A call for evidence

January 29, 1999

A principle of car mechanics is, when the vehicle is not running perfectly, start by adjusting the engine rather than by dismantling the car. This principle should apply equally to policy-making. The recent criticisms by health secretary Frank Dobson ("V-cs defend nurse training", THES, January 15) threaten to dismantle the structure of nurse and midwifery education before we have assessed if there is anything wrong with it.

Mr Dobson's comments are particularly untimely because the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) has been charged with reviewing the reforms to nurse education initiated about ten years ago, usually referred to as Project 2000. The UKCC is due to report in the early autumn, although given current uncertainty it could perhaps be persuaded to report earlier. Mr Dobson should wait for that report before he does anything we might all regret.

One reform he is enthusiastic about is evidence-based healthcare. I am enthusiastic about evidence-based policy-making. Too often we have seen major shifts in policy made without a proper evidential basis, rushed through and wrong.

Part of that evidence base must be an understanding of what nurse education was like when it was in the National Health Service, before it was integrated into higher education and why there was such strong pressure for that integration. Most came from the nursing professions. They wanted to stop student nurses being used as poorly paid labour; to have a truly professional training; and to equip nurses for challenging, rapidly changing healthcare settings.

The suggestion that placing nurse education within higher education is at the heart of the shortage of nurses is wrong. There is no evidence that potential nurses are deterred from training because it is seen as "too academic" or university based. Rather, this problem is linked to low pay, an inadequate clinical career structure and poor working conditions - all issues the government is addressing.

Universities and colleges have worked hard to make a success of integrating nurse education into the sector. We strive to develop effective working relationships with our partners in this enterprise. By and large we are very successful. Nobody would claim that it is perfect, and it is appropriate that the UKCC should review curricula and delivery arrangements.

At a time when the government is emphasising raising educational attainment, are we really saying this excludes nurses? Project 2000 was about educating and training nurses and midwives for the future. The profession's analysis was correct ten years ago, and it is valid now. As implemented, it may need adjustment. It does not need dismantling.

Malcolm McVicar Vice-chancellor University of Central Lancashire

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