The Parliamentary Under-Secretary of State for Health (Ben Gummer)
It is a privilege to respond to this debate, and the hon. Member for Ilford North (Wes Streeting) made a powerful speech. I know that he has experience and expertise in student finance. He was on the front line when we had discussions in this place some years ago, albeit outside the Chamber, and he brings passion and knowledge to this debate. He may feel that I am rehearsing points that he has heard previously, but before I address some of the specific and detailed questions that he rightly raised, I hope he will not mind if I run through some of the issues and reasons why the Government feel that this measure is the right thing to do at this time.
The hon. Gentleman will be aware that nursing remains one of the few subjects not within the purview of the current student finance system. To our mind, the current system is not delivering as it should for either students or patients. Simply put, nursing is one of the most oversubscribed subjects in the whole academic range, and the fifth most popular subject that UCAS offers. Last year, there were 57,000 applicants for the 20,000 nursing places available.
I do not wish to go down the route of discussing NHS finance, because it will lead us to a place that is not easy for the hon. Gentleman’s argument and not particularly realistic. There is no way that any Government of any stripe would be able to offer a place to every single person with the necessary qualifications who wished under the current funding system to apply for a nursing place. The question for us is this: how do we change the system to give more people the opportunity to study nursing, and do so in a way that we are able better to supply the nurses and the nursing positions required in the NHS?
The hon. Gentleman asked a very important and pertinent question, which is why in his hospital, which I know from having gone there and from discussing this with him in other debates in this place, he should be seeing a shortage of filled nursing places. It is a function of parts of London that there are problems in recruiting—I was in Hull last week where they have a similar problem, albeit for different reasons—and yet there is an oversubscription for places. He could have added that we almost have a record number of nurses in training at the moment. So how does that add up?
Under the Government, we have seen a significant expansion in the number of nurses in the workplace. The response to the tragic events at Mid Staffs, the subsequent Francis report and the results of the Morecambe Bay inquiry led us to the conclusion that had eluded previous Governments: we needed safe staffing levels on wards that were not, in some parts of the country and in some hospitals, safely staffed. That required a significant increase in nursing numbers, which could be provided in the short term only by agency nurses. That is why we have not only increased the number of nurses in training—clearly, they take a while to come through—but have been required to take action on the cost of agencies taking advantage of the situation. That does not change the fact that it is simply not possible, within the current funding set-up, to satisfy either the demand for or the supply of nursing places.
There are other reasons. Even if we did not need to do something to get a better match between the number of nursing places and what the NHS requires and students want, I would want to push this reform. It is for that reason that I directly disagree with the hon. Gentleman’s assessment of student finance reform. I disagreed with him when we had this discussion in 2011, albeit not in this Chamber. If I may gently put it, I think those on the Conservative side of the House were proved right by those reforms. The simple fact is that we now have more applications from disadvantaged students to higher education than ever before in the history of higher education. We have seen a significant expansion in the number of students full stop going into higher education. Eighteen-year-olds from the most disadvantaged areas were 72% more likely to apply to higher education in 2015 than they were in 2006. It has happened in precisely the opposite way to what he and his friends on the Labour Benches, when they were making the argument in 2011, expected to happen.
Wes Streeting
The Minister should look more carefully at what happened to mature student applications following the reforms—they plummeted—and think about the profile of the people applying to be nurses and midwives. Does he accept that the majority of loan debt will never be paid back, including by graduates who will earn far more than nurses?
Ben Gummer
I will turn to mature students, but I hope the hon. Gentleman will concede my central point. The significant majority of students going into nursing are doing so at an undergraduate point at 18 or 19 years of age. For that cohort across the rest of the higher education sector, we have seen the most spectacular expansion in opportunity than at any time since higher education was opened up more broadly to people after the second world war. That is something that Members on both sides of the House should celebrate. I know that those on the sensible wing of the Labour party also embrace the reforms and see why they were a good thing.
I disagree with many in the Opposition, but to be direct with the hon. Gentleman, I want to bring those advantages to student nursing. I want to expand the number of places available to people from all backgrounds to give them the opportunity to enter nursing, and I want to secure the advantages that come from bringing people from non-traditional and disadvantaged backgrounds into nursing, in the same way as we achieved in the rest of the higher education sector. I believe passionately in that. Even if the NHS and the students themselves—the 37,000 who applied but did not get a place last year—did not require this change, I would still be making it, because it is the right thing to do for those who otherwise would not have an opportunity. Under the new student financing arrangements, they will have that opportunity.
