NHS Bursary

Heidi Alexander Excerpts

Monday 11th January 2016 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

It is a pleasure to speak in this debate under your chairmanship, Mr Evans, and to follow the excellent contribution of the hon. Member for Central Ayrshire (Dr Whitford). I also thank the hon. Member for Sutton and Cheam (Paul Scully) for bringing the debate to the Chamber and I pay tribute to the petition’s organisers, because it is no mean feat to get 154,000 signatures.

We have had a good debate, with some excellent contributions. In particular, I pay tribute to my hon. Friends the Members for Ilford North (Wes Streeting), for Heywood and Middleton (Liz McInnes), for Sheffield Central (Paul Blomfield) and for Coventry North East (Colleen Fletcher) for their contributions. I also thank the hon. Member for Lewes (Maria Caulfield) for her insights. She was right to highlight the realities of life for student nurses, but I am afraid I do not share her optimism about the other training routes the Government are developing for nursing staff. She was also right to acknowledge that the bursary is not perfect, but it is beyond me why we should replace it with something worse.

In the short time I have, I want to set out why I think the Government are taking a huge gamble with the future of the NHS workforce and with patient safety. As others have said, the Government’s proposals affect not only nurses and midwives, but those studying radiography, radiotherapy, physiotherapy, occupational therapy, podiatry, chiropody and speech and language therapy. Many of those specialisms face recruitment challenges, and they are all integral to the NHS’s ability to continue functioning.

Before I turn to the problems with the Government’s proposals, we need to understand why the country has a problem with nursing supply in the first place. Shortly after the 2010 election, the Government cut the number of nurse training commissions in an ill-judged attempt to make some short-term savings. Those cuts saw nurse training places reduced from more than 20,000 a year to just 17,000—the lowest level since the 1990s. As a result, we trained 8,000 fewer nurses in the last Parliament than we would have done if we had maintained training commissions at 2010 levels. At the time, experts such as the Royal College of Nursing warned that the cuts would cause

“serious issues in undersupply for years to come.”

They were right. Hospitals are now forced to rely on recruitment from overseas or on expensive agency staff. That is a key cause of the projected £2.2 billion black hole in NHS finances.

Although the Government have tried to correct the problem and increase the number of training commissions in recent years, even today we are training fewer nurses than we were five years ago. There is therefore a problem. No one disputes that, but no one should be under any illusion about the cause.

The danger with the Government’s proposals is not only that they risk making staff shortages even worse by putting off the next generation of student nurses, but that they are ill-judged and not backed by a shred of evidence. As we have heard today, the starting salary for a nurse is just above the loan repayment threshold, which has, shamefully, been frozen. That means that nurses will start paying back their loans as soon as they graduate. As my hon. Friend the Member for Ilford North said, nurses will, on average, take an effective pay cut of £900 a year to meet their debt repayments. How on earth can the Minister justify that? Why is he so sure that burdening nurses with debts of more than £50,000 will have no impact on recruitment or retention?

If the Minister will not listen to me, perhaps he will listen to the stories of some of the student nurses themselves. Just before Christmas, I met four deeply impressive young women who were studying to become nurses—Danielle, Charli, Marina and Sophia. Those women were in their 20s, and their lives have not followed the simple path of GCSEs, A-levels and going straight to university. Danielle left school after her GCSEs, but she went back to do her A-levels. She got a job as a healthcare assistant and then decided she wanted to go into nursing. Marina had a child when she was 16. By the sound of things, she has had a pretty tough life. However, she is clear she wants to be a mental health nurse. When she says she thinks the best people to care for others are those who have experienced hardships themselves, she has a point. My fear about the Government’s proposals is that they will mean that those who end up training to be nurses will be those who are best placed to pay, not necessarily those who are best able to care.

Has the Minister read the testimonies of student nurses past and present, which the Royal College of Nursing collated? It is a hefty volume, and I recommend it to him. Natalie from Sheffield says this about the bursary:

“Without it I wouldn’t have been able to start the course...My mum gives me help when she can, but as a single parent she can’t afford to look after my sister as well as me. I think there will be a huge loss of people taking part in the course, which will further impact on the nursing shortage.”

Daniel, from south-east London, says:

“I would not have taken the course if it were another £20,000 plus worth of debt to incur. To cut the bursary is ridiculous. Student nurses are thrown into the…deep end as soon as their first placement a month into their studies, leaving less time for work that pays. If anything, the NHS bursary should be raised.”

Vicky, from York, says:

“I would not have been able to, or chosen, to study to be a mental health nurse without the bursary for the following reasons…I am a single mum and need support for childcare costs. I have debts from a previous degree. I am a mature student at 33. I would not take on further debts which would be impossible to pay back, and would not be fair on my little girl.”

I say to the Minister that I know about the fear of debt that can be instilled in people by a working-class upbringing. I know what discussions take place in homes across the country about the pluses and minuses of people going away to university and racking up debts when they could just start earning. I know that because I experienced those discussions.

My other main concern with the proposals is that, as others have said, the Government do not seem to understand that student nurses are not like other students. Student nurses are required as a normal part of their studies to spend a significant amount of their course working with patients in clinical practice, including on night and weekend shifts. They have less holiday than other students, and they spend hours on their course caring for patients and, sometimes, keeping our hospital wards running. The changes will, effectively, charge students for working in the NHS. How can that possibly be justified? What the Minister seems to have failed to grasp is that student nurses are far more likely to be mature students. We have only to look at what has happened to applications from mature students under the new student finance system to see what a risk the proposals will be to the NHS.

