‘It’s time nursing had a marketing campaign – and we can help deliver it’

Universities have the expertise to promote all specialties, says Brian Webster-Henderson

Council of Deans of Health chair Brian Webster-Henderson says nursing as a whole, not just the hardest-hit specialties, needs support from the NHS Long Term Plan

Brian Webster-Henderson wants a seat at the table when decisions that will shape
education and the workforce are made. Picture: John Houlihan

Brian Webster-Henderson is a man who chooses his words carefully. As chair of the Council of Deans of Health (CoDH), the body that represents UK university faculties engaged in education and research for nurses, midwives and allied health professionals, he wants a seat at the table when the decisions that will shape education and the workforce are being made.

This means he isn’t going to pick a fight with NHS England by rushing to judgement on the much-delayed NHS Long Term Plan. His caution, however, means that when he says something in the plan has ‘shocked’ him you sit up and pay attention.

Why are potential nursing students turned away?

The plan blames universities for the lack of growth in nursing student numbers, calling it 'paradoxical' that thousands of highly motivated and well-qualified applicants who want to the join the health service are being 'turned away'.

‘A number of Higher Education Institutions (HEIs) have entry tariffs well above the levels set by other HEIs and deemed to meet appropriate standards by the Nursing and Midwifery Council,’ it says.

Professor Webster-Henderson says this amounts to ‘an unfair slap at universities’.

‘One of the biggest problems is that a lot of the applicants are just not meeting the English and maths requirements for a nursing degree’

‘They have taken a UCAS figure and not given it any analysis or interrogation – I was somewhat shocked if not disappointed by the lack of interrogation of that.

‘Our members tell us that they get far more applications to children’s nursing than other areas, so there is a higher rate of rejection for some applications, primarily because the placements are not there. You can’t have one without the other.’

He also suggests that there’s an issue with the quality of applicants. ‘We did our own survey in 2018 and found that one of the biggest problems is that a lot of the applicants are just not meeting the English and maths requirements for a nursing degree. There’s obviously something wider around our education system. It is not just universities turning away lots of students – it is much more complex than that.

‘I would also say, surely you don’t want us taking in students who are going to fail the nursing degree programme? Surely you don’t want us taking students who don’t have the English and maths required to provide strong, evidence-based care?’

Modernise the NHS to meet today’s needs

Our interview takes place two days after publication of the plan, which aims to reset how the NHS is run to deliver improved care to a growing and ageing population. As is so often the case with national health plans, there is a lot that sounds familiar and is impossible to argue against.

The Long Term Plan aims to enable people to live and age well through a more holistic approach to care, achieved by breaking down barriers between organisations, embracing new technology and shifting the focus to prevention and care in the community.

Asked about the emphasis on the community, Professor Webster-Henderson says a little wearily: ‘I’ve been a nurse for 36 years so this is not the first time the government has talked about a push for more community focus.’

‘The Long Term Plan’s direction of travel is largely a positive one’

But he adds: ‘The plan does give a kind of change in the direction of services. The NHS has to be modernised in the way it organises itself and the way services are shaped, and that’s what’s happening (here). The Long Term Plan’s direction of travel is largely a positive one. Certainly, from the perspective of higher education we are really keen to support it.’ 

Increase undergraduate nurse places

The plan acknowledges that success depends on increasing staff numbers, and on recruiting and retaining appropriately skilled staff. This is a tall order at a time when nursing shortages in England stand at 40,000.

Professor Webster-Henderson is encouraged by most of the announcements on workforce in the plan, particularly the focus on undergraduate degree nursing, the commitment to boost funding for clinical placements – up to a 50% increase in placements – and increased investment in continuing professional development (CPD) over the next five years.

‘The plan recognises that undergraduate degree nursing is the main source of increasing nursing numbers, and that’s to be welcomed,’ he says.

Support for CPD

The plan promises desperately needed increased investment in continuing professional development (CPD) over the next five years. It states that support from employers is key – in particular in allowing staff the time they need for their professional development.

Professor Webster-Henderson says the boost for CPD is crucial, both to ease workforce pressures by keeping nurses in the profession and to enable them to meet the NMC’s new education standards.

‘Invest in existing workforce’

The standards set the bar high not just for students but for the profession as a whole. Due to be introduced this year, they are designed to increase nurses’ contribution to public health and enable them to take a lead role in managing increasingly complex healthcare.

He hopes employers will respond to the plan by recognising the necessity of CPD. ‘We have a huge registered workforce out there. It’s really important that we invest in the existing workforce. Education has to shape up, but we can’t do without our practice partners.’   

Consequences of ‘earn and learn’

But he is concerned there will be unintended consequences from the promise to explore the option of ‘earn and learn’ support premiums, intended to enable mature students to undertake undergraduate degrees in mental health or learning disability nursing. 

