NHS Bursary

Paul Blomfield Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

The hon. Gentleman has not listened to what I have said, because the whole point about the loan system is that the loans will not kick in until after a student has graduated, so the repayments will not start until that point. Student nurses will not be making any repayments while they are studying and doing those placements, but I absolutely take the point that nursing is a very different proposition from a normal degree in so much as placements take up 37 or 38 hours a week and beyond, which is a considerable strain on nurses.

[Paul Blomfield (Sheffield Central) (Lab)]

The hon. Gentleman cites the example of the introduction of fees for other university students, but does he acknowledge that the impact has been patchy and that the one group that has been significantly discouraged from going into higher education as a result of those fees is mature students? Mature students are particularly well represented among nursing, midwifery and allied professions, which we encourage.

[Paul Scully]

It is beholden on us to explain the system to mature students, because I see no reason why they should be discouraged.

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[Paul Blomfield (Sheffield Central) (Lab)]

I am delighted to follow the hon. Member for Lewes (Maria Caulfield), who made a powerful contribution. Many of the points she made echo those raised by my constituents. She gave a devastating critique of the Government’s proposals. I am grateful to the 154,000 people who signed the petition. That reflects their concern about the Government’s proposals, and we should recognise their contribution. Without them we would not be having this debate in quite this way today. When I last checked, my constituency had the highest number of signatories to the petition. Many have written to me expressing their fears about the impact of withdrawing bursaries for student nurses, midwives and the allied health professions. It is important that we recognise the diversity of professions that are impacted by the Government’s proposals and the different demographics and the different factors that will have an impact.

I am pleased to have the opportunity to press some of my constituents’ concerns on the Government, and I will quote from four. Teri-Lisa Griffiths wrote to me about her mum, who is from a working-class home and was forced to leave school due to family income and family pressures. In her desire for personal development and to be a positive role model for her children, she went to university and trained as a nurse. She said

“attending my mum’s graduation was one of the proudest moments of my life and reinforced my aspirations to attend university and aim for a professional career. The proposed changes leave me dismayed at the potential implications both for the NHS and wider social mobility…With a young family to raise, my mother would never have been able to achieve this without the financial support offered through the NHS bursary.”

Susi Liles is a graduate nurse who did a first degree in sociology. She drew on that experience, saying that

“the work load for the nursing degree is much more than for a normal degree, and there are fewer holidays”.

She also said that

“you couldn’t do other work while training.”

Other Members have made that point. She pointed out that nurses simply do not earn enough money to repay the loan, and we could contest some of the figures that have been given. She said that the bulk of nurses on band 5 would not find it easy to pay rent, run a car, which is usually a necessity for shift work, and meet all the other costs of living while also repaying their loan.

Jessica Gallagher, whose mother has been a nurse for 40 years and who has been qualified herself for two years, works in an acute and emergency setting. She said:

“I truly love my job but as a ‘mature student’, I have no doubt that I would not have completed the course had it not been for the bursary support.”

Ella Williams is a student midwife in her final year. She told me:

“I have struggled financially as it’s not really feasible to have a job as well as do degrees like mine.”

Echoing the point that the hon. Member for Sutton and Cheam (Paul Scully) made in opening the debate, she also said that, unlike other students,

“although you are learning you are then almost free labour. Sometimes it is disheartening to feel you are working as hard as everyone else, but doing it for free and I think that students would feel that even more were they getting no government assistance. I completely love what I do, but…I’m sure it isn’t just me that feels as though I’m headed into a career that is misunderstood and undervalued by the government.”

