Another contribution from Centre members for the ‘Scholars at Work’ lunchtime talks run by the Department of Adult and Child (nursing) and Midwifery at Middlesex University.
Brief Outline: Some politicians and sections of the media see nursing as the only profession where it is actually preferable for its members to be less educated. This presentation discusses the links between level of education and professional status. On the way it summarizes different views of the professions. It ends by setting out some of the benefits of university education for members of the nursing profession.
Short Biography: Michael Traynor was born in London. He read English Literature at Cambridge University, then completed nursing and health visiting training. He moved to Australia where he was a researcher for the South Australian Health Commission. He worked at the Royal College of Nursing in London and at the Centre for Policy in Nursing Research at the London School of Hygiene & Tropical Medicine. He is now Professor of Nursing Policy at the Centre for Critical Research in Nursing and Midwifery at Middlesex University. He is editor of the journal Health: an interdisciplinary journal for the social study of health, illness and medicine. He recently wrote Critical Resilience for Nurses, published by Routledge in March 2017 and Stories of Resilience in Nursing, 2020.
Helen gave a talk at the ‘Scholars at Work’ series at Middlesex University.
Brief Outline: I seem to have Two contradictory existences:
Phd supervisor and researcher where I spend my time encouraging my students (and making myself explore theory to inform the social world.
Contract researcher where I work on contracted work as a researcher with no seemingly obvious theoretical stance; neither is one wanted (apparently). It reminds me of earlier work I did on the massification and commercialisation of HE (in relation to students and maximising profit from numbers of students) while at Surrey. But here I am actively contributing to profit while doing nothing to develop theory which does rather seem the point of an academic?
Short Biography: Helen Allan is Professor of Nursing at Middlesex University in the Department of Nursing, Child Health & Midwifery. She has had three professional careers: as a practitioner in intensive care and women’s health; as a teacher and for the last 20 years, predominantly as a researcher. Her research is informed by sociological view of the world and she is co-founder and lead of the Centre for Critical research in Nursing and Midwifery in the Department.
Mike gave a talk based on initial findings of his PhD work at the series ‘Scholars at Work’ at Middlesex University in January 2021. See the video here.
Title of presentation:Attitudes of public staff and other key stakeholders to privatisation in the general public
Brief Outline: I will present the initial exploratory findings from the first data collection of my Doctoral research – an online survey with a sample of the general public in England (n=220) regarding their attitudes to privatisation and rationing in the NHS (especially since the Health and Social Care Act 2012 which radically changed the structure of the NHS) .
The fundamental problem which inspires this research is an apparent contradiction between the views of the public regarding how the National Health Service (NHS) of the U.K. should be run and the way in which the service is actually run, in terms of recent reforms and its apparent future trajectory.
The NHS has been described as the closest thing the UK has to a national religion and opinion polls suggest that it is the most valued and trusted public service (King’s Fund / MORI 2018) and one of the UK’s greatest national achievements. Research suggests that a majority of people are opposed to privatisation of the NHS, regardless of political affiliation or demographic profile and yet most governments from Thatcher’s onwards have, in one way or another, sought to impose market models and privatisation on the NHS and this reached unprecedented levels with the Health and Social Care Act (2012) which was described by a senior Department of Health official as ‘‘the only change management system you can actually see from space – it is that large’’(Timmins 2012).
This Act abolished Primary Care Trusts and forced GPs to take the lead for commissioning healthcare services by coming together in clinical commissioning groups (CCGs). CCGs were obliged by the Act to tender healthcare contracts externally, so that ‘any qualified provider’ (public, private or third sector) could bid and also removed the responsibility of the Secretary of State for Health to provide a universal healthcare service, granting CCGs considerable discretion to choose which services to provide and who to provide them to. This has led to an increase in private sector provision and rationing of healthcare with many CCGs choosing not to offer, or to severely limit, varicose vein removal, cataract removal, IVF and many other procedures or treatments (Heneghan 2017).
These changes have attracted relatively little media coverage and awareness of them amongst the general public (and indeed amongst health professionals) seems to be low although there does not seem to be any published research on this point (one of the gaps in the literature which I hope to fill).
