Exclusive: Nursing universities ‘open to change’, say new charity chiefs

Universities across the UK are “willing to do things differently” to tackle recruitment and retention issues across the health and education sectors, nursing education leaders have said.

In their first interview with Nursing Times since being appointed, the new chief executive and chair of the Council of Deans of Health (CoDH) have described some of the key challenges facing nursing education right now, and how universities are looking to address them.

The CoDH is a charity which represents UK university faculties that deliver education and/or research for nursing, midwifery and allied health professions.

Professor Alison Machin, who is a registered nurse and health visitor, was appointed as chair of the charity last month, after undertaking other roles within the organisation.

As part of her new role, Professor Machin explained to Nursing Times that she is responsible for ensuring that the CoDH keeps focus on all four UK countries that it represents.

She explained that recruitment and retention issues existed all over the UK, and that it was “a national endeavour” to try and solve them.

Professor Machin said: “It’s absolutely the thing that everybody is talking about and it’s the thing our members need our help with. It’s a cross-party, cross-professional, cross-organisational problem and we really need to work together on this.”

It comes as recent data from the Universities and Colleges Admissions Service (UCAS) revealed that the number of people in the UK applying for undergraduate nursing courses had dropped by 16% this year.

Professor Machin noted that while the UCAS data gave an overview of student numbers nationally and each UK country, it did not break down the disparities at a more local and regional level.

She said: “The UCAS data gives the whole picture, but actually it’s worse in some areas, and better in some areas, and understanding some of those trends with our members is going to be really quite important.”

For example, Professor Machin said that in Scotland, where she works as dean of the school of health and social care at Edinburgh Napier University, there had been particular challenges with nurse recruitment in rural areas like the Highlands and neighbouring islands.

She argued that this was because so much of nurse education, particularly for specialties like learning disability nursing, took place in the “central belt” (the most densely populated area of the country).

She said: “There’s quite a lot of work that we need to do to try and understand where seems to be the place that students are gravitating to, and how we can look to see what they’re offering and then help develop our [other university] members in that respect.”

Meanwhile Professor Machin said that the charity was struggling to have as much influence on health education policy in Northern Ireland, due to the lack of a functioning executive there.

“Our members are telling us that they’re willing to do things differently"

- Alison Machin

The country has gone months without ministers in post due to a boycott by the Democratic Unionist Party (DUP) of power-sharing arrangements with Sinn Féin in defiance of the post-Brexit Northern Ireland protocol.

Professor Machin said: “The fact that they don’t have a fully functioning government actually makes it more challenging for the council to get in there and influence policy to support our members.

"We have good member relationships but there’s a lack of opportunity to get in there and engage at the ministerial level.”

Overall, Professor Machin described how, amid the NHS workforce crisis, universities across the UK “want to be part of the solution”.

“Our members are telling us that they’re willing to do things differently, to look at things differently, to maintain the high standards of graduate education and professional standards,” she added.

As such, she said universities would welcome further regulatory reforms to support recruitment and retention on nursing and midwifery courses. It comes as the Nursing and Midwifery Council (NMC) no longer has to include European regulations in its standards, since the UK left the EU.

In recent months the NMC approved several changes which aimed to modernise its education programme standards, including doubling the number of clinical placement hours that students can undertake in a simulated setting.

Now, universities are looking to the regulator to take that work even further, such as moving to an “outcome” rather than hours focused curriculum, explained Professor Machin.

She said: “It’s really challenging having an hours focused curriculum, so most of our members would like an outcome focused curriculum.

"They would like to be able to judge on outcomes and have a robust set of outcomes and processes without necessarily having to count the number of hours.”

Universities in England are particularly willing to embrace changes in health education following the publication of the NHS Long Term Workforce Plan in June, which detailed the current shortfall of health staff in the NHS in England, as well as targets for the next 15 years.

Among the key pledges in the plan was to increase the number of nursing training places by 80% by 2031-32.

While the CoDH has welcomed these targets, Professor Machin warned that not much consideration had been given to the increase in the academic workforce that would be required to accommodate such a jump in students.

She said: “A good number of members tell us that they have difficulty recruiting to academic posts in our disciplines, and they’re needed to be able to deliver different programmes.

"We need more people in those roles, and we’re struggling. So the workforce shortage runs across higher education in all disciplines as well.”

Professor Machin described how the increasing pay differences between the NHS and universities in higher education was also making it harder to recruit nurses into teaching positions.

"There needs to be a cultural shift in the way trusts and the NHS act with wider education partners"

- Ed Hughes

“In the past it would have been more senior nurses and midwives who would have then gone on to be nurse teachers or academics,” she said, adding: “But now those senior nurses and midwives are quite [high] up in the banding in NHS salaries and perhaps haven’t got the academic qualifications coming into the university to be paid at [the same] level yet.”

Similarly, ministers had also not thought about whether universities have enough facilities to accommodate an increase in nursing places, argued Professor Machin.

She said: “A lot of universities have got really good state-of-the-art facilities, but if they were going to increase the number [of students] significantly, in line with the plan, they would need more.”

Just a few days after the NHS workforce plan was published, the new CoDH chief executive, Ed Hughes, was appointed.

Previously Mr Hughes was director of insight and engagement at Research England, and before that he spent more than 15 years at the Higher Education Funding Council for England and at the Office for Students.

Mr Hughes told Nursing Times that it looked like it was going to be a “pretty challenging period for universities” as they are expected to meet these government targets while applications to study nursing and midwifery are down.

One of the alternative ways that ministers are hoping to boost nursing numbers in England is through increasing the number of students training through registered nursing degree apprenticeships, from 9% to 28% by 2031-32.

Mr Hughes explained that expanding the routes into nursing was important as it “gives different people different opportunities”.

However, he warned that some CoDH members had identified that degree apprenticeships were creating further challenges around workplace placement capacity.

“Because of the workforce pressures within trusts, the number of people who are able to supervise students, whether those are on degree apprenticeships or on traditional undergraduate courses, is limited [or] is finite,” said Mr Hughes.

He stressed that any expansion of nursing education, irrespective of what type of qualification it was, needed to be “joined up and coordinated in a way that optimises the resources across the system”.

He said: “I think, more broadly, to deliver the education expansion that’s set out in the long-term plan, there needs to be a cultural shift in the way trusts and the NHS act with wider education partners, to make sure that the education piece is properly valued and resourced.

"Because without that, it's going to be really difficult to feed the growth that's talked about in the plan by the whole range of routes.”

Mr Hughes commended the work that the CoDH had contributed to the NHS workforce plan before he joined and said that it would “continue to have those conversations with NHS England and regulators” to implement it.

Equally, he stressed that he wanted to start having similar workforce conversations beyond England and across the rest of the UK.

“What we want to be able to do is make sure that the voice of the healthcare faculties across the UK is at the heart of that discussion,” he said.

Over the next few months Mr Hughes said he would be visiting universities from all over the UK to speak to them about what their priorities are going forward.

He said he wanted the CoDH to be a charity that could encourage conversations about nursing education “at a UK-wide level”.

Mr Hughes added: “I think there's some really fruitful conversations to have about how we can learn from what's going on in different systems, how we can address the different healthcare challenges in different parts of the UK and bring that piece together.”