The University of Bolton
Cheshire and Merseyside Strategic Health Authority

MARCH 2005

RG 134 08/05

Major review of healthcare programmes

The Department of Health, in partnership with the Nursing and Midwifery Council, the Health Professions Council and the Strategic Health Authorities have contracted with the Quality Assurance Agency for Higher Education (QAA) to carry out reviews of all NHS-funded healthcare programmes in England during the period 2003-06.

QAA helps to provide public assurance that the quality and standards of higher education are being safeguarded and enhanced by conducting academic reviews of higher education provision.

Major review

Major review is a peer review process. It starts when higher education institutions in partnership with their commissioning Strategic Health Authorities evaluate their provision in a self-evaluation document. This document is submitted to QAA for use by a team of academic and practitioner reviewers who gather evidence to enable them to report their judgements on the academic and practitioner standards and the quality of learning opportunities. Review activities include meeting academic and clinical staff and students, scrutinising students' assessed work, visiting practice learning environments, reading relevant documents, and examining learning resources.

Full details of the process of major review can be found in the Handbook for major review of healthcare programmes, 2003.

Judgements

The range of judgements that reviewers may utilise when they have completed a major review are summarised below.

Academic and practitioner standards

Reviewers make one of the following judgements on standards:

confidence, which may be expressed as
limited confidence, or
no confidence.

To reach this judgement, reviewers look at:

learning outcomes
the curriculum
student assessment
student achievement.

Confidence in academic and practitioner standards: a judgement that is made if reviewers are satisfied with current standards and with the prospect of those standards being maintained into the future. A judgement of limited confidence is made if standards are being achieved but the reviewers have doubts about the ability of the HEI and partner placement providers to maintain them into the future.

No confidence in academic and practitioner standards: a judgement that is made if arrangements are inadequate to enable standards to be achieved or demonstrated. If a failure to achieve standards has occurred in specific programme/s and/or mode/s and/or level/s only, and there is confidence in standards at other levels, the failing programme/s mode/s level/s will be identified separately.

Quality of learning opportunities

Reviewers make one of the following judgements for each of three elements of learning opportunities:

commendable
approved
failing.

The three elements of quality of learning opportunities are:

learning and teaching
student progression
learning resources and their effective utilisation.

Maintenance and enhancement of standards and quality

Reviewers also report the degree of confidence they have in the providers' ability to maintain and enhance quality and standards in the healthcare programmes under review.

Commendable - the provision contributes substantially to the achievement of the intended outcomes, with most elements demonstrating good practice.

Approved - the provision enables the intended outcomes to be achieved, but improvement is needed to overcome weaknesses. The summary report will normally include a statement containing the phrase 'approved, but...', which will set out the areas where improvement is needed.

Failing - the provision makes a less than adequate contribution to the achievement of the intended outcomes; significant improvement is required urgently if the provision is to become at least adequate.

Summary of the main review outcomes

Subject provision and overall aims

Nursing and health visiting programmes at The University of Bolton in partnership with Cheshire and Merseyside Strategic Health Authority and Greater Manchester Strategic Health Authority were reviewed in the academic year 2004-05. Judgements were made about the academic and practitioner standards achieved and the quality of the learning opportunities provided.

The review covered the following programmes, all of which are learning beyond registration programmes:

BSc/BSc (Hons) Community Health Care Nursing - Community Specialist Practice (CSP), including Health Visiting, District Nursing and General Practice Nursing Pathways (full and part-time)
Extended/Supplementary Nurse Prescribing (part-time)
PGCE Adult, Further and Higher Education - Practice Educator/Lecturer* (full and part-time)
BA (Hons) Health Studies, including Preparation for Mentorship (part-time).

*This programme underwent Nursing and Midwifery Council (NMC) annual monitoring as part of the major review of healthcare programmes.

Academic and practitioner standards

Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in nursing and health visiting at The University of Bolton in partnership with Cheshire and Merseyside Strategic Health Authority and Greater Manchester Strategic Health Authority.

Strengths

Nursing curricula have an appropriately patient-centred focus with patient perspectives incorporated into many of the Department's curriculum development and delivery processes (paragraph 12).
There are clear progression opportunities provided by a number of the programmes offered to nursing students (paragraph 14).
The unusually high quality of the written feedback across all the nursing programmes is particularly supportive to student learning (paragraph 21).
The transferable skills acquired on the nurse prescribing programme also significantly improve professional practice of nurses in aspects beyond prescribing (paragraph 24).
Attributes that employers consider Bolton nursing graduates demonstrate to a particularly high level are reasoning skills, a capacity for critical analysis and creative thinking, an ability to put theory into practice and project management skills (paragraph 27).
The health visiting curriculum is informed by wide-ranging staff expertise in the public health role of health visitors (paragraph 35).
Health visiting students value the clear and constructive guidance that they are given on areas for improvement in their work (paragraph 40).
There is an effective protocol to deal with students at risk of failing the practice element of the health visiting programme (paragraph 42)

Good practice

The flexibility of the capability-building programme for district and general practice nurses meets individual learning needs (paragraph 13).
Within the CSP general practice nursing and district nursing pathways, practice-based learning is assessed particularly effectively using a comprehensive practice assessment schedule (paragraph 18).
The open module, undertaken by students in preparation for their programme, is particularly valuable to health visiting students (paragraph 34).
There is effective assessment of health visiting practice-based learning using a comprehensive practice assessment schedule, particularly valued by students (paragraph 38).

Weakness

There are opportunities to articulate and coordinate curriculum development of the PGCE/PE programme and the mentorship module which have not yet been fully explored (paragraph 15).

Quality of learning opportunities

Learning and teaching

The quality of learning and teaching is commendable.

Strengths

Problem-based learning approaches foster the patient-centred focus of the CSP curriculum (paragraph 46).
A thorough audit of all clinical placements is carried out by university and clinical staff and managers working in close collaboration (paragraph 47).

Good practice

The PGCE/PE mini-CD and the module learning packs for all other programmes are a valuable support to student learning (paragraph 45).
CSP mentors are required to maintain an audited professional portfolio providing evidence that they have good clinical, teaching and assessing skills which are being constantly updated and developed (paragraph 48).

