Friday, 13 March 2015

Project Making a Shape of Francis

Roger Watson

Yesterday - 12 March 2015 - Willis II, Raising the bar The Shape of Caring: a review of the future education and training of Registered Nurses and care assistants was published. My impression is that this offers a new way back to the past of nursing education; there are some good proposal therein but, otherwise, this is a crossbreed between the visionary Project 2000 (the common foundation programme is back), the disastrous Making a Difference (widening access to nurse education and contiguity between care assistants and registered nurses) and, of course, The Francis Report (standardised training for care assistants).

First the good points.  While there is little that could be described as visionary in Willis II, the proposal under Theme 6 (Assuring predictable and sustainable access to ongoing learning and development for registered nurses) for a possible future model of postgraduate pathways involving memberships and fellowships is excellent.  Some will say it apes the medial model of education and career pathway, but so what?  They're successful...nursing is not!  The proposal is sketchy and one vital ingredient is missing -  funding; I would not expect Willis II to make detailed funding proposals but the incredible disparity between, for example, the budget for medical postgraduate training and nursing postgraduate training is, apparently, huge.  Willis II does call for greater transparency about this gap; that would be a start.

Care assistants form a main focus of Willis II.  The proposals under Theme 2 (Valuing care assistants) are largely about ensuring proper education and training for care assistants, defined role descriptions and transferability of competences through a national database.  All good, very much an echo of the best of Francis - which the government ignored - but stops short of a register.

Sadly, there it ends.  Making a Difference raises its ugly head again in terms of Theme 3 (Widening assess for care assistants who wish to enter nursing).  Like Making a Difference, Willis II tries to stretch nursing to the limits: fellowships at one end; widened access at the other.  I would take such proposals seriously if anyone were calling for widening access (other than for the working classes, ethnic minorities and women which have thankfully been addressed with some success) into medicine.  However, this is about widening access to people who, frankly, did not make the grade first time round - to which a fair amount of altruism can be ascribed - but then crediting them with part of the care assistant training towards their nursing education.  Care assisting is not nursing and surely it is time to put some clear blue water between care assistants and nurses.  Nurses may be assuming medical and surgical tasks at the 'upper end of the care spectrum' (in inverted commas as I also have doubts about how 'caring' these tasks are) but there is an ocean of turbulent water before you even reach the clear blue stuff between nursing and medicine - de facto and de jure.  I am perfectly happy for care assistants to enter nursing education and even medical education but the difference between one and the other should be clear, they should meet the appropriate educational entry standards and undertake the whole programme.

Naturally, there is more to Willis II about the necessity for research (good), appropriate funding models (the present one is holed with cabins being built as we sink) and the usual stuff about patient and public involvement.  Buried in all of that Willis II makes the interesting point that the number of nursing professors is 0.1% of the nursing workforce.  The implication is that there should be more of us but I can't wait to see which 'eagle-eyed' broadsheet journalist spots that one and gives Willis II a good pasting.  We are seen as being part of the problem and not the solution and no politician from either end of the political spectrum is going to support that vote-loser.

A final word about the structure and information sources for Willis II.  The report is 'splattered' (I just cannot find a better word) with case studies (Bob is 70 and has diabetes...), photographs, voice bubbles and inforgams.  Not all bad, but the tone seems to be that which would be used to address a group of five year olds which begs the question: 'just for whom was this written?'  The information sources are wide and largely low level: eg Twitter and discussions with nursing students.  I'm an avid tweeter - especially during my reading of Willis II - but just who were the thousands of tweeters who contributed views to Willis II?  And, are nursing students the best source of opinion about nursing?  I was a student full of opinion about nursing and the NHS and most of those views changed under the experience of being a staff nurse and a charge nurse mainly because I only thought I knew what I was talking about (plus ca change?).  By all means we need to know what nursing students think about their programme, its delivery and content and quality but they are not yet nurses and they are not responsible for nursing education.

The 6 C's made a cameo appearance in Willis II to which I would add a 7th: curate's egg.

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