Peter Kyle (Hove) (Lab)
I wish to press the Minister on my hon. Friend’s point about mature students. In higher education, the number of mature students attending has now fallen by half. This is directly related to the current funding regime. The social mobility commissioner has cited education as the key vehicle by which mature people can achieve social mobility. How will the Minister prevent the number of mature nursing students falling as it has done in higher education?
Ben Gummer
I will turn to that point with pleasure, if the hon. Gentleman will give me a few minutes, because I have several things to say about mature students. I accept that this area of the proposals requires close attention, which is why I want to ensure that they are as robust as possible and that the consultation, to which the hon. Member for Ilford North referred, is as good as possible.
I want to answer the questions from the hon. Member for Ilford North about the consultation. We will consult on the full gamut of the reforms, but we will not consult on the principle, because that has been decided, as was outlined by my right hon. Friend the Chancellor. It is unfair to say he sneaked it out, given that it was made evident in his speech and was reacted to by the Opposition, as I know because I heard them. As for the timetable, the consultation will begin in January. We have not determined precisely when it will conclude, but it will be a full consultation. In significant part, it will look at how to ensure that mature students are supported, and I can confirm one element of it: we will allow mature students to apply for a second loan. Of course, that will account for only a small number of the cohort, but we will look at the impact of the changes on mature students, because they make up about a third of the cohort going into nursing.
Mr George Howarth (Knowsley) (Lab)
I am a little confused by the Minister’s argument, which appears to be that by removing an existing advantage, he will create an advantage for more people to enter the nursing profession. Most people listening will find that slightly illogical, but he is not normally an illogical person. Would it not be sensible to do as my hon. Friend the Member for Ilford North (Wes Streeting) suggested and have a proper impact assessment followed by a vote in Parliament, so that we can decide the right way forward, on the basis of that impact assessment?
Ben Gummer
The right hon. Gentleman makes a fair point, and I can tell him that an economic impact assessment and an equality impact assessment will be published with the consultation. I hope that that will begin to inform the debate. He might imagine that my proposition does not align with what he thinks the effect will be. I just ask him to look at what happened in 2011 when we did the same for the vast majority of other students, when Opposition Members put exactly the same arguments and warnings, and since when the precise opposite has happened.
Mr Howarth
The Minister is being generous in giving way twice, but we are not talking about what happened then; we are talking about a particular group that at the time was excluded from the provisions. He has not yet explained why he has now decided to include them in those provisions, other than by saying he is taking away an advantage that already exists.
Ben Gummer
It is simply because I wish to see the same advantages that accrue to those already on the new finance system accruing to those who are not. I want to see an expansion in the number of places and I want to see the effects of the changes made by the Office for Fair Access to university admissions in the rest of the sector applied to nursing, so that we see not only an expansion in the numbers of nurses being trained, but a broadening of the backgrounds of those going into nursing, exactly as has happened in all other areas of higher education.
I want to explain, I hope quickly, how this change forms part of a wider reform we are making in student access to nursing. The hon. Member for Ilford North framed his entire speech, understandably so, around the university route into nursing, but he omitted to reflect on the fact that the Government have stated that we will introduce an apprenticeship route into nursing to degree level—level 6. That will provide an alternative route into nursing, whereby nurses will be able to earn while they learn from healthcare assistant level all the way to a full nursing qualification at degree level. It will be possible for them to do so as mature students, which means it might take a bit longer, but they will be able to earn all the way from an existing job to gaining a nursing qualification—an innovation that should be welcomed on both sides of the House and which will mark a real expansion of opportunity for the current NHS.
Ben Gummer
Before I give way to the hon. Lady, I should also explain that there are many people working as healthcare assistants at the moment who do not have the opportunity to progress to a nursing position unless they leave the workforce to do so. That puts many of them in an impossible position, because they have families to support and other duties and responsibilities. For the first time, we have been able to give that group of people an opportunity to progress, through the apprenticeship route, to a full nursing position. That will expand the whole area of career progression to include one of the larger cohorts in the NHS workforce, in a way that no Government have previously been able to do.
Jess Phillips
I wonder whether the Minister can clarify whether people will be paid for doing that apprenticeship and, if so, at what rates they would be paid. He rightly referred to getting mature students with families into work, so will he also say whether that cohort will fall foul of the rule that people must be doing 16 hours of work, and not be in training, to receive the Government’s 30 hours of free childcare? It was made clear in the Childcare Public Bill Committee that those nurses currently studying would not be able to access the 30 hours’ free childcare because that would not be considered work. When they saved my life, it looked like work.