Weakness

There is no formal mechanism for verifying and recording the appropriateness of PGCE/PE teaching practice placements (paragraph 47).

Student progression

The quality of student progression is commendable.

Strength

Tutorial support provided for students both while in the University and on practice placement is particularly effective (paragraph 51).

Good practice

A comprehensive recruitment pack is provided for prospective students on CSP (paragraph 49).
Skills and 'learning to learn' modules are integrated into all programmes to answer the needs of students with diverse educational backgrounds (paragraph 50).

Weakness

The CSP pre-course information concerning the capability-building programme is not explicit enough and, on entry, students were not fully aware of the range of options available to them under this scheme (paragraph 50).

Learning resources and their effective utilisation

The quality of learning resources and their effective utilisation is commendable.

Strength

There is good liaison with the library through the subject specialist librarian and a healthy budget based on student numbers (paragraph 56).

Good practice

The development opportunities and support made available to practice-based staff are extensive (paragraph 55).

Weakness

The work-based mentors on the PGCE/PE are not well integrated into the teaching team (paragraph 55).

Maintenance and enhancement of standards and quality

Strengths

The close partnership between the University, the SHAs and NHS Trusts successfully underpins all aspects of the provision (paragraph 59).
Qualitative information is used effectively to inform programme development in a process of continuous evolution (paragraph 60).

Good practice

The Clinical Placements Project, where the University is working together with GMSHA, is an example of good collaborative practice (paragraph 64).

Introduction

1 This report presents the findings of a review of the academic and practitioner standards achieved, and the quality of the learning opportunities provided, in nursing and health visiting programmes at The University of Bolton in partnership with Cheshire and Merseyside Strategic Health Authority (CMSHA) and Greater Manchester Strategic Health Authority (GMSHA). The review was completed during the academic year 2004-05.

2 Bolton Institute of Higher Education received permission to use the title of university in April 2004 and from January 2005 adopted the title of The University of Bolton. The Institute was founded in 1982, following the merger of Bolton Institute of Technology and Bolton College of Education (Technical). Community Nursing and Health Visitor education and teacher training for health care have been offered since the 1960s. The courses were initially part of the School of Education but, since 1996, nursing and healthcare programmes have been offered by the Department of Health and Social Studies, the largest of the 12 departments which now comprise The University of Bolton. The Department has 560 full-time equivalent (FTE) students on healthcare programmes, supported by 34.2 FTE academic staff, 1.0 FTE professional (technical) staff and 2 FTE administrators. A Research Professor for the healthcare provision has recently been appointed.

3 For a number of years, CMSHA and predecessor organisations have been the lead commissioner of the BSc/BSc (Hons) Community Health Care Nursing - Community Specialist Practice, including Health Visiting, District Nursing and General Practice Nursing (CSP) for the North West. This is reflected in the spread of Primary Care Trusts (PCTs) within the region that have historically worked with The University of Bolton. The CSP contract held between the SHA and The University of Bolton will be devolved to the GMSHA from August 2005. This transition in commissioning has seen a change in Trusts working with the Higher Education Institution (HEI) who are predominantly from Greater Manchester. The GMSHA covers 10 Acute Hospital Trusts, including one Foundation Trust, three Mental Health Trusts, 14 PCTs and one Ambulance Trust.

A Subject provision and overall aims

4 Both CMSHA and GMSHA, contract with the Department of Health and Social Studies at The University of Bolton to deliver the following post-registration and continuing professional development (CPD) programmes:

BSc/BSc (Hons) Community Health Care Nursing - Community Specialist Practice, including Health Visiting, District Nursing and General Practice Nursing Pathways (full and part-time)
Extended/Supplementary Nurse Prescribing (part-time)
PGCE Adult, Further and Higher Education - Practice Educator/Lecturer* (full and part-time)
BA (Hons) Health Studies, including Preparation for Mentorship (part-time).

*This programme was also subject to annual monitoring by the Nursing and Midwifery Council (NMC).

5 The vision for the University is to become an enterprise model for a new generation university, known for excellence in innovation and applied learning and ability to offer higher education which makes a practical difference to the economy and society. The University's mission is to:

provide education which stimulates boldness of thought, innovation and creativity
contribute to the cultural, creative, scientific and technical resources of the region and the locality, enhancing economic development and the quality of people's lives
provide work-related education, learning for action, innovation and research which make a real difference to business development and to the quality of public services
expand educational opportunity for individuals and communities
work with employers to enhance knowledge and skills
act as a catalyst for the creation, exchange and application of knowledge in the public and private sectors.
6 The response of the Department of Health and Social Studies to the University's strategic priorities is to:
provide work-related education which makes a real difference to the quality of public services
expand the range of healthcare programmes commissioned and supported by the NHS as part of their workforce development strategy
build on its strengths in practice-based learning and e-learning by establishing a range of continuing professional development programmes.

7 The healthcare subject provision within the Department, in partnership with the SHAs and the wider community of stakeholders, aims to provide healthcare programmes of education that demonstrate:

a commitment to the education and training of health and social care professionals as reflective practitioners, fit for purpose, fit for practice and fit for award
an awareness of the need to situate practice and understanding of the professional role in the broader social, cultural, organisational and professional contexts which influence the work of health and social care practitioners and the experiences of service users and communities
a commitment to enabling students to develop academic and professional knowledge and key transferable skills to become flexible, autonomous and highly skilled, competent practitioners
provision that is responsive to the needs and views of health and social care providers, users and carers and professional bodies who require skilled, knowledgeable and adaptable professional staff from our programmes
a readiness to respond to changing policies which affect the roles of nurses, health visitors and other health professionals by embracing new ways of learning for new ways of working, to meet the Modernisation Agenda that are based upon professional accountability, care and respect
a commitment to students and the quality of the student experience that engenders lifelong learning and facilitates flexible progression routes from initial professional education to advanced study and practice.

