(6 years, 6 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
20:14 - divided: - Ayes: 234 / Noes: 295 - Question accordingly negatived.
Madam Deputy Speaker (Dame Rosie Winterton)
I must inform the House that the Speaker has certified the instrument as relating exclusively to England and being within devolved legislative competence. The motion is therefore subject to double majority voting of the whole House and those representing constituencies in England.
Angela Rayner (Ashton-under-Lyne) (Lab)
I beg to move,
That an humble Address be presented to Her Majesty, praying that the Education (Student Support) (Amendment) (No. 2) Regulations 2018 (S.I., 2018, No. 443), dated 28 March 2018, a copy of which was laid before this House on 28 March, be annulled.
I thank the Leader of the House for scheduling this debate, which marks an important moment. In this Parliament, Members have had to assert our right to decide the law of the land—a right that some Ministers have tried to avoid by denying us votes on statutory instruments. In this case, the Government let the 40-day period lapse without providing time. They have now agreed to the step, which I think may be unprecedented, of revoking their own regulations and relaying them to allow us a binding vote. Whatever the decision tonight, I hope that we have established the right of the Opposition to secure votes on the Floor of the House. The Government cannot simply legislate by the back door.
On the regulations, the Government’s actions once again seem to defy basic sense. Just last week, they rejected our motion to implement their own guarantee and manifesto commitment on school funding. Now, they are ploughing ahead with their plan to scrap bursaries for yet more nursing students, despite knowing full well the disastrous consequences that will follow.
Two years ago, the Government ignored the Opposition and those who work in the health sector when they scrapped the undergraduate bursary. The results were predictable. In 2016, before the abolition, there were more than 47,000 nursing applicants in England. In 2018, the figure fell to about 31,000—a fall of over 15,000. It is clear that this is the reason why we have seen the sharpest ever decline in nursing applications. I know what the Minister will say. He will say that the number of applications is less important than the number of acceptances; he will say that the Government have committed to create more trainee places for nurses. They promised an increase of 5,000 nursing places and said that the nursing bursary had to be scrapped to make that possible, but what have they delivered? Seven hundred fewer students training to be nurses.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Does the hon. Lady agree that what is important is that we train more nurses and that there are more applicants than the number we need to train, so that there is good competition that ensures we get the best candidates? It is not necessary to have masses more than we need; we just need enough.
Angela Rayner
I agree with the hon. Lady that we need to ensure that we have not only more applicants, but more people in training. However, 700 fewer students have been training to be nurses since 2017.
Mr Jim Cunningham (Coventry South) (Lab)
Once again it is women who are being hurt, particularly adult women who have brought up a family and want to take up a new career in nursing. They are being denied that opportunity or being forced into debt.
Angela Rayner
Forced debt for students and nurses of whatever gender is a really important issue, which I will come on to. My hon. Friend is absolutely right to highlight that we need to encourage both genders to see nursing as a legitimate career.
I mentioned that there are 700 fewer students training to be nurses. That is the first fall in close to a decade.
Karen Lee (Lincoln) (Lab)
Does my hon. Friend agree that the bottom line is that without applications we cannot train nurses? That is just all there is to it.
Angela Rayner
My hon. Friend is absolutely right and I congratulate her on her outstanding dedication to nursing.
The Government said that they can fill the gap with nursing apprentices. They promised 1,000 of them, yet it has now been revealed that just 30 apprentice nurses have started the course. To miss a target may be unfortunate, but to miss it by 97% and carry on regardless just seems reckless. The shortfall is not the only problem with relying entirely on apprenticeships. A nursing apprentice will take four years to become a registered nurse. Even if there is a miraculous surge in apprentices starting this summer, we would not see any new qualified nurses on our wards until 2022.
Maria Caulfield (Lewes) (Con)
I am not sure the hon. Lady understands what life is like on a bursary as a student nurse. There is just £400 a month to live on. Apprentice nurses are paid. They are a member of a team and they have a guaranteed job at the end of it. That is a very different system, which is a step forward in progress towards getting more nurses into the profession.
Angela Rayner
I respect the hon. Lady and I pay tribute to her for her work in the NHS as a nurse, but the figures show that not only is this change making it difficult for trainee nurses, who do an excellent job on our wards, it is contrary to what we need. Applications fell by 33%, with a 42% drop in mature students. In contrast, an undergraduate nursing course can take three years and postgraduate courses, referred to in the regulations, can take two years, making them some of the quickest ways to tackle the shortfall in numbers.
The same is true with the nursing associates suggested by the Government as another solution. The Government’s policy is not only unfair, it is failing completely on their own terms. They have pushed ahead with a policy that has reduced the number of people training to work in our NHS and now they are trying to do it again. I should add that trainee nurses in any of these routes have to do the day job as well. I pay tribute to our nurses for the fantastic job they do every single day in our NHS. Trainee nurses do not get paid the going rate. Those affected by the regulations actually have to borrow money for the privilege.
I hope the Government are clear that simply having more trainees on wards is not a solution to staff shortages. They are there to learn their job, not to do someone else’s. There is clear evidence that using support workers or trainees as replacements for qualified nurses has potentially disastrous consequences for care. I hope the Minister will confirm that that is not the Government’s intention.
This measure does not make any financial sense. Tuition and a bursary for a postgraduate or diploma student could cost less than the average premium the NHS pays for an agency nurse for a single year. Providers have suggested that they could expand their courses by up to 50% if funding was available. This comes at a time when there are 40,000 nursing vacancies in the NHS. The Government’s failure to fill vacancies is so severe that the Migration Advisory Committee has placed nursing on the shortage occupation list, even as potential recruits in our constituencies are denied the support that they need to serve in the NHS.
Layla Moran (Oxford West and Abingdon) (LD)
Does the hon. Lady agree that in the end, the only people we must care about are the patients? In Oxfordshire, in the John Radcliffe Hospital, 170 beds were closed primarily because there was a staff nursing shortage. These measures are not going to fix the immediate problem. Why are the Government continuing to do something that is not evidence-based and will not work?
