NHS Bursaries

Lisa Cameron Excerpts

Wednesday 4th May 2016 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I must declare an interest due to my work in the NHS and having had the privilege of a grant when training to be a doctor.

The NHS is one of our most esteemed public services, but there is a long-standing shortage of qualified healthcare professionals. While the current bursary system for nursing and allied healthcare students in England may not be without issue, the UK Government’s proposed changes are concerning, as is the manner in which they have been presented, with detailed consideration of the impact somewhat lacking.

As we have heard, the UK Government have proposed changes to the current NHS bursary system. Instead, healthcare students will be required to pay tuition fees and will be subject to the same standard loans-based system to which other students in England are subjected. The UK Government have indicated that they expect the reforms to create up to 10,000 additional nursing and health professional training places over the course of the current parliament. However, that appears to be narrow-sighted. The proposed move to a system that relies on students funding themselves by taking on significant debts has raised substantial concerns among unions, professional bodies and students. One of the key fears is that such a move could be a barrier that deters prospective students from entering the profession. I stand here as the first doctor in my family, and I have to say that I would not have considered applying if it had meant racking up debt. I am particularly concerned about access to doctorate courses and postgraduate requirements. Will we create an elite workforce based not on ability, but on means?

Unison estimates that a student undertaking a three-year, 30-week course outside London under the new scheme will graduate with a debt of at least £51,600, plus interest and any overdraft and commercial debt.

[Richard Graham]

The hon. Lady’s achievement as the first doctor in her family is to be applauded by us all, but does she recognise that there are many people who do not think that university is for them? The two-year apprenticeship course offered by the new nursing associate route will provide them with a real opportunity to get into the NHS and maybe to go on to become a full nurse later on.

[Dr Cameron]

I want to see a widening of access to training schemes in the NHS, and I would hope that that would be properly funded and that we do not rely on NHS staff doing other jobs while dealing with the stress of training. We should invest in and fund them properly, letting them know that NHS staff are invaluable.

For many, loans may be higher due to the additional costs of longer courses or of courses within London. As I said, I am particularly concerned about postgraduate courses and doctorate trainees, who may not be able to afford further loans that will add to their debt. It is likely that debt could be considerably higher for the majority of healthcare students. It is naive to think that larger loans will not be a psychological deterrent, especially to those from poorer or non-university backgrounds or to mature students and career changers, who may have additional financial responsibilities or debts from first degrees or family life.

The demographic of students on nursing, midwifery and allied health professions courses tends to be different from other student populations, as we have heard. They are more likely to be women, from black and minority ethnic backgrounds, parents or mature students. It is therefore likely, and a real concern, that abolishing bursaries will reduce diversity, foster inequalities and discourage potentially high-quality applicants.

[Angela Rayner]

The hon. Lady is making an important point. Returning to something the Minister said, the frustration for me is that I was a Unison rep in homecare before coming to this place, and we were able to give unqualified women access to a foundation degree when they were healthcare assistants. They could then do a vocational degree and get into hospitals in much the same way as what the Minister claims is not currently available. It is important that that route remains open and that its users, mature students in particular, do not get disadvantaged because of the thousands of pounds-worth of debt that they would take on at the end.

[Dr Cameron]

The hon. Lady makes her own point. It is important that people from all backgrounds are encouraged to enter our NHS. The UK has a diverse society and we must ensure that our healthcare staffing system reflects that and supports those from all backgrounds to enter it.

It is not enough just to increase numbers by creating an open market for training. In order to ensure a quality service, it is crucial that student placements are well planned, well supervised and well distributed between the various areas within the service, so much consultation is required. In response to the Government’s proposals, a former chief executive of the Royal College of Nursing commented:

“The last thing we need are disincentives to recruitment. We should be doing everything possible to attract applicants, as the country needs more nurses now than at any other time in its history.”

