Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 40-59)



  40. Three seems quite a high incidence, does it not, at one university?
  (Sir Brian Fender) The university might have 20,000 students.

  41. This one has not, not in nursing.
  (Sir Brian Fender) Not in nursing?

  Mr Burns: It just seems odd to me that a situation like that can exist. Thank you anyway.

  Chairman: Geraint Davies?

Mr Davies

  42. Thank you very much. Mr Crisp, I wanted to pursue your comments about midwifery. I realise that the whole area of training is a very complex area and midwifery is just one facet. Am I right to say that there is a problem with the age profile of the stock of midwives you have got? Is there a danger in time that there is going to be greater leaving of midwives than you have got coming on stream and this may cause a bit of a problem?
  (Mr Crisp) I am not sure is the answer to that. I do not have that information here.

  43. I do not suppose Sir Brian has that information?
  (Mr Crisp) We are talking about the people who are employed.

  44. I was led to believe that if you look at the stock of midwives in terms of the age profile we are reaching a point where we may face a problem in terms of the number coming in versus the number going out.
  (Sir Brian Fender) No, I do not have that information.

  45. Is it possible to have that information for the Committee?
  (Mr Crisp) I think that should come from me probably as you are talking about staff in post, are you not? We can certainly give you an age profile, I would imagine that we have one[1].

  46. In terms of the relative incentives for becoming a midwife versus becoming a professional nurse—obviously a midwife has a professional role, do not get me wrong—would you agree with me that there are less career opportunity advancements in terms of salary entering that profession versus nursing generally[2]? That is one of the problems we need to address to re-balance supply and demand in terms of targets on midwifery.

  (Mr Crisp) Again, I am not absolutely sure. That is probably true given that there are far fewer midwives than there are nurses and proportionately there are less higher grade midwifery posts. I think that is probably true but, again, I would have to actually check that figure because that does not immediately relate to the training issue. What we are doing though around midwifery, and the reason that I raised it, is that we have seen a very substantial increase in the number of nurses in the last year but we have not seen the same in midwifery.

  47. Yes.
  (Mr Crisp) So we have to target it. We are targeting it by, firstly, doing a lot more about return to practice programmes, in other words getting people in who are trained but have not been working for some time, getting them back in. We have also actually widened the entry gates, made it easier for people to get into the profession, and supporting staff and people with a wider educational background to bring in to the profession. Thirdly, we have a national recruitment campaign. There is actually quite a lot of work going on on this right now. I am not absolutely certain whether the particular point that you are raising is part of that or not.

  48. In terms of the superficial statistics on this, namely the supply and demand of nurses versus midwives for the salaries and conditions being offered, it clearly is the case that the market place of people is going for nursing rather than midwifery. Would you not conclude from that that there is an argument to review the relative pay, secondly the career advancement and, thirdly, the terms and conditions in terms of family friendly practices and the like? Clearly people are voting with their feet to go into nursing rather than midwifery.
  (Mr Crisp) Right. Let me make a wider point than that which is that actually it is always slightly difficult to talk about nursing as if it was a single integrated thing.

  49. I appreciate that.
  (Mr Crisp) You understand there are five branches[3].

  50. It is the case that a heterogenous bundle of nurses, picking out midwifery—
  (Mr Crisp) I would also say to you that there are some other groups within there as well with whom it is relatively harder to recruit and attract and, therefore, we have to look at all of these. We have to target specifically. We have to make sure we have got the right incentives and the right people coming through.

  51. You mentioned radiographers before. Say that the choice for a given person may be for many people they could either become a midwife or a nurse as opposed to a radiographer—this requires some funding—it sounds to me as if you are not particularly looking at whether careers, relative pay and family friendly policies could be made more attractive so there could be a better balance of demand for midwifery when clearly there is a problem.
  (Mr Crisp) Right. It is a slightly more complex problem than that as well. Actually when you survey midwives about their attitudes to their jobs, you discover they are more satisfied than nurses on average. That largely seems to be correlated with the fact they have more autonomy in their work than nurses. Pay is not the only issue here.

