Sunday, 15 November 2009

A story so big I almost missed it!

This week I was invited to book a place at the forthcoming first meeting of the Universities new Professoriate. All professors in the University were. The invitation made me ponder, and that is something we should do more in the increasingly ever turbulent world environment of Universities. University’s everywhere have to find new responses to the problems resulting from the need to respond to the new knowledge society/economy, globalization, and the massification of higher education. At times the responses prescribed can be uncomfortable and challenging. So I found the opportunity to re-engage with something familiar was somehow reassuring and comforting. Likewise, receiving the invitation also promoted a reaffirmation of my sense of identity, which is of my professional self, and the relationship I have with the University. It was Basil Bernstein who in his amazing paper The Divorce of Knowledge from the Knower (1996) warned of the inherent dangers of Universities, and the professoriate’s that make up these, losing their pedagogic identity. He argued that the relationship of knowledge production to is utilization and the value accorded to knowledge creators was critical a factor in ensuring societies continue to have access to the knowledge required for economic growth, physical health and sustainability of its moral fabric.

He worried that the very concept of knowledge and its relationship to those who create and use it, was being changed irreparably. He warns that the very concept of higher education is in danger of being lost to processes of economic commodifcation and demand. What has now become an internationally universal process of educational massifcation illustrates the worst aspect of this shift in how higher education is increasingly being conceptualized. Massification essentially refers to the actions taken in fulfilling the desire to increase the scope of participation in higher education. Paradoxically, this concept is said to be located midway between the notion continuing to provide both elite higher education and higher educational opportunities for all. This is a somewhat flawed conceptual model, and its pursuit has unintended consequences. For example, we know from UNESCO (reported in THE July 2009), that internationally, the range and level of qualifications possessed by many academics is reducing. This is a direct consequence of needing to increase the number of teachers required to satisfy the spiraling global demand for higher education. Up to half of the world’s university teachers may lack postgraduate degrees because of the pressures of massification. The UNESCO report also warned that “in terms of accountability and assessment, the professoriate has lost much of its autonomy. The pendulum of authority in higher education has swung from the academics to managers and bureaucrats, with significant impact on the university”.

I hope as our professoriate engages in its own renaissance that we ensure the pendulum swings back to a more balanced view of the value of engaging with a professoriate that is comprised of appropriately qualified academics. I mention this as the really big story I nearly missed was the announcement that all new nurses will need to be educated to degree level from 2013, in what was said to be one of the biggest changes in medical education in the history of the NHS. Talk about losing ones identity.

I was sent many copies of how this story was reported all the major British press, and almost without exception, the changes to medical education featured prominently. The Government claimed this change is designed to raise the status of nursing and to end the stigma of nurses being the doctor’s handmaiden. Where have Government Ministers been these past 20 years? I think it was Stein who wrote about the Doctor-Nurse Game – but that was in 1967 and was not based upon any kind of an empirical evidence base!

It was not a good day for the largest single profession within the British health service. It didn’t end there. Critics claimed that these planned changes will create an elitist profession and scare off recruits with the prospect of a long and expensive period of study. There are also concerns that some nurses would be too clever to care and refuse to carry out duties such as washing and feeding patients and helping them to the lavatory. A criticism that yet again would seem to play into the hands of others. For example, Alistair Henderson, Deputy Director, NHS Employers noted that: Employers will need consider the implications of the change and look at how they use all their nursing staff, both registered and non-registered, ensuring they have the right skills mix appropriate to the task required.

This last observation is very apposite given the latest report published by the Kings College London Policy Trust this week. In a study that looked at the relatively scarce evidence on the relationship between skill mix, patient outcomes and costs, they found there was no simple relationship between either numbers or skill mix of nursing staff and either outcomes and cost. Helpfully, the study essentially reinforces the benefits of a degree qualified nursing workforce and rejects the notion of the reinvention of a second level nurse, akin to that of the previous Enrolled Nurse, as being a simple solution to current workforce challenges. However, you can bet there will be NHS Trust managers out there somewhere working out the cost benefits of the employing the latter over the former. As with the modern professoriate, the dilution of experience, qualification and knowledge is likely, in the long term, to be a step we will come to regret.