Healthcare Students: Pay and Financial Support

Monday 20th November 2023 Westminster Hall

[Relevant document: Summary of public engagement by the Petitions Committee on pay and financial support for healthcare students, reported to the House on 5 September 2023, Session 2022-23, HC 73.]

16:30

[Marsha De Cordova (Battersea) (Lab)]

I beg to move,

That this House has considered e-petitions 610557, 616557 and 619609, relating to pay and financial support for healthcare students.

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the petitioners, Victoria, Charlotte and Jacorine, on starting the petitions, which were signed by more than 36,000 people. I thank all the organisations that prepared briefings ahead of the debate, including the Royal College of Nursing, the Royal College of Midwives and the National Union of Students, and I thank the Petitions Committee for its work.

Today’s debate is timely, as many of our constituents have been impacted by the cost of living crisis in multiple ways, but the impact on students and the unique challenges they face are rarely acknowledged. The president of Universities UK, Professor Steve West, stated:

“Students risk becoming the forgotten group in the cost of living crisis.”

Academic and workplace commitments leave little room for students to earn outside their studies, so it is inevitable that cost of living pressures will hit them hardest. Those pressures are more pronounced for those studying healthcare subjects, as many are mature students and may have to balance parenting duties with course commitments, not to mention the extra costs they face supporting their children.

Healthcare students who responded to the Petitions Committee’s survey ahead of the debate said that they were struggling with the cost of living, with 58% saying that it was difficult or very difficult to afford energy, including gas and electricity. Nineteen per cent said that they had visited a food bank, and 26% said that they were considering using one. Further adding to the pressure, healthcare students are required to complete thousands of hours of unpaid clinical placements over their course programme. One student nurse said:

“I wanted to leave my course this year when I was working on placement and not able to afford food. I was so hungry, and my energy was so depleted that it was affecting my work. I was struggling so much financially that the staff resorted to giving me toilet rolls, sanitary products and even paying for some food for me.”

As healthcare students are not paid or classed as workers, they often lose out on additional support or entitlements, such as the 30 hours of free childcare available to working parents. Many said that they were under considerable financial strain and found their workload difficult to manage, as they were juggling childcare, their unpaid nursing placements, study, and a second, paid job. Worryingly, many said that they were considering leaving their course due to financial pressures related to childcare costs, with 93% strongly agreeing that healthcare students should be eligible for free childcare. In the words of one student:

“I am working just as hard as I was when was employed by my local police force 12 months ago and yet, as I am now considered a student and not a worker, I can no longer claim the 30 hours free childcare for my 3-year-old. There are shortages of many NHS staff so I can’t understand why the government does not make it easier for parents to study for these roles.”

It is a fact that England has the least generous financial support for healthcare students.

[Paul Blomfield (Sheffield Central) (Lab)]

I regret that I cannot stay for the whole debate, but, as chair of the all-party parliamentary group for students, I wanted to make a contribution. My hon. Friend refers to a debate that we had seven years ago, I think, when I recall the then Minister, Ben Gummer, told us that he was keen to share the benefits of the undergraduate student funding system with healthcare students, including nurses and midwives, who had previously benefited from the bursaries, and was anticipating that that would lead to better support and an expansion of the number of people coming into the service.

Does my hon. Friend recognise that those of us who argued at that stage that the changes would lead in the other direction have been validated by experience? Does she agree that we have seen more potential nurses and midwives, particularly mature ones, no longer entering the profession? Also, is she concerned—I hope that the Minister will respond to this point—about the UCAS figures for this year, which show a 16% decline in the number of people applying for healthcare courses?

[Marsha De Cordova]

My hon. Friend makes an important point, which I will come to shortly, and he is absolutely right. It is clear that the changes to the bursary scheme have led to a fall in the number of students taking up these much-needed roles.

Since the removal of the bursary scheme, students studying nursing, midwifery and allied health professional courses in England are only eligible for the standard student finance package of tuition fee and maintenance loans, whereas students in Wales, Scotland and Northern Ireland who are eligible enjoy fully funded education.

