NHS Bursary

Maria Caulfield Excerpts

Monday 11th January 2016 Westminster Hall

[Maria Caulfield (Lewes) (Con)]

I welcome the opportunity to speak in such an important debate. I acknowledge that the changes affect all sorts of healthcare professionals, including midwives, physios and speech therapists, but I will keep my remarks mainly to student nurses because I am a qualified nurse and have worked in the NHS for more than 20 years—I was even working as a full-time NHS nurse until just after the last general election.

I trained under the bursary scheme. I was one of the second intake, after the scheme was introduced in the early ’90s, so I have first-hand knowledge of how it works. I have met student nurses, the Royal College of Nursing—the RCN—and qualified nurses to discuss some of the issues that the changes raise. I have also met the Minister to express my concerns, and have been reassured that alternatives to a student loan mechanism for entering nurse training are in the pipeline. These might be better than the nurse bursary scheme, and they will certainly be better than the proposed student loan scheme.

Let us not pretend that the bursary system is ideal—I speak as someone who went through that method of training. It started in the early ’90s as a replacement for the old-style nurse training system in which student nurses were part of the workforce and were on the payroll. Let us be honest though, the students were used as a spare pair of hands and often there was not a huge opportunity for them to learn on the job. At that time, there were two ways for someone to become a nurse. They could do a two-year course to become a state-enrolled nurse, in which role they could do only so much, or they could do a three-year course and become a fully qualified state-registered nurse, taking on all aspects of the role of a registered nurse. The bursary scheme, when it was introduced, was a move to make nursing more academic, and to create supernumerary student nurses. Or rather, that is what is supposed to happen. As my hon. Friend the Member for Sutton and Cheam (Paul Scully) pointed out, in practice, student nurses are still used as a spare pair of hands and are rarely supernumerary when they are on placement.

Student nurses were, however, taken off the payroll and the bursary scheme was introduced as a sort of income to acknowledge that, although the students were not counted as part of the workforce, they still had to do a huge number of hours while on placement, including night shifts and weekend and evening work. The bursary was supposed to compensate the students for their loss of income, but a bursary is not a wage, and it certainly does not reflect the number of hours student nurses put in during their training.

Let us not miss the point. Someone can do a three or four-year academic nursing degree, but unless they do the clinical placement hours, they cannot register as a nurse. That is the crux of the matter. In addition, a bursary certainly does not reflect the increase in experience and skills that students gain as they go through their training. A first-year student nurse gets exactly the same bursary as someone who has almost qualified and is practically working—under the supervision of a qualified nurse—as a qualified nurse.

The bursary system undervalues the contribution that student nurses make, and it means that student nurses across the country live on little more than £3,000 a year. The system has changed over time—it was not means-tested when I was doing my training, but it is now. Let us not pretend, therefore, that the system is ideal. The bursary has never adequately supported student nurses, and I welcome the chance to change it. Let us look at other professions. I certainly do not want people sitting in the Public Gallery to suddenly rush out and change profession completely, but a trainee police officer has a starting salary of £19,000 and a trainee firefighter starts on £21,000. Airlines are now moving to in-house training. A new pilot with no flight experience training with British Airways is on £23,000 and Virgin has a similar policy, with Richard Branson saying that he welcomes those with no experience to be part of the Virgin family from day one. Yet for student nurses, who take similar life and death decisions every single day, we propose not just that they work in clinical areas for free but that they pay for their training as well.

I believe Ministers when they say that this is not a cost-cutting exercise, because the money will instead increase the number of student nurse placements. Currently, more than 50% of people who apply to become student nurses are turned away simply because the places are not there in the universities. The RCN’s figures from only last year show that there were 57,000 applications, of which 37,000 were rejected.

[Ruth Cadbury]

Will the hon. Lady give way?

[Maria Caulfield]

I will not, if the hon. Lady does not mind, just because I know that so many Members want to speak.

Although not all of those 37,000 will have been rejected because of a lack of places, a significant number of them will. The current system restricts the number of student nurses that enter the profession so, in theory, the changes should increase the numbers of qualified nurses in a few years’ time. From my clinical practice I know, however, that what works in theory will have the opposite effect in reality.

My main concerns about moving from a bursary scheme to a student loan scheme are, first, that many nurses go into a degree system simply because there is no other way to become a nurse. They do not necessarily want a degree in nursing; they want to be a qualified registered nurse. If we commit to a student loan scheme, we are committing them to take on debt for years to come. As we have heard, many of them—more than 30%—are mature students, and by mature students we do not mean people in their 40s and 50s. They are people in their mid-20s and early-30s. They have young families; they are single mums; and they have a first degree and have to take on a second one just to become a nurse. It is a crazy situation. For someone who already has a student loan, and/or a mortgage and/or childcare to pay for, the thought of taking on more debt will definitely put them off entering nursing, and to say otherwise is madness.

