GCSE is the ‘common exam at 16+’ created by the merging of the GCE and CSE systems. I entered university in 1965 on the basis of the national ‘matriculation’ entry requirements. These required GCE passes (C+) in five subjects including English, maths and a foreign language, plus a minimum of two A Levels at grade E or above.
This September, places were available at, for example, the University of Central Lancashire (UCLAN) for the BSc Midwifery course. The published entry requirements are five GCSE passes at grade 4 or above plus two A Levels or an appropriate BTEC qualification, although it is also made clear that entry to this degree course is still possible by other routes without these qualifications. These entry requirements for midwifery degrees appear to apply to all English universities.
A first impression might be that not that much has changed, but this is far from the case. Let us concentrate on the GCSE requirements. In 1988, when the GCSE was created it had a seven point scale from A – G. This historically would have covered only the top 60% of the ability range, but the raising of the school leaving age to 16 in 1972 required the CSE, and hence the GCSE, to be accessible to the full comprehensive intake. Grades D – G became ‘level 1 passes’ and grades A – C became ‘level 2 passes’.
The key fact is that in 1965 a GCE C grade was just three rungs down from an A which incorporated the maximum possible attainment, on the seven rung scale. The A grade GCSE was later devalued by the introduction of A*, and in 2017 by the 1 – 9 numerical GCSE grades, which in effect added A** (grade 9) above A*. These changes were in themselves inflationary because they devalue the status of the intermediate grades, especially A and C. Should teaching and learning standards in our schools have risen so high that increased proportions of students were gaining the A grade, then plainly the exams needed to be harder. The alternative explanation is that as a result of competition for entries between the examination boards, the exams actually got easier, and this was the reason for the increase in A grade passes. The 1997 Labour government was especially cavalier about GCSE standards, as evidenced by its promotion of the GNVQ scam. In 2015 I wrote about how marketisation-based ideologies always lower educational standards, while creating the illusion of raising them.
Now fast forward to 2018, thirty years after the 1988 Education Reform Act, which provided the legal framework for the marketisation of the English education system based on encouraging competition between schools and privatising the GCSE examination boards, which then began to compete with each other to sell their syllabuses and examinations to schools. GCSE exam entry fees began to rise, eventually becoming a significant drain on the budgets of secondary schools following the imposition in 1990 of Local Management (LMS).
I have chosen midwifery as an example of potential damage to society caused by educational qualification inflation. It is a profession, like doctors and airline pilots, where life and death decisions frequently need to be made as a normal part of the job.
Recall that in 1965, GCE (later GCSE) grade C, was just three rungs down from the highest rung (A), on a seven rung ladder. In 2018, GCSE grade 4 (C) is six rungs down a nine rung ladder. This implies that the minimum cognitive ability percentile needed to become a midwife could have halved. But it gets worse. Back in 1965, our teachers told us that the C grade pass mark in GCE was about 40%. In 2018, according to their website, in the Pearson GCSEs the grade 4 (C) boundaries in the higher tier exams were:
maths – 21%
combined science (double award) – 25%
What this means is that in 2018 school leavers who got wrong answers or failed to answer 4/5 of the paper in maths and 3/4 in science (presumably the harder questions), are gaining access to midwifery degree courses. A high proportion of NHS maternity units are ‘midwifery-led’ and not supervised by obstetric consultants.
In Scotland entry to midwifery training requires SQA Highers with minimum grades BBBC including English and Biology or Human Biology. Highers are equivalent to English AS Level qualifications. They have a four grade scale A – D, of which C+ is regarded as a pass. So in Scotland entry requirements are much higher than in England, suggesting a far higher minimum cognitive ability percentile than in England.
Readers of my articles will know that I believe that Piaget’s Formal Operational cognitive level is of great significance for the ability to make rational decisions on the basis of evidence. While a majority of Scottish midwifery trainees will be at this Piagetian level, this is now much less likely to be the case in England.
We all know that there is a huge shortage of midwives, which is already worsening as a result of BREXIT, but I hope no-one is going to argue that, instead of the higher tier GCSE, the foundation tier courses, designed for less cognitively able students, are appropriate for school leavers aspiring to midwifery degrees.
I have recently read a book by a retired American obstetrician, Amy Tuteur MD, entitled ‘Push Back – guilt in the age of natural parenting‘.
Interestingly, the Amazon review responses are completely polarised. Overall it gets three stars, but 55% of the reviews award five stars with 45% awarding the minimum of one star, with very few in between. Here are examples.
***** This book is absolutely essential reading for anyone who values evidence-based argument and solid science over the unexamined ideologies of the present-day natural-childbirth and attachment-parenting movements.
* Scaremongering, non evidence based and disempowering. Trust your instincts and push back against this!
This reflects the tensions in the English NHS between obstetricians, most midwives and a well organised and deeply embedded minority of ‘natural childbirth’ advocating midwives inspired by an extreme form of feminism. Amy Tuteur writes:
[the latter] are fond of catchphrases like ‘trust birth’ and ‘pregnancy is not a disease’. They insist that obstetrics has ‘pathologised’ childbirth and [they] can display a shocking and callous fatalism by dismissing infant deaths with the dictum that, ‘some babies are not meant to live’.
The 2015 Kirkup investigation into the deaths of babies and mothers in the Furness General Hospital maternity unit of Morecambe Bay trust found that 11 babies and one mother had died avoidably. The Kirkup Report identified that an “over-zealous pursuit of the natural childbirth approach” was a factor in the deaths.
Ten years have passed since the Morecambe Bay investigation, and its wide ranging conclusions and recommendations, all accepted by the Morcambe Bay NHS trust. Its maternity services have been transformed for the better. The Chief Executive was awarded a Damehood and moved on to take charge of a much larger NHS trust. The head of midwifery has also been promoted out of the trust and, crucially, the ‘natural birth’ ideology presently no longer dominates maternity care at any of its maternity units.
Yet earlier this year an apparently even greater scandal emerged at Shropshire and Telford NHS trust. This was reported by the BBC on 31 August 2018.
The BBC gave this example of a mother whose baby had died.
Throughout her 36 hour-long labour at the Princess Royal Hospital in Telford [the mother] was refused a caesarean section several times and had a natural birth during which her son’s shoulder was trapped.
On the same date the Daily Mail published an article from which the following is extracted.
More than 60 babies and mothers are feared to have died or suffered devastating harm at a maternity unit. An investigation began last January into 23 suspicious incidents at the Shrewsbury and Telford hospital trust. But the Mail can reveal that this number has almost trebled to an estimated 63.
The vast majority of the cases involve the deaths of babies and mothers during childbirth. The rest include babies suffering lifelong harm. Some parents say they were pressured into natural births in midwife-supervised units.
Given that lessons are apparently not being learned from the Morecambe Bay tragedy despite the comprehensive report of Dr Kirkup, and that the ‘natural birth’ movement is still promoting home births and midwifery-led NHS maternity units, is it appropriate that GCSE grading decisions imposed by the government should be further lowering the bar for admission to midwifery degree courses?