B Academic and practitioner standards

B1 Nursing

Intended learning outcomes

8 Intended learning outcomes (ILOs) on all nursing programmes covered by the review meet NMC requirements. They also reflect The framework for higher education qualifications in England, Wales and Northern Ireland (FHEQ), the Subject benchmark statement for nursing, and the emerging Health Professions Framework.

9 The way in which the ILOs are developed ensures that, on successful completion of their courses, students are fit for purpose, practice and award. This process involves all key stakeholders, including the SHAs, service users, placement providers and mentors. In consequence, outcomes of all programmes are appropriate and relevant to professional practice as well as meeting service needs. SHAs, NHS Trusts and PCTs are involved with the University in the ongoing monitoring of ILOs to ensure that they reflect changes in working practices, national developments and new ways of working.

10 ILOs reflect the aims of the nursing programmes and are clearly expressed in all programme specifications. ILOs are communicated by means of the programme handbooks and module learning packs, and are reinforced in individual learning sessions and in discussions between students and tutors. Meetings with students, mentors and clinical practitioners confirmed that all are well informed about the ILOs for both theory and clinical practice.

Curricula

11 The University offers a number of post-registration programmes for nurses, all of which meet the NMC's regulatory requirements. These include courses for specialist practitioners, Extended and Supplementary Nurse Prescribing (nurse prescribing), PGCE Adult Further and Higher Education - Practice Educator/Lecturer programme (PGCE/PE) and a Preparation for Mentorship module (mentorship module). Annual monitoring by NMC visitors confirms that programmes continue to meet their requirements.

12 Curriculum development for all nursing programmes is informed by dialogue with, and referral to, a wide range of external stakeholders, professional debates and reference points. Curricula take account of the recommendations of current national developments, such as those contained in the report 'Liberating the Talents' published by the Department of Health in 2002; NMC and Further Education National Training Organisation (FENTO) standards for the preparation of teachers as well as the FHEQ; the Subject benchmark statement for nursing; and the emerging Health Professions Framework. Nursing curricula have an appropriately patient-centred focus, with patient perspectives incorporated into many of the Department's curriculum development and delivery processes. The representation of patient organisations and the Patient Advisory and Liaison Service on curriculum development initiatives are examples of how a patient-centred focus is maintained. Clinical staff and placement providers have had considerable input into the planning and design of nursing programmes. The effective communication between the University and SHA/NHS Trust staff enhances curriculum development. There is clear support provided by the SHAs in the development of nursing curricula. For example, a number of regional events have been hosted by the SHAs and attended by university staff that have examined practice educator preparation and agreed a job description for practice educators employed in the locality.

13 The BSc/BSc (Hons) Community Specialist Practice (CSP) programme is a one-year programme with both district nursing and general practice nursing pathways, offered to applicants with suitable prior experience and credits. The reduction of this programme to 32 weeks, when it was revalidated for 2004 entrants, meets the regulatory requirements, and the structure was at the request of the SHAs. However, these changes require close monitoring to ensure that requisite learning outcomes are achieved and successful students are competent and safe practitioners. In order to supplement the 32-week programme, a series of capability-building professional development modules has been developed. These may be taken both before the start of the course to supplement prior learning and experience and, on graduation, to enhance fitness for purpose by the acquisition of further specialist skills. The flexibility of the capability-building programme for district and general practice nurses meets individual learning needs. It is an example of good practice and is a very useful basis on which to build further development.

14 The Nursing programmes are responsive to individual professional needs by offering flexible modes of attendance. There are clear progression opportunities provided by a number of the programmes offered to nursing students. The BA (Hons) Health Studies programme offers modules on a flexible basis to students with prior experience and qualifications entering at levels 2 and 3. Students may access individual modules for professional development or use the course to top up existing credits to achieve honours graduate status. The Preparation for Mentorship module falls within the curriculum of this programme and meets the current standards of the NMC.

15 A joint lecturing appointment between the University's Departments of Health and Social Studies, and Education is a valuable initiative. This opens up the opportunity for consideration of a number of fresh and innovative approaches to curriculum development in the PGCE/PE and the mentorship module. There are opportunities to articulate and coordinate curriculum development of the PGCE/PE programme and the mentorship module which have not yet been fully explored. This would build on the strength that exists elsewhere in the provision where progression through programmes of different levels is possible.

16 Despite the fact that the University has no pre-registration programmes for allied health professions, social workers or medical students, there are a number of examples of interprofessional teaching and learning available to nursing students. The PGCE/PE programme has a long history of offering teaching preparation to a wide range of disciplines, and students on this programme have a number of interdisciplinary learning opportunities. Students on the BA (Hons) Health Studies are, on occasions, drawn from a number of healthcare backgrounds and the sharing of diverse experience enriches their learning. CSP and nurse prescribing students have practice placements that focus on care delivery by multiprofessional primary healthcare teams. CSP students also have additional placement experiences with other primary healthcare workers arranged by their specialist practice mentors.

Assessment

17 The assessment strategies for all nursing programmes under review provide appropriate opportunities for students to demonstrate achievement of both theoretical and practical ILOs. The assessment strategy for preparation for mentorship, CSP general practice nursing and district nursing pathways, nurse prescribing, and PGCE/PE has been designed to meet NMC statutory regulations, FHEQ standards and, for the PGCE, FENTO benchmarks.

18 There are well thought out, comprehensive methods of assessing practice performance across nursing programmes. Within the CSP general practice nursing and district nursing pathways, practice-based learning is assessed particularly effectively using a comprehensive practice assessment schedule; this is an example of good practice that could usefully be disseminated to other providers. The PGCE/PE programmes use Analysis of Individual Development and Achievement packs as a valuable tool to demonstrate practice-based learning. Practical skills on this programme are assessed through observation of teaching, carried out by work-based experience assessors (WBEA) who provide particularly supportive and developmental feedback to students. The nurse prescribing programme and Preparation for Mentorship module employ the portfolio as a way of assessing understanding in practice. Practical skills and understanding in practice are also tested on the nurse prescribing programme using objective structured clinical examinations (OSCEs). Essays, literature reviews, reflective essays, and critical reviews of papers are used to test knowledge and understanding of theoretical content and its application to practice on the BA Health Studies programme. This varied assessment diet is particularly well illustrated in the open modules at levels 2 and 3 which incorporates a reflective log and a personal action plan among the assessment tools designed to develop the lifelong learner.

