Student Support in Times of Diminishing Resources in the School of Health and Social Care



In 2005 a Review of student support in the School of Health and Social Care was initiated by the School’s Senior Management. The trigger for the Review was the anticipated change introduced by the Department of Health to provide a national rather than local funding framework for NHS education provision in HEIs and the threat of reduced commissions. It was predicted that these factors would lead to a significant fall in School income and subsequent reduction in staff. Thus the Review of student support was one of a number of initiatives set up to enable the School to cope with the impact of the anticipated reduced income. The aim of the Review, undertaken by the School Teaching Learning and Assessment Committee, was ‘to review the strategic and currently utilised approaches for student support in terms of their effectiveness and efficiency in order to recommend changes’ and the objectives were to:

  1. Identify current strategies, approaches and resources used for student support.
  2. Identify and share creative approaches and good practice, in particular those resulting in savings in time and resources.
  3. Identify new strategies and modules from a variety of sources, including discussion, other Schools/HEIs and the literature.
  4. Explore the implications on staff, resources, students and partners of a range of strategies and approaches.
  5. Identify the interface with other support resources and determine referral points and processes.
  6. Make recommendations based on the strategies and modules that are efficient and effective.

Of particular concern to the School were the proposed attrition penalties in the new national funding framework and possible increase in attrition within the School, if the reduction in resources meant that there were fewer resources for student support. Although calculation of attrition rates is fraught with difficulty it appears that attrition within nursing education is comparatively high. It was reported by the BBC that a survey undertaken by the Nursing Standard discovered that ‘Out of 19,995 nursing students who began degrees or diplomas expecting to finish in 2004, a total of 4,956 student dropped out – an overall attrition rate of 24.8%.’ (BBC News, 15February 2006). National attrition rates for all full-time first-degree students for the equivalent cohort is 21.6% (National Audit Office, 2007). Although the equivalent rate for the School of Health and Social Care was 17.25% it was clear that it was important, in the Review, to establish the nature of the links between student support and attrition and that any changes arising from the reduction in resources did not lead to an increase in student attrition.

Whilst the views of some were that the reduction of resources would inevitably lead to a deterioration of quality, the alternative perspective was that the Review would identify practices that could be changed to maintain and enhance quality by doing things differently.

The majority of students within the School undertake a proportion of their programme in practice placements, and therefore, in addition to the core student support activities identified in University documents on student support, Health and Social Care students also need support in relation to working in partner organisations, working with a range of professionals in different roles and integrating theory and practice.

The Student Support Review

In undertaking the Review, the Committee recognised the need to include the student perspective but also acknowledged the difficulty in receiving messages from students who fail or leave. It therefore sought to integrate student views through referring to literature rather than directly communicating with student groups. Student feedback through standard feedback processes, i.e., module and programme feedback systems, were used. The views of staff were integrated through the use of focus groups that responded to a standard proforma of questions about student support.


The Review discovered many examples of good practice but also a number of issues for attention, including the following:

The confusion of roles and responsibilities in relation to student support

It is not always clear to students to whom they should go for support. For some aspects of support there may be a number of possible staff who can be approached whereas for other issues it may be less clear who is responsible.

The impact of change (becoming a student) was underestimated in some instances

The process of becoming a student varies considerably for applicants, and it is challenging for staff to anticipate and accommodate the needs of a wide range of people taking on the role of student. Customising induction and semester one activities to meet the needs of disparate groups and individuals, in order to increase the likelihood that they will be engaged in the learning process, is complex and time consuming.

Resources for supporting students were poorly targeted and tended to be reactive

Central to this issue is the model of staff–student contact that the University, School and programmes adopt. An open-door, surgery approach based on an adult learning model was a common model adopted by a number of programmes where students make informed choices about when they need to consult a tutor or member of staff. This model may meet the needs of students who are engaged in the learning process but students who are disengaged for whatever reason are not necessarily well served by this model. ‘Self-referral, notes Anderson (in Simpson, 2005:42) does not promote retention. Students who need help the most are the least likely to seek it.’ This model can also lead to inefficient use of staff time if several students individually seek verbal confirmation about core information which is or should be available elsewhere.

Methods of providing core information to students vary and in some instances were inefficient

Students require a wide and varied range of information during their time as students, and access to this in terms of timing and quantity needs careful management. The integration of new information systems, e.g., virtual environments, e-mails and websites into traditional methods such as student handbooks and notice boards, occurred in an ad hoc way and sometimes lacked the required overview of the management of the information.

The findings from the focus groups indicated that although staff worked within the University framework for student support in terms of their roles and responsibilities and there was some innovative and effective work being carried out, there was little strategic input regarding the purpose and aim of the support provided and there was evidence of significant differences in the quality and quantity of support offered across the School.


Exploration of McNay’s (Ramsden, 1998:31) management models within Higher Education provide a useful framework to understand this situation. McNay uses a model that identifies the degree of ‘tightness’ or ‘looseness’ across the two dimensions of policy definition and control over implementation.

