Editorial: Nursing education in the United Kingdom – clocks forward

or clocks backward?

The United Kingdom of Great Britainand Northern Ireland (UK) in 2010gained a new government, and wewonder what the future for nursing willbe. After a battle between the majorparties – Labour, the Conservative Party(known as the ‘Tories’) and the LiberalDemocrats (the ‘LibDems’), a hungparliament ensued, with no party hold-ing enough seats to take power in itsown right; the LibDems held the balanceof power and were wooed by both sides.The result was a completely new gov-ernment, with the Tories the majorparty (with Prime Minister DavidCameron) supported by the LiberalDemocrats, with their leader, NickClegg, taking the deputy prime ministerposition. Most media pundits saw thisas a result that had to happen, that theLabour Party under, first, Tony Blairand, latterly, Gordon Brown had lost itsway and had not managed to protect thecountry from the effects of the recentglobal financial crisis. Because the coun-try has switched from a left wingLabour government to a right wing(though perhaps modulated by theliberal policies of the LibDems) conser-vative government, changes are ex-pected to affect all aspects of Britishlife. This, of course, must include theNational Health Service (NHS), andnursing within that. Because of the belttightening necessitated by the globalfinancial crisis, the NHS as one of thelargest and most expensive organisa-tions in the world must expect anoverhaul.

The NHS, when it was established in1946, was a wonderful ideal – freehealth care at point of delivery, foreveryone, regardless of income, occupa-tion or social standing. However, thefounders of the NHS could never have

foreseen the developments in health caretechnology, improvements in care, evo-lution of highly complicated systems ofmanagement of health services, the needfor increasingly complex education ofhealth professionals, nor the exponen-tial rise of costs associated with suchdevelopments. In 1949, the NHS budgetin current terms was £9 billion; atpresent, the budget is £110 billion perannum (Patel & Spilsbury 2010). In2011, all UK residents have come toexpect free access to the highest stan-dards of health care as a right from birthto death. The NHS usually figureslargely in any election campaign andits aftermath but, strangely, there waslittle emphasis on it in this last election.We suggest that the cuts that all partiesknow are so necessary are also sounpalatable to the UK electorate thatno one was brave enough to raise themas an election issue, preferring to keepthem until after they had won power.

We are wondering how this is goingto affect nursing. We (Watson &Thompson 2000, 2004, Thompson &Watson 2001, 2005a,b, McKenna et al.2006, Shields & Watson 2007, 2008,Watson & Shields 2009a) have pub-lished previously on the dire state ofnursing and nursing education in theUK, with most of our comments aboutnursing in England, and before theelection, debate was beginning on someof the suggestions we made. First, in2008, under the Labour government,the Nursing and Midwifery Councildeclared that all nurses in the UKwould, from 2013, need a degree to beable to register as a nurse (NMC 2008).This welcome and very late – comparedwith other countries – stand broughtmedia attention, most of it negative,with statements like ‘All sorts of people

who might make excellent nurses will beput off, and lost to nursing: anyone whois not particularly academic; anyonewho — frankly — is not particularlybright’ (Marrin 2009) and ‘Of course,medicine is a university course with avery large element of apprenticeshipabout it. But medicine is both a learnedprofession and a severely practical art,which nursing is not and is never likelyto be … The quest for power and status,then, is more important than the questfor higher nursing standards. That iswhy the nurses’ leaders are so keen onthe idea: kudos is their goal.’ (Dalrym-ple 2009). However, some much betterinformed and less inflammatory writerssupported the need for nurses to beeducated at degree level (Street-Porter2009), and of course, there is very solidevidence that a degree-educated nursingworkforce improves patient outcomes(Aiken et al. 2003, Duffield et al. 2007,Klein 2007, Rafferty et al. 2007, Ken-dall-Gallagher et al. 2011). Before theelection, on 10 March 2010, a lengthyreport by the Prime Minister’s Commis-sion on the Future of Nursing andMidwifery in England (2010), entitledFront line care was published. As withmany government documents abouthealth care, which very often seem totake the line of not upsetting too manypeople, and lack the rigour necessary topush home hard facts about the state ofthe NHS, this document concludes that,while supporting the call for all nursesto have degrees, and the necessity ofresearch to nursing practice, all nursesmust take a pledge ‘to deliver highquality care’. In 2011, all that suchemotive, old-fashioned thinking does isprovide a basis for any nurse (or mid-wife) to be the scapegoat when mistakesare made, enforcing a blame culture,