I am sure that, in responding to the points made by my hon. Friend the Member for Sheffield Central (Paul Blomfield), the Minister will point out that since 2020, students eligible for the standard student support package receive an additional £5,000 training grant through the NHS learning support fund, that there are additional grants for some qualifying students and that the Government have increased travel and accommodation support. But that simply is not enough. Eighty per cent of student midwives in England who took part in the Royal College of Midwives survey said that they would be taking on additional debt over and above the loans available to students. Moreover, nearly three quarters of student midwives in England said that they expect to graduate with debts of more than £40,000. I am sure that my hon. Friend agrees that that cannot be acceptable.

Government-imposed barriers are making healthcare studies unaffordable for many students. In the first year after the changes to the bursary model, the number of applicants from England for nursing courses fell by 23%. My hon. Friend highlighted the latest UCAS figures, which showed that this year there has been another fall in the number of people applying.

Why does this all matter? I will make two key points today. The first is that it is a matter of fairness and equity. Healthcare students make a significant contribution and play a vital role in delivering high-quality healthcare. Many of those on placements are often required to cover the responsibilities of qualified healthcare workers, due to the workforce shortages.

The Government must look at increasing financial support for healthcare students, and I hope the Minister will address that point. They could do so by creating a scheme to offset or write off debt run up by healthcare students through tuition fees if they commit to working in the NHS for a period of time. That would be similar to the scheme in Wales, which I am fairly certain is working. They should also ensure that higher education funding models are complemented by a financial package for students, to make sure that grants reflect the true cost of living, as they do in Scotland, which has the most generous living cost support. The Government should also extend the 30 hours of free childcare to those on placements.

I would welcome it if the Minister addressed those points in his response. To adequately address fairness and equity, the Government must also focus on intersectionality by looking at the age and sex of healthcare students, as many tend to be women and/or mature students, who are more likely to have dependants.

The second point I want to touch on is the workforce crisis in the NHS, which is so severe that it is undermining the NHS’s capacity to properly deliver its services—we all know it is on its knees. The long-term workforce plan produced by NHS England suggested that the system is operating with over 150,000 fewer staff than it needs. According to the Royal College of Nursing, there are 43,000 vacant registered nursing posts in the NHS in England alone.

Like my hon. Friend the Member for Sheffield Central, the general secretary of Unison, Christina McAnea, rightly predicted the damage that the Government’s reforms would do were they to get rid of the bursary scheme. She said:

“They seem not to care that in a few years’ time”—

that is now—

“the NHS will be seriously short of nurses and there will be too few new recruits coming through to fill the gaps”.

Seven years later, we can all attest to that being the truth.

The NHS, our greatest institution, was established 75 years ago by a Labour Government, and it is experiencing some of the most severe pressures in its history. Waiting lists are at an all-time high. Ministers point to the impact of the pandemic, but waiting lists were already too high before the pandemic. If we want to make sure our NHS survives another 75 years, the Government must make progress on the workforce challenges. They need to look at all options and think bigger to incentivise more people to take up healthcare professions. Restoring some sort of financial support package may do that. They must fundamentally rethink the way they approach their support for healthcare students, including by making extra funding available for healthcare education and training.

We owe it to our healthcare students to ensure that they have adequate financial support as they provide the care that keeps us all healthy, and to protect the long-term interests of our country by having a workforce that can truly deliver all the services that the national health service provides.

16:43

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I welcome the Minister to his latest position on the Government Front Bench. I hope he enjoys what remaining time the Conservatives have in government in the Department of Health and Social Care. I wish him all the best over the next few months.

I am grateful for the opportunity to respond to the debate on behalf of the shadow Health and Social Care team. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for her powerful speech, and my hon. Friend the Member for Sheffield Central (Paul Blomfield) for his wise contribution. I also thank the Petitions Committee for its work in preparation for the debate.

Being a student nurse during the cost of living crisis is tough. We know that valuing our NHS workforce through fair pay and conditions is crucial to tackling vacancies, yet according to the RCN’s 2023 summer survey, almost nine in 10 student midwives in England—89%—worry about the amount of debt they are in, and 74% of them expect to graduate with debts of more than £40,000.

