Healthcare Students: Pay and Financial Support

Paul Blomfield Excerpts

Monday 20th November 2023 Westminster Hall

[Marsha De Cordova (Battersea) (Lab)]

I beg to move,

That this House has considered e-petitions 610557, 616557 and 619609, relating to pay and financial support for healthcare students.

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the petitioners, Victoria, Charlotte and Jacorine, on starting the petitions, which were signed by more than 36,000 people. I thank all the organisations that prepared briefings ahead of the debate, including the Royal College of Nursing, the Royal College of Midwives and the National Union of Students, and I thank the Petitions Committee for its work.

Today’s debate is timely, as many of our constituents have been impacted by the cost of living crisis in multiple ways, but the impact on students and the unique challenges they face are rarely acknowledged. The president of Universities UK, Professor Steve West, stated:

“Students risk becoming the forgotten group in the cost of living crisis.”

Academic and workplace commitments leave little room for students to earn outside their studies, so it is inevitable that cost of living pressures will hit them hardest. Those pressures are more pronounced for those studying healthcare subjects, as many are mature students and may have to balance parenting duties with course commitments, not to mention the extra costs they face supporting their children.

Healthcare students who responded to the Petitions Committee’s survey ahead of the debate said that they were struggling with the cost of living, with 58% saying that it was difficult or very difficult to afford energy, including gas and electricity. Nineteen per cent said that they had visited a food bank, and 26% said that they were considering using one. Further adding to the pressure, healthcare students are required to complete thousands of hours of unpaid clinical placements over their course programme. One student nurse said:

“I wanted to leave my course this year when I was working on placement and not able to afford food. I was so hungry, and my energy was so depleted that it was affecting my work. I was struggling so much financially that the staff resorted to giving me toilet rolls, sanitary products and even paying for some food for me.”

As healthcare students are not paid or classed as workers, they often lose out on additional support or entitlements, such as the 30 hours of free childcare available to working parents. Many said that they were under considerable financial strain and found their workload difficult to manage, as they were juggling childcare, their unpaid nursing placements, study, and a second, paid job. Worryingly, many said that they were considering leaving their course due to financial pressures related to childcare costs, with 93% strongly agreeing that healthcare students should be eligible for free childcare. In the words of one student:

“I am working just as hard as I was when was employed by my local police force 12 months ago and yet, as I am now considered a student and not a worker, I can no longer claim the 30 hours free childcare for my 3-year-old. There are shortages of many NHS staff so I can’t understand why the government does not make it easier for parents to study for these roles.”

It is a fact that England has the least generous financial support for healthcare students.

[Paul Blomfield (Sheffield Central) (Lab)]

I regret that I cannot stay for the whole debate, but, as chair of the all-party parliamentary group for students, I wanted to make a contribution. My hon. Friend refers to a debate that we had seven years ago, I think, when I recall the then Minister, Ben Gummer, told us that he was keen to share the benefits of the undergraduate student funding system with healthcare students, including nurses and midwives, who had previously benefited from the bursaries, and was anticipating that that would lead to better support and an expansion of the number of people coming into the service.

Does my hon. Friend recognise that those of us who argued at that stage that the changes would lead in the other direction have been validated by experience? Does she agree that we have seen more potential nurses and midwives, particularly mature ones, no longer entering the profession? Also, is she concerned—I hope that the Minister will respond to this point—about the UCAS figures for this year, which show a 16% decline in the number of people applying for healthcare courses?

[Marsha De Cordova]

My hon. Friend makes an important point, which I will come to shortly, and he is absolutely right. It is clear that the changes to the bursary scheme have led to a fall in the number of students taking up these much-needed roles.

Since the removal of the bursary scheme, students studying nursing, midwifery and allied health professional courses in England are only eligible for the standard student finance package of tuition fee and maintenance loans, whereas students in Wales, Scotland and Northern Ireland who are eligible enjoy fully funded education.

I am sure that, in responding to the points made by my hon. Friend the Member for Sheffield Central (Paul Blomfield), the Minister will point out that since 2020, students eligible for the standard student support package receive an additional £5,000 training grant through the NHS learning support fund, that there are additional grants for some qualifying students and that the Government have increased travel and accommodation support. But that simply is not enough. Eighty per cent of student midwives in England who took part in the Royal College of Midwives survey said that they would be taking on additional debt over and above the loans available to students. Moreover, nearly three quarters of student midwives in England said that they expect to graduate with debts of more than £40,000. I am sure that my hon. Friend agrees that that cannot be acceptable.

