TRAINING: The NHS is working with educational institutes to recruit the people who will eventually provide it with much-needed skills, reports Claire Laurent

With three or four applicants for every place in its adult branch, Plymouth University describes recruitment to pre-registration nursing courses as 'buoyant'.

But, as deputy head Rosalynd Jowett freely admits, three years ago the department was struggling to meet its contract numbers.

Good marketing and more student-centred interviews have helped lift recruitment, while some in-depth work on attrition is beginning to tackle the issue of retention.

'In 1996, our numbers were about 350 a year, now we are recruiting about 500 a year.

We are interviewing for 2002 and having to reign in a bit because no-one wants to hang around that long waiting for a course to begin, ' she says.

Ms Jowett describes her university's approach (see panel) as just 'one stab' at tackling the recruitment crisis in nursing. But it is one that gets to the root of some of the problems identified by the National Audit Office in its report Educating and Training the Future Health Professional Workforce for England.

The purchaser-provider split of the 1990s encouraged the NHS to see itself solely as a purchaser of education and training and higher education institutions as the providers.

NAO audit manager Karen Taylor says: 'In the days of the purchaser-provider split there was little recognition that the NHS had a role and responsibility for practice placement, for recruiting and retaining students on courses.'

Now all professions and workforce planners recognise that this is key to the longterm increase in staff numbers.

When the NHS plan was published last year, England had 50,000 nursing and midwifery students and 14,000 therapist and science students on NHS-funded pre-registration education and training programmes.

By 2004 it proposes a further 5,500 nursing and midwifery students, and 224,450 therapist and other healthcare students on training programmes each year.

Nursing has probably had the most publicity in terms of its recruitment and retention problems. The NAO report found the number of nursing students in England had grown 50 per cent since 1995-96 and 14 per cent in the past 12 months.

However, other areas are struggling. Radiotherapy is the most clinically effective treatment for cancer after surgery. A further 160 posts are required to ensure there are enough operators for the additional equipment to be installed as part of the government's commitment in the NHS cancer plan.

Yet in recent years there has been an average underrecruitment of 20 per cent against available places.

When the plan emerged last March, 7 per cent of therapeutic radiography posts had been vacant for more than three months. This linked to the shortage of suitable practice placements and a lack of staff to supervise students.

The physical infrastructure of higher-education institutes is another pressing issue.

'Until now, higher-education institutes have been able to accommodate year-on-year increases in numbers. . . but there is clear evidence from our work. . . that many were at near or full capacity, ' says Ms Taylor, who believes there is a need for more teaching staff and teaching accommodation.

'Part of the problem is a historical one about who should be funding the extra facilities. The NHS is clear that the non-medical and education levy is a revenue stream and should not be funding capital [infrastructure], ' she says.

The good news, says Ms Taylor, is that many institutes and trusts are working together to find solutions.

Whether or not training provides value for money is another issue the NAO recommends for overhaul.

'There is a wide variation in price per student for qualification, ' says Ms Taylor.

'One training consortium could be paying£2,500£3,000 per student - and another up to£10,000.'

Again, she says the reasons appear to be historical and there is a need to benchmark prices more effectively.

Student-centred recruitment strategy

Plymouth University is a pilot site for a new pre-registration nursing programme which is likely to be rolled out across all higher-education institutions by autumn next year.

It recruits pre-registration nurses for the whole of the South West - from Somerset in the north to Devon and Cornwall in the south.

The course developed its own prospectus, which highlights the rural nature of the area with photographs and sets out the good balance of acute trusts, community and primary care on offer.

It developed a strategy to promote the academic aspect of the course.

Interviews are conducted on location, so prospective students get the chance to see the relevant parts of campus.

The university has worked in partnership with NHS colleagues to decide the content of the curriculum and is working with Somerset, Cornwall and Devon Workforce Development Confederation on attrition.

Financial hardship and social reasons are important causes of attrition, and Plymouth is looking at enabling students to take a break in their training and return more or less where they left off, rather than having to start again. National consideration is being given to reimbursing travel expenses for students attending placements.