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

Lord O'Shaughnessy Excerpts

Thursday 27th April 2017 Lords Chamber

[Lord Watson of Invergowrie (Lab)]

My Lords, when, in February, I was granted a topical Question on this subject—which, incidentally, I very much appreciate my noble friend Lord Clark raising—the Minister, the noble Lord, Lord O’Shaughnessy, chose to characterise my opposition to the Government’s damaging proposal as a sign that I did not support the policy of student loans. He was being disingenuous because, when student loans were first introduced by a Labour Government in 1988, those studying for nursing, midwifery and allied health professions were specifically excluded.

As tuition fees rose and student loans followed, successive Governments—Labour, coalition and, until now, Conservative—maintained that exclusion. We do not need to ask why. My noble friend Lord Clark and other speakers in this debate have made it quite clear that students building a career in those professions are quite unlike the wider student population. Perhaps the most revealing statistic on that—I will not repeat the others—is that 41% in those categories are over the age of 25, compared with 18% of the total student population. That sets them apart. As the noble Baroness, Lady Walmsley, has just said, they are unable to support themselves as other students can do, and often need to do, during their studies because of the hours required of students in nursing, midwifery and allied health professions.

However, none of that was taken into account by the Government—a Government anxious to make only “savings”. Worse, despite having those facts set out before them, they have declined to alter the course on which they are so dogmatically set. As my noble friend Lord Clark said, the nursing workforce already has severe shortages—up to 25,000 and rising—and already we know that fewer nurses from the EU are coming to work here and that by 2020 nearly half the workforce will be eligible for retirement.

So what do the Government do? They end the established practice of providing nursing students with bursaries and tell them to take out loans that will leave them with debts of at least £50,000 by the time they qualify. I heard what the noble Lord, Lord Willetts, said about loans—it is an argument that he repeated during the passage of the Higher Education and Research Bill. None the less, it is a fact that for those seeking to study for nursing, midwifery and allied health professions on the basis that they would have a bursary, it is quite a shock to find that that is not the case. Those going through school and going to university for what one might term more mainstream courses have known all along that that would be the situation. This is a sudden shock brought about by the Government, and it will have a detrimental effect on those wanting to study.

We like to think that, whenever we need the NHS, it is there for us and our families, but we are naturally anxious when we or our loved ones need to spend time in hospital, and we require an adequate number of nurses for that treatment. The Government are failing the NHS. A further example was provided just today when, in response to my noble friend Lord Hunt, counsel’s opinion was that the Government are acting illegally by not compelling NHS England to treat the required 92% of patients within 18 weeks. My noble friend Lord Hunt has submitted a Motion—for those noble Lords who are interested, it appears on page 4 of House of Lords Business—and I think that that highlights the fact that the Government are cavalier in the way they are allowing patients to be treated.

As we heard in February, the applications for nursing courses starting in September last year were down by some 23%, and the latest data available for March show that that decline is continuing. Although the ratio of applicants to training places is still 2:1, the fall in the number of applications could compromise the quality of candidates applying, as well as geographical provision, which of course is important in the long term. Moreover, it could deter prospective students once they understand fully the implications of the student loan system.

Janet Davies, the general secretary of the Royal College of Nursing, said:

“The nursing workforce is in crisis and if fewer nurses graduate in 2020 it will exacerbate what is already an unsustainable situation. … The outlook is bleak”.


Those are her words. She is the general secretary of the Royal College of Nursing—she should know. The National Health Service Pay Review Body in its 29th report said that,

“The removal of bursaries for student nurses could also have a disruptive impact on supply or the quality of supply”,


and that,

“the removal of the incentive of the bursary could have an unsettling effect on the number and quality of applications for nursing training places”.

They, too, should know. Why are the Government certain that, as always, they have a monopoly on wisdom? Why do they think they know better than the professionals in the NHS?

