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Summary of the main review outcomes

Subject provision and overall aims

Health visiting, midwifery and nursing programmes at the University of Brighton in partnership with the Surrey and Sussex Strategic Health Authority (SHA) 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 courses:

Pre-registration courses

• Diploma in Higher Education in Nursing (Enrolled Nurse Conversion, ENC)*
• Pre-registration BSc (Hons) Nursing*
  Adult Branch*
  Child Branch*
  Mental Health Branch
• Pre-registration BSc (Hons) European Nursing (English version)*
• BSc (Hons) European Nursing (Spanish version)
• Pre-registration BSc (Hons)/Diploma in Midwifery - three years
• Pre-registration BSc (Hons) Midwifery - shortened
• Pre-registration Diploma in Nursing
  Adult Branch*
  Child Branch*
  Mental Health Branch
  Learning Disabilities Branch
• BSc Community Specialist Practice (Public Health Nursing/Health Visiting)
• Postgraduate Diploma in Community Specialist Practice (Public Health Nursing/Health Visiting).

Undergraduate Continuing Professional Development courses

• Diploma in Professional Practice in Palliative Care
• BSc (Hons)/Diploma in Professional Practice - including the following Nursing and Midwifery Council (NMC) recordable qualifications
  Return to Practice (Adult*, Child*, Mental Health, Learning Disabilities, Midwifery and Health Visiting)
  Supplementary Prescribing
• BSc (Hons)/Diploma Professional Practice in Working with Older People
• BSc (Hons)/Diploma Professional Practice in Mental Health
• BSc(Hons)/Diploma Professional Practice in Midwifery
• BSc (Hons)/Diploma Professional Clinical Practice - with pathways in:
  Accident and Emergency Nursing
  Anaesthetic Nursing
  Cardiac Surgery Nursing
  Day Surgery
  Intensive Care
  Cardiology Nursing
  Cancer Nursing
  Neonatal Nursing
  Burns and Plastics Nursing
  Renal Nursing
• BA (Hons) Professional Studies in Nursing (Open Learning)
• BSc (Hons) Nursing Studies
• BSc (Hons)/Postgraduate Diploma Community Specialist Practice, with pathways in:
  Nursing in the Home/District Nursing
  Community Mental Health
  General Practice Nursing
  School Nursing.

Postgraduate courses

• Postgraduate Certificate in Health and Social Care Education
• MA Health Care Ethics
• MA Midwifery Studies (with Education or Management)
• MA Nursing Studies (with Education or Management)
• MSc Clinical Studies (with Education or Management)
• MSc Cognitive Psychotherapy
• MSc Nurse Practitioner Studies
• Professional Doctorate in Midwifery
• Professional Doctorate in Nursing.

* These programmes underwent 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 health visiting, midwifery and nursing at the University of Brighton in partnership with the Surrey and Sussex SHA.

Strengths

• The effectiveness of the practice teacher is a notable strength of the BSc (Hons) Community Specialist Practice (paragraph 20).
• Internal moderation of practice assessments in the BSc (Hons) Community Specialist Practice is highly effective, with the teaching team working together to ensure that the assessment process is continually developing (paragraph 21).
• The initial observation period of three weeks that allows students to settle into the BSc (Hons) Community Specialist Practice programme and the practice environment is a significant strength of the student practice experience (paragraph 25).
• Pre-registration midwifery courses have adopted a PBL approach, where learning is integrated, meaningful, cumulative and contextual (paragraph 29).
• The placement allocation plan in pre-registration midwifery courses mirrors the curriculum intentions and facilitates the integration and application of theory to practice (paragraph 32).
• The pre-visit for pre-registration nursing students to the operating theatre suite, where key outcomes are identified for the placement, are considered by both mentors and students as an area of strength (paragraph 44).
• The continuing professional development and graduate course frameworks in nursing contain a comprehensive range of modules that successfully enable practitioners to devise programmes that meet their personal and professional needs (paragraph 53).
• CPFs play an important part in the preparation of students for practice and in supporting clinical staff in their mentor role. Practitioners and practice managers contribute to the development of assessment strategies and modules (paragraph 57).
• Assessment feedback to nursing students is comprehensive, constructive and consistent (paragraph 58).

Good practice

An innovative continuing work-based learning module, running throughout the BSc (Hons) Community Specialist Practice programme, allows students to identify and develop skills and knowledge within a chosen area of practice, appropriate to both student and local need (paragraph 18).

The mapping of trigger learning outcomes in midwifery against module outcomes is an example of good practice in ensuring that course outcomes are met (paragraph 26).

Quality of learning opportunities

Learning and teaching

The quality of learning and teaching is commendable.

Strengths

• The Institute's learning and teaching strategy promotes a coherent and comprehensive approach to teaching development and the dissemination of good practice (paragraph 65).
• PBL is extensively used in midwifery (paragraph 65).

Good practice

• The Institute's commitment to service-user involvement in learning and teaching demonstrates good practice (paragraph 68).
• An example of good practice was observed where the link tutor places feedback information within the placement staff communication book, ensuring effective dissemination and implementation of actions agreed as a result of student feedback (paragraph 71).
• The contribution of mentors to the education process is recognised by the SHA through the Mentor of the Year Award (paragraph 73).

Weakness

• Post-registration students highlighted that they are part of the workforce and that greater emphasis on the need for protected time with their mentors would be of benefit to them (paragraph 75).

Student progression

The quality of student progression is commendable.

Strengths

• The Institute has responded well to the challenges of supporting students with a diversity of learning needs. Monitoring of the progression of such students is in place (paragraph 77).
• The creation and funding of the CPF role has strengthened the support of students during clinical placements (paragraph 78).

Good practice

• The Institute has taken appropriate and effective measures, such as establishing the multi-stakeholder 'Recruitment and Retention Group', to review attrition, identify causes and plan intervention strategies (paragraph 83).

Weakness

• Some concern was expressed by mentors in pre-registration nursing and midwifery programmes about the late identification of failing students (paragraph 81).

Learning resources and their effective utilisation

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

Strength

• The library and study facilities at the Falmer site are modern and excellent, with student access to IT, printing and photocopying facilities, and to small-group study rooms equipped with technology for preparing presentations (paragraph 87).

Good practice

• The reviewers were impressed by the approach of a number of practice-based staff, including ward sisters and primary care practitioners, promoting a holistic learning environment and exceeding the criteria within the audit tool (paragraph 92).
• Studentcentral, the Institute's managed learning resource, and Staffcentral, the equivalent intranet for staff, afford excellent access to course materials and discussion boards, thereby supporting students' educational experience effectively, as well as providing access to university pastoral services (paragraph 93).

Maintenance and enhancement of standards and quality

Strengths

• The Institute's self-evaluation document provided an excellent basis for the review. All stakeholders in the provision were involved throughout the generation of the document (paragraph 97).
• Placement providers report receiving regular evaluative feedback from the University and reacting positively to it (paragraph 101).

Good practice

• The Student Council for pre-registration students meets with INaM staff to address concerns that transcend individual course issues, following which student representatives disseminate information to the student body about the actions taken (paragraph 100).

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 Health Visiting, Midwifery and Nursing programmes at the University of Brighton (the University) in partnership with the Surrey and Sussex Strategic Health Authority (SHA). The review was completed during the academic year 2004-05.

2 The University took its present title in 1992. It has developed over sites in Brighton, Hastings, Pembury and Eastbourne. There are now more than 17,800 students registered for the University's awards. The programmes under review are offered by the Institute of Nursing and Midwifery (INaM or the Institute). The Institute is one of four schools in the Faculty of Health. In 1994 the Sussex and Kent Institute was integrated into the University, incorporating the existing Nursing Studies Department to form INaM.