Angela Rayner
I absolutely agree with the hon. Lady. She is absolutely right to point out that all our focus has to be on making sure that the jewel in Britain’s crown—the national health service—has the qualified staff to do the job and keep our patients and loved ones safe.
I have talked about the failure to fill the vacancies in the NHS at the moment, and that is even before we consider the impact of Brexit on the 21,000 brilliant nurses who have come from EU countries to serve in our national health service. Only two months ago, the Health Secretary said that the winter crisis in our NHS was “probably…the worst ever”, but if he carries on like this, there will be worse to come.
It is one thing for Ministers to push ahead with policies against the warning of the Opposition. It is quite another for them to ignore their Departments’ impact assessments, yet that is precisely what Ministers have done. The Department for Education’s assessment of the changes to the bursary said that it would disproportionately affect women and ethnic minority students, yet Ministers have wilfully pressed ahead. Then the Department of Health and Social Care found that the change could make women, older students and students with lower incomes less likely to participate in postgraduate nursing courses. Again, Ministers pressed ahead, and we have seen the consequences not just in the number of applications, but in who has applied. Just as they were warned, the profile of our future nurses has become less representative. In particular, there has been a 42% fall in applications from mature students.
This is not simply a matter of fairness or even just about the benefit of a diverse workforce providing frontline care to a diverse population. Older nursing graduates are more likely to stay longer in the NHS and are more likely to choose areas such as mental health or learning disability nursing, which are facing severe staff shortages. Just yesterday, campaigners warned of the impact that the abolition of the bursary has had on those areas.
Vicky Ford (Chelmsford) (Con)
The hon. Lady is making a very powerful point, but we need to be very focused with our intervention. I represent an area that has a nursing school. Although applications have dropped, we still have five applicants for every place and 30% more qualified applicants for every place, so if we are to take measures, we need to make sure that they are very targeted in the areas in which we intervene.
Angela Rayner
I absolutely agree that we have to make sure that we target interventions and make sure that they work, but part of the reason I have brought the motion before the House today is that the interventions are simply not working. Since 2017, we have 700 fewer students training to be nurses, so the impact is absolutely clear, and I hope that Government Members will support our motion.
Some universities are even looking at closing down specialist courses entirely. If today’s regulations pass, there is every reason to believe that this will get worse. Nearly two thirds of postgraduate nursing students are over 25, more than a quarter are from ethnic minorities and 80% are women, so the impact of today’s regulations will surely be even worse than the previous cuts. Even if the Government are determined to make the change, there are good reasons not to make it now. This policy would move postgraduate nursing students over to the main student finance system, which means dealing with the Student Loans Company.
There is every reason to believe that the Student Loans Company is not yet ready. In recent weeks, the Government have been dealing with an error by the company that has led to 793 nurses being hit with unexpected demands to repay accidental overpayments they were unaware of. The Government’s response was a hardship fund of up to £1,000 per student, yet the Minister for Universities, Science, Research and Innovation, the hon. Member for East Surrey (Mr Gyimah), admitted in a written answer to my hon. Friend the Member for Blackpool South (Gordon Marsden) that the majority of students were overpaid by more than £1,000 and will be left short. Perhaps when he responds, the Minister will tell us how he can possibly expect nursing students affected by this policy to have any faith in the system they will be stuck in.
With the Government finally embarking on their flagship review of higher education, they could have allowed this issue to be considered as part of the review before going ahead with this change today. Ministers have insisted that this change is necessary now to make how we fund training sustainable, yet there is little reason to believe that it will achieve this. The average NHS nurse earns just over £31,000 a year and the average graduate now leaves university with £50,000 of debt. A new nurse with a postgraduate qualification will take 86 years to repay their undergraduate debt on the average NHS salary—that is before we add interest—which is nearly triple the current repayment period before debt is written off, meaning they will not even begin to repay the debt. How many postgraduate students affected by this policy will repay any of, let alone all, their additional loan, and how much of that debt will simply be written off by the taxpayer in decades to come?
Rachel Maclean (Redditch) (Con)
Does the hon. Lady not agree it is completely wrong to talk about debt in the way she is—in this place—as though it is some sort of credit card debt? It completely misrepresents the situation for young people from disadvantaged backgrounds thinking about going to university. Her words will be putting them off.
Angela Rayner
I am not sure it is my words that are putting people off; I would say the thought of having £50,000 of debt hanging over them for a very long time is putting people off going into education.
Karen Lee
I started my nurse training in 2000 as a single mum. When I finished, I had £15,000 of debt—and that was with a bursary. It took me five years to pay it off. People say we should not talk about debt, but we have to talk about it—debt is debt. Students come out with debate. I came out with debt. I sit here listening to people who know nothing about this talking as if they do. It simply is not true.
Angela Rayner
The passion from my hon. Friend reflects how people feel up and down the country. It is funny because we all know what happened at the general election—and the verdict was clear on the Government’s position on education and student debt and tuition. [Hon. Members: “You lost!”] And of course the Government lost their majority at the same time, and the weak and wobbly Prime Minister has done nothing to make anyone in the country feel more confident about her future—but I digress.
How many postgraduate students affected by this policy repay any of, let alone all, their additional loan? Will the Minister explain how this is sustainable? How much will really be saved in the long run? Or is this another example of what the Treasury Select Committee has called the fiscal illusion—in this case, of a student finance system that allows the Government to pretend they have made a saving when they are simply passing the bill down to the next generation? It is no wonder that all the devolved nations have maintained their own NHS bursaries.
Dr Caroline Johnson
The hon. Lady talked about the general election and promises on education and education funding. Will the Labour party be keeping its education promises to repay the debts of students who have already incurred them?
Angela Rayner
I should have thought that Conservative Members would have read what was a great manifesto. They have hidden theirs now—I cannot see it, because it is hard to find—but ours was absolutely clear, and we continue to be clear about the fact that we would abolish tuition fees. The debt that our students face at the moment is the result of a tripling of student debt on the Conservatives’ watch.
I hope that Conservative Members will support our motion, not least given the financial consequences of Government cuts for their own budgets, but also because I believe that we should welcome nursing students from all over the United Kingdom. If we do so, the whole country will benefit. If the House votes for the motion, that vote will be a clear call for the Government to rethink the cuts, restore the bursary, and respect the will of the House.