19 The assessment tasks on all the nursing programmes are clear and effectively communicated to students using module learning packs and, on the PCGE/PE, a mini-CD. Module packs also give a clear articulation of the link between assessment and learning outcomes and this relationship is well understood by students and practice and academic staff.

20 Students on the nurse prescribing programme described the assessment load as heavy. The reviewers recognise that this is a problem but that the high workload is a consequence of NMC regulatory requirements.

21 External examiners for the BA, CSP general practice nursing and district nursing pathways and nurse prescribing are encouraged to meet with students and practice-based assessors, and this facilitates a clear understanding of the assessment process and the context in which it is taking place. The University's policy on assessment and feedback reflects the Code of practice for the assurance of academic quality and standards in higher education (Code of practice), Section 6: Assessment of students, published by QAA, and stipulates procedures for the marking and moderation of work both on campus and in the practice setting. The nursing programmes demonstrate consistent application of the policy. The unusually high quality of the written feedback across all the nursing programmes is particularly supportive to student learning. The feedback is detailed, constructive and clearly identifies opportunities for future improvement.

22 Mentors from the CSP district nursing and general practice nursing pathways take part in the moderation process, and have been supported to take on the role of first marker of the students' reflective essay. All practice-based staff involved in assessment are fully qualified and briefed for their role. The University provides regular training days for mentors and medical supervisors on the CSP and nurse prescribing programmes respectively. The mentor study days provide an opportunity to ensure that assessment strategies and procedures are consistently applied and that professional and regulatory requirements are met. Practitioners and managers have contributed to the development of assessment strategies, for example in the revision of the practice assessment schedule for CSP and the development of the OSCE for nurse prescribing.

Student achievement

23 The reviewers scrutinised the full range of assessed work from a representative sample of students on both the general practice nursing and district nursing pathways of CSP. This shows that the ILOs have been achieved and confirms that students on these courses achieve fitness for purpose, practice and award. Where students achieved a First class honours award, the sample showed that this was fully merited by excellent work. Overall, the profile of awards is appropriate, with an average over the past three years of 48 per cent of students on the BSc (Hons) achieving an Upper Second class honours award or better (Table 1a). This is a good standard of achievement. The practice assessment schedule used on the CSP gives a clear illustration of progressive achievement of the ILOs in practice. Work reviewed from a representative sample of modules and types of assessment on the BA (Hons) Health Studies demonstrated that the standards achieved by students meet expectations and, on average over the past three years, 63 per cent of students who have completed the award have achieved an Upper Second class honours degree or above, which is a laudable achievement. Work for the level 2 open module was particularly impressive for the level of reflection demonstrated by students.

24 Student work reviewed from the PGCE/PE confirmed that appropriate standards are being achieved. The portfolios and examination scripts from the nurse prescribing programme provide evidence of excellent student achievement on this demanding programme. Visits made to practice by the reviewers provided further evidence that qualified prescribers are effectively prepared for their professional role. The transferable skills acquired on the nurse prescribing programme also significantly improve professional practice of nurses in aspects beyond prescribing.

25 The external examiners' reports show that it is their view that student achievement is of a good standard. However they have commented that some students display weak academic writing skills. The University has taken steps to resolve this problem through its study skills programme.

26 In respect of employment, the situation of individual students varies. While some are sponsored to attend programmes and have a guaranteed specialist appointment on finishing their course, others have to seek relevant progression in employment on graduation. Although statistics are not available to indicate the success rate of this latter group, discussions with former students indicate that they have all secured relevant positions. Students are given support by tutors and NHS Trusts/PCTs in identifying suitable vacancies and opportunities.

27 It is apparent that the very good level of student achievement is the product of close cooperation among the University, partner placement providers and the SHAs in ensuring that students are fit for purpose and meet the needs of employers. Attributes that employers consider Bolton nursing graduates demonstrate to a particularly high level are reasoning skills, a capacity for critical analysis and creative thinking, an ability to put theory into practice and project management skills.

Summary of academic and practitioner standards for Nursing

Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Nursing at The University of Bolton in partnership with Cheshire and Merseyside Strategic Health Authority and Greater Manchester Strategic Health Authority.

Strengths

Nursing curricula have an appropriately patient-centred focus with patient perspectives incorporated into many of the Department's curriculum development and delivery processes (paragraph 12).
There are clear progression opportunities provided by a number of the programmes offered to nursing students (paragraph 14).
The unusually high quality of the written feedback across all the nursing programmes is particularly supportive to student learning (paragraph 21).
The transferable skills acquired on the nurse prescribing programme also significantly improve professional practice of nurses in aspects beyond prescribing (paragraph 24).
Attributes that employers consider Bolton nursing graduates demonstrate to a particularly high level are reasoning skills, a capacity for critical analysis and creative thinking, an ability to put theory into practice and project management skills (paragraph 27).

Good practice

The flexibility of the capability-building programme for district and general practice nurses meets individual learning needs (paragraph 13).
Within the CSP general practice nursing and district nursing pathways, practice-based learning is assessed particularly effectively using a comprehensive practice assessment schedule (paragraph 18).

Weakness

There are opportunities to articulate and coordinate curriculum development of the PGCE/PE programme and the mentorship module which have not yet been fully explored (paragraph 15).

Table 1a: Completion and achievement statistics for all award-bearing programmes

Programme (award-bearing only)	Cohort (Last three cohorts)	Diploma programmes		Diploma programmes		Degree classification
		Pass		Fail		1		2i		2ii		3		P		F
		No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%
BA (Hons) Health Studies	2001					4	10	21	50	17	40
	2002					5	16	21	65	6	19
	2003					2	9	9	39	12	52
BSc(Hons) CSP - district and practice nursing	2001					2	4	20	43	15	33	3	7	6*	13
	2002					2	6	15	44	14	41	3	9
	2003					4	10	15	35	18	43	4	10	1*	2

* These students were enrolled on a non-honours degree programme which has now been phased out.