3 The Institute is a large and diverse provider of education spread across five education sites and 21 NHS Trust placement sites. The majority of academic and administrative staff are based at the University's Falmer site, with a smaller facility on the University's site at Darley Road, Eastbourne. The three other teaching sites are based within NHS Trust accommodation at Eastbourne, Hastings and Pembury. The Centre for Nursing and Midwifery Research is based on the Falmer site.

4 There are 110.8 full-time equivalent (FTE) academic staff, of whom 21 are lecturer practitioners and 46 administrative staff, with a further 5.8 research staff in the Centre for Nursing and Midwifery Research. In 2003-04, there were 1,429 FTE students on pre-registration Nursing, Midwifery and Health Visiting courses, 438 on post-registration courses, with a further 1,059 students registered for single modules and 20 for Professional Doctorate awards.

5 Since 1994, the portfolio of courses has been developed in response to local service provider needs and requests from the Surrey and Sussex SHA. The Authority, one of the largest of the 28 new SHAs, serves a population of approximately 2.5 million and a geographical patch stretching from London to the Sussex coast, and from Chichester in the west to Camber Sands in the east. It provides leadership, coordination and support to the NHS across this area. The SHA is accountable to the Department of Health which monitors its performance against targets set out in the NHS Plan. The SHA places contracts with INaM for all its pre-registration health profession programmes. In addition to the pre-registration activity, the SHA also contracts for a range of post-registration courses, including the training of community specialist practitioners and second qualification training. The ongoing development of continuing professional development (CPD) activity to support the national agenda around advanced practitioners is seen as crucial to the SHA. In this respect, the SHA currently purchases in excess of £1 million of CPD activity each year.

A Subject provision and overall aims

6 Health Visiting, Midwifery and Nursing are currently offered in the following courses:

Pre-registration courses

• Diploma in Higher Education in Nursing (Enrolled Nurse Conversion, ENC)*;
• Pre-registration BSc (Hons) Nursing*:
  Adult Branch*
  Child Branch*
  Mental Health Branch
• Pre-registration BSc (Hons) European Nursing (English version)*
• BSc (Hons) European Nursing (Spanish version)
• Pre-registration BSc (Hons)/Diploma in Midwifery - three years
• Pre-registration BSc (Hons) Midwifery - shortened
• Pre-registration Diploma in Nursing
  Adult Branch*
  Child Branch*
  Mental Health Branch
  Learning Disabilities Branch
• BSc Community Specialist Practice (Public Health Nursing/Health Visiting)
• Postgraduate Diploma in Community Specialist Practice (Public Health Nursing/Health Visiting).

Undergraduate Continuing Professional Development courses

• Diploma in Professional Practice in Palliative Care
• BSc (Hons)/Diploma Professional Practice - including the following Nursing and Midwifery Council (NMC) recordable qualifications
  Return to Practice (Adult*, Child*, Mental Health, Learning Disabilities, Midwifery and Health Visiting)
  Supplementary Prescribing
• BSc (Hons)/Diploma Professional Practice in Working with Older People
• BSc (Hons)/Diploma Professional Practice in Mental Health
• BSc (Hons)/Diploma Professional Practice in Midwifery
• BSc (Hons)/Diploma Professional Clinical Practice - with pathways in:
  Accident and Emergency Nursing
  Anaesthetic Nursing
  Cardiac Surgery Nursing
  Day Surgery
  Intensive Care
  Cardiology Nursing
  Cancer Nursing
  Neonatal Nursing
  Burns and Plastics Nursing
  Renal Nursing
• BA (Hons) Professional Studies in Nursing (Open Learning)
• BSc (Hons) Nursing Studies
• BSc (Hons)/Postgraduate Diploma Community Specialist Practice, with pathways in:
  Nursing in the Home/District Nursing
  Community Mental Health
  General Practice Nursing
  School Nursing.

Postgraduate courses:

• Postgraduate Certificate in Health and Social Care Education
• MA Health Care Ethics
• MA Midwifery Studies (with Education or Management)
• MA Nursing Studies (with Education or Management)
• MSc Clinical Studies (with Education or Management)
• MSc Cognitive Psychotherapy
• MSc Nurse Practitioner Studies
• Professional Doctorate in Midwifery
• Professional Doctorate in Nursing.

* These programmes underwent NMC annual monitoring as part of the major review of healthcare programmes.

7 The Corporate Plan 2002-07 sets down the University's current direction and reaffirms the commitment to professional formation and civic engagement through support of lifelong learning, social inclusion and knowledge exchange in an information-rich age. The Faculty of Health is charged to provide a high-quality learning environment in which teaching and research take place in partnership with, and for, the health and social care communities. Teaching is organised with the ultimate objective of benefiting the patients and clients of the services to which it relates. The Faculty is committed to the continuing development of multiprofessional and interprofessional engagement with learning, teaching and research in health and applied social science.

8 The Institute aims to:

• develop a professionally-orientated academic community in which active pursuit of knowledge and expertise unites staff and students in their commitment to lifelong learning
• provide wide access to those able to benefit from its programmes and make a contribution to caring for patients and clients
• nurture the growth of a research culture that permeates education and practice
• work in partnership with health and social care organisations to provide a comprehensive portfolio of flexible education programmes, which are responsive to local and national needs
• value and actively support the contribution of carers and users to education provision and research
• develop relationships with international colleagues based on mutual respect for the enhancement of Nursing and Midwifery education and practice
• establish a strong, local, national and international reputation for innovation in Nursing, Midwifery and Health Visiting education.

B Academic and practitioner standards

B1 Health Visiting

Intended learning outcomes

9 Health Visiting students can take the BSc (Hons) Community Specialist Practice course at level 3 or master's level (M) but, in most of the modules, they learn together. The exceptions are the work-based learning modules where the M-level module is drawn from the Graduate Programme in Health and Social Sciences (GPHSS).

10 Students stated that intended learning outcomes (ILOs) are generally clear, although the language used is sometimes difficult to understand. ILOs are sometimes interpreted differently by different mentors and this causes confusion among students, particularly with work-based learning.

11 The programme meets the standards of the professional and statutory regulatory body, the NMC, for Public Health Nursing/Health Visiting, with integrated Nurse Prescribing (UKCC 2001) and is mapped against the health visiting competencies (NMC 2002). Designed to meet the requirements of the NMC standard for balance between theory and practice, the programme has an extended period of consolidated practice, making this a 52-week programme.

12 The Subject benchmark statement for health visiting, published by QAA, the health professions framework, The framework for higher education qualifications in England, Wales and Northern Ireland (FHEQ) and regulatory requirements are all met and understood by learners and mentors. Additionally, the submission for approval of the course and programme for the BSc (Hons) Community Specialist Practice comprehensively maps the programme against key skills, relevant national service frameworks (NSFs), Every Child Matters, Valuing people, Liberating the Talents, and relevant competencies specified by the Sainsbury Centre for Mental Health. Outcomes for the programme demonstrate the integration of theory with practice and the achievement of knowledge and skill for fitness to practise.

13 ILOs are consistent with the Subject benchmark statement for health visiting. They are met through a range of assignments and assessment of practice strategies. The reviewers' scrutiny of samples of students' academic work confirms that assessments reflect the module outcomes, which are extensive.

14 Placement outcomes are contained within the practice placement portfolio. Where work-based learning is undertaken, students negotiate individual learning outcomes with the practice teacher. Practice teachers generally feel supported and are guided by the link tutors in negotiating outcomes but some in one placement area stated that they were unclear about domains.