The difference between student nurses and other undergraduates is that the starting salary for a nurse is £21,000. Most nurses will only ever be a band 5 or 6, and the maximum they can earn as a band 6 is £34,000—that is if they do not have a break to have children or go part time for some other reason. They will never be in a position fully to pay off their student loan. Student nurses are different, therefore, from other undergraduates, and that has not been recognised in the debate. An issue in the wider debate about graduates is that a graduate is, on average, £100,000 better off than a non-graduate, but that is not the case with nurses. Other graduates earn, on average, more than £40,000 a year, but nurses do not earn anything like that and that difference needs to be recognised when decisions are made.

We have heard how much time student nurses spend on clinical placements—more than 50% of their course, including nights, weekends and evenings—which makes it almost impossible for them to get any other income from part-time work. We must recognise that. Being dependent on a loan is not a great way of life either, but other students are able to supplement their loans by working in pubs and shops, and doing other evening work. Student nurses are not in a position to do that.

My second concern is that, if I am completely wrong and we suddenly have a huge increase in the number of student nurses, the placements will not be able to cope. To qualify as a student nurse, not only does someone have to pass their exams and essays and do the required hours, they also have to be clinically assessed by a registered nurse—not just any old registered nurse, but someone who has done their mentoring and assessing course. I know that there are student nurses now who struggle to find placements because there are not enough qualified nurses able to assess them. That needs to be taken into account as well. It is not just about increasing the numbers; it is about having the support services in place.

When I met the Minister, I was hugely reassured by what he said about other schemes that are being proposed. My plea is that he outlines those schemes so that student nurses are reassured that, in order to qualify, they will be able to use schemes other than the student loan system. Routes such as nursing associates and nursing apprenticeships are being proposed. I am probably getting a little old now—

[Stephen Pound]

No!

[Maria Caulfield]

I thank the hon. Gentleman for his intervention. Those routes sounds like the state-enrolled nurse or state-registered nurse route again, and they worked pretty well in years gone by.

[Fiona Mactaggart (Slough) (Lab)]

Will the hon. Lady give way?

[Maria Caulfield]

I have almost finished, so I will not take any more interventions. The Minister told me that those routes are alternatives to the proposals that have been put forward today. I urge him to highlight those alternative routes and to give a timescale. If those alternatives are realistic, they need to be in place as the bursary system is phased out, if not before, so that student nurses have choices on how they become nurses. When I was running a clinical team, we used the assistant practitioner role effectively and made some great progress. Some of those assistant practitioners are in the process of becoming qualified nurses themselves.

I have a couple more points to make. One thing that we are missing is a return-to-nursing scheme. Under the proposals, money will be saved from the bursary scheme. Huge numbers of nurses go off to have children or take a break from their career, like me, and they have to do a six-month course and pay for that themselves. An efficient way of building up nursing numbers quite quickly would be to fund return-to-nursing courses, so that we can easily and quickly increase the number of nurses who can get back into the profession. They have huge amounts of experience.

It is hard to be a student nurse. Although it was a long time ago, I still bear the scars of my nurse training. Not only do student nurses have to learn and take exams, but their placement changes every eight to 12 weeks. They go to a new ward, new day unit or new community placement, and they never really feel part of any team. As soon as they start to get that feeling, they are moving on to the next team. They are struggling to survive on less than £4,000 a year and have to rely on family and friends. We are now asking student nurses to take on more debt to do their training. They may or may not come to nursing with a lot of life experience, but they are telling people that either they may die or their loved ones are dying. Student nurses witness death at first hand—sometimes that death is expected and sometimes it is not. They are kept going, however, by the thought that one day they will be a qualified nurse with that bit of paper that says, “You are registered.”

We have an extremely high turnover of student nurses. Many are leaving before they are qualified, and my concern is that, if we add to their financial pressures, the turnover will be even higher. We are spending nearly £12,000 a nurse to recruit from overseas and fill our vacancies, and I would prefer to see that money being used to sponsor nurses to get into their nurse training, whether that is through the associate route, the apprenticeship route, which sounds exciting, or through encouraging and paying nurses to come back into nursing. We need to have that Virgin philosophy, where a student nurse is part of the team from day one. I hope the Minister can give us some positive feedback from the petition.