Can nursing degree apprenticeships deliver on their promise?
Despite a faltering start, they offer new opportunities for would-be nurses in England
Despite a faltering start, they offer new opportunities for would-be nurses in England
A nursing apprenticeship has offered a way into a career that was otherwise impossible for Michelle Flannery.
As a single mother of three children, she needed an income and did not want to take on tens of thousands of pounds in debt – so the introduction of tuition fees and the loss of the bursary ruled out traditional degree courses for her.
Ms Flannery, who was working as a healthcare assistant, instead applied for a nursing apprenticeship with her employer Virgin Care, which runs community healthcare services in north Kent.
‘In a sector that is struggling to attract people into the profession, it is opening up the opportunity to a wider talent pool’
Stuart Rennison-Price, Virgin Care chief operating officer
She now attends Greenwich University for the classroom-based part of her nursing degree, and works two days a week as a healthcare assistant at Sheppey Community Hospital and three days on placement with the community team in the area.
Small price to pay
As her hours spent in placement are slightly less than those for students doing the standard three-year degree, she will need to do an extra year to make up the hours required by the Nursing and Midwifery Council for registration. But Ms Flannery sees that as a small price to pay for having an income – and avoiding going into debt – while she trains.
‘Nursing was always something I wanted to do,’ she says. ‘The only thing that stopped me from going to university was the ending of the bursary.’
She joined Virgin Care as a healthcare assistant after hearing that it was planning to support nursing apprenticeships, and was one of 70 applicants for three apprenticeship positions starting this September.
Unaware of apprentice option
Her training started with a five-week block in the classroom. She was one of only two nursing apprentices on the course – the other works in a nursing home – and says other students were disappointed that they had not known about the apprenticeship option.
Ms Flannery's experience as a healthcare assistant has helped while on placement, but she says some aspects are new or she is seeing them through a different lens. ‘The medication side is something I was not familiar with, but it is fascinating,’ she says. And while she was familiar with issues such as pressure ulcers, her knowledge extended only to what she needed to carry out her previous role, so she is learning from the nurses on the team.
‘The team I have been moved to has been very supportive,’ she says.
Virgin’s community nursing lead in north Kent, Sarah Hutton, says Ms Flannery may soon be joined by other apprentices. ‘You can see the potential in other healthcare assistants, and this gives others an example to follow. At the moment we are in the process of advertising again and are hoping to have two more apprentices for the March intake.’
Virgin Care chief operating officer Stuart Rennison-Price says the company deliberately started small with the intention of appointing three nursing apprentices, but wants to expand quite rapidly. ‘In a sector which is struggling to attract people into the profession, it is opening up the opportunity to a wider talent pool,’ he says.
Critical report by MPs
Over the next three years the company wants to build up to having around 12 nursing apprentices for each of its services, with the eventual aim of being able to replace retiring nurses with ‘home-grown’ graduates – many of whom may never have seen a university degree as within their grasp.
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But the opportunity open to Ms Flannery has not been available to many other aspiring nurses, including many working for NHS trusts, according to a critical report by the House of Commons Education Committee, published in early December.
The report, Nursing degree apprenticeships: in poor health?, says the initial intake of nursing apprentices across the country in 2017 was only around 30 students spread across two universities, far below the 1,000 a year envisaged by the government.
‘There are too many obstacles in the way of nursing degree apprenticeships’
Commons Education Committee report
It highlights the mismatch between the aspiration to offer would-be nurses this route into the profession and the costs for trusts. These costs include the NMC requirement for nursing students to be ‘off the job’ for half the time, and the supernumerary status of nursing students while they are on placement, which means they do not count towards the staffing levels deemed necessary for safe care.
This status also means that even though their employer is paying them while they are on placement their role has to be backfilled, usually at a cost of up to £10 an hour.
The report says that while the government has set a target for apprentices to make up 2.3% of the head count at most larger public sector bodies, it has failed to appreciate what makes nursing apprenticeships different, including the time spent in the classroom, which is far more than for most apprenticeships.
‘There are too many obstacles in the way of nursing degree apprenticeships, making it extremely difficult for the NHS to play its part in achieving the public-sector target,’ it says.
‘Little incentive to spend time and resources’
‘There is currently little incentive for the NHS to spend precious time and resources building nursing apprenticeships. It is imperative that nursing apprenticeships work for the NHS as well as for providers and nursing students,’ the report says.
The Commons committee said it looked forward to the outcome of the NMC’s consultation on whether nursing associate students should remain supernumerary and whether there are alternative approaches.
Its report said: ‘We urge the NMC to apply any safe and effective flexibility to supernumerary status to nursing degree apprentices in addition to nursing associates.’
‘The university route remains the fastest and safest way to educate, train and recruit the nurses we so desperately need’
Anne Corrin, RCN head of professional learning and development
The RCN says supernumerary status is vital for a safe route into nursing.
Funding students who are away from the workplace half the time and supernumerary for the rest is a challenge. NHS Employers told the Commons committee that the cost was £35,000-40,000 per student per year – including salary, mentoring and supervision, and backfill.
The cost of the course is covered through the apprenticeship levy, which all large employers have to pay, but this levy cannot be used to cover other elements of the costs such as backfill.
MPs suggest changes
The committee suggested this system needs to change – and that the funding paid to universities for nursing apprenticeship courses should potentially increase if the courses are to remain viable for them.
Mr Rennison-Price says Virgin Care faces the same challenges over cost as NHS trusts. ‘The finances are difficult. But what we have recognised is that we have to train these people regardless, and if there is an opportunity to get funding support for this, even if it doesn’t cover everything, why would you not do it?’
While nurses on placement do not count towards safe staffing requirements, he says there are still benefits for the organisation in having them there. In the longer term, any organisation that has vacancies will be paying far more to fill them with agency staff, he suggests.
Not a magic bullet
The Commons committee also suggested more postgraduate apprenticeships could be created, which would offer nurses continuing professional development. Health Education England chief executive Ian Cumming told the committee this would be a ‘perfectly legitimate use of the apprentice levy’.
RCN head of professional learning and development Anne Corrin says the college welcomes apprenticeships if they are properly resourced and implemented safely. ‘But they are far from the magic bullet the government promised to grow nurse numbers and keep patients safe.
‘This report makes it clear that the university route remains the fastest and safest way to educate, train and recruit the nurses we so desperately need. The government must invest at least £1 billion back into nursing higher education to help fill the growing number of nurse vacancies in England.’
Alison Moore is a health journalist
- Nursing degree apprenticeships: in poor health? (Commons Education Committee)