Education (Student Support)

Karen Lee Excerpts

Wednesday 9th May 2018 Commons Chamber

[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.

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[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.

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[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—

[Karen Lee]

rose—

[Stephen Barclay]

Would the hon. Lady like me to go on or to give way?

[Karen Lee]

Would the Minister confirm the number?

[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—

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[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.

[James Cartlidge (South Suffolk) (Con)]

You shouldn’t have.

[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.

[Karen Lee]

I have the briefing here, and it does mention it.

[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.