Curricula

15 The BSc (Hons) Community Specialist Practice programme meets the academic and professional requirements for competence and safe practice. The programme was validated against both the Standards for Specialist Practice and the NMC requirements for pre-registration health visiting programmes 2002. The programme is also mapped against the NMC draft standards for entry to Part 3 of the professional register. The final version was not available at the time of the validation and, therefore, the programme does not fully meet the final published requirements.

16 Practitioners regard the BSc (Hons) Community Specialist Practice curriculum as comprehensive for health visiting, with clear outcomes. Both practice and education staff determine curricular content and course requirements in partnership. For example, there are discussions at applicant interviews about M-level practice and the need for community experience as a prerequisite. Robust systems for course development are in place. Some students are members of curriculum planning teams and course boards. Processes are in place to clarify the difference in levels of progression between those students who are studying at M-level and those studying at BSc level. However, some confusion was expressed by students about guidelines for what is expected at M-level.

17 There is excellent opportunity in the BSc (Hons) Community Specialist Practice for interprofessional education (IPE) and collaboration both in the classroom and in practice, because two modules are shared with students from four other disciplines. This is in recognition of both local need and the requirement of the Specialist Practitioner Standard. Collaboration with other agencies, including social services, education, housing, voluntary organisations and the police, is achieved in practice. The structure of the BSc (Hons) Community Specialist Practice, the post-registration modular schemes at undergraduate level and, to a greater extent, postgraduate courses in the faculty-wide GPHSS, facilitates productive IPE. Links are being developed with the Brighton and Sussex Medical School, which provides a powerful research presence.

18 A spiral curriculum model enables the coherence of topics allowing students to transfer and build upon knowledge and skills in their developing health visiting/public health role. An innovative continuing work-based learning module, running throughout the BSc (Hons) Community Specialist Practice programme, allows students to identify and develop skills and knowledge within a chosen area of practice, appropriate to both student and local need. This provides flexibility and choice in developing practice skills.

Assessment

19 Students are able to demonstrate achievement of the ILOs through a variety of appropriate and innovative assessment methods. Practice teachers and Trust representatives are actively involved in the development of assessments, which are mapped against the ILOs. Each module assignment contains a weighted practice skills component, which contributes to the degree classification. The introduction of the 52-week programme is supported by the SHA and regarded by the reviewers as beneficial to students in developing skills across the continuum of public health.

20 There are extensive ILOs to achieve, particularly in level 3 modules, with some lack of clarity about how all outcomes are assessed, although the focus on practice is a strength. Part-time students' needs are met through individual assessments covering more than one module. Opportunities are provided for formative feedback on assignments. Module learning outcomes are formatively and summatively assessed by health visitor practice teachers through the development of a practice portfolio. The effectiveness of the practice teacher is a notable strength of the BSc (Hons) Community Specialist Practice and commented on positively by students. Marking workshops and training materials successfully support the practice teachers in their assessment role.

21 The use of practice portfolios gives a clear insight into students' competence in practice and demonstrates evidence-based practice, reflective skills and integration of theory and practice. Campus and practice-based assessment is internally moderated through the use of a Practice Moderating Board, which is an effective way of ensuring parity between assessors. Internal moderation of practice assessments in the BSc (Hons) Community Specialist Practice is highly effective, with the teaching team working together to ensure that the assessment process is continually developing. M-level practice assessment requires a higher level of achievement through students carrying out an intervention.

22 External examiners are involved in all aspects of the assessment process and comment positively on the assessment strategies and the quality of student support and feedback. Feedback is constructive, consistent and helpful in developing the students' academic abilities.

Student achievement

23 The overall performance of the students on this programme is confirmed as being comparable with that of students in other institutions. Over one-half of the graduates achieve a Distinction or Merit grading in practice. The majority of BSc (Hons) graduates achieve a Second class honours degree classification (Table 1a). Almost all students remain with their current employers following successful completion of the programme (Table 2a).

24 Student academic work shows a logical progression of achievement to the appropriate academic level. The external examiner confirms that student work demonstrates evidence of reflective skills and integration of theory with practice.

25 Students reported feeling generally able to achieve the necessary practice skills, although the ease of this varies according to the allocated placement area. The initial observation period of three weeks that allows students to settle into the BSc (Hons) Community Specialist Practice programme and the practice environment is a significant strength of the student practice experience.

Summary of academic and practitioner standards for Health Visiting

Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programme in Health Visiting at the University of Brighton in partnership with Surrey and Sussex Strategic Health Authority.

Strengths

• The effectiveness of the practice teacher is a notable strength of the BSc (Hons) Community Specialist Practice (paragraph 20).
• Internal moderation of practice assessments in the BSc (Hons) Community Specialist Practice is highly effective, with the teaching team working together to ensure that the assessment process is continually developing (paragraph 21).
• The initial observation period of three weeks that allows students to settle into the BSc (Hons) Community Specialist Practice programme and the practice environment is a significant strength of the student practice experience (paragraph 25).

Good practice

• An innovative continuing work-based learning module, running throughout the BSc (Hons) Community Specialist Practice programme, allows students to identify and develop skills and knowledge within a chosen area of practice, appropriate to both student and local need (paragraph 18).

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

Programme (award bearing only)	Cohort	HV Specialist Degree classification Practice only 60 credits Pass		Degree classification
				1		2i		2ii		3		P		F
		No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%
BSc (Hons) Community Healtd Nursing (Healtd Visiting)	2002					6	40	9	60
	2003	2	13	2	13	5	33	5	33	1	7
	2004			1	6	6	38	7	44	2	13
Practice grading				Dist		Merit		Pass
	2002			3	20	7	47	5	33
	2003			2	13	6	40	7	47
	2004			2	13	10	67	3	19

Table 2a: Employment statistics for all pre-registration programmes and exception reporting for post qualification programmes in Health Visiting

Programme (award bearing only)	Further study		Local employers		Employers elsewhere		Unemployed		Other
	No.	%	No.	%	No.	%	No.	%	No.	%
BSc (Hons) Community Health Nursing (Health Visiting)
2002			15	100
2003			15	100
2004			15	94	1	6

B2 Midwifery

Intended learning outcomes

26 The ILOs for midwifery reflect professional and academic standards. They are developed in partnership with the external stakeholders. Wider access is provided by the programmes being offered at diploma and degree level. Problem-based learning (PBL) is an innovative approach to curriculum delivery and the mapping of trigger learning outcomes in midwifery against module outcomes is an example of good practice in ensuring that course outcomes are met. On occasions, when students have found PBL sessions difficult, additional fixed-resource sessions are arranged. Students confirm that the programmes prepared them for entry to Part 2 of the professional register.

27 Students and mentors have a good understanding of ILOs for practice and these are clearly defined in the clinical assessment of practice (CAP) document. Students suggested that, in the initial placements, they sometimes had unrealistic expectations of what they could achieve in a placement area. However, they received guidance from the mentors and became more focused as they progressed through the programme. Interprofessional learning is an area that is currently being developed. Students expressed some dissatisfaction with the interprofessional approach to the research module for years one and two.

Curricula

28 Midwifery curricula are client-focused, with robust stakeholder involvement in their design. Students are members of curriculum planning teams and course boards. Course outcomes are mapped against the Subject benchmark statement for midwifery, published by QAA. Currently, pre-registration programmes meet the statutory body requirements in theory and practice.

