What does detriment mean when a student makes a complaint?

The TL;DR is that some universities didn’t return their programmes to the NMC’s approved provision of simulated practice hours when Covid-era emergency and recovery standards were removed.

And some universities had been wrongly counting parts of their programme that would not meet its pre-registration standards for practice learning (including standards for student supervision) focused mainly on “reflection hours.”

That meant students were short. In April, the NMC told us that it couldn’t confirm how many students were affected by a shortfall in practice hours, or to what extent, and so it was also unconfirmed that any student’s registration would be delayed.

Now six months on, there’s an update.

After a “thorough review”, the MNC is confident that most providers met its standards – although it is “working with a small group” to address some “remaining issues”.

I don’t think that means “a bunch of providers had to put in loads of extra placement hours” and I do think that means “it turns out that it was all fine in most places”, but it sounds like good news either way.

A major shortfall

Not so much at the University of Brighton, where a large number of students had a shortfall of supervised practice learning hours. The NMC says that the university has put in place an action plan to rectify this, which it approved. Students are now on the path to completing their programmes, but for some of them this will mean they will complete their programmes up to eight weeks later than originally planned.

All students, I was assured, have been receiving support from the university and practice learning partners to complete the required number of hours.

The university told me that it has provided all students with a financial study support package to cover the equivalent of eight weeks additional course time, which it says has mitigated any loss of earnings from delay and recognises any inconvenience and upset caused:

Working with the NMC, we have been able to make in-year adjustments to the course schedule and the supervision of clinical practice hours which has resulted in our final year students requiring an average of six weeks additional time in practice. A number of students have opted to undertake these hours during university vacation periods and are completing the course with minimal delay.

But it turns out that it wasn’t just current students that were affected. 350 nurses were also affected from cohorts that have graduated since 2019. And they all got a letter late last week.

The NMC’s plan is to assess – on an individual basis – whether the shortfall in hours is mitigated by any supervised practice hours that have happened following completion of the programme while working as a registered nurse during their period of induction and preceptorship.

It’s keen to stress that the students have not done anything wrong and were assessed as meeting its standards of proficiency (what they need to know and be able to do at the point of registration) when they joined the register.

But they might now need to make the hours up. Over on reddit, one of the impacted students describes the situation like this:

We basically spent 2 years of uni on MSTeams. No access to the library or sim suite, or 2nd placement cancelled at the start of the pandemic. We didn’t get compensated for this. And in year 2 & 3 we had extended placement to make up hours as well as sim suite and 5.5 hours reflection a week. Now we have been told this was incorrect. UoB sent out emails to us 2 days after the NMC. No warning from them this was happening. Since then I have discovered current students are finishing late to make up hours. The NMC have asked us for proof of supervised hours since we qualified. Hopefully this will be enough, but if not we could face the reality of having restrictions put on us.

I feel we are owed a refund or compensation but we barely even got an apology. In fact the university contacted our employers before they contacted us.

Compensation?

The NMC said that it hadn’t expressed a view on financial compensation as that is a matter for the universities.

The university told us that their students will nearly all have completed the required hours through the post-graduation activities undertaken as part of induction of a new nurse – and that if any former student wishes to submit a complaint, they will be able to do so via its complaints procedure.

That’s where things get trickier. The university’s procedure – which is pretty standard around the sector as things stand – says that students should raise their complaint as soon as they become aware of a problem and normally within 30 calendar days of the issue or concern arising. It also says that former students must submit a formal complaint within 60 calendar days of their withdrawal or last day of attendance, whichever is the sooner, though the university “may exceptionally consider complaints outside of our time limits, at the discretion of the university.”

When I raised this with the university it said that it was confident that these graduates will not suffer any detriment, but that if an individual felt that they have been disadvantaged, they should submit to its complaints process – and if there are “exceptional circumstances” their complaint would be considered.

Learning lessons

Outside the specifics of the individual cases in question, this situation raises wider issues for me. We might not see another pandemic like Covid-19 in the foreseeable future, but it’s certainly possible to imagine future scenarios in which circumstances force a number of institutions to change provision in some way without an obvious roadmap for how this ought to be done – and so this particular situation offers an opportunity to tighten up how these moments are managed.

The first issue is about problems with provision that students may only become aware of long after actually experiencing that provision. It should surely be a central principle that students are able to complain when they become aware and/or when it has an impact, rather than tying deadlines to experiencing the provision itself.

The second concerns the centrality of “detriment”. In this and other cases, students pay for the provision to do what it says on the tin – and while it may be that the students in this or other cases won’t experience material detriment to their career, they don’t seem to have got what it was that they paid for.

These types of arguments have been floating around OIA blogs for a long time – whether “detriment” relates more to students’ outcomes or to the learning opportunities – and are obviously a central feature of the ongoing student group claim over both Covid and strikes. It feels like consumer-law compliant complaints policies should be very clear on the difference.

The third is about consumer protection law in general. Despite what I’ve said above, student nurses are almost certainly not consumers in law, because the education/training on offer is for a specific profession. OfS and the OIA have tended to argue in the past that providers should just treat everyone as if they are consumers anyway – but that couldn’t be more buried, and doesn’t change the difference in rights if they ended up in the courts.

But the final one is about compensation for loss of earnings, or for distress and inconvenience. Any student advancing an argument that they are due compensation might come across the OIA’s “putting things right” pages, but I’m told that across the sector, students usually either have to appeal or get their completion of procedures letter and go to the OIA to get what is suggested.

And while we might not expect the specific characteristics of this case to show up in examples, I can’t imagine it makes much sense for a student to have to wade through OIA case summaries to get a sense of what their circumstances might mean in terms of any right to a payout.

In his review of OfS, David Behan noted that there are significant asymmetries of power and information between providers and students, that contracts are not always clear about what the student is consuming for the fees that are paid in their name, and nor what recourse is available should delivery not equal expectation. It does feel like there’s still work to do in this area.