Cynulliad Cenedlaethol Cymru | National Assembly for Wales
Y Pwyllgor Plant, Pobl Ifanc ac Addysg | Children, Young People and Education Committee
Ymchwiliad i Effaith Brexit ar Addysg Uwch ac Addysg Bellach: Cylch Gorchwyl | Inquiry on the Impact of Brexit on Higher and Further Education
IB-12
Ymateb gan: Cyngor
Deoniaid Iechyd Cymru
Response from: Council of Deans of Health Wales
The Council of Deans of Health Wales is the strategic voice of university faculties in Wales engaged in nursing, midwifery and allied health education and research. Our members are:
· Providing educational solutions to workforce challenges in health and social care
· Educating the next generation of healthcare professionals
· Contributing to world class research and innovation
· Working with organisations across Wales to promote the contribution of education and research to high quality care
The Council of Deans of Health Wales fully supports the joint response of Universities Wales and Welsh Higher Education Brussels to this consultation. The issues it raises considering the whole higher education sector in Wales, also apply to the healthcare faculties. Our response aims to complement their joint response by highlighting some issues specifically related to the potential impact of Brexit on health higher education.
EU nationals leaving the NHS in Wales could exacerbate the increase in future workforce needs, which requires health faculties to increase the number of places they offer on nursing, midwifery and allied health courses to ensure the sustainability of the workforce.
Should the UK opt out of the EU’s mutual recognition of qualifications regime, this could change training requirements for healthcare courses in the UK, and impact onthe mobility of UK healthcare professionals and UK healthcare organisations’ ability to recruit staff from the EU.
The number of EU nationals studying healthcare courses in Wales is small, however Brexit could reduce this pool of talent even further, especially if EU nationals living in the UK would no longer be eligible for the NHS bursary.
Student mobility in the healthcare disciplines in the UK is low compared to other subjects. The potential loss of access to the Erasmus+ programme could reduce funding and opportunities for these valuable international exchanges even further.
UK health faculties are committed to working with their European partners on collaborative health research, which makes vital contributions to improving evidence-based guidance and practice, increasing research capacity in participating countries, challenging and testing hypotheses and practices, as well as disseminating and implementing research findings. Brexit could not only result in the loss of EU research funding but also in UK universities’ access to well-established European research networks and frameworks.
The Nursing and Midwifery Council’s recent figures show a significant rise in the number of EU nurses and midwives leaving the register. At the same time, the number of EU nurses and midwives who joined the register fell by 87% between April 2017 and March 2018. [1]Should this trend continue over the coming years, this could have a profound effect on workforce planning across the UK. Current uncertainties about whether EU Freedom of Movement will continue to apply to the UK during the transition period, and about the post-Brexit immigration policy for EU nationals, make it more difficult for employers to plan ahead. At the same time, demand for healthcare professionals has been increasing steadily[2] and can be expected to do so in the future due to population ageing and an increasing number of complex conditions, co-morbidities and long-term care needs. Hence, the education and training of more healthcare professionals is required to meet this increased demand in the future that could be exacerbated by Brexit.
The Council of Deans of Health Wales welcomes the Cabinet Secretary for Health and Social Services’ announcement of a £12 million increase in education and training funding for healthcare professionals in Wales. This aims to increase the number of new healthcare students from 8,573 in 2017/18 to 9,490 in 2018/19. However, challenges remain in determining the long-term future of funding in Wales. A financially sustainable model is needed that will deliver the numbers of health and social care staff required in the long-term. Whilst the NHS Bursary has now been extended for healthcare students commencing their studies in September 2019,[3] a timely decision on longer term funding is essential to help plan provision and ensure a sustainable healthcare workforce, especially in light of the challenges Brexit may pose.
Meeting future workforce demands also requires a robust retention and staff development strategy. Universities provide post-registration education to nurses, midwives and allied health professionals at all levels ranging from short courses to advanced practice Masters degrees and education in specialist clinical areas, prescribing and chronic disease management. This education is essential for patient safety, service transformation and staff retention. We want to ensure all our healthcare staff are supported with development whether they intend to stay in their current role or progress in their careers. Professional development is both a requirement of the regulator for revalidation but also, and most importantly, a factor for patient safety, particularly in the context of rapid developments in science and digital technology.
The Council of Deans of Health Wales welcomes the advent of Heath Education and Improvement Wales in October 2018 and hopes that it will promote the on-going training and development of the current and future workforce in NHS Wales.
It is unclear whether the UK will continue to adhere to the current recognition of qualifications regime and minimum training requirements regulated by Directive 2005/36/EC, as amended by Directive 2013/55/EU.[4] Any changes to education requirements could have a profound impact on higher education institutions that are educating future healthcare professionals. Should the Directive no longer apply to the UK, training requirements could be changed, for example by reducing the current requirement of 2,300 hours of clinical practice to become a registered nurse and allowing for a greater proportion of simulation-based learning. This could decrease the need for practice placements relative to the number of students and therefore enable universities to offer more places on healthcare courses.
However, opting out of the Directive would also imply that UK qualifications would no longer be automatically recognised in the EEA and EEA qualifications no longer be automatically recognised in the UK. This could compromise the international mobility of UK healthcare professionals and UK healthcare providers’ ability to recruit healthcare professionals from the EEA as seamlessly as is currently the case.
