Nursing provision heads for critical list

July 21, 2006

Raids on training budgets to meet health service deficits could have a devastating effect on tutors and students, finds Claire Sanders

Nursing academics are facing redundancies and a "nightmare" future as education and training accounts are raided to meet National Health Service budget deficits, nursing leaders have warned.

Giving evidence to the Commons Health Select Committee last month, Dame Jill Macleod Clark, chair of the Council of Deans and Heads of UK university faculties for nursing and health professionals, described the cuts in nursing provision as "dangerous" and potentially "devastating".

"My nightmare prediction is that there will be a continual raiding of this budget unless it is ring-fenced," Dame Jill said.

The crisis is so severe across all the allied health disciplines that some deans are warning that universities will pull out of key areas of health provision altogether - as Sheffield did last year. Universities are already having to lay people off, with more redundancies to come.

Some universities, such as Thames Valley, have recently invested millions of pounds in new facilities and campuses and now face cuts of up to 30 per cent in their intake of healthcare students.

Janet Finch, chair of the Universities UK health strategy group and vice-chancellor of Keele University, warned that insecurity in health funding created yet another source of instability for universities.

"Tuition fees will bring greater volatility to the sector, and these health budgets now contain a risk factor," she said. "Institutions are nervous."

The impact on future student recruitment, as NHS trusts slash new posts, is also a serious worry.

A recent Council of Deans survey showed that eight out of ten nursing students who will qualify this summer have been unable to find jobs. This compares with three out of ten last year.

Physiotherapy, which had a bad year last year, is now in an even worse predicament. According to the Council of Deans survey, just 15 per cent of students at universities that responded had jobs to go to.

Dame Jill told the select committee that drop-out rates on university courses could rise if students felt they had no prospects of getting a job.

Deans are particularly concerned because the cuts are a result of NHS budget deficits, not workforce needs.

Professor Finch wrote to Lord Warner, Minister of State for Reform at the Department of Health, warning against any return to a "stop-go" funding cycle.

She refers to council of deans figures, which show that some universities are being asked to make cuts of up to 30 per cent in their healthcare student intakes for next year.

"I cannot stress too strongly how potentially serious this is for the workforce needs of the health service, as well as for higher education institutions, particularly those worst affected," Professor Finch writes.

The deans' survey found overall reductions in commission numbers across the country of about 10 per cent.

Over the past few years, nursing and allied health education has been one of the fastest growing areas in the higher education sector. Nursing numbers alone increased from nearly 52,000 in 1994-95 to 186,600 in 2004-05.

A considerable amount of effort has gone into stabilising the relationship between health faculties and the NHS.

Professor Finch says in the letter: "The cuts are undermining confidence in this relationship."

Workforce Development Confederations, which had started to develop good relationships with universities, were absorbed into Strategic Health Authorities two years ago. The 28 SHAs are now being reduced to ten, and there is no longer a place for a higher education representative on the new boards.

Professor Finch wrote to Lord Warner saying: "This is disappointing, controversial and risks undermining the necessary ongoing collaboration between higher education and the health service."

To date, Universities UK has not received any guarantees about the place of universities on the new SHAs, and Lord Warner has been clear that there will be no ring-fencing of the education and training budget.

On top of this there are wide variations between the funding of medical students and other health students, as well as between health students.

Attempts to benchmark prices for nursing students are being resisted by some universities, notably those at the top end of the scale.

Unions are concerned at the job losses and argue that more must be done to ring-fence the budgets nationally and within universities.

"Universities must stop top-slicing these budgets to support other departments elsewhere," said Andy Pike, a senior national official at the University and College Union.

Calls are growing for the health education and training budget to be moved from the DH to the Higher Education Funding Council for England, in line with medical and social work education.

This would, in effect, ring-fence the budget. A paper has already gone to Hefce on this matter, and Professor Finch and Dame Jill are to meet David Eastwood, the incoming head of the funding council, later this month.

The DH, however, has indicated that no shift is forthcoming. An official said that the current arrangements allowed the NHS to plan and commission workforce needs locally. "We continue to believe that the best way for this to be carried out is for the funding to remain as DH/NHS budget." the official added.



Steven West, deputy vice-chancellor of the University of the West of England, will lose £900,000 from his health and social care budget next year - a cut of about 12 per cent.

Some courses will not run at all next year. One-year programmes designed to retrain qualified nurses to work in the community will go, as will conversion programmes for qualified nurses wishing to switch specialisms.

Degree courses have not escaped unscathed, with a cut of 48 places.

Physiotherapy, occupational therapy, mental health and midwifery courses have also been hit.

The cuts are a result of a budget deficit in the local National Health Service trust.

"They represent a one-year saving for the NHS but a three-year hit for us, as we have to cope with reduced student numbers through the system," he said. "If this blip in funding becomes a trend, the consequences will be dire," Professor West said.

He added that he could not guarantee jobs if the cuts became permanent. He predicted that some universities would pull out of allied health provision altogether if the situation was not stabilised.

Thames Valley

Thames Valley University is facing cuts of 30 per cent in its nursing numbers for next year and is already having to make staff redundant.

Gail Thomas, dean of nursing and midwifery, said: "I cannot be precise about the number of redundancies at the moment. It may be very difficult to recruit in the future:as it is, salaries in higher education do not match those in the NHS."

Dr Thomas added: "There are no guarantees that our budget will go back up again in the future; we anticipate it staying at this reduced level for at least the next two years."

She said that most of the students graduating from Thames Valley were finding jobs.

The university has invested significantly in a new campus for its healthcare students. The Paragon campus, situated in Brentford, includes 240 key-worker housing units, 840 study bedrooms for students and a 12-storey teaching block.


George Brann

George Brann is a third-year nursing student at Southampton University. He is a couple of months from qualifying, has so far applied for 30 jobs and he has had one interview, which did not lead to a job.

Like many students on his course, he is angry. "When we enrolled we had no idea of the budget problems in store," he said. "We all thought we would get jobs at the end of the three years."

At 23, Mr Brann is one of the youngest students on his course.

"In many ways, I consider myself to be one of the lucky ones," he said. "I do not have children and have been able to work part time at my local Asda-WalMart, so I do not have huge debts.

"I studied nursing as I wanted a serious career that would satisfy me for the next 40 years of my working life," he said.

"It looks as if that was a waste of time."

Tracy Jenney

Tracy Jenney is married with two children and faces a future without a job.

"We are currently renegotiating our mortgage, as it now looks as if I will not be working this September," she said.

Having studied at Southampton University on a nursing course for the past three years, alternating her commitments with her husband's shiftwork, she is baffled at the poor employment prospects.

"I am doing my placement in an accident and emergency department, and the nurses are run ragged," she said.

"More are needed - it is the financial climate that's the problem."

She was shocked when she attended a job fair at the university this year and heard the representative from the local NHS trust say that there were currently no jobs - and would not be for the foreseeable future.

"Many of my fellow students are going for healthcare support worker jobs,"

she said. "What is the point of training for all those years at the taxpayers' expense and ending up as cheap labour?"

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