The Great University Con

by David Craig

  Expansion has diluted the undergraduate experience for nearly all students. The brightest are not being tested or stretched by their study as they would have been prior to expansion. Moreover, the massive inflation of degree classifications has made it much more difficult for employers to differentiate between the good and the outstanding graduate. In 2012, Personnel Today commented on a survey of 182 graduate employers which found that:

  “... many employers faced barriers when trying to recruit graduates, with poor–quality applicants cited as the biggest problem. Four–fifths (80%) of those surveyed said they faced difficulties recruiting graduates due to a lack of skills, knowledge or the attitudes of the candidates. The findings are similar to a recent survey from the Association of Graduate Recruiters, which found that one–third of employers had failed to meet their targets on recruitment in 2010–11 because of a lack of candidates with the right skills.”

  Perhaps the single most worrying symptom of this disconnect between universities and employers is that UK universities are even struggling to provide the requisite calibre of graduate that they would employ themselves. Many of the elite research–intensive universities are increasingly looking for research students (graduates) in STEM subjects from overseas. In other words, they are not happy with their own product. A 2011 Higher Education Funding Council for England report noted that:

  “...the number of international students studying taught postgraduate STEM courses has almost doubled in eight years. However, for home students the rise was just 1 per cent. In mechanical engineering, international student numbers grew from 22 per cent of the total studying population in 2002–03 to 54 per cent in 2009–10. The numbers of postgraduate research students in STEM courses followed a similar trend. There was a 23 per cent increase in the international student population between 2002–03 and 2009–10, while the number of home students fell by 2 per cent.”

  In 2009, the Institute of Physics noted in a submission to the House of Commons committee on universities that European universities now regard UK Masters degrees as inferior in content and structure to their own Masters degrees: “Europeans do not consider our Masters programmes to be at a comparable level to their own Education.”311

  Ultimately, if UK universities are not prepared to demonstrate faith in their own outputs, then why should they expect other UK employers to do so? Moreover, as far back as 2001, the Wellcome Trust (the research council responsible for medical research) articulated the fears of its members in a report:

  “Senior scientists yesterday criticised the ‘massive dumbing down’ of UK degree courses, which they say has made graduates ill–prepared for research. Many university supervisors are turning to students from the rest of the European Union who, they say, are better qualified and better motivated.”312

  The report went on to criticise the research skills and knowledge that UK undergraduates developed during their time at university: “Many UK students are thought to finish their first degree with little or no relevant individual, practical research experience and were felt, therefore, unlikely to be able to complete a substantial piece of high–quality individual research within three years.”313

  All in all, these problems do not constitute a resounding and enthusiastic vote of confidence from either potential employers or the universities themselves in the quality of graduates being produced by British universities following the Great Expansion.

  Graduate nurses

  One other issue resulting from the rush to get as many people as possible into Uni and on to degree courses has been the move to change some occupations from vocational training–based to becoming degree–based. Nursing is a good example of this. Nursing degrees have been one of the main subject growth areas during expansion.

  In 1986, under Project 2000, the NHS started moving nurse training away from hospital–based schools into colleges and universities. The next change was that nursing started to morph from being a (often 18–month) diploma qualification to becoming a 3–year degree. Then in 2009, the Department of Health announced that by 2013 it would require all new entrants into nursing to be graduates. The profession is critical to the nation’s health and there is a wealth of statistics with which to compare healthcare during the period when nursing moved away from the practical, hands–on focus of hospital–based schools to a more academic approach first in college diplomas and then to an even more academic university degree. Consequently, nursing provides a useful lens for analysing the supposed benefits brought by more increasingly academically–educated people into the workplace.

  The prospect of nursing becoming graduate entry did raise concerns within the NHS that it would restrict the number of people entering into the profession and eventually lead to staff shortages similar to those experienced in the 1990s and 2000s. But the change was strongly supported by the Nursing and Midwifery Council, possibly because they saw this as a way of enhancing the status of nursing.

  At first the necessity for nurses to have a degree wasn’t too much of a problem as, until 2017, nurses were given bursaries to help cover their tuition and living costs. But in 2017, these bursaries were abolished and student nurses were forced to take out loans just like most other students. The result was an immediate drop of 23% in the number of people applying to study nursing. Given the relatively low earnings profiles of nurses, it is easy to see how the prospect of incurring tens of thousands of pounds of graduate debt could act as a serious disincentive for potential entrants to the profession.

  If we believe that college–based diplomas and then university degrees provide more skills, more knowledge and create a more effective workforce as was claimed by the NHS at the time when nursing became a college–based diploma and then a degree subject, we should expect to see some form of improvement in the running of hospitals and particularly in the outcomes for patients from more nurses having college diplomas and then degrees. But there appear to be few such positive changes for patients following the introduction of college– and university–educated nurses. There have been no major news stories from successive governments to highlight dramatic decreases in mortality rates or massive increases in the quality of care within hospitals. It is a reasonable assumption that, if there had been, politicians would have been very quick to claim credit for these successes.