In contrast to other subject areas, the number of EU students on nursing, midwifery and allied health courses is relatively low. In 2016/17 the proportion of EU nationals among nursing, midwifery and AHP students in Wales was less than 1.5%[5]. Unlike students on most other courses, UK and EU nationals who have been resident in the UK for at least three years on courses that lead to a qualification in healthcare are currently eligible for the NHS bursary if they commit to working in Wales for at least two years after completion of their course.[6] Should EU nationals no longer be eligible to apply for the NHS bursary post- Brexit, this could have a negative impact on the number of EU nationals deciding to study healthcare courses in Wales in the future. Current figures demonstrate that applications for professional programmes in Wales remain buoyant, as compared to some programmes in England, but complacency must not be allowed to dilute the current levels of demand and Universities in Wales must ensure that reputation for quality is retained – as evidenced by Nursing in Swansea being 2nd in the Guardian University Guide 2019.[7]
In 2015-16 about 1% of undergraduate students studying subjects allied to medicine in their second or third year went abroad as part of their programme.[8] As the UK prepares to leave the EU, the UK government has indicated a need for the country to become even more global and internationalist in action and spirit. Student mobility should form a key part of this agenda. Mobility helps graduates become more globally engaged, open-minded, and culturally aware and helps us reassure the rest of the world that we still promote these values.
The Council of Deans of Health and Universities UK are calling for continued engagement in Erasmus+ and for this to be confirmed in the UK government’s negotiations with the EU. The benefits that the Erasmus+ programme, and mobility more generally, can provide students – and universities’ employability offers – are clear. We must continue to enable future generations of students to access these valuable mobility opportunities and ensure that there remains sufficient funding for them to do so.[9]
As the European Commission is planning to double funding for the Erasmus+ programme in the new budget 2021-27[10], European students’ opportunity to participate in and benefit from international exchange will be even greater, and the UK government’s ability to create similar opportunities for UK students outside of this programme will likely be diminished. Therefore, the UK’s continued access to the Erasmus+ programme would be the best option for the future UK-EU relationship.
Brexit poses questions over whether UK higher education institutions will have access to or be able to apply for EU grants and funding. Higher education institutions reported a total of £3.397 million in EU research grant funding in 2015-16 recorded against the HESA category for Nursing and Allied Health Professions[11]. This includes EU grants from EU industry, commerce and public corporations, EU governmental bodies, EU-based charities, and other EU funding sources. Higher education provider (HEP) EU research grant funding varied across the UK, with Wales having received £27,000 (an average of £3,000 per HEP in sector)[12]. Wales reported most of this funding (£20,000) coming from EU governmental bodies. The European Commission’s plan to increase funding for Horizon Europe, the successor to Horizon 2020, to €97.6 billion,[13] will create more opportunities for European research collaboration, which the UK could lose out on post-Brexit. Even if the UK government committed to provide research funding at a scale that could match UK universities’ current EU research funding, it will not be possible to replicate the valuable European collaboration frameworks and networks that UK academics have engaged with up until now. We therefore agree with Universities Wales and Wales Higher Education Brussels that securing full ‘associate’ status for the UK should be a top priority for the future UK-EU relationship agreement.
As the joint response from Universities Wales and Wales Higher Education Brussels highlights, collaboration in European research projects is not just an important source of funding but also enables cross-national exchange, research and innovation. In the health disciplines, international collaboration in health research makes vital contributions to improving evidence-based guidance and practice, increasing research capacity in participating countries, challenging and testing hypotheses and practices, as well as disseminating and implementing research findings.[14] The European Academy of Nursing Science (EANS), for instance, has brought together leading nurse scientists from 30 European countries to provide a source of inspiration, collaboration and academic leadership. It also provides 100 PhD students every year with the opportunity to participate in EANS’ summer school, which exposes them to different perspectives and encourages them to add a European dimension to their research.[15]
Welsh universities have also received EU funding for specific health related projects and new technological advancements. For example, Cardiff University received more than £4 million of funding from the European Regional Development Fund toward the development of the Cardiff University Brain Research Imaging Centre project (CUBRIC)[16]. The CUBRIC project, which opened in 2016, includes imaging equipment unique in Europe and has allowed Cardiff University to further its leading health research.
[1] Nursing and Midwifery Council (2018) The NMC register
[2] NHS Wales Shared Partnership (2017) NHS Wales’ Workforce trends (as at 31st March 2017)
[3] Welsh Government (2018) NHS Bursary to continue in Wales – Health Secretary, Vaughan Gething
[4] Nursing and Midwifery Council (2017) Nursing and Midwifery Council submission to Migration
Advisory Committee’s Call for evidence - EEA-workers in the UK labour market
[5] HESA Student Record 2016-17 Copyright Higher Education Statistics Agency Limited
[6] NHS Wales Shared Services Partnership, NHS Wales Bursary Scheme – Terms and conditions
[7] The Guardian (2018) University league tables 2019
[8] HESA Student Record data (2015–16)
[9] Council of Deans of Health and Universities UK International (2017) Outward student mobility for nurse, midwife and AHP students
[10] European Commission (2018) EU Budget for the future – Investing in people
[11] Council of Deans of Health (2017) EU research grant funding: Nursing & allied health professions
[12] Council of Deans of Health (2017) EU research grant funding: Nursing & allied health professions
[13] European Commission (2018) EU Budget for the future – Research and innovation
[14] Council of Deans of Health (2018) UK health faculties’ global engagement
[15] Ibid.
[16] Cardiff University, Cardiff University Brain Research Imaging Centre