After the election: reading the runes for health HE

14 May 2015

With two government departments to keep an eye on, reading the runes of what’s likely to be significant for health higher education in the next parliament isn’t always easy. But here are four areas that I think we can predict with a reasonable degree of confidence.

Education funding reform

A majority Government and an explicit commitment to rebalance public expenditure makes reform of the funding for pre-registration education for nurses, midwives and AHPs in England much more likely. Taxpayer funding for the three key elements (placement tariff, student bursary and tuition fee) amounts to approximately £1.4bn per year and are surely likely to attract attention in a CSR. There’s always a danger of destabilising salami-slicing of the budget – cuts to the bursary that will push up student attrition or an attempt to cut funding to universities, for example; but a stable majority Government at least makes the prospect of more strategic reform possible.

The ongoing workforce crisis

With no sign that the nursing workforce crisis is abating, not to mention huge pressures on paramedics and smaller professions such as prosthetists, the gap between workforce supply and demand will continue to be a crunch issue for health and social care in this parliament.

We’re likely to see the (re)emergence of the myth that education to become a registered nurse can be ‘shortened’ (under EU law, it can’t – before all-degree entry, the DipHE was 3 years as well) and that it is a luxury (it isn’t – the international literature shows a 10% increase in nurses with degrees is associated with a 7% decrease in the risk of death in hospitals). That’s not to say that much more can’t be made of roles such as assistant practitioners, which might be done more quickly if the leadership is there to do it; but there are no simple shortcuts to resolve the current crisis.

If we’re to learn from this, the failure of centralised workforce planning tied to predicted affordability and artificial capacity constraints needs to be challenged. When the definition of what is affordable changes (e.g. because organisations have taken the risk of overspending to meet service need) the current system for future workforce supply has no resilience. Health ministers and officials will always want a say on future workforce numbers in the NHS but adherence to a rigid central plan for future supply cannot be an article of faith.

We also need to challenge this because it is hindering the significant change in workforce needed to deliver future services. A top physio course in England had its numbers cut by 30% for the coming academic year because the local area (a sub-division of a LETB) in which the university happens to be based predicts that it won’t need as many physios in 2019/20. Is anyone confident that’s right? And given that the university recruits students nationally for a national workforce, is it right that a such a localised view is decisive?

The impact of greater devolution – health professional regulation

The tidal wave of support for the SNP means further differentiation between the UK home nations is only likely to accelerate. With health professional regulation (including the standards of education) one of the few UK-wide frameworks in health and higher education, there will be difficult discussions ahead on policy reforms in these areas and a need to find better fora for genuinely UK-wide discussion. An assumption that England can find a solution and tell the rest of the UK simply won’t hold, if it ever did.

Europe

Looking beyond the particular boundaries of health higher education, the significant of the referendum on membership of the EU will make almost any other policy change pale into insignificance. Universities UK and other organisations have already started work to put the case for EU membership and we can expect the campaign into the referendum to generate as much heat as light.

It is a mistake, however, to think that the so-called ‘shackles of EU law’ will be easily cast off. This is particularly important for health education in relation to the mobility of professionals across the EU. Whether or not we remain in the EU, the current laws will be influential as long as the UK wants health professionals from other EU countries to be able to work here (and vice-versa). For the so-called sectoral professions, which include nursing (the adult field), midwifery and medicine, the overarching framework of EU law that sets fundamental building blocks for the delivery of education is likely to remain for some time to come.

Lizzie Jelfs, Director, CoDH 

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