29 Pre-registration midwifery courses have adopted a PBL approach, where learning is integrated, meaningful, cumulative and contextual. This approach facilitates the development of generic competencies, such as self-directed and lifelong learning, reasoned decision-making and communication. It also fosters collaborative relationships with colleagues, members of other professions and service users. Students report that their initial difficulties with the PBL strategy were successfully overcome.

30 Triggers, case studies relating to real-life clinical scenarios or where the client is the focus, illustrate that the pre-registration curricula are client focused. Students use the triggers to share, compare and debate different practices. Students report that they are 'getting to grips' with PBL. The reviewers' visits to clinical practice showed that one-to-one care, client-centred approaches are utilised, and that the opportunity in some areas for students to participate in home births and midwifery-led care is evident.

31 In the three-year programme, the studies are supported by interprofessional modules that enable the progressive development of core skills, such as research and professional studies. IPE is evident in some practice areas. Students on the shortened course join the interprofessional research module at level 3. Cultural issues are explored in the final part of the course and the learning is supported by national or European placements. The MA Midwifery Studies Programme provides the opportunity for some IPE. The number of students accessing postgraduate midwifery programmes is small. Postgraduate courses are part of modular schemes that support IPE outcomes. An example of this is the Exercise and Nutrition During Childbearing module.

32 The placement allocation plan in pre-registration midwifery courses mirrors the curriculum intentions and facilitates the integration and application of theory to practice. Together with link lecturers, lecturer practitioners play a large part in ensuring allocations meet curriculum outcomes. Communication about curricular information is satisfactory. It is available to the clinical staff through the clinical assessment of practice document and verbally through the lecturer practitioner. The clinical assessment of practice document is revised regularly with student and mentor involvement.

33 Exploratory talks about opportunities for joint curricular working with the Brighton and Sussex Medical School are at an early stage. There are good relationships with the Medical School staff in promoting further collaborative working. The Exercise and Nutrition During Childbearing module in the MA Midwifery Studies is an exciting example of collaboration with other professional groups.

Assessment

34 There is a clear strategy for assessing learning outcomes in the midwifery programmes. Multiple assessment methods are used that are appropriate to the assessment task and are used to counter possible bias. Students are required to demonstrate a range of skills through a CAP document. A variety of methods, including practical skills and reflection, is used to demonstrate achievement of the ILOs.

35 The assessment strategies integrate theory and practice and measure student performance in the content and level of the module learning outcomes. The assessment process is well managed, with its integrity and consistency secured through formal moderating processes. Formative assessment provides ongoing feedback to students about their progress. It also facilitates development of their abilities and forms part of both campus and practice assessment. Feedback to students tends helpfully to follow the headings of the marking criteria. It is generally well structured and comments are considered appropriate to the academic level of work assessed.

36 Assessment strategies are considered at validation events attended by partner placement providers, SHA and NMC representatives. Ongoing review has resulted in some modifications being made to assess more appropriately the ILOs. Marking criteria, distinguishing between different categories of achievement, are provided in programme and module handbooks.

37 The School has made positive efforts to accommodate flexible mentorship updating, which is included in mandatory updates. Mentors understand their assessment responsibilities and requirements, and feel prepared and supported by practice placement facilitators and link lecturers. This is a good example of how the University, SHA and partner placement providers are working together to ensure the consistent application of assessment strategies and procedures.

Student achievement

38 There has been a steady increase in the proportion of students successfully completing diploma programmes, rising from 93 per cent in 1999 to 100 per cent in 2003. Approximately three-quarters of graduates from pre-registration programmes achieve a First or Upper Second class degree (Table 1b). The majority take up employment following successful completion of the programme, with a high proportion of these remaining locally (Table 2b). Students confirmed that they feel prepared for practice at the point of completion of their programmes and this is reflected in the end-of-course evaluations.

39 A range of student academic work reflected a variety of grades. These were justified by markers' comments and feedback in the majority of cases. The standards achieved by learners meet requirements for their awards, are consistent with the guidelines given in the Subject benchmark statement for midwifery and indicate the achievement of fitness for practice, purpose and award. External examiners state that assessed students' work is of a level comparable to that in other universities. They confirm that the ILOs allow students to demonstrate achievement in both theory and practice. Mentors work with link tutors to support students who are slow to achieve practice requirements, and feel that this has a positive effect on these students.

40 External examiner feedback confirms that students undertaking postgraduate programmes demonstrate a range of achievement that, overall, is consistent with the published objectives, and the majority of students demonstrate appropriate skills of critical analysis. Postgraduate students expressed satisfaction with the learning experience. They state that it provides areas of opportunity and enables study of broader topics.

Summary of academic and practitioner standards for Midwifery

Overall, the reviewers have confidence in the academic and practitioner standards achieved by the programmes in Midwifery at the University of Brighton in partnership with Surrey and Sussex Strategic Health Authority.

Strengths

• Pre-registration midwifery courses have adopted a PBL approach, where learning is integrated, meaningful, cumulative and contextual (paragraph 29).
• The placement allocation plan in pre-registration midwifery courses mirrors the curriculum intentions and facilitates the integration and application of theory to practice (paragraph 32).

Good practice

• The mapping of trigger learning outcomes in midwifery against module outcomes is an example of good practice in ensuring that course outcomes are met (paragraph 26).

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

Programme (award bearing only)	Cohort (last 3 cohorts only)	Diploma		Diploma programmes		Degree classification programmes
		Pass		Fail		1		2i		2ii		3		P		F
		No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%
DipHE/BSc (Hons) Midwifery (three years)	1999	13	100	0	0
	2000	19	95	1	5
	2001	24	100	0	0
BSc (Hons) Midwifery (18 months)	Feb 02					3	30	7	70
	Sept 02					4	50	2	25	2	25
	Feb 03					2	29	3	43	2	29
Return to Practice - Midwifery module	2001	4	100
	2002	6	100
	2003	6	100
BSc (Hons) and the Diploma in Professional Practice (Professional Practice Framework Award): Midwifery	2001-02	7	N/A ***	N/A	N/A	1	25	2	50	1	25
	2002-03	5	N/A ***	N/A	N/A			1	50	1	50
	2003-04	1	N/A ***	N/A	N/A			3	60	2	40

*** Awards are given on accumulation of the appropriate number of modules

Table 2b: Employment statistics for all pre-registration programmes and exception reporting for post qualification programmes in Midwifery

Programme (award bearing only)	Further study		Local employers		Employers elsewhere		Unemployed		Other
	No.	%	No.	%	No.	%	No.	%	No.	%
DipHE/BSc (Hons) 1999			9	69	4	31
Midwifery (3 years) 2000			15	75	3	15			2	10
2001			Data	not	yet	available
BSc (Hons) Midwifery (18 months)
Feb 02			Data	not	available
Sep 02			5	63	3	37
Feb 03			7	88	1	12
Return to Practice 2001			4	100
Midwifery module 2002			6	100
2003			5	83	1	17

B3 Nursing

Intended learning outcomes

41 ILOs are clearly defined in the specifications for all programmes leading to entry to Part 1 of the Professional Register. They are designed to reflect theory and practice and are appropriately related to the level of learning, with differentiated outcomes for diploma, honours and postgraduate degrees. ILOs are developed in partnership with colleagues in clinical practice and other external stakeholders to ensure flexibility that meets the needs of the individual NHS Trust.

42 Clinical learning outcomes are clearly defined and incorporated in the CAP document which forms the student's practice portfolio. Copies of the ILOs for the Pre-registration Diploma in Nursing (PRDN) are contained in the resource folders present on wards or through the intranet in some Trusts. In one clinical area, good practice is demonstrated through a programme of learning and personal letters to students provided by mentors.