  52. Do you also find in your survey they think they do a more important job, not least because obviously they are dealing with life and death and bringing life into the world? I realise nurses are also in the business of saving lives.
  (Mr Crisp) I think most professions think they are doing a pretty important job and that relative to others they probably see themselves as being more important. I am not quite sure what you are driving at.

  53. I am wondering whether there is a special case for midwives to give them a better mix of pay and conditions.
  (Mr Crisp) What I obviously will not do in front of the Committee—

  54. It is not surprising that we are seeing the adverts we are. It appears to me from your responses you have got no particular enthusiasm for changing anything to address this problem.
  (Mr Crisp) I think what I am doing is I am not about to announce to this Committee that we are going to review midwives' pay and terms and conditions. If that is what you are asking me to do then I am not about to do that. It is not my decision to do that.

  55. I assumed that these things would always be under review in a situation where there were clear problems.
  (Mr Crisp) We are indeed looking at the issues and making sure that we can attract more people into training for midwifery and equally as importantly, and perhaps more importantly, that we can actually bring more people into midwifery from other sources because bear in mind training is only part of it.

  56. Can I say through the Chair then that I would be grateful for any information that is available in terms of research that has been done on midwives versus non midwives in terms of why or not they are becoming midwives which might give us some instruction on the way forward on that[4]. Can I turn to Sir Brian. It was nice to see Sir Brian in Croydon College giving out certificates. I thought I would mention that. Turning to Croydon College, and the report on pages 30 and 31, these bar charts obviously show the variation in costs. My understanding is more generally across higher education and the like there is this principle of convergence. There is a presumption that a unit of education in colleges costs the same, say, in Croydon as it does in Durham. Clearly in the South of England there are various costs which are more—as has already been mentioned—in terms of travel, in terms of capital, in terms of accommodation, in terms of competitive salary levels. What is happening is that colleges, such as Croydon College, are facing all sorts of difficulties balancing their books in that respect and perhaps abandoning courses like nurses and nursing because of this presumption that unit costs should be the same. We can see from the NAO report that there is empirically a lot of variation. I was just wondering whether you could just comment on what I am commenting on? You seem to be saying there are good reasons to explain this but if that is the case does that call into question the whole principle of convergence?

  (Sir Brian Fender) Nursing is different from the way that we fund other subjects because, as you know, from this report the prices are determined by a tendering process and a negotiation with the National Health Service. Other courses are funded indeed on a basis of a benchmark price, in fact there are four different prices for different subjects. We do not take account of the regional variation of cost except for London where there is a London weighting, there is an inner London weighting and an outer London weighting. Only in that context do we make allowances in our funding programme for location.

  57. Being slightly anecdotal, I realise, in the case of Croydon College where the financial managers decided to cut the nursing course, presumably because of the cost versus revenue associated with that versus other courses, despite the fact that there is a University Hospital up the road, do you not think there is a cause for alarm there and a need to look perhaps at the factoring funding for these courses again in such locations versus other courses?
  (Sir Brian Fender) Yes. There would not be a connection between the decision by Croydon College with respect to nursing, I think. There would not be a link there with the funding of its other courses. It would be a decision made in conjunction with the NHS—it was bidding to the NHS—as to whether it decided it could continue the course in terms of its ability to recruit both students and staff and the price it was given by the National Health Service.

  58. In that particular example obviously they may have made the wrong choice but the management decision clearly at the margin, at a time when they are facing massive problems, the choice would be to go for the most cost effective courses. I am just concerned that one of the courses falling out of bed is nursing at a time when the Government is keen to pursue more and more nurses.
  (Sir Brian Fender) Yes. I understand your concern but in a rather more general sense what we see from the evidence is that universities and colleges have been able to accommodate the expansion that the National Health Service has called for. It has been able to do it speedily and effectively.

  59. Is it just because there are anecdotal problems? The overall picture, the aggregate lie is—
  (Sir Brian Fender)—is a very good one. When the National Health Service has called for more students then higher education has been able to provide them.


1   Note: See Evidence, Appendix 2, page 21 (PAC 152). Back

2   Note: See Evidence, Appendix 2, page 23 (PAC 152). Back

3   Note by Witness: There are, in fact, four branches, not five branches. Back

4   Note by Witness: The Department has not undertaken any recent research specifically on this subject. Back

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