How we can put new money for nursing degree apprentices to work

 

£172 million new funding to double nursing #apprentices 

Money talks, and if the attendance at the information sharing event on the new funding for nurse degree apprentices is anything to go by, it is speaking loud and clear to the NHS!

The announcement last Monday (10 Aug) of £8,300 per apprentice per year to support the much-needed growth in the number of registered nurses is incredibly welcome.

The government’s pledge to create 50,000 new nurses is an ambitious one, and this funding is part of a much broader strategy to increase numbers through a range of channels. The nurse degree apprenticeship has already supported the development of new registrants, but this additional funding will certainly help support business cases for further growth and investment with employers.

We are familiar with the criticisms of the levy, but the NHS has been particularly concerned about the cost of salary support, especially when apprentice nurses need to be supernumerary and are not included in the required staffing ratios. This issue has made the nurse degree apprenticeship ‘too expensive’ for some – the cost of salary support and supervision needed in clinical practice makes it a difficult financial equation to balance. What is the return on investment?

The introduction of the nursing associate role in 2017 brought with it a payment to employers to support the establishment of a new role. We quickly learned that where this funding had been used to employ clinical educators, the project was very successful, with low levels of attrition. There was no obligation to use the funding in this way, and not all did, but it worked well when it was. This served to highlight the importance of the clinical educator – a staff member whose priority it is to work alongside learners and help them to make links between theory and practice. The clinical educator role also provides support to other staff in that learning environment. They are the first port of call if there are problems in practice and can help to support learners and practitioners alike.

For traditional nursing programmes, some funding is made available to support placements through the ‘tariff’ paid to organisations for each student when they are in practice. This funding is not available for apprentices, even though they require the same level of support. We are seeing ever increasing numbers of learners in the workplace, not just nursing students or apprentices, and the introduction of T levels may see this rise even higher.

We cannot lose sight of the fact that nursing teams are there to care for patients and this must be their priority. All health professions have an obligation to support the development of students but delivering safe and effective care should not be sacrificed.

Of course, apprentices and students make a significant and positive contribution to patient care, but there is still a requirement to supervise them, support and assess their development. This, combined with the salary support needed for apprentices, has deterred some employers.

That is not to say that employers do not value apprenticeship routes. They have presented unique opportunities to seize control of workforce development and provide an important career pathway for existing staff. Days when the NHS was wondering how to spend its apprenticeship levy seem to be a distant memory, and the recently published NHS People Plan recognises the importance of apprenticeships to meet workforce development needs.

Across the NHS, an industry to support spending the apprenticeship levy has sprung up and many training leads have rapidly up skilled and expanded their teams to meet rising demand.

Where employers are using their levy to its best advantage, we are seeing entry level roles offer opportunities for young (and not so young!) to get into the workforce, and this is not just in the NHS.

The levy has broadened opportunities in social care and the independent sector – the push to work collaboratively across the whole system means that innovative schemes are making good use of the levy and levy transfer is becoming more common. Career pathways which offer opportunities for school leavers and career changers, as well as existing staff, are offering real opportunities for meaningful employment, widening participation and, ultimately, social mobility.

There have, however, always been the naysayers. Even as the announcement was made, the old chestnuts about the nursing apprenticeship being a lesser route, nursing on the cheap, or a route for those not bright enough for university, surfaced once more.

It is not lesser, it is different. You do need to be bright; you might just not have had the opportunity. It certainly isn’t cheap. It is an alternative, in the same way that qualifying to become a nurse via a Masters qualification,, using an overseas qualification as a basis to convert to a UK equivalent or becoming a nursing associate and then studying for two more years to become a registered nurse all are. All require aspirant nurses to meet the standards required by the Nursing and Midwifery Council. All different routes to the same thing.

What the funding does signal, however, is that there needs to be wider investment in the system to really become successful. Simply using the levy to pay the tuition element of an apprenticeship isn’t enough. There are many cogs in the apprenticeship machine and all need to be functioning well in order to make the machine work. There is evidence from previous iterations of apprenticeship policy to support this, but the potential to make the same mistakes as before is still there. The Covid-19 pandemic has also necessitated changes to End Point Assessment, and in the case of nursing, it has all but disappeared overnight.

This change challenges the very heart of the government’s policy. If apprenticeships are reliant on that final, synoptic assessment, until that becomes impossible to undertake, it fundamentally challenges that central tenet of the current scheme. How can we justify reintroducing this additional assessment when normality resumes, and in health, who knows when that is likely to be? Perhaps sometime never?

The last 18 months have seen enormous upheaval in the drive to encourage more students into nurse (and other health profession) education. An annual grant is offered to supplement the student loan scheme and additional payments are made to students on small and vulnerable professional programmes, like learning disability nursing. And now we have funding to support employers to employ more apprentices.

With other incentives available, aspirant nurses need to consider the route which is the best for them and their personal circumstances. There is no mandate about how much apprentice nurses should be paid (over and above that laid out in the funding rules) and the benefits of being a traditional student may mean more money in their pocket during the training period. The loan will of course need to be repaid, but on current salary scales in the NHS, that may not ever happen during their career lifetime.

There are a number of work streams dedicated to increasing the health workforce, and there has never been a better time to enter a career in health and social care. We have seen significant interest in the NHS and careers as a result of Covid-19, and potentially an opportunity to offer opportunities for retraining to those being made redundant or seeking a more rewarding career. Apprenticeships are an important part of this, but they need to sit alongside existing schemes – ones which often lead from entry to registration far more quickly than a four-year apprenticeship. This funding sharpens the focus and is very welcome. We need to understand the small print and a collaborative system-wide approach is critical.

But what about the apprentice? They deserve the best quality experience we can offer. We need nurse apprentices to enter and remain in the workforce. Here is funding to help us get this right; let’s put this money to work, but remember, health is better than wealth.

Denise Baker, Head of School – Allied Health and Social Care, University of Derby