The finding of the focus groups suggested that in McNay’s terminology ‘a Collegium organisational model’ existed where a loose degree of policy definition and control over implementation existed. The autonomy and authority regarding how and when student support is provided had been passed to individual members of staff. Quotations from the focus group feedback about the amount of support offered by staff included statements such as ‘as much time as was necessary’ illustrate this point. In this model, management take a passive, permissive approach. Whilst resources were relatively plentiful and external quality indicators positive, e.g., levels of attrition, there was little incentive to change this position. However, the prospect of reduced funding raised concerns about how quality and consistency of provision could be overseen if it was left to individual members of staff to decide how much support students were offered during a period of contraction.

In responding to the external funding changes it was recognised by the School Senior Managers that a shift from a Collegium to a Corporate model culture (in McNay’s terms) where both policy definition and control over implementation was tighter, was necessary. This would result in policy and resource allocation and use being determined centrally by senior management, and overall the focus of student support would be efficiency, quality and factors such as attrition and quality of the student experience.

The alternative ‘Bureaucratic or Enterprise’ positions presented by McNay, where either policy definition or control of implementation were ‘loose’ were, given the changes in funding, less acceptable because of the need for the School to tighten control over policy and implementation.

A key aspect of this new directive approach was that the School’s strategic direction for student support be informed by evidence-based practice from a number of sources and overseen by the School Senior Managers. Much of the evidence examined (Krause, 2005; Clift, 2003; Taylor, 2005; Tinto, 2005) emphasises the need for Universities to recognise and respond to the issues around individuals taking on the role of student and for support to be directed towards facilitating a successful transition and first year. This need for responsiveness is particularly important as Universities are accommodating an increasingly broad range of students from different ethnic and social backgrounds through widening participation initiatives.

Taking this into account together with the need to maintain or enhance levels of effectiveness as resources contracted, strategic changes within the School have focussed around the following two areas:

  1. A shift from reactive ‘open door’ student support models to proactive targeting and monitoring of disengaging and failing students
  2. Coordinated and coherent approaches to anticipating needs of cohorts including those of disparate groups and individuals, thereby enabling support and information to be offered in a broad range of effective and efficient ways.

Proactive targeting and monitoring

The first strategy presented a number of challenges regarding the targeting and monitoring of student engagement and progression.

Operational challenges – The main method of tracking and monitoring is via simple formative assessment early in semester one designed to check which students are engaged and responsive to staff requests about the programme. Through this students receive quick and straightforward feedback about introductory topics or processes to do with their new role as a student. Use of Brookes Virtual greatly simplifies this process; students can receive immediate feedback to simple multiple choice questions and staff can quickly identify students who haven’t completed the task. The School Learning Teaching and Assessment Strategy has identified that by Summer 2008 70% of modules in the Directorate for Continuing Professional Development will have formative assessment, 30% of which will be web based and in the Directorate for Pre-Qualification each programme will have at least one module in stage one and two with a formative assessment.

Work with University ‘Up-Grade’ staff to identify and follow up modules which have a 10% or greater resit or failure rate has also been introduced. This monitoring system aims to target resources towards group resit support and refinement of modules that persistently have a high resit/failure rate.

Profiling methods have also been explored but these are at an early stage of development within the School. Krause (2005) in Australia identified and examined 12 different characteristics of ‘persisters and potential dropouts’, and in a similar initiative (Clift, 2003:14) in Glasgow introduced a simple method of profiling to good effect via a web-based resource by using the following 4 questions to assess level of risk of withdrawal:

  • Are you living away from home?
  • Are you the first person in your family to go to University?
  • Are you working more than 8 hours a week?
  • Do you know anyone in your class at the moment?

The Physiotherapy programme team has received funding from the Brookes Student Learning Experience Strategy initiative to develop and evaluate a combination of monitoring and targeting processes. Three processes are being adapted and combined from September 2007 (admissions information, an adaptation of Smith and Begg’s profiling and early formative assessment) to identify and contact, by mid semester one, students who are not engaged or who may benefit from contact with University or School support systems.

Educational challenges – One of the difficulties of introducing a targeting and monitoring system is that students may perceive this as a punitive checking up process, which singles students out, and, therefore, the School is being careful to promote targeting and monitoring systems which focus on student achievement and not, for example, attendance. It is also essential to follow up the identification of students who potentially need support in a sensitive and facilitative manner exploring and enquiring about need. The Brookes Virtual provides an appropriate framework for this type of formative assessment where students are expected to attempt various very basic activities early in their course and staff are able to identify students who have not attempted the task or have not understood what was being asked of them. This provides an early opportunity to communicate with the students and ascertain whether they understand what is expected of them and whether they have any specific difficulties in, for example, logging on. This approach is being used successfully in the School’s Operating Department Practice programme, whose staff report that it enables them to pick up on issues earlier than an ‘open door’ tutorial approac
h and to target resources for student support more effectively.

