NHS Bursaries

Nicholas Dakin Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

I am grateful to the hon. Gentleman for his intervention. The key question we need answered with regard to nursing associates is whether the Government intend them to replace registered nurses. If that is the case, I fear the proposals would be bad for patient care.

Madam Deputy Speaker, you might think a sensible approach to trying to resolve this problem would be to sit down with the Royal College of Nursing, other trade unions, universities and healthcare providers to work out a way forward. But no, this Government seem incapable of that. Instead, in just two lines in the Chancellor’s autumn statement, they announced that they would be scrapping NHS bursaries and asking student nurses to pay tuition fees. The Minister will argue that this will allow universities to train more students, but his problem is this.

[Nic Dakin (Scunthorpe) (Lab)]

Does my hon. Friend agree that the Government should listen to the Royal College, which said that these proposals were “high risk”, potentially

“deterring prospective students from entering the nursing profession”,

and that they risked “worsening the nursing shortage”?

[Heidi Alexander]

I entirely agree with my hon. Friend. I think the Government’s problem is this: they have failed to back up their claim with any evidence and they are now faced with a breadth of opposition to this proposal, not just from Members but from the Royal College of Nursing, the Royal College of Midwives and Unison, while organisations such as MillionPlus, the association for modern universities, are also questioning the assumptions on which the Government base this policy.

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[Ben Gummer]

By reforming the system so that this becomes a loan rather than a grant, we are able to produce 25% extra support for these students while they are training, much as with the rest of the student population.

The results relating to newly qualified nurses are not as the hon. Member for Lewisham East suggests. She should be very clear in the way she addresses this question, because all of us, whatever our views on this subject, have a duty to inform the public properly. It would be remiss of all of us, even those who disagree with the policy as she does, to mislead potential students into thinking that they will have to pay more than they would otherwise. She said that students would have to pay hundreds of pounds more in repayments once they had qualified. That is just not the case. We anticipate that a newly qualified nurse will pay roughly £90 a year more; that will be about the same as they are currently paying, because of the way in which student payment finance is gradated. The impact on newly qualified nurses will therefore not be anywhere near the impact that she has suggested. She should be very careful about how she addresses her points; otherwise, people could receive an impression about these loans that is not actually a fact.

[Nic Dakin]

What calculation has the Minister made of how much of the loan will not be paid back over a period of time? Can we have that information in the public domain as well?

[Ben Gummer]

The economic impact assessment is part of the consultation, and the hon. Gentleman should consult that. It will obviously depend on the way in which the student workforce develops over the next 20 or 30 years, but this has been fully costed within the Treasury’s assumptions, and we anticipate that people working beneath the current limits will not be paying back more than they are doing at the moment. That is in the nature of the way in which student finance repayments are calculated. These measures will not land newly qualified nurses with new payments that they might otherwise not have expected.

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[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the thoughtful contribution by the hon. Member for South West Wiltshire (Dr Murrison), who draws attention to the whole issue of workforce planning, which is clearly very challenging for those who are doing it—or not doing it.

The recent inspection of North Lincolnshire and Goole Hospitals NHS Foundation Trust exposed issues of real concern about staffing levels at Scunthorpe general hospital. The challenge of attracting, securing and retaining sufficient nurses and other medical staff has been a constant theme in my conversations with the trust since 2010. In that respect, Scunthorpe hospital is no different from many others around the country. The more I have got involved, the more I have thought that locally designed solutions have a role to play. Having talked to Health Education England, it is disappointing that it cannot do more to support healthcare assistants, for instance, in growing into nurses on the local patch, because they are clearly a potential resource.

There are lots of issues about recruitment, training and retention, as the right hon. Member for Hitchin and Harpenden (Mr Lilley) said, and about how, if we lose 3,000 nurses a year, as the hon. Member for Morecambe and Lunesdale (David Morris) said, we try to keep them. That is a big issue, as well as how we recruit and retain them.

[David Morris]

Just to clarify that, we are not losing 3,000 nurses a year—we are losing 3,000 applicants to be nurses a year.

[Nic Dakin]

I thank the hon. Gentleman, but many nurses are being lost to the system as well, as his comments clearly highlighted.

In Scunthorpe, as in other areas, we are having to recruit from Spain, Portugal and elsewhere in the world. Although that is helping and supporting us, it has impacts, as we have heard, on those areas of the globe from where those nurses are being recruited.

I would like to quote the words of a young student nurse—a constituent—because in some ways they capture the comments that people from around the country are making to us. Katie-May Taylor says:

“I’m a first year student nurse and when I start placement (for 3 months), I will just about be able to cover my travel on top of my rent and food. When you see the hours we have to complete and having a fraction of the summer holidays other students get, you have to understand why the proposed cuts to the bursary and overall funding to the NHS isn’t beneficial.

I appreciate that to other students, getting a monthly bursary must seem like a luxury, however every penny I get goes towards my rent—it’s not just pocket money.

We’re seeing reports that parents are already telling their children not to go into the nursing profession and future nurses are being scared out of applying for university. This is deeply saddening; it’s such a wonderful course to be a part of and our nurses are absolutely vital in the care of society’s health and the maintenance of OUR NHS.