Furthermore, both COVID and Brexit may lead to further NHS privatisation. The current government’s approach to managing the COVID pandemic has been heavily focussed on the private sector in terms of track and trace, test laboratories, PPE procurement and the use of private hospital facilities (Wrigley 2020; The Guardian 2020). The EU referendum was allegedly ‘won’ by the Leave campaign on the promise of dramatically increase NHS funding (London Economic 2017) but many fear that Brexit may in fact lead to further privatisation as part of a trade deal with the US.
Short Biography: Mike O’Driscoll is a mixed methods researcher with a particular interest in the use of IT in social research. His first degree was in Sociology and Social Policy and has an MSc in research methods and is currently a Doctoral student at Middlesex. Mike O’Driscoll has worked in many research environments including local government, charities and academia and has considerable experience in evaluations, particularly in health and education settings (this link to publications gives an idea of his research interests https://orcid.org/0000-0001-9221-6164).
The Learn and Earn career pathway (LECP) was established in 2017 following a pilot by Islington, Haringey and Camden community education provider networks (CEPNs) and is managed via Community Matters. It attempted to address some of the perceived barriers to employers’ engagement with apprenticeships by means of administrative assistance, financial incentives and the development of a bespoke ‘apprenticeship-plus’ model where additional training, particularly clinical skills, are included within the offer. Specifically, it was set up to promote the career pathway towards nursing and to explore the viability of using apprenticeships as a sustained funding source for training required to progress along the pathway.
The central ‘offer’ on the pathway was a Healthcare Assistant (HCA) programme, adapted to accommodate both newcomers to the HCA role (e.g. admin or reception staff) as well as experienced HCAs who want to gain the level 3 Diploma in Clinical Healthcare Support, and to develop additional clinical skills. The programme was based on a traditional apprenticeship model but with additional clinical skills classrooms that reflect the tasks typically undertaken by HCAs in General Practice.
Evaluation commissioned In 2019 a research team from the Centre for Critical Research in Nursing and Midwifery Education in Middlesex University led by Mike O’Driscoll was commissioned to carry out an independent evaluation of the Learn and Earn project. The evaluation aims included understanding the take up of each course on the Learn and Earn pathway (numbers of employers/learners, profile, progress, outcomes, reasons for take up and barriers to take up);comparing progress against targets; understanding what worked well and what did not work well and evaluating the impact of project activities at individual/business and project level.
Evaluation methods The mixed methods process evaluation which was completed in early 2020, involved an online survey, focus group and telephone interviews with all stakeholders (learners, training providers, employers, CEPNs and the project managers). It also included a ‘business case’ analysis of the project, providing a tool to inform and support employer decision-making regarding placing learners on the LECP. The business case tool, developed by Dr Wendy Knibb, provides a structure around which employers can develop their consideration of key aspects of the decision-making process such as benefits and potential non-monetary benefits of training; costs and potential non-monetary costs to training; perceived risks/challenges of training and comparing the apprenticeship model to other training options. The evaluation also provided an evaluation toolkit, to facilitate future evaluations.
Key evaluation findings included: Learner’s main reasons for taking part in courses were career development (86%), followed by wanting a role which involves more healthcare expertise (83%) and job satisfaction (72%). 62% said that they had taken part in course/s because they wanted to improve their employability and just over half (51%) chose ‘get a better salary or working arrangements’ and 38% did the course/s because they ‘want a role with more contact with public’.
Overall satisfaction with courses, which may have been negatively impacted by some initial teething problems, was moderate – however the vast majority of current learners (84% ) reported feeling very or fairly confident about taking part in their current course and satisfaction with current course was high for peer interaction and support (79% very or fairly satisfied), employer support (74% very or fairly satisfied) and timing / pattern of course (68% very or fairly satisfied).
Many learners felt that their course would have a positive effect on their career and their current employing organisations (or had already done so) and that their course had had a positive effect on the level of service provided to patients (especially in increasing capacity and the range of services which are offered in a GP practice).
Employers were, on the whole positive about their experiences of Learn and Earn courses and recognised benefits such as the ability to ‘grow their own’ primary healthcare workforce, i.e. to increase skills and capacity in their existing staff and to gain specific skills which the employer needed and which could be tailored to the needs of the employing organisation and to provide a better service for patients.