Anticipating and responding to cohort need proactively via structural processes

At the heart of the second strategy is the need to ensure that constructive alignment exists across all programmes, i.e., that the skills, knowledge and attributes required to successfully complete a programme are taught, practised and assessed appropriately, thus minimising the need for students to seek assistance with skills, knowledge and attributes that are necessary but not addressed via the curriculum. Supplementing the core curriculum are activities that are in place or in development to reduce the need to seek individual support. These include clarification of roles and responsibilities and the development of group tutorials operating within or outside modules with set programmes of activities to address topics such as referencing and preparation for placement. By December 2007 50% of all tutorials in the Directorate of Continuing Professional Development will be in groups, and in the Pre-Qualifying Directorate all programmes will have group tutorials in place. Programmes within the School such as Adult Nursing and Social Work that have used Group tutorials for a number of years have found that the benefits of seeing students in small groups go far beyond resource efficiency. Group tutorials provide students with valuable opportunities to take on different roles such as ‘helper’ and ‘helped’, avoiding the tendency for lecturers to be always cast in the role of expert. They also promote the construction of support networks with other students and enable staff to structure and present core information appropriately as students come to face new challenges on their programmes, such as practice placements and assessment of practice. Students will continue to have access to staff on a one-to-one basis, but it is envisaged that the need for these will be reduced through the refocusing of tutorial provision and will in the main be confined to emergencies and exceptional circumstances.

The information management infrastructure is also being reviewed to simplify and rationalise the quality, quantity, format and timing of information students need access to during their time on the programme. Induction is also being reviewed to explore other ways of ensuring that students are assisted with the transition in their new role, have the opportunity to build up effective support networks and have access to sufficient, but not excessive, information as first impressions do appear to be significant, as Yorke and Longden (2006:16–17) state, “The first year of full-time study in higher education is the most critical for continuation’. The Occupational Therapy programmes have for a number of years used a ‘Buddy’ system that encourages contact between new and existing students.

Staff Development designed to enable staff to adapt to the new student support framework is being put in place and overseen by the School Learning Teaching and Assessment Committee. It’s clear from the focus groups that staff approach student support in a wide variety of ways, use different methods and often struggle with the tension of providing sufficient support, i.e., not too much or too little. The Committee intends to run a series of workshops to explore these tensions, support staff with the changes arising from the shift in culture and provide a forum for identifying and resolving the general issues arising from the need to establish appropriate professional and personal boundaries within tutorial relationships.


These proactive and anticipatory strategies are being progressively put in place during the coming year, and the impact and effectiveness of the changes will be evaluated through a number of existing structures, which will feed into next year’s annual review.

Without the new strategies it was likely that, as resources became scarcer, inconsistencies in the level and quality of student support would almost certainly have occurred. A proactive strategic perspective has enabled the School to put in place systems and structures that, despite fewer resources, are designed to deliver and promote effective student support in line with Thomas and Yorke’s (Krause, 2005:57) principles of good practice for promoting retention:

‘A supportive and student friendly institutional climate: an emphasis on student support prior to and during the first undergraduate year: frequent and widespread use of formative and early assessment; provision of opportunities to engage students in the social dimensions of learning activities and an awareness of responsiveness to the fact that students’ patterns of engagement in HE are changing’.

Author details

Peter Bradley is a qualified social worker and has worked at Brookes since 1987, initially as a social work lecturer and more recently overseeing the quality assurance and programme developments in the School of Health and Social Care. He is particularly interested in exploring and understanding the way people learn and identifying and overcoming obstacles to learning at a personal, organisational and cultural level.


BBC News Website (15 February 2006), Retrieved on 24 July 2006 from the World Wide Web:

Clift, P. (2003), Student Support and Retention: Models of Explanation and Good Practice, University of Manchester and UMIST.

Krause, K. (2005), ‘Serious thoughts about dropping out in first year: Trends patterns and implications for higher education’, Studies in Learning Evaluation Innovation and Development 2(3), 55–68.

National Audit Office (2007), Staying the Course: The Retention of Students in Higher Education, London:The Stationery Office.

Ramsden, P. (1998), Learning to Lead in Higher Education, London: Routledge.

Simpson, O. (2005), ‘The costs and benefits of student retention for students, institutions and governments’, Studies in Learning Evaluation Innovation and Development 2(3), 34–43.

Taylor, R. (2005), ‘Creating a connection: tackling student attrition through curriculum development’, Journal of Further and Higher Education 29 (4), 367–374.

Tinto, V. (2005), ‘Reflections on retention and persistence: Institutional actions on behalf of student persistence’, Studies in Learning Evaluation Innovation and Development 2(3), 89–97.

Yorke, M. and Longden, B. (2006), ‘The vital first year’, Higher Education Academy Exchange, (4), 16–17.

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