Nursing: Higher Education Investment

Marion Fellows Excerpts

Wednesday 21st November 2018 Westminster Hall

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Wolverhampton South West (Eleanor Smith) for securing this important debate, to which I have listened with great interest. I will not summarise what everyone said, but cut to my speech, as there are a few other important things I want to say. We have heard questions to the Minister from both sides of the Chamber about the state of nursing and applications to study nursing in England. It seems passing strange to me that the Government have chosen to abolish bursaries at a time when nurses from the EU are leaving NHS England, causing even further shortages. I was particularly struck by the hair-raising stories that the hon. Member for Mitcham and Morden (Siobhain McDonagh) gave us about patient safety and nurse safety—I hope the Minister addresses that.

As has been mentioned, the situation in Scotland is quite different. In case the Minister is not aware, I shall give him some ideas about how we do things in Scotland, to see whether that will help. I do so in a spirit of help, to see whether we can improve things in NHS England. In Scotland, the First Minister has just announced an increase in nursing and midwifery bursaries—the bursary will go up to £10,000 in 2021. That is part of a drive to continue the increase in numbers of student nurses we have had over the past few years. The Scottish Government also have discretionary funds for those nursing and midwifery students who are most in need, and are upping the number of places for students of nursing and midwifery in the academic year 2019-20. We recognise the importance of those nurses.

On a personal note, after what I have been through over the past year, I would not be able to stand here were it not for the support of nurses throughout the entire stage of my late husband’s treatment and the end-of-life care that he received, and I appreciate the opportunity to put on record my thanks to St Andrew’s Hospice in Airdrie, of which I am a patron.

The Scottish Government’s discretionary fund will give more money to mature nursing students—that cause has been mentioned—if we use the word “mature” to apply only to those who have children. Those people need extra support and are given it. As most previous speakers have said, it is important that we attract mature students into nursing, as well as those who come straight from school. From personal experience, I think that mature students bring an extra level of care and understanding that we do not always get right away from young entrants into the profession.

Student nursing and midwifery places in Scotland will increase for the seventh consecutive year, reaching record levels with the intake rising by 7.6% to more than 4,000. Upping intake for the 2019-20 academic year is one of a number of measures to support the sustained recruitment and retention of NHS staff, but it is also important to retain our existing staff. We have heard stories about the pressures that nurses are currently under, and they must be alleviated. In addition to increased student places, almost 460 former nurses and midwives have signed up to retrain through the Return to Practice programme since 2015. The Scottish Government are funding the Open University to deliver a pre-registration programme, which currently supports around 116 nursing students. In October 2016, 10,239 students were in education—an increase from 9,936 the year before—and we will get the 2017 data next month.

I often find myself standing in this place, especially in Westminster Hall, and asking Ministers whether they have looked at the situation in Scotland, because sometimes we are more progressive. Sometimes it is easier, because Scotland has a smaller national health service, but we also value the NHS in Scotland. Earlier this decade, the First Minister announced that, in all hospitals in Scotland apart from those built under private finance initiative contracts, parking charges would be withdrawn. That has been carried out. That simple measure can help nurses, and I urge the Minister most sincerely to consider it, as well as some of the other practices that we have taken on board to increase nursing numbers in Scotland.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies, and I congratulate my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) on securing this important debate. The level of interest from Members shows how important this subject is. My hon. Friend spoke from great personal experience, and I thank her and everyone else who has worked in the NHS for their contribution over many years to make it an institution of which we are all rightly proud.

My hon. Friend comprehensively dismantled the Government’s arguments on the merits of removing the bursary. As she said, it is indisputable that the number of applications and the numbers of people starting courses have fallen, and that the age profile of students has changed. She was right to say that the decision to abolish the bursary was a political choice, and not one that the Labour party would have made. Along with other Members, she highlighted areas that have fewer nurses in community and district hospitals and in settings that treat those with learning disabilities or mental health problems. Given that the pipeline for delivering nurses is not working as it should, those shortages may worsen. My hon. Friend was right to say that higher education is the best way to train enough highly skilled nurses to meet the needs of patients.

