“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Strategic Education Partnership Meeting Towards an all Graduate Nursing Workforce Workshop: Discussion and Debate March Suzanne Rankin Deputy Chief Nurse and Head of Clinical Standards South Central Strategic Health Authority

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Background Registered nurses need high levels of knowledge and skills in order to deliver high quality patient care. This is essential to the capacity and capability of healthcare delivery The Government’s position to work towards a degree based registered nurse workforce was endorsed by the outcome of Lord Darzi’s Next Stage Review The Nursing and Midwifery Council’s consultation and review of Pre-Registration Education has resulted in a decision in principle to implement degree level registration as the minimum award for pre-registration nursing programmes in the UK The Next Stage Review will consider how clinical education should be commissioned and funded, to deliver a clinical workforce of the right size, skills and structure. Current bursary arrangements will be considered as part of this There is no evidence that degree educated nurses are less caring. Patients expect nurses to have high levels of knowledge and skills and who can demonstrate both caring and technical competence Healthcare teams, with a range of staff at different levels, already make a valuable contribution to a patient’s care. For example, health care support workers assist registered nurses. There is wide spread consensus to consider regulating all those who provide direct care to patients

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” High-level timetable for transition to degree level registration for nurses Jan – March 2009 April - June 2009 July – Dec 2009 Jan – Dec 2010 Jan – Dec 2011 Jan – Dec 2012 DH transition timetable NMC actions (with related HEI actions) DH review of student support Other work February - Risk and cost analysis complete July 09 – Dec 09 – SHAs develop transition plans with HEIs April – Consult on transition timetable June – Agree transition timetable Announce transition timetable July 08 – Dec 09 – DH Review of Student Support March – Findings announced September (at the earliest) new student support in place Jan 09 – Dec 09 – start developing standards and competences Spring – NMC consult on draft standards Sept 2010 onwards - HEIs develop new programmes for NMC approval Sept – first new degree courses start? January - SHAs commission 2011 courses Throughout 2010 – marketing campaign for prospective students Sept – NMC feasibility study of preceptorship due Summer – NMC finalise standards

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Arguments in favour of moving to degree entry to the register Nurse leaders in service and education, the Royal College of Nursing and NHS Employers support this position Registered nurses need higher levels of knowledge and skills in order to deliver high quality patient care. This is key to the capacity and capability of healthcare delivery Patients’ complex needs - nurses need high level skills and competencies to lead and deliver intimate personal care sensitively for the spectrum of patients/users’ needs Complex environments – nurses frequently manage whole episodes of care across patient pathways and lead/oversee the delivery of care by others Increasing autonomy and responsibility – nurses practice using high-level judgement and decision-making skills All other registered healthcare workers in England are graduates. Most nurses in Scotland, Wales and Northern Ireland enter the NMC register as graduates. Midwives have moved to a graduate registered workforce. Nurses in England are educationally disadvantaged and many nurses spend a number of years “topping up” their education following registration. This has organisational and personal costs Cost neutral - diploma and degree nursing education programmes cost the same to run Increasingly competitive labour market - nursing needs to remain attractive in a market with 50% graduate workers

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Arguments opposing move to degree entry to the register UNISON opposes move because it is concerned that the pre-requisite academic requirements for a degree programme may reduce the current ‘wide entry gate’ into nursing –Favours a return to the apprentice model of nurse training, with students as salaried NHS employees. –The Head of Nursing for UNISON has agreed to have further discussions about measures to mitigate the effect on the entry gate and access to nursing There are false perceptions that a degree education sacrifices the caring dimension of nursing in favour of technical competence There are perceptions that a graduate registered workforce may re-introduce a two-tier structure into nursing, reminiscent of the former Enrolled Nurses Student funding differentials between diploma and degree students need to be addressed – currently there is a financial incentive for students to study at diploma level rather than degree level

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” WORKSHOP Questions – what needs to be agreed Stakeholders Risks and mitigation Models – academic pathway career Models for transition – options