Education (Student Support) (Amendment) (No. 2) Regulations 2018

Lord Clark of Windermere Excerpts

Monday 21st May 2018 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw the House’s attention to my interests as listed in the register and I congratulate the noble Lord, Lord Hunt, on securing this debate.

I should like to put my contribution in context. At lunchtime I came back from Geneva, where I had been at the World Health Organization working with the International Council of Nurses, representatives from the Nursing Now campaign and the Chief Nursing Officer of the WHO in looking at the future of the profession. One of the big discussions was on the need to increase the number of nurses worldwide and to ensure that we have health security across the globe. A major topic of discussion was, not surprisingly, the re-emergence of Ebola in the Congo. At least one Health Minister asked me how, as a country, we could really justify a recent advertisement from, I believe, the Home Office, encouraging nurses with a two-year graduate qualification to come to this country.

The noble Lord, Lord Hunt, has outlined the key concerns over extending the normal student maintenance regime to nursing students undertaking programmes at postgraduate level. As others have said, these programmes take two years, including theory and practice, and enable successful students to register as nurses with the NMC. I do not need to remind noble Lords that this is an intensive programme with significant periods of work in a practical setting.

The aim of introducing new systems of funding was to increase the number of nursing students, yet on undergraduate programmes this was not achieved in the 2017 intake, where a fall took place, particularly in applications for mental health and learning disability nursing courses. Why should there not be a similar fall in the number of students entering the postgraduate programmes this year if the change takes place? In effect, this would result in an even more significant drop in the number of nurses qualifying in 2020, in that the undergraduate numbers due to qualify in 2020 will be much lower than originally planned. If we could boost the postgraduate intake numbers for 2018, this could provide additional nurses ready for registration in 2020—just as they will be so desperately needed according to the NHS Five Year Forward View.

Therefore, does it not make sense to delay the implementation of the regulations while a systematic review of post-18 education funding is undertaken and retain the current system of funding for the group due to commence in 2018? This would provide us with an opportunity to run a campaign to increase the numbers for this year in the way that campaigns have been conducted to attract people to social work and teaching programmes in areas where there are similar staffing challenges.

We know that sufficient levels of registered nurses are critical for the health and social care system to ensure patient and client safety. The sombre reading of both the Francis report and the learning disabilities mortality review reminds us that not only do we need to retain our current staff but that we must train new nurses to further enhance the quality of our provision.

Graduates who enter postgraduate nursing programmes add value to our workforce, bringing a range of life skills. In particular, many mature entrants come into mental health nursing through the postgraduate route, and yet we know we are not meeting the numbers required to meet mental health services workforce demands.

I recognise that the Government have offered a new pay deal for nurses that may improve retention and recruitment and plan to offer golden hellos in some hard-to-recruit areas for nurses entering the profession, both of which I have expressed my support for and hope will be effective. However, until the new degree apprenticeship routes into nursing at both undergraduate and postgraduate level are properly designed and funded through the apprenticeship levy, I urge the Government to think again and to wait to introduce the reform we are discussing today.

NHS Providers reminds us that plans to boost the NHS workforce will take years to deliver, but to change this decision for at least one year would result in a larger cadre of nurses qualifying in only two years. I urge this because society expects us as policymakers to ensure safe healthcare in the NHS. This, I argue, cannot be achieved without a sufficient supply of newly qualified nurses and allied healthcare professionals.

[Lord Clark of Windermere (Lab)]

My Lords, I find the Government’s approach to NHS staff very perplexing indeed. They continually pay tribute to them, and I think they do understand the commitment of the workforce, yet repeatedly they take action that makes the life of nurses and other staff even more difficult than it is at the moment. At the same time, they make it more difficult for those nurses to guarantee the safety of patients in our NHS.

I congratulate my noble friend on drawing this SI to the attention of the House and allowing us an opportunity to debate this critical issue. In making my case today, I accept the points made by the noble Baronesses from the Liberals and the Cross Benches—they were absolutely right in the points that they made. But let us remind ourselves of the serious situation we are in. The points I am going to make now are agreed right across the National Health Service; points which every royal college and every responsible organisation in the health service agrees with.