43 Postgraduate students feel well supported to achieve their learning outcomes, which are stated clearly in the module handbooks. Actual outcomes achieved are consistent with those intended and are appropriate to the defined areas of practice.

44 Mentors have support from university tutors in completing the CAP documentation and clearly understand the requirements for different branches of nursing. The pre-visit for pre-registration nursing students to the operating theatre suite, where key outcomes are identified for the placement, are considered by both mentors and students as an area of strength. Support in achieving learning outcomes in practice is provided to both students and mentors by the clinical placement facilitators (CPFs) who work to ensure that all students reach the required standard at the point of professional registration. There are occasions when students aim to achieve too many or inappropriate learning outcomes in practice and, although mentors provide guidance, it is sometimes necessary to put learning outcomes 'on hold' for a particular placement experience.

45 ILOs are consistent with the NMC nursing competencies, as well as the University's Common Academic Framework and the Subject benchmark statement for nursing, and articulate with the FHEQ. NSFs underpin course learning outcomes and, in some cases, are specifically identified within module learning outcomes, for example, in the insight experiences on BSc (Hons) Nursing and the BSc (Hons) in Professional Practice in Working with Older People.

46 External examiners confirm that programme outcomes are appropriate to the subject, academic level and professional requirements, and ensure practitioners who are fit for purpose, practice and academic award on successful completion. Interprofessional learning outcomes are a component of the BSc (Hons) Nursing course and these become more specific through modules shared with other health professionals.

47 ILOs for all nursing programmes are communicated effectively to students, academic and clinical practitioners, and other stakeholders through programme and module handbooks. They are incorporated into programme handbooks and individual modules. Students can access learning outcomes electronically through the University's managed learning environment, Studentcentral. Meetings with undergraduate and postgraduate students at pre and post-registration level confirmed that the majority of students are well informed of the learning outcomes for theoretical as well as for clinical learning and that these are appropriate to the defined areas of practice.

Curricula

48 Nursing curricula are client focused, with robust stakeholder involvement in curriculum design. The Service Users Strategy Group works towards ensuring that the service users' voices are heard properly across all curricula. Students and practitioners are also represented on curriculum planning teams and course boards.

49 Pre-registration programme documents in all branches of nursing demonstrate the prerequisites for registration and therefore a licence to practice. Course outcomes are mapped against the Subject benchmark statement for nursing. NMC requirements are met in practice. Currently, the pre-registration programme prepares students for practice as qualified nurses.

50 Curriculum documents demonstrate appropriate academic, intellectual and professional progression. Curricula for pre-registration nursing courses show clear progression though academic and NMC competency levels. Initially, students are informed about the course at the start of the programmes. They are also provided with course and module handbooks and are clear about what they should achieve.

51 Practitioners report that PRDN students are well prepared for their further development of skills in clinical areas. In particular, they cite student pathways as an example of good practice developed in partnership with them. Practice staff can refer to their university counterparts if they have concerns about the curriculum.

52 The NMC requirements for shared learning are provided in both the Common Foundation Programme and the Branches. A good range of learning opportunities is available, particularly with members of other professions. IPE and person-centred learning opportunities are evident in areas of practice experience.

53 The CPD and graduate course frameworks in nursing contain a comprehensive range of modules that successfully enable practitioners to devise programmes that meet their personal and professional needs. Progression and coherence are maintained through the stipulation of mandatory modules, providing a balance between clinical studies and professional skills. Stakeholders appreciate the expanding variety and flexibility in modes of course and module delivery provided through the growing provision of on-line modules, the introduction of work-based learning, and open learning that form part of the BA (Hons) Professional Studies in Nursing.

54 The majority of Return to Practice students stated that they were well supported and that, on the whole, the course was 'enjoyable' and well timetabled. In relation to the potential problems connected with childcare, no teaching is undertaken during the Easter and Christmas periods, and the students are able to claim childcare costs. The programme meets statutory requirements. Although mental health returnees felt the programme was 'geared towards adult nursing', there is an additional reading list. Measures are taken to enhance parity and currency of skills across disciplines.

Assessment

55 Assessment processes are underpinned by the policies of the INaM and the University and demonstrate an integrated approach to campus and practice-based assessment. A range of methods enables students to demonstrate achievement of the ILOs in both campus and practice settings. Assessment of practice learning is given equal weight to campus learning. Practice outcomes are clearly identified and students are required to provide a range of evidence to support their achievement of the competency domains. The formative element within the CAP document provides feedback to students and assists in the development of their intellectual skills.

56 Assignments for the learning disability branch clearly reflect and meet learning outcomes. Marking criteria enable internal and external markers to distinguish successfully between different levels of work. These criteria are provided for students through programme and module handbooks and are used to structure feedback. Feedback is considered useful in identifying specific areas for students to learn from. Changes to assessment are made in response to students' and external examiners' comments, and NHS Trusts' views are sought through the Course Board. Consistency, validity and appropriateness of the level of marking, in line with marking criteria and guidelines, are ensured through internal moderation.

57 Practice assessors are prepared through a variety of mentorship programmes and annual updates, and a database containing a register of qualified assessors is maintained. Mentor update sessions importantly enable mentors to raise and discuss concerns relating to the assessment. Interassessor reliability is assessed through a formal moderation process. Liaison between practice areas and the University is effective, with demonstrated knowledge and understanding of assessment requirements. The CPFs play an important part in the preparation of students for practice and in supporting clinical staff in their mentor role. Practitioners and practice managers contribute to the development of assessment strategies and modules.

58 External examiners agree that assessment methods are appropriate and suitable. Validity and reliability within assessment strategies for both theory and practice are also affirmed. Assessment feedback to nursing students is comprehensive, constructive and consistent.

Student achievement

59 The majority of graduates successfully completing programmes achieve a First or Upper Second class degree. The proportion who take up employment locally following successful completion of the programme varies from 40 to 100 per cent (Table 2c). Government targets for widening participation are being implemented through recruitment of students with greater learning needs, yet the pass rate is maintained.

60 A sample of students' academic work was reviewed across all levels. This showed appropriate achievement of overall learning outcomes. Samples of student work confirm achievement of the specified programme ILOs. On occasions, when student work has failed to meet the ILOs, this is reflected in the feedback and mark awarded, and these help the student towards eventual achievement. The standards achieved by learners meet at least the minimum requirements for the award, as measured against relevant professional subject benchmarks and fitness for practice, purpose and award. External examiners state that assessed students' work is of a level comparable to that in other universities.

61 Students' learning experiences in practice and their achievement of practice skills had been enhanced with the appointment in April 2001 of six CPFs, who also provide support for mentors. This was subsequently increased to eight in 2003 following extensive consultation with Directors of Nursing and senior higher education institute personnel. This has potential to impact directly and positively upon student achievement.

62 All mentors are aware of the policy to follow once a student is identified as failing to meet the expected standard. There is good communication between practitioners and academics that has a positive effect on supporting the student to meet the required standards.

63 Students confirmed that the nursing programmes prepare them for practice. Employers stated that nursing programmes effectively prepare students who are fit for purpose and practice.

64 In the undergraduate and postgraduate CPD courses, external examiners consistently comment that levels of student achievement are comparable with the national norms. One external examiner praises the MSc Clinical Studies for the 'high quality in the application of theory to nursing practice' and another comments on the students' commitment to generating solutions to practice problems.

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 Brighton in partnership with Surrey and Sussex Strategic Health Authority.

