"REALISING THE POTENTIAL" A Strategic Framework for Nursing, Midwifery and Health Visiting in Wales into the 21st Century Briefing Paper 1 "CREATING THE POTENTIAL" A Plan for Education "to ensure that pre and post registration programmes in Wales are conceived and planned in recognition that future health care provision will require adaptable and flexible practitioners with reflective, lifelong learning skills" December 2000
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"REALISING THE POTENTIAL"
A Strategic Framework for Nursing, Midwifery and Health Visitingin Wales into the 21st Century
Briefing Paper 1
"CREATING THE POTENTIAL"A Plan for Education
"to ensure that pre and post registration programmes in Wales are conceived and planned
in recognition that future health care provision will require adaptable and flexible practitioners
with reflective, lifelong learning skills"
December 2000
Further copies of this document can be obtained from:
Jacqui SharplesNursing DivisionNational Assembly for WalesCathays ParkCardiffCF10 3NQ
Tel: (029) 2082 3328E-mail [email protected]
Designed and Typeset by Text Processing Services
ISBN 0 7504 2598 9 January 2001 © Crown Copyright
In July 1999, I launched "Realising the Potential", A Strategic Framework for Nursing,Midwifery and Health Visiting in Wales. This was the first major document produced by theNational Assembly for Wales, and set out, in a patient/client focused way, a framework toenable the nursing, midwifery and health visiting professions in Wales to maximise theirdistinctive contribution to health in Wales.
To achieve the aims of the Framework and the health objectives of the National Assembly, itis essential that the education of nurses, midwives and health visitors at pre-registration,continuing education and advanced levels be based on sound education principles.Furthermore, systems must be flexible enough to provide practitioners with the knowledge,skills and competencies necessary now, as well as for future decades.
I am therefore pleased to support the vision and strategy set out in this first briefing paper'Creating the Potential'. This document represents the first real strategy for nursing, midwiferyand health visiting education for Wales. It has been produced by a collaboration of serviceand education.
The document underpins and supports the aims of 'Realising the Potential' and it provides aclear direction for the development and provision of professional education in Wales.
There is a clear direction for the future, which will assist both education and service providersto work in partnership to deliver the skilled and qualified nurses, midwives and health visitorsrequired to meet the health needs of the people.
I would commend this paper to all those who have a responsibility, managerially andprofessionally to deliver the health agenda of the National Assembly for Wales.
Finally I would like to take this opportunity to thank the members of the Nurse EducationForum without whom this document could not have been produced.
Assembly SecretaryHealth and Social Services
FOREWORD
Page
Executive Summary 1
Section 1: Introduction 5
Section 2: Present and Future Needs 7
2.1 Changing needs 7
2.2 Fitness for practice, purpose and award 8
2.3 A competent practitioner 10
2.4 Matching needs with resources 13
2.5 Ongoing education and development 14
Section 3: The Way Forward 15
3.1 Key Principles 15
Conclusion 19
References 20
Section 4: Implementation Plan 21
CONTENTS
1. The ability to deliver nursing, midwifery and health visiting services dependsfundamentally on the way in which practitioners are prepared, both during their initialeducation which leads to registration, and in their post registration education and continuedprofessional development. Education and training provision must be responsive to theknowledge, skills and competencies required for present and future health care delivery.
2. This briefing paper provides the direction for nursing, midwifery and health visitingeducation in Wales which is necessary to achieve the goals set out in "Realising the Potential",(National Assembly for Wales [NAW] 1999). It is for this reason that the paper is entitled"Creating the Potential". The purpose of the paper is therefore;
I. To support and complement the Strategic Framework for Nursing, Midwiferyand Health Visiting in Wales into the 21st Century, "Realising the Potential"(NAW1999).
II. To acquaint key stakeholders with the main issues in nursing, midwifery andhealth visiting education, and to propose how education should be developedto promote and achieve service objectives, which contribute to meeting thehealth needs of the people in Wales.
III. To set current thinking and aspirations about the future of nursing, midwiferyand health visiting education in Wales into the context of European trendsand challenges, to ensure that the needs of the public, the NHS and other careproviders contribute to and drive the education and training agenda inpartnership with Higher Education Institutions (HEIs).
3. The intention is that the briefing paper will be a working document which will assistboth education and service providers to engage in joint planning initiatives for the future. Thepaper considers both the Report of the United Kingdom Central Council (UKCC) Commissionfor Nursing and Midwifery Education, Fitness for Practice (1999), and also the government'sproposals for education in England set out in "Making a Difference" (Department of Health1999). However, it is clear that the needs of Wales are different and therefore requireparticular consideration. A briefing paper that clarifies the confusion and sets a clear directionfor the future is therefore timely.
Present and Future Needs
4. Today's students are preparing for practice well into the new millennium. Nurses,midwives and health visitors must be able to respond to changing demographic needs,changing patterns of health and illness, rising public expectations, new technologies(especially information technology), new ways of delivering health care, and a rapidlychanging knowledge base. Nurses, midwives and health visitors must therefore be prepared towork in a variety of settings and to develop transferable skills which can be adapted todifferent situations and changing requirements. As part of the public health agenda the abilityto work in new ways, in new partnerships and with other organisations will be essential.
1
EXECUTIVE SUMMARY
2
5. General education is also changing just as rapidly. As educational aspirations andpublic expectations rise, nursing, midwifery and health visiting education must continue torespond with more flexible curricula, which will usually be modular, often undertaken on apart time basis, and delivered by alternative methods. Higher Education is expected to exploitthe new information and communication technologies and to use them to achieve greaterresponsiveness and flexibility in delivery.
6. There are many different stakeholders whose priorities legitimately differ and have tobe reconciled. Meeting their needs requires close and continuous partnership to ensure thatthe selection of future practitioners, the content and quality assurance of their preparation andtheir continuing professional development, is appropriate to the ever changing requirementsof health care provision.
7. Although there are staff shortages in particular areas and particular specialities, Walesdoes not currently suffer from a serious shortage of qualified nurses or midwives.Recruitment of students is also buoyant. However, the process of workforce development andplanning is in need of constant review to enable accurate commissioning of future studentplaces and to monitor staff retention and career patterns.
8. Key Principles
Principle 1: Achieving fitness for practice, purpose and award
Fitness for practice is the responsibility of the Regulatory body, (currently the UnitedKingdom Central Council), as part of its role for public protection. Fitness for purposerepresents the particular requirements of employers. Fitness for award is the requirement thatthe student has achieved the level of attainment specified by the awarding body. Pre-registration education must produce a safe and competent practitioner who can demonstratethe competencies specified by statute and can be held accountable for his/her decisions andactions.
Since nursing, midwifery and health visiting are practice based professions, clinicalcompetence is as important as and should be valued as highly as, theoretical excellence.Clinical placements are an essential part of pre-registration education programmes/courses butthe quantity and quality of provision depends greatly on service providers.