B2 Health Visiting

Intended learning outcomes

28 The ILOs for the BSc/BSc (Hons) Community Health Care Nursing - Community Specialist Practice Public Health Nursing (Health Visiting) pathway reflect the programme's aims. They are consistent with NMC requirements and are informed by the FHEQ, the Subject benchmark statement for health visiting and the emerging Health Professions Framework.

29 Statements from key stakeholders, including SHAs and NHS Trusts/PCTs, students and practitioners and from external examiners, confirmed that the ILOs are informed by the four principles of health visiting, as originally defined by the Council for the Education and Training of Health Visitors (1977). Scrutiny of the work of individual students demonstrated that learning outcomes are relevant to professional practice, particularly in the area of public health, ensuring that students who achieve them are fit for purpose, fit for practice and fit for award.

30 ILOs are stated in the programme specification and communicated to students by means of module handbooks and learning packs. Students and mentors confirmed that the ILOs for both theory and practice are well understood and are reinforced during learning sessions and mentor training days.

31 Health visiting students, mentors, clinical practitioners, academic staff and SHAs contribute to the monitoring and evaluation of the ILOs, thereby ensuring that ILOs remain current and relevant to practice.

Curriculum

32 The BSc/BSc (Hons) Community Specialist Practice (CSP) incorporates a Public Health Nursing (Health Visiting) pathway. This programme meets the regulatory requirements for the preparation of health visitor practitioners. Annual monitoring visits by NMC Visitors confirm that the programme meets the regulatory requirements. Its design also takes into account the FHEQ, the Subject benchmark statement for health visiting and the emerging Health Professions Framework.

33 For a number of years, the health visiting programme offered by the University has been fully embedded in the CSP programme. This has resulted in valuable opportunities for interprofessional learning. However, consideration will be required as to the best framework for future curriculum development to incorporate the distinctiveness of the new public health function of health visiting.

34 The recent reduction in the length of the BSc /BSc (Hons) Community Specialist Practice Public Health Nursing programme to 32 weeks meets the regulatory requirements. However, these changes require close monitoring to ensure that requisite learning outcomes are achieved in order to prepare students to be competent and safe practitioners. In order to supplement the 32-week programme, a series of capability-building professional development modules has been developed. These may be taken both before the start of the course to supplement prior learning and, on graduation, to enhance fitness for purpose by the acquisition of further specialist skills. The open module, undertaken by students in preparation for their programme, is particularly valuable to health visiting students as they may have no prior experience in the profession. The flexibility of the programme in meeting individual learning needs is a very useful basis on which to build further development.

35 The health visiting curriculum is informed by wide-ranging staff expertise in the public health role of health visitors. Staff are also involved in a number of local and national bodies and committees, and this activity keeps them up-to-date with regional and national trends. Well thought out perspectives on how the public health role may be developed in the future emerged in discussion between staff and the reviewers.

36 Clinical staff and placement providers from the SHAs and NHS Trusts/PCTs have had considerable input into the planning and design of the health visiting programme, particularly in developing the public health role. However, it is recognised by all stakeholders that effective development of public health activities of health visitors also needs to be accompanied by changes in current practice activities.

37 The CSP programme gives scope for interprofessional learning, despite certain limitations imposed by the University's portfolio of programmes. Examples include the team approach to the area of child protection and practice experiences that are enhanced by participation in care delivery by multiprofessional primary healthcare teams. Multiagency teamworking involves health visiting students in a variety of innovative projects, emphasising the emerging public health role of community practitioners. For example, in a project based in a children's centre, health visitors are working closely with education, housing and social services departments.

Assessment

38 The assessment of the health visiting route on CSP has been designed to meet NMC requirements. It includes an appropriate range of assessment methods that enable students to demonstrate achievement of both the theoretical and practical ILOs. There is effective assessment of health visiting practice-based learning using a comprehensive practice assessment schedule, particularly valued by students.

39 The assessment tasks are clear and effectively communicated to students using the module learning packs. They test the full range of ILOs, including the public health role of the health visitor. In order to gain a more comprehensive overview of the programme, external examiners are encouraged to meet with students and practice-based assessors.

40 University procedures for the marking and moderation of student work both on campus and in the practice setting are consistent with the Code of practice, Section 6: Assessment of students, and the health visiting pathway demonstrates consistent application of these procedures. The high quality of written feedback on the student work scrutinised by the reviewers is particularly supportive to student learning. Health visiting students value the clear and constructive guidance that they are given on areas for improvement in their work.

41 All practice-based staff involved in assessment are fully qualified and briefed for their role to ensure that assessment criteria are consistently applied and NMC regulatory requirements are met. Mentors act as first markers for the students' reflective essay and value the training and feedback they have received to support them in this role. There is active collaboration among practitioners, managers and University staff in the development of assessment strategies, and the recently revised practice assessment schedule is the product of this joint working.

Student achievement

42 The reviewers scrutinised the whole range of assessed work from a representative sample of students following the health visiting pathway on the CSP course. This demonstrated that the ILOs had been achieved. Fitness for purpose and practice was apparent from student portfolios, and this was reinforced by the assignments, which provided evidence of students' ability to relate theory to practice and of their fitness for award. Where students had achieved a lower classification of award, this was seen as appropriate but demonstrated that required expectations were still met. Over the past three years, 55 per cent of students on the BSc (Hons) have achieved an Upper Second class honours degree or better (Table1b), and this included some very good performances from students awarded First class honours degrees. There have been no failures. Overall, this is a very good standard of performance. There is an effective protocol to deal with students at risk of failing the practice element of the health visiting programme. For example, where an individual student had initially failed to achieve the appropriate standard in practice, the protocol was effectively followed to achieve an ultimately positive outcome.

43 Former students related how the programme had equipped them for practice in a dynamically changing role, particularly noting how it had equipped them for lifelong learning and provided them with research skills. Learning contracts and the practice assessment schedule enable students to achieve the practice ILOs. Community service managers are reported as considering that newly-qualified health visitors from the University are fully prepared for their role. Although posts are not guaranteed to graduates, all past students have gained health visiting posts, and PCT managers envisage that this will continue to be the case. PCT managers are actively involved in ensuring that students reach an appropriate level of achievement in practice by their role in monitoring the suitability of placements and their involvement in the selection of dissertation topics.

