Calculating the costs of work-based training: the case of NHS Cadet Schemes.

BACKGROUND: The worldwide shortage of registered nurses [Buchan, J., Calman, L., 2004. The Global Shortage of Registered Nurses: An Overview of Issues And Actions. International Council of Nurses, Geneva] points to the need for initiatives which increase access to the profession, in particular, to those sections of the population who traditionally do not enter nursing. This paper reports findings on the costs associated with one such initiative, the British National Health Service (NHS) Cadet Scheme, designed to provide a mechanism for entry into nurse training for young people without conventional academic qualifications. The paper illustrates an approach to costing work-based learning interventions which offsets the value attributed to trainees' work against their training costs. OBJECTIVE: To provide a preliminary evaluation of the cost of the NHS Cadet Scheme initiative. DATA SOURCE: Questionnaire survey of the leaders of all cadet schemes in England (n=62, 100% response) in December 2002 to collect financial information and data on progression of cadets through the scheme, and a follow-up questionnaire survey of the same scheme leaders to improve the quality of information, which was completed in January 2004 (n=56, 59% response). PRINCIPAL FINDINGS: The mean cost of producing a cadet to progress successfully through the scheme and onto a pre-registration nursing programme depends substantially on the value of their contribution to healthcare work during training and the progression rate of students through the scheme. The findings from this evaluation suggest that these factors varied very widely across the 62 schemes. Established schemes have, on average, lower attrition and higher progression rates than more recently established schemes. Using these rates, we estimate that on maturity, a cadet scheme will progress approximately 60% of students into pre-registration nurse training. CONCLUSIONS: As comparative information was not available from similar initiatives that provide access to nurse training, it was not possible to calculate the cost effectiveness of NHS Cadet Schemes. However, this study does show that those cadet schemes which have the potential to offer better value for money, are those where the progression rates are good and where the practical training of cadets is organised such that cadets meet the needs of patients which might otherwise have to be met by non-professionally qualified staff.

NHS cadet schemes: do they widen access to professional healthcare education?

AIM: The aim of this paper is to report a study investigating the extent to which National Health Service cadet schemes widen access to professional health care education. BACKGROUND: Cadet schemes have been reintroduced in the United Kingdom to increase recruitment of nurses and other health care staff to the National Health Service and also to widen access and increase participation in professional health care education by groups poorly represented in such education, including minority ethnic groups. METHODS: A questionnaire survey of all cadet schemes (n = 62) in England at the time of the study was carried out, and the respondents were cadet scheme leaders (n = 62) and cadet students (n = 411). The questionnaires to scheme leaders enquired about when the schemes were established, what the schemes were preparing cadets for, modes of delivery and entry qualifications. The questionnaires to cadets enquired about age, gender, family circumstances, prior experience and ethnic background. FINDINGS: The majority of schemes had been established since the health service reforms of 1999 and most were preparing cadets to enter professional nurse education programmes. Very few provided opportunities for part-time study and some asked for entry qualifications. Cadets were younger on entry than a comparator group of student nurses, fewer were married, fewer had previous employment or health-related employment and a lower percentage of cadets were white. CONCLUSION: Cadet schemes have the potential to widen access to professional health care study, but there is only limited evidence that they are doing so. In particular there was a lack of mature entrants to health care professional education via the schemes. However, the majority of schemes offered a route into professional education for students who did not hold sufficient educational qualifications for direct entry to professional health care education. It is encouraging that cadet schemes appear to be attracting a significantly greater proportion of students from Black and minority ethnic groups than preregistration nursing programmes overall.

NHS cadet schemes: student experience, commitment, job satisfaction and job stress.

In the context of various policy initiatives concerning widening access to and strengthening recruitment and retention in the health services, cadet schemes--predominantly in nursing--have proliferated over the last few years. As part of a larger national evaluation of National Health Service (NHS) cadet schemes, this paper reports on a survey of senior cadet students across 62 cadet schemes in England and examines their experience of being a cadet on such a scheme. Cadets forming the most senior cohort from each of the 62 schemes (n = 596) were surveyed using a questionnaire. The questionnaire included self-rated measures of job satisfaction, job stress and commitment. A 5% sample of these cadets participated in follow-up telephone interviews. Cadets reported high satisfaction with their courses. One of the most positive aspects of the schemes was the first-hand experience of working in the NHS they provided, whilst also giving cadets the opportunity to gain recognisable skills and qualifications. Cadets scored highly on the job satisfaction scale and, on the job stress scale, showed low stress overall. A significant positive correlation was found between satisfaction and stress, indicating that the cadets who are most satisfied are also more highly stressed. A negative correlation was found between stress and the dimensions of commitment indicating that those cadets who are stressed are less committed to the NHS. A negative correlation was also found between satisfaction and the dimensions of commitment, suggesting that commitment to the NHS is not contingent on high satisfaction. The implications for the findings of the survey are discussed.