Existing and future practitioners need to be prepared for team working across professional andorganisational boundaries, for flexible working outside current role boundaries, and to be ableto make the best use of the range of skills and knowledge which they will have developed asnew roles and organisational structures emerge.
Quality assurance activity to ensure fitness for practice, purpose and award for pre-registrationand post registration courses, must be undertaken in a streamlined way, and in partnershipwith all stakeholders.
3
Principle 2: Development and leadership of practice and education
Nursing, midwifery and health visiting need strong leaders with drive and enthusiasm in orderto address current problems and prepare for future challenges. They must be seen to beeffective and relevant not only to their nursing, midwifery and health visiting colleagues butalso to politicians, managers and other health professionals.
A commitment to lifelong learning is a professional responsibility which is a challenge to beundertaken by each individual, but resources also need to be made available to facilitate suchinitiatives. In addition to appropriate educational provision, nurses, midwives and healthvisitors should have the same opportunities and entitlements to protected time for continuingprofessional development as other health professionals.
Principle 3: Expanding the research and education environment
The preparation of nurses, midwives and health visitors must be at the same academic level tothat of other health professionals with whom they will be expected to work as members of amulti-professional healthcare team. This is in line with the National Assembly's policy forgraduate entry into practice. As much as possible of the programmes should be shared withother professionals with recognition given to the skills and knowledge which all staff canbring to patient/client care.
The development of nursing and midwifery knowledge through research is an essential pre-requisite for clinical effectiveness, evidence based practice, and clinical governance. Theeducation system must, therefore, enable the development and testing of knowledge throughresearch in addition to the transmission of knowledge through teaching.
Principle 4: Meeting future human resource requirements
The supply of places on education programmes or courses of preparation and fundingarrangements to support them must take account of the requirements of service providers andsociety's need for qualified nurses, midwives and health visitors. Education and serviceproviders must work together in partnership, with the practitioners, to ensure that future needsare met. Furthermore the processes involved in workforce development, workforce planningand data collection are the focus of current attention that will continue to influence theeducation and training agenda.
Conclusion
"Creating the Potential", based upon the Strategic Framework for Nursing Midwifery andHealth Visiting, "Realising the Potential" (NAW 1999), together with its associated actionplan, is realistic and feasible, but it will require sustained commitment and investment. TheNational Assembly for Wales supports these initiatives believing that education is aninvestment capable of producing high returns.
.
1.1 In July 1999 the National Assembly for Wales (NAW) published a StrategicFramework for Nursing, Midwifery and Health Visiting in Wales into the 21st Century,"Realising the Potential". The strategic goal is stated as:
"to realise the full potential of nursing, midwifery and health visiting in order to meet, incollaboration with others, the future health needs of people in Wales." p1
1.2 The ability to deliver nursing, midwifery and health visiting services dependsfundamentally on the way in which practitioners are prepared, both during their initialeducation which leads to registration, and in their post registration education and continuedprofessional development. Realising the Potential (NAW 1999) includes among its aims:
"To ensure that all nurses, midwives and health visitors develop their practice in a reflectiveand evidence based manner, founded upon a standard of education which enables them topractise as equal partners with other healthcare professionals, supported by continuing
professional development and clinical supervision." p1
1.3 This paper considers the Report of the UKCC Commission for Nursing and Midwiferyeducation, "Fitness for Practice" (1999). The spirit of their recommendations, many of whichreflect current practice in Wales, are supported. The government's proposals for education inEngland set out in its own strategy, "Making a Difference" (Department of Health 1999), arealso considered. However, the needs of Wales are different and require particularconsideration. A briefing paper which clarifies the confusion and sets a clear direction for thefuture is therefore timely.
1.4 This paper provides the direction for nursing, midwifery and health visiting educationin Wales which is necessary to achieve the goals set out in "Realising the Potential" (NAW1999). It is for this reason that it is entitled "Creating the Potential". The paper focuses onpre-registration preparation and also considers issues surrounding continuing professionaldevelopment and clinical governance.
The intention is that it will be a working document which will help both education and serviceproviders to plan together for the future, to ensure the supply of an appropriately qualifiednursing, midwifery and health visiting workforce to provide the highest quality service for thepeople of Wales.
1.5 The purpose of this briefing paper is therefore;
➯ To support and complement: the Strategic Framework for Nursing,Midwifery and Health Visiting in Wales into the 21st Century, "Realising thePotential" (NAW 1999).
➯ To acquaint key stakeholders who have an interest in the development ofhealth services in Wales, with the key issues in nursing, midwifery and healthvisiting education.
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SECTION 1
INTRODUCTION
6
➯ To propose how this education should be developed in Wales and within thewider UK context in order to promote and achieve NHS and intersectoralservice developments and objectives thus contributing to meeting the healthneeds of the people in Wales.
➯ To set current thinking and aspirations about the future of nursing, midwiferyand health visiting education in Wales into the context of European trendsand challenges, to ensure that the needs of the public, the NHS and other careproviders contribute to and drive the education and training agenda.
1.6 This paper attempts to achieve these aims by setting out the present and futureeducational needs of practitioners to work in an ever changing health care arena. Section 3sets out the key principles which must underpin nursing, midwifery and health visitingeducation in Wales, if we are to meet the needs identified. Finally, Section 4 sets out animplementation plan which will enable the targets set out in "Realising the Potential" (NAW1999), and the principles identified here, to be achieved.
2.1 Changing needs
2.1.1 Today's students are preparing for practice well into thenew millennium. Nurses, midwives and health visitors will requirethe skills to access, understand and evaluate information, both toinform their own practice and also to help patients and clientsmake fully informed choices about their own care.
2.1.2 'Realising the Potential' [NAW1999], sets out a "Glimpseinto the Future" both of nursing, midwifery and health visiting andof healthcare. Many others have also set scenarios for the future.All agree that future professionals must be able to respond tochanging demographic needs, changing patterns of health andillness, rising public expectations, new scientific and technologicalbreakthroughs, new technologies (especially informationtechnology), new ways of delivering health care, and a rapidlychanging knowledge base. The World Health OrganisationStrategy for Nurse Education [WHO 2000], proposes that nurses,midwives and health visitors must be educated and trained to meetthe challenges posed by a new emphasis on health promotion anddisease prevention, community development, multidisciplinaryteam working, the provision of health services closer to wherepeople live and work, and equality of access. It is therefore,essential that practitioners are above all, flexible and able to adapttheir knowledge and skills appropriately.
2.1.3 While a commitment to lifelong learning and continuousprofessional development will facilitate the maintenance ofcompetence and the development of new skills, it is important torecognise that the initial preparation must provide the cognitiveand transferable skills on which continuing education will build. Itis for this reason that 'Realising the Potential' [NAW 1999]envisages that in future, entry to the nursing and midwiferyprofessions must be, as for all other health professions, at graduatelevel. At the same time it is important to value the knowledge,experience and skills of the existing workforce.
