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Graduate professions

Arguably it is all Lionel Robbins’ fault.

Lionel Robbins (1898-1984) was head of the economics department at the LSE. He wrote a highly influential report at the beginning of the 1960s advocating a massive expansion in the number of UK universities.

The most astonishing part about the report, looking back at it, is how few universities there were at the beginning of the 1960s:

Technically, London University was a single university back then because the degrees were all awarded by the University, not by the Colleges, even though they did their own teaching and set their own exams. Today, we would talk about University College, Imperial College, Kings College, Birkbeck, LSE and Queen Mary’s plus a dozen minor entities not all of which were affiliated to LU in 1962. But there were only 14 “redbrick” universities (which Robbins called Older and Younger Civic). So the total number of universities has increased by about a factor eight to the current two hundred or so.

There were just over a hundred thousand students at the universities, so about thirty thousand graduated a year with a reasonable degree, maybe twenty thousand if you demanded a 2:2 or better. This was a fairly small number, so they tended to get the best jobs.

Getting a 2:1 or a 2:2 was not particularly demanding for the best students, unless you wanted to stay on to do research, which few did. So viewed from the outside it was fairly magical. You had an enjoyable time for 3 years, not working that hard, with lengthy vacations and then you ended up walking into one of the best jobs.

It would not have been surprising if all teenagers had seen university as something they wanted too. But I am not sure it happened that way. Some muddled thinking led to the idea that it was in the national interest to expand greatly the number of universities. As that was gradually implemented, so more and more teenagers began to see “going to uni” as their birthright.

The snag should have been obvious. The concept of a university is that the students are taught by active researchers. That is an excellent way of identifying and recruiting more researchers, but it is also an excellent form of education for the brightest students. They are taught not simply facts and techniques, but how those facts and techniques were found and how they fit into the broader span of human knowledge. In other words, they are taught to think. The hope is that that will have more lasting value than a mere set of facts and techniques which may fade dramatically in importance over the following decade.

It follows that there are two indispensable requirements for a good university: excellent researchers and the brightest students. But both those are in limited supply. The nature/nurture argument goes back and forth. I would read the current evidence as showing that both are important, so to be in the top 10% you need both good genes and a good education, or conceivably truly excellent genes (but a mediocre education) or a truly excellent education (but mediocre genes). But the exact truth hardly matters: quite obviously both good genes and good schools are in short supply, so only 5-10% of 18 year-olds are likely to benefit from a university education.

One can argue about whether it is 5% or 15%, but it is clearly not 30% or 50%. The fact is that vast numbers of students today have no prospect of deriving any serious benefit from a university education.

Similarly, one only has to spend a few days scanning the academic journals to realize that most researchers (not just those in the UK) are not doing useful research. Indeed whole fields of knowledge are now just junk. [That was the theme of Damian Thompson’s Counter-Knowledge, which I reviewed here.]

This is far from humorous. Our teenagers are being conned. They are being encouraged to spend three years of their life completely wasting their time. Of course, they do not need much encouragement. Many of them have grasped that “uni” is basically a holiday camp, best complemented by a gap year before and another after. That way they can put off the tiresome business of slaving away in a boring job for at least 5 years. The taxpayer is being conned. This nonsense was sold as vital for the UK to maintain its place in a rapidly changing technological society. Instead it is hugely expensive, and keeping vast numbers of people out of the work force to no good purpose. Moreover, it is giving them inflated ideas of their worth. As graduates they expect something more than stacking shelves at Tesco or serving as a waiter in a restaurant.

Unfortunately, that is not the end of the disaster. Many professions have now decided to increase their status by becoming graduate professions. The most disastrous case is probably nursing.

Nursing covers a wide range of jobs. Nurses who are part of the surgical team in a demanding modern specialty such as heart transplants clearly need advanced training. It is much less clear that a nurse on a geriatric ward does. The job there is probably 90% basic care, such as helping patients to eat or visit the lavatory. Moreover, there are a large number of nurses, so the profession has its own management structure with sisters and matrons (or ward managers in the modern jargon). Again more competence and skill is required to be a matron than a junior nurse.

This used to be reflected in SENs and SRNs. A “State Enrolled Nurse” was mainly trained on the job by more senior nurses. She was a second-class nurse, not qualified to promotion as a matron, but nonetheless highly competent at the nursing she did. The “State Registered Nurse” was more elaborately trained with umpteen exams to pass. Project 2000 was established in 1984 to get rid of such antiquated nonsense and turn nurses into properly qualified graduates who learnt their profession in a university classroom, not in a hospital.

This had predictably disastrous results. As graduates, nurses were not keen on tiresome low-skilled work like feeding elderly patients. Of course, they were also not particularly competent at it, having focussed their attention whilst training on more highfalutin matters. That, and budgetary pressures led to the recruitment of “healthcare assistants”, who appear to have minimal or zero training.

All this was brought to mind by the suggestion a week ago from the Royal College of Nursing (RCN) that relatives should turn up to hospital wards on a regular basis to feed their aged relations, since nurses were too busy. I was in two minds whether this was just a ploy to stir up public support for more nurses – or at least to avoid the threat of budget cuts – or whether it was a serious suggestion.

There is certainly an argument that caring for the old has become a serious drain on the public purse. There have been several studies coming up with alarmingly high figures for the proportion of all NHS cost devoted to those in the last six months of their life. Of course, one does not know that it was the last six months until they die, so it is hardly a useful guide for what treatment to give the individual patient. [Irritatingly, I cannot now lay my hands on such a study, but the NICE recommendation is that one should not spend more than £22k to gain 6 months of life, and that implies one certainly should not spend more than £22k on someone in their 6 months. Suppose, however, that was in fact the average expenditure. About 0.75M people die a year, so that gives about £16 billion, out of a total NHS budget of about £100 billion, or 16%.] It does, however, suggest that we should be focussing more on hospice type care for those who are clearly getting close to death.

But the major cost of caring for the elderly is nursing time. If you go back 50 years, most old people were cared for by their families. In practice, that probably meant that most women could look forward to spending the first half of their adult life caring for their children and the second half caring for their parents. Women now want more varied careers, but the snag is that the cost of a carer is similar to the average wage, which means that a wife’s earnings will typically not pay for someone else to do the caring, so it has got dumped on the NHS and local authority social service departments.

How we afford this as a nation is clearly an issue. But I find it fairly irritating that RCN wants to wash its hands of the matter. Nursing clearly needs a major shake-up.

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