44 Concern regarding the shortened CSP programme and the impact on achieving fitness for practice has been raised by students and mentors. Although the 32-week programme meets regulatory body requirements, students are generally unfamiliar with the role of health visitor before embarking on the course, and thus have a considerable body of new information and practice to assimilate. The concern has been addressed by introducing the capability programme, which offers additional modules before the course to prepare entrants and after graduation to enhance fitness for purpose. These modules are supported by SHA funding.

Summary of academic and practitioner standards for Health Visiting

Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Health Visiting at The University of Bolton in partnership with Cheshire and Merseyside Strategic Health Authority and Greater Manchester Strategic Health Authority.

Strengths

The health visiting curriculum is informed by wide-ranging staff expertise in the public health role of health visitors (paragraph 35).
Health visiting students value the clear and constructive guidance that they are given on areas for improvement in their work (paragraph 40).
There is an effective protocol to deal with students at risk of failing the practice element of the health visiting programme (paragraph 42).

Good practice

The open module, undertaken by students in preparation for their programme, is particularly valuable to health visiting students (paragraph 34).
There is effective assessment of health visiting practice-based learning using a comprehensive practice assessment schedule, particularly valued by students (paragraph 38).

Table 1b: Completion and achievement statistics for all award-bearing programmes

Programme (award-bearing only)	Cohort (Last three cohorts)	Diploma programmes		Diploma programmes		Degree classification
		Pass		Fail		1		2i		2ii		3		P		F
		No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%
BSc (Hons) CSP - health visiting	2001					7	21	13	38	11	32			3*	9
	2002					2	8	11	44	11	44	1	4
	2003					4	12	13	41	13	41	2	6

* These students were enrolled on a non-honours degree programme which has now been phased out.

C Quality of learning opportunities

Learning and teaching

45 A wide variety of teaching and learning methods is employed, including effective use of information technology (IT) resourced presentations, group work and role play. There is widespread staff and student use of the e-learning system, WebCT. Students confirm that the standards of teaching are high and that their learning is supported by high-quality teaching materials both on WebCT and in the module learning packs, which they consider to be a particularly useful resource. Similar information for the PGCE/PE is contained on a mini-CD. The PGCE/PE mini-CD and the module learning packs for all other programmes are a valuable support to student learning.

46 Problem-based learning approaches foster the patient-centred focus of the CSP curriculum. Students were very positive about the value of this approach. The Department has a well thought out strategy to develop the independent and lifelong learner. It utilises a variety of learning tools, including the writing of the reflective diary in the BA open module, problem-based learning and the requirement for students to maintain professional portfolios.

47 The University's close links with SHAs and NHS Trusts have ensured that there are appropriate clinical placements available for all students and teaching placements for students on the PGCE/PE programme. The newly-created post of University Placement Administrator has the remit to develop and manage an electronic database of placements areas, mentors and mentor updates. This should enhance effective management of clinical placements provision in the future. SHA strategies concerning zoning of placements for individual universities will also provide a clearer picture of placement areas available for CSP students. A thorough audit of all clinical placements is carried out by university and clinical staff and managers working in close collaboration. Although the WBEA has direct personal responsibility for checking the suitability of the placement, there is no formal mechanism for verifying and recording the appropriateness of PGCE/PE teaching practice placements.

48 Students are very positive concerning the tuition they receive while on practice placement, describing mentors as responsive to their specific learning needs. The University maintains very close links with practice mentors to ensure that they are fully informed of programme developments and that they reflect on and improve their performance as mentors. CSP mentors are required to maintain an audited professional portfolio providing evidence that they have good clinical, teaching and assessing skills which are being constantly updated and developed. A number of examples of innovative learning opportunities were identified in clinical practice, such as a breast-feeding initiative and a smoking-cessation programme. Such experiences clearly enhance the clinical learning opportunities for students. Discussions with a number of practitioners revealed that the quality of the clinical learning environment is enhanced by regular visits and contact with University staff. Due regard is given to health and safety issues in all the clinical placement areas visited.

The quality of learning and teaching is commendable.

Strengths

Problem-based learning approaches foster the patient-centred focus of the CSP curriculum (paragraph 46).
A thorough audit of all clinical placements is carried out by university and clinical staff and managers working in close collaboration (paragraph 47).

Good practice

The PGCE/PE mini-CD and the module learning packs for all other programmes are a valuable support to student learning (paragraph 45).
CSP mentors are required to maintain an audited professional portfolio providing evidence that they have good clinical, teaching and assessing skills which are being constantly updated and developed (paragraph 48).

Weakness

There is no formal mechanism for verifying and recording the appropriateness of PGCE/PE teaching practice placements (paragraph 47).

Student progression

49 Roadshows are held to attract as wide a range of prospective students on to healthcare programmes as possible, consistent with the University's policies on equality and diversity. There are appropriate joint recruitment procedures in place for CSP. A comprehensive recruitment pack is provided for prospective students on CSP. It outlines what would be expected of a student on the programme, gives details of the application procedure including how to apply, admissions criteria and details of the interview process. Recruitment involves the University, SHAs, placement providers and specialist practice mentors. Students may access both CSP and the BA Health Studies as individual modules, which is very commonly the case on the latter programme. This provides opportunities to fulfil the professional development needs of practitioners. Students appreciate the flexibility of the way this course is offered, which enables them to fit attendance with work and domestic commitments. Students enter the nurse prescribing programme as a result of formal nomination by their employers. Some students on the PGCE/PE reported that it required considerable persistence in gaining admission to the course because of difficulty in securing the agreement of their SHA. However, there is now evidence that the SHAs have a strategy in place to formalise recruitment to this programme

50 Students receive induction at university, departmental and programme level. The Student Centre and the Learning Support and Development Unit provide good resources and support for students with a variety of special needs, including those for whom English is a second language. This was confirmed by a student with dyslexia. Skills and 'learning to learn' modules are integrated into all programmes to meet the needs of students with diverse educational backgrounds. Students who followed the newly-introduced capability-building programme in preparation for the CSP course state that it has helped them gain appropriate skills to undertake the programme successfully. However, the CSP pre-course information concerning the capability-building programme was not explicit enough and, on entry, students were not fully aware of the range of options available to them under this scheme. For the first round of recruitment, generic information was designed by the SHA for use by all universities offering the programme and did not list the full range of options available to students at individual institutions. For the second round of recruitment, capability options will be discussed at interview between the student, their manager and the University.

