Sunday, 31 March 2013

As Maggie might have said, its the wrong answer to the wrong question


Five days before All Fools Day, came the announcement from JH that he plans to require pre-registration nursing students to have worked for up to a year as a healthcare assistant. All Fools' Day (or Poisson d'Avril in French) is a day when humour should reign and practical tricks get played on others, and often such tricks are played out for mass consumption. I had hoped that JHs announcement was just that; but I fear he was being serious. In his response to the second Francis Inquiry into the failings at the Mid Staffordshire NHS Foundation Trust, JH, the Secretary of State for Health said: ‘every student who seeks NHS funding for nursing degrees should first serve up to a year as a healthcare assistant, to promote frontline caring experience and values, as well as academic strength. They will also provide students with helpful experience for managing healthcare assistants when they qualify and enter practice’.
Now some readers of this blog might have realised over the years that my reading of the Daily Telegraph and the Iron Lady Portrait hanging on my bedroom wall, and the blue rosette pinned to my lapel during general elections might have provided a clue to my political loyalty – in the interest of fairness, there are other political parties that can be supported – but this policy announcement from the Tories really tests such loyalty – sorry Maggie, but its true! 
The new body for commissioning nurse education (and all other health professions education and training), Health Education England is to take this work forward. Ian Cummings, the HEEs Chief Executive, welcomed the initiative. And whilst we all agree that many NHS professionals lost their way at Mid Staffs, and perhaps for a number of reasons forgot what the underpinning values and beliefs required for compassionate care involved, this is not the way to tackle the problem. In my view it’s the wrong answer to the wrong question. And I despair for the future of our great NHS.   
The experience in our School, one of the largest Schools providing nurse education in England, is that many of our students are mature in age, have already gained a range of life experiences, often in health and social care settings. They have often worked hard at achieving the necessary academic qualifications to gain a place on the programmes, are very motivated, self confident individuals whose passion for nursing is articulated well in our values based recruitment processes. Nursing education standards were comprehensively reviewed in 2010 and include compassionate care as a core component.
Last year, nationally there were just under 200,000 applications for student nursing places. It’s difficult to see how the proposed initiative would work with this number of potential applicants. Finding places on wards and in community settings and expecting already stretched staff to provide learning opportunities seems to be adding a burden rather than providing a workable solution. It appears to me that rather than focusing on pre-registration students, JH would be better concentrating on getting the right numbers and skill mix of qualified nursing staff into clinical areas.
Most surprisingly to me, I found myself agreeing with Peter Carter of the RCN over the issue. Peter Carter is the Chief Executive of the Royal College of Nursing. He acknowledged the commitment from JH to review the staffing levels in clinical areas, but cautioned about leaving the decision as to what staffing levels might result in higher standards of compassionate care, to local managers. This was an approach that clearly didn’t work in Mid Staffs, so why would it work elsewhere post the Francis Report? Last year, the RCN commissioned the independent but somewhat ill conceived Willis Report into pre-registration nurse education. This report found no evidence whatsoever that current nursing education is failing, nor that it is associated with a decline in compassion. As for me, well I recovered my composure at finding myself in total agreement with the RCN by lying down in a darkened room for an hour. I bet Florence and Mary are turning in their graves.