2.1.4 General education is also changing just as rapidly aseducational aspirations and public expectations rise. The targetsfor participation in higher education which the government has setare already being exceeded. Nursing and midwifery must maintaina wide entry gate, especially for mature entrants, but it must alsobe attractive to the most able school leavers. Informationtechnology is revolutionising methods of teaching and learning.
Client choice
Flexible and adaptablepractitioners
Graduateness
Flexible learning
7
SECTION 2
PRESENT AND FUTURE NEEDS
Nursing, midwifery and health visiting education must respondwith more flexible curricula, which will usually be modular, oftenundertaken on a part time basis, and increasingly delivered byalternative methods such as video-conferencing, Internet accessand other forms of distance and open learning. Higher EducationInstitutions are expected to exploit the new information andcommunication technologies and to use them to achieve greaterresponsiveness and flexibility in delivery. Methods of supportingstudents to enable them to use more flexible learning modes mustalso be considered.
2.1.5 To prepare for future challenges, nursing, midwifery andhealth visiting will need strong leaders with drive and enthusiasm.They must be seen to be effective and relevant not only to theirnursing, midwifery and health visiting colleagues but also topoliticians, managers and other health professionals. Educationhas a duty in developing and supporting present and future leadersto help steer the many changes that face health care provision.
2.2 Fitness for Practice, Purpose and Award
2.2.1 The primary purpose of nursing, midwifery and healthvisiting education in Wales is to prepare and provide a workforcesufficient in both quantity and quality to meet the Principality'sneed for their services. There are many different stakeholderswhose priorities legitimately differ and have to be reconciled.Stakeholders include the NHS, other employers, higher educationinstitutions, the public, the nursing, midwifery and health visitingprofessions, and the students themselves. Meeting their needsrequires close and continuous partnership between education andservice providers as well as the local community, to ensure that theselection of future practitioners and the content of their preparationand their continuing professional development is appropriate torequirements.
2.2.2 The Report of the UKCC Commission for Nursing andMidwifery Education [UKCC 1999] notes that fitness for practiceis different from fitness for purpose and fitness for award. Fitnessfor practice as a registered nurse or registered midwife means theability to provide professional nursing or midwifery care to manykinds of people in and across a variety of environments. It involvesautonomous clinical decision making, and personal accountabilityfor decisions and actions. It is not limited to the care of thephysically sick in hospital; it includes working with individuals,families and communities in a variety of settings to prevent illnessand promote health. It is not limited to the performance of tasks;it includes assessment, risk management, planning and co-ordinating care, evaluating outcomes, and delegating to, and
8
Leadership
Working in partnership
Fitness for practice
supervising the work of, assistants. Ensuring fitness for practice isnecessary to protect the public and is the primary purpose ofprofessional regulation. The requirements for professionalpractice at the point of registration as a nurse, midwife or healthvisitor are specified by statute and are the responsibility of theUKCC and any successor body established by current changes.The remit of the UKCC Commission for Nursing and MidwiferyEducation was "to propose a way forward… that enables fitnessfor practice based on health care needs", and theirrecommendations on this issue are supported.
2.2.3 Fitness for purpose represents the particular requirementsof employers, who will legitimately have needs for specific roles.Different employers will have different requirements which willchange in line with service changes. Fitness for purpose mustensure that nurses, midwives and health visitors are equipped withthe skills, knowledge and attitudes to deliver the services thatpatients’, clients and their families expect. Acknowledging thatexpectations change rapidly it is imperative that education cankeep pace with both short and long term targets for change.Implementation of the principles contained within this paper mustensure that present and future practitioners are able to meet thehealth needs of the people in Wales, in light of existing needs ofthe NHS in Wales, and current analyses for the future [BetterHealth Better Wales 1998; Access and Excellence NAW 2000].
2.2.4 Fitness for award is the requirement of the higher educationinstitutions that students achieve the level of attainment specifiedfor a particular award. Fitness for award is the responsibility of theawarding body, not of the employer nor of the body responsible forstandards of professional practice. In the case of academic awards,the awarding bodies (i.e. the universities) are required to ensureconsistency of standards across disciplines, while the QualityAssurance Agency is responsible for ensuring consistency acrossinstitutions. The QAA is currently developing benchmarkinformation on threshold standards which articulates the abilitiesand skills expected of graduates in different subjects includingnursing, midwifery and health visiting; specifications and criteriawill be set for professional programmes which are comparablewith those set for other university courses.
Whilst examination has been given to each focus of fitness forpractice, purpose and award as separate, the principles areconsidered as inextricably linked.
2.2.5 For UK nurses and midwives, the recommendations of theEuropean Union are particularly important, because therequirements for free movement of labour for nursing and
Skills of delegation
Fitness for purpose
Fitness for award
9
midwifery are laid down in Directives which specify relevantqualifications, the minimum length of training, the ratio of theoryto clinical practice, and the content of programmes leading toregistration. The EU Advisory Committee on Training in Nursing(ACTN) and the Advisory Committee on Training in Midwifery(ACTM) have recently recommended changes to the original 1977Directives in line with the trends outlined above. A survey ofnursing and midwifery education in Europe undertaken by theACTN and ACTM [EU document XV/E/9432/7/96-EN] showsthat nursing and midwifery education in the UK differs from thatof other EU members in a number of respects. For example, theUK is the only country in Europe which does not prepare ageneralist nurse and, although the current pre-registration AdultNursing Branch programme currently meets the requirements ofthe existing Directives the other three branches do not.
2.2.6 The recommendation of the UKCC Commission forNursing and Midwifery Education that "the current programme offour branches of nursing should be reviewed in the light ofchanging health care needs, and that the review should consider arange of options including ….. generalist nurse preparation", iswelcomed.
2.3 A Competent Practitioner
2.3.1 Nursing, midwifery and health visiting education are anintegral part of the legislative and regulatory framework for theprofessions. Both education and practice must be underpinned byvalues focusing on the promotion and maintenance of health inindividuals, families and communities and on individual andholistic care of those who are ill. Professional education mustpromote non-judgemental care that is sensitive to the social,cultural, economic and political contexts.
2.3.2 Pre-registration education will in the future be based ondefined competencies. However, the concept of competency iscomplex. It is important to recognise that for professional practice(in any profession) the definition of competency is broader thanthat specified for vocational training, and must include theintellectual competencies required for clinical decision making.The EU, ACTN and ACTM which have recommendedcompetencies for nurses and midwives across the European Union,defines competencies as;
"the personal attributes (knowledge, abilities and attitudes)which enable individuals to function autonomously in the
workplace, to improve their performance continuously, and toadapt to a rapidly changing environment" (EC XV/E/8481/4/
97-EN 1998)
EU requirements
Branch programmes
Regulatory frameworkand core values
10
2.3.3 The development of pre-registration programmes in the UKarise from the premise that nursing, midwifery and health visitingare practice based professions that recognise the primacy ofpatient/client well-being and respect for individuals. From thisstance the competencies for entry to the Register for nurses arefocused in the following domains;
I. Professional/Ethical practice
II. Care delivery
III Care management
IV Personal/professional development
2.3.4 There are however, a number of core competencies that canbe identified as essential to enable fitness to practice as a registerednurse, midwife or health visitor. These include technical skills,critical thinking, communication skills, assessment, andcommitment to continuing professional development.
