open space:

The objective of the Project 2000 educational programme was to produce an educated workforce of 'knowledgeable doers'. It was launched in the late 1980s and coincided with the new era of managerialism in the NHS espoused by the Griffiths report of 1983.

On the face of it, the evolution and implementation of Project 2000 and the new general management ethos seemed compatible. So what led to the perception that Project 2000 and higher education have failed nursing, nurses and the NHS?

To understand the answer, the key policy initiatives of the era - the nurse grading system, the Working for Patients white paper and the 1990 NHS and Community Care Act - must be analysed.

Nurse grading

The grading system seemed to offer a career structure and clear lines of clinical responsibility, but the reality did not match the ideals.

Many of the criteria for grading nurses were interpreted subjectively by managers at local, regional and national levels. The exercise was also financially driven - managers had a finite sum of money to implement the structure and they had to ensure that their organisation did not overspend.

The implications were painful for many nurses. Grading set them against each other, and the intense competition seriously undermined teamwork and adversely affected morale. Many nurses, unhappy with the grades allocated to them, left through early retirement or voluntary redundancy.

Enrolled nurses fared worst. And as the Commission for Racial Equality stated in 1992, many ethnic minority nurses were systematically discriminated against in grading.

The appeal system was slow, cumbersome and seen by many as a paper exercise. The episode made a mockery of the spirit of fairness, justice and equality outlined by the Whitley Council.

Working for Patients

At the same time, the NHS was undergoing a major reorganisation as set out in Working for Patients. This saw the development not only of trusts, but the split between purchasers and providers. The quasi-market ideology became a reality for the NHS.

Local trust hospitals had to compete against each other, and in order to be competitive and 'financially efficient' many had to streamline their workforce. Nurses were again the target of these cutbacks. This, too, disproportionately affected ethnic minority nurses.

Clearly, when nurses left, they took with them much-needed experience and knowledge. And many inexperienced nurses were allocated duties for which they were inadequately trained.

This left units and departments without adequate nursing staff, and staff who remained experienced extreme stress and frustration.

In that environment many nurse managers failed to invest in the development of their staff - vital if they were to supervise Project 2000 nurses.

Many student nurses now report that they are frequently supervised by nursing assistants while doing clinical work.

The Community Care Act

The implementation of the community care aspects of the 1990 act, after a three-year delay, did not help the progress of Project 2000. Many large mental health, learning disability and elderly people's institutions were either closed down or lost beds. This, too, forced many nurses to leave the NHS, with ethnic minority nurses again disproportionately affected.


It is clear that Project 2000 was implemented during an era of radical reorganisation in the NHS. Apart from a devaluation of nurses, there were fewer available clinical placements to enable students to practise their skills.

Responsibility for this state of affairs lies with senior managers. Trust managers did not want 'knowledgeable doers', but 'doers who do not ask questions'.

Project 2000 - like all educational programmes - now needs reassessment and readjustment. But it is the political-economic and managerial ideologies of the late 1980s and 1990s that circumvented its successful implementation.

It is these that need to be challenged - not nurses.

Madhun Foolchand is senior lecturer, school of nursing, Wolverhampton University.