NHS Bursaries

Justin Madders Excerpts

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

It is precisely to help my hon. Friend’s hospital that we are introducing these reforms.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Minister said there was no alternative to these proposals. Which of the royal colleges did he consult before coming to that decision?

[Ben Gummer]

Contrary to what the hon. Member for Lewisham East said, I did consult the royal colleges. I have spoken at length with the Royal College of Nursing and with Unison. As I would expect, we differ on key parts—though not every part—of the plan, but the royal college’s initial response accepted that the premise on which we were proceeding was, in significant part, correct. In the consultation, I want to find areas we can agree on and improve the proposals we have put before the public. We were open about the consultation and offered the full 12 weeks—many people said we would not do so, but we did—precisely so that we could listen to the concerns, proposals and exciting challenges from people across the sectors, and thereby improve the proposals we have put before the NHS.

The motion suggests a series of things, but not a proposal from the Opposition to do anything different. They are not offering the NHS any new money—they offered £4.5 billion less than we did at the last election—so I can only presume that the money would have to be found from cuts elsewhere in the service. The hon. Lady will have no credibility unless she tells the House that she will pay for the 10,000 additional training places out of taxpayers’ money, rather than by finding an alternative funding mechanism. I will not offer the House a series of suggestions that might or might not be better, or merely criticise proposals, rather than offering constructive improvements.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This has been a high-quality and comprehensive debate. I have to say that I have a small amount of sympathy for the Minister for Community and Social Care, because, as we all know, this policy was not devised in his Department, but hastily put together on the back of a fag packet somewhere in the Treasury following the Chancellor’s £2 billion raid on the Department of Health budget. It looks very much like a case of “Cut first and ask questions later.” I say that because in just two lines of the autumn statement, with no consultation and no evidence base, the Government have committed themselves to a huge gamble with the future of the NHS workforce and with patient safety.

I pay tribute to my hon. Friend the Member for Ilford North (Wes Streeting) for leading the campaign with his early-day motion. His record in this area is unparalleled. He explained expertly why many student nurses are in a different position from that of other students, and expressed the concern that he and many other Members feel about the deterrent effect that the Government’s proposals will have on future numbers. Other Members spoke in similar vein, including my hon. Friends the Members for Manchester, Withington (Jeff Smith) and for Coventry North East (Colleen Fletcher), as well as my hon. Friend the Member for Scunthorpe (Nic Dakin), who pressed the Minister on what estimate had been made of the number of loans that would be written off. He did not receive a reply; I trust that the Minister for Community and Social Care will be able to fill in the details.

My hon. Friend the Member for Wirral West (Margaret Greenwood), who came to this place with a strong reputation as a health campaigner, spoke with great authority about the pitfalls of the proposals. My hon. Friend the Member for Cambridge (Daniel Zeichner), who also has great experience in this area, asked a very pertinent question about the capacity of the health service to take on the extra students. The Chairman of the Health Committee, the hon. Member for Totnes (Dr Wollaston), made an important contribution, and I hope that the Minister will respond directly to some of the very real concerns that she raised.

The Government are presiding over the worst A&E figures since records began, the biggest financial crisis in the history of the NHS—three quarters of trusts are now in deficit—and a crisis in morale across the workforce, with a Secretary of State too belligerent to listen. They have already alienated a generation of junior doctors, and now they risk doing the same for our future nurses and midwives, as well as many other health professionals. Why are they looking to unsettle a huge section of our NHS workforce at a time when good will is more important than ever?

We have several concerns about this policy, many of which hon. Members have aired today and to which the Government are yet to give any credible answer. First, let us look at the actual problem the proposals are trying to address—not the black hole created by the Chancellor but the shortage of nurses in the NHS. Be in no doubt, the Government are entirely responsible for that shortage, because they decided to reduce the number of nurse training places. Had they maintained the level set by the last Labour Government, 8,000 more nurses would have been trained in the last Parliament alone. When we hear, therefore, about spiralling agency costs and staffing shortages, let us remember the cause—not the nurses, the trusts or the patients, but the Government’s chronic mishandling of the NHS.

The proposal, with all its risk and uncertainty, will, in the Government’s most optimistic scenario, deliver 10,000 more nurses, midwives and other health professionals. When they say the proposal could deliver up to 10,000 more staff, they really are looking at the glass half full. The figure comes with so many caveats that, if it were a used car, I would not even take it for a test drive. The Government’s own equality assessment acknowledges that there could be an adverse impact on parents and carers and that childcare costs could have a significant influence on participation. It is worth picking up a few quotes from their impact analysis and evidence document, to get a flavour of just how flaky the proposal is. It says that the

“precise impact is difficult to estimate with certainty”,

that

“Behavioural change is uncertain”,

that

“there may be some uncertainty over applications in the very short term”

and—my favourite—that there

“is no robust set of information to make this assessment.”

In other words, the Government are saying they have done an assessment but have absolutely no idea what the impact of the policy will be. If that does not amount to a huge gamble, I do not know what does.

If the Government will not take heed of their own assessments, they might listen to the Royal College of Nursing, which has said that

“there is a risk of people being put off from applying to nursing degrees, because of concerns over debt.”