A few months ago, the Health Secretary said that the NHS was “nothing without its nurses”. I support that sentiment tonight, but the sentiment without substance is not enough. I am sure that there is not a single Member in the Chamber who would not acknowledge the urgent need for us to recruit more nurses, so I ask all Members to put their votes where their voices are. I commend the motion to the House.
The Minister for Health (Stephen Barclay)
I join the hon. Member for Ashton-under-Lyne (Angela Rayner) in welcoming the opportunity to discuss the increase in the number of postgraduate places that will be unlocked as a consequence of the statutory instrument. She ended her speech by saying that there was an “urgent need” to recruit more. The central premise of her opposition to a change that will remove the arbitrary cap imposed by the bursary, and hence unlock additional places for postgraduate students, seems a strange one on which to base her speech, given that we are ensuring that we can continue to increase the number of nurses that the Government have delivered through the postgraduate route, as we have through the undergraduate route.
At present, about 2,500 students gain access to nursing, midwifery and allied healthcare professions through the postgraduate route, a number that is constrained by the cap. The policy that we are discussing has already been applied to the much larger population of about 28,000 undergraduates studying the same subject. The statutory instrument will ensure consistency in the approach to both populations, while enabling both to increase their number by 25%.
This is part of a much wider package of Government measures. We are, for instance, increasing the number of apprenticeships. I know that my right hon. Friend the Member for Harlow (Robert Halfon), as Chair of the Education Committee, has repeatedly championed their importance as a route into nursing for those who do not want to go to university. Similarly, my hon. Friend the Member for Chelmsford (Vicky Ford) has campaigned repeatedly in respect of medical school places. There are five new medical schools and 1,500 new medical places, again as part of the increase in the number of nurses. We have made a commitment through “Agenda for Change”, working with the trade unions, to deliver pay increases and we have programmes such as the return to work programme, which has seen more than 4,000 former nursing staff applying to return to the profession.
Robert Halfon (Harlow) (Con)
I will be supporting my hon. Friend this evening. I welcome what he said about apprentices. I think this squares the circle. We need to rocket-boost apprenticeship programmes in the NHS. I intend to say more about that in my speech, but may I ask whether he is committed to that today?
Stephen Barclay
I was just taking inspiration. Let me explain the route into nursing through apprenticeships. A four-year package will enable people who do not want to go to university—this is a point that my right hon. Friend has repeatedly made in the Education Committee—to progress to nursing roles by means of what he has often referred to as a ladder. Healthcare assistants tend to feel trapped in roles that do not give them an opportunity to progress. This is at the heart of what the Government stand for: giving people an opportunity to progress at different stages in their lives through the apprenticeship route.
Sir Desmond Swayne (New Forest West) (Con)
Will my hon. Friend address the allegation that there are 700 fewer nurses in training?
Stephen Barclay
My right hon. Friend will not be surprised to learn that that is a selective picking of the facts because it does not include direct entrants, to cite just one example that was not included. I could go on, but I know the—[Hon. Members: “Go on”.] It does not take account of direct entrants; that is one population that was not included. It also—
Stephen Barclay
I am happy to confirm that. We now have 13,100 more nurses on wards since 2010 and we have a commitment to expand the numbers—[Interruption.] It is a new programme and we are expanding the number of apprenticeships. We have committed to 5,000 this year, expanding to 7,500.
It is interesting, is it not? Having routes that give people opportunities to progress—having different choices for people and empowering individuals, not all of whom want to go to university—so that people from different backgrounds can go into the profession is the very essence of what our party stands for. It is shame—
Dr Philippa Whitford (Central Ayrshire) (SNP)
Does the Minister therefore challenge the figure of only 30 apprentices and does he recognise that with a four-year course they will not be ready until 2022, and there is a need for nurses now?
Stephen Barclay
I absolutely recognise that the apprenticeship route will take four years, but the Government have given a clear commitment to that and that is backed up by significant—[Interruption.] The UCAS figures are embargoed, so I do not have the latest figure. The point is that it is a four-year programme and it will take time to roll out, but it is backed by significant funding: the NHS is contributing £200 million to the apprenticeship levy. That is a signal of this Government’s commitment. The Minister for Apprenticeships and Skills is here, championing the apprenticeship route, as are other Members through the Select Committees. It is a shame that some Opposition Members are not reflecting on the benefits offered by apprenticeships as an alternative route into the nursing profession that will deliver more nurses. That should be welcomed.
John Howell (Henley) (Con)
I think my hon. Friend the Minister has forgotten that the Minister for Education, my right hon. Friend the Member for Bognor Regis and Littlehampton (Nick Gibb), is also here, which reinforces the point that the starting point for promoting nursing is at school. Does my hon. Friend agree?
Stephen Barclay
I do agree with my hon. Friend. Indeed we have three Ministers from the Department for Education here, which again shows the Government’s joined-up approach. The NHS, as the employer of 1.5 million people, is a standard setter that can provide leadership in the apprenticeships market and looks at doing so not just for nursing apprenticeships, but across a range of apprenticeship routes. The Minister for Apprenticeships and Skills, who is a former Minister in the Department of Health, understands that issue extremely well.
Layla Moran
Does the Minister really think that this needs to be an either/or? Could we not do the very good work that is going on with apprenticeships and also maintain this important bursary? Does he have something to say to the chief executive of the Royal College of Nursing, who says these changes are short-sighted? Has the RCN’s position changed?
Stephen Barclay
I agree with the hon. Lady that we can do both: we can have the apprenticeship route, but we can also increase the number who do postgraduate training as an entry point into the profession. It is also why we are looking to expand the number of undergraduates. This is also empowering for students because it means that, while they are undertaking their course, they will receive more funding than they would under the existing system. Under the move to the loan system, depending on the circumstances of the course, health students will typically receive up to 25% more in the financial resources available to them for living costs during the time they are at university. For example, a student without dependants living away from home could access £9,256 under the loans system, compared with £6,975 under the NHS bursary system.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Minister is being typically gracious in giving way. He said in his opening remarks that he wanted to unlock additional places but, according to the RCN, far from unlocking additional places, the removal of the bursary has led to a fall of 700 places on nursing degrees and a 3% decline in the number of people starting nursing courses since 2016. Is it his view that the RCN is lying?