Technical skills are immediately and universallyrecognised as essential, but it is important to note that in nursing,midwifery and health visiting, technical skills must beunderpinned by the cognitive and social skills that are necessaryfor the clinical judgement that any particular task should beundertaken at all, by whom, when, and how. While registerednurses and midwives must be able to exercise such skillsthemselves, they must also be able to delegate, teach, superviseand monitor the performance of others. Skill development shouldfocus on the mastery of core principles, so that as practice changesand particular tasks become obsolete, the practitioner is able toadapt and apply the skills to new circumstances and in differentcontexts.
Critical thinking underlies clinical decision making; itincludes finding and using knowledge through the cognitiveprocesses of questioning, analysis, synthesis, interpretation,inference, inductive and deductive reasoning, problem solving,intuition, and creativity. These are the features of graduateness,which is the level at which nurse, midwives and health visitors willneed to be educated.
Communication skills are essential for building therelationships with patients and clients within which nursing,midwifery and health visiting practice takes place. Appropriaterelationships with colleagues are necessary to enable care to beshared. The public health agenda will require skills to enable
Competency domains
Core competencies
Technical skills
Critical thinking
Communication skills
11
dialogue across organisational boundaries. Communication skillsinclude listening, oral, and non-verbal communication, teachingand counselling, and written communication skills.
Assessment involves gathering information about patients',clients' and communities' health status, needs, and wishes,analysing and synthesising this data, making judgements aboutinterventions based on the findings, and evaluating outcomes andservice availability locally.
Practitioners must be able to identify their ownprofessional development needs by engaging in activities such asreflection in and on practice and lifelong learning. They must alsobe willing to share experiences with colleagues and patient/clientsto identify additional knowledge/skills needed to manage new andchallenging situations, taking action to meet any deficits.
2.3.5 These competencies must be achieved by the point ofregistration as well as be maintained throughout the practitioner'spractising life. To meet the requirement of fitness for practice inpre-registration, the foundations, especially in the cognitivecompetencies concerned with critical thinking, must be establishedfrom the very beginning of the programme, with each successivemodule building on what has been achieved in earlier modules.The new fitness for practice programmes will enable students toachieve a common level of outcome at the point of entry to thebranch programme, and students who leave the programme at thispoint will be accorded credit for their achievement. For thisreason, it is essential that pre-registration education continues to beseen as a three year preparation for practice. Stepping on andstepping off arrangements must overcome the potential forfragmentation and discontinuity of competence development.
2.3.6 However, to enable students who leave the course to takeadvantage of the experience gained in the first year, theirachievements should be accredited. Achievements may bemeasured against the standards and criteria of the NationalOccupational Standards (NOS). Profiles of individual studentachievements, which relate to the cognitive, affective andpsychomotor skills acquired during the first year, can be madeavailable by the educational institution. All evidence ofachievement in practice, including the underpinning knowledgefrom the course, should be incorporated into the student's portfolioof development and retained by the student as evidence of his/herachievement. Any mapping of experience to join a pre-registrationprogramme at year 2 must ensure compliance with UKCCoutcomes to join a branch. This new flexibility for entry and exitpoints will affect workforce planning.
Assessment
Continuing professionaldevelopment
Maintaining competence
Stepping on Stepping off
Portfolio development
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2.4 Matching need with resources
2.4.1 Currently the National Assembly for Wales commissionsan annual workforce survey of all non medical staff categories toidentify the needs of the independent sector, the prison service, andgeneral medical practitioner services as well as the NHS.However, workforce planning is a very inexact science, andadequate means of standardised data collection are essential.
2.4.2 Although there are shortages in particular areas andparticular specialities, Wales does not suffer from the seriousshortage of qualified nurses, midwives or health visitors. At 1/2/00there were 753 vacancies in the NHS in Wales. It is estimated thatthe number of registered nurses, midwives and health visitors inWales who are not working as nurses in the NHS is approximately9000. There are however, around 14,000 beds in the private andvoluntary sectors in which it is assumed many of these nurses areemployed. Methods of attracting nurses, midwives and healthvisitors back into the profession may offer one way of addressingsome localised recruitment difficulties.
2.4.3 Recruitment of students is also buoyant. For example, in1999 there were 8000 applications for the 1000 places on Diplomaand undergraduate nursing programmes. All of the educationalproviders in Wales have waiting lists for their pre-registrationprogrammes at both degree and diploma levels. Applications forpost registration courses have also increased significantly in recentyears.
2.4.4 Rates of attrition during training vary slightly from courseto course and institution to institution, but the overall rate duringthe period 1997-2000 was approximately 16.2%. This should becompared with the average UK attrition rate of 18% for students ofother disciplines. Attrition from degree programmes is also lowerthan from Diploma programmes. However, figures are difficult tointerpret in the absence of a common definition of attrition andstandardised ways of measurement.
2.4.5 Workforce planning figures similarly need carefulinterpretation. Workforce studies have shown that the nursing,midwifery and health visiting workforce is ageing; staff turnover istoo high, and is expensive. Furthermore, the requirement fordifferent specialities can fluctuate. Hence, retention of nurses,midwives and health visitors is a greater challenge thanrecruitment. It is also difficult to track the career patterns ofpractitioners in Wales. Statistics are required to identify thepercentage of the workforce that leave the profession annually andthose that move between the private and independent sectors andwithin the NHS in Wales.
Standardised workforceplanning
Recruitment
Attrition
Retention
13
2.5 On going education and development
2.5.1 Healthcare professionals have a duty to keep theirknowledge and skills up-to-date. The public have a right to expectnothing less. There is however, a challenge of matching employerrequirements regarding a fitness for purpose workforce with ameaningful framework for continuing professional development(CPD). Furthermore, clinical governance demands a moresystematic approach to CPD which ensures that priority is given toaddressing learning needs linked to specific service quality issues.In developing local approaches to CPD as part of their learningplans, NHS Trusts will need to consider not only their locallearning objectives and priorities but also the variety of resourcesneeded to support CPD and how these are best targeted to ensurevalue for money.
2.5.2 NHS Trusts have a responsibility for the post-registrationeducation of their practitioners. While this arrangement enablesemployers to ensure "fitness for purpose" in their staff, costconstraints mean that they may be unable to meet either need ordemand. Unlike doctors, nurses, midwives and health visitors arenot entitled to protected time for continuing education andprofessional development. In addition to appropriate educationalprovision, nurses, midwives and health visitors must have the sameopportunities and entitlements to protected time for continuingprofessional development as other health professionals.