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whereby any breakdown in servicedelivery can be laid at the feet of anurse who has ‘broken his/her pledge’.Surely the future of nursing and mid-wifery should be premised on the basisof a solid, rigorous pursuit of the higheststandards of knowledge to enable thenurse and midwife to provide the veryhighest standards of practice.

The change in power in the UKcomplicates these issues significantly, asthe Tories, all along, have said that theywill not entertain degree-educatednurses. In a speech on 11 May 2009 tothe Royal College of Nursing, DavidCameron (Cameron 2009) said ‘there isthe danger that all-degree training mightput some people off. The teenager whohas got a handful of reasonable GCSEsand just wants to care for people. Thebusy mum who hears the word degree,pictures the typical undergraduate andthinks – that is not me. We need to makevery sure that the doors to nursing areopen to all.’

On 2 February 2010, (Evans 2010)the now Secretary for Health, AndrewLansley, told Nursing Times ‘A degreeshould be an aspiration for nurses, ratherthan an entry requirement’, while on 15February 2010 (Santry 2010), confusionover this was apparent when anotherTory ministerial candidate, then Shadowhealth minister Anne Milton, told Nurs-ing Times there was ‘no doubt thatregistered nurses needed degrees’. Butominously, in the same article, a spokes-person for the Conservative Party wenton to say that ‘Mr Lansley’s definition of‘nursing profession’ included healthcareassistants. … These people provide carefor patients in a nursing fashion andthat’s part of the wider terminology ofnursing.’

The LibDems have been very quiet ontheir ideas for nursing. A speech to theRoyal College of Nursing (Clegg 2010)on 27 April 2010 was about the NHS,with little reference to nurses or nursing,and very blank on the subject of degrees,or, for that matter, health care assis-tants, so it is impossible, at this stage, toknow what they will do if the newgovernment tries to scrap the initiativeto ensure that a degree is the basicstandard for registration.

In June 2009, we wrote a report forthe Conservative Party in response totheir call for submissions about the

future of nursing (Watson et al. 2009).We outlined the absolute necessity forregistered nurses to be educated todegree level and the concomitantimprovement of patient outcomes; anda warning about the ‘dumbing down’of the nursing workforce and theemployment of health care assistantsin large numbers. Now the new gov-ernment is in place, it does not look asif they listened.

With the Tories in power, what isin store for UK nursing? Two of us(Watson & Shields 2009b) have previ-ously – and not very originally –described nursing as a ‘political foot-ball’; extending the analogy, nursing isalways the first to get kicked whensomething is wrong in the NHS. Weare simultaneously praised as ‘angels’and demonised as ‘too posh to wash’;and we really fear another upheaval atthe point in the nursing system where allblame seems to lie – nursing education –which has undergone at least two majorredirections since the late 1980s. Adher-ing to the football metaphor, many of us– including the present authors – reallythought that the ‘ball was in the back ofthe net’ regarding graduate entry to theprofession and university schools ofnursing have been working towards theintroduction of the new curriculum for2011. We now experience uncertaintyand face the prospect of undoing theonly sensible decision made by theprevious Labour government regardingnursing: the move to graduate entry.

Linda ShieldsCurtin University, AustraliaE-mail: l.shields@curtin.edu.au

Roger WatsonUniversity of Sheffield, UK

David R ThompsonAustralian Catholic University,Australia

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