Stephen Barclay
The hon. Gentleman is quoting selectively. He is right to point to 2016, because the number of nurses in training was at a record high—an achievement by this Government for which little credit was given by the Opposition. The new system will take time to bed in, but it is important to ensure that more places are available and that there are more applicants, and that is our approach.
Maria Caulfield
Opposition Members seem to be portraying the bursary system as a panacea, but it was not a well-functioning system. There were more applicants than available places, and it was a real struggle for students from poorer backgrounds, such as myself, to live on £400 a month with no alternative income. The system also only catered for students with an academic background. The new apprenticeship system allows degree-entry nursing, but not necessarily through the academic route.
Stephen Barclay
As a nurse, my hon. Friend speaks with great authority and she is right. This is about empowering those who want to be a nurse, not all of whom want to go to university. She is also right to remind the House that many people’s ambitions are choked off by the existing system. Under the bursary system, over 30,000 people who applied to be a nurse were rejected. Too many people were being rejected, and we need more nurses, so we have a package of measures to increase the number of nursing places. Nothing has been said about those who were thwarted in that ambition. Universities, too, have consistently argued that healthcare postgraduate courses were an area prime for growth if we offered suitable loan products.
Dr Andrew Murrison (South West Wiltshire) (Con)
The Minister is right to highlight the university sector but has he, like me, recently visited his local further education college? If he has, I am sure that staff will have expressed the same view that I heard in Trowbridge recently: the new apprenticeship route into nursing is good for FE colleges that want to offer nurse training. Some colleges currently feel constrained because they are frozen out by universities but, in setting up such courses, colleges will be able to offer nursing to a much greater range of people than is currently the case.
Stephen Barclay
As a medic, my hon. Friend alights on an important point that I am happy to pick up. A number of the professions are degree entry, which precludes the further education college sector, so I will be happy to discuss that with him.
It is worth drawing to the House’s attention that it is not just universities that have been pushing for a change. Professor Dame Jessica Corner, the chair of the Council of Deans of Health, said:
“Our members report receiving a high number of good quality applications for most courses and they will continue to recruit through to the summer. Where courses have historically had a large number of applicants, fewer applicants might well not affect eventual student numbers”.
The key issue is not just how many people apply; it is ensuring that there are sufficient applicants for the places and then increasing the number of places on offer.
Stephen Barclay
I have given way quite a lot, so I will make a little progress.
In addressing the Opposition’s points, we have moved slightly outside the scope of the SI before the House, which concerns postgraduates, into a discussion about undergraduates, and the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), made the point that the postgraduate market has certain features that are distinct from the undergraduate market. In certain disciplines, such as mental health and learning and disability, some older applicants may be more risk averse about taking on a student loan, depending on when they did their first degree. If it was before 1998, they probably will not have a student loan, but let us not forget that the Labour party introduced tuition fees, so many who studied after 1998 will have a loan.
Working in conjunction with colleagues in the Department for Education, and taking some of the lessons about targeted support that have been learned in teaching, we intend to offer £10,000 golden hellos to postgraduate students in specific hard-to-recruit disciplines—mental health, learning and disability, and district nursing—to reflect the fact that those disciplines often have particular recruitment difficulties. That £9.1 million package will be supplemented by a further £900,000 to mitigate a particular challenge with recruiting in any geographical areas. For example, if an area such as Cornwall suddenly found itself having difficulty in recruiting speech and language therapy recruits, a targeted measure—perhaps at a different quantum from £10,000—could be implemented in order to reflect those geographical issues.
Dr Sarah Wollaston (Totnes) (Con)
I thank the Minister for meeting me to discuss the concerns raised by the Health Committee in our nursing workforce inquiry. As he has stated, applicants for learning disability and mental health nursing tend to be older, and those applicants are more likely to stay. They are particularly affected, so I am grateful to the Minister for listening to our concerns. Putting the needs of patients first by allowing for these targeted extra packages is very welcome.
Stephen Barclay
I am grateful for that support from the Chair of the Health Committee. Having spent four years on the Committee myself, I know the value that members of Select Committees bring to the House. The Health Committee, particularly under her chairmanship, is hugely valued in the Department. The mitigation package that has been put before the House tonight reflects the constructive engagement that we have had with the Committee. We realise the importance of having consistency between undergraduates and postgraduates, and of expanding the supply of places, but it is also important to recognise that there might be specific areas in which there are recruitment challenges, and that targeted action to mitigate those challenges is appropriate.
Vicky Ford
I thank the Minister for the announcement that he has just made. At the nursing college in Chelmsford, and also at Cambridge and Peterborough, we have 30% more qualified applicants, but there have been fewer applicants for mental health nursing. This targeted intervention will really help to address that need. Will he confirm that this will be locally based where necessary—that is, in the areas where we need the help most?
Stephen Barclay
I am happy to confirm to my hon. Friend that there will be a local element to the targeting of the package. She has been a powerful advocate in helping to secure the new medical school at Chelmsford, which will be a huge boost to the local health economy.
The statutory instrument before the House tonight is part of package being brought forward by this Government, alongside the “Agenda for Change” increase in pay and alongside our ambitions to increase the number of apprenticeships and to encourage people to return to the profession. We have already made this change for the much bigger population of 28,000 undergraduates, and it is right that we should now apply that consistently to the 2,500 postgraduates. We have a targeted measure of support to address any hard-to-recruit areas, and I therefore commend this statutory instrument to the House.
Dr Philippa Whitford (Central Ayrshire) (SNP)
As the Minister says, we are here to discuss removing the bursary from postgraduate nursing students, but it would be crazy not to learn from the experience of the past two years following the removal of the undergraduate bursary in 2016. Scotland maintained that bursary, as indeed did Northern Ireland and Wales. We provide £6,500 as a bursary and up to £2,500 carers allowance for those with caring commitments, and obviously there are no tuition fees, so that saves another £9,000 a year. Our students are therefore £18,000 a year better off. Only in England has the undergraduate bursary been removed and tuition fees introduced. So nurses in England will face coming out with debts of £50,000 to £60,000.