[Marion Fellows]

I wonder how many Members are aware that the Select Committee on Education will shortly publish the results of its inquiry into nursing apprenticeships.

[Justin Madders]

I thank the hon. Lady for her public service announcement. Let me now refer to some other contributions.

The hon. Member for Henley (John Howell) made a fair point about how the price of housing exacerbates the shortage of nurses in some areas, and all Members will be aware that earlier this year more than 1,900 nursing vacancies were advertised in the Thames Valley area, although only five were filled.

My hon. Friend the Member for Lewisham East (Janet Daby) gave a thoughtful and persuasive speech that highlighted the fact that the number of applicants over 25 has fallen by 40%, and she mentioned the impact of that in specialist areas. She was right to say that the nature of the nursing degree limits the opportunities for students to earn income outside their course demands.

The hon. Member for Sleaford and North Hykeham (Dr Johnson) made a considered contribution about her criteria for what would make a successful training course, and I will reflect on that good piece of advice.

As always, it was a pleasure to hear from my hon. Friend the Member for Sheffield Central (Paul Blomfield), who has great experience in this area. He referred back to a debate in 2016, and was right to say that this policy has damaged mature students and social mobility. Many concerns that were raised back in 2016—including by Government Members—have been ignored, or indeed come to pass.

The hon. Member for Chelmsford (Vicky Ford) gave us the benefit of the thoughts of nurses in her constituency. It is always a good idea to hear directly from those on the frontline, and she came up with some interesting practical suggestions about what could be done to make the lives of nurses easier. Along with other Members, she mentioned the impact of this policy on the number of mature students applying, and the impact that that has on particular specialisms.

My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) set out why, due to a combination of factors, now is not the time to experiment with a flawed and unproven model. She mentioned the challenge of retention, and related some graphic and moving stories from her constituents. She was right to say that if we do not fix this issue now, we will pay the consequences for decades to come.

Finally, my hon. Friend the Member for Lincoln (Karen Lee) spoke of her own frontline experience, and mentioned the expense and risk of over-reliance on agency staff. No doubt the challenges that we face and have discussed today will be exacerbated, which will place even more reliance on temporary and agency staff.

We have had a broad and wide-ranging debate. This is the Minister’s first outing in his role, and I welcome him to his place and congratulate him on his appointment. I was trying to work out whether he is the fourth or fifth Minister I have shadowed since I was appointed to my role just over three years ago, which shows that it is not just the NHS that has problems with retention.

The NHS faces a significant workforce challenge, and nowhere is that more pronounced than in nursing. England is missing about 42,000 nurses and, according to conservative estimates, without significant intervention that figure may rise to more than 48,000 by 2023. The situation is serious—other Members have described it as a “crisis”, which is absolutely right, but this crisis could have been avoided.

As Members have said, we are facing a perfect storm, with recent trends showing that more nurses are leaving the profession than joining it, the ongoing uncertainty over Brexit, the fact that one in three nurses is due to retire within the decade, and the catastrophic decision to scrap bursaries for nurses, midwives and allied health professionals. According to the Royal College of Nursing,

“without enough nurses, care is fundamentally unsafe, frontline staff are compromised and people seeking access to health and care services are not able to receive the care that they need.”

The RCN also reports that services are sometimes so short-staffed that nursing students are inappropriately used to plug gaps in the workforce and have to look after patients before they are qualified to do so. That is an extremely worrying development.

This is a crisis of the Government’s own making. Before I come on to the current policy context of higher education funding, I will say a little about the circumstances leading to the decision to undertake the reforms back in 2015. As my hon. Friend the Member for Wolverhampton South West said, workforce planning has not traditionally been a great strength of the NHS.