[Paul Blomfield]

My hon. Friend is making a very important point, and I am sure that he will come on to say that the experience of midwives also applies to nurses and others on healthcare courses. The report by the APPG for students, which I mentioned a moment ago, highlighted the way in which the student funding model was broken, not least by pointing out that, according to Save the Student, the average loan now falls short of living costs by £439 every month. Most students are dealing with that by taking on ever-increasing amounts of paid employment, which is raising some concerns. One Russell Group university told us that a significant number of its students work more than 35 hours a week. Does my hon. Friend agree that that option is not available to most nurses, midwives and other healthcare students on similar courses, because of the structure of their courses? The Government are failing to address that issue.

[Andrew Gwynne]

My hon. Friend hits the nail on the head. We are talking about student nurses and student midwives, who do not have any spare time to dedicate to other forms of paid employment: it is physically and mentally impossible for them to do so. There needs to be greater recognition of the unique nature of these kinds of students. Many students—including me, many years ago—rely on extra support to make ends meet, but people studying in the caring professions, including nursing and midwifery, do not have that same ability. That was one reason why there was always additional support for those groups of people.

Fifty-eight per cent of respondents to the survey conducted by the Petitions Committee for this debate said that it was difficult or very difficult to afford energy, including gas and electricity, 19% said they had visited a food bank, and 26% said they were considering using one. That is a national scandal—a cost of living scandal that is having a devastating impact on our ability to recruit and retain staff in the national health service. Over nine in 10 student midwives in England—91%—know someone who dropped out of their midwifery studies because of financial problems.

The Conservative Government abolished NHS bursaries for student nurses, midwives and allied health professionals back in 2017. Students undertaking their degree since then have had to pay to train to work in the NHS. As a result, not surprisingly, the number of applications to study nursing in England fell, with applications down by almost 30% by 2019. It is not rocket science to work out what caused that. Labour said at the time that the decision to remove the NHS bursary was the wrong one, and the Public Accounts Committee, in its September 2020 report, agreed that the decision

“failed to achieve its ambition to increase nursing student numbers.”

That is just another example of a Government who have time and again failed to plan for the long term.

In this NHS workforce crisis, we have deteriorated to the point where we now have over 100,000 vacancies, including 40,100 nursing vacancies. We have waited so long for the NHS workforce plan, and now we finally have it. Labour has been calling for a workforce plan for years, and I am glad that the Government pinched the plan of my hon. Friend the Member for Ilford North (Wes Streeting). Since its publication, though, not much has happened. It makes clear the scale of the neglect—a wasted decade of drift and inaction, impacting not only on staff but on trainees.

Placements are an important part of nursing and healthcare courses. They provide the vital supervised training that allows students to gain the necessary skills and experience to meet education outcomes and work in clinical settings. Labour knows the value of placements, which is why increasing them is an important part of our plan to expand the NHS workforce. We will focus on ensuring we have the roles, trainees and senior professionals needed to tackle the challenges we face and seize opportunities, drawing on a diverse range of skills and inspiring people around the country to pursue a career in the NHS and caring professions. We will also work with health staff and their trade unions to review existing training pathways and explore new entry routes to a career in the NHS, including high-quality apprenticeships.

The childcare sector is under huge strain. While some healthcare students may be eligible for parental support from the NHS learning support fund of £2,000 a year, that is dwarfed by the ever-increasing cost of childcare. It leaves many studying parents vulnerable to childcare costs, particularly considering the hours needed to fulfil placement requirements. It has been reported by openDemocracy that some nursing students considered leaving their courses because of financial pressures related directly to childcare costs. That is, sadly, a trend across our economy. The cost of childcare is pricing parents, especially women, out of the professions they love.

Does the Minister agree that adequate support for a profession as critical as nursing or midwifery should not depend on where a person studies but should be the same across the board? What assessment has he made of support at all stages of training for studying parents, in order to build an effective and inclusive workforce in our NHS? The 11,000 people who signed the petition will be looking for a response from the Government, so does the Minister regret the decision to abolish NHS bursaries? What additional support can healthcare students expect, given the current cost of living crisis?

