Background
The Department of Health (England) (DH), in partnership with the Nursing and Midwifery Council (NMC), Health Professions Council (HPC) and the Workforce Development Confederations (WDCs)/Strategic Health Authorities (SHAs), has contracted with the Quality Assurance Agency for Higher Education (the Agency) to carry out reviews of all NHS-funded healthcare programmes in England during the period 2003-06.
The reviews will consider all pre-registration, post-registration and continuing professional development (CPD) taught programmes (from undergraduate to professional doctoral level) in nursing, midwifery, health visiting, and allied health profession programmes where the NHS funds the majority.
The development of the Major Review methodology has reflected the partnership ideology that exists in the delivery of healthcare programmes and has had input from DH, the WDCs/SHAs (as commissioners and partner placement providers), the HPC, the allied health professions bodies, the NMC as well as a large number of representative bodies, practitioners, and academics. All these organisations and people have worked together to minimise duplication, reduce overlap between the organisations’ quality assurance activities and promote appropriate links with the different quality assurance activities or requirements.
The draft methodology was tested and revised based on the evidence/evaluation of six prototype reviews carried out in 2001-02. The two evaluation reports undertaken by the Agency and an independent evaluator, commissioned by the Department of Health (England), can be found on the example and evaluation reports page.
The DH has recognised the need to integrate and streamline the quality assurance mechanisms that exist currently in healthcare higher education and are often deemed as burdensome for higher education institutions (HEIs) and their partner placement providers. Major review is the first step in this integration process and is one element of the National Quality Assurance Framework (see figure 1 below).
Figure 1 Five Elements of the National Quality Assurance Framework (Department of Health 2003) 1
The purpose of Major Review
The purpose of Major Review is to provide assurance that healthcare programmes produce practitioners who are safe and competent to practice and who are equipped to work in a patient-centred health service.
Major Review focuses and builds on existing internal quality assurance arrangements and existing documentation and data, and in doing so contributes towards statutory bodies fulfilling their requirements for the protection of the public. Major Review will also encourage, through the identification and dissemination of good practice, improvements and facilitate enhancement in quality of education provided, assure the DH, the NMC, HPC and WDCs/SHAs that the programmes they fund are of approved quality and that the provision is fit for purpose, fit for practice and fit for award. Finally, Major Review will provide effective and accessible public information on the quality of higher education in the healthcare professions.
In the year of Major Review, NMC annual monitoring will be incorporated into Major Review. The NMC Visitor in these cases will form part of the review team and will draw on the evidence base to write an NMC Visitor’s Monitoring Report.
Full detail of Major Review can be found in the Handbook for major review of healthcare programmes.2
Principles of Major Review
Major Review is based on peer review, carried out by specialist teams of professional peers from both academic and practice backgrounds, resulting in judgements on the standards and quality of NHS-funded healthcare programmes and the quality of learning opportunities however and wherever delivered ie in practice and academic settings. Therefore, Major Review will require a high degree of openness, transparency and trust between HEIs, partner placement providers, their staff and the review team.
Peer review enables judgements to be made by those who understand the healthcare programmes under scrutiny and who are familiar with teaching and learning processes. It enables transparent judgements to be credible to subject providers, to safeguard the public interest in sound standards of higher education qualifications and to encourage continuous improvement in the management of the quality of higher education.
The focal point of Major Review is the self-evaluation undertaken and endorsed by the HEI in partnership with the practice placement providers/WDCs/SHAs in advance of a review. The self-evaluation document (SED) draws on existing documentation/data, relating to both the academic and practice environments. The production of new data for the purposes of Major Review is not expected.
Review activity
A review normally happens over a period of six weeks, with five visit days to the HEI and partner placement providers. Reviewers analyse the SED and explore evidence to verify or support the claims made in self-evaluation document.
The timing of the review is scheduled by the Agency using specific criteria after the HEI and WDCs/SHAs complete a scoping and activities forms that outline the size, range scope of the provision, identifies the commissioning WDCs/SHAs and other quality assurance activities conducted by the professional bodies, the statutory and regulatory bodies and the WDCs/SHAs. All dates for the visits are confirmed when the review is scheduled.
Review teams
Review teams are made of up registered practitioners, from practice and academic backgrounds, and nominated by various stakeholders 3, 4, 5. The teams are led by a (non-subject specialist) review co-ordinator who will manage all aspects of a review including liaising with the HEI and practice placement providers via the Major Review facilitator (an individual nominated by the HEI) and practice review facilitator (an individual nominated by the WDC/SHA) respectively. The number and type of reviewers reflects the size, range and complexity of the education provided. The size of the review team is normally a maximum of eight reviewers at least one review from each discipline and normally one practitioner and one academic. Teams are allocated according to the published criteria and as far as possible, within the resources available; the Agency will match the expertise of the team with the broad specialisms of the subject provision under scrutiny.