[Christina Rees (Neath) (Lab)]

The hon. Lady is making many valid points. If someone lives in Wales and wants to study at an English university, it is proposed that the bursary will be stopped. If someone lives in England, Scotland or Northern Ireland and wants to study nursing, midwifery or an allied health profession at a Welsh university, the Labour Welsh Government will pay the bursary. Taking that to its logical conclusion, the numbers will decrease in England and increase in Wales, Scotland and Northern Ireland. Of most concern is the fact that the UK Government did not commit to undertake an impact assessment of cross-border applications before proceeding with the changes. Does the hon. Lady think that they should have?

[Dr Cameron]

Once again, the hon. Lady makes her point very well. I believe we need to staff the NHS well right across the UK. Impact assessments may require consideration down the line if there is a shortage in England as a result of this policy. I hope that answers her question.

In Scotland, the SNP Government recognise the value of investing in our NHS, providing a support package that is hugely generous in comparison with that in England. The nursing and midwifery student bursary in Scotland provides all eligible students with a non-income-assessed and non-repayable personal allowance of £6,578 per year, excluding additional allowances. That can be topped up by a range of income-assessed allowances, and it comes in the context of there being no tuition fees. Therefore, there are other examples of ways to make progress in this policy area.

Under the SNP Government, NHS staff numbers have increased by more than 10,000, and the party is committed to supporting the development of a quality health service that will meet the needs of the Scottish people, not just now, but in the future. Workforce projections show that more than 1,000 extra NHS staff are expected to be recruited across Scotland this year. There has been an 8.4% increase in NHS staffing, to a record high. There are more qualified nurses and midwives per 1,000 of population in Scotland than there are in England and Wales. In the past year, Scotland has seen the total number of nursing and midwifery staff increase by more than 500 whole-time equivalents, with boards projecting an increase of more than 600 whole-time equivalents in this financial year. The number of doctors has increased by 26.7% or by 2,560 whole-time equivalents, and the number of consultants is now at a record high, having increased by 40.3%. Every newly qualified nurse is guaranteed one year of employment once they complete their studies—that commitment is not offered anywhere else in the UK. Our health Minister, Shona Robison, has also confirmed that the nursing and midwifery student bursary and allowance will be protected at existing levels in 2016-17. A review of the scheme is due to report in June 2016.

The NHS is a crucial public service, and the UK Government cannot continue to railroad their way through it. They are making significant changes and although reform may be needed to address current issues within the service, such decisions should not be made hastily and without full consideration of their impact and of potential workable alternatives. We have heard about some workable alternatives today. I therefore urge the Minister to commit to having a comprehensive consultation on the full proposals, to determine the best way to support and invest in this service and its students. This is a vital workforce, whom we depend on in our times of crisis. It is only right therefore that they should be able to depend on us during their training and when they hope to help the NHS in the future.

[Several hon. Members rose—]

--- Later in debate ---

[Mr Peter Lilley (Hitchin and Harpenden) (Con)]

It is a pleasure to follow on from the hon. Member for Ilford North (Wes Streeting), who made a thoughtful speech and highlighted an important point about the different study load of those training to be nurses, compared with some of us when we were at university. I do not think that that invalidates the Government’s proposals, but it is an important point to take into account.

Like the hon. Gentleman, I congratulate the Opposition spokesman on calling the debate, which has been an important one, and I congratulate the Minister on a characteristically thoughtful, reasonable and lucid response to it. I cannot help observing that the debate demonstrates the value of having people in this House who come from genuine professions, rather than having reached here purely as a result of being political professionals. There has been considerable input from those who have studied, worked or been in the national health service.

Although it is an Opposition debate, there are some points that we can all agree on. First, we should agree that we need to recruit, train and retain enough nurses to staff our health service to meet the needs of the British people. Secondly, we can agree that it is wrong—morally wrong—to rely on recruiting nurses from poor countries, who have had to bear the cost of their training, to meet our failure to train enough nurses ourselves. Thirdly, we should not be turning away British people who want to train as nurses when we need more nurses. Surely all of us can agree on those three points. We can debate how best we finance the recruitment, retention and motivation of sufficient nurses in this country, but we should all agree that that is the objective.

