NHS Bursary

Mark Durkan Excerpts

Monday 11th January 2016 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to take part in this important debate. I commend the hon. Member for Sutton and Cheam (Paul Scully) for introducing it as a Petitions Committee member. He had the difficult task of framing the wider debate by drawing attention to a number of the background and contextual issues in the way that he felt was fairest and on the broadest issues. Many of us are in-filling the debate with a different emphasis, taking account of some other considerations.

As a Northern Ireland MP, I am conscious that this debate is about the bursary scheme for the NHS in England. Of course, the scheme recruits students from Northern Ireland who are undertaking courses in England, and as a devolved Administration we also have our own variant of the scheme. In previous contributions on this subject, the hon. Member for Ilford North (Wes Streeting) has raised the question of whether there will be an immediate Barnett consequential to this change to the NHS in England. Even when we get the answer from the Treasury, it changes over time. I have served as a devolved Finance Minister, so I know that in one instance the Treasury will tell you that there is no Barnett consequential, but then a year or two later some new thinking will mean that there is and that the vice has been tightened. Its usual rule of thumb is, “We’re the Treasury; we don’t need a reason,” so it can change at will.

Although, as the hon. Member for Belfast East (Gavin Robinson) said earlier in an intervention, the current Health Minister in Northern Ireland has properly set his face against going down the same road as the UK Government on the bursary scheme, the fact is that a significant change such as this has the potential to become the predictable text of future devolved policy. It has a conditioning effect by creating a context, and even when devolved Administrations resist such policy changes it usually adds to their costs, which makes the choice not to make the change harder. There is usually policy opportunity cost elsewhere as well.

We need to ask where the rush to this policy change has come from. Two lines in the autumn statement have heralded a significant change. We are told that a consultation will start this month, so will the Minister tell us how serious, thorough and far-reaching that consultation is going to be? Will it include a comprehensive consideration of all the implications of the change and a proper consultation on all the shortcomings and benefits of the current scheme?

Those of us with concerns are not coming here with a “Little House on the Prairie” picture of how the existing scheme operates. We are not pretending that nursing students and students in the allied health professions currently have a sweet life. They clearly face many serious pressures, but we heard from the hon. Member for Sutton and Cheam that the pressures, difficulties and life costs justify the change. In my view, they justify taking great care with any change. We need to address the problems that exist without creating new problems or compounding the existing ones, for exactly the reasons mentioned by other Members, including the hon. Member for Isle of Wight (Mr Turner), who described the implications of changing to a loan-based system.

We must recognise that the roots of nursing education have historically been very different from those of other education. It is only recently that we have seen the well motivated move to ensure that nursing and the allied health professions are truly recognised as professions of degree standard. The problem is that some people take that to mean that we should treat the bursaries in the same way as any other student loan and that that should be the norm. We know, for the reasons that Members have set out, that it should not. The students in question are not just in training but in service in a real, pertinent and highly pressurised way, which means that they do not have the options for covering their maintenance costs that other people have, and that their time is much more precious. Given their life circumstances, they have responsibilities that students on many other courses do not, so we are not comparing like with like.

Where has the support for the change come from? Has it come from the professional bodies that represent nurses, midwives, physiotherapists, speech and language therapists, occupational therapists, dieticians, radiographers, chiropodists and podiatrists? No, it has not. They have real concerns about the implications of the change for their members and the services they work in. Has it come directly from the employers? Health service employers in Northern Ireland, including in my constituency, constantly talk about workforce problems and the huge pressure to fill places and keep services running. A new radiotherapy unit has opened in a hospital in my constituency, and there will be huge pressure on it to employ and sustain radiologists for the future. Health service employers in Northern Ireland are acutely conscious of the pressures, but none of them has said to me that they believe this change will solve the problem.

The change seems to be sponsored mostly by the Council of Deans of Health, which is responsible for education, because it will perhaps solve a problem for universities. Universities look at their numbers and their funding and ask what the change will do for their economics, given that they have a key role in educating health service professionals. It will solve a problem for them, but not for the services that are meant to be supported or the professions. We must include in the consultation those whose voices have not been listened to and who have not canvassed and pushed for this change. Their voices must be heard, which is why this debate and others like it are so important.

