department of Health are
in agreement that the targets in the NHS Plan can only be achieved
through increased education and sustained improvements in recruitment
and retention. The RCN is therefore particularly concerned about
the potential impact of new funding freedoms for universities
on nursing students, the staff who teach them and the profession
in general.[33]
Paragraph 7.47
The White Paper is ambiguous about existing
arrangements whereby tuition fees for nurses undertaking training
at HEIs are met by the NHS, i.e. exempting students from tuition
fees. The White Paper proposes that individual departments
and employers will, as now, need to look at the impact of these
proposals on their labour markets and decide, in the light of
available resources, what steps to take to support public service
modernisation and recruitment and retention. Consequently,
the employer, (i.e. the NHS) is asked to review existing arrangements
and could as a result decide to introduce tuition fees.
Additionally, a review could impact on current
purchasing arrangements and could see a return to short term tendering,
which is particularly problematic with nurse education.
A recent survey of university Vice-Chancellors
undertaken by the Times Higher Education Supplement[34]
identified that nearly two thirds of universities intend to charge
the full £3,000 fee (the maximum suggested by the White Paper)
on some courses. This would see an increase in the financial hardship
already faced by nursing students. Maintenance funding for nursing
students differs between degree and diploma students - degree
students receive a means-tested bursary which can be supplemented
with a student loan, whilst diploma students receive a non means-tested
bursary. Many nursing students are mature students, with an average
age of 29, often with a family and other financial commitments.
However unlike other students who may take part-time jobs to supplement
their income especially during vacation time, clinical placements
during training prevent nursing students from benefiting by doing
the same.
If tuition fees are set according to the demand
for courses there could potentially be different fees charged
across the four pre-registration branches of nursing and midwifery.
This could further affect demand for training places.
Paragraphs 7.39 to 7.41
These paragraphs (right to defer fees and pay
at a rate that depends on income) outline new arrangements for
students to contribute to their tuition fees through a Graduate
Contribution Scheme. Under this proposal students will be allowed
to defer making contributions until they have completed their
course and raise the threshold for repayment will be £15,000
a year. The basic salary for a nurse post-registration is £16,005
(grade D, base salary)[35]
which would immediately trigger course-fee repayments. If nurses
were expected to contribute to tuition fees, not only could it
deter nurses from taking up posts in the UK but potentially increase
the numbers of nurses seeking work overseas, where salaries and
benefits may be higher in order to repay course fees. The White
Paper is unclear about what arrangements would be put in place
for individuals to make repayments if they do work abroad after
training.
The RCN believes that nurses must be recruited
and educated to reflect the diversity of the population they serve.
We believe that any proposals to charge nurses tuition fees would
detrimentally affect the recruitment and retention of nurses.
We believe that nursing students require adequate financial and
pastoral support in order to complete their studies successfully
and that non-means tested bursaries should be made available for
nursing students across all four countries of the UK, regardless
of course.
CHAPTER 2. RESEARCH
EXCELLENCE—BUILDING
ON OUR
STRENGTHS
The transfer of nursing education to Higher
Education Institutions (HEIs) has seen a fundamental re-orientation
of some of its goals and values, balancing clinical practice and
teaching with a major expansion of research capacity. Working
alongside organisations such as the National Institute of Clinical
Excellence (NICE), nurses are developing supportive evidence based
practice and expertise, and implementing quality in all aspects
of care.
Despite the contribution and commitment of nursing
lecturers to research, there is still a sense in higher education
that nursing education is not treated on a par with other academic
disciplines in universities. The RCN is committed to promoting
the significance of practice and relevant research and seeking
to ensure that nurses enjoy protected time within their HEI contracts
for research work vital to achieve high quality patient care.
Paragraphs 2.7 and 2.8
The White Paper examines the relationship between
research and teaching, seeking to recognise the highest quality
teaching and focus resources more effectively on the best research
performers. The RCN's experience is that research and good teaching
are linked with research informing teaching practice. Both strong
research and good teaching practice should be recognised, especially
where it results in improving patient care and informing practice.
Paragraph 2.21
This paragraph indicates that the Higher Education
Funding Council for England (HEFCE) will look at how funding for
academic departments with lower research ratings under the existing
system can be related to further progress. Promising departments
with comparatively low but rising research ratings, especially
those working in new research areas, should be encouraged. Additional
funding should be available for this.
CHAPTER 4. TEACHING
AND LEARNING—DELIVERING
EXCELLENCE
Paragraph 4.14
The RCN broadly welcomes proposals in the White
Paper to introduce national professional standards to provide
the teaching skills required in Higher Education. Nursing and
the RCN has led the way in establishing standards for its teachers
of nursing. In order for a nurse to record a teaching qualification
on the Nursing and Midwifery Council (NMC) register, an individual
is required to undertake additional preparation and education.[36].
Paragraph 4.11 and 4.12
The RCN welcomes greater transparency in higher
education and recognises that a fair and open approach will help
to improve quality. Currently the power to regulate standards
of education, practice and conduct for health professionals is
given by Act of Parliament to independent regulatory bodies. These
bodies maintain a register of recognised professionals, setting
the educational conditions for entry and determining when names
should be removed from the register. Statutory regulation is to
protect the public by giving assurance that those on the register
are fit to practice is currently regulated by the NMC.
Occasionally in nursing education issues can
arise around clinical placements and a student's fitness to practice.
The RCN is concerned that appropriate matters should continue
to be governed by the proper professional regulatory bodies and
their professional standards rather than an independent adjudicator.
March 2003
32 Quality education for quality care: a position statement
of nursing education, page 3. RCN. October 2002. Back
33
Delivering the NHS Plan: next steps on investment, next steps
on reform. April 2002. Para 1.7. Back
34
The Times Higher Education Supplement, 31 January 2003. Back
35
NHS Pay rates for nursing staff at April 2002 - RCN Newsline,
vol 26, no 13. 17 December 2001. Back
36
Standards for the preparation of teachers of nursing, revised
December 1999, Nursing & Midwifery Council. www.nmc-uk.org/cms/advice/standards. Back
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