Government-imposed barriers are making healthcare studies unaffordable for many students. In the first year after the changes to the bursary model, the number of applicants from England for nursing courses fell by 23%. My hon. Friend highlighted the latest UCAS figures, which showed that this year there has been another fall in the number of people applying.

Why does this all matter? I will make two key points today. The first is that it is a matter of fairness and equity. Healthcare students make a significant contribution and play a vital role in delivering high-quality healthcare. Many of those on placements are often required to cover the responsibilities of qualified healthcare workers, due to the workforce shortages.

The Government must look at increasing financial support for healthcare students, and I hope the Minister will address that point. They could do so by creating a scheme to offset or write off debt run up by healthcare students through tuition fees if they commit to working in the NHS for a period of time. That would be similar to the scheme in Wales, which I am fairly certain is working. They should also ensure that higher education funding models are complemented by a financial package for students, to make sure that grants reflect the true cost of living, as they do in Scotland, which has the most generous living cost support. The Government should also extend the 30 hours of free childcare to those on placements.

I would welcome it if the Minister addressed those points in his response. To adequately address fairness and equity, the Government must also focus on intersectionality by looking at the age and sex of healthcare students, as many tend to be women and/or mature students, who are more likely to have dependants.

The second point I want to touch on is the workforce crisis in the NHS, which is so severe that it is undermining the NHS’s capacity to properly deliver its services—we all know it is on its knees. The long-term workforce plan produced by NHS England suggested that the system is operating with over 150,000 fewer staff than it needs. According to the Royal College of Nursing, there are 43,000 vacant registered nursing posts in the NHS in England alone.

Like my hon. Friend the Member for Sheffield Central, the general secretary of Unison, Christina McAnea, rightly predicted the damage that the Government’s reforms would do were they to get rid of the bursary scheme. She said:

“They seem not to care that in a few years’ time”—

that is now—

“the NHS will be seriously short of nurses and there will be too few new recruits coming through to fill the gaps”.

Seven years later, we can all attest to that being the truth.

The NHS, our greatest institution, was established 75 years ago by a Labour Government, and it is experiencing some of the most severe pressures in its history. Waiting lists are at an all-time high. Ministers point to the impact of the pandemic, but waiting lists were already too high before the pandemic. If we want to make sure our NHS survives another 75 years, the Government must make progress on the workforce challenges. They need to look at all options and think bigger to incentivise more people to take up healthcare professions. Restoring some sort of financial support package may do that. They must fundamentally rethink the way they approach their support for healthcare students, including by making extra funding available for healthcare education and training.

We owe it to our healthcare students to ensure that they have adequate financial support as they provide the care that keeps us all healthy, and to protect the long-term interests of our country by having a workforce that can truly deliver all the services that the national health service provides.

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I welcome the Minister to his latest position on the Government Front Bench. I hope he enjoys what remaining time the Conservatives have in government in the Department of Health and Social Care. I wish him all the best over the next few months.

I am grateful for the opportunity to respond to the debate on behalf of the shadow Health and Social Care team. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for her powerful speech, and my hon. Friend the Member for Sheffield Central (Paul Blomfield) for his wise contribution. I also thank the Petitions Committee for its work in preparation for the debate.

Being a student nurse during the cost of living crisis is tough. We know that valuing our NHS workforce through fair pay and conditions is crucial to tackling vacancies, yet according to the RCN’s 2023 summer survey, almost nine in 10 student midwives in England—89%—worry about the amount of debt they are in, and 74% of them expect to graduate with debts of more than £40,000.

[Paul Blomfield]

My hon. Friend is making a very important point, and I am sure that he will come on to say that the experience of midwives also applies to nurses and others on healthcare courses. The report by the APPG for students, which I mentioned a moment ago, highlighted the way in which the student funding model was broken, not least by pointing out that, according to Save the Student, the average loan now falls short of living costs by £439 every month. Most students are dealing with that by taking on ever-increasing amounts of paid employment, which is raising some concerns. One Russell Group university told us that a significant number of its students work more than 35 hours a week. Does my hon. Friend agree that that option is not available to most nurses, midwives and other healthcare students on similar courses, because of the structure of their courses? The Government are failing to address that issue.