2.5.3 The nursing, midwifery and health visiting professionsmust continue to control the standard, kind, and content of itseducation. This is one of the defining characteristics of aprofession and an integral part of professional self-regulation. Itmust, however, do so in consultation and collaboration withservice providers, education providers, and the public.
CPD
Clinical governance
Professional selfregulation
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3.1 Key principles
3.1.1 This section sets out the fundamental principles which should underpin arrangementsfor nurse, midwife and health visitor education in order to meet future needs. These principlesincorporate those set out by the World Health Organisation in its European Strategy forNursing and Midwifery Education (WHO 2000)
3.1.2 Pre-registration education must produce a safe and competent practitioner who candemonstrate the competencies specified by statute and can be held accountable for his/herdecisions and actions. The registered nurse, midwife and health visitor should be able topractise at this level in any location and within any employing organisation. Changes in healthneeds and in healthcare, including the requirement for accountability and evidence basedpractice increasingly require higher level skills and those most commonly associated withgraduate status. For this reason Realising the Potential (NAW 1999), recommends that infuture, entry to the professions should be at graduate level.
3.1.3 Since nursing, midwifery and health visiting are practice based professions, clinicalcompetence is as important as and should be valued as highly as, theoretical excellence.Clinical placements are an essential and integral part of pre-registration educationprogrammes/courses, but their quantity and quality depend on service providers more than onthe education providers. More consideration needs to be given to how students can be bettersupported in clinical areas, and how clinical competence can be assessed. The principle thatthose who teach these professionals should also practice is supported. There are many goodexamples of lecturer-practitioner and link teacher arrangements, and many more teacherswould like to spend more time in clinical practice. However, structural barriers and thecompeting demands of teaching, research, administration and clinical practice make itdifficult. All the recommendations of the UKCC Commission for Nursing and MidwiferyEducation on this matter, are supported and the resource implications noted.
3.1.4 Existing and future practitioners need to be prepared for team working acrossprofessional and organisational boundaries, for flexible working outside current roleboundaries, and to be able to make the best use of the range of skills and knowledge whichthey will have developed as new roles emerge.
3.1.5 Quality assurance activity to ensure fitness for practice, purpose and award for pre-registration and post registration courses, must be undertaken in a streamlined way, and inpartnership with all stakeholders.
SECTION 3
THE WAY FORWARD
Principle 1 Achieving fitness for practice, purpose and award
3.1.6 Nursing, midwifery and health visiting need strong leaders with drive and enthusiasmin order to address current problems and prepare for future challenges. They must be seen tobe effective and relevant not only to their nursing, midwifery and health visiting colleaguesbut also to politicians, managers and other health professionals.
3.1.7 Nurses, midwives and health visitors who have the opportunity to move acrossclinical, management, education and research boundaries are likely to bring a broaderperspective to the leadership role. This can be assisted by increased opportunities for jointappointments rotational posts and secondments involving Trusts, Health Authorities, HigherEducation, Government, other Statutory agencies and the non-statutory sector and practiceabroad. Personal and professional development opportunities should continue to be madeavailable to those aspiring to leadership and/or management roles.
3.1.8 Nurses, midwives and health visitors who work in Higher Education are well placedto contribute to the development of the leadership role. However, in order to provide andcontribute to leadership of the profession as a whole, they need to establish more meaningfullinks with practice, developing an appreciation of the real needs and concerns of nurses,midwives and health visitors delivering care.
3.1.9 With the ever-increasing diversity of roles and specialities, it is becoming moredifficult to agree common standards for advanced practice. The establishment of an academyof subject based faculties which would have several functions needs to be considered. Thefunctions might include the interpretation of standards for advanced practice, requirements foreducation and training etc. In addition the academy and its faculties could be the source ofspecialist advice at all levels in the service. It is envisaged that an academy could act as afocus for excellence in care, evidenced based care, the development of clinical leadershipskills and the possible accreditation of continuing professional development and clinicallearning environments
3.1.10 A commitment to lifelong learning is an essential part of professional practice andmaintenance of an adaptable flexible workforce. Lifelong learning is a continuous process oflearning through study, experience, personal reflection and shared learning. It is not aboutgoing on courses. People should be encouraged to learn when, where and how it suits thembest. To support lifelong learning, staff need easy access to a wide and flexible range oflearning opportunities, including those which information technology is increasingly makingpossible.
3.1.11 Everyday work situations provide a rich source for creative problem-based learningopportunities to complement more formal training activities. Everyone with staffmanagement responsibilities should be encouraged to think imaginatively about arrangementslike secondments, rotational posts, work shadowing, learning sets and other innovativeopportunities for learning. Teaching, mentoring and peer review all provide valuableopportunities for people to share their learning experiences.
16
Principle 2 Development and leadership of practice and education
3.1.12 Successful lifelong learning has to be convenient, relevant and planned. All nurses,midwives and health visitors should have the opportunity to discuss and receive guidance ontheir development needs and how these might be addressed. Wherever possible, peopleshould be free to decide whether to consult an educational or clinical supervisor, their linemanager, a colleague or mentor. The action agreed should reflect the needs, learning stylesand preferences of the individual and must also be agreed by line management as part of asystematic appraisal which links individual need with the service priorities of the organisation.
3.1.13 The rapidly changing environment of health care requires practitioners to maintaintheir competence, to develop their knowledge base as knowledge expands and changes, andto adapt their skills to new circumstances. Continuing professional development is theresponsibility of the professional practitioner, which is a challenge to be taken by eachindividual, but resources need to be made available to help. In particular nurses, midwivesand health visitors should have the same opportunities and entitlements to protected time forcontinuing professional development as other healthcare professionals (Agenda For Change1999).
3.1.14 The preparation of nurses, midwives and health visitors must be equivalent to that ofother health professionals with whom they will be expected to work as members of a multi-professional healthcare team. There is value in promoting effective team working byencouraging methods of working and learning which support an integrated approach topatient/client care. As much as possible of the educational programme should be shared.Innovative schemes, in which the first year of the undergraduate nursing programme and thefirst year of the undergraduate medical programme are shared, demonstrate what can beachieved. However it is unrealistic to expect such sharing if the level, location andorganisation of the two programmes and the educational level of the two groups of studentsare very different.
3.1.15 Nursing, midwifery and health visitor education must continue to be fully integratedwithin higher education. Students must not be required to be employees during theireducation and must enjoy a status equivalent to that of other university students. This impliesthat the same opportunities for development, including the establishment of links with othersubject areas and the pursuit of research are equal to other disciplines.
3.1.16 The development of nursing and midwifery knowledge through research is an essentialpre-requisite for clinical effectiveness, evidence based practice, and clinical governance. Thenursing, midwifery and health visiting education systems must enable the development andtesting of knowledge through research as well as the transmission of knowledge throughteaching. The NHS funding for nursing, midwifery and health visiting education does notcurrently contain provision for research.
