Education (Student Fees, Awards and Support)(Amendment) Regulations 2017

Lord Clark of Windermere Excerpts

Thursday 27th April 2017 Lords Chamber

Moved by

[Lord Clark of Windermere]

That this House regrets that the Education (Student Fees, Awards and Support) (Amendment) Regulations 2017, which pave the way for students of nursing, midwifery and allied health professionals to receive loans rather than bursaries, have already been seen to discourage degree applications by a quarter, at the same time as Brexit has already reduced European Union migrant nursing and midwifery registrations by over 90 per cent; and that these factors risk turning an increasing problem in the National Health Service into a chronic one that potentially puts at risk safe levels of staffing (SI 2017/114).

Relevant document: 26th Report from the Secondary Legislation Scrutiny Committee

[Lord Clark of Windermere (Lab)]

My Lords, it is particularly appropriate that the final debate of the Parliament in this House is on a matter of such concern to the British people: our National Health Service. If there is one group of people who always top the approval ratings among the British people, it is nurses. I will not say where we politicians are.

It is widely accepted that the National Health Service provides real value for money. In fact, we get health on the cheap in this country. We spend less on health than any other member bar one of the G7 nations, and I am not sure that that can continue for much longer. I think we will have to spend more on health, with our ageing population and the growth of what is technologically possible.

In a sense, we have been helped in this debate by the report of a Select Committee of this House on The Long-term Sustainability of the NHS and Adult Social Care. It draws to our attention how we have failed over the years to have long-term planning for organising staff. We must remember that approximately 150,000 people work for the health service. It is a fascinating organisation. It is a labour-intensive organisation—which applies in one way to nursing—married to and working alongside cutting-edge technology and science. It works, and we must continue to ensure that it works. The key is the staff at every level.

Anyone who follows the press or talks to doctors, nurses or the other health professionals knows that our National Health Service is in deep trouble and is functioning safely only due to the work level of the staff and their intense dedication to the service in which they work. That cannot continue indefinitely. Repeatedly, the royal colleges of nursing, midwifery and all the other medical disciplines tell us that we are getting towards breaking point. The strain is intense; the morale is low.

Let us take just nursing. Currently, we are about 24,000 nurses short—I think there is no disagreement with that. That affects not only our National Health Service but another big issue at the moment, the after-care service. A number of care providers, nursing providers and Care England have contacted me to say that they have had to close beds because they cannot get nurses to staff them. We tend to neglect that, and I mention it only in passing today because I want to concentrate on the health service.

I gather that the Government have had a report available to them in March which is not yet public which suggested, on a worst figure scenario—I emphasise that—that by the early 2020s we would be not 24,000 but 42,000 nurses short. Morale is not helped by the fact that nurses were not well paid to start with. They are highly qualified. All nurses are now graduates. They have to do professional work. Increasingly, they are doing work traditionally done by doctors. They are able and skilled do it, and we benefit greatly from that. The 1% annual pay increase which they have had to accept since 2010 is having a massive effect on morale, especially when people are having to work so hard.

We get by only because we import nurses from overseas. We have traditionally done that—I am not just blaming the Government in this case—but the problem is now acute. Of those nurses from overseas, 20,000 originate from European Union countries. Despite effort and pleading by me and others, we cannot get the Government to commit to those 20,000 people who work so hard in our National Health Service being allowed to stay in Britain. That will be easy to do: we need only to tweak the residency rules. That could be done without causing any problem, yet it would be of great benefit in retaining those nurses. I believe that we should offer them permanent residency in this country, as they have dedicated so much effort to providing healthcare for our population but, at the end of the day, we must train more home-grown nurses. The supply is there, because for every person who is accepted on to a nursing course at university, twice as many people apply. There is the quality and quantity of individuals who want to train nurses. The reason why they are not is because the Government have insisted on a cap on the numbers. Universities are not allowed to accept more nurses than has been agreed with the Government. By imposing this cap, we are exacerbating the problem.

I challenge the Minister that we are only really talking about saving money. That is what is dominating the Government’s approach to the training of nurses.

To recap a little, the bursary system that has been developed meant that nurses who went into training did not pay fees. The quid pro quo was that most of them went on to work in the care services or the National Health Service. That system worked well and was fully subscribed. Under the proposals we are debating today, those individuals will have to pay £9,000 per year in fees for three years which, with their living costs, will mean that nurses enter their profession not well paid and with £50,000 minimum hanging on their shoulders. I doubt that that is a sensible approach.

We must accept that nursing students’ courses at universities are very different from most courses. It is not just lectures and library work. At least half the time of nurses in training is spent on the job, on clinical training. In most hospitals, most patients could not determine who is a student nurse and who is a qualified nurse, because student nurses are doing the work of trained nurses, except in a few technical, specialist areas.

[Lord Forsyth of Drumlean (Con)]

I am most grateful to the noble Lord. On his point about the number of nurses who previously got bursaries and about financial controls on the bursaries, what proportion of those applying were unable to get bursaries and, therefore, unable to get training places?