We should also ask why the Government are doing it. They have given two reasons. The first is the claim that it will add an extra 10,000 nurses up to 2020. But as I have said, far from encouraging additional training places by that time, cutting NHS bursaries will discourage many from becoming a nurse, midwife or allied health professional because of the fear of debt. The House of Commons Public Accounts Committee said in its report entitled Managing the Supply of NHS Clinical Staff in England that,

“the changes could have a negative impact on both the overall number of applicants and on certain groups, such as mature students or those with children”.

If the student numbers are not there, higher education institutions will be worse off because of the decline and the need to finance access bursaries under the Office for Fair Access guidance.

The Government’s proposal also stated that it will ensure sustainable funding for universities, but as yet there has been no indication of an increase in funding that the Government provide for clinical placements. Yet a study by London Economics, a leading policy and economics consultancy used by the Department for Education, found that higher education institutions would be worse off by around £50 million per cohort. Approximately half of that decline will be as a result of the decline in student numbers to which I referred. As a result, there is a real danger that some universities may decide to stop running some health-related courses altogether if they are deemed to be unsustainable. That is related to another government objective—to widen access to nursing training. I want to make clear that we are not opposed to that, but not at the expense of the traditional route through university.

The Government have also said that scrapping NHS bursaries will save the Treasury money. But there will in fact be no cost savings to the Exchequer because most nurses will not earn enough to repay the entire loan and the decline in numbers entering nursing will increase agency nursing staffing costs to cover shortfalls. London Economics also estimated that, with those increased agency costs to cover staffing shortfalls, there will be more than an additional £100 million cost by trusts per cohort wiping out any potential cost savings.

These proposals should not be proceeded with, at least until the Government have published the results of the second stage of their consultation on these measures—a point made and expanded on by the noble Baroness, Lady Walmsley. That consultation has been delayed and of course we will not see it now until the other side of the election, if we see it at all. That is entirely unsatisfactory. It is confirmation of what is no more than a leap into the dark. That is no way to treat the career development of some of our most valuable public servants. These changes are high risk at a time when the NHS is ill-equipped to manage such risk. We support the Motion in the name of my noble friend Lord Clark because it is a risk that should not be taken.

I end by responding to the rather dismissive jibe by the noble Lord, Lord Forsyth. Yes, we are keen to get on with campaigning for the leader of the Opposition. That is what we will do to encourage the people of the UK to elect a Government who will properly fund the NHS and properly value its dedicated staff. Bring it on.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, I thank all noble Lords who have contributed to this debate and congratulate the noble Lord, Lord Clark of Windermere, on his prescience in scheduling this debate several weeks ago. He clearly has admirers in the Leader of the Opposition’s office if they have taken his proposal and put it in their manifesto. I leave it to others to judge whether having a policy adopted by Jeremy Corbyn is a good thing or not.

[Noble Lords]

Oh!

[Lord O'Shaughnessy]

While the noble Lord may have been prescient and influential, I fear that on this issue he, the Labour Party and the Liberal Democrat party are wrong. They are wrong because the system that we are introducing for student nurses matches that experienced by other undergraduate students—a system that has been the primary driver of the big expansion of higher education and improved participation among disadvantaged young people—and wrong because of the fears of the impact of Brexit that he has evoked. I thought that the Labour Party was in favour of leaving the European Union, although having heard the tortured exposition of Labour’s policy earlier this week that is anyone’s guess. But I reassure the House that this Government not only understand the difficult choices that need to be made to ensure that our NHS has the resources and personnel that it needs to thrive, but, if we are fortunate enough to be re-elected, intend to make a success of Brexit and, as immigration is reduced, to bring more of our domestic workers into the NHS to meet the challenges ahead.

I join other noble Lords in paying tribute to the amazing work that more than 2.5 million people working in the NHS and care systems do every day, often in challenging conditions. They represent values to which we all aspire—service, hard work, compassion—and are an inspiration to us all. There can be no person in this country who does not have cause to give them thanks for their expertise and commitment.

