NHS Bursaries

Helen Whately Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

I have already given way to the hon. Gentleman, and I want to make some progress.

These changes will effectively charge students for working in the NHS. Of course, longer term times and clinical placements also make it harder for these students to get a part-time job to supplement their income in the way many other students do. It is not just the course that makes healthcare students unique; they are much more likely to be women, much more likely to be mature students, much more likely to have children and more likely to be from BME backgrounds.

Many nursing students have already completed one degree and turn to nursing in their late 20s or early 30s—indeed, the average age of a student nurse is 28. When I think of my own friends who are nurses and midwives, I find that three out of four took the decision to re-train, having done a different first degree.

The Minister probably moves in different circles from me, but I can tell him that if he wants a dose of reality, my friends would, I am sure, be more than happy to oblige. I understand that he may not have experienced the conversations that I had in my working-class family about the pluses and minuses of racking up debts to get a degree, but I can tell him that for many nurses, under his proposals, that consideration will be all too real. Does he not realise that for the one in five healthcare students with children, the fear of debt is greater than it is for carefree, privately educated history students bound for Cambridge? My concern about these proposals is that we ultimately end up with those best placed to pay becoming nurses and midwives rather than those best placed to care. That brings me on to why these proposals are bad for patients.

[Helen Whately (Faversham and Mid Kent) (Con)]

I think we are all agreed on the need for more nurses; the question is how we fund them. Will the hon. Lady tell us how much money she would take away from front-line NHS care in order to fund the expansion of nursing places that the country needs?

[Heidi Alexander]

We set out at the last election our clearly costed plans for how to recruit additional nurses, doctors and care staff to the NHS.

The NHS should have a workforce that reflects the population it serves—just as this place should, too. The mental health sector in particular relies on mature students and the additional life experience they bring to what is a very demanding environment.

A few months ago, I met Marina, a young woman who has not had an easy life, but who is now on a mission to become a mental health nurse. When Marina says that she thinks some of the people best placed to care for others are those who have experienced hardships themselves, I think she has a point; and when she says she would not have been able to start her training without the bursary, I believe her. Why is the Minister so convinced that the NHS can do without people like Marina in the future? Why does he think they should pay to train, and why will he not consider other options for increasing student numbers?

The quality of training that student nurses, midwives and other allied health professionals receive will also depend on the quality of their clinical placements. Government Ministers claim these changes could deliver up to 10,000 extra places over the course of this Parliament, so can they set out what capacity hospitals and other providers have to accommodate these extra students, and confirm whether Health Education England has sufficient funds set aside to fund these placements? Will the Minister be clear about how this 10,000 figure was arrived at? Is it the Government’s assessment of what the system needs, what Health Education England can afford to fund or simply a big-sounding number plucked out of the air at random?

An extra 10,000 compared with when? What is the baseline year on which we should judge the Minister’s policy? I have asked him that three times in written parliamentary questions, and each time I have not received an answer. Does he not understand that if his Department cannot even answer a simple question relating to one of its key claims about the policy, that does not exactly inspire confidence? There are so many questions that the Minister needs to answer that it is impossible to do all of them justice in a single speech.

--- Later in debate ---

[Helen Whately (Faversham and Mid Kent) (Con)]

If we ask any patients about their experience in hospital, one thing they are sure to talk about is the nurses who looked after them. In doing so, they are usually talking about both nurses and healthcare assistants—in my experience, patients do not tend to make a distinction. We know that nurses have far more interaction with patients, day to day, than doctors. Nurses’ quality and time are absolutely critical to patients’ experience.

Nurses are also critical to outcomes for hospital patients. Good nursing can be the difference between life and death. We have known that since Florence Nightingale, we were reminded of it by the inquiry into Mid Staffordshire and the Francis report, and we can see it from recent research into stroke outcomes. It will be clear to anyone who has looked at how Salford Royal has such good outcomes and such a good reputation—a lot of that is because of the focus on extraordinarily high standards of nursing.

The excellent NHS that I believe we all want needs excellent nurses. It also needs enough of them. This afternoon, people have talked about how we need something in the order of perhaps 10,000 to 20,000 more nurses—the numbers range widely. We also know that we need a shift in nursing skills, as we will need more nursing care for older people and people with long-term conditions, as well as more mental health nurses.

Right now, however, there are not enough nurses in our system, and hospitals across the country have vacancies. We know that they use large numbers of agency staff, and international recruitment is important to many hospitals, including those serving my constituents in Kent. I am not confident that more of the same will solve the problems, and neither was the nursing department of a London university that I spoke to last year. It said that it needed more funding per nurse place, but recognised that asking for more money for their nurses could mean taking money from front-line care in the NHS. That was not a good answer, and the department was open to a new funding model.

Last summer, the Council of Deans of Health and Universities UK stated that the

“current funding system is no longer working for either students or universities.”

Universities have to subsidise the cost of nursing and physio degrees from other courses, and NHS-funded nursing students have less to live on than others, even though they often study longer, more intense degrees with more hours, and are therefore even less able to do other work outside their qualification. We know that we need more nurses, and that the current funding system is not working.

How should we get more nurses? Around 2008-09, when plans were being drawn up for the Centre for Workforce Intelligence, I remember hearing that the answer was better workforce planning, with lots of skilled experts doing fabulous modelling of future workforce demands. I remember being a sceptic about that then, because when we consider the history of the NHS, and systems around the world that have centralised planning for the healthcare workforce, we find that it is almost always wrong. There are periods of over-supply and of under-supply—right now, we are in a period of under-supply, with all its knock-on consequences. Doing things better and having more experts sounds great in theory, but in practice we have seen that it does not work.

A much better answer is to set universities free to offer more places to all those students who, as we have heard, want to study nursing but are currently being turned away. I hope that we will have more nursing applicants, and that that career will become even more attractive, particularly as universities work more closely with employers on what is needed, and we must consider more of the specialist skills and expertise required within nursing by our care system now and in future.

To do that we must uncouple the funding of nurse training from the NHS, and take away the constraint that every £1 spent on training an NHS nurse is £1 potentially taken from front-line care, because that puts a premium on avoiding excess nurses. That is the right direction of travel, and it is also important to increase maintenance grants for nurses so that they do not struggle with their living costs as currently happens. There should be more routes into nursing. The nurse associate role is welcome, as is the apprenticeship route so that nurses can work and train in parallel. We know that that is appealing to more mature students who need an income and who want to be more hands-on during their training, and for whom a university environment has less appeal. Having worked for some time with healthcare assistants, I would like more recognition to be given to their role and qualifications, and I recognise the opportunity to support them even more to train to become qualified nurses.

We must invest more in continuous professional development for nurses. We know that we need a more flexible workforce that can adapt to future demands, yet in times of financial pressure, the investment and time given to ongoing training are often squeezed. Let us use this opportunity to try to shift that balance, and repurpose the workforce to meet the system’s demands and needs.

I would also like more attention paid to the appeal of nursing and the experiences of nurses in work. I have heard many nurses on the frontline say, “This weekend, I’ll be on my own—I will be the only permanent nurse on this ward. I will be working alongside agency nurses who do not necessarily know this ward, and it will make this weekend really difficult.” We badly need to put an end to that. The only way to do that, alongside the ongoing work to reduce the use of agency staff, is to increase the number of nurses who have been trained to work in the NHS.

I am out of time, but to sum up I think the direction of travel is absolutely right. Let us make sure that we get the details right on how the proposals are put into practice.