As has already been said, there has been a 33% fall in applications. Several Government Members have said that there are still plenty of applications, but what talent has been lost in that third? Exactly who are the people who are not applying for nursing because there is no longer a bursary? There has been an even bigger fall—42%—in the number of mature students applying, yet we know that mature nursing students have a much greater tendency to stay in the place where they start and to stay in nursing. We are discussing postgraduate students tonight, and the biggest advantage of postgraduate students is that they will be trained more quickly. The Minister mentioned the fact—although he did not expand on it—that postgraduates already have student loans. The idea of asking them to take on second student loan is likely to result not in a 33% or 42% drop but in an even bigger drop.
The Minister talks about the extra money that the NHS is investing, but why not invest it in attracting people to study nursing as a degree? It is fine to talk about nursing apprenticeships, but we hear that only 30 people have taken those up, and they will not be ready until 2022, so they are not a quick answer. I have nothing against the idea of nurse apprentices, but nurses are now leaders in the health service; we have advanced nurse practitioners and nurses who are managing and leading services. That requires them to be educated to degree level and to have the experience to act as leaders.
What we hear from the Royal College of Nursing is not that there are now 700 fewer nurses in total, but that 700 fewer nurses have started training through the degree course, yet all this change was meant to be about expanding that number. It has not expanded; it reduced last year. The danger is that that pattern will continue and be even more marked for postgraduate students.
In Scotland, obviously, we have maintained the bursary. Instead of a 3% fall in the number of people starting studying, we have seen an 8% rise. Indeed, we have already seen a 10% increase in the number of people signing up for nursing places this year. We all need nurses, because all four national health services are struggling with the workforce, but NHS Improvement reports that there are 36,000 vacancies in NHS England. That is catastrophic. Literally, one in 10 nursing jobs in England is empty. That is more than twice the vacancy rate we face in Scotland. This is safety issue. The Secretary of State talked about safety. This is part of what led to the junior doctors’ strike, because we are talking about avoidable deaths. Research shows that the only measure that reduces avoidable deaths in hospital is the ratio of registered nurses to patients—not healthcare assistants, auxiliaries, doctors or anyone else. This is about registered nurses actually looking after patients.
The extra places that we were told would be funded by removing the undergraduate bursary will start only this autumn, so they will not be ready until 2021. The apprentices will not be ready until 2022. Postgraduate students starting this autumn will at least be ready in 2020. This is urgent. The NHS in England is struggling for want of nurses. They are the people who make the difference to safety. The Government should be investing in whatever will produce high-quality nurse leaders as quickly as possible, and that is postgraduates.
Robert Halfon (Harlow) (Con)
To achieve social justice and deal with the skills deficit, we need a skills revolution. In many sectors, we have a real skills shortage, particularly at level 4 and above. Young people are pushed towards traditional degrees, but only 52% are getting jobs after graduation that require a degree, according to the Chartered Institute of Personnel and Development. On the flipside, degree apprenticeships are just not growing fast enough, and we need to invest more in further education and skills provision.
I welcome what the Minister has said today, and I thank him for meeting me to discuss this issue. We must go further on nursing apprenticeships, which I believe are the answer to this whole problem. We can square the circle and support nurses by rapidly expanding the apprenticeship programme. Hon. Members will know that I am a passionate advocate of apprenticeships, and I therefore support the introduction of new routes into nursing, through degree apprenticeships and the creation of the nursing associate role.
Nursing degree apprentices will not have to pay anything themselves, as my hon. Friend the Member for Lewes (Maria Caulfield), a brilliant former nurse, explained. They will be able to become degree-registered nurses in four years. Similarly, the new nursing associate role will provide extra capacity in the workforce, and many of those who train as nursing associates may decide to continue to degree-level nursing.
The twin themes of the Education Committee in this Parliament are social justice and productivity. Nursing degree apprenticeships are key to both. They offer an attractive route both for mature students and for those with children, ensuring that all those who wish to train as nurses have the opportunity to do so. I am not suggesting that people should not have the choice of a three-year undergraduate course, but we must maximise the opportunities provided by degree apprenticeships. Doing so would mean that we have a sufficient nursing workforce and that aspiring nurses have options for training.
I have real worries about the fact only 30 people began training as a nurse through the nursing apprenticeship schemes this year, and we need to rapidly improve the number of people doing degree apprenticeships. There needs to be a taskforce involving the Minister for Apprenticeships and Skills, the Minister for Universities, Science, Research and Innovation, Health Ministers, the Institute for Apprenticeships and others to drive this forward and to encourage people with a proper advertising campaign, using the £200 million levy. Thirty is just not enough; we need many thousands of people. If people in my constituency and across the country knew about the schemes, they would want to take them up.
Dr Murrison
Does my right hon. Friend agree that part of the way we might expand the numbers taking the apprenticeship route is to unleash the power of the further education sector? The sector now has degree-awarding powers and would be very attractive to a large number of people not just in the big urban centres but in the smaller regions, too.
Robert Halfon
Like me, my hon. Friend is a big champion of further education and understands it completely. This could be an incredible moment for our further education colleges because, along with some very good private providers, they could be leading the way in providing degree apprenticeships.
Julian Knight (Solihull) (Con)
My wife was a renal nurse for 15 years, and she says that one of the key changes that happened in her time as a nurse was the university-fication of the nursing profession. Does my right hon. Friend agree that having this diverse route is a much better way to do things and brings in people from all backgrounds?
Robert Halfon
My hon. Friend is right. My hope is that, rather than 50% of all students just going to university, one day 50% of all students will be doing degree apprenticeships in all subjects, but especially in the subjects we need, particularly in coding, healthcare, science, engineering and nursing.
Dr Wollaston
I welcome my right hon. Friend’s work as Chair of the Select Committee on Education. Does he agree that we are losing too many healthcare assistants because in the past there have not been the opportunities for them to progress? These regulations are an important way to retain such a valued part of our workforce.
