The government must give more detail on how it will tackle the biggest problems facing nurse education, according to leading figures in the sector, in response to the recently published 10-year plan for the NHS.
Last week, the UK government published its long-awaited 10 Year Health Plan, outlining the changes to the structure of the health service and how its staff work, which it hopes to achieve over the next decade.
“Students are finding it more and more difficult to afford to be able to come to university and undertake education programmes”
Denise Baker
It is centred around three major ‘shifts’: making the health service more digital, emphasising prevention over treating sickness, and moving care from hospitals into the community.
It also describes how the government wants to change education for nurses, midwives and other healthcare professionals, as part of an aspiration to move away from international recruitment to prioritising a domestic pipeline.
Impacting all healthcare profession courses was a government pledge to speed up reimbursement for travel expenses, an issue which has significantly hampered the cash flow of student nurses.
To achieve this, the government said it would work with the NHS Business Services Authority to “reform and modernise” the payment system in time for the start of the 2026-27 academic year, next September.
This and some other policies designed to bring about improvements for nursing students and educators were trailed early last week by health and social care secretary Wes Streeting, ahead of the main plan.
Another was for students to be able to start work more quickly after finishing their degrees. The plan stated it would create a “standard for confirmation of course completion” by September 2026, in order to make it easier for them to find work.
The plan stated: “We will help nursing students overcome financial obstacles to learning, including reducing delays to reimbursement for their placement travel and the time lag between course completion and its confirmation.”
In addition, as part of its shift from hospitals to the community, the government said it would be working to widen the availability of student placements in community and neighbourhood settings.
It also announced it would create 2,000 more nursing apprenticeships across the next three years, prioritising the geographical areas of greatest need.
Meanwhile, universities are to be instructed to “urgently address attrition rates”, in response to high numbers of student healthcare professionals dropping out before the conclusion of their courses.
How universities should do this was not addressed in detail by the plan. But it stated it would be a “key objective” of a separate nursing and midwifery strategy, due to be published later this year by the chief nursing officer for England.
For post-registration training, the plan stated that it would be further developing advanced practice roles, with work to begin in the coming years on accreditation and regulation of courses to train for these roles.
Dr Denise Baker, pro vice chancellor and dean of the College of Health, Psychology and Social Care at the University of Derby, said it would be “interesting” to see how the plan would be implemented.
“That’s one of the things that we didn’t really see in [it],” she said. “There were a lot of things that are being suggested, perhaps quite a lot of rhetoric…
“The plan suggests [the government is] committed to investing in education, both financially and in terms of looking at the future of [it],” she noted. “But, again, it’s very light on detail.”
Dr Baker was supportive of many of the changes the government called for in the plan, such as improving the tech-readiness of student healthcare professionals, improving payment systems and providing more community healthcare placements. However, she identified some gaps.
“We know from our current experiences that students are finding it more and more difficult to afford to be able to come to university and undertake education programmes,” Dr Baker said.
“So there is a particular concern, for me, that paying the students’ expenses more quickly is, whilst welcome, not going to resolve the financial challenges that our students find themselves in.”
Recently, the government announced that it would be clamping down on NHS organisations spending money on hiring agency staff and the plan reiterates this.
However, Dr Baker warned that this could act as an indirect cut to student financial support, because many student nurses and midwives take on agency work alongside their studies.
In response to creating more placements for students in the community, she said: “Whilst I very much welcome the notion that we will be supporting students to gain more experiences outside of hospital settings, we do have to maintain a balance of where students undertake that placement learning.
“They need to be able to achieve the outcomes that the regulators and the universities require, and that can be in many varied places,” she said.
Dr Baker further aired frustration at the lack of detail in the plan regarding how to tackle student attrition from courses.
“There’s the suggestion in there that we need to reduce attrition, as if that is the sole responsibility of the university. This is a multi-factor problem that we are dealing with every day,” she said.
“Of course, there are some elements of attrition that we can have better control over, in how we support our students to undertake their learning in the university settings…
“But 50% of the time they spend working in the NHS or social care, and we have an indirect influence on the quality of the experiences that they have out in placement.”
Dr Baker added: “One of the biggest reasons we see for people choosing to leave the programmes is that they cannot afford to maintain their place during their three years of learning, and that, for me, is a real tragedy.”
Ed Hughes, chief executive of the Council of Deans of Health
Ed Hughes, chief executive of the Council of Deans of Health, which represents higher education providers, said his members supported the overall aims of the plan.
He said the government must engage closely with education providers in the creation of the separate 10 Year Workforce Plan, the publication of which was revealed in the 10 Year Health Plan.
“It is vital that this factors in the experience, challenges and ideas of the universities and colleges responsible for education and training; they will be the ones who prepare the next generation of nurses, midwives and allied health professionals for the three shifts set out in the plan,” he said.
“Delivering the ambitious changes set out in the plan will require concerted effort across not just health systems but for education too,” noted Mr Hughes.
“Addressing the challenges facing our higher education sector – so that we have a sustainable clinical academic workforce to lead teaching and research, ensuring students can access the financial support they need to afford to study, widening access to careers in health, and making the NHS an employment destination of choice – are central to this.”
Jon Czul, managing director for the government arms’-length body Skills for Health, similarly welcomed the plan, but aired concerns about the lack of detail about how its ambitions would be delivered.
Speaking about the plan overall, Mr Czul said: “The practicalities of these plans will need to be considered carefully in the context of integrated workforce planning across the NHS.”
He welcomed, in particular, the ambition to train more doctors and nurses in the UK. But added: “Given the current and historic workforce models, it is worth noting the difficultly ahead to create a service that doesn’t require the skills of overseas workers.”
