NHS Bursary

Liz McInnes Excerpts

Monday 11th January 2016 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank the hon. Gentleman for his comments about Martin Lewis. May I just ask whether Martin Lewis advised the Government when they proposed the plans for the NHS bursary scheme?

[Paul Scully]

I am a new Back-Bench MP so I was not around then, but I know that Martin Lewis was on a Committee at some point afterwards to determine relationships, but I will take advice on that.

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[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to be able to make a contribution to this important debate. I congratulate the 154,000 people who have signed the petition and brought this issue to the House for discussion.

I declare an interest: I am a Unite member and an ex-Unite workplace rep in the NHS. I used to work as a healthcare scientist in the NHS. I did not receive a bursary for my training; I was employed in a supernumerary position. I was privileged to be able to do that. In my day, it was recognised that I was making a contribution to the NHS while being trained. The Government should perhaps go back a few decades and have a look at how NHS staff were treated in the 1980s, when I trained.

Members have quoted various figures about the proposed changes. From the reading I have done, I believe that under the proposed changes, students could be burdened with up to a staggering £65,000 of debt by the time they finish their training. Under the current system, the bursary allows those without financial means to study as nurses, midwives and, importantly, allied health professionals—I am grateful that a lot of Members have mentioned AHPs, because it is important that we do not forget them and their contribution to our NHS. Many trainees already struggle to make ends meet, even under the bursary system. As Members have said, the system is not perfect, and we need to look at it, but let us do it properly and put in place a system that actually works, rather than one that appears not to have been tested or consulted upon.

[Mr Nigel Evans in the Chair]

Many Members referred to the difficulty of getting part-time jobs. It was a pleasure to listen to the hon. Member for Lewes (Maria Caulfield) talk about her own experience. Given the number of hours that NHS trainees—nurses, midwives or AHPs—are expected to work during clinical placements or at university, plus all the extra hours on assignments, exams, practicals and study, there are not enough hours in the day for them to take on a part-time job.

I was interested to hear the hon. Member for Sutton and Cheam (Paul Scully) refer to Martin Lewis’s MoneySavingExpert.com website. I had a look at it during the debate to see the advice that he gives about NHS bursaries. I could not find anything particularly relevant, but I noticed that, to help students financially, he advises them to get a part-time job. That is obviously not suitable in this situation. The hon. Member for Lewes highlighted the relatively low pay that nurses on band 5 or 6 can expect to earn. Under a loan system, those people, once qualified, will be paying back that debt for their whole career. I urge the Government to consider those points, which have been well made.

[Mr Andrew Smith (Oxford East) (Lab)]

My hon. Friend is making an excellent speech. Does she agree that the pressures will be all the more acute in high-cost housing areas such as Oxford, where nurses are already struggling, which will be a further disincentive to recruitment and retention in services that are already under enormous pressure?

[Liz McInnes]

I thank my right hon. Friend for his important intervention. Housing costs must be borne in mind in any discussions about changes to NHS bursaries. The days when cheap accommodation was available to NHS trainees are long gone. I can remember staying in a tower block in Greenwich at a reasonable rate during my training, but those tower blocks were sold years ago and are now privately owned.

Replacing bursaries with loans will reduce the diversity of those able to access a career in healthcare. I noted with interest that the hon. Member for Sutton and Cheam claimed when challenged that that would not be the case, but was then unable to quote any equality impact assessments. I would be interested to hear from the Minister what assessments have actually been performed. The NHS bursary is not a cost but an investment in the health and wellbeing of our society. To lose the bursary would affect not only prospective students but each and every citizen of this country, by which I mean England, because the proposals apply to England only.

In the Budget debate of July last year, I spoke against the change from maintenance grants to loans for young people hoping to go to university. The withdrawal of NHS bursaries, as announced in the comprehensive spending review, directly mirrors that change. As a result of the Budget proposals, our students will be saddled with even more debt. I said at the time that there was a real risk that the Government were experimenting with the future of the current generation of secondary school students, but it now appears that they are also experimenting with the future of current and potential nursing and health trainees. In short, it is an experiment on the future staffing of our NHS that has the potential to go badly wrong.

I put out a simple statement on Twitter regarding the views of the Royal College of Midwives, which opposes the proposals to remove NHS bursaries, and received this response:

“My daughter a single parent budgeted carefully b4 becoming a student nurse, may not be able to complete studies.”

