Karen Stansfield: The future of health visiting is at risk
A downward trend in the number of health visitor training places being taken up could be made much worse by the introduction next year of a complex and expensive apprenticeship route, warns the Institute of Health Visiting's Karen Stansfield.
A downward trend in the number of health visitor training places being taken up could be made much worse by the introduction next year of a complex and expensive apprenticeship route, warns the Institute of Health Visiting's Karen Stansfield
The take-up of health visitor education places has fallen over the past three years in many higher education institutions (HEIs). Without a viable cohort of health visiting students it will be difficult for HEIs to deliver education programmes. Once programmes are closed the likelihood of reopening them is small.
Workforce figures released by Health Education England (HEE) indicate that 15% of places for health visitor training were not taken up in 2015-16. This jumped to 44% in 2016-17 - a concern for the sustainability of the profession, compounded by the cessation of HEE funding for health visiting training from 2018. After this date, it is expected that unless students can self-fund, the apprenticeship funding route will be their only option.
While it is expected that apprenticeship standards will be in place for SCPHN (specialist community public health nursing, covering health visiting, school nursing and occupational health nursing) by September 2018, this is not guaranteed. Early data suggest that pre-registration nursing apprenticeships have not been taken up by employers.
Previously, HEE would fund the HEI course fees and the salary to ‘backfill’ clinical posts while students were on health visiting programmes. The apprenticeship model of funding only covers course fees, leaving employers to cover the cost of backfill.
The new triad of stakeholders with key roles in health visitor training – local authorities, HEE and NHS (and other) employers – is still developing, and the lack of clarity and collaboration has had an impact on the number of training places taken up and the number of available posts for qualified health visitors.
This is a perfect storm for health visitor training: a downward trend in places being taken up over the past three years, a complex and expensive funding route through apprenticeships, and a lack of collaboration between stakeholders.
Uncertainty about whether there will be a job available on qualifying and the pay disparity while students undertake health visitor training, with some paid at band 4 and others on midpoint band 5, may also deter potential students – as will new uncertainties regarding local authority commissioning plans. This makes it difficult for experienced nurses and midwives to enter the health visiting profession.
Without a clear funding stream, employers will be reluctant to commit to supporting health visitor training. This may well lead to an even lower uptake of training for 2018-19.
With the new funding arrangements and the downward trend in the maintenance of practice teachers at band 7, it is unclear how the Nursing and Midwifery Council requirement for 50% of learning and assessment in practice will continue.
An urgent rethink is required about how to fund health visiting programmes and/or simplify the apprenticeship process. HEE may need to fund health visiting training past 2018, until the issues associated with access to apprenticeship funding are addressed.
How much health visiting students are paid during training also needs to be reconsidered and a consistent approach agreed across England. Health visitors are advanced specialist nurses. They should not be treated as clerical workers.
Karen Stansfield is head of department, education and quality, Institute of Health Visiting