Strengths

• The pre-visit for pre-registration nursing students to the operating theatre suite, where key outcomes are identified for the placement, are considered by both mentors and students as an area of strength (paragraph 44).
• The CPD and graduate course frameworks in nursing contain a comprehensive range of modules that successfully enable practitioners to devise programmes that meet their personal and professional needs (paragraph 53).
• CPFs play an important part in the preparation of students for practice and in supporting clinical staff in their mentor role. Practitioners and practice managers contribute to the development of assessment strategies and modules (paragraph 57).
• Assessment feedback to nursing students is comprehensive, constructive and consistent (paragraph 58)

Table 1c: Completion and achievement statistics for all award-bearing programmes in Midwifery

Programme (award bearing only)	Cohort (last 3 cohorts only)	Diploma		Diploma programmes		Degree classification programmes
		Pass		Fail		1		2i		2ii		3		P		F
		No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%
Enrolled Nurse Conversion Course (encc)	April 2000	51	100
	April 2001	40	95	2	5
DipHE Nursing (encc) All branches	April 2002	29	81*
BSc (Hons) Nursing	1999					3	34	5	55	1	11
	2000					2	9	8	35	11	48	2	8
	2001					7	33	7	33	7	33
BSc (Hons) European Nursing	1998					3	50	2	33	1	17
	1999					2	50	1	25	1	25
	2000					4	57	3	43
Diploma in Nursing (all branches)	Sept 00	117	98	3	2
	May 01	151	100
	Sept 01	153	**
Return to Practice - Nursing Modul	May 03	16	100
	Sept 03	10	91	1	9
	Jan 04	22	100
	May 04	16	100
BSc (Hons) and the Diploma in Professional Practice (Professional Practice Framework Award)	2001-02	37	N/A***	N/A	N/A	6	26	15	48	5	16			3	10
	2002-03	52	N/A***	N/A	N/A	7	22	17	55	4	13	1	3	2	7
	2003-04	48	N/A***	N/A	N/A	11	41	11	41	5	18
BSc (Hons) Nursing Studies	2001-02		N/A***	N/A	N/A	2	33	2	33	1	17			1	17
	2002-03	4	N/A***	N/A	N/A	3	43	4	57
	2003-04	5	N/A***	N/A	N/A	1	10	5	45	5	45
BA (Hons) Open Learning	2001-02	N/A	N/A	N/A	N/A
	2002-03	N/A	N/A	N/A	N/A
	2003-04	N/A	N/A	N/A	N/A	2	29	5	71

* Seven students resubmitting
** Not yet available
*** Awards are given on accumulation of the appropriate number of modules

Table 2c: Employment statistics for all pre-registration programmes and exception reporting for post-qualification programmes in Nursing

Programme (award bearing only)	Further study		Local employers		Employers elsewhere		Unemployed		Other
	No.	%	No.	%	No.	%	No.	%	No.	%
DipHE Nursing (encc) All branches	N/A seconded students
BSc (Hons) Nursing
1999	1	10	4	40	5	50
2000			19	83	3	13			1	4
2001			19	90	2	10
BSc (Hons) European Nursing
1998			5	83					1	17
1999			2	50					2	50
2000			4	57	2	29			1	14
Diploma in Nursing (all branches)
Sept 2000			104	59	10	6			61	35
May 2001			110	74	11	7			28	19
Sept 2001			110	74	16	11			22	15
Return to Practice - Nursing Module
May 03			13	81	3	19
Sept 03			9	100
Jan 04			19	86	2	9	1	5

C Quality of learning opportunities

Learning and teaching

65 The Institute's learning and teaching strategy (2002-05), developed in collaboration with the SHA and placement providers, and in the context of the University's Learning and Teaching Strategy (2002-05), promotes a coherent and comprehensive approach to teaching development and the dissemination of good practice. Across the three divisions, pre-registration, CPD and postgraduate programmes, a wide variety of teaching and learning approaches is evident within academic and practice settings. This includes lectures, seminars, group work, PBL and teaching from specialist practitioners, such as lecturer practitioners. Students appreciate the range of teaching and learning methods used by staff. External examiners also comment favourably on the quality and variety of campus-based learning and teaching methods. While most students generally enjoy PBL, which is extensively used in midwifery, some report finding it initially challenging.

66 Academic teaching is informed by lecturers' subject background and clinical experience, and is enhanced by staff development. A staff development strategy is in place and the Institute is keen to increase the amount of clinical research undertaken by staff to further support teaching through the use of contemporary knowledge and evidence-based practice. New academic staff undertake an induction programme and are offered appropriate guidance and support. All new staff are expected to undertake a teaching qualification. Peer observation is being implemented to ensure that consistent practice occurs across the institution.

67 Opportunities are being investigated by CPFs and the Institute to integrate formal methods of IPE into the practice curriculum. This currently occurs in the BSc (Hons) Nursing, where nursing and medical students work with child-bearing families. The reviewers' visits to practice demonstrated effectively-used opportunities for IPE, with examples including ward rounds and interactions with allied health professionals. IPE and joint learning opportunities derived from working alongside patients were also noted. The advent of the Medical School affords the opportunity to develop IPE further.

68 Clients and patients are placed at the centre of the students' learning experience by stakeholder involvement. User involvement in the renal post-registration pathway development and delivery is also evident. The Institute's commitment to service-user involvement in learning and teaching demonstrates good practice.

69 The Institute provides sound support to lecturer practitioners across the range of healthcare programmes. Discussions with postholders highlight that these posts are effectively supported and valued by both the Institute and their host Trust, and cover a variety of specialities at pre and post-registration levels.

70 Lecturer practitioners are seconded from the Trusts to run courses and modules. Lecturer practitioner posts are considered of strategic importance to the partnership with NHS and nine of these receive some funding from the SHA. These initiatives ensure that best use is made of staff resources. Visits to practice confirmed that these positions are valued by students and postholders. CPFs work with the Institute to manage placement plans and support learning in practice. They are also a valuable asset, although sustained funding for these posts is not guaranteed beyond March 2006 when current funding streams are reviewed.

71 Placement learning evaluations are analysed and fed back to placements by the CPFs. An example of good practice was observed where the link tutor places feedback information within the placement staff communication book, ensuring effective dissemination and implementation of actions agreed as a result of student feedback.

72 ILOs are understood by practice staff and facilitate a structured approach to learning in clinical environments. Challenges exist in clinical areas to allocate time for initial, mid and final placement interviews between students and mentors. This problem is overcome by flexible approaches between students and clinicians. Learning contracts are being effectively used in practice to develop autonomous and self-directed learners.

73 NMC regulation is met in relation to mentorship preparation and update. Assessors are prepared through a successful level 3 module. Mentors report attending the annual updates that are delivered jointly with the University. Mentors are encouraged to feed back on issues of concern and this year 'failing to fail' issues are being addressed through a staff conference. Mentors report feeling well prepared for the role. When they are unable to attend updates, flexible approaches are utilised to ensure that mentors are updated, usually through link teacher involvement. Overall, mentors are updated through study days and link teachers, although the consistency of this mentor support is unclear in some instances. However, examples of good practice were also provided. A contemporary database is maintained with practice profiles and mentor details. While there are opportunities to expand the numbers of staff who hold appropriate qualifications to undertake this role, it is clear that the Institute and Trusts are working collaboratively to undertake the mentor role. The contribution of mentors to the education process is recognised by the SHA through the Mentor of the Year Award. Placement learning is enhanced through good communication between the Institute and the education lead in the placement provider.