The Government are taking action on several fronts to support that workforce so that it can deliver excellent patient care through flexible working, good leadership, expanded routes into practice and new career structures. As part of these changes, from August 2017 new full-time students studying pre-registration nursing, midwifery or one of the allied health subjects will have access to the standard student support system for tuition fee loans and maintenance loans.

These reforms will enable more money to go into front-line services—around £1 billion a year to be reinvested in the NHS. Additionally, they will help to secure the future supply of nurses and other health professionals in several ways, such as by removing the cap, identified by my noble friend Lord Willetts as being a feature of the current system, so that more applicants can gain a place. Universities will be able to deliver up to 10,000 additional training places. The changes also enable a typical provision of a 25% increase in living-cost support for healthcare students and put universities in a stronger financial and competitive position so they can invest sustainably for the long term. The noble Baroness, Lady Watkins, in her excellent and of course, expert and well-informed speech, also pointed out that they remove a perverse incentive of the current system where it is the sole degree that is subsidised in that way. That brings with it a number of benefits, including addressing the issue identified by the noble Baroness, Lady Walmsley, of the retention on courses of people who are fully committed to taking part in a nursing career.

Successive Governments’ reforms to student finance have put a system in place that is designed to make higher education accessible to all, as my noble friend Lord Willetts pointed out in his excellent intervention. This has allowed more people than ever to benefit from a university education and has spread more fairly the burden of costs between society at large via the taxpayer and the individuals who benefit financially from the degree course. As a consequence, disadvantaged people are now 43% more likely to go to university than in 2009, and for the last application cycle the entry rate for 18 year-olds from disadvantaged backgrounds is at a record high: 19.5% in 2016, compared with 13.6% in the last year of the Labour Government in 2009. That is what we mean by a country that works for everyone. It is precisely because of these positive effects that moves towards a loan-based system have been supported by political parties across the House. They were introduced by a Labour Government, extended by a Conservative and Liberal Democrat Government and taken on by this Conservative Government.

Turning to the applications for nursing and midwifery courses, the latest data published by UCAS on 6 April show around a 22% fall in the number of applicants to nursing and midwifery courses in England compared with the same point in the 2016 application cycle. However, as my noble friend Lord Willetts pointed out, in previous cases when fees have been introduced application numbers have gone down but rebounded in future years. The same UCAS data also show that since January there have been more than 3,000 additional applicants for nursing and midwifery places, taking the current total to more than 40,000 applicants for around 23,000 places in England. The chair of the Council of Deans of Health, Dame Jessica Corner, has commented on the situation, saying:

“It is to be expected that there would be fewer applications in the first year following the changes to the funding system, but we would expect this to pick up in future years”.


The Chief Nursing Officer, Jane Cummings, said:

“Despite the drop, the level of applications received suggest that at a national level, we are still on track to meet this target in England although we need to monitor this very carefully. We are also introducing a number of opportunities to support future applicants including additional routes to become a graduate nurse”.


Based on all of the information available, Health Education England is confident that it will still fill the required number of training places for the NHS in England.

On the issues raised around Brexit, future arrangements for student support after the UK leaves the EU will need to be considered as part of wider discussions about the UK’s relationship with the EU. However, the Government have confirmed that EU students starting their courses in 2017-18 or before will continue to be eligible for student loans and home fee status for the duration of their course.

On numbers of non-UK nurses, it is correct that the Nursing and Midwifery Council has seen a reduction in the number of registration applications from nurses in the European Union. At the moment, it is unclear whether the drop is attributable to the introduction of more robust language testing by the NMC, rather than as a result of the decision for the UK to leave the EU. The drop in the number of applications is balanced by a reduction in outflows from the profession, meaning that, while monthly fluctuations continue, the number of EU-born nurses is broadly the same. Indeed, slightly more nurses from the EU are working in NHS trusts and CCGs than in June 2016, the time of the referendum.

[Lord Watson of Invergowrie]

Will not the figure that the Minister has just cited be significantly skewed by the immigration skills charge, where, for every overseas person coming in on a type 2 visa, the NHS will have to pay £1,000? Will that not have an effect on nursing figures?

[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.