If the bursary is scrapped, a lot of student nurses will end up working 70 plus hours a week (placement, study time, job/s). Is a student nurse working that many hours a week safe patient care?”

Those words capture very effectively the concerns that we have.

The Government are taking a huge gamble with the future of the NHS workforce and patient safety. There is already a shortage of nurses in the NHS, and scrapping bursaries risks making the recruitment and retention of staff even harder. Student nurses are not like other students: they are required to work in clinical practice throughout their degrees, and they deserve to be treated differently. The hon. Member for South West Wiltshire was right to say that it is worth looking at how much they are an intrinsic part of the NHS, and if they are, that must be recognised within the consultation so that they are given credit and remunerated effectively for it. My hon. Friend the Member for Ilford North (Wes Streeting) rightly emphasised the unique position of student nurses.

The longer courses and clinical placements make it harder for NHS students to get part-time jobs to supplement their income. NHS students are much more likely to be women, more likely to come from black and minority ethnic backgrounds, and more likely to be mature students. Many nursing students have already completed one degree and turned to nursing in their late 20s or early 30s. The average age of a student nurse is 28. Many student nurses have family or caring commitments. MillionPlus has pointed out that the changes to the higher education funding system in 2012 have been much less favourably received by mature students and part-time students. Those two groups make up a much greater proportion of the nursing, midwifery and allied health student body, so it is worth looking at that part of the evidence as well.

Analysis by London Economics estimates that the switch to loans will have a significant negative impact of minus 5% on participation, at least initially, especially if one bears in mind the composition of the student health cohort. The Government’s insistence that undergraduate and postgraduate loans will be repaid at the same time will require a repayment rate of 15% above the earnings threshold for those students accessing both undergraduate and postgraduate loans. That will be in addition to any tax, national insurance and pension contributions that will be due.

The savings to the taxpayer are questionable. The Minister was not clear about that when I pressed him on it during his opening remarks. The Department of Health estimate that taxpayers will be better off as a result of the switch is very much a short-term calculation. In fact, it is much less likely that these students will repay their loans as graduates in the 30-year repayment period than the general higher education cohort. Essentially this is a switch in responsibility for the funding of the education of the health workforce from the state to the workforce itself, and it is primarily designed to reduce the departmental budget of the Department of Health.

We need to know more about what estimate the Government have made of the percentage of second degree student loans that will be written off after a 30-year period. We need the Department of Health to provide an estimate of by how much the taxpayer will be better off. We need those figures.

All the key stakeholders have expressed concern, including the Royal College of Midwives, the Royal College of Nursing, the College of Podiatry and the Royal College of Speech and Language Therapists. Even the NHS Pay Review Body has said 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 in the early years.”

Those who are closest to what is going on are all concerned.

The Minister for Community and Social Care is a very good and thoughtful Minister, and I am sure that he is concerned about the issue. I hope that he will listen to and engage with all those bodies, which know what they are talking about. They are not making it up—their concerns are real and genuine. The Royal College of Nursing is calling on the Government to work with all stakeholders to create a model of student funding that encourages people to join the profession and that recognises the unique aspects of nursing degree courses.

I hope that the Government will take this opportunity to engage with the strong initiative proposed by the shadow Health Secretary and work together to come up with a solution that will allow us not only to recruit professionals, but to retain them into the future. As the son of a nurse and the father of a speech and language therapist, I hope that the Government are listening.

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[Alistair Burt]

If the hon. Lady had been here for the entire debate, she would have heard people speak about the problems of hardship following bursaries; that was referred to by the hon. Member for Ilford North (Wes Streeting) and by Government Members. People want access to more funds, which might help those whom the hon. Lady just mentioned, but the assumption is that, because it will be a student loan and because it is a change, people just will not want to do the courses. There is no evidence to suggest that that is correct. Using it as a scare story is unhelpful for the recruitment that we want.

[Nic Dakin]

Does the Minister accept that the royal colleges and others are genuinely anxious about the proposals? If he does, will he commit to engaging with them as fully as possible?

[Alistair Burt]

That is a good question. Yes, of course. At a time of change, there is a degree of uncertainty. My main point is about how the matter has been blown up yet again, as it was for student loans originally. The idea that people would be deterred from ever going to university, and that no one would go from disadvantaged backgrounds, has been proved false. Of course, the concerns are very much being addressed by the consultation that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich, is undertaking, and he is listening extremely carefully. The consultation process is very wide and genuine, and he is listening particularly to ideas on alterations and proposals. The consultations are not complete and the scheme is not complete, and he is keeping a close ear on those consultations.

There is recognition that there are different characteristics for those who go into nursing, midwifery and allied health professions, which is why we want to make sure that appropriate support is available. Department for Business, Innovation and Skills student support regulations give more support than the bursary; the Secretary of State retains the power to give discretionary funding in exceptional cases; and in the consultation, respondents can give examples of unique characteristics, so that the reforms can reflect that. Our position recognises that, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said, more of the same will not do the job. The need for change is there. We need more nurses, and we need more nurses domestically trained. We are going to do something different, recognising what changes there might be. That is why we have the consultation. Unique characteristics will be reflected in it; that is what the consultation is about. Keeping the current system is not working and will not work in the future. That is why we need change.