The hon. Member for Sutton and Cheam said that something has to give and that the bursaries need to be changed. At one point, he actually said that one reason why bursaries are not good is that they can be taken away, as though that was an argument against bursaries. It is pretty cheeky to justify a proposal to take bursaries away by saying that we should do it because they can be taken away.

[Paul Scully]

Forgive me, I was talking about the title and the semantics. “Bursary” is a bit of a misnomer when, as had been said, it is more like a salary, albeit an inappropriately low one.

[Mark Durkan]

I take the hon. Gentleman’s point, which resets the context of his comments. I gladly acknowledge that clarification.

Just as we should not presume that bursaries are a given and cannot be taken away, people cannot afford to presume that the assurances about the loans-based policy are a given. The current rate of 9% of earnings over £21,000 can change—we must remember that the registration fees for people in the nursing and midwifery service have been hiked up. The Government’s justification for that significant hike in percentage terms is that they have been raised from a fairly low base. When people hear the argument that some students will not pay much of the loan or the whole loan, many fear that more money will be sought in the future in comparative and relative loan repayments. People cannot rely on the assurances that have been given and some of the other arguments that have been made. I hope the Minister is able to convince us that the consultation will look at all those issues and that they will be answered properly.

--- Later in debate ---

[Ben Gummer]

The hon. Lady probes like an expert, but she should know that there has been a detailed assessment of the impact of the changes as part of the policy development, which is still taking place. When we launch the consultation, the full details of the assessment will be made public as part of the process, so she will be able to see very soon what the changes will mean.

My hon. Friend the Member for Lewes spoke with great eloquence about her own nursing experience. Other hon. Members may not know that she has a master’s degree connected with her nursing work. She certainly knows about the full gamut of the academic discipline of nursing, and I take her views with considerable seriousness. She was right to point out that the change is part of a wider package of reform.

Several hon. Members spoke clearly and, in one case, movingly, about people who want to become nurses but cannot, either because they did not achieve the necessary grades earlier in life to go to university—that was a failing of their education rather than because of an innate inability to be a nurse or to pass the exams—or because they have caring responsibilities. We want both sorts of people to be in nursing, because they care and because of their vocational call to be nurses. At the moment, a significant number of them are working as healthcare assistants and cannot progress to being nurses. They are prevented from doing so unless they leave the workforce, go to university and then come back into the system. Even under the existing arrangements, that makes it impossible for many of them, which is profoundly wrong.

That is why it is a priority for me, as I announced a few weeks ago, to open up an apprenticeship route to enable healthcare assistants to move from a band 3 position in the NHS to an intermediate new position—nursing associate—that is part of a vocational route to full nursing registration. The exciting thing about that is that it will provide a dual training route into nursing. There is the traditional nursing undergraduate route, which will still take three years, and there will be the new route—an apprenticeship—which will open up nursing to a whole new group of applicants who are currently precluded from achieving their dream of going into nursing and who do not even count in the statistics of those refused a place.

In the round, we are doing what I hope many Opposition Members want. I share their wish to see the diversity of the workforce, which is already one of the most diverse in the country, improve still further, and to see opportunity expanded, the quality of training improved and support given to people at university. Conservative Members also want all those things.

I appreciate the sensitive way in which hon. Members on both sides of the Chamber have spoken. I also appreciate that they may disagree with how the Government want to proceed to try to improve nurse training. In the absence of alternative ideas, I believe that our proposals really are the way to expand places, improve diversity, increase opportunity, especially for those from disadvantaged backgrounds, improve quality and provide support for those at university.

[Mark Durkan]

The Minister has criticised colleagues several times during the debate and said that the Government are not hearing alternatives. Will he reframe the consultation so that they can hear alternatives? It is clear that people want to work on a different premise and to a different agenda, with much better outcomes, including achieving the important goal of better equipment that he referred to. Widening the consultation would allow those alternatives to be heard, but the way the consultation is framed at the moment means they will not be heard.

[Ben Gummer]

I would be delighted to hear alternatives, and not just via the medium of the consultation. I would very much like them to be offered within the current spending envelope, but if people wish to offer alternatives outside that envelope, they must explain how much they will cost and how they will be funded. Within that spending envelope, the reforms will allow us to expand the number of places and improve quality, support and opportunity.