Two in five student nurses and three in five student midwives said that they considered leaving their course last year, so we must take this seriously, especially given the threat to the future of the NHS workforce that it poses. Already students have cited the placement experience and lack of support as major factors in their leaving their course. The Conservative-made crisis in the NHS only makes this worse. We might have expected in this month’s King’s Speech to hear of something to deal with the worst NHS crisis in its history, but there was virtually nothing.

The energy price cap has increased by half this Parliament, the cost of living crisis is hammering healthcare students, and we have a flagship energy Bill that

“wouldn’t necessarily bring energy bills down”.

Whether we are talking about the NHS or the cost of living crisis, this Conservative Government look like they have thrown in the towel. They are divided, weak, out of ideas and out of time. Every day that goes on, it is British people, our public services and our patients who pay the price. For Labour’s part, we know that our healthcare staff are our national health service’s most valuable asset, and we know how vital it is to ensure that there is a pipeline of future talent coming through. That is why the next Labour Government will put their workforce plan at the heart of their plans to restore, renew and rejuvenate our national health service.

16:54

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

It is a great pleasure to see you in the Chair, Ms Fovargue, for my first Westminster Hall debate in my new role. I am grateful to the British public for raising the important issues covered in the three petitions we are considering today, and to the hon. Member for Battersea (Marsha De Cordova) for opening the debate. I also thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his contribution and his qualified welcome to me in my new role, and the hon. Member for Sheffield Central (Paul Blomfield) for his interventions during the debate.

Our students are the future of our NHS, so it is imperative that we not only support them throughout their studies, but ensure that as many as possible go on to successful careers in healthcare. The Government recognise the unique nature of healthcare degrees, the intensity of the courses and the additional financial pressures that clinical placements can cause, which is why we are doing as much as we can with the funding available to us to ensure that clinical students have the financial support they need to succeed.

Two of the petitions focus on pay for student placements. While they are on placement, student nurses, midwives and allied health professionals make valuable contributions to clinical teams, but the purpose of such placements is student development, not meeting staffing needs. They exist to give students the opportunity to learn and to acquire the skills and experience they need to graduate and join the professional register. That is why we believe that clinical placements should not be described as jobs. Students are not contracted to provide care and do not hold contracts of employment, so while we recognise the significant contribution made by students, the Government do not plan to introduce pay for students on placement at this time.

[Marsha De Cordova]

The Government are not planning to look at this issue again, but have they looked at the impact of student nurses being taken out of the workforce in NHS care settings, to see how the workforce would manage without them? They play a vital role. Yes, they are learning and so forth, but they also fulfil another role. Have the Government carried out any assessment of the impact of taking them away from that by not giving them pay?

[Andrew Stephenson]

The Government and the professional bodies that set the rules for student placements have made it very clear that if the students are not there, the setting should still be clinically safe and procedures should be able to be conducted. All student placements should be in addition to regular staffing; they should not be used to fill gaps in staffing rotas. That is not to suggest in any way that students on placement do not make a significant contribution—I think we all agree that they do, and I pay tribute to them for the contribution they make—but in all settings, if the students are not there the employed staff should be able to continue to deliver NHS services in the way that we all want.

We do not wish to introduce pay for students on placement, but we do intend to continue to listen to students’ concerns about the cost of training and to consider what we can do to support them, building on the work we have already done. Since September 2020, all eligible nursing, midwifery and allied health professional students have benefitted from a non-repayable, non-income-assessed training grant of at least £5,000 per academic year from the learning support fund. On 1 September this year, we announced a 50% increase to the travel and accommodation payments available through the learning support fund, ensuring that students are appropriately reimbursed for travelling to clinical placements.