‘While I understand that, it could be to the detriment of adult nursing. I’d like a little bit of wisdom around this – why would we do it for some fields and not for others? Are we just going to rob Peter to pay Paul, and end up with a big gap in adult nursing?’

He says the decline in mature students, which has created so much concern in mental health and learning disability nursing, is also now becoming marked in adult nursing programmes, which are also becoming less popular. ‘Many universities are telling us we are seeing a lot more 18 year olds coming in than before.’

Nursing as a whole needs to be supported and promoted, he argues. ‘We haven’t seen the recruitment campaign we asked for when there was a change to the loans system (to replace the student bursary in England).

‘The CoDH made the point that we have to have a sustained recruitment campaign to demonstrate the breadth and depth of careers we have in nursing – that’s something that should have happened before the loans system was introduced.’ 

We need a marketing campaign

The plan promises to develop annual recruitment campaigns in conjunction with the royal colleges and the trade unions. Might it be too little, too late? Professor Webster-Henderson is optimistic that the national campaign will hit the mark.

‘The government has listened to us about the desperate need for a sustained, good quality marketing campaign around nursing. And I think they have responded to that in the plan.’

He adds: ‘I’m going to nail my colours to the mast. Universities are expert at running campaigns. Let’s take those really good ideas and translate them into a national campaign. And I feel confident that we as a council will be part of that.’

The key message to get across is that nursing ‘is a really rewarding career’.

‘We tend to focus, particularly in the press, on the negatives as opposed to the benefits of being in the profession.’

Impact of replacing the bursary

It isn’t just the demise of the bursary that may be putting off potential students, he suggests. A lack of clarity around its replacement is also an issue. ‘There is a lack of understanding about how the loan system works. People think they have to pay up front.’

He points out that the CoDH has set up a helpline to answer queries about the loans system, ‘but the government should have done that’.

‘Nursing is a high-cost subject – it’s not a cheap option to run a nursing programme’

He says it is ‘early days’ to decide the impact of the shift from bursaries to loans. But nursing students should be treated as a special case because they have to move between clinical placements and university studies, he says. ‘They are not the same as mainstream students. We are pushing for a maintenance grant for our students because they find the cost of living difficult.’

Online nursing degree reaction is premature

One of the most eye-catching – and criticised – announcements in the plan is a proposal to establish an online nursing degree, costing substantially less than the £9,250 a year paid by current students. This is intended to minimise student debt and attract mature students. Nursing Standard readers’ responses to our news story on this novel idea ranged from ‘Good God, what next?’ to ‘Dangerous and unnecessary’.

Professor Webster-Henderson says it would be ‘a bit premature’ to condemn online degrees without knowing more. ‘I wouldn’t want to jump the gun and get anxieties running. But nursing is a high-cost subject – it’s not a cheap option to run a nursing programme.’ 

He says that as with many workforce announcements, much depends on the detail, which will only be known when the workforce implementation plan is published later this year. He expects the CoDH to be fully involved in the workforce group that will develop the implementation plan. ‘I would be shocked if the Council of Deans is not at the table.’

Picture: John Houlihan

Undergraduate degree is ‘the best and quickest route’

In July 2017, when Brian Webster-Henderson was the newly appointed chair of the CoDH, he told Nursing Standard he had done all his degrees part-time, while working full-time. ‘I have never been to university as a full-time student. It was a long haul.’

He started out in the profession as a mental health nurse. He had originally planned to be a social worker but left school, without the necessary qualifications, after his mother died. His first degree was in politics.

Given his personal experience, it is not surprising that he is in favour of broadening access into nursing and supporting potential applicants to meet the profession’s educational requirements. ‘Times are changing, and we should be encouraging people to come into nursing through whatever route.’

Apprenticeships ‘a slow burn’

Some fear the new nursing associate role and the degree apprenticeship route will undermine the profession, or be a backwards step. But Professor Webster-Henderson’s concerns, as chair of the CoDH, are purely pragmatic.

‘Our position has been that we welcome other routes into the profession, and why would we not?  But they are not quick routes into the profession. (People undertaking the apprenticeships) take four years not three, and not all nursing associates will go on to become nurses.’

He says employers and universities have experienced difficulties setting up apprenticeships: ‘They are a slow burn’.

And he suggests that they will never be a means to significantly increase nursing numbers: ‘I think apprenticeships are likely to remain a relatively minor route into nursing. It will be valuable to some, but the main focus has to be on the graduate programmes that we provide.’   

The Long Term Plan shows no sign that the government is cooling on the nursing associate or apprenticeship initiatives. It promises continued investment and encourages NHS employers to consider taking on the lead employer model, setting up the infrastructure to deliver apprenticeships on behalf of several trusts.     

But there is also explicit recognition that the main supply for the nursing workforce will remain the higher education degree, something that Professor Webster-Henderson welcomes. ‘The government in its Long Term Plan has been really clear that the undergraduate degree is the best route into the profession – it is the quickest route.’

Thelma Agnew is commissioning editor, Nursing Standard

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