Robert Halfon
As so often, my hon. Friend is a mind reader. I will address her point, but of course she is right.
These jobs should not be limited to degree level; we should ensure there are apprenticeships in healthcare professions from level 3. We must have sufficient progression for those already working in the sector. The nursing associate role is a positive step that will provide opportunities for healthcare assistants to progress within the sector. From there, they could train to become registered nurses, if they wish.
Bambos Charalambous (Enfield, Southgate) (Lab)
Will the right hon. Gentleman give way?
Robert Halfon
This is the last intervention because I am conscious that other people want to speak.
Bambos Charalambous
In the light of the poor recruitment to the apprenticeship schemes, does the right hon. Gentleman agree it is best to keep both routes open—the bursaries and the apprenticeship schemes—to maximise the number of people coming into the system?
Robert Halfon
I thought that initially, but I have listened to my hon. Friend the Minister’s arguments. There was previously a cap, and not everybody was able to get into the system. If we can encourage people down the apprenticeship route, they earn while they learn, there is no debt and they get a lot more than they would get if they had a bursary.
Robert Halfon
This is genuinely the last time I give way. It is impossible to say no to my fellow member of the Education Committee.
Michelle Donelan
Further to the intervention made by my hon. Friend the Member for South West Wiltshire (Dr Murrison), my constituency neighbour, I, too, met Wiltshire College last week, and it is eager to take on nursing apprenticeships. The college shows we can get past the few roadblocks, because it is already affiliated with universities in offering degrees. That is one way in which we can look positively at increasing the number of apprenticeships, rather than looking at it negatively, as we hear from the Opposition.
Robert Halfon
My hon. Friend is a remarkable member of our Committee and she is right in what she says. It is good that the Minister for Health, the Minister for School Standards, the Minister for Universities, Science, Research and Innovation and the Minister for Apprenticeships and Skills are here, because we need to unblock the roadblocks and bureaucracy and really make these things happen, so that thousands of people are doing this, not just 30.
We need to ensure that we are making the progression as smooth as possible. Our Committee is concluding its inquiries on value for money in higher education and the quality of apprenticeships and skills training. Nursing bursaries are relevant to both, so we decided last week to hold a one-off evidence session on the subject in the next few weeks. I hope that the Minister for Health will accept our invitation to discuss the matter in greater detail then. I urge him to carry on championing nursing apprenticeships for other healthcare professionals and to set out in detail, at a later date, what the Government will do on apprenticeships. Let us make that culture change, so that apprenticeships are not seen as the inferior option to traditional courses. The change must start in Whitehall, and only when it happens will we see nursing apprenticeships used to their full potential, contributing effectively to tackling the skills deficit and helping the most disadvantaged to have the careers that they and our country need.
Karen Lee (Lincoln) (Lab)
As Members probably know, I was a nurse until last June. I did 12 years in cardiology and almost three in out-patient gynaecology clinics. As an ex-nurse, I could not be any more in opposition to this amendment to nursing bursaries, as I am concerned that it will fail to address the problems with nursing recruitment and will intensify the fall in applications to nursing courses. Overall, applications have fallen by 33% since March 2016, when bursaries were withdrawn. At that time, the Royal College of Nursing, a much respected and non-political body, said the changes were unfair and risky, and the Royal College of Midwives argued that the move threatened the future of maternity services in England.
I hope that all of us in this Chamber acknowledge that there is a workforce crisis across the whole NHS. As the RCN has said,
“plans by the government to remove the NHS bursary for pre-registration students in England must be stopped immediately”.
It goes on to say that
“nurses need bespoke financial support if the government is to meet its commitment to grow the nursing workforce and meet the future population demand for health and care services”.
The National Audit Office has reported that the impact of the EU referendum appears to be driving EU nurses away, and both the Care Quality Commission and the NAO have raised safety concerns relating to nursing shortages—it is not just Opposition Members who are saying that.
Alex Sobel (Leeds North West) (Lab/Co-op)
My hon. Friend gave many years’ service as a nurse and I am sure she worked with many nurses who came here from abroad. The Migration Advisory Committee has placed nursing back on the shortage occupation list. In the light of that, is not this statutory instrument wrongheaded, as we need nurses to come through all routes if we have a nursing shortage?
Karen Lee
I completely agree with that.
There are 40,000 nursing vacancies across the NHS and, for the second year in a row, more nurses are leaving the profession than joining, with one in three expected to retire in the next 10 years. The Government have made much of the nursing associate role and apprenticeships for nurses. Nursing associates provide a support role for nurses, and the RCN feels that diluting and substituting registered nurses with associate nurses has potentially life-threatening consequences for patients. That is the RCN saying that, not me.
This Government also speak in glowing terms about the apprentice nurse role. I do take the points made by the right hon. Member for Harlow (Robert Halfon)—he means well—but it takes four years to train as an apprentice nurse and our health service is, as the RCN says, in crisis right now. Furthermore, this route is not currently providing the 1,000 new nurses per year that the Government planned for, with RCN figures suggesting that there are just 30 apprentice nurses at present—I will give that answer.
I was a mature student. I was 41 when I started my training, and a single parent. We have heard a lot tonight about how we will encourage people who do not want to go down the university route. I worked in Tesco on a checkout. I had been to grammar school and it had failed me, so I had to go to night school to get my A-levels to become a nurse. That took me a year, three nights a week, on top of working. I then worked for three years as a nursing student to become a nurse. I could not have completed my training without a bursary. I also borrowed £5,000 a year from the Royal Bank of Scotland, so I came out hugely in debt, even though I had a bursary, and it took me five years to clear that debt.
Karen Lee
That is what I had to do to become a nurse. I think I got around £500 of bursary at that time, and I had myself and my 10-year-old daughter to keep.
My friend Ali was a wife and a mum, and she needed her bursary, and my friends Clare, Haley, Adele and Lisa were younger and single, but they still needed their bursaries, because everybody has bills to pay. None of us could have trained without our bursaries and none of those friends would have gone on to be the nurses they are today without them. Please, will no one on the Government Benches talk about encouraging disadvantaged people to train as nurses? When we had bursaries, we did—I did.
