December 2015, student midwives and nurses, joined by students from other professions including medical trainees, demonstrated outside the Department of Health in London. Many dressed in scrubs and holding homemade placards and banners, they were protesting against something of potentially huge significance; a radical change to English policy on supporting student health professionals.
A week earlier the Chancellor of the Exchequer set out the future of funding for student midwives, nurses and allied health professionals in his autumn spending review:
‘Grants for health students will also be replaced by loans, and the cap on the number of nurses and midwives that can go into training each year will be removed, providing up to 10,000 more nurses and other health care professionals for the NHS. These students will be able to receive 25% more financial support during their studies as a result.’(HM Treasury 2015)
This blandly worded statement hides a momentous change not only in the way that health care education is funded, but in how the whole structure of education, workforce planning and the National Health Service (NHS) is conceived. It matters for student midwives and their educators, but it also matters for NHS Trusts and for the public.
This paper will unravel the ideas and issues behind the change to student funding, and will argue that it heralds a revolution in health care education in England. The paper will focus on the midwifery experience in England, but the implications for the changes to midwifery education will be felt much more widely and reflect and sharpen debates at national and international level.
How did we end up here?
The idea that the midwife required training was one which developed in fits and starts during the 19th century. There was no national system of training and no legal requirement that midwives had to be trained, but increasing numbers of hospitals offered some preparation for the job. Large and prestigious city centre hospitals, including St Marys in Manchester and the Jessop Women’s Hospital in Sheffield supplied cases, both on the district and in hospital for pupils (as they were described) to practise on, together with courses of lectures given by doctors attached to the hospital. The idea was never to provide the midwife with enough knowledge to give her ideas above her station (and in this period she was always a ‘she’); the midwife needed to know enough to deal with ordinary cases, and enough to know when to leave well alone and call a doctor. The training made sure that midwives knew that they were subordinate to doctors at all times. It also tied them into the structure of the hospitals because hospitals trained midwives who would then work for them. The idea that the knowledge midwives received might be portable horrified hospital boards; some funded their pupil midwives and therefore felt that basically they owned them. In 1891 the Jessop Hospital medical staff protested strongly when one of the midwives they had trained left to work elsewhere and wanted a reference:
‘…it should not be written upon official paper. The Medical Staff at the same time beg to point out to the Board that the granting of this certificate is a dangerous precedent… It opens up the whole question as to training of midwives for other than the purposes of the Hospital.’ (Jessop Hospital Minutes 1891, quoted in McIntosh 1998:406).
Following the 1902 Midwives Act, training for midwives was no longer a choice but a legal requirement for anyone who wanted to practise midwifery (McIntosh 2012). The cost of training was to be covered by pupil midwives themselves. Before the Act, pupil midwives at the Jessop were paid £10 per year. After the Act they had to pay over £15 for three months’ training. Hardly surprisingly the hospital struggled to recruit pupils. As time went on this was seen to be unsustainable as it stopped many potential students from taking up courses, particularly as they got longer and more complex. Midwifery had always been a job for older married or widowed women with families. Changes to funding of training meant that it became increasingly difficult for these women to undergo training. Local authorities gradually stepped in to pay for training costs and eventually the requirement was subsumed by the NHS.
Tania McIntosh is the Principal Lecturer in Midwifery, School of Health Sciences at the University of Brighton.
Reference: McIntosh T. MIDIRS Midwifery Digest, vol 26, no 1, March 2016, pp 5-10
Original article. © MIDIRS 2016
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