One of the first decisions of the coalition Government back in 2010 was to cut the number of nurse training places at university. In 2010-11, 20,092 places were funded, but that fell sharply to 17,741 in 2011-12 and dropped again to 17,546 in 2012-13. At that stage, David Green, vice-chancellor of the University of Worcester and a former chair of the west midlands group of universities said:

“We are heading straight for a national disaster in two to three years’ time.”

The RCN also warned that the cuts would cause

“serious issues in undersupply for years to come.”

Those warnings were not heeded by the Secretary of State at the time, and a completely predictable and preventable crisis in the nursing workforce was created. Had the coalition Government only maintained the levels set by the last Labour Government, 8,000 additional nurses would have been trained in the last Parliament alone.

In the midst of this completely manufactured crisis, the abolition of undergraduate nurse bursaries was announced. I ask the Minister to consider whether that response to the crisis was the correct move. In just two lines in the 2015 autumn statement, with no consultation and no evidence base, the Government committed themselves to a huge gamble with the future of the NHS workforce and with patient safety. The then Minister described the proposal as

“potentially one of the most exciting things that we will do in the NHS in the next five years to increase opportunity and quality, and the presence of nursing staff on wards.”—[Official Report, 4 May 2016; Vol. 609, c. 196.]

We were told at the time that our many concerns were misguided, and that the changes would lead to an additional 10,000 training places being provided. However, as we have heard, the opposite has happened. As of September 2018, almost 1,800 fewer people are due to start nursing university courses in England. The number of mature students has plummeted by some 15%, which as we have heard has had a particular impact on specialist areas. There has been a 12.9% reduction in the number of mental health nurses since 2010.

As my hon. Friend the Member for Stroud (Dr Drew) said, there has been a shocking 40% reduction in learning disability nurses. Learning disability nursing celebrates its 100th anniversary in 2019. It will be an astonishing failure of the Government’s if they allow it to disappear altogether. That reduction comes at a time when the needs of people with learning disabilities have never been more paramount, with premature mortality resulting from complex health conditions and people being detained in assessment and treatment units for far longer than necessary.

We warned at the time that this policy would have precisely the effect that is has. After meeting representatives from the profession and looking at the evidence, the Government carried on. On the other hand, they did not formally consult the Royal Colleges before announcing their plans. I know that there has been some dialogue since then, and I will be grateful if the Minister will set out his recent discussions with the sector about the impact of the bursary cut and what steps the Government are taking to deal specifically with the crisis in learning disability and mental health nursing, which have been particularly hard-hit by the changes.

As various Members have said, the new Secretary of State recognised the crisis by saying

“simply put: we need more”

nurses, and that:

“That is something we will specifically address in the long-term plan for the NHS”.

That plan is due to be published any time now, and we will examine it very closely. However, if the Secretary of State is serious about tackling the workforce crisis and increasing the nursing workforce, he needs to make a key element of the strategy the reintroduction of NHS bursaries. It remains our policy to do so, and there has not been a single jot of evidence since they were removed to dissuade us from our initial view that their abolition was short-sighted, damaging and, ultimately, self-defeating. In a written answer on 19 April this year, the former Minister indicated that the Department would publish an update on the effect of the plans later this year. Will the Minister advise us of where that is up to?

Although I have referred to a lot of large numbers to highlight the overall impact of the policy, it is important to hear, as we have from some Members, about the impact on individuals. I do not know if the Minister had the opportunity to attend the RCN drop-in earlier today. If he did not, I convey to him how well the students I spoke to conveyed how difficult it is to work what they and I consider to be unsafe hours to make ends meet; how the inclusion of the student loan in income for benefits calculations leaves families worse off; and how the students notice that, each time they return to the lecture theatre, there are fewer and fewer of them. What assessment has the Department made of the attrition rate of university courses since the abolition of the bursary?

In conclusion, the uncertainty created by Brexit means that the reliance on recruitment from the EU that we have seen in recent years is no longer an option to shore up nursing numbers. Our NHS staff cannot keep giving more at the same time as we give them less. The Government need to fund our future and invest in nursing higher education. They simply cannot afford not to.