The Impact for Access project funded by the SFC set the following outcomes for nursing and midwifery:
- increase the retention and completion rates in nursing and midwifery
- improve the gender balance across all fields of nursing
- increase regional collaboration between universities across all fields of nursing and midwifery provision
- increase collaboration with Scotland's Colleges to strengthen access and articulation into pre-registration programmes.
The observations and recommendations delivered in this final report of the Commission will, we believe, enable progress to be made across all of these areas.
Scotland faces challenges in recruiting to nursing and midwifery education and careers. It is not alone in this regard – as the rapid review of UK and international literature requested by the Commission shows, many countries find themselves in similar situations. But the fact that the problems are common, and that many of them are very challenging to face down, does not provide an excuse not to confront them. That is why CNO set up the Commission, and it typifies the spirit in which the Commission set about its task.
This final report summarises the Commission's observations and recommendations, based on the relevant information and evidence regarding access to nursing and midwifery education and careers it has gathered. It reflects the views of a wide range of stakeholders and identifies key areas in which action is required to widen participation in nursing and midwifery education and careers now and in the future.
Action in this area requires partnership-working to produce national, flexible and transferable education solutions. The shared aim of CNO and all involved in the Commission's processes is to achieve a highly skilled, ambitious and sustainable nursing and midwifery workforce that is responsive to the challenges of providing high-quality, safe and person-centred care for Scotland's communities.
The importance of widening participation in education and careers is not unique to nursing and midwifery, and some transferable issues and learning exists across healthcare and other professions. It will remain important to channel and maximise impacts and learning from approaches to widening participation in education and employment generally as we progress.
There are many areas relevant to widening participation in nursing and midwifery education and careers that for logistical and practical reasons, the Commission has been unable to address in detail. These include issues as diverse as the impact of Brexit, specific measures to support people with disabilities and those from ethnic minority communities, the ongoing fitness for purpose of some existing routes, and the availability of broadband access throughout Scotland (which presents a barrier to those wishing to study by distance or online learning means). Each of these highly relevant issues, and others, will undoubtedly be addressed through wider mechanisms in place now and in the future that focus on developing social, economic, employment, health and education policy and practice in Scotland. Implementation of the Commission's recommendations will also have a positive impact on these issues moving forward.
In addition, some of the areas in which we have been able to focus attention and suggest actions – such as the gendered nature of nursing and midwifery and the status and future contribution of the care home sector to nursing and midwifery education and careers – demand much greater specific focus and tailored actions. And the question of how nursing develops as a graduate profession from the moment of students' first interaction with their HEI programmes throughout their postgraduate careers and research activity – the concept of graduateness – needs to be teased out further.
The Commission has nevertheless been able to process a great deal of information and evidence over a relatively short period of time. This has enabled it to produce what we believe are observations and recommendations that will have an impact in this area. They are set within a positive narrative of achievement in Scotland. Scotland has led the way in many areas, such as developing the nursing and midwifery workload and workforce planning tools and putting in place measures to help support workers, and these initiatives have been replicated in the UK and elsewhere. The appointment of the Commission is in itself a positive development, signalling a willingness to identify and act on perceived challenges with confidence and transparency.
CNO needs to ensure that evidence of the impact of actions based on the Commission's observations and recommendations can be collected, so that each action can be reviewed in a few years' time. Some mechanisms for collecting evidence of impact already exist, while others may have to be created. The key principle, though, is that without evidence, incorrect assumptions about effects might be made.
The aim of the Commission has been to build on what is working well in Scotland, develop it if possible, and change what is not working well. Action on its observations and recommendations will, the Commission feels, achieve that aim, and is vital to the future of the nursing and midwifery workforce and the wider design and delivery of health and social care services in Scotland.