74 Learning in practice is supported by the high quality of learning environments observed during visits to practice. At the Meadows Surgery at Burgess Hill high standards of mentorship are evident. At the McIndoe surgical centre active engagement in the patient journey is reflected within placement pathways. This level of involvement with patients is highly regarded by students. Chichester Ward at the Royal Sussex County Hospital has created a fully effective clinical learning environment. Students highlighted their experience of working with, rather than for, staff, with everyone focused on what they can learn.

75 Opportunities exist for post-registration students to continue their professional academic development with the provision of a wide range of CPD programmes. Over 1,000 students undertake such modules, but are not registered for an award. Challenges exist for post-registration students. Neonatal post-registration pathway students, for example, reported a lack of protected study time, with mentors providing support within their off-duty time. Post-registration students highlighted that they are part of the workforce and that greater emphasis on the need for protected time with their mentors would be of benefit to them. These students suggested that it would be valuable if they and their mentors could be supernumerary in clinical practice for allocated shifts, to ensure that the clinical skills achievement of their programme could be more effectively addressed.

The quality of learning and teaching is commendable.

Strengths

• The Institute's learning and teaching strategy promotes a coherent and comprehensive approach to teaching development and the dissemination of good practice (paragraph 65).
• PBL is extensively used in midwifery (paragraph 65).

Good practice

• The Institute's commitment to service-user involvement in learning and teaching demonstrates good practice (paragraph 68).
• An example of good practice was observed where the link tutor places feedback information within the placement staff communication book, ensuring effective dissemination and implementation of actions agreed as a result of student feedback (paragraph 71).
• The contribution of mentors to the education process is recognised by the SHA through the Mentor of the Year Award (paragraph 73).

Weakness

• Post-registration students highlighted that they are part of the workforce and that greater emphasis on the need for protected time with their mentors would be of benefit to them (paragraph 75).

Student progression

76 Effective arrangements, which involve service providers, are in place for admission and induction. Some M-level and post-doctoral students allege that they have had difficulties with registration, while these and pre-registration undergraduates have had difficulty initially in accessing information on Studentcentral.

77 Wide participation in professional programmes is encouraged. Accreditation of prior (experiential) learning arrangements and 'bridging pathways' are viewed positively by students. The Institute has responded well to the challenges of supporting students with a diversity of learning needs. Monitoring of the progression of such students is in place.

78 In addition to University-wide facilities for support, the Institute has an appropriate overall strategy for campus and practice-based support for students involving personal tutors, duty tutors and link lecturers. Comments about these roles were generally positive but a few shortcomings were highlighted, including two students who experienced a lack of support from their personal tutors over academic and practice issues. The creation and funding of the CPF role has strengthened the support of students during clinical placements. In recognition of the importance of this role, contingency plans are being considered should SHA funding not continue.

79 There are mechanisms in place for students with disabilities and decisions regarding their fitness to practice through Student Services and occupational health screening. Where possible, reasonable adjustment is made for students with disabilities by the purchase of specialised equipment.

80 Clinically-based mentors/assessors are well prepared in accordance with NMC requirements for their role, many to M-level, and are provided with updating by the University. The strains upon service providers in making available the numbers of mentors required are recognised, and the SHA and providers are working together to improve the uptake of mentor training and updates. Examples were found of updating being scheduled into mentors' rostered duty time. Students feel well supported in practice.

81 Placement opportunities, which meet NMC requirements, are planned with placement providers. Students are encouraged to contact the placement and their mentor ahead of their arrival. Students have access to prior information on the placement, and induction packs and student and mentor learning/resource packs are widely available. The valuable Student Pathway document has been introduced in some areas. Although, generally, students indicate very positive experiences of mentor and link lecturer support on all courses, instances were reported where this has been poor. Monitoring by INaM has identified specific problems and remedial action has recently been implemented. Some concern was expressed by mentors in pre-registration nursing and midwifery programmes about the late identification of failing students, or those slow to achieve learning outcomes. However, effective mechanisms are in place to deal with this once the problem has been identified. Overall, support of students in practice enables appropriate progression.

82 Course-specific assessment of practice documentation is used to gauge student progress on professional courses and enables the involvement of clinical staff directly in progression decisions. At a strategic level, the SHA and placement providers play a full part in annual monitoring and review. To ensure that pre-registration students are assessed in practice on their continuing fitness to practise, comments on students' health and conduct are invited on the assessment document. To ensure fairness in progression around such issues, the Fitness for Practice Committee has been newly established.

83 Excellent partnership arrangements with the SHA have led to achievable targets within commissioning plans. Recruitment, retention, progression and achievement statistics for courses leading to registration and recordable qualifications are routinely made available. The high attrition rates on pre-registration Diploma in Nursing (Table 3) and poor progression on some other programmes have been identified by the providers. In recent years, no students have discontinued the BSc (Hons) Community Specialist Practice programme as a result of academic failure and retention on this programme is high (Table 3a). The proportion of students withdrawing from the midwifery programmes is low, although statistics show a small but steady increase in attrition from both long and short degree programmes. A quarter of students undertaking Return to Practice in 2003 withdrew prior to completion (Table 3). The Institute has taken appropriate and effective measures, such as establishing the multi-stakeholder 'Recruitment and Retention Group', to review attrition, identify causes and plan intervention strategies which have, to date, included the Student Newsletter which is a method of communication with students, the pilot Student Ambassadors Scheme and reflective sessions in tutorials. Ongoing work is also being progressed with Student Services.

84 Statistics indicate a good return rate of students to the University for further professional and professionally-related study at M and doctoral level, a positive quality indicator for the provision.

Table 3a: Recruitment and attrition statistics for pre-registration and NMC recordable qualifications for Health Visiting

Award title	Recruited	Withdrawal		Transfer in		Transfer out		Discontinuation
		No.	%	No.	%	No.	%	No.	%
BSc (Hons) Community Health Nursing (Health Visiting)
2001	21	2	10			1	5
2002	17	2	12	1	6	1	6
2003	16	1	6	1	6
Nursing, Midwifery and Health Visiting
PgCert Health and Social Care Education
2001-02	39	8	21
2002-03	25	0	0
2003-04	19	0	0

Table 3b: Recruitment and attrition statistics for pre-registration and NMC recordable qualifications for Midwifery

Award title	Recruited	Withdrawal		Transfer in		Transfer out		Discontinuation
	No.	No.	%	No.	%	No.	%	No.	%
DipHE/BSc (Hons) Midwifery (3 years)
2001	31	5	16	2*	6	2	6
2002	30	6	20	3*	10	2	7
2003	30	7	23	2*	7
BSc (Hons) Midwifery (18 months)
Feb 2002	13	2	15
Feb 2002	12	2	17			3	25
Feb 2003	10			1	10	2	20
Sept 2003	9			2	22
Feb 2004	9
Return to Practice - Midwifery
2001	4
2002	6
2003	8	2	25
BSc (Hons) Diploma in Professional Practice (Professional Practice Framework Award)
2001-02
2002-03
2003-04	15	8	53**

* Intermitted and returned; or intermitted, joined and repeated year
** A number of students who were not active were identified in this year

Table 3c: Recruitment and attrition statistics for pre-registration and NMC recordable qualifications for Nursing

Award title	Recruited	Withdrawal		Transfer in		Transfer out		Discontinuation
	No.	No.	%	No.	%	No.	%	No.	%
DipHE in nursing (encc) (all branches):
April 2002 entry	49	11*	22					2	4
April 2003 entry	34	9	26	3	9
April 2004 entry	20	0	0
BSc (Hons) Nursing
2001 entry	30	5	16	2**+2	13	1	3
2002 entry	31	3	10	2**+2	13	2	6	3**+1	13
2003 entry	39	1	3	2**+2	10	3	8	1**	3
BSc (Hons) European Nursing
2001	9					2	22
2002	8	2	25			3	38
2003	12					1	8
Diploma in Nursing
Sept 2000	230	58	25	23	10	11	5	7	3
May 2001	217	55	25	25	12	29	13	4	2
Sept 2001	221	56	25	40	18	19	9	2	1
Return to Practice - Nursing Module	17	1	6
May 03	12	2	17
Sept 03	22
Jan 04	20
BSc (Hons) Diploma in Professional Practice (Professional Practice Framework Award)
2001-02
2002-03
2003-04	214	4	2

*Three of these students restarted with the April 2003 cohort
** These students have intermitted from the course with the intention of returning or have returned

The quality of student progression is commendable.