17
Principle 3 Expanding the research and education environments
3.1.17 Workforce development has to start from the definition of the services and potentialservices that the public need. This leads to the debate on the skills and competencies requiredto deliver theses services and the numbers and types of staff required. The supply of trainingplaces and funding arrangements to support them must therefore take account of therequirements of service providers (NHS, independent sector, and other employers), andsociety's need for qualified nurses, midwives and health visitors. The nursing, midwifery andhealth visiting workforce must be seen as a global, not merely a local resource. Supply anddemand must be estimated for the long term as well as for the short term, and must takeaccount of labour mobility between employers, between fields of practice, and betweencountries. Education and service providers must work together in partnership, and with thepractitioners, to ensure that future needs are met. To facilitate this the processes of workforceassessment, workforce planning and data collection require immediate attention.
3.1.18 The entry gate to preparation for nursing and midwifery must be wide enough toenable anyone who wishes to become a nurse or midwife and who has the ability to achievethe competencies specified for registration to do so. Universities in Wales are alreadycommitted to widening the entry gate to higher education, especially for mature entrants.Relationships with further education institutions, including access courses, are already welldeveloped in Wales. Modularisation should enable programmes to be delivered in a variety offull-time and part-time modes, and to spread the programme over a longer period of time toaccommodate those who have family commitments or who have to catch up on previouslymissed education.
3.1.19 Retention of students and of newly qualified practitioners is a particular challenge.Education and service providers must work together to ensure adequate support for studentsin the clinical environment, and to develop realistic arrangements for preceptorship andclinical supervision to support the transition from student to a competent and confidentpractitioner. The resource implications of such arrangements are considerable and should berecognised. The provision of opportunities and support for continuing education andprofessional development are an important factor for attracting and retaining qualified staff.Strategies for recruitment and retention must demonstrate career progression and jobsatisfaction which fulfils the needs and aspirations of nurses, midwives and health visitors.
3.1.20 It is important to promote staff development as an investment in quality by raisingawareness among service providers and managers of the value of education, training andlifelong learning in the delivery of high quality services. Retention of a motivated andcompetent workforce is influenced, in part, by the maintenance of close liaisons betweeneducation and service. The importance of their partnership will need to be enhanced andfurther recommendations of the Human Resource Strategy, Delivering for Patients (NAW2000), implemented.
18
Principle 4 Meeting future human resource requirements
The following implementation plan provides a framework for ensuring that each of theseprinciples is addressed.
As Realising the Potential (NAW 1999) states, nursing, midwifery and health visiting inWales will gradually develop a distinctive identity under the guidance of the Assembly. Weshare the aspiration of 'Realising the Potential' that in the future many nurses, midwives andhealth visitors may choose to come to work in Wales, where their professional aspirations canbe realised in an environment which genuinely values high quality care and dedication to theinterests of patients and clients.
It is important to modernise education and training to ensure that all staff are equipped withthe skills they need to work in a complex changing health care arena. This will requirestreamlined workforce planning and development which stems from the needs ofpatients/clients, carers and communities, not of professionals. This will involve thedevelopment of new, more flexible careers for staff of all professions and non professionals.Expansion of the workforce is needed to meet these future demands.
The role of the National Assembly for Wales Education and Training Group and the EducationPurchasing Unit will require careful consideration. The Wales Cyngor for Nursing, Midwiferyand Health Visiting Education and Research (formally, Nurse Education Wales), and theWelsh National Board and/or its successor body, working with and through the NurseExecutive Wales group, and the nursing, midwifery and health visiting professions in Wales,is committed to working with the Assembly and its institutions to ensure that nursing,midwifery and health visiting education in Wales meets the needs of the people of Wales.
Over the past decade much of the success of nursing and midwifery education in Wales hasbeen due to careful strategic planning and a commitment to evolution rather than revolution.The principles set out in this document will not be achieved overnight. It will requiresustained commitment and investment, including financial investment. The NationalAssembly for Wales is committed to education as a means of achieving excellence in all fields.The nursing, midwifery and health visiting professions in Wales are committed to achievingexcellence in the service provided, as set out in Realising the Potential, by;
"ensuring that all nurses, midwives and health visitors develop their practice in a reflectiveand evidence based manner, founded upon a standard of education which enables them topractice as equal partners with other health care professionals, supported by continuing
professional development and clinical supervision"
19
CONCLUSION
Department of Health (1999) Agenda for Change. Modernising the NHS Pay System
Department of Health (1999) Making a Difference. Strengthening the nursing, midwifery andhealth visiting contribution to health and healthcare
Department of Health (2000) A Health Service for all the talents. Developing the NHSworkforce. Consultation document on the review of workforce planning
NAW (1999) Realising the Potential. A Strategic Framework for Nursing Midwifery andhealth Visiting in Wales into the 21st Century
NAW (2000) A Human Resource Strategy for NHS Wales - Delivering for Patients
NAW (2000) Access and Excellence
National Occupational Standards for Health and Social Care (1997)
Nursing and Midwifery Education in Europe EU XV/E/9432/7/96-EN
Scottish Executive (1999) Learning together. A Strategy for Education, Training and LifelongLearning for all staff in the National Health Service in Scotland
UKCC (1999) Fitness for Practice. The UKCC Commission for Nursing and MidwiferyEducation
Welsh Office (1998) Strategic Framework - Better Health Better Wales
WHO (2000) Nurses and Midwives for Health. European Strategy for Nursing and MidwiferyEducation
20
REFERENCES
21
SECTION 4:
IMPLEMENTATION PLAN
.
23
Wid
e en
try
gate
Ent
ry c
rite
ria
to p
re r
egis
trat
ion
cour
ses
to s
uppo
rt w
ide
acce
ss f
orm
atur
e ap
plic
ants
with
min
imal
form
al q
ualif
icat
ions
, whi
lst a
lso
attr
actin
g th
e m
ost a
ble
cand
idat
es.
The
use
of A
P(E
)Lto
be
exte
nded
for
entr
y in
to a
s w
ell a
s ex
empt
ion
from
com
pone
nts
of th
e co
mm
onfo
unda
tion
prog
ram
me
Max
imis
e pa
rt-t
ime
prof
essi
onal
prep
arat
ion/
educ
atio
nop
port
uniti
es
Mec
hani
sm in
pla
ce to
est
ablis
hm
ulti
mod
es o
f ed
ucat
ion
deliv
ery
The
goo
d pr
actic
e of
HE
Ispr
ovid
ing
wid
e ac
cess
sho
uld
beco
ntin
ued
and
exte
nded
Impl
emen
tatio
n of
Fitn
ess
toPr
actic
e re
com
men
datio
ns
Adh
eren
ce to
Uni
vers
ity s
etta
rget
s fo
r ac
cess
Con
side
ratio
n to
be
give
n to
Wel
sh la
ngua
ge is
sues
Rec
onci
le o
verl
ap a
nddu
plic
atio
n of
com
pete
ncy
base
dst
anda
rds
of le
vels
of
NV
Q in
FEan
d H
E/O
ccup
atio
nal
stan
dard
s/ B
Tec
etc.
