Covid-19 has had a significant impact on nurse education. As its “recovery phase” continues, chief nurse and deputy chief executive officer at Health Education England (HEE) Professor Mark Radford gives a snapshot of the landscape right now and identifies the next steps to facilitate its full recovery.
Student nurses, midwives and allied health professionals were “phenomenal” during the pandemic, Professor Radford told Nursing Times. He highlighted how, at times, students had experienced “a double burden” of trying to complete their courses as well as providing support.
“It’s really important we set out a vision that recognises how critical nurses are to communities”
However, the last few years have seen positive trends emerge, said Professor Radford, including a growth in the number of people applying for nursing and midwifery courses. There had been a slight drop this year, he noted, because of the “bumper year” in 2021, which saw a record 56,650 apply. Despite the dip in numbers this year, which still remain above pre-pandemic levels, he said long-term trends of student nursing were “really positive”.
Speaking about the next cohort of students coming in, he said: “I’m expecting similar demand profiles that we’ve seen in the last recent years, the appetite for nursing doesn’t seem to have diminished.” However, there were still “problems and challenges”, which Professor Radford said were not dissimilar to those experienced by NHS staff.
HEE conducted two Covid-19 surveys of students, both of which demonstrated “an increasing set of pressures”, particularly around course completion and experiences of placements. Burnout and mental health issues were also identified; another consequence of the NHS remaining under “real pressure”, said Professor Radford.
One central issue identified by students, and something which HEE has had to risk-assess “at every stage”, is the number of students who could be potentially delayed in progressing on their courses because of the pandemic. Professor Radford said that, even though delays were “much lower” than anticipated, there were still stories of students struggling and HEE was working with them to tackle delays and get them back on track.
He said HEE has been engaging with students and student leaders to see what support needed to be in place. “One of the things that we’ve really championed through this process is making sure that the voice of the student has become integral to decision making,” he said.
Alongside the Council of Deans of Health and the Royal College of Nursing, HEE has been in regular contact with those involved with nurse education to make sure they are delivering and designing approaches that support recovery. “We’re trying to build an infrastructure that allows students to have a voice in terms of how HEE delivers policy, but also importantly, our regulatory role,” said Professor Radford, who is also deputy chief nursing officer for England.
One of the biggest fallouts from the pandemic has been a lack of placements available. Professor Radford said that placement accessibility continued to be a big issue. “In some cases, placements have not been able to take place, primarily because there have been risks or there have been changes to service models. We’ve also seen a completely fundamental shift in some cases, to different types of delivery for patients.”
As these changes came into force, virtual and online appointments required universities “to think very creatively”, he said. “We’ve had to really be quite agile over the last two to three years to be really flexible about what placement provision is available.”
To support placement accessibility, Professor Radford said HEE had invested £30m over the last two and a half years directly into providers. Looking longer term, he highlighted that HEE had a number of plans in place to improve placement provision. For example, it has revised tariff arrangements for placements, which ensure that providers are reimbursed for placements they provide. The amount per student nurse has risen from £3,400 to £5,000.
HEE has been looking to develop a placement management system with universities, to help understand where placement capacity is nationally and regionally. These systems already exist in Scotland and Wales, Professor Radford said, and HEE has commissioned a multimillion-pound investment to introduce it in England over the next 18 months.
The move to simulation activities has increased among education providers. Professor Radford identified simulation as a significant change in nurse education. He said HEE had “pump primed” over £10m directly into universities to enhance simulation capacity, working with the Nursing and Midwifery Council to make sure those hours “were part of the composite” to support students.
HEE was also looking at the number of practice hours students undertake to “really get the evidence right about what the optimum number is”, he said. “There’s a real pressure for students to complete a number of hours, where actually something around a mix between the number of hours, competency outcome and simulation would decongest that pressure a bit.”
Last year, the NMC approved the use of up to 600 hours of simulated practice for undergraduate student nurses. However, Professor Radford argued that, while simulation was important, “it can’t replace placements”.
This was why universities were looking for innovations in curriculum design and placement experience, to “maximise” student opportunities, he said. For example, the University of Buckingham and University of Roehampton have undergraduate programmes specifically designed around community and general practice. “As a direct result, students are choosing to come out of university and go directly into community practice, which is exactly what we need to see,” said Professor Radford.
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HEE is a government arms-length body. In November 2021, the Department of Health and Social Care announced that it would create a new organisation that would integrate HEE with other bodies like NHS England, NHS Digital and NHSX. At the time, the government said the move would improve waiting list backlogs, help the recovery of NHS services amid the pandemic, and drive digitisation of the NHS.
Joint work is taking place between HEE and NHS England to design “a better way of delivering education and training” for its students, trainees and learners. The bodies have until 31 March 2023 to complete that process, and Professor Radford said he felt “positive” the changes would deliver the approach they wanted, “in a way that reflects the needs of the service”.
“I think if we were to take a step back and look at how we would have designed education and training as part of the NHS and, importantly, social care, we would have the service and education and training much more interlinked, and perhaps not as two separate bodies.”
Professor Radford said he had many ambitions for the future of nursing and education, which must begin with a period of “really deep reflection” coming out of the pandemic. “From my perspective, I’ve seen the phenomenal impact of nurses up and down the country in all sorts of sectors, settings, in their communities, in people’s homes, in care homes, in hospitals. And I think it’s really important that we set out a vision for the future of the profession that recognises how critical they are to communities,” he said.
Professor Radford said HEE would continue to work with the NMC, as a “key partner” in developing the standards of education for nurses, making sure that public protection, safety and moving the profession forward “is still deeply embedded” in what they do.
He added that amplifying student nurses and midwives in the design and delivery of services was key in moving the profession forwards. “In developing a future vision, I think it’s going to be resetting how we as a graduate profession are working across the health and social care system to deliver changes.”
Professor Radford said he was keen on widening access and participation, citing the number of nursing associates recruited.
“I know in parts of our profession that’s been controversial, but the appetite for those nursing associates then to convert into registered nurses has been huge. So it gives people an access opportunity into a profession, gives them a qualification. And then importantly, a lot of those go on to do their top up training to be nurses.”
He added: “Growing the number of nurses we have is a fundamental part of what we need to do; we simply don’t have enough.”
Professor Radford thanked students, universities and services for their efforts over the last few years but recognised there was still much more to do. “We’ve got to ensure that the stabilisation of the health and social care system is a key priority. Also, importantly, that we can continue to grow the career opportunities that nursing affords individuals, but also the systems and communities that they serve.”