All Hands on Deck

by Dr Ann Bradshaw

The huge body of student nurses in training is not being mobilised onto the front line in the Covid pandemic crisis, as I wrote in Spiked recently.

Beds aren’t the problem, it is said. It’s the shortage of doctors and nurses. On December 27th the Sunday Times stated that hospitals have been ordered to mobilise their “surge capacity” in the face of soaring Covid infections, staff absence and longer patient stays. Amanda Pritchard, NHS Chief Operating Officer, ordered trusts to use the independent sector, community provision, specialist hospitals and the Nightingale Hospitals. Some hospitals in London are now operating above 100% ICU capacity and are said to be near “breaking point”.

The following day the Telegraph reported that the London Nightingale hospital was even being dismantled.

This desperate need for health care staff in the Covid crisis was clear at the start of the outbreak of the pandemic. Health Education England (HEE), the Education Commissioning Branch of the NHS worked together with nursing and other organisations on a national response. At this time, students came forward to work in their clinical placements as paid members of the NHS health care team. By July, 28,108 student nurses and student midwives had opted into and been eligible for paid employment.

In June, although the pandemic was not officially over and restrictions remained in place, HEE noted that the Nursing and Midwifery Council (NMC), the nursing regulator, planned to withdraw these emergency paid placements from September. As HEE states:

We recognise that the pandemic has been disruptive and it is important that we support you back onto your education programme or into employment. We therefore need to re-establish normal supernumerary placements in preparation for the withdrawal of the NMC Emergency Standards from September 30th and the start of the new academic year. Placements are important for developing skills and the best way to ensure students receive a mixture of academic, theoretical and safe practical learning. There is clear commitment from the Chief Nursing Officers of England, Scotland, Wales and Northern Ireland, the NMC, universities and unions to do this.

On November 17th, in the face of surging infections in the UK, the NMC confirmed that it was withdrawing its emergency education standards and hence student nurses from paid placement employment. Clinical practice for students was supernumerary again. The withdrawal of their emergency programme is justified by the NMC with reference to support of students and to “protect” their learning. It also cites EU legislation:

All courses must still comply with the minimum training hours requirements under EU legislation – 4,600 programme hours – and a maximum two thirds clinical weighting which we have no legal power to change or waive.

This seems rather a specious justification, as if the NMC is asserting its protectionist authority without consideration of any overriding emergency pandemic legislation, or indeed the possibility of adapting training to meet the crisis needs of NHS patients.

On November 18th the Royal College of Nursing (RCN), which is both a professional body and a trade union, supported the NMC.

As we move into the second wave of the COVID-19 pandemic, the priority is to support students to complete their studies and complete educational programmes on time. There is currently no intention to return to the option of paid clinical placements … all students will be returning to supernumerary status for their clinical placements.

So the paramount priority for the nursing establishment is the “support” of students and not the desperate health needs of the nation in a winter epidemic crisis. Is the nursing establishment being protectionist in keeping its students on their university courses and preventing them from working as paid employees under the control of the NHS? After all, paid working in the NHS in this context would provide a deep enrichment of their training experience as well as financial security and crucial hospital staffing. The 28,108 student nurses and student midwives who opted for this plan at the start of the pandemic show they welcome the opportunity. So why has the nursing establishment withdrawn this plan? What is the explanation for this bizarre situation?

In 2015, the Council of Deans of Health (representing UK university health faculties) and Universities UK issued a joint statement asking the Government to change student funding from grants to loan. This House of Commons Briefing Paper notes the costs of university nursing education. The estimates for a nurse (2015-16):

is that the total cost of tuition is around £24,000. Costs linked to clinical placements increase this cost to £29,000. However, the largest element of their total estimate are the costs of living expenses while training/studying and lost ‘production’ when they are away from their posts training. This increases the total pre-registration ‘investment’ for a nurse to around £85,600.

This gives rise to the following question: Are student nurses being prevented from paid NHS employment in clinical placements in Nightingale and other hospitals to defend the supernumerary status of current nurse education, and thereby maintain the financial funding and ideological structure that protects the university nursing departments? Is the ideology of nurse as university student being put ahead of saving lives? And this raises important questions about the fitness for practice of the current model of nursing education. Arguably, the Covid crisis has highlighted the relevance of these questions with a profound urgency. Why is the state unable to adequately staff NHS hospitals? Has university based nurse education been tested by this pandemic and found wanting? These questions, however, are for the future.

The more urgent question is why in this crisis the Government has passed draconian emergency legislation to lock the public down, destroying human freedoms, education and businesses but has not used this same emergency power to conscript and deploy willing nursing students into the NHS front line by compelling the nursing bodies to cooperate?

Dr Ann Bradshaw is a retired Senior Lecturer in Adult Health Care, Oxford Brookes.