Est
ablis
hmen
t of
part
-tim
eco
urse
s
HE
Is
Reg
ulat
ory
bodi
esN
HS
Wal
esN
AfW
ET
G
Sept
embe
r 20
01
Sept
embe
r 20
02
Ong
oing
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
Pri
ncip
le 1
Ach
ievi
ng f
itne
ss f
orpr
acti
ce, p
urpo
se a
nd a
war
d
24
Com
pete
ncy
base
dcu
rric
ulum
Cur
ricu
lum
mus
t be
rese
arch
-ev
iden
ce a
nd c
ompe
tenc
yba
sed
Hea
lth s
ervi
ce a
nd E
duca
tion
prov
ider
s to
giv
e ev
iden
ce o
fth
eir
inve
stm
ent a
nd s
uppo
rtfo
r st
uden
ts d
urin
g cl
inic
alpl
acem
ents
Iden
tific
atio
n of
res
ourc
eim
plic
atio
ns
Incr
ease
d pr
epar
atio
n an
dsu
ppor
t of
clin
icia
ns f
or th
eir
teac
hing
rol
e an
d te
ache
rs f
orcl
inic
al r
oles
Dev
elop
men
t of
com
pete
ncie
ssh
ould
be
unde
rtak
en in
part
ners
hip
betw
een
univ
ersi
ties,
regu
lato
ry b
odie
s an
d se
rvic
epr
ovid
ers
Serv
ice
prov
ider
s to
des
igna
tere
spon
sibl
e pe
rson
in e
very
clin
ical
pla
cem
ent a
rea
with
spec
ific
allo
catio
n of
tim
e an
dfi
nanc
ial r
esou
rces
Aca
dem
ic c
redi
t to
be a
lloca
ted
to le
arni
ng th
at ta
kes
plac
e in
both
the
educ
atio
n in
stitu
tions
and
prac
tice
plac
emen
t set
tings
Fina
ncia
l fra
mew
ork
for
allo
catio
n
Incr
ease
in jo
int a
ppoi
ntm
ents
and
hono
rary
con
trac
ts
Reg
ulat
ory
bodi
esH
EIs
NH
SW
ales
Oth
er S
ervi
cepr
ovid
ers
Sept
embe
r 20
01
Sept
embe
r 20
02
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
Gen
eral
ism
and
Spec
ialis
atio
n
Gra
duat
enes
s
25
Rec
onci
le th
e re
quir
emen
tsfo
r ge
nera
lism
and
spec
ialis
atio
n in
hea
lth c
are
Con
tinue
the
plan
ned
expa
nsio
n of
nur
ses
and
mid
wiv
es w
ho a
re e
duca
ted
to d
egre
e le
vel a
t the
poi
nt o
fre
gist
ratio
n to
the
agre
edtim
esca
le.
Sepa
rate
the
leve
l of
awar
dan
d le
vel o
f re
gist
ratio
n
Re-
alig
n cu
rric
ulum
to le
vel
of a
war
d us
ing
Hig
her
Edu
catio
n C
redi
t Ini
tiativ
eW
ales
(H
EC
IW)
leve
lde
scri
ptor
s
Info
rmat
ion
prov
ided
toU
KC
C d
ebat
e fo
r pr
ere
gist
ratio
n ed
ucat
ion
Rev
iew
in r
elat
ion
to p
ost
regi
stra
tion
educ
atio
n
Incr
emen
tal i
ncre
ase
Reg
ulat
ory
body
to d
efin
eco
mpe
tenc
e fo
r en
try
to th
ere
gist
er
Re-
exam
ine
curr
icul
umen
suri
ng a
cade
mic
val
ue g
iven
to p
ract
ice
com
pone
nt
Hig
her
educ
atio
n in
stitu
tions
to d
efin
e le
vel o
f aw
ard.
June
200
1
Sept
embe
r 20
01
100%
gra
duat
enu
rse
entr
y by
2004
100%
gra
duat
em
idw
ife
entr
y by
2002
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
Reg
ulat
ory
bodi
es
NA
fWN
HS
Wal
es
HE
IsN
AfW
ET
GSe
rvic
e pr
ovid
ers
Reg
ulat
ory
bodi
es
Pri
ncip
le 2
Dev
elop
men
t an
d le
ader
ship
for
prac
tice
and
edu
cati
on
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
26
Iden
tify
the
key
elem
ents
of
lead
ersh
ip f
or th
e pr
ofes
sion
Dev
elop
men
t of
stru
ctur
edsu
cces
sion
pla
nnin
g w
ith
acce
pted
car
eer
path
way
s
Dev
elop
spe
cifi
c pr
ogra
mm
esco
ntai
ning
the
key
know
ledg
e an
d sk
ills
that
nur
se/m
idw
ife/
heal
th v
isito
r le
ader
s as
wel
l as
man
ager
s sh
ould
req
uire
Est
ablis
h pl
anne
d ed
ucat
iona
lsu
ppor
t to
enco
urag
e al
lpr
actit
ione
rs to
bec
ome
mor
epo
litic
ally
aw
are
Man
ager
s at
bot
h op
erat
iona
l and
stra
tegi
c le
vels
to h
ave
acce
ss to
educ
atio
n an
d tr
aini
ng in
wor
kfor
ce d
evel
opm
ent a
ndpl
anni
ng is
sues
Exp
lore
pot
entia
l exc
hang
es w
ithou
tsid
e or
gani
satio
ns f
or c
aree
rde
velo
pmen
t
NA
WH
EIs
Serv
ice
prov
ider
sPr
ofes
sion
alor
gani
satio
nsSt
aff
colle
geO
rgan
isat
ions
out
side
the
NH
S/H
EIs
Ong
oing
Eff
ectiv
ele
ader
ship
27
Hig
her
leve
l pra
ctic
e to
hav
ehi
gher
leve
l com
pete
ncie
san
d ag
reed
mea
ns o
fas
sess
men
t
Aca
dem
ic p
repa
ratio
n an
dsu
ppor
t ava
ilabl
e fo
rco
nsul
tant
nurs
es/m
idw
ives
/hea
lthvi
sito
rs
Faci
litat
e de
bate
on
the
esta
blis
hmen
t of
an a
ctua
l or
virt
ual o
rgan
isat
ion
Dev
elop
sys
tem
s to
ena
ble
acce
ss to
exp
ert a
dvic
e
Enc
oura
ge m
ulti-
prof
essi
onal
refl
ectio
n on
the
patie
nt/c
lient
exp
erie
nces
of
heal
th c
are
prov
isio
n/sy
stem
sas
par
t of
the
clin
ical
gove
rnan
ce a
nd/o
r cl
inic
alsu
perv
isio
n ag
enda
Reg
ulat
ory
body
to d