All those women have two things in common in appealing to me as their Member of Parliament: they are not affected by the changes and they have no personal axe to grind. They are not individually going to lose out. They simply want to share their experience of why taking away the bursaries and introducing tuition fees will damage the NHS and the professions of which they are proud, and they make powerful points. We have already discussed the impact on mature students. They have been disproportionately hit by the introduction of tuition fees and the new regime in higher education as a whole. We know that they are positively disproportionately represented within nursing and in particular within midwifery and allied professions. We also know that they are more likely—my hon. Friend the Member for Walthamstow (Stella Creasy) made this powerful point—to have dependents, and the changed arrangements will hit them in that regard, too. The changes will be a particular barrier to those from lower income families. Nursing and midwifery have been an important route of social mobility for many who have ruled out university because of the cost. The package is attractive and makes stepping up into a profession more achievable.

My constituents and other hon. Members have made the point that student nurses cannot work outside the course. Before I was elected to this place in 2010, I worked at the University of Sheffield, where I was partly involved in negotiating the contract for the university to take over nursing and midwifery training. From my experience working with those students, I know that it simply is not feasible for student nurses to do what other students do in offsetting the cost of their higher education by working while they are studying, because of the intensity of the course, the time spent in clinical practice and the early, late, night and weekend shifts that are a normal part of their studies. I was under the impression that nursing students have to complete a minimum of 2,300 hours in clinical practice, but the hon. Member for Sutton and Cheam said that it was more than that. I will take his advice. None the less, it makes it impractical for them to work as other students do and it is wrong to treat them like other students.

I was unsure about the hon. Gentleman’s numbers on this, but my understanding is that, for a nurse on a band 5 salary, repaying the loan would cost about £900 a year. In practical terms, that is approaching a 5% cut in salary. The Government’s training policy in other sectors is to introduce an apprenticeship levy, and I agree with that, because it says that employers have to take responsibility for training their workforce. That is right. But what are the Government doing when they are the employer? They are saying the reverse: that the employee should take responsibility for training the workforce. They are imposing a 5% cut on nurses to meet the cost of training the NHS workforce. That is wrong.

The Government are stumbling into a potential disaster, not only for the lives of those who will not be able to pursue their dreams of a career in nursing, midwifery or the allied health professions, but for recruitment in the NHS. When I was elected in 2010, I assumed that I would disagree with the Government on a number of issues, and I have not been proved wrong. Nevertheless, I also assumed that, by and large, they would pay attention to evidence when reaching decisions and, on issues as important as this one, listen to that evidence. As has been pointed out already, so far that does not appear to be the case with regard to the serious concerns raised across the professions—those working in and managing the health sector—about the effect of the changes.

If nothing else comes out of this debate, will the Minister at least agree to publish the evidence that the Government considered when they first reached this decision? Most importantly, will he agree to a proper consultation on the full proposals, not just a technical consultation on their implementation? In his opening speech, the hon. Member for Sutton and Cheam said that this debate was positive because the Government had initiated a discussion that would give nurses and midwives the opportunity to shape future funding arrangements. He said that the current system is not good enough, as did the hon. Member for Lewes. They are right: it is not good enough. But why not come up with a better system, rather than a worse one? If the consultation to which the hon. Member for Sutton and Cheam aspires—one that engages with student nurses and midwives to reshape the system—is to mean anything, it must be proper, full and comprehensive. I hope the Minister will commit to that today.

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[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I add my voice to those of other Members who have spoken today to say how much I appreciate the decision of the Petitions Committee to bring the matter to the notice of the House. I thank my hon. Friend the Member for Sutton and Cheam (Paul Scully) for outlining the case as many of the petitioners see it. As both shadow Ministers—the hon. Members for Lewisham East (Heidi Alexander) and for Central Ayrshire (Dr Whitford)—said, we had a high-quality debate, and Members raised a huge range of points in a calm and collected but passionate way. I hope Members will forgive me if I address as many points as I can. I hope to finish before the end of our allotted time, so that people can get away, but I am aware of the number of different points that were raised. I am also aware of the intense public interest in this important issue, which is why I want to make sure that I address every point that was raised—including detailed points.

