Tag: Council of Deans of Health

Fees, theses and project updates

Last week brought the news that, in England, people beginning nursing degrees from the 2017-18 academic year will need to take out student loans to cover the cost of their tuition fees. The cap on student numbers will also be removed. The Council of Deans of Health broadly supports this move, having previously argued for change. One of the things it points out is that current funding for students (via the agreement of the benchmark price) does not cover the real costs of educating new nurses. The Royal College of Nursing, on the other hand, is concerned that last week’s announcement prepares to break the connection between the NHS and financial support for student nurses, and simultaneously risks making nursing a less attractive career option. This concern particularly relates to mature students and those contemplating a second degree, for some of whom the prospect of additional debt may be exceptionally unappealing. As a nurse academic in Wales I wait with interest to see what policy on fees will emerge from the Welsh Government.

In other news, I find myself engaged in a prolonged period of doctoral student activity. I’ve examined a number of theses in and out of Cardiff in recent months, and have sat with students during their vivas as either supervisor or independent chair. This term has been particularly packed. Plenty of writing has also been taking place: papers and reports are being written from COCAPP, RiSC and Plan4Recovery, and from completed theses I have helped to supervise. Data generation in COCAPP-A has almost concluded, and new research ideas are taking shape. Exciting times, if a little frenetic. 

Mental Health Nurse Academics UK meets in Nottingham

I was unable to make Thursday evening’s Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement event hosted by Patrick Callaghan at Nottingham University. My congratulations to Ian Norman and to Marion Janner, this year’s very worthy award winners. As it happens, Ian was one of my PhD examiners. My following of Thursday’s proceedings from afar, via Twitter, tells me I missed a treat.

I was, however, able to make the trip to Nottingham for Friday’s summer term meeting of Mental Health Nurse Academics UK (MHNAUK). This was held in the new, and rather impressive, Institute of Mental Health building:

Here’s a picture I took of the sculpture, titled House for a Gordian Knot, displayed at the entrance to the Institute’s main building:

We had three local presentations. First up was  Paul Crawford, who gave a broad overview of the Creative Practice as Mutual Recovery research programme which he leads, followed by Andrew Grundy giving an account of qualitative findings from the Enhancing the Quality of User Involved Care Planning in Mental Health Services (EQUIP) study. EQUIP is an important, NIHR-funded, programme of work which (along with COCAPP and COCAPP-A) is producing evidence of how care planning is being done and how it might be improved. Here’s a photo, taken and shared by Karen Wright, of one of Andrew’s final slides outlining steps to successful user involvement in this process:

Tim Carter talked us through his freshly-minted mixed methods PhD, in which he investigated the use of a preferred-intensity exercise programme for young people with depression. I thought this to be a very well-designed study, which generated considerable discussion around the active ingredients of the intervention and plans for a future follow-up.

Elsewhere Lawrie Elliott, editor of the Journal of Psychiatric and Mental Health Nursing, was welcomed by the group to give an update on developments at the journal in his first year at the helm. I really liked what I heard, and said as much in our discussion. Quality of papers, and relevance to mental health nursing, are being prioritised. Word limits have been increased to allow for more in-depth analysis in accepted articles. To extend its reach the journal now has a Twitter account, which can be followed by clicking the following link:

Ben Thomas from the Department of Health opened a discussion on the future of the Student Mental Health Nursing Conference, the inaugural event having taken place at the O2 Arena in London in February this year. As I understand it, much of the organising was done by staff and students at Greenwich University: well done, them. A group of MHNAUK members representing different universities has agreed to collaborate to keep this initiative going, and with a view to turning it into a cross-UK, rather than an England-only, opportunity.

Following David Sallah’s meeting with MHNAUK in York in March 2015, Joy Duxbury and Steven Pryjmachuk chaired a discussion on the current status of the Shape of Caring review. Since returning from Nottingham I have found that Health Education England is planning to sound out opinion through a series of events running into the autumn. Details are to follow.