That is an appalling situation into which the Government have put that student nurse. Again, that gives the lie to their oft-repeated claim to be the party of working people. Simply repeating the same line over and over again does not make it true, although that does seem to be this Government’s modus operandi on so many issues.

As with the Government’s conversion of maintenance grants to student loans, I would be interested to read an equality impact assessment, should such a thing exist, of the removal of NHS bursaries. The Government’s claim that cutting the bursary will encourage more prospective students into nursing is ludicrous, and even some Government MPs are saying so publicly. I was pleased to hear the hon. Member for Lewes on Radio 5 live yesterday stating that she would have not been able to train as a nurse without an NHS bursary. Today she hinted at alternatives, including apprenticeships and maybe even a return to the days of state-enrolled and state-registered nurses, and I hope that the Minister will be able to elaborate on them.

The Royal College of Midwives believes that the NHS workforce deserves a better future and says, interestingly, that the Government have

“taken money away from other parts of the health system, including student education, to be able to give ‘the NHS’ more money. According to the King’s Fund, spending on health activity that falls outside NHS England’s budget will decrease by more than £3 billion in real terms by 2020/21—a reduction of more than 20%.”

The RCM then quotes the King’s Fund, which states that

“it is clear that a large amount of the additional increase in NHS England’s budget has come at the expense of other areas of health spending.”

The Royal College of Nursing is similarly opposed to the plans and refers to them as “ill thought out”. As the RCN celebrates its centenary, it calls upon the Government to listen to its knowledge and expertise, stating:

“The future of nursing must be protected. Our patients deserve nothing less.”

Unite the union also opposes the plans, highlighting the other health professions covered by the NHS bursary, including occupational therapists, physiotherapists, radiographers and speech and language therapists, to which other hon. Members have referred. Those professions are the backbone of our NHS, and we cannot allow entrants to them to train at their own expense while racking up debt. To do so would be disastrous for our NHS and for future patient care. I urge the Government to reconsider the proposals and, more importantly, to take advice from the professional bodies.

--- Later in debate ---

[Ben Gummer]

The hon. Gentleman knows that I cannot commit other Ministers to debates, but I will certainly represent his concerns to the Minister for Universities and Science, my hon. Friend the hon. Member for Orpington (Joseph Johnson). He makes a strong point. It seems that I am the only person in this Chamber not to have a close acquaintance with Martin Lewis, but I will ensure that the hon. Gentleman’s points, including the one about the Delegated Legislation Committee—I sat on such Committees for a few years and never received anything nearly as exciting as student grants—are represented to the Universities Minister, so that he can answer him directly.

I wish also to address the points raised by the hon. Member for Heywood and Middleton (Liz McInnes), who talked about equality impact assessments. We have worked up an assessment of the impact that the changes will have on recruitment into nursing—of course we have—as part of our policy generation. That will culminate in a full equality impact assessment and a business case, which will be published at the time of the consultation, not long from now. I hope that that will inform the discussions that take place, so that we can have a robust and evidence-based debate.

The hon. Lady talked about housing costs, which was reflected in an intervention by the right hon. Member for Oxford East (Mr Smith). Housing costs are a considerable pressure for many students—not only those applying for nursing courses, but those in high-cost parts of the country. That is partly why we want to increase the amount of maintenance we can provide. To return to my central point, within the current spending envelope we can do that by such a considerable amount—25%—only through a reformed system. To do it in other ways would be prohibitively expensive, and I do not believe the Opposition have proposed that.

The hon. Lady asked about NMC registration fees. At the moment, they are incurred at the point of registration when the university course has finished and are tax-deductible. They have risen in the last year, which I know has caused disquiet among nurses. I have spoken to the regulators, including the NMC, and implored them to keep their fees at a sensible level and to avoid rises whenever possible. The NMC has had to deal with a considerable increase in fitness-to-practise cases, but I hope that with internal cost savings it will be able to mitigate further rises. I have certainly asked it to do that, although it is an independent body.

The hon. Lady cited someone she had spoken to who was, if I understood her correctly, halfway through a degree. It is important to state that the change is for new students only, so those on existing courses will not be affected.

[Liz McInnes]

The Minister has said that the equality impact assessment will be published at the time of the consultation, but what assessment has been made to ascertain the effect of the proposed changes?