The first point has been raised already: we are 40,000 nurses short, and the Government have a real responsibility for that. The number of nurses and midwives leaving the profession is greater than the number of those entering the profession—that is a recipe for disaster. We have critically relied not only on nurses from the far ends of the globe but especially on nurses from the European Union. Since the Brexit vote, they are deserting the National Health Service, and who can blame them?

Let me go right back to 2010, when this Government assumed office. That is when they started making massive errors, from which they have not recovered. Neither, critically, has the National Health Service. In an Answer to me, the noble Viscount, Lord Younger, pointed out that, when they assumed office, there were more than 97,000 entrants to nursing courses. The coalition Government’s first response was cut, cut, cut, and by 2012 the figure had dropped from over 97,000 to 75,000, a drop of 22,000 nurses entering the profession in one year alone. The figure improves marginally but does not get much better for many years. When I say the Government are 40,000 nurses short, it is because of their mistake in 2012 in cutting the numbers of young people and older students entering the nursing profession. We have never recovered from that.

I accept the point that the Government want to widen the area of recruitment—I will come back to that—but, having made the mistake in 2012, only two years ago they scored another own goal by abolishing the bursary scheme and introducing a charge of over £9,000 a year for people training for the nursing profession. Last year that led to a drop of 705 students. I admit that is not the same as the 22,000 drop the Government were responsible for in 2012 but we cannot afford any drop whatever. Now, having created a serious recruitment policy, they are introducing even more costs into the system by this SI we are discussing today. It is affecting older graduate entrants, those who do postgraduate courses and usually graduate after about 18 months or two years, which is the quickest way to get qualified nurses, as we have already heard.

However, the Government do not seem to have learned anything. The point from the Liberal Front Bench was well made when the noble Baroness pointed out that the cost of training a postgraduate student was £33,500—a lot of money—but we should not forget the cost of the agency nurses needed to fill that vacancy. That £33,500 cost is less than the average annual premium paid by trusts for a full-time equivalent nurse filling a post that is vacant because of shortages. It is a false economy and yet the Government do not seem able to see the picture in the round, which is the position we should be looking at.

There are other ways in which the Government could ease the nursing situation. Instead of bringing forward SIs such as those we are discussing at the moment, if they have got a bursary scheme, as they have, why do they not write off the cost of repaying the student loan for nurses who have spent a number of years in the National Health Service? One of the Minister’s predecessors said that the Government were looking at a similar proposal for doctors but I never saw whether it materialised. However, that would be one way of equalising the situation.

Many nurses from European Union countries and other National Health Service workers have got permanent residence status to live in Britain. After five or six years, they were entitled to apply for permanent residency, and they got it. To me, and to most nurses, permanent residency means just that: you have residence in this country which is permanent, but the Government will not admit that. They say that the permanency may not be honoured after Brexit. That is a terrible thing to say. A British Government are breaking their word to people who work in the health service and give so much. Why not say that those people who have permanent residency can remain in this country permanently? That would do a lot to retain the confidence of EU nurses.

I shall finish with a word about financing nursing apprenticeships. As we have heard, the Government’s target of 1,000 apprentices in nursing has not only fallen short, it has fallen ridiculously short. The Minister may have more up-to-date information than either I or the Royal College of Nursing have, but its figures show that there are not 1,000 apprentice nurses, there are 30. Of course, one of the difficulties lies in the whole concept. An apprenticeship requires a mix of work on the ward and work in the classroom at university, but that is exactly what undergraduate nurses do at the moment. Over the three-year period, 50% of their time is spent working—I emphasise that word—on the wards. Why should they pay more than £9,000 when apprentices may get that for nothing—or is it nothing? The universities which provide the classroom opportunities for these apprenticeships tell me that they have no alternative but to charge for them. I do not think that the apprenticeship levy will cover it because they are talking in terms of £7,000 a year for apprentices to do the university courses for their apprenticeship. I wonder who is going to pay that £7,000. Is it to be the student, or is it the trusts which are already hard pressed, or is it the Government? Most of us would agree that it ought to be the Government. It is their baby, their scheme and how they see the gap being filled—their salvation to ease the nursing shortage. It is the Government’s responsibility.

We are debating a statutory instrument which shows how ill thought through and chaotic the Government’s policies are when it comes to nurse training in this country.