  What politicians were less keen to discuss during expansion was the rise in hospital–acquired infections. In his 2009 book Squandered David Craig noted that the UK had: “... about 300,000 cases of hospital–acquired infections each year, about 50 times higher than some other European countries.”314

  Two of these infections, MRSA and C Diff are potentially fatal. Statistics showed huge increases in the numbers of patients contracting them and in the number of fatalities resulting from them. Full information on both conditions is limited, but estimates suggest that the number of MRSA cases doubled between 1997 and 2004, when they reached over 7,200 a year. We can see a similar pattern with MRSA fatalities, in 1997 MRSA killed around NHS 250 patients, by 2006, this figure was closer to 1,500. In 2001, the NHS reported fewer than 20,000 cases of C Diff contracted in its hospitals. By 2005/06 this had reached nearly 55,000 cases. In 1999, C Diff fatalities in the NHS were under 1,000 per year; by 2006 they were over 4,500. Moreover, these figures are likely to be underestimates due to the political pressure that was put onto hospitals to under–report both cases and fatalities as the scale of the problem started to be covered by the mainstream media. Several newspapers subsequently reported that deaths, which could be attributed to other causes were, to reduce this media pressure on hospitals.315

  The main issue in the growth of hospital–acquired infections was a lack of basic cleaning within wards. At one point, the situation was so dire that even someone like Claire Rayner CBE, a former nurse, President of the Patients’ Association and prolific writer on health matters, twice caught MRSA in dirty NHS hospitals. She described her experiences in one hospital:
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  “The dust in the corner of the ward just got worse and worse. It was disgusting. Bedpans were left at the side of the bed for God knows how long. Nobody tidied up. It was a depressing and dirty place …there was a piece of dressing on the floor which I noticed when I was admitted. It was still there when I was discharged.”316

  The eventual solution was to subject hospitals to a so–called “deep clean”.

  Some commentators have since suggested that college–educated and university graduate nurses, with an emphasis on theory rather than practical skills, were a contributory factor to declining standards of cleanliness during this period. A former intensive care nurse, Rona Johnson, linked the two areas in the Daily Mail in 2009:

  “... many ‘graduate’ nurses feel they are too superior to clean floors and change beds. As a result, the incidence of lethal hospital infections is going through the roof. Indeed, many patients would be horrified by how today’s nurses even ignore essential routines such as regular hand–washing….. Student nurses were removed from the hospitals and trained in lecture halls, rather than wards. Many less glamorous but vital elements of nursing care – such as cleaning dropped off the syllabus and were replaced by empty, jargon–filled theorising about ‘holistic care’ and ‘cultural sensitivities’.”317

  This may be a controversial view. But what is clear is that the introduction of more academically–educated nurses certainly had no discernible positive impact in preventing the spread of hospital–acquired infections. The net result of these infections was that tens of thousands of people acquired serious illnesses, or even died, rather than being cured as a result of going to hospital.

  Other problems within the NHS have included ongoing concerns about the neglect of patients (especially the elderly) on NHS wards. The most publicized case was at Mid–Staffordshire: “A secret inquiry held last year found between 400 and 1,200 patients died after suffering routine neglect by hospital staff between 2005 and 2009.”318

  National surveys have revealed a depressingly similar picture across the NHS, suggesting that the true number of patients who suffer neglect is more than 200,000 per year. When patients are asked for their views on their treatment, their response is often highly critical. Katherine Murphy, the chief executive of the Patients Association, had this to say: “... patients should not be left starving or thirsty, they shouldn’t be left in pain and they shouldn’t be forced to urinate or defecate in their bed because the nurse designated to them says it’s easier for them to change the sheets later than to help them to the toilet now. Yet this is what is happening around the country every day.”319

  One of the most harrowing accounts of the dirty conditions and poor patient care in NHS hospitals was given by Midlands housewife Amanda Steane in her book Who Cares? recounting how her husband eventually committed suicide after being horrifically disabled as a result of repeated neglect in several badly–managed and dirty NHS hospitals. In her book she describes seeing patients unable to eat their food because it had been placed out of reach and then taken away uneaten, unable to drink water, again because it was placed out of reach, and lying for hours in soiled beds while graduate nurses chatted to each other about their social lives, love lives, their pay rises and other similarly important issues. Again to quote Claire Rayner: “The food was served by catering staff, instead of nurses, and we barely got time to eat it before the tray was taken away.” Why this poor care should be the case when many nursing degree courses boast that they “offer a person–centered approach, offering holistic care for the individual and their family” may remain forever an unsolvable enigma.