[Ben Gummer]

The hon. Lady probes like an expert, but she should know that there has been a detailed assessment of the impact of the changes as part of the policy development, which is still taking place. When we launch the consultation, the full details of the assessment will be made public as part of the process, so she will be able to see very soon what the changes will mean.

My hon. Friend the Member for Lewes spoke with great eloquence about her own nursing experience. Other hon. Members may not know that she has a master’s degree connected with her nursing work. She certainly knows about the full gamut of the academic discipline of nursing, and I take her views with considerable seriousness. She was right to point out that the change is part of a wider package of reform.

Several hon. Members spoke clearly and, in one case, movingly, about people who want to become nurses but cannot, either because they did not achieve the necessary grades earlier in life to go to university—that was a failing of their education rather than because of an innate inability to be a nurse or to pass the exams—or because they have caring responsibilities. We want both sorts of people to be in nursing, because they care and because of their vocational call to be nurses. At the moment, a significant number of them are working as healthcare assistants and cannot progress to being nurses. They are prevented from doing so unless they leave the workforce, go to university and then come back into the system. Even under the existing arrangements, that makes it impossible for many of them, which is profoundly wrong.

That is why it is a priority for me, as I announced a few weeks ago, to open up an apprenticeship route to enable healthcare assistants to move from a band 3 position in the NHS to an intermediate new position—nursing associate—that is part of a vocational route to full nursing registration. The exciting thing about that is that it will provide a dual training route into nursing. There is the traditional nursing undergraduate route, which will still take three years, and there will be the new route—an apprenticeship—which will open up nursing to a whole new group of applicants who are currently precluded from achieving their dream of going into nursing and who do not even count in the statistics of those refused a place.

In the round, we are doing what I hope many Opposition Members want. I share their wish to see the diversity of the workforce, which is already one of the most diverse in the country, improve still further, and to see opportunity expanded, the quality of training improved and support given to people at university. Conservative Members also want all those things.

I appreciate the sensitive way in which hon. Members on both sides of the Chamber have spoken. I also appreciate that they may disagree with how the Government want to proceed to try to improve nurse training. In the absence of alternative ideas, I believe that our proposals really are the way to expand places, improve diversity, increase opportunity, especially for those from disadvantaged backgrounds, improve quality and provide support for those at university.

[Ben Gummer]

I would be delighted to hear alternatives, and not just via the medium of the consultation. I would very much like them to be offered within the current spending envelope, but if people wish to offer alternatives outside that envelope, they must explain how much they will cost and how they will be funded. Within that spending envelope, the reforms will allow us to expand the number of places and improve quality, support and opportunity.

[Liz McInnes]

The Minister mentioned introducing apprenticeships to enable healthcare assistants to move on and train as nurses. Before I left the NHS, a similar scheme was being implemented. It was called “Modernising Scientific Careers” and applied to healthcare scientists. There was a long and arduous consultation process, which to my knowledge has still not been completed. How long does the Minister envisage it will take to implement the process for nurses and healthcare assistants?

[Ben Gummer]

We have a commitment to have 100,000 apprenticeships across the NHS in this Parliament, a significant proportion of which will be for nurses. I am approaching this at the utmost speed, and I and the Government will be judged on whether we deliver in five years’ time. I know that the hon. Lady will hold us to account. I will happily pick up on where the consultation to which she contributed has gone—I hope there is not still someone in the basement of the Department of Health working on it—and give her an answer as to what happened as a result of it.

I want to address one final result of the reforms that we are bringing in. It was raised by my hon. Friend the Member for Isle of Wight (Mr Turner) and by the hon. Member for Scunthorpe (Nic Dakin), both of whom talked about the rurality of their areas and the impact that isolation has on recruitment. I hope that, especially through the introduction of nursing associates—an apprenticeship route through to nursing—we can help address problems of recruitment and retention in specific parts of the country. I recently floated that not far from the hon. Gentleman’s constituency, in Hull, where people were receptive of the idea of a different route into nursing that complemented the university route.

This is potentially an exciting moment for nursing. We will be able to expand the number of places and improve support, diversity, opportunity and quality—all things that have been achieved in the rest of the university sector. We will do so quickly, and we will do it even better if we have a good and robust consultation on the details. I will of course write to hon. Members who feel that their points have not been answered, and I once again thank the Petitions Committee for bringing the matter to the notice of the House.