There are around 90,000 students in the UK studying healthcare courses leading to registration with the Health and Care Professions Council (HCPC) or the Nursing and Midwifery Council (NMC). These courses include nursing, midwifery and the many and varied allied health professions, for example physiotherapy, paramedic science, radiography and dietetics. Universities are critical partners in the UK’s healthcare sector educating the future workforce and providing post-registration education for current staff.
Healthcare education in England has received increased media attention since 2017 when students moved from a system of paid tuition and NHS bursaries into mainstream student funding arrangements. The sector expansion that the Government had hoped for following the end of commissioned healthcare education has not materialised. In fact, HESES data show student numbers have fallen in some healthcare subjects over the past two years, with worryingly steep declines in the numbers of students starting courses on learning disability nursing (-43 per cent), podiatry (-38 per cent) and therapeutic radiography (-23 per cent). Some universities have been forced to cease provision of these subjects. Adult nursing, the largest of these courses, has suffered a 10 per cent fall in student starters. Meanwhile the NHS is grappling with huge workforce challenges. One in eight nursing posts are vacant in England and this is expected to worsen in the short term.
Changes in healthcare education
During this time, degree apprenticeships have been designed and introduced for most healthcare subjects. Over 800 apprentices are now on the registered nurse degree programme but implementation has not been smooth. These apprenticeships offer some benefits but are expensive for employers because of backfill costs, have complicated end point assessment requirements and will never provide a solution to the NHS’s recruitment problems. At least one standard has recently been funded well below the likely costs of education, reducing the appeal to universities of provision.
The post-registration healthcare education market has experienced real volatility in recent years with cuts of over 60 per cent to NHS workforce development budgets in England since 2015. This has had inevitable consequences for university provision, though there has been some commitment recently to reinvestment and a particular emphasis on growing Masters-level advanced practice education.
Healthcare courses are subject to regulation by healthcare regulatory bodies as well as the usual higher education regulation. Alongside all the recent regulatory changes experienced by the higher education sector, nursing standards have undergone a thorough redesign by the NMC necessitating considerable ongoing programme change in universities. A similar process is now underway for midwifery and for the allied health professions under the HCPC. Healthcare faculties have generally welcomed these changes to educational standards but have had to work hard to adapt existing programmes and gain regulators’ approval.
Planning for the long term
In January the NHS published its long-anticipated Long Term Plan, which will be followed in the coming months by more detailed workforce implementation plans. The Plan commits to workforce expansion over the next 10 years and acknowledges university education as being central to the NHS’s wider objectives. The Council of Deans of Health, which represents the UK university faculties educating healthcare students, has welcomed plans for annual recruitment campaigns, possibly supported by job guarantees for healthcare graduates. It is also pleased that the NHS intends to increase clinical placement capacity for students to support sector growth. The Council is less convinced by the commitment to exploring an online nursing degree.
Despite suggestions that universities are turning away highly qualified applicants to these courses, most of our members report challenges in attracting and recruiting suitable students, particularly for the less popular and less well-known healthcare subjects. The Office for Students already supports interventions to raise awareness of the smaller allied health professions and has commissioned research on mature and male student participation. Though this involvement is very welcome, the Council has called for student maintenance grants to support healthcare students, consideration of loan repayment schemes in return for post-qualification service and for the up-front payment of tuition fees for postgraduate students. These would not be cheap interventions and are more likely to be considered for subsections of the student population, for the most vulnerable subjects, for mature or postgraduate students. Similar interventions have recently been supported by influential health think tanks but so much is likely to depend on this year’s Spending Review.
The Augar effect
The NHS Long Term Plan offers some hope to those universities educating healthcare students and staff but we cannot ignore the simultaneous threat to these courses from the Augar review. Healthcare courses are high cost subjects, which already rely on public subsidy of student tuition fees by the Office for Students for sustainable provision. Any reduction in overall course funding would undermine the quality of education and is likely to lead to a contraction of this sector through a reduction in student places and a withdrawal of courses where these become unaffordable. We will be looking to the government to guarantee existing levels of funding for healthcare pre-registration education. This is necessary to give universities the certainty they require to continue to work with the NHS to grow the workforce.