  There is one further consequence of this upskilling of nurses. Nurses are increasingly taking on jobs, which previously would have been done by doctors. At the same time, care assistants are picking up some of the more menial tasks that used to be done by nurses. It’s not always obvious that these changes benefit patients. For example, one of the authors suffered a very minor stroke in April 2018. After a couple of hours in A&E, the author was ‘assessed’ by a specialist stroke unit nurse, rather than a qualified doctor. The nurse concluded that the author hadn’t had a stroke and he was eventually sent home. When the author saw a neurologist five days later, it took the neurologist probably less than two minutes to confirm that the author had in fact suffered a minor stroke – a diagnosis that was confirmed by an MRI scan seven days after the neurologist’s assessment. Though by then, the 6–hour window for treating the minor stroke had long since passed. NHS guidance is that all patients suspected of having a stroke should be scanned within one hour of arrival at the hospital, not almost twelve days later. This might indicate either that our supposedly more qualified nurses are being asked to do work that is beyond their competence levels or else that they are so confident in their own knowledge and abilities that they don’t ask for help from a more qualified person when they should.

  The filthy wards, the rise in hospital–acquired infections and the wrong diagnoses may not be entirely the fault of college–educated and graduate nurses. But neither are they a ringing endorsement of the contribution to the NHS as a result of nurses’ increasingly academic qualifications and university degrees. This raises the question as to how successful an academic qualification, such as a college–based diploma or a university degree, can be in imparting a practical, rather than a theoretical, understanding of care for patients. In 2011, the Telegraph commentator Christine Odone made exactly this point:

  “A senior executive of a care charity told me, off the record, how he rued the day that degrees became compulsory for nurses. The move professionalised what had hitherto been a vocation. Until that point, only those truly dedicated to soothing fevered brows and administering TLC joined the nursing ranks.”320

  The high stakes involved in national healthcare provide a graphic illustration of the effectiveness (or not) of a more academically–educated often graduate work force. With other industries and sectors, it is not so easy to isolate their obvious successes or failures. But it is worth asking the question though: has the mad scramble to hand out university degrees like confetti led to any other examples of workplace problems which have been created or worsened by the shift towards a (usually heavily–indebted) graduate workforce?

  CHAPTER ELEVEN: WHAT ABOUT THE ECONOMY?

  Whenever arguments are made about how expansion boosts national economic performance, we rarely hear anything about the costs or the disadvantages of expansion. If we were to believe politicians and university leaders, every pound that has ever been spent on Higher Education has been an extraordinarily wise investment.

  We have already seen that this is untrue at the individual level. Many graduates will achieve little or no return on their investment and increasing numbers will incur a massive liability and falsely–raised expectations from their degree. The same is true at the national level. Some money spent on Higher Education is well spent. Much though has been wasted on substandard degrees in pointless subjects at third–rate or worse institutions, poor teaching and oppressive bureaucracy.

  The current system incentivises universities to accept students who are not likely to benefit in terms of learning, earnings or employment prospects. As a result, it encourages expansion regardless of the cost to graduates, parents or taxpayers. Exactly where the lines between solid investment and squandering are drawn is subjective and should leave room for a genuine public debate. For the last thirty years, however, the very idea of lines or even a debate at all has been largely ignored. Despite this absence, those three decades have still produced plenty of data with which we can now measure the economic contribution of expansion.

  Much of the literature on Higher Education spending is published by universities, or by those employed within universities, hardly the most neutral and disinterested voices. This literature generally offers little more than an encomium to the immense economic value of said investment. It seeks to extol rather than explain and off
ers the critical impartiality that one would expect from any corporate public relations material.

  A different perspective was provided in a 2009 report by the Adam Smith Research Trust entitled The Broken University. In this report, James Stanfield approached Higher Education spending using the idea of “what is seen” and quantified by the traditional literature and “what is not seen” or the hidden costs of this expenditure:

  “... when a government spends £14.3 billion, those receiving these funds are clearly going to benefit ... Experts are then tasked with attempting to measure how much everyone benefits ... and this is identified as a positive gain. What is not seen is that because the government makes no money of its own, for every £1 it spends it must first remove at least £1 from the taxpayer’s wallet. Therefore, when the government spends £14.3 billion on Higher Education, taxpayers are forced to spend at least £14.3 billion less in their local community.”321

  This point is never addressed in the publications extolling the value of Higher Education – that government spending can only occur through taxation, and that this taxation inevitably means that the taxpayer has less money to spend. The Broken University continues:

  “It is therefore meaningless to claim that £14.3 billion public investment in Higher Education has had ‘a direct economic impact on the UK economy’ or that its impact has been ‘substantial’ and ‘very important at the macroeconomic level’, without also acknowledging that removing £14.3 billion from taxpayers’ wallets will also have a substantial economic impact.”322