The bottom line is that more nurses equals better healthcare provision. We cannot go on with an NHS in the state it is currently in. The Government continue to ignore completely the wise words of those who are experts in their field—like the Royal College of Nursing—when it comes to the support available for future healthcare professionals. They seem to think that they know best, but the reality does not bear out that fantasy. The regulations must be scrapped and the Government should reinstate nursing bursaries immediately.
I stand in this Chamber time and again defending our NHS, and I hear people who have no idea what it is like on the ground. Sometimes they sit looking at their phones when people like me are talking. I despair. If the Government will not listen to me, I hope they will heed the wise words of the RCN, because it is right on this. Please listen to the RCN and please reinstate nursing bursaries.
Maria Caulfield (Lewes) (Con)
May I start by declaring that I still work as a nurse on the bank shift, mainly at the Royal Marsden Hospital in London? It is a pleasure to do so.
I have previously been very outspoken against the removal of bursaries and the move to a tuition fee-based system, for practical reasons: student nurses are different from most students. The course requires them to do a set number of practical hours, and the fact that those are often unsocial and irregular means that it is almost impossible for student nurses to get other part-time work to supplement their time on their courses. We have heard today that student nurses are often mature students who have come from other professions and so already have financial commitments, such as mortgages and loans, that they have to bear in mind when they start a nursing course. Postgraduates who have existing debt are often reluctant to take on more to become a student nurse.
However, since the changes were introduced a couple of years ago, the background has changed. We have seen the rise of the apprenticeship route for nursing and of the associate nurse. My difference with Opposition Members is that I have actually worked with some associate nurses who are in training, and with apprenticeship nurses in training, and the difference is phenomenal. They are enjoying their courses a huge amount more because they are working in a practical setting. It is not just about what they are learning on their nursing course; they are back to being part of the team. They are not students who just come to their placement from university; they are learning about being part of a hospital team and a clinical community.
Associate nurses and apprentice nurses are more than just students; they bring experience with them. Many have backgrounds as healthcare assistants. The experience that they bring from a variety of settings is phenomenal. I know about the support that they have given me on shifts as a bank nurse, and that would not have been available with student nurses previously. We are underestimating their power.
I echo some of the comments in the debate: we do need to ramp up the apprentice and associate routes, because that is the way forward. The bursary system was far from ideal. I lived on a bursary of £400 a month for the three years that it took me to train as a nurse, with little or no additional income. As the hon. Member for Lincoln (Karen Lee) said, student nurses rack up significant debt during those three years. That shows that the bursary system was far from ideal. The statutory instrument took some of those points into account, establishing a hardship fund for struggling students and grants for childcare, travel and accommodation—none of which were available under the bursary system. They are there to support students who have financial pressures.
The bursary system has failed to achieve the number of students that we need. There was a cap on the number of places. Each and every year there were more applicants, but there were not more students coming through the system, because the cap did not allow those applying to secure the places. We need to embrace change, and use this as an opportunity to increase the number of nurses. We should also make student nurses feel valued, and give them a variety of routes into nursing. They have the associate nurse role, which means that they are healthcare assistants who want to do their associate training. They can then top up their training in the future to become registered nurses, or they can go down the apprenticeship route to qualify.
I see Opposition Members laughing. They seem to find it difficult to understand how a Conservative Member of Parliament can be a nurse—I am talking about someone who came from a deprived background and who took the route into nursing because she could not get into university. I will not apologise. I am not afraid to speak out for student nurses and for nurses. I worked with the RCN in the “Scrap the cap” campaign. I spoke out when there was a move away from the bursary system, but, with my hand on my heart, I can say that the associate and apprenticeship routes into nursing are the way forward. It is misleading to pretend that the bursary system was a panacea, that student nurses were happy and that we were fulfilling the numbers that we needed.
I am a member of the RCN and I fully respect everything that it does to support nurses, but its briefing has been slightly misleading. It lists only two routes into nursing: the two-year postgraduate route, and the three-year route into nursing. It does not even mention the associate route or the apprenticeship route, which we need to take into account. It also highlights the fact that applications into nursing have fallen, but it has not mentioned that 2017 saw the second-highest number of students ever accepted on to nursing courses—26,620 students—and that was despite an overall fall in the total number of applications.
Maria Caulfield
I thank the hon. Lady for her intervention. As a member of the RCN, I, too, have had the briefing, and it does not mention the associate and apprenticeship routes into nursing.
The bursary system was not the panacea that Opposition Members claim it to be. I am happy to stand up to fight for nurses when I think that Labour Members may have a point, but I think they are now moving into the realm of scoring political points, which is their usual tactic. There is a better way to get nurses into training, and I urge Ministers to continue both the associate route and the apprenticeship route, to give student nurses alternative routes into nursing, to boost nursing numbers and to develop nursing into a degree-entry healthcare profession.
Vernon Coaker (Gedling) (Lab)
May I just say to the hon. Member for Lewes (Maria Caulfield) that this is not about scoring political points? It is about debating in this House of Commons something that is of immense importance to our country. I agree with her that no one has a monopoly on these things, but it is only right and proper that we have an open and frank debate about the matter. That means that there will be a clash of views and a clash of opinions, but out of that will come better policy, and I hope that the Government, as they move forward, will listen to some of the concerns that have been raised, even if they do not change their policy. There is nothing wrong with that. That is not political point scoring; that is holding the Government to account for the policies they are pursuing.
Let me also say this: the only reason why the Government are being held to account is that my hon. Friends on the Opposition Front Bench have obtained this debate. They deserve a great deal of credit for that, because the Government were not going to debate these regulations. Indeed, the House of Lords Committee, that scrutinises these secondary legislation reports said that it was unprecedented for the Government to be forced to hold a debate in this place when revoking one set of regulations and replacing them with another. So, it is quite right that we are actually saying this to the Government. We would not be able to get the Government to put forward their views as to why removing bursaries is a good thing, and we would not be able to explain why we are holding them to account, were it not for the fact that we raised this matter in the way that we have.