Many Members, including the hon. Member for Lewisham East, were here for the debate on tuition fees in 2011. It was a searing experience. It is the only time I can think of—the hon. Lady and other Opposition Members will remember this—when protests could be heard by those in the Chamber. We all remember, too, having to leave by secret exits because of the riot outside. It was understandable that, at the time, people were so passionate about the change being made. The hon. Member for Ilford North (Wes Streeting) was a central player in the great debate, and he acquitted himself with honour. He explained in great detail his side of the argument—and that of the National Union of Students—at the time of probably the most controversial change made under the coalition Government. Yet every single one of the claims made at the time—the central claims against the changes—has been proven untrue.

I want to address the core point made in the considered speech of the hon. Member for Sheffield Central (Paul Blomfield)—that the Government should make changes on the back of evidence. My contention is that that is exactly what we are doing. Since the changes made in 2011, there has been an increase in the number of students in every part of the higher education universe. Most importantly, to my mind, there has been a considerable increase in the number coming from disadvantaged backgrounds. That is precisely why, even if it were not for the reasons that I want to come on to about why what we are doing is important for the NHS and for nursing in particular, it is an important change. Nursing students are the only significant group of students not to have been included in the reforms that have so significantly benefited the rest of the university sector.

[Paul Blomfield]

Clearly we could have a lengthy debate—I am sure you would counsel us not to, Mr Evans—on the merits of the student loan system. I was surprised by the Minister’s unequivocal statement a moment ago. Will he agree that one section of the demographic that has been negatively impacted by the introduction of the new student funding regime in 2012 is mature students?

[Ben Gummer]

I will not agree with the hon. Gentleman’s contention. UCAS figures for mature students in 2011, the year of the change, show that there were 42,170 acceptances. That figure dropped in the following year, as did the figures for all students across the university sector. It then went up to roughly the same figure in 2013, and up again in 2014. In 2015 the figure was 48,690, so the number of mature students has increased, and in percentage terms the increase is, I believe, more than that for university students of the normal age. When we consider the core reasons for the change—expanding the opportunity to go to university, through the number of places; increasing quality, which has improved according to a number of metrics; improving student experience, which has also happened in the past few years; and, most importantly for a university system, creating a ladder of opportunity for those born with least—we see that the reforms have delivered by every one of those measures. It is precisely for that reason that, even were it not for the wider issues that the NHS confronts, I would believe what we are doing to be entirely right. It enables us to spread to nurses the same benefits that have been realised in the rest of the student population.

[Paul Blomfield]

I thank the Minister for giving way again. I want to challenge him on those figures, which I guess—I do not have them before me—relate purely to full-time students. If we consider full-time and part-time students, we see unambiguous evidence that the number of mature students has fallen dramatically.

[Ben Gummer]

The numbers do relate to full-time students. I concede that, in the case of part-time students, there have been, for a longer period than the time since 2011, problems in maintaining a rise consistent with that across the population. The Chancellor has accepted that fact, which is why he devoted specific attention and funds in the spending review to supporting part-time mature students. However, in this case we are talking about a nursing degree that is, for the vast majority, a full-time one. For the majority of nurses—I believe the figures are not quite those given by the hon. Member for Central Ayrshire, although I do not have them to hand—their degree is a normal undergraduate degree, taken before maturity. For all those people, I want the same benefits that have been provided across the rest of the university sector. The hon. Member for Sheffield Central was a Member in the previous Parliament, as was the hon. Member for Lewisham East, and they made exactly the same claims then as they do now about a reduction in opportunity, a reduction in number of applicants and a reduction in all the areas where we want universities to perform. I am afraid they have been proved wrong and the Government have been proved right, and that is why it is important that we extend those benefits to nursing.

I will address in terms the process by which we have come to this decision, about which the hon. Member for Ilford North raised some detailed questions, and our intention for the wider reform of training routes into nursing. It is important that hon. Members should see the changes that we are making to university training as part of a wider reform enabling us to increase both numbers and the quality of courses, as well as improving the student experience for nurses entering nurse registration by whatever route. The policy has been worked through in considerable detail in the Department of Health. There has been consultation with leading nursing professionals. The Department of Health is advised by a number of chief nurses. All were consulted and involved in working up policy in this area, which is entirely how it should be.

