The Care Quality Commission (CQC) (2023) defines the independent (private) healthcare sector in the UK as any provider of health, or residential nursing care, that is not part of the NHS or a GP service. The UK has a long history of blending and blurring private health services and/or education with that of state systems.
There are five private universities in England. These are Arden, Buckingham, BPP, University of Law, and Regent's University London. Of these, BPP provides pre-registration nurse training.
Student nurses receive their theoretical education in higher education institutions (HEIs). Students then demonstrate their acquired competencies by applying their knowledge and understanding in delivering care in various healthcare settings, some of which will be in the independent sector. The NHS and the independent sector often work in a complementary way to provide services based on population need. The NHS will commission beds in the independent sector to reduce long waiting lists. HEIs will have contracts with independent providers of health care for pre-registration nursing education clinical placements. This partnership working has been extended due to the advent of nurse training by apprenticeships in that the apprenticeship levy is being used to commission independent HEIs, and state HEIs, to develop healthcare organisations' own healthcare assistants and healthcare support workers into registered nurses, or in England to become nursing associates.
Does it matter where or how a registered nurse is trained? The traditional 3-year direct entry route, versus the 4-year part-time apprenticeship route, and the 2-year training for nursing associate status available in England, can provoke debate. The journey to registration status might take a different route, but the end goal of delivering nurses who are critical thinkers and safe practitioners displaying competence and compassion is paramount, irrespective of the sector in which they are employed, or the organisations in which they are undertaking clinical placements. The Nursing and Midwifery Council (NMC) has set standards for the required proficiencies for pre-registration students (NMC, 2018a; 2024).
In all organisations associated with health care it is the core components of clinical and educational governance that underpin quality assurance in the service. Current evidence-based practice must be delivered, and organisational policies and procedures must reflect this. A robust infrastructure of risk assessment and risk management must be present to assure patients, students and staff of a safe environment in which high-quality care is provided. The NMC Code (2018b: 20.8) expects all registered nurses to act as positive role models of behaviour for students and new registrants and this applies to all of us, irrespective of our work setting. In principle, therefore, there should be no discernible differences in the quality of care each patient receives, or each student experiences educationally.
So, what is the difference between working in the independent and state sectors? For HEIs, the government does not subsidise students' tuition fees in the independent sector. Independent HEIs tend to have smaller student populations and often specialise in specific fields of study. Public HEIs tend to focus on research and have links with industry and the local community. For all HEIs, there must be adherence to the required national accreditation and evaluation processes. The awarded degree must be recognised by employers, and other educational institutions. Regarding employment, there might be differences in terms of pay and employment conditions, including pension rights and payment relating to sick leave. For anyone contemplating studying or working in any organisation it is advisable to take the time to arrange an informal visit to see that what is on offer meets personal requirements, and that the individual feels comfortable in the environment. Additionally, check the educational or employment contract for the terms and conditions of the organisation and that these meet expectations.