51 Tutorial support provided for students both while in the University and on practice placement is particularly effective. In meetings with the reviewers, students highlighted the excellence and friendliness of the support they receive as being the most important factor in ensuring the successful completion of their programme. This support is from personal tutors in the University and mentors in practice. Tutors also undertake placements visits whenever required, in addition to the scheduled visits. There is a clear understanding by the mentors of their role and responsibilities in respect of NMC and health and safety requirements. They also have a good level of awareness of the ILOs of the practice placement and of the programmes as a whole, and are able to support students in their achievement. This is a result of a close working relationship between practice placement providers and the University. Placement evaluation by students and feedback to mentors occurs each semester.

52 Attrition rates on the CSP are low. There were no failures or withdrawals on the health visiting pathway from the last three intakes to have completed, and an average of less than 10 per cent failure or withdrawal on the district and general practice nursing pathways (Table 2). Withdrawal from the BA (Hons) Health Studies programme is high, in some cohorts as high as 50 per cent. Many students who enrol on the programme only do so with the intention of attending single modules for professional development purposes. Change in personal circumstances is also a common reason for withdrawal. In order to reduce the level of withdrawal, a database has been developed to track each individual student so that potential withdrawals can be identified early and given appropriate support. Enrolments now differentiate between those intending to progress to the award of BA and those wishing to undertake individual certificated CPD modules. For those students who complete, module pass rates are high, averaging 95 per cent. The preparation for mentorship module has a completion rate of 93 per cent and a pass rate of 90 per cent. This has been improved by extending the deadline for assignment submission following course evaluation. The nurse prescribing course has a pass rate of 97 per cent. The first cohort has not yet completed the PGCE/PE. The fact that over 95 per cent of the first intake of students are continuing on to the second year of the course is encouraging.

The quality of student progression is commendable.

Strength

Tutorial support provided for students both while in the University and on practice placement is particularly effective (paragraph 51).

Good practice

A comprehensive recruitment pack is provided for prospective students on CSP (paragraph 49).
Skills and 'learning to learn' modules are integrated into all programmes to answer the needs of students with diverse educational backgrounds (paragraph 50).

Weakness

The CSP pre-course information concerning the capability-building programme is not explicit enough and, on entry, students were not fully aware of the range of options available to them under this scheme (paragraph 50).

Table 2: Recruitment and attrition statistics for pre-registration and NMC recordable qualifications

Award title	Recruited number	Withdrawal		Transfer in		Transfer out		Discontinuation
		No.	%	No.	%	No.	%	No.	%
BSc (Hons) CSP - district and practice nurse
2001	42	5	12
2002	45	5	11			1	2
2003	54	3	6
BSc (Hons) CSP - health visitor
2001	28
2002	25
2003	35

Learning resources and their effective utilisation

53 The programmes under review are delivered in the University by a team of academic staff whose qualifications, experience and research interests are well matched to the curricula. The staff:student ratio enables the provision to meet NMC standards. Full and part-time lecturers on secondment from practice areas supplement the permanent academic staff, and this enhances the relevance to practice and currency of programmes. Increase in academic staff is directly linked to increase in student numbers. External speakers contribute to the delivery of the programmes. Practice staff who take part in the teaching on the course are supported by means of briefing sessions and by participating in course planning groups.

54 There is a staff development strategy, encompassing individual staff appraisals leading to personal development plans. There is good evidence of relevant professional development and research activities among the staff. Newly-appointed academic staff who do not have a recognised teaching qualification are required to enrol on the PGCE programme.

55 The development opportunities and support made available to practice-based staff are extensive. Mentors are provided with a Mentorship Handbook which they find very useful. If problems arise with students on practice placement, the protocols laid down in the Programme Handbooks ensure that they are effectively resolved. A placement database has recently been developed to identify mentors' updating and support requirements. The information is then discussed with the mentors on visits to practice placements. Mentors have established their own support groups and an experienced mentor will always monitor a new mentor. In addition, the University runs mentor study days. In the case of general practice nursing mentors, their professional commitments can make it difficult to attend these sessions, even though the Department makes a point of fixing them well in advance. In response to this problem, departmental staff go out into practice to conduct lunchtime one-to-one sessions with mentors. Although this is not ideal, as it precludes these mentors from sharing experience with others, it demonstrates the University's willingness to commit resources to ensure that mentors are effectively supported and integrated into the team. Similarly, for medical supervisors on the nurse prescribing course, there is good preparation and support, including a useful written information pack and briefing sessions at the University. Where supervising doctors are unable to attend these sessions, they are encouraged to submit written feedback and questions, and departmental staff visit them in their surgeries to provide the information on an individual basis. The work-based mentors on the PGCE/PE are not well integrated into the teaching team. Although, because of the key role played by the WBEA, they do not have the same overall responsibility for the students in practice as the clinical mentors, they indicated to the reviewers that they would prefer closer links with the University.

56 The University's Learning Support and Development Unit provides appropriate learning resources in respect of both library and IT facilities to support students' learning. The main library resources for most of the students on the programmes under review are based on the Deane Campus. The PGCE/PE students are based on the Chadwick Campus which has its own library. Both libraries are open in term-time Monday to Thursday until 9 pm, Friday until 5 pm and on Saturday morning until 12.30, with an extension to 4 pm at some key times of year. During vacations, closure is generally at 5pm. Students report that these opening times are entirely adequate for their needs. This is because many of the relevant library holdings, particularly journals, are available on-line and so much of the material that students use is available through the WebCT. Books, journals and fact-sheets may also be ordered or renewed online. There is good liaison with the library through the subject specialist librarian and an appropriate budget based on student numbers. Thus, when new titles are required, they are promptly ordered. Popular texts are placed on short loan and most students are satisfied with this arrangement. Due to a temporary increase of student numbers in 2003-04, there was a shortage of key texts. However, as the increase in students had been at the SHAs' request, they provided the University with an injection of funding to resolve the problem. Within the Deane library there are dedicated facilities for the use of those with special needs. There are also fully-equipped seminar rooms that students may use for group work or preparing presentations. Students may also use a media studio with video-recording facilities to improve their presentation and teaching skills. In addition to the University's library facilities, students on healthcare programmes have access to accredited health library facilities in NHS Trusts, PCTs, and postgraduate medical schools in the North West Region.

57 There is good IT provision on both Deane and Chadwick campuses. The reviewers saw no evidence of a shortage of terminals nor did students report any problems with access. Students receive IT orientation training as part of their induction programme. Students and mentors consider the on-line system, Bolton Interactive Study Skills Tutorials, a very useful aid in enhancing their learning skills. It is an on-line tutorial facility designed to help students with practical skills for completing assignments. In addition to the IT facilities housed in the libraries, which observe library opening hours, there is also an IT facility open 24 hours a day, 365 days of the year. This is greatly appreciated by students.

58 The robust system of placement audit ensures that students have adequate access to resources while on placement. In addition, GMSHA managers are carrying out a survey of each clinical placement to assess the suitability of the environment for students. Students have access to email and internet in all practice locations as well as necessary documentation including policies and guideline documents and relevant learning materials. Students find the WebCT and discussion boards particularly useful while on placement, but the timetabling of chat rooms is too inflexible.

The quality of learning resources and their effective utilisation is commendable.

Strength

There is good liaison with the library through the subject specialist librarian and a healthy budget based on student numbers (paragraph 56).

Good practice

The development opportunities and support made available to practice-based staff are extensive (paragraph 55).

Weakness

The work-based mentors on the PGCE/PE are not well integrated into the teaching team (paragraph 55).

D Maintenance and enhancement of standards and quality

59 The close partnership between the University, the SHAs and NHS Trusts successfully underpins all aspects of the provision. There is a genuine enthusiasm and support for the nursing and health visiting programmes by CMSHA, GMSHA, the University and Trust partners. The closeness of the working relationship is exemplified by the joint writing of the SED. In the maintenance and enhancement of quality there is strong evidence of a partnership with CMSHA and an emergent partnership with GMSHA through a five-yearly contractual review process. The strategies, policies and procedures of CMSHA and GMSHA, the University and Trust partners are effective to ensure the maintenance and enhancement of the standards and quality of provision.

60 Qualitative information is used effectively to inform programme development in a process of continuous evolution. An example of this is the compilation of an audio tape containing students' recommendations to lecturers, mentors and future students. The University has well-developed procedures for quality assurance. Each year a programme quality enhancement plan is produced that incorporates a detailed response to evaluative data from the previous year. It also includes issues raised by external examiners and NMC annual monitoring reports. At subject level, the subject annual self-evaluation report is produced. These reports are tracked through course committees and staff team meetings to ensure quality enhancement, prior to consideration by the Departmental Board of Study and University's centralised quality committees. Scrutiny of the reports indicates a satisfactory level of critical awareness.

61 Students' views are collected through module evaluation questionnaires; these focus on the academic aspects of the programme. Students are represented on course committees and they confirmed to the reviewers that timely action is taken on problems they raise. There are opportunities for mentors to evaluate the programmes during mentor training days.

62 There is an external examiner appointed for each programme and the University has recently appointed a specialist external examiner for the PGCE/PE. An action plan is developed in response to the external examiners' comments. A good example of the responsiveness of this process is the particularly effective way in which the inadequacies of feedback on assessment for an individual BA module were addressed.

63 External and internal reference points, including the Code of practice, particularly the sections on assessment, placement and external examining, the FHEQ, NMC statutory regulations, FENTO benchmarks and the University's own quality assurance framework, are all reflected in the quality assurance processes of the Department.

64 The annual audit of placements is undertaken by placement providers in partnership with the University. The audit contains a SWOT analysis of the placement area identifying strengths, weaknesses, opportunities and threats and an action plan in response. The CMSHA, GMSHA, the University and Trust partners have been responsive to issues that have arisen. The partnerships also result in quality enhancement initiatives. The Clinical Placements Project, where the University is working together with GMSHA, is an example of good collaborative practice. Outcomes of this project are the proposal for a single document for the assessment of practice placements and the potential development of a placement database linked to course learning outcomes, in order to develop interprofessional learning experiences in practice. There is evidence of strong positive and effective working relationships between the University and its partner placement providers in the involvement of Trusts in curriculum development groups, regular managers' meetings and validation of programmes. For example, the 32-week BSc (Hons) Community Health Care Nursing/Community Specialist Practitioner programme for district nursing, general practice nursing and health visiting pathways was developed jointly by the University, CMSHA and GMSHA. The shortened programme is in its first year and concerns have been raised by academic and practice staff and students that the course may prove too intensive for full-time students. The University has monitoring arrangements in place to analyse achievement levels, sickness absence rates, and student and mentor evaluations.

65 The self-evaluation document (SED) formed an adequate basis for the review of nursing. It gives a detailed description of nursing provision which is well documented and defines its particular character and approach; however, it would have been more useful had it devoted more attention to action that had been taken to address weaknesses, such as those identified in external examiner reports. During the review a picture emerged of a provision which was highly responsive to criticism but this is not evident from the SED. The separate sections devoted to health visiting are very brief and do not do justice to the provision, providing no evaluative commentary. However, during the course of the review a clear and comprehensive picture of health visiting emerged.

Strengths

The close partnership between the University, the SHAs and NHS Trusts successfully underpins all aspects of the provision (paragraph 59).
Qualitative information is used effectively to inform programme development in a process of continuous evolution (paragraph 60).

Good practice

The Clinical Placements Project, where the University is working together with GMSHA, is an example of good collaborative practice (paragraph 64).

Action plan

Major review of healthcare programmes

March 2005