That raises an important question about the kind of people we want to train to be nurses. The application process is rigorous, and rightly so, but the average age of a student nurse is 28, and many have caring and family responsibilities. Are those not precisely the people we want to attract into nursing? If so, is it not all the more alarming that those people are the most likely to be put off a career in nursing as a result of the changes?

The Minister will stand up and no doubt eloquently argue that I am wrong, and that the Royal College of Nursing, the Royal College of Midwives, Unison and various other stakeholders are wrong. However, every one of the claims I am sure he will make has been questioned by experts. The Government’s case for the changes has been put together on the back of an envelope—they did not even bother to consult anyone before announcing them. The Royal College of Midwives has said:

“The RCM is extremely disappointed that the government did not seek advice or consult with us prior to making this decision.”

The Royal College of Nursing has said:

“This decision was made with no consultation or evidence gathering.”

Talking to organisations that might know a thing or two about nursing is not just good policy making but plain common sense. Will the Minister explain why he did not talk to the Royal College of Nursing or the Royal College of Midwives before the Chancellor made his announcement?

Will the Minister also explain why the proposed consultation is only a technical consultation on the proposals’ implementation, not on the principle behind them? Surely it makes sense to have a proper, detailed look at the matter and to work with all sides to explore how we can improve the support available to student nurses and increase the supply of excellent staff to the NHS. By jumping to a solution that is not based on evidence or facts, the Government are taking a reckless gamble with the future of the NHS workforce, and with patient safety. I serve notice on the Minister today that the Opposition will oppose the plans every step of the way.

--- Later in debate ---

[Ben Gummer]

That is the case at the moment. The hon. Gentleman must answer the question of precisely how we increase support for people who are working in clinical learning placements. Converting the bursary regime means that we can increase that support by 25%.

It is easy for the hon. Gentleman to make a play to the gallery about how the reforms might work, but I ask him again to look carefully at the experience of other students and at the 47,000 applicants who are unable to secure a place because of the constriction in places. He is not able to give those people an answer about how we expand places without resources that I imagine he is not willing to commit from his position. The best way of giving those people the opportunity is reforming the education system. I am afraid that it is simply not credible for the Opposition to decry the proposals, which is their right, without providing an alternative of how we might fund the additional places and the maintenance of those who are in position.

[Heidi Alexander]

The Minister talks about the ratio of applicants to nursing students. Will he say what proportion of the applicants who failed to secure a place met the entry criteria to the course? What guarantee can he give that removing the bursary will increase the number of successful applicants?

--- Later in debate ---

[Ben Gummer]

The hon. Lady mentioned in her speech, as did the hon. Member for Ilford North, the need by some trusts to recruit from abroad and to use locum and agency nurses. I hope she will understand therefore the internal logic of our argument: even at the moment, we are not able to fill places from the domestic supply of nursing graduates. It is precisely our wish to expand that supply. Planning the workforce will, in large part, be controlled through the placements that Health Education England buys from universities on behalf of the taxpayer and the NHS.

Several hon. Members raised the issue of clinical placements, on which we are now in deep discussions with Universities UK. The hon. Member for Ilford North raised that issue, as did my hon. Friend the Member for Lewes. I urge them both to look at the example of the University of Central Lancashire, and its relationship with Central Manchester University Hospitals NHS Foundation Trust and Bolton NHS Foundation Trust. They are delivering innovative and exciting ways of providing new placements outside the scope of the existing placement scheme, even without any Government support or change in the rules.

There is an appetite for delivering additional clinical placements, and we will see how that progresses in our discussions with Universities UK. All the while, it is important to point out that the Nursing and Midwifery Council has to register nurses at the end and ensure that the degrees are satisfactory. All of this will have to abide by the NMC’s recommendation that the placements are up to scratch, so we are constrained, quite rightly, in anything we might want to do by what it decides in that regard.

[Heidi Alexander]

The Minister gave the example of the University of Central Lancashire. Does he accept that one reason that pilot is successful is that individuals are guaranteed a job at the end of it, which would not be the case for the students to whom he proposes applying these more general changes?

[Ben Gummer]

In the course of taking interventions, I am skipping around the points that hon. Members have raised, which I want to address. The hon. Lady is right that the University of Central Lancashire has worked up a really good course, which is partly about job security at the end of it. It is exactly the kind of scheme we are looking at to improve attrition rates, which were another point that my hon. Friend the Member for Lewes raised. We have to do better to help nurses complete their courses, and again, that metric has improved across the rest of the university sector since 2012. I hope that in freeing up nurse training a little through our reforms, we will be able to provide better incentives for foundation trusts and NHS trusts to have an end-to-end training offer for student nurses—if not modelling the one that the University of Central Lancashire has brought in, then a variant on it.

There is a lot of exciting thinking out there in universities, foundation trusts and NHS trusts about how we can implement the reforms to make nurse training better, expand the number of places and solve their workforce problems. My job is to release that thinking. I cannot do it within the straitjacket of the existing system, but I can through the reforms I am able to make.