The hon. Member for Lewes criticised the Royal College of Nursing’s figures, but the RCN—a highly respected body in this country—has laid out the statistics, including for many of the routes that she says it has not, regarding the fall in the number of applications since NHS bursaries were got rid of two years ago. There has been a 33% fall in the number of applications for nursing degrees. It may be that that does not matter, but the Government still need to address and defend it and explain why the RCN is wrong to highlight that as a figure that should cause us concern.
Maria Caulfield
That is the point: despite the fall in the number of applications, the number of placements has actually increased to its second-highest level ever. If the bursary system was so great, why were the nursing student numbers not coming through it, and how come we had such a high drop-out rate of student nurses?
Vernon Coaker
Let us see where this goes. The hon. Lady’s point is that it does not matter that there has been a 33% fall in applications, because other things will happen, but that is not the view of the Royal College of Nursing. Applications from mature students have been disproportionately affected by the funding reform; the number of applicants aged over 25 has fallen by 42%. I do not know whether the Minister intends to respond—it would be a shame if he did not—but perhaps he can explain why that figure does not matter. That point needs to be addressed in debate. The hon. Lady disagrees, but I say that it does matter, and that it will cause problems for future nursing recruitment.
Dr Whitford
The hon. Member for Lewes (Maria Caulfield) asks why not enough nurses were coming through. Is that not simply because there was a cap on places? The Government keep linking the bursary with the cap. The issue was not the bursary; it was the cap. If the Government want to invest in nurses, they should lift the cap but not remove the bursary, because that will shrink the number of applications.
Vernon Coaker
I thank the hon. Lady for her intervention. I say to the Minister that there is hard evidence from the Government’s own equality analysis that the reforms will
“increase the amount of student loan borrowing for postgraduate students and could lead to a fall in student numbers. The government has acknowledged that, due to the student intake, the impact will fall largely on women, older students and, to a lesser extent, students from ethnic minorities.”
Where is the Government’s defence of that, and what are they doing to mitigate it? I have no doubt that the Government would say, “We have done x, y and z.” Indeed, that is what the hon. Member for Lewes has said, but where is the Minister’s explanation?
It is not just the Government equality analysis that says we should be concerned about the changes. A House of Lords Secondary Legislation Scrutiny Committee report, published just a few days ago, also raised concerns. First it criticised the process and then it said:
“Our second, no less strongly felt concern is with the wider impact on recruitment to post-graduate nursing courses which may result from the switch from bursary to loan support”.
That is why this debate is so important. There is evidence from a highly respected Select Committees of this House, and from the Government’s own equality analysis, and were it not for the actions of my Front-Bench colleagues, we would not even be debating the issue and the House of Commons would not even be reflecting on a major change to the way in which we fund the postgraduate training of our nurses.
We all agree that the nurses of this country deserve our respect, and that they do a wonderful job, but the point of this debate is to ask whether we are going to address the shortage of nurses following the removal of nursing bursaries. As my hon. Friend the Member for Ashton-under-Lyne (Angela Rayner) said, we have serious concerns and doubts about that, and it is quite right that those are debated.
Let us see whether the hon. Member for Lewes is right, or whether the Royal College of Nursing is right that the huge fall in applications we have seen at undergraduate level will be reflected at postgraduate level, and that down the track the Government will regret ignoring the professional bodies and their own equality analysis. The Government need to reflect on that and see what more can be done. Rhetoric about our nurses being brilliant is fine, and we all share that admiration, but at the end of the day, what this country needs is hard-nosed policy that works.
Rachel Maclean (Redditch) (Con)
I will keep my remarks brief. It is a great pleasure to follow the hon. Member for Gedling (Vernon Coaker). I agree with him that we need a new long-term system that works and removes the cap from people who wish to study as nurses. The vice-chancellor of Oxford Brookes University, Alistair Fitt, has said that nursing bursaries “had to end” and were not a sustainable system. The cap on places was discouraging people who wished to enter the nursing profession, which is so important for all our constituencies.
In Worcestershire, we need more nurses, not fewer. I welcome the work that has been going on in a partnership between my NHS trust and the University of Worcester. I backed their calls for a medical school, and the work being done on the ground is already reducing nursing vacancy rates. They are down from 8.4% to 7.5%, and nursing turnover rates are down from 14% to 10% in the last year. That is a tribute to local professionals working hard to tackle the real problems in my area for the benefit of my constituents. I want to see more of that.
Under the new system under the regulations, postgraduate healthcare students will be 25% better off as they take part in their studies. These are new measures, and we need to back the Government. We should not vote for the Labour party’s motion to annul these Government regulations, which will help more people to enter the nursing profession at senior levels. We are talking about the senior leadership roles that we need in all our hospitals to deal with the needs of our population and their healthcare.
Finally—I said I would be brief, and I will be—we definitely need to stop the rhetoric about student debt, because it puts people off going to university. I refer Labour Members to the comments of Martin Lewis, a respected financial expert, who just last week said that it was completely wrong—[Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. The hon. Lady is making a serious speech. There should not be so much chuntering going on.
Rachel Maclean
Thank you, Madam Deputy Speaker.
Martin Lewis’s comments were, it is true, aimed at politicians on both sides of the House, but we have all heard the Labour party’s recent claims about student debt. The idea that that is the same thing as a debt has, in reality, put people from different backgrounds off studying at university. Student debt is not the same thing as a credit card debt. It is a graduate tax that people pay only when their income reaches a certain level, and that is the same for nursing students. We have to go forward with a sustainable solution.
Rachel Maclean
I will not, because time is short.
Conservative Members will work to fight against the weaponisation for political ends of students and people who want to be students. We will open up more opportunities for everyone in this country to make a career in the NHS, if that is what they choose to do, and we will run the economy in a balanced way to support our precious NHS during this Parliament and in the years to come. I will not be voting for Labour’s motion tonight.
Question put.
The House proceeded to a Division.
Madam Deputy Speaker (Mrs Eleanor Laing)
I remind the House that the motion is subject to double-majority voting of the House, and of Members representing constituencies in England.