NHS Bursaries

Richard Graham Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

I do not agree with the hon. Gentleman, and later in my speech I shall explain why in some detail.

I would like to return to the Migration Advisory Committee report, because it does not make happy reading for Ministers. It goes on to say:

“It seems self-evident to us that the reduction in the number of commissioned training places between 2010 and 2013 across England, Scotland, Wales and Northern Ireland, was a significant contributing factor towards the current national shortage of nurses.”

Finally, there is the crucial sentence that sums up why we are experiencing across-the-board nursing shortages:

“Almost all of these issues relate to, and are caused by, a desire to save money. But this is a choice, not a fixed fact. The Government could invest more resource if it wanted to.”

Those are the words of the Migration Advisory Committee. Hospitals are short of nurses; mental health services are short of nurses—so, too, are care homes, hospices and primary care. We therefore have a big problem. No one in this House disputes that, but no one in this House should be under any illusion as to the cause. The question, when faced with this problem, is this: what is the right thing to do? How best can the Government work with experts to ensure that we are training enough staff and supporting those staff so that they stay motivated and stay working in the NHS?

[Richard Graham (Gloucester) (Con)]

Of course we all agree that there is a significant shortage of nurses, and the hon. Lady is absolutely right to ask what should be done. Does she therefore support the Government’s concept of associate nurses, which I believe will make a huge difference in places like my constituency where we need new nurses of this kind to increase the numbers of home-trained nursing staff?

[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.

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[Ben Gummer]

It is an assertion that is backed up by the evidence of the past five years, and which has received the recommendation of Professor Dame Jessica Corner, the chancellor of the Council of Deans of Health. I can tell the hon. Member for Lewisham East, in answer to her barracking, that Professor Dame Jessica Corner said:

“We recognise that this has been a difficult decision for the government but are pleased that the government has found a way forward. Carefully implemented, this should allow universities in partnership with the NHS to increase the number of training places and also improve day to day financial support for students while they are studying. The plan means that students will have access to more day to day maintenance support through the loans system and recognises that these disciplines are higher cost, science-based subjects.”

Likewise, Universities UK has said:

“We support increasing health professional student numbers and will work with Government and the NHS to secure the sustainable funding system”

that the Government have provided. It is particularly pleased about the impact that this will have on placement training. These are the people who are providing training in our NHS, and they support our proposals because they will release the same kind of innovation that we have seen elsewhere in the university sector.

[Richard Graham]

I want to reinforce a point that the Minister has made. I think—he will know this—the evidence shows that far more people from deprived backgrounds have gone to university since the changes we made five years ago, at a time when Opposition Members were saying that they would have precisely the opposite effect. So the evidence is even more conclusive than my hon. Friend suggests. Can he confirm that the maintenance grants will go up by about 25%, which will help in regard to the specific point being made by Universities UK and the other lady?

[Ben Gummer]

I thank my hon. Friend for that intervention. It brings me neatly on to my next point, which is that the great virtue of these reforms to student finance is that we will be able to increase student finance support—maintenance support—by 25%.

The hon. Member for Lewisham East made some clear and sensible points. She suggested that training as a student nurse was different from being a history undergraduate, because student nurses have less time to take on a second job. There is therefore even more reason to provide better maintenance support for them. However, she has not come to tell the House that she will provide 25% additional maintenance support for students who do not have time to do a second job. She has not made that commitment, yet she has criticised our efforts to increase maintenance support by 25% precisely to help those people who would not otherwise be able to take time out to take on a university course. She cannot have it both ways. She cannot criticise us for the reforms we are undertaking while at the same time saying that students need greater support. It is precisely through these reforms that we are producing the support that so many students require.

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[Ben Gummer]

I will make some progress now, if the hon. Lady does not mind.

We are introducing a new nursing associate grade. This will present an extraordinary opportunity to eradicate one of the great unfairnesses in the NHS, which is that there are brilliant people working as healthcare assistants who are unable to become registered nurses because they were let down by the schools they went to. I am afraid that this is a consequence of the failure of school reform under the previous Government. Under previous Governments, people were failed to the extent that they have not been given the opportunities that they deserve.

We are going to reverse that situation by providing an apprenticeship ladder to a nursing associate role, and from there to a registered nursing position. A degree apprenticeship will be available to those who are able and competent to reach that grade. That will provide a route of opportunity that was not available under the previous Labour Government. It is being brought in by this Conservative Government—a one nation party for all.

By bringing in these reforms, creating a nursing associate role and creating 100,000 apprentices in the NHS, many of whom will be healthcare assistants working their way towards a nursing associate position and from there