Strengths

• The Institute has responded well to the challenges of supporting students with a diversity of learning needs. Monitoring of the progression of such students is in place (paragraph 77).
• The creation and funding of the CPF role has strengthened the support of students during clinical placements (paragraph 78).

Good practice

• The Institute has taken appropriate and effective measures, such as establishing the multi-stakeholder 'Recruitment and Retention Group', to review attrition, identify causes and plan intervention strategies (paragraph 83).

Weakness

• Some concern was expressed by mentors in pre-registration nursing and midwifery programmes about the late identification of failing students (paragraph 81).

Learning resources and their effective utilisation

85 The School has an effective learning resources action plan set within the Institute's Learning and Teaching Strategy.

86 The standard of clinical-skills teaching facilities at present ranges from the contemporary skills laboratory at the Falmer site to the relocatable accommodation facility at Eastbourne and adequate facilities at Eastbourne District General Hospital (DGH) and Pembury Hospital. Overall, they enable the development of students' clinical skills to the level required. Clinical teaching facilities have benefited from securing refurbishment of facilities on the Falmer site and will be further enhanced by the capital build of a new clinical skills laboratory and classroom facility on the University's Eastbourne site. Due for completion in March 2006, this will improve the quality of the teaching and learning environment, accommodate groups of 40 to 50 and reduce inefficient use of time caused by travel between split sites. Adequate learning resources were evident in clinical areas visited by the reviewers and reported at meetings.

87 The library and study facilities at the Falmer site are modern and excellent, with student access to information technology (IT), printing and photocopying facilities, and to small-group study rooms equipped with technology for preparing presentations. Library resources at Eastbourne DGH, Queenswood library, Hastings and Pembury offer similar facilities, as well as considerable flexibility in terms of loaned resources, returns and access, often well beyond normal library opening times. Dedicated IT technicians are available, as are identified learning resources officers who are included in course board meetings to ensure that programmes may be appropriately resourced. The midwifery stock has been built up at Queenswood as a direct result of learning resources officer engagement in the Board of Study.

88 The reviewers noted an appropriate range of books, journals, videos and databases to support student learning. Additionally, the catalogues Information Resources on Nursing and Information Resources on Midwifery are accessible to students. Students receive an induction to the full library and learning facilities at all sites. There are support mechanisms in place for students with disabilities, students on placements (distance learning) and specific training for improving students' IT skills. The libraries conduct an annual user survey of all services and facilities.

89 In clinical practice, mentors, tutors and CPFs are all registered practitioners with the NMC, and have other professional academic qualifications and experience. The development of such individuals indicates considerable investment in staff, the evolving infrastructure to support learning and commitment to education and continuing professional development by Trusts.

90 Often students are allocated two mentors to ensure shifts are adequately covered. Students reported examples of first-rate practice. The reviewers met with mentors who were demonstrating them. Effective mentor activity was evident in clinical scenario workshops, mentor resource packs, student resource files and visits organised to other agencies.

91 The learning afforded by such high standards in mentorship was often directed and supported by ward managers having themselves completed programmes such as Leading Empowered Organisations and the RCN Leadership programme. Managers reported investment in their ongoing personal and professional development. This supports the overall impression of Trusts developing into Learning Organisations. Pre-registration students valued having 45 minutes dedicated to reflective practice learning during shifts. Even when the demands of the clinical setting precluded such practice, mentors were reported to be so motivated as to arrange support for learners in their own time. This was especially true of mentors to CPD programmes undertaken by learners in highly-specialised areas. It is rarely reported that placements are unaware of their allocation of learners. Learning opportunities are facilitated by specialist libraries and resources, as well as by the link lecturer/lecturer practitioner.

92 Undoubtedly, effective working and learning relationships between INaM and practice placements are enhanced by the link lecturer role and significantly improved by the introduction of CPFs with all partners feeling well supported by them. There is a robust system for audit of all nursing clinical placements annually by the University. The audit tool is based on the Department of Health's Placements in Focus (2001) and the Code of practice for the assurance of academic quality and standards in higher education, Section 9: Placement learning, published by QAA. Over 90 per cent of clinical placements have been audited over the last year by the newly introduced placement audit process, and action plans have been produced. Practitioners in practice are fully aware of these audits and associated action plans. The reviewers were impressed by the approach of a number of practice-based staff, including ward sisters and primary care practitioners, promoting a holistic learning environment and exceeding the criteria within the audit tool. One example of good practice, resulting from the collaboration with representatives from the Commission for Social Care Inspections, is a jointly written policy for reporting complaints about abuse in the independent sector.

93 Students, staff and mentors/supervisors have, for the most part, access to IT facilities both on campus at all sites, in practice placements and from private addresses. All students are provided with an IT induction programme and have the facility for further support if required. The use of innovative IT is evident. Studentcentral, the University's managed learning resource, and Staffcentral, the equivalent intranet for staff, afford excellent access to course materials and discussion boards, thereby supporting students' educational experience effectively, as well as providing access to University pastoral services. They also act as repositories in which personnel, committee minutes and quality assurance information may be accessed.

94 Academic staff are appropriately qualified and sufficient in number to deliver the programmes. Sufficient administrative staff, organised in teams, provide support to programmes. The high number of PRDN teaching sessions that were cancelled during 2003-04, particularly affecting the PRDN September 2003 cohort, were due to staff sickness, rather than a lack of accommodation or administrative organisation. There is considerable investment in the development of all categories of staff. This is evident in the record of administrative staff development activity. All administrative staff should benefit from personal development review within the new team structures.

95 Mentor preparation is part of a strategic infrastructure supporting learning and development providing progression of clinicians through to academic careers. This extends to a systematic approach to induction and development of academic staff, maintaining their clinical skills through honorary contracts with Trusts or through direct supervision of students in clinical practice.

96 All students are given hard copies of the handbook for their programme. Additionally, these are available on Studentcentral. Handbooks detail specific learning outcomes which students find valuable. Resource packs are available for mentors. Each placement area is profiled, with a procedure in place if ILOs cannot be met.

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

Strength

• The library and study facilities at the Falmer site are modern and excellent, with student access to IT, printing and photocopying facilities, and to small-group study rooms equipped with technology for preparing presentations (paragraph 87).

Good practice

• The reviewers were impressed by the approach of a number of practice-based staff, including ward sisters and primary care practitioners, promoting a holistic learning environment and exceeding the criteria within the audit tool (paragraph 92).
• Studentcentral, the Institute's managed learning resource, and Staffcentral, the equivalent intranet for staff, afford excellent access to course materials and discussion boards, thereby supporting students' educational experience effectively, as well as providing access to university pastoral services (paragraph 93).

D Maintenance and enhancement of standards and quality

97 The self-evaluation document (SED) produced by INaM and the SHA provided an excellent basis for the review. It was evaluative and well referenced, with references available electronically through hyperlinks. Students felt that they had been i