1. The Commission
This brief chapter describes the Commission's aim, strategic drivers and processes .
1.1 Aim of the Commission
The aim of the Commission was to maximise opportunities to participate in nursing and midwifery education and careers, identifying best practice and barriers to entering the professions through engagement with potential and actual students, nurses, midwives and key stakeholders. It formed part of wider work to ensure Scotland's nursing and midwifery workforce is sustainable and fit for the future, with the right numbers, the right training, the right skills, the right opportunities, and the right support.
The recently published Nursing 2030 Vision reaffirms this commitment and highlights that the Commission's observations and recommendations will play a big part in determining approaches to maintaining and improving access – and consequently ensuring an ongoing and sustainable supply of nurses – as we move towards 2030. The Best Start  five-year forward plan for maternity and neonatal care in Scotland likewise commits to reconfiguring the existing midwifery and obstetric workforce to support continuity of care for women, noting that it is particularly essential for staff in remote and rural areas to be able to access high-quality education, training and support.
1.2 Strategic drivers of the Commission's work
The Scottish Government has committed to taking measures through its Plan for Scotland: the Government's Programme for Scotland 2016–17  to ensure that the entire workforce in Scotland, including young people, is equipped with the skills they need to find meaningful employment in today's economy. General measures include:
- increasing the number of modern apprenticeships with the aim of securing 30,000 per year by 2020, and widening access to modern apprenticeships to people with disability, those from ethnic minority backgrounds and young people who have been in care
- developing proposals to implement a new Jobs Grant for 16–24-year-olds returning to work after six months' unemployment
- continuing to fund local authorities to deliver the Opportunities for All commitment, which offers an appropriate place in learning or training to all 16–19-year-olds
- supporting 11,650 places through the Employability Fund
- working towards a reduction in youth unemployment of 40% by 2021 through the Developing the Young Workforce strategy
- developing and implementing new services to help people find and stay in work by better aligning employability support to encourage sustainable and fair work and focus support on those who need most help.
In relation to health and social care, key strategic drivers include the Health and Social Care Delivery Plan  and the National Health and Social Care Workforce Plan Part 1.
The Commission worked within a wider – and evolving – economic, employment, education, and health and social care policy landscape, and positioned its work within, and took active account of, the implications of the Developing the Young Workforce Strategy,  the final report of the Commission on Widening Access, A Blueprint for Fairness ,  the ongoing Review of the 15–24 Years Learner Journey, youth employment strategies and the Apprenticeship Levy. Wider reviews of student support in Scotland and nursing and midwifery student support from 2018/19 were also ongoing and relevant to the review process.
As an Impact for Access project funded by the Scottish Funding Council ( SFC) reported in October 2017,  the First Minister's goal is to increase the proportion of people from the 20% most deprived communities in Scotland ( SIMD1) entering full-time HEI degree courses in Scotland by (at least) 16% by 2021, 18% by 2026 and 20% by 2030, and to ensure at least 10% of all entrants to HEIs in Scotland come from SIMD1 postcodes by 2021. The Commission was cognisant of this aspiration throughout its term.
1.3 Overview of the Commission's approach
The Commission was Chaired by Professor Paul Martin, CBE, and was supported by a core project team consisting of Scottish Government and NES staff and colleagues from UWS. It used a combination of methods to gather evidence from a diverse range of sources, including collating relevant information and data, reviewing available evidence and literature, commissioning a rapid review of the international and UK literature (see Section 2.5) and a survey of students and registered nurses (see Section 2.6), and engaging with the Commission's Stakeholder Group, other key stakeholders and subject experts.
The project team identified five broad themes to help structure the review process. These reflect the themes of the Review of the Learner Journey and are as follows.
1. Learner Choice and Application – improving information, advice and application processes
2. Learner Choice and Application in Colleges and Universities – improving information, advice and application processe s
3. Access and Application – improving the ease with which people can apply to colleges and universities
4. Provision Transition/Progression – improving the design, alignment and coherence of the learning journey and subsequent career pathway
5. Funding – improving the learning system and career pathway and removing unnecessary duplication.
The project team also worked with the Scottish Government Strategy Unit and Ingage teams to apply methods such as storytelling, Rapid Reflection (see Section 1.5) and systems mapping. This allowed the Commission to challenge preconceptions and map the system as it currently exists.
The overall approach enabled the Commission to build an inclusive and comprehensive picture of current pathways into nursing and midwifery education and careers and how they are experienced; from there, it was able to identify what is working well and where blockages lie, and make observations and recommendations to strengthen the former and mitigate the latter.
1.4 Engagement strategy
A wider engagement strategy was developed to ensure an inclusive approach and to gather system-wide and multi-sectoral experience and insights.
The Stakeholder Group had representatives from nursing and midwifery professional bodies, health and social care employers, higher and further education bodies and representative groups, national organisations and Scottish Government officials (membership is set out in Annex 1). The Group met at three full-day workshops in June, August and October 2017, and individual members engaged directly with the project team on an ongoing basis. Members were actively involved in shaping the observations and recommendations that appear in this final report.
A key priority was to engage with and hear from people with direct experience, including those who have taken steps towards – or had embarked upon – nursing and midwifery education or careers, as well as those who have chosen alternative paths or decided to leave nursing and midwifery education. To this end, a series of focus groups was held with people with direct experience.
Current nursing and midwifery students from a diverse range of backgrounds took part in the Stakeholder Group's first workshop to provide personal experience of accessing education and progressing into the nursing and midwifery workforce. Focus groups were conducted to explore students' and support workers' perceptions of nursing and midwifery education and careers, barriers and enablers, and potential future support, the result of which was a report prepared for the Commission by Dr Rosie Stenhouse of the University of Edinburgh into students' experiences of accessing nurse education through widening participation routes. Some of the observations from this report, which had a strong influence on the Commission's deliberations and actions, are set out in Section 2.6 and elsewhere in the text.
CNO and the Commission's Chair were committed to ensuring that everyone involved in this process had an equal voice, be they a potential or current nursing and midwifery student or someone with a well-established career.
1.5 Rapid Reflection methodology
The Commission's approach was informed by the Rapid Reflection methodology, which guided the Commission's work throughout the process.
The Rapid Reflection model is described as a thinking tool that consists of a large-scale infographic and an accompanying structured collaborative discussion process. It provides decision-makers faced with difficult policy challenges with a strategic framing of the context and consequences of the issue in question. A rapid immersion into the big picture allows for a better understanding of what the challenge may mean and helps inform strategic policy-making going forward. The model overcomes the limitations of traditional knowledge transfer by constructing and presenting information in an easy-to-understand and highly visual strategic framework. 
The Commission's Stakeholder Group began an initial appraisal of key issues, uncertainties and pressures using the Rapid Reflection methodology at its first workshop in June. The Situation Report developed through the methodology, which allowed stakeholders to look not only at the current situation, but also consider the wider historical context and 'back story' underpinning the Commission's task, focused on key issues, pressures and uncertainties identified by the Stakeholder Group. It was refined at successive Stakeholder Group workshops.