[Andrew Gwynne]

My hon. Friend hits the nail on the head. We are talking about student nurses and student midwives, who do not have any spare time to dedicate to other forms of paid employment: it is physically and mentally impossible for them to do so. There needs to be greater recognition of the unique nature of these kinds of students. Many students—including me, many years ago—rely on extra support to make ends meet, but people studying in the caring professions, including nursing and midwifery, do not have that same ability. That was one reason why there was always additional support for those groups of people.

Fifty-eight per cent of respondents to the survey conducted by the Petitions Committee for this debate said that it was difficult or very difficult to afford energy, including gas and electricity, 19% said they had visited a food bank, and 26% said they were considering using one. That is a national scandal—a cost of living scandal that is having a devastating impact on our ability to recruit and retain staff in the national health service. Over nine in 10 student midwives in England—91%—know someone who dropped out of their midwifery studies because of financial problems.

The Conservative Government abolished NHS bursaries for student nurses, midwives and allied health professionals back in 2017. Students undertaking their degree since then have had to pay to train to work in the NHS. As a result, not surprisingly, the number of applications to study nursing in England fell, with applications down by almost 30% by 2019. It is not rocket science to work out what caused that. Labour said at the time that the decision to remove the NHS bursary was the wrong one, and the Public Accounts Committee, in its September 2020 report, agreed that the decision

“failed to achieve its ambition to increase nursing student numbers.”

That is just another example of a Government who have time and again failed to plan for the long term.

In this NHS workforce crisis, we have deteriorated to the point where we now have over 100,000 vacancies, including 40,100 nursing vacancies. We have waited so long for the NHS workforce plan, and now we finally have it. Labour has been calling for a workforce plan for years, and I am glad that the Government pinched the plan of my hon. Friend the Member for Ilford North (Wes Streeting). Since its publication, though, not much has happened. It makes clear the scale of the neglect—a wasted decade of drift and inaction, impacting not only on staff but on trainees.

Placements are an important part of nursing and healthcare courses. They provide the vital supervised training that allows students to gain the necessary skills and experience to meet education outcomes and work in clinical settings. Labour knows the value of placements, which is why increasing them is an important part of our plan to expand the NHS workforce. We will focus on ensuring we have the roles, trainees and senior professionals needed to tackle the challenges we face and seize opportunities, drawing on a diverse range of skills and inspiring people around the country to pursue a career in the NHS and caring professions. We will also work with health staff and their trade unions to review existing training pathways and explore new entry routes to a career in the NHS, including high-quality apprenticeships.

The childcare sector is under huge strain. While some healthcare students may be eligible for parental support from the NHS learning support fund of £2,000 a year, that is dwarfed by the ever-increasing cost of childcare. It leaves many studying parents vulnerable to childcare costs, particularly considering the hours needed to fulfil placement requirements. It has been reported by openDemocracy that some nursing students considered leaving their courses because of financial pressures related directly to childcare costs. That is, sadly, a trend across our economy. The cost of childcare is pricing parents, especially women, out of the professions they love.

Does the Minister agree that adequate support for a profession as critical as nursing or midwifery should not depend on where a person studies but should be the same across the board? What assessment has he made of support at all stages of training for studying parents, in order to build an effective and inclusive workforce in our NHS? The 11,000 people who signed the petition will be looking for a response from the Government, so does the Minister regret the decision to abolish NHS bursaries? What additional support can healthcare students expect, given the current cost of living crisis?

Two in five student nurses and three in five student midwives said that they considered leaving their course last year, so we must take this seriously, especially given the threat to the future of the NHS workforce that it poses. Already students have cited the placement experience and lack of support as major factors in their leaving their course. The Conservative-made crisis in the NHS only makes this worse. We might have expected in this month’s King’s Speech to hear of something to deal with the worst NHS crisis in its history, but there was virtually nothing.

The energy price cap has increased by half this Parliament, the cost of living crisis is hammering healthcare students, and we have a flagship energy Bill that

“wouldn’t necessarily bring energy bills down”.

Whether we are talking about the NHS or the cost of living crisis, this Conservative Government look like they have thrown in the towel. They are divided, weak, out of ideas and out of time. Every day that goes on, it is British people, our public services and our patients who pay the price. For Labour’s part, we know that our healthcare staff are our national health service’s most valuable asset, and we know how vital it is to ensure that there is a pipeline of future talent coming through. That is why the next Labour Government will put their workforce plan at the heart of their plans to restore, renew and rejuvenate our national health service.