We have been very open about the fact that we want a full and detailed consultation about how the proposals should be implemented. We want that to be thorough and to involve everyone, whether they oppose or are in favour of the changes, so that we get the detail right. While I will maintain that the overall policy direction is correct for the reasons I have given, it is important to make sure we implement the detail correctly. If we do not get it right, it could have a perverse impact. If we do, this could be an important moment for the nursing profession, because we will be able to do something that previous Governments have not been able to do. Even in the wildest spending realms of the imaginations of some colleagues of the hon. Member for Lewisham East, it would not be possible to commit the resources to expand the training places that the route we have decided on will make possible.

The Opposition must answer a central point when they set out their opposition to the proposal. The fact is that we want to give more training places to people who want to become nurses. Last year, there were 57,000 applicants for 20,000 places. We want to expand the number of places so that people get the chance to become a nurse, but within the current spending envelope—even if we were to increase it more significantly than we propose to over the next five years, and certainly far more significantly than the Opposition propose—it is not possible to do that.

[Ben Gummer]

I agree with the hon. Lady that one key thing we have to do is ensure we have a permanent workforce and do not depend across the service on agency and locum nurses and doctors. However, part of that is ensuring we have the workforce numbers trained to be able to fill places. In the past, we have failed to predict workforce numbers with any accuracy, which is something all Governments are guilty of.

No matter what happened to training places, the changes required across the service because of the impact of Mid Staffs on our understanding of safe staffing ratios has meant an increase in the requirement for nurses. At the moment, in the very short term, that requirement has to be plugged by agency and locum nurses, but we want to replace them with a full-time permanent staff that is sustainable. I hope the Opposition are able to bring an alternative view—I would be interested to hear it—but if we are to increase the number of training places, we have, simply put, to be able to afford to do so. The surest way of expanding places is to repeat exactly what we did for all other university degrees back in 2011, which has seen a massive expansion in training places.

The other point that the hon. Member for Lewisham East and her colleagues must address if they wish to oppose this reform is how they would afford not only the expansion in training places, but the maintenance support for nurses going through training. I completely agree with the hon. Member for Central Ayrshire and my hon. Friend the Member for Lewes (Maria Caulfield): the current bursary funding is not generous. It is certainly not sufficient for many, especially those with caring duties, to maintain themselves, but how can we find the increase while ensuring we expand places at the same time?

Through reforming bursaries, we are ensuring that we can increase the cash amount by 25%—something that, again, could not be funded out of the existing envelope, even though we are increasing NHS spending more than any other major party promised at the last election. We are therefore able to provide the support that people going through nurse training are rightly asking for.

[Paul Blomfield]

The Minister makes great play of the comparison between the reforms introduced in 2012 for other undergraduates and this reform. I admire the way he talks—I say that without any irony—about sharing the benefits of the current scheme with student nurses, midwives and allied professions. I am not quite sure they would describe a £56,000 debt as a benefit. Putting that to one side, does he not recognise the sharp difference between other undergraduates and those studying nursing, midwifery and allied professions in terms of the commitment to clinical placements, the shift patterns and everything else that will prevent them from being able to take employment in order to offset the cost of their education?

[Ben Gummer]

That is the case at the moment. The hon. Gentleman must answer the question of precisely how we increase support for people who are working in clinical learning placements. Converting the bursary regime means that we can increase that support by 25%.

It is easy for the hon. Gentleman to make a play to the gallery about how the reforms might work, but I ask him again to look carefully at the experience of other students and at the 47,000 applicants who are unable to secure a place because of the constriction in places. He is not able to give those people an answer about how we expand places without resources that I imagine he is not willing to commit from his position. The best way of giving those people the opportunity is reforming the education system. I am afraid that it is simply not credible for the Opposition to decry the proposals, which is their right, without providing an alternative of how we might fund the additional places and the maintenance of those who are in position.