It, like many Members, is particularly concerned about the impact on mature students. As we have heard, the average age of a student nurse is 28. The RCN has said:

“There is a worrying lack of assessment of the potential for the changes to act as a disincentive for some students, such as mature students or those from lower income backgrounds.”

Research by the trade union Unison shows that nine out of 10 student nurses surveyed said they would not have gone into training had the new proposals been in place. That is not a trivial number. If the numbers put off turned out to be even half that, the implications for the NHS would be catastrophic. So where is the evidence to reassure us that it will not happen? There is not any. The Minister prays in aid the experience across the general higher education sector, but he knows that he is not comparing like with like. The evidence from the mature student experience does not support his case. In fact, the Higher Education Statistics Agency says that between 2011 and 2015 the number of mature students fell by 17%.

Let us be clear about what the policy really means for nurses. Owing to the Government’s reprehensible decision to freeze the student loan repayment threshold at £21,000 from 2017, all future nurses are facing a real-terms pay cut. According to Unison, based on current salaries, the average nurse, midwife or allied health professional will lose over £900 a year to meet their debt repayments. Staff retention is a huge issue across the NHS, including in nursing, and as the hon. Member for Morecambe and Lunesdale (David Morris) rightly pointed out, the Government’s record is poor. Saddling nurses with extra debt will only make the matter worse.

[David Morris]

I did not say that the Government’s record was poor; I pointed out that we needed reform, which is what we are here to discuss. I am disappointed in the hon. Gentleman’s approach, because we have had a very constructive debate today.

[Justin Madders]

I thank the hon. Gentleman for his intervention. If he is stating the facts, then I interpret them as being a poor record for the Government; that is more about the facts than about the way in which he presented them.

Let us be clear: we are talking about a debt that nurses are never likely to pay off. They will graduate with debts of between £50,000 and £60,000. Many of the mature students who take nursing as a second degree will find themselves with more than £100,000 of debt. Let me repeat that figure so that it sinks in: our country is looking down the barrel of a policy that will saddle nurses with a six-figure debt. They are not bankers or lawyers; the people who keep the NHS going will be earning just a fraction of what they earn. We already have the highest level of student debt in the English-speaking world, which is not a record we should be proud of, and these proposals will only make matters worse.

It would be an error to put nurses into the same category as other students, but I think that the Government are making that error. Student nurses’ courses take up much more of the year, meaning that they have much less opportunity than other students to work while they study. They are also required to spend 50% of the time working with patients in clinical practice, including on evening and weekend shifts. That requires a real commitment of at least 2,300 hours over the length of their course, during which they do difficult jobs at unsocial times. Now the Government are asking them to pay for the privilege of doing that. This policy is like some kind of perverse extension of workfare. Last year, there were 10,000 unfilled nurse places in London alone. Is getting people to work for free really the answer to that?

The Government really need to raise their game to improve retention among nurses. The situation has been getting steadily worse over the past few years, and nearly 9% of nurses left last year. Some might have gone to work elsewhere in the NHS, but many have left the profession altogether. Surely sorting that out would provide a more effective solution to our problems than taking a punt on an untested plan. There appears to have been no dialogue with providers, who seem unaware of the oncoming rush. Each student nurse has to be clinically assessed by a registered nurse who has done their mentoring and assessing course, but no assessment appears to have been made of the capacity for trusts to take on those extra responsibilities.

It is clear that this policy, with all its flaws, was announced with no consultation, no engagement with the sector and no evidence basis. With such a high degree of uncertainty, surely it would have been sensible to consult on the principle before embarking on the policy. But not this Government; they know best, even though they do not seem to know their own record in this area. When I asked the Minister a simple written question on how many nurses had qualified in the last five years, I received the following response:

“The Department does not hold information on the number of nurses who qualified in the last five years”.

What an absolute shambles!

Anyone would think that with such a gap in the available evidence, the Government would have gone out of their way to undertake a full consultation and to seek out evidence before announcing the policy, but no. The Royal College of Midwives, the Royal College of Nursing, the Royal College of Podiatry and the Royal College of Speech and Language Therapists are all respected institutions with years of experience and a wealth of knowledge in this area, but not one of them was asked to make a formal input into this policy before it was announced, contrary to what the Minister has said today. When he was asked, in a Westminster Hall debate on 11 January, who he had consulted, he said:

“There has been consultation with leading nursing professionals.”—[Official Report, 11 January 2016; Vol. 604, c. 237WH.]

He said nothing about the royal colleges. I hope that we shall be able to clear this up. I ask him to tell us exactly who he did consult, and to place in the Library a copy of the advice that he received following the consultation.

Let us not pretend, now that the consultation has been published, that it is a meaningful consultation on the principle or the detail of the proposals. It simply asks a few technical questions on how to implement the changes. You can have any colour you want as long as it is black. It is frankly an insult to the public, to patients and to the profession. The Government should withdraw this proposal and instead commit to a full consultation on how to improve the support available to student nurses, how to increase the number of nurses in the NHS and how to improve retention. I urge all Members who genuinely care about the future of our health service, who have concerns about the potential deterrent effect of these proposals, and who are not prepared to gamble recklessly with our nurses, to join us in the Lobby today and send a clear message to the Government that it is time to think again. I commend the motion to the House.

[Christian Matheson (City of Chester) (Lab)]

Pick that one out of the back of the net!