The Sunday Times, Uncategorized

November 15th, 2009

Oh nurse, your degree is a symptom of equality disease

One of the government’s sillier initiatives was its announcement last week that in future all NHS nurses must have a university degree. From 2013, all would-be nurses will have to have taken a three- or four-year university course to enter the profession. The disastrous consequences of this ought to be obvious to the meanest Whitehall intelligence. All sorts of people who might make excellent nurses will be put off, and lost to nursing: anyone who is not particularly academic; anyone who — frankly — is not particularly bright; anyone who has a vocation to care for patients without wishing for the most high-tech training; anyone who is unable to take on a mass of student debt on a nurse’s poor pay; any late entrants — and this at a time when the NHS is desperately short of nurses. Rare though it is for me to agree with any trade union, I believe the nursing unions Unison and Unite are right when they say that there is no “compelling evidence” that degrees for nurses would improve patient treatment. I have come across a great deal of anecdotal evidence quite the other way: that nursing degrees on a university campus with too little practical hospital experience have recently been producing graduates who are all too often, in the words of one consultant, “a liability on the wards” — not necessarily “too posh to wash” but often not much good at it, or at the important clinical observations that go with it. To say this is not to dismiss the value of demanding degree courses for any would-be nurse who is suited to intense academic and technical study. Such nurses should be able to take degrees and already can, though one might argue about the nature of the present courses: more than 25% of nurses already hold a degree. However, not all would-be nurses are suited to a university degree; just as people vary hugely, so do nurses, so do the nursing roles they are fitted for and so does the training that suits them best. Plenty of the best bedside nurses are not academic, and much essential nursing work does not depend on the dizziest heights of training. There is more than one way to be a “supernurse”, and a degree is not enough. As the nursing unions said last week, “The emphasis should be on competence, not on unfounded notions about academic ability.” The health minister, Ann Keen, has been making predictable noises about providing higher-quality healthcare, but the real motivation beneath all this, quite explicitly, is the desire of the Royal College of Nursing and the nursing establishment to raise the status of nursing, and to end the stigma of the “doctor’s handmaiden”. Nurses — or rather those who claim to represent them — want to have the status of professionals, on a level with doctors, and part of being a professional is having a degree. So nurses must have degrees. All of them. What’s particularly depressing is that this obsession with status is not unique to the nursing establishment; it has become a national obsession, of which this is just one expression. It’s what explains the feeling that everyone must go to university now and the government’s determination to turn 50% of all school-leavers into undergraduates, regardless of the consequences. (There have been some suggestions that the government welcomes the idea of sending all nurses to university because it will effortlessly bump up the student numbers closer to the promised 50%.) When I was a child only very few people, and only those of supposedly high learning and intelligence, called themselves professionals and had concomitantly high social standing. Now, increasingly, everyone is described as a professional, even journalists occasionally. This unthinking pursuit of professional status and distinction has been hobbled from the first by the uncritical pursuit of equality, as if there were no real differences between people; it is hard to proceed in both directions at the same time. If, in the name of equality, at least half the country, rather than a tiny academic elite as before, must have a degree, degrees must become easier, to suit a wider range of intelligence, and universities must accept a greater number than before of students who are less bright. If half of all sixth-formers need good A-levels to get to university, A-levels must become easier. If in the name of social justice more people ought to get upper seconds and firsts, degrees will have to become easier. But, quite inevitably, a degree that is easier is also by definition less professional. And a degree that is held by many is a degree that by definition has lost some of its status. You cannot have both equality and professional status: the attempt leads to some strange absurdities. A few years ago, when I was visiting a small day centre for young adults with marked learning disabilities, a member of staff proudly showed me some artwork and some typed pages produced by three young women as part of their submission for an NVQ certificate. Having just met these girls, I knew they could barely communicate, and certainly could not read or write, so I asked how they could have produced such written work. Their tutor admitted that they had done so “with support” and when I expressed doubts, she overrode them firmly, saying she thought “everyone has the right to a qualification”. Clearly she felt — she can scarcely have thought — that social inclusion in the form of a qualification was more important than the objective value of that qualification. That is the reductio ad absurdum of the muddled thinking that has overtaken us. Few would go so far, even in the disability lobby. However, it is not quite as remote as it might seem from public policy. For if, as many people think, 50% of the population should have university degrees, why not 75%? And why stop there? After all, that would be discriminatory. Why not degrees for all? And so — why not for all nurses? Tony Blair once declared that we are all middle class now, despite all the evidence to the contrary; these days he could almost as well say we are all professional now. Such has been the collapse of standards and the debasement of language and thought under his new Labour experiment.