Thanks particularly to John Baker, in the weeks leading up to this latest meeting MHNAUK published a response strongly criticising the announcement that the National Institute for Health and Care Excellence (NICE) was ending its work in the area of safe staffing. This decision, defended two days ago by Jane Cummings (Chief Nursing Officer at NHS England), has also been challenged by others including Sir Robert Francis and now the Council of Deans of Health. The Safe Staffing Alliance campaigns in this area, and MHNAUK will continue to make a contribution via a further response the outline of which was agreed in Nottingham. As a reminder of some of the key evidence supporting the importance of registered, graduate, nurses for quality and safety follow this link to an earlier post on this site and this link to a recording of Linda Aiken delivering the Winifred Raphael Memorial Lecture at the University of South Wales on October 1st 2014. And, for those interested in how #safestaffing is shaping up differently across the countries of the UK, follow this link for a record of the progress of the Safe Nurse Staffing Levels (Wales) Bill through the National Assembly for Wales. Following this link brings you to a report reviewing the evidence, commissioned by the Welsh Government and produced by a team led by Aled Jones in the Cardiff School of Healthcare Sciences.

Fiona Nolan shared progress on her survey of mental health nursing research interests and expertise in UK higher education institutions. And, finally, on behalf of the organising and scientific committee Russell Ashmore, Laoise Renwick and I took the chance to update MHNAUK members on progress for the 21st International Network for Psychiatric Nursing Research conference.

#NPNR2015 takes place at the Manchester Conference Centre on Thursday 17th and Friday 18th September 2015. We think the programme is shaping up perfectly, with keynote speakers including England’s National Clinical Director for Mental Health Dr Geraldine Strathdee, Prof Shôn Lewis from the University of Manchester, Mark Brown who ran One in Four magazine and is now involved with The New Mental Health, and André Tomlin who runs The Mental Elf service. We have symposia, workshops and concurrent sessions with papers accepted from presenters around the world, a walking poster tour and the opportunity for fringe events. Make your booking now!

The shape of nursing (reprise)

York, March 10th 2015
York, March 10th 2015
Yesterday I joined other members of Mental Health Nurse Academics UK at the University of York, for what turned out to be a particularly lively spring term meeting. 

We were treated to two high-quality local presentations in the morning: from Simon Gilbody on smoking cessation interventions for people using mental health services, and from Jerome Wright on developing community mental health in Malawi. 

In the early afternoon David Sallah from Health Education England (HEE) took the floor to talk about the Shape of Caring review, the final report from which is due to be published later this week. From David’s presentation it is evident that HEE will be making a case for a significant shake-up to the way nurses are prepared. 

MHNAUK members in York were concerned with what they heard. Uppermost for many was a concern that HEE’s wish for future student nurses to commence their courses with two years of Project 2000-style generalist preparation will erode the time available for mental health-specific learning. People were also struck by the apparent lack of a clear evidence base for change. It is, after all, only a handful of years since the Nursing and Midwifery Council introduced its current standards for education, and curricula up and down the country were rewritten in response. In the absence of robust evaluations of what we already have, are we really sure we know what needs fixing in nurse preparation? 

The Shape of Caring review is sponsored by a body with authority in England only, but I am under no illusions that any changes flowing from it will be felt equally here in Wales. David Sallah mentioned cross-UK talks as having already opened. As people observed yesterday, however, any changes to nursing education recommended at this point may be lost following a general election where greater priorities occupy the time of a newly formed government. 

Meanwhile, and with a firm eye on the forthcoming election, the Council of Deans of Health has been busy making a case for health higher education and research in its new publication Beyond Crisis. This has three main messages, addressing: workforce planning; building on the talents of the current workforce; and investing in research. Amongst other things the Council is asking for proper forward planning to avoid cycles of boom and bust, opening up opportunities for continuous professional development and protecting and advancing research. It is also suggesting that new ways of financially supporting health professional education should be looked at, including models where contributions are made by students and employers.