The Government are not just supporting the more traditional routes into education and training. As we set out in the first ever NHS long-term workforce plan, we are expanding alternative routes into healthcare, enabling people from diverse backgrounds and those for whom a traditional university degree is not possible, or is not the right thing for them, to bring their unique skills and perspectives to the NHS. We are now offering blended learning courses, allowing students to take some of their courses online, and more than a quarter of nurses’ mandatory practice learning hours can now be delivered via innovative simulation. We are also continuing to expand our apprenticeship offer, allowing students to study towards a degree while also learning on the job. As set out in the long-term workforce plan, we will deliver a huge increase in the number of clinical staff apprenticeships; we intend to get them up from 7% today to 20% by 2032. That is building on the success of our existing registered nursing degree apprenticeship programme; more than 10,000 students have started on that course since 2017.

We are providing a more diverse set of pathways into healthcare careers in order to open up more opportunities for staff to progress and move into new roles. Thanks to an increase in the number of associate roles, such as nursing associates, it will be possible to join the NHS as an apprentice healthcare support worker and go on to qualify as a registered nurse.

I would like to pick up on a point made by the hon. Member for Sheffield Central, who talked about the UCAS figures showing a 16% decline in applications. The drop in applications compared with previous years reflects an expected rebalancing following the unprecedented demand for healthcare courses during the pandemic. At the June application deadline this year, there were 44,000 applicants for nursery and midwifery courses in England, which is an increase of 12% compared with this time in 2019. The latest data shows that over 22,000 students have accepted places on nursing and midwifery courses in England, which is an increase of 6% compared with the same time in 2019. If we look at allied health professionals, 2,200 more graduates enrolled on paramedic science courses overall in England in 2021-22 than did so in 2019-20, which represents a 30% increase.

Let me address the second issue raised today: childcare payments for student midwives, nurses and paramedics during their placement hours. The Government understand how important childcare is for studying parents, and we believe that they should have every opportunity to continue in education and achieve their aspirations. As the Minister for Skills, Apprenticeships and Higher Education set out in our response to the petition, the Government provide a range of financial support to students with children. They are eligible for 15 hours of free early education for three and four-year-olds, and full-time students on undergraduate courses who have dependent children could also be eligible for the childcare grant and the parents’ learning allowance. The childcare grant covers whichever is the lowest: 85% of childcare costs or a fixed maximum amount of around £190 a week for one child or £320 for two or more children. The parents’ learning allowance of up to £1,915 a year does not have to be repaid; it is paid in three instalments—one at the start of each term—and goes directly into students’ bank accounts. What is more, as part of the learning support fund, my Department offers all eligible nursing, midwifery and allied health professional students an additional non-repayable and non-income-assessed grant of £2,000 per academic year towards childcare costs.

Using the budgets available to us, the Government will continue to provide students who have children with as many opportunities and as much support as possible to allow them to pursue a career in healthcare. As we set out in the first ever NHS long-term workforce plan, a robust and resilient education and training system is critical to the future of our NHS, because, by having the right people with the right skills in the right places, we can deliver first-class care for patients, now and into the long-term future.

17:03

[Marsha De Cordova]

I thank my colleagues, my hon. Friend the Member for Sheffield Central (Paul Blomfield) for his important contributions and my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), the shadow Public Health Minister, for his contributions.

It is disappointing, given all of the information that was set out in my speech and in the speech delivered by my hon. Friend the Member for Denton and Reddish, that the Government really have not fully addressed the challenges around financial support. We already know that the support that the Minister set out is not good enough; the evidence, which is clear and truthful, suggests that that is not enough. The number of people entering the professions is falling because of the financial constraints. The Minister did not address the disproportionate impact on women and mature students with dependents. I again ask him to look at some of those challenges and ways to address them—for example, the scheme in Wales, where students can commit to working in the NHS, which helps to bring down any debt that they may incur as a result of their studies. It would be useful to know whether any impact work was ever done on the abolition of the bursary in 2017.

Our NHS is everybody’s pride and joy, and those entering healthcare do it because they care and want to make a difference. The Government’s job should be about making it as easy, as flawless and as seamless as possible for them to do so. We have seen the removal of the bursary and then its replacement with the student learning support packages, but they are simply not enough. That is why tens of thousands of people signed the petitions. They wanted this debate here today.

Question put and agreed to.

Resolved,

That this House has considered e-petitions 610557, 616557 and 619609, relating to pay and financial support for healthcare students.

17:05

Sitting adjourned.