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Does Healthcare Education have a future?

A) ‘Yes’            

B) ‘NO’             

C) ‘Maybe’   

Please tick appropriate box.

To say that we live in ‘interesting times’ is an understatement. We have moved into a nightmare “post-truth” world where lies and fake news are just ‘alternative facts’, where expertise is pilloried as ‘elitism’ peddled by smart-Alecs, where professional knowledge and experience is easily trumped by any random ‘personal experience’ story, where journalism becomes a ‘churnalism’ of social media chimera and confected ‘outrages’ and where nursing and other health professions  as crafts, disciplines, professions, arts or whatever STILL struggle to say and ‘cut through’ with any unified voice, what they are, what they do and why it matters to people’s lives.

The world of healthcare that we are preparing today’s students for is light years away from the clinical world that the majority of their educators inhabited. Is there something wrong with this picture? There could well be if we fail to recognise that this new world comprises both new and possibly unimagined challenges for nurses, midwives and all health professionals. Meanwhile, the fundamental, elemental dimensions of the human condition, especially when facing illness, injury, loss and more, that will be as germane now, and in the future, as they have always been.

Healthcare is now a multi-billion-pound business (NHS England alone cost £124.7 BILLION in 2018) and nursing and health professional education are most certainly part of this business. The challenge for educators is knowing the nature of their particular business and how they and their students can thrive in such a world with their humanity and integrity intact. Is this a big ask? Damned right it is, but no one ever promised you that healthcare education was going to be easy. If they did, they lied through their teeth.

Many of our universities have become little more than corporate degree mills handing out the requisite pieces of paper to their duly ‘satisfied’ paying customers. They have ingested and regurgitated the ugly argot of the neoliberal business and audit culture age but without adopting any of the convictions, innovations or genuinely radical approaches that the best businesses and social enterprises have in their DNA.

Our literature and science have been polluted by predatory publishers and their scam journals and conferences.  These are the same worthless outlets that many academics will readily and knowingly support by sending them their work and credit card details in the hope that they can chalk up another quick publication or score another conference jaunt to some exciting destination.

Reports of exemplary nursing care jostle for position beside accounts of hideous neglect and poor care. After Francis, Morecambe Bay, Gosport and more, I write this, reading of a man with Down Syndrome who died in hospital following 19 days without receiving adequate food or drink. Losing 12kg in 19 days, he was essentially starved to death and died of aspiration pneumonia. To say that nursing and health professional education has a problem with ‘fundamental care’ must be one of the euphemisms of the decade.

What does all of this this mean for educators? What is our future and the future of our art, craft or profession?

In this presentation, my reach will almost certainly exceed my grasp, but I want to at least come close to the erudition and thoughtfulness shown by my many keynote predecessors, upon whose shoulders I gratefully teeter. If you had wanted simply a cheerleader with bigger pom-poms to announce just how wonderful all educators and health professionals are, you would not have invited me to give this keynote. I want to ask today, if we are as good as we all seem to think we are, both health professionals and their educators alike.

If we are prepared to acknowledge that there are systemic problems in both clinical practice and education, then the next question we face is ‘what do we do about changing these?’ Again, there are few comfort zones for educators to inhabit. The history of organisational change in both public and private sectors over the last 20 years has been an almost unmitigated disaster. Aside from the almost complete lack of any real change, the financial costs involved have been almost incalculable. Just try toting up the costs of the failed, transient initiatives, ‘restructures’, ‘leadership academies’, re-engineering, ‘moving forward programmes’, reforms and transformation strategies that you are even personally aware of then multiply this by heaven only knows how much. 

Are our educators prepared to spend another 20 years in meetings tinkering with and re-ordering ‘curriculum content’ and having insular arguments in ever decreasing circles about academic progression, relative merits of qualifications, graduate qualities and career ladders while the world is not just changing but spinning on its axis? We have to hope not.  The problem that healthcare education faces, is NOT that it needs to change. That is not even under dispute. The question is HOW do we change.

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