My initial interest in this topic came a couple of decades ago and resulted from my first career as a development economist working in Africa and Asia. I discovered while I was in the House that we were denuding Africa of nurses. We had recruited more than one in eight of all the nurses in sub-Saharan Africa and brought them to this country. That could not be right. I lobbied against it and the then Prime Minister promised that there would be no active recruitment from Africa, but seven years later I discovered that we had recruited another 60,000 nurses. We were continuing to recruit at several thousand a year, but we were promised that that would cease.

What I blame myself for is that it took me so long to realise that the problem did not lie so much in recruiting from Africa and other poor parts of the world as in our failure in this country to train enough nurses of our own. I did not ask why we were not doing so until I was talking to people in my local NHS, who told me that they were recruiting abroad, mainly in southern Europe but also in Asia, and they were doing so despite the fact that they would have preferred to recruit and employ nurses from the University of Hertfordshire, whom they described as excellent, well trained and in every way desirable. I asked why they did not recruit more, but they said that they could not recruit enough. Even if they recruited the next several years’ worth of output, that would not meet the needs of Hertfordshire’s health service, which is why they were recruiting abroad.

[Dr Lisa Cameron]

Does the right hon. Gentleman agree that it is ironic that through our international aid programmes we are assisting developing countries to pay for trainee placements in clinical establishments such as hospitals abroad, yet we do not afford the same rights to our NHS trainees here?

[Mr Lilley]

It is certainly bizarre that we pay African countries to train nurses and promptly recruit them to come here, so we are getting them cheaply trained abroad. I do not mind particularly the manner in which their training is financed.

The problem faced by my local NHS was that it could not get enough nurses from the University of Hertfordshire. I spoke to the University of Hertfordshire, which said that there was no lack of applicants—it turned away three quarters of applicants to its highly regarded nursing courses—but it was not allowed to expand. It had taken me decades in this House to realise that we had a system that limited the number of people we were recruiting. I duly lobbied the Government, and it may be because of my lobbying that we now have this proposal for bursaries, though I suspect the Government reached the decision on their own evidence.

The sad truth is that successive Ministers of all parties—we should recognise that—have bucked the question of how we train enough people in this country. Ministers tend to have a time horizon of roughly the time it takes to train a nurse, so why put up with diverting resources into training when the output of extra nurses will come after they have ceased to be Health Ministers? I am glad that this Secretary of State for Health and his fellow Ministers have addressed the question. However, we should recognise that it is symptomatic of a wider problem across British business in both the private and the public sector that we have a culture that does not put enough emphasis on training. It is particularly bizarre that we allow unlimited numbers of people in universities to study art history and media studies—very valuable subjects—but restrict the numbers who can train to be nurses, when we know we have a crying and desperate need for more.

I am agnostic about the best way to finance the training of more nursing recruits. Clearly, if nurses bear the extra cost, that will have to be reflected in some way in their remuneration. The Minister told us that they will actually be no worse off, so I suppose the assumption is that they will not have to repay much of their loans. It is a somewhat artificial feature of the public finance rules, but it is a feature of them, that perhaps the only way of not borrowing the money from the public ourselves is for the nurses to borrow it and for us then to write off their loans. However, whatever the financial system—the end of bursaries and their replacement with loans is probably the only option—we have to pay nurses enough in the long run to recruit, retain and motivate them.

There is one other issue we should look at before we close the debate. There are 200,000 trained nurses who maintain themselves on the register at their own expense, but who are not currently working in the NHS or elsewhere—they may be taking time off to raise a family, and they may be thinking about coming back some time. We must be much more flexible and creative about providing patterns of work that meet the family needs of those trained, valuable, caring and experienced people if we are to bring them back into the health service. That, too, will help to meet the needs of the health service, as the Government are trying to, sensibly and wisely, in the measures they have brought before us to replace bursaries with loans.