[Lord Clark of Windermere]

As I understand the question, anyone accepted on to the course got a bursary—so they all got the bursary. I am pretty sure that I am right on that. But the point I was making about the course being different was not only that it is more intensive and about working on the job—the course is also longer. The average course length at universities for nursing, midwives and allied health professionals is 39 weeks a year, much longer than the average student course. So it is a different course; they have no opportunity, or little opportunity, to do any extra-curricular work, because of the nature of the job. Yet while they are working on wards, they work as a team.

In essence, the Government are insisting—for, I think, the first time in decades—that nurses pay for working in the health service. They are paying £9,000 a year to work as unpaid nurses. That is absolutely scandalous. Even before the new system came in, going back 50 years, you were accepted on a nursing course and went to the hospitals where you were trained. There was a mixture of blocks in the hospital and working on wards; that is how it traditionally went, but the nurses did not have to pay to perform those tasks. It is outrageous that this Government are insisting that nurses should pay for their own training.

The Government’s justification for this change is to increase the number of nurses being trained, which we all welcome—we all want the number of nurses to be increased. It would help in so many ways. Virtually every hospital now survives by using agency nurses, paying far more by the hour than the NHS staff nurses get paid. We could save billions of pounds if we had sufficient nurses to staff our NHS and aftercare services. So what I am arguing for makes financial sense. The Government say that they are prepared, if nurses pay for their own education—and this is perhaps the point that the noble Lord was making—to lift the cap, so the universities could train as many students as they want. I hope that works; I want the system the Government are proposing to work. But then we come to the problem that it is easy enough for the universities to expand their lectures and provide library facilities; the difficulty comes when the National Health Service has to provide mentors, tutors and practical oversight of students when they work on wards and in clinical situations. There is no provision, as far as I can see, by the Government to provide extra money to hospital trusts to perform that critical part, which is at least half the cost of nurse training.

I want the proposal to work but it is highly risky. We are dependent on nurses from the European Union—and the latest figures are that there was a 90% fall in the registration of nurses from European Union countries since last December, which is an ominous sign. Then we have the figures from the Government, which show that the number of applicants to health courses was down by 23%. I accept the Government’s point that those were applicants, not people who had actually been accepted on to a course. What worries me is that, if it follows through, and if the Government do not get students prepared to enrol at universities, we will find that we make no inroads at all into the shortage of 24,000 nurses.

--- Later in debate ---

[Lord O'Shaughnessy]

I am not going to speculate on the impact of that. What I can tell the noble Lord is that, despite the scare stories that numbers will have been affected, there have been more EU-based nurses in the past year. That is the point that I wish to get across.

The real issue at stake is whether the number of staff in the NHS is increasing to meet the growing demands on it, and here the Government have a strong record. Over the past year, the NHS has seen record numbers of staff working in it. The most recent monthly workforce statistics show that, since May 2010, there are now over 33,000 more professionally qualified full-time equivalent staff in NHS trusts and clinical commissioning groups, including over 4,000 more nurses.

Health Education England’s Return to Practice campaign has resulted in 2,000 nurses ready to enter employment and more than 900 nurses back on the front line since 2014. There has been a 15% increase in the number of nurse training places since 2013, plus the introduction of up to 1,000 new nursing apprenticeships and the creation of nursing associate roles—the kind of non-graduate nursing roles that my noble friend Lord Forsyth pointed out as being such a crucial part of the mix. These all form part of our plan to provide an additional 40,000 domestically trained nurses for the NHS. These new and additional routes into the nursing profession will allow thousands of people from all backgrounds to pursue careers in the health and care sectors and, critically, allow NHS employers to grow their own workforce.

I will end as I began. I believe that this regret Motion is misguided. The extension of the loan-based system to nursing and midwifery training is a natural development of reforms that have received cross-party support, successfully expanded higher education, dramatically improved the participation of disadvantaged groups and provided a fairer distribution of the costs of funding higher education.

Despite the pessimism of some, the decision by the British people to leave the European Union, which this party respects, has not had a material impact on the workforce. Furthermore, and paid for in part by the resources freed up by our changes to student finance, this Government have put in place a series of programmes that have successfully increased the number of staff in the NHS and provided more training places than ever, allowing us better to grow our own workforce among UK residents.

The true source of regret is that the Opposition have used this opportunity to run scare stories about both the impact of sensible funding changes we have made and the impact of leaving the European Union on the NHS workforce. I urge all Members of this House to vote against the Motion.

[Lord Clark of Windermere]

My Lords, I have listened very carefully to the Minister. I wanted to be persuaded; I am not persuaded. I believe that the Government are taking a big risk. They have gambled before. It may not be known, but in 2011, 2012 and 2013, they reduced the number of nurses in training because they thought we had sufficient. As a result, several thousand nurses were short-trained in those three years, because the Government got the figures wrong. I believe that they have got the figures wrong again. It is a big risk that we do not need to take. It is unfair on the nurse’s career, but, most of all, it is unfair to potential patients in the National Health Service. I want to test the opinion of the House.