Nursing beleaguered?

Catching my eye earlier this week was an interview in The Guardian with Jane Cummings, Chief Nursing Officer (CNO) with a place on NHS England‘s National Commissioning Board. Under the header, ‘Nobody can say care is brilliant all the time’ the article opened with this understated quote:

‘It was very clear that nursing was getting a bit of a bad name and it felt like the profession was being quite beleaguered and criticised.’

Nursing certainly has been under siege. Responses to descriptions of poor care have included the three year Compassion in Practice strategy introduced by the CNO and her Director of Nursing counterpart at the Department of Health, Viv Bennett. It is in this document that the 6Cs are described:

It is also in this general context, but specifically following the publication of the Francis Report into Mid Staffordshire NHS Foundation Trust, that the proposal was made that student nurses should spend a year doing health care assistant (HCA) work before beginning their training. This government plan has proven mightily controversial, and when announced provoked immediate broadsides from (amongst others) June Girvin (a nurse, and Pro Vice Chancellor at Oxford Brookes University) and Jackie Kirkham (a health visitor and researcher at Edinburgh University). Now it has drawn a closely referenced rebuttal from the Council of Deans of Health. Here is what the Council says in its conclusion:

The proposals for HCA experience prior to joining a pre-registration nursing programme are underpinned by a set of assumptions about nursing education and selection of prospective students that is deeply flawed. It paints a picture of students who have never had experience of caring and little interest in patient care, picked out for their grades by a group of academics in total isolation from staff working in clinical services. The message from current practices and the NMC Standards that govern them is that this mental picture needs to change. In particular, the assumption that students are not recruited for their values and that students do not have prior care experience are incorrect.

What about the nub of the proposal: that exposure to the clinical frontline as a HCA will create better nurses? The evidence here is equivocal at best. What care experience does seem to do is give prospective students exposure to the reality of working in healthcare and so it may reduce attrition from programmes. But there is also evidence that working as a HCA can socialise prospective students into poor practice and inhibit their development as nurses. Unless the evidence is looked at carefully, these proposals could therefore embed rather than challenge poor patient care. As the pilots of the proposals are developed, care must be taken both to recognise existing practice and carefully test assumptions against the evidence.

So, nursing practice and nursing education are in the spotlight, and the profession has responded. Senior members have asserted a set of fundamental values (the 6Cs), and in resisting the year-as-an-HCA idea have reminded people of the differences between what nurses and other health care workers do.

Nurses discomforted by this heightened scrutiny might consider their position alongside that of other public services workers. Social workers draw attention to the problem they face of being ‘damned if they do and damned if they don’t’. Then there are teachers, who fear the erosion of their professional standing as former servicemen and women prepare to enter the classroom without having to study for degrees. Back in the health service, some doctors (psychiatrists, in this instance) express concern over threats to their role and identity, whilst the profession as a whole is accused of greed.

We are therefore in good company. Other workers know what it is like to be told they have collectively fallen short, and understand how it feels to have their status undermined. Status-knocking sometimes happens because professional groups engage in ongoing division of labour skirmishes, as I have drawn attention to on this site before. But nursing’s current predicament, in which we are charged with having a ‘compassion deficit’ and sacrificing a commitment to care in the pursuit of academic credentials, is different.

Perhaps nurses have finally lost enough of the untouchable, ‘angel’, image (no bad thing, in my view) to now be viewed as ‘just’ another professional group in whom trust is conditional. We control entry to our profession, expect degrees from new entrants, have university departments and lead interprofessional teams and whole services within the NHS. In turn, we must expect to face questions when things go wrong, and to justify why we do practice and education in the ways that we do. For the record, I strongly favour system explanations for what happens in the health service (including its failures), see no evidence that student nurses no longer care and much prefer practitioners to be educated than not. But I also think we must expect, and should prepare for, more ‘bashing’ in the future.