Fit to care for children?
This year has already seen a plethora of reports, some disturbing to say the least, such as the Oxford Child Sex Exploitation Serious Case Review and the Morecambe Bay inquiry. Another produced by the Children and Young People’s Health Outcomes Forum provided the evidence, if anyone was in doubt, that improvements are still required to children’s services. However, the long awaited second Willis report on nursing education is likely to be controversial unless it is buried as being inconvenient before a general election.
The report contains some welcome elements: ensuring that healthcare assistants are valued and they have a secure career pathway is one. Other positive facets include a restatement of the desirability of a national careers framework; Lord Willis has suggested a community field of practice and he encourages a review of mentorship, which the RCN is leading. His recommendation that the profession returns to a form of 'state final' with a structured formal postgraduate education to follow, will have the more mature nurse wandering down memory lane.
The report is glossy with some irritating graphics with some carefully chosen examples of good practice. However many children’s nurses are shocked and appalled with the 2+1 model leading to registration. How a 'whole person' foundation plus a year to 'specialise' will enhance and improve children’s services is open to speculation. My view is that it takes every day of three years to educate and train a children’s nurse, plus the rest of their career to excel as one.
Children’s nurses need to understand that the health needs of children, young people and their families are constantly evolving because every year there are new technologies, advances and opportunities and every child should have every possible advantage. Any government worthy of election should see an investment in children’s health as an absolute essential for the future. Despite some improvements in the health outcomes for children the fact remains that children’s health is improving at a slower rate in the UK than many other countries in northern and western Europe (Report of the Children and Young People’s Health Outcomes Forum 2014/15).
Common sense should dictate that all staff who come into contact with children, young people and their families, regardless of the service provided but especially in healthcare settings need special preparation for their roles. Of course staff must be flexible, responsible, caring but above all adequately trained to meet the needs of the child. How is that to be achieved in a year?
The Report of the Children and Young People’s Health Outcomes Forum (2014/15) stated that this would require Health Education England (HEE) to develop a life-course approach to the planning of the healthcare workforce to provide the right level of advice and care, in the right place and at the right time for children, young people and families. I agree.
The theme group of the Children and Young People’s Health Outcomes Forum was charged with focusing on workforce, education and training. Their message was clear but unheard. They urged training reviews, such as the Shape of Caring (for nursing) and Shape of Training (for medicine), to ensure a child and young person focused workforce, to enable the modernisation of service provision which would aim to improve the health outcomes of children and young people Sadly this was an opportunity lost.
The Nursing and Midwifery Council (NMC) has previously consulted on the branches of pre-registration nursing, they became fields of practice and the first graduates on the new degree-only programmes of preparation are emerging from universities now. They have studied to achieve the NMC field specific nursing education standards (2010). I feel that it is too soon to throw this provision out - unevaluated and recklessly adopt a new model. My view is that the curriculum and practice preparation should put children at the centre of the learning rather than tacked on at the end.
Arguably the NMC might want a generic programme but HEE when considering children’s nursing were apparently content to invest. They were forecasting 1,950 graduating students in 2017 to join a current workforce of 15,877 full time/or equivalence. They calculated that was 12.3% of the workforce so if there was a net turnover between 5% and 7% then there would still be workforce growth if sufficient posts were created. What changed their minds?
It is said that a year is a long time in politics, perhaps so. Politicians and policymakers may have short memories. It is more than 20 years since the Clothier Report and the fallout from the Jimmy Savile scandal will continue for the time being. One has a suspicion that there will be more unsavoury disclosures to come. If we are going to truly learn anything from the past let it be, what can happen when unsuitable individuals work with or gain access to children.
Clothier Report (1994) Independent Inquiry relating to deaths and injuries on the children's ward at Grantham and Kesteven General Hospital. HMSO, London.
About the author
Doreen Crawford is senior lecturer in nursing and midwfery at De Montfort University, Leicester, and consultant editor, Nursing Children and Young People