Last week I was awarded a fellowship of the Royal College of Nursing. It is extremely flattering and fun to be involved with the opening of the RCN’s 2019 Congress in Liverpool with their new president Anne Marie Rafferty.
The RCN is facing some challenges in the wake of what was widely seen as a failure to manage and communicate the government’s pay offer last year. The then General Secretary resigned and some active RCN members campaigned for the organisation’s Council also to stand down. The campaign turned out to be controversial with some suggestions of a left wing ‘infiltration’ of the RCN. So we have the appearance of a confrontation between an ‘old guard’ and ‘modernisers’.
One of the long-standing disappointments is that nursing (in England at least – the other countries of the UK may be different) rarely seems to be able to draw on its huge strength in numbers and wield political power in the field of health service policy or regarding the working conditions of nurses. I would hope for changes that move the RCN in the direction of being able to do this.
Back in July, with our long-time collaborator Pam Smith, we threw an NHS@70 event, complete with a choir and some key figures in nursing invited to look back over not only their own careers but the progress of nursing over those seventy years of work in the UK’s National Health Service. To mark the event we are gathering all the talks together along with many photographs taken on the day by our colleague Justin McDermot and publishing a book with one of the self-publishing companies. Check back for some further details.
Here is former General Secretary of the Royal College of Nursing, Christine Hancock, looking at some significant events in her own career.
Last week Helen Allan and I interviewed Pam Smith, one of the founding members of the Radical Nurses Group and writer about emotional labour (really useful link there) in nursing. I’ve published the first part of the interview on YouTube, where Pam talks about her reasons to go in to nursing and about the groundbreaking course at the University of Manchester. You can find it here: https://youtu.be/ZlLbhPTYdBA
Research by Professors Sue Dyson and Olga van den Akker, Dr Liang Liu and Mike O’Driscoll uniquely draws together three important concepts for the first time: namely student volunteering, critical thinking skills for nurses, and caring and compassionate nursing practice and shows how these relate to critical pedagogy in the nurse education. The programme of research has so far resulted in three conference papers, one peer-reviewed publication, a book and international collaboration with Dr Kwadwo Korsah at the University of Ghana School of Nursing in Accra and the establishment of academic networks in Canada, Australia, and Latvia.
The presentations were very well received and led to many interesting discussions around volunteering in health professional education and how critical pedagogy relates to compassionate care.
The presentation titled ‘The extent, variability and attitudes towards volunteering among nursing students: Implications for pedagogy in nurse education’ presented by Mike O’Driscoll at the AITNER conference in Athens can be downloaded here AITNER 2017 PRESENTATION.
Middlesex’s Prof Helen Allan collaborates on ground-breaking study revealing importance of delegation training for nurses
A new study carried out by researcher Helen Allan, Professor of Nursing at Middlesex, and colleagues at the University of Surrey, University of Salford and UCL Institute of Education sheds light on the practice of delegation in NHS nursing roles.
The research – which followed newly qualified nurses in four hospital trusts across England over a three year period – found increased educational and organisational support is needed to develop nurses’ delegation skills.
The team identified five styles of delegator among the nurses they followed. These ranged from the ‘do-it-all’ nurse who felt unable to delegate anything, to the ‘inspector’ who delegates but constantly checks the work of others for fear of being held accountable for mistakes.
Professor Allan’s work highlights an immediate concern as the most recent Nursing and Midwifery Council Code of Conduct states registered nurses should be accountable for their decisions to delegate tasks.
“Our research focuses on a little understood area of nursing – the delegation of key nursing tasks to untrained and unregistered care staff,” she says.
“Delegation falls into the category of essential nursing task which has for many years gone unacknowledged and unvalued.
“It is important because patients’ safety rests on effective delegation between nurses and care assistants. In fact, delegation is important across the whole health care team.”
The research findings will feed directly into Middlesex’s undergraduate nursing and midwifery courses to ensure students graduate with the necessary skills to delegate effectively.
“It’s important to act according to your Code of Conduct, which for the first time specifically stipulates that effective delegation is a key role for registered nurses,” explains Helen.
“Always feel confident that you know how to do what’s expected of you – and that anybody you ask to do something is competent too.”