Where a review incorporates programmes that are part of NMC annual monitoring the review team will include a NMC Visitor/s with due regard to the relevant part of the NMC register. All Visitors are full members of the review team as reviewers.
External reference points
During the visit, reviewers use a series of external reference points including: NHS policies, SHA/WDC guidelines, subject benchmark statements, the emerging health professions framework, professional and other statutory/regulatory requirements and practice initiatives such as the National Service Frameworks. Other reference points include programme specifications, the Framework for Higher Education Qualifications (FHEQ), and the Agency's Code of practice for the assurance of academic quality and standards in higher education, especially the sections on placement learning and programme approval, monitoring and review.
Judgements
Reviewers make a judgement about the academic and practitioner standards set and demonstrated in the programmes for each of the professions delivered by the providers. The reviewers consider in essence:
- whether there are clear learning outcomes that have been set appropriately in relation to the qualifications framework and the relevant subject benchmark statements and the relevant professional requirements;
- whether the curriculum is designed to enable the intended learning outcomes to be achieved;
- whether assessment is rigorous, equitable and consistent in measuring achievement of the outcomes; and
- whether student achievement matches the intended outcomes and the level of the qualification.
In the light of this, reviewers state whether they have:
- confidence in academic and practitioner standards (a judgement that is made if reviewers are satisfied with current standards and with the prospect of those standards being maintained into the future); or
- limited confidence in academic and practitioner standards (a judgement that is made if standards are being achieved but reviewers have doubts about the ability of the institution to maintain them into the future); or
- no confidence in academic and practitioner standards (a judgement that is made if reviewers feel that arrangements are inadequate to enable standards to be achieved or demonstrated).
For each subject area in an institution, judgements about the quality of learning opportunities offered to students are made against the broad aims of the provision and the intended learning outcomes of the programmes.
Reviewers have looked at:
- the effectiveness of learning and teaching, wherever and however it takes place - in relation to curriculum content and programme aims;
- student progression - recruitment, learning support, progression within the programme;
- learning resources and their effective utilisation - the adequacy of the library, equipment, accommodation, placement facilities and staff.
Each of these three categories is judged as either:
-
commendable - provision contributes substantially to the achievement of the intended outcomes, with most elements demonstrating good practice; or
-
approved - provision enables the intended outcomes to be achieved, but improvement is needed to overcome weaknesses; or
- failing - provision makes a less than adequate contribution to the achievement of the intended outcomes; significant improvement is required urgently.
If reviewers had no confidence in the standards achieved or if they found that any aspect of quality of learning opportunities was failing, then that part or all of the provision would normally be subject to a further formal review within one year. Major Review recognises that a judgement of no confidence will have implications for the statutory regulatory and professional bodies and the WDCs. Protocols are in place to ensure all partners in Major Review will be made aware of the judgements reached.
Review reports
Based on the evidence gathered and judgements made by the review team a report of the review is written. The HEI and practice placement providers have the opportunity to comment on the accuracy of the report prior to publication.
The production of the Major Review report is not the final stage of the review process. The HEIs and partner placement providers prepare an action plan setting out the actions they will take to build on the strengths identified by the review team and to address any weaknesses in need of improvement. The action plan is published with the review report and provides the focus for on-going quality assurance activities in which the HEIs, WDCs/SHAs, professional statutory and regulatory bodies and the DH will have an interest.
At the end of each year an annual report will be produced and published highlighting the trend emerging from the review reports, including good practice.
Summary
The outcomes from Major Review are:
- confirmation that publicly-funded education is of approved quality;
- speedy identification of major shortcomings in the quality of education where they occur, so that rectification can take place;
- judgements about the standards and quality of education;
- sharing of good educational practice to encourage improvement in provision;
- published reports that provide accessible public information about the quality of higher education in the healthcare professions;
- used to inform and be informed by on-going quality monitoring and enhancement, and approval.
1 Department of Health (2003) Streamlining quality assurance in healthcare education: purpose and action. See the Department of Health web site.
2 Quality Assurance Agency for Higher Education (2003) Handbook for major review of healthcare programmes.
3 Reviewers must be registered practitioners because major review is a new method that includes reviewers going into practice areas and gathering evidence on practice and learning in practice. Reviewers and the review report need to be able to reflect and evaluate the fitness for practice required by the regulatory bodies and the other WDC requirements.
4 Those wishing to reviewers may self-nominate
5Each reviewer nomination is screened by the Agency against the person specification and only those who pass through screening and complete successfully a 3-day training programme will be invited to be reviewers
Top
QAA updates
QAAtweets
QAAtube