eter
min
eco
mpe
tenc
ies
linke
d to
pub
licpr
otec
tion
Prog
ram
mes
dev
elop
ed to
supp
ort p
rese
nt a
nd f
utur
eco
nsul
tant
s
Mul
ti pr
ofes
sion
al g
roup
to b
ese
t up
to d
evel
op th
is c
once
ptan
d pr
oduc
e a
brie
fing
pap
er
Deb
ate
of m
echa
nism
s
Est
ablis
h cl
inic
al in
form
atio
nsy
stem
s to
pro
vide
info
rmat
ion
Mee
t tar
gets
set
in B
ette
rIn
form
atio
n B
ette
r H
ealth
Reg
ulat
ory
bodi
es
HE
IsSe
rvic
e pr
ovid
ers
NA
fWN
ursi
ng a
nd M
idw
ifer
ypr
ofes
sion
s
HE
IsSe
rvic
e pr
ovid
ers
NH
SW
ales
Ong
oing
Dec
embe
r 20
01
July
200
1
Dec
embe
r 20
00
2002
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
Lev
els
of p
ract
ice
An
acad
emy
as a
sour
ce o
fsp
ecia
list a
dvic
e
Supp
ortin
gC
linic
alG
over
nanc
e
28
Supp
ortin
glif
elon
gle
arni
ng
Dev
elop
men
t of
clin
ical
aca
dem
icca
reer
s
Equ
itabl
e IC
Tac
cess
toin
form
atio
n an
d kn
owle
dge
base
sin
all
geog
raph
ical
are
as
All
prof
essi
onal
sta
ff to
hav
epe
rson
al d
evel
opm
ent p
lans
and/
or c
ompe
tenc
y po
rtfo
lios
toge
ther
with
the
oppo
rtun
ity to
disc
uss
lear
ning
nee
ds a
t reg
ular
inte
rval
s.
Prov
isio
n of
and
acc
ess
to c
aree
rco
unse
lling
Acc
redi
tatio
n of
car
eer
path
s
Faci
litat
ion
of c
aree
r sh
ifts
All
nurs
es, m
idw
ives
and
hea
lthvi
sito
rs to
hav
e w
ork
base
dac
cess
to I
CT
Rev
iew
of
the
vari
ety
ofre
sour
ces
avai
labl
e to
sup
port
CPD
and
life
long
lear
ning
Plan
for
the
fina
ncia
l and
trai
ning
impa
ct o
f in
crea
sed
Inte
rnet
usag
e w
ithin
the
serv
ice
Apr
il 20
02
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
End
200
1
Ong
oing
2001
Apr
il 20
01
Pri
ncip
le 3
Exp
andi
ng t
he r
esea
rch
and
educ
atio
n en
viro
nmen
ts
Inte
r-pr
ofes
sion
alw
orki
ng a
nded
ucat
ion
Res
earc
h A
gend
a
Dev
elop
edu
catio
n an
dtr
aini
ng a
rran
gem
ents
for
sta
ffw
hich
are
gen
uine
ly m
ulti
prof
essi
onal
to p
rovi
de g
reat
ersc
ope
for
switc
hing
car
eer
path
s
Seek
opp
ortu
nitie
s to
est
ablis
han
d su
ppor
t fam
ily f
ocus
edco
mm
unity
pro
gram
mes
Est
ablis
h fo
rmal
mec
hani
sms
for
infl
uenc
ing
the
rese
arch
agen
da f
or n
ursi
ng, m
idw
ifer
yan
d he
alth
vis
iting
, to
ensu
rere
flec
tion
of o
rgan
isat
iona
lan
d pr
ofes
sion
al
issu
es
New
mod
els
of le
arni
ng a
ndte
achi
ng to
be
expl
ored
App
ropr
iate
ly r
elat
ed h
ealth
care
pro
fess
ions
to b
e ac
tivel
yen
cour
aged
to le
arn
with
and
from
one
ano
ther
Join
t int
erpr
ofes
sion
al a
ppro
ach
to d
evel
opm
ent o
f pr
ofes
sion
alst
anda
rds
and
audi
t
Pilo
t of
new
mod
els
of c
are
Rev
iew
of
curr
ent s
trat
egy
for
nurs
ing
and
mid
wif
ery
rese
arch
Incr
ease
d W
OR
D f
undi
ng to
deve
lop
evid
ence
bas
e of
nurs
ing/
mid
wif
ery
Reg
ulat
ory
bodi
esH
EIs
ET
GN
HS
Wal
esN
AfW
WO
RD
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
29
Dat
aco
llect
ion
Cha
ngin
gcu
lture
Aco
mpr
ehen
sive
rev
iew
of
info
rmat
ion
requ
irem
ents
to
supp
ort w
orkf
orce
pla
nnin
g
Wor
k on
wor
kfor
ce a
nd s
kill
mix
revi
ew, m
ulti
skill
ing
and
rest
ruct
urin
g of
the
wor
kfor
ce
Plan
ning
sho
uld
cove
r th
e w
hole
heal
th c
are
wor
kfor
ce, l
ooki
ngac
ross
sec
tors
, em
ploy
ers
and
staf
f gr
oups
and
take
acc
ount
of
evol
ving
rol
es
Futu
re e
duca
tion
prog
ram
mes
deve
lope
d in
par
tner
ship
with
serv
ice
prov
ider
s w
hich
ref
lect
empl
oyer
s de
man
d fo
r w
orkf
orce
plan
ning
The
pro
mot
ion
of in
terp
rofe
ssio
nal
curr
icul
um p
lann
ing
and
teac
hing
Min
imum
dat
a se
t for
per
sonn
elag
reed
on
all W
ales
bas
is
Syst
ems
avai
labl
e to
col
lect
stan
dard
ised
dat
a
HE
Is to
be
invo
lved
inde
velo
ping
wor
kfor
ce p
lans
Rev
iew
pri
vate
sec
tors
cont
ribu
tion
to e
duca
tion
and
trai
ning
In d
evel
opin
g st
rate
gies
for
CPD
and
life
long
lear
ning
,th
ere
is a
nee
d to
foc
us u
pon
reso
urci
ng a
nd s
uppo
rtin
ggr
eate
r ca
reer
fle
xibi
lity
and
deve
lopm
ent o
f ad
ditio
nal s
kills
for
staf
f
Apr
il 20
01N
AfW
NH
SW
ales
HE
Is
Pri
ncip
le 3
Mee
ting
fut
ure
hum
an r
eeso
urce
req
uire
men
ts
Key
Iss
ues
Act
ion
poin
tP
rogr
ess
Indi
cato
rR
espo
nsib
ility
Targ
et D
ate
30
31
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