Ben Gummer
The hon. Lady speaks with authority from her own personal experience—I have noticed that recently she has spoken her mind without holding back. We are in detailed discussions with the Nursing and Midwifery Council about precisely how the apprenticeship route will work. The council is the independent regulator and has to certify that the qualification matches the existing degree/university route. The qualification has to have complete equality of both esteem and rigour. Of course we envisage the apprentices earning a salary. We envisage opening the route to existing healthcare assistants to give them the opportunity to progress to a nursing grade while continuing at a similar salary point as an apprentice. However, because the hon. Lady’s question about maternity care pertains to student nurses rather than apprentices, I will ensure that I write to her in detail.
The hon. Lady clearly sees why this is an idea with strength, so I hope that in asking her question she realises that there will be two routes into nursing: the university route and the apprenticeship route. I think this is potentially one of the most exciting innovations in the workforce of the NHS for several decades, because it opens up nursing to a whole range of existing workers who have not had an opportunity before, and provides a wholly different route into nursing, but with the same rigour and robustness that the existing university degree route provides.
Ben Gummer
I shall give way once more, but I do not want to detain the House much longer.
Peter Kyle
I thank the Minister for giving way a second time. It is clear that he really cares about getting mature students into these nursing training programmes. If the numbers fall as we go forward, will he come back to us and report on it, and will he pause any further reforms until that decline is halted?
Ben Gummer
I expect to be held account for this significant reform right the way through the changes that are envisaged. I hope to be able to return to provide good news about progress, as has happened in other student areas. That is why we want to be very deliberative about the way in which we form this consultation, because it is important to get it right.
I have taken note of the careful questioning of the hon. Member for Ilford North, who clearly understands the full gamut of the issues that need to be addressed in this consultation. Let me answer some of the questions he raised, and I shall write to him about any that I do not answer.
The hon. Gentleman asked about the funding of clinical placements. We have already started discussions with Universities UK about that, and it will form part of the wider consultations. The Barnett consequentials will be a matter for Her Majesty’s Treasury, as is the case for everything else connected to Barnett consequentials. I know that BIS officials are discussing the issue in the normal way.
The hon. Gentleman asked about research into financial hardship, and I know that that will form part of the consultation. The Government will be open to any further research beyond the economic impact assessment.
I was asked whether I would be happy to meet students. Of course I would. I have already met Unison and the Royal College of Nursing to discuss the changes I wish to make. I should not pretend to answer for them, but I have had productive discussions with both, especially about the apprenticeship route. I know that we will disagree with both Unison and the RCN about bursaries, but I think there is an understanding, particularly on the part of Unison, of how we are trying to open up different routes to nursing for different parts of the workforce. If we get it right, the apprenticeship model will be a strong one.
The hon. Member for Ashton-under-Lyne (Angela Rayner) made an important point in her intervention about agency nurses, so let me answer that as I am passing. As I alluded to earlier, part of the reason we are looking at that issue is to ensure that we provide a more sustainable workforce throughput, so that we do not need to rely on agencies and bank staff for the peaks in NHS demand. That is why we need to do something about numbers, and I hope that, as a result of the Chancellor’s announcement, we will increase the number by 10,000 over the course of this Parliament—a very significant increase in the establishment of student nurses. In fact, it will be the largest increase in student nurses under any Government since 1948.
I hope I have answered the majority of the questions put by the hon. Member for Ilford North—
Ben Gummer
Clearly I have not. I will allow him an opportunity to intervene once more, but I do not want to detain the House much longer.
Wes Streeting
I particularly welcome what the Minister said about treading carefully and thoughtfully around the consultation. The one issue he has not addressed, however, is whether extending the tuition fees regime to nursing, midwifery and other allied health subject students will be subject to a full and thoughtful debate followed by a vote in this House and the other place.
Ben Gummer
I cannot give the hon. Gentleman a definitive answer to that question yet. Let us wait and see the outcome of the consultation, so that the House can be best informed. I imagine that there will be ample opportunities in Backbench Business Committee debates and indeed Opposition day debates, and I know that the hon. Gentleman and his colleagues will want to bring these issues up for further debate. I will reflect the hon. Gentleman’s concerns to the Secretary of State and to the Leader of the House, and I am sure they will receive them with interest.
I genuinely thank the hon. Gentleman for bringing forward this debate, which has provided an opportunity for the Government to explain our plans and the rationale behind them. There will be points on which we will disagree, but I hope the hon. Gentleman will see the force of our arguments about wanting to expand the nursing workforce, to provide different routes into nursing and to provide the sort of opportunities to 18 and 19-year-old undergraduate nurses that have been extended to other parts of the higher education sphere. These are big proposals. They could mean a remarkable and rapid transformation of the NHS workforce, and a significant expansion in the number of nursing students. We need to get it right, and I hope that, through a constructive discussion across the House, drawing on the kind of expertise we have heard from Members in this short Adjournment debate, we will indeed get it right.
Question put and agreed to.