Examination of Witnesses (Questions 180-199)
WEDNESDAY 4 APRIL 2001
SIR JOHN BOURN, KCB, MR GLENN HULL, MR NIGEL CRISP AND SIR BRIAN FENDER
180. I can believe it. It still does not seem to me that you have answered the question as to why we have this wide range and why you are not looking for some optimum position which you can advise all colleges they ought to be aiming for.
(Sir Brian Fender) Students who go to universitiesand although the recruitment area for nursing is smaller than in some other subjects nevertheless they often have a choice of institutionmake their own judgment about which is most suitable for them and that leads across the sector as a whole to some variations between the nature of students that enter and their qualifications. The system in a sense is diverse and I think what you are trying to do is to suggest there should be a standard entry for each institution which is not realistic and in fact would not even be desirable.
181. I am not sure I agree with you but there we are, it is your view. Have you seen any difference in the drop-out rate between sexes?
(Sir Brian Fender) I would not know that for nursing. It is a factor that we take into account in trying to produce our benchmark in order to assess what would be a reasonable figure. If you took the national average as a reference point, there was rather more drop-out across the country as a whole for males rather than females.
182. Are there any lessons to be learned from that?
(Sir Brian Fender) No, because it is complicated. For example, if you come back to the subjects, the subjects where there is a higher drop-out rate are engineering, the physical sciences and mathematics. They have a higher proportion of male students so the fact that males tend to drop out across the whole sector rather more often than women may be related to the subjects they choose.
183. Finally, I think it was Mr Crisp who was saying that students nowadays have a host NHS trust which they work with. Can you give us any idea what proportion of the students who have a host NHS trust go on to work for that NHS trust when they have finished their training?
(Mr Crisp) The only indication I could give was that it is high. I could not give you a figure now but we could provide you with one.
184. Do you think that it helps keep people in the NHS sector after they have finished training and if they have this host they are more likely to join rather than if they did not know anything about the hospital they are going to?
(Mr Crisp) Yes I do. I think it is a very positive way of wooing people into your local service. The trusts need to compete with each other, it seems to me, for very valuable people.
(Sir Brian Fender) Because you were not satisfied with the reply and I like to have satisfied customers, could I add that one of the ways we are trying to reduce non-completion is to createand we have createda task group whose job is to look for good practice, to identify those institutions with better completions and try to identify the critical factors which will help other institutions lower their non-completion rates?
185. Good, I feel partially satisfied.
(Sir Brian Fender) Give me another five minutes.
Chairman: Alan Williams?
186. It has taken rather a long time, has it not?
(Sir Brian Fender) To do what?
187. What you were just saying that you are just beginning to work out why they were different. Why has it taken you so long?
(Sir Brian Fender) One always with hindsight wishes one had done things earlier.
188. It is not a new problem, is it? Tell me why you are only just getting round to it.
(Sir Brian Fender) "Only just" is not quite the right words to use. We have started to look at this issue of completion for several years and I would sayand it is not an adequate answer to you in some waysI am pretty certain there is no country that has done more to look into non-completion rates and the factors behind them. Let me say in international terms
189. With respect, and you know I am limited on time, the fact that other countries have not done it is irrelevant. You are employed to monitor the use of scarce public money to achieve maximum cost benefit and you are only just beginning to ask why you have not achieved cost benefit.
(Sir Brian Fender) I dispute the "just" of course, but the position is that completion rates in Britain are higher than in any other country except Japan and Japan has (from a recent study) a very low satisfaction rate among its graduates for its higher education. We were not dealing with a problem here. You could argue that we should nevertheless have looked at non-completion as something which always needed to be addressed.
190. It is not just non-completion, it is across the board. The Audit Commission recently did a report on training and it discovered in the trusts, as far as training and development were concerned, that the best were spending five times as much as the worst and as far as registered nurses and midwives were concerned the best were ten times better in terms of higher education based training than the worst. This is not a newly arrived at situation. Why is it that you know so little about it?
(Sir Brian Fender) We have moved the ground a bit here. We are now talking about continuing professional development or further study for nurses in post. Is that where you are now?
191. I am dealing with the issue of the inadequacy of training or the disparity in levels of training between trusts where the Audit Commission, as I am sure you know, has told you and the Department that there is a five-fold variation in spending by trusts on training and they have said that there is a ten-fold variation in higher education based training for registered nurses and midwives. I am asking why this has not been examined either.
(Sir Brian Fender) I think that is a question of staff development and probably one for Mr Crisp.
192. Mr Crisp, you answer that.
(Sir Brian Fender) In order to show
193. No, no, if he is the man who is supposed to answer, let him answer.
(Mr Crisp) The question was why is there a variation?
194. The question is a) why is there a variation but, more importantly, why is it that since this is not a newly discovered situation that the Department has not done anything about it before?
(Mr Crisp) What has happened over the last few years is that we have seen an expansion in education more generally but we have got a serious disparity which you are pointing to. It has not perhaps been given as high a priority as it now has.
195. In other words, you had it wrong before?
(Mr Crisp) We did not give it enough priority, yes.
196. Let's look in that case at page 19.
(Mr Crisp) Are you on the National Audit Office report or the Audit Commission report?
197. The NAO report. Go to figure 4 on page 19 and also look at paragraph 2.15 where it says "entries to pre-registration nursing and midwifery programmes decreased from around 17,000 in 1991-92 to just under 12,000 in 1994-95." We are not exactly dealing with a new phenomenon. If you look at that chart below and take it back three years you were at a level of 17,000 at that stage. The gap in getting back to where you had been in 1991-92 is around about 15,000. What is the current shortfall in nurses?
(Mr Crisp) I do not have a figure for the current shortfall in nurses.
198. Give me your best estimate.
(Mr Crisp) If we are looking for 20,000 more by 2004 and we have vacancies running at about 10,000 at the moment I would have thought our current shortfall must be in the 5,000 to 10,000 area.
199. So had it not been for what we see in table 4, this unbelievable pit in the graph in which the training was cut so substantially and where we lost 15,000 potentially trained nurses and staff, we would not have a shortfall?
(Mr Crisp) We might or might not have had a shortfall but it would certainly have helped.