Editorial: Nursing education in the United Kingdom – clocks forward or clocks backward?
Article first published online: 14 JUL 2011
© 2011 Blackwell Publishing Ltd
Journal of Clinical Nursing
Volume 20, Issue 15-16, pages 2095–2097, August 2011
How to Cite
Shields, L., Watson, R. and Thompson, D. R. (2011), Editorial: Nursing education in the United Kingdom – clocks forward or clocks backward?. Journal of Clinical Nursing, 20: 2095–2097. doi: 10.1111/j.1365-2702.2010.03341.x
- Issue published online: 14 JUL 2011
- Article first published online: 14 JUL 2011
The United Kingdom of Great Britain and Northern Ireland (UK) in 2010 gained a new government, and we wonder what the future for nursing will be. After a battle between the major parties – Labour, the Conservative Party (known as the ‘Tories’) and the Liberal Democrats (the ‘LibDems’), a hung parliament ensued, with no party holding enough seats to take power in its own right; the LibDems held the balance of power and were wooed by both sides. The result was a completely new government, with the Tories the major party (with Prime Minister David Cameron) supported by the Liberal Democrats, with their leader, Nick Clegg, taking the deputy prime minister position. Most media pundits saw this as a result that had to happen, that the Labour Party under, first, Tony Blair and, latterly, Gordon Brown had lost its way and had not managed to protect the country from the effects of the recent global financial crisis. Because the country has switched from a left wing Labour government to a right wing (though perhaps modulated by the liberal policies of the LibDems) conservative government, changes are expected to affect all aspects of British life. This, of course, must include the National Health Service (NHS), and nursing within that. Because of the belt tightening necessitated by the global financial crisis, the NHS as one of the largest and most expensive organisations in the world must expect an overhaul.
The NHS, when it was established in 1946, was a wonderful ideal – free health care at point of delivery, for everyone, regardless of income, occupation or social standing. However, the founders of the NHS could never have foreseen the developments in health care technology, improvements in care, evolution of highly complicated systems of management of health services, the need for increasingly complex education of health professionals, nor the exponential rise of costs associated with such developments. In 1949, the NHS budget in current terms was £9 billion; at present, the budget is £110 billion per annum (Patel & Spilsbury 2010). In 2011, all UK residents have come to expect free access to the highest standards of health care as a right from birth to death. The NHS usually figures largely in any election campaign and its aftermath but, strangely, there was little emphasis on it in this last election. We suggest that the cuts that all parties know are so necessary are also so unpalatable to the UK electorate that no one was brave enough to raise them as an election issue, preferring to keep them until after they had won power.
We are wondering how this is going to affect nursing. We (Watson & Thompson 2000, 2004, Thompson & Watson 2001, 2005a,b, McKenna et al. 2006, Shields & Watson 2007, 2008, Watson & Shields 2009a) have published previously on the dire state of nursing and nursing education in the UK, with most of our comments about nursing in England, and before the election, debate was beginning on some of the suggestions we made. First, in 2008, under the Labour government, the Nursing and Midwifery Council declared that all nurses in the UK would, from 2013, need a degree to be able to register as a nurse (NMC 2008). This welcome and very late – compared with other countries – stand brought media attention, most of it negative, with statements like ‘All sorts of people who might make excellent nurses will be put off, and lost to nursing: anyone who is not particularly academic; anyone who — frankly — is not particularly bright’ (Marrin 2009) and ‘Of course, medicine is a university course with a very large element of apprenticeship about it. But medicine is both a learned profession and a severely practical art, which nursing is not and is never likely to be … The quest for power and status, then, is more important than the quest for higher nursing standards. That is why the nurses’ leaders are so keen on the idea: kudos is their goal.’ (Dalrymple 2009). However, some much better informed and less inflammatory writers supported the need for nurses to be educated at degree level (Street-Porter 2009), and of course, there is very solid evidence that a degree-educated nursing workforce improves patient outcomes (Aiken et al. 2003, Duffield et al. 2007, Klein 2007, Rafferty et al. 2007, Kendall-Gallagher et al. 2011). Before the election, on 10 March 2010, a lengthy report by the Prime Minister’s Commission on the Future of Nursing and Midwifery in England (2010), entitled Front line care was published. As with many government documents about health care, which very often seem to take the line of not upsetting too many people, and lack the rigour necessary to push home hard facts about the state of the NHS, this document concludes that, while supporting the call for all nurses to have degrees, and the necessity of research to nursing practice, all nurses must take a pledge ‘to deliver high quality care’. In 2011, all that such emotive, old-fashioned thinking does is provide a basis for any nurse (or midwife) to be the scapegoat when mistakes are made, enforcing a blame culture, whereby any breakdown in service delivery can be laid at the feet of a nurse who has ‘broken his/her pledge’. Surely the future of nursing and midwifery should be premised on the basis of a solid, rigorous pursuit of the highest standards of knowledge to enable the nurse and midwife to provide the very highest standards of practice.
The change in power in the UK complicates these issues significantly, as the Tories, all along, have said that they will not entertain degree-educated nurses. In a speech on 11 May 2009 to the Royal College of Nursing, David Cameron (Cameron 2009) said ‘there is the danger that all-degree training might put some people off. The teenager who has got a handful of reasonable GCSEs and just wants to care for people. The busy mum who hears the word degree, pictures the typical undergraduate and thinks – that is not me. We need to make very sure that the doors to nursing are open to all.’
On 2 February 2010, (Evans 2010) the now Secretary for Health, Andrew Lansley, told Nursing Times ‘A degree should be an aspiration for nurses, rather than an entry requirement’, while on 15 February 2010 (Santry 2010), confusion over this was apparent when another Tory ministerial candidate, then Shadow health minister Anne Milton, told Nursing Times there was ‘no doubt that registered nurses needed degrees’. But ominously, in the same article, a spokesperson for the Conservative Party went on to say that ‘Mr Lansley’s definition of ‘nursing profession’ included healthcare assistants. … These people provide care for patients in a nursing fashion and that’s part of the wider terminology of nursing.’
The LibDems have been very quiet on their ideas for nursing. A speech to the Royal College of Nursing (Clegg 2010) on 27 April 2010 was about the NHS, with little reference to nurses or nursing, and very blank on the subject of degrees, or, for that matter, health care assistants, so it is impossible, at this stage, to know what they will do if the new government tries to scrap the initiative to ensure that a degree is the basic standard for registration.
In June 2009, we wrote a report for the Conservative Party in response to their call for submissions about the future of nursing (Watson et al. 2009). We outlined the absolute necessity for registered nurses to be educated to degree level and the concomitant improvement of patient outcomes; and a warning about the ‘dumbing down’ of the nursing workforce and the employment of health care assistants in large numbers. Now the new government is in place, it does not look as if they listened.
With the Tories in power, what is in store for UK nursing? Two of us (Watson & Shields 2009b) have previously – and not very originally – described nursing as a ‘political football’; extending the analogy, nursing is always the first to get kicked when something is wrong in the NHS. We are simultaneously praised as ‘angels’ and demonised as ‘too posh to wash’; and we really fear another upheaval at the point in the nursing system where all blame seems to lie – nursing education – which has undergone at least two major redirections since the late 1980s. Adhering to the football metaphor, many of us – including the present authors – really thought that the ‘ball was in the back of the net’ regarding graduate entry to the profession and university schools of nursing have been working towards the introduction of the new curriculum for 2011. We now experience uncertainty and face the prospect of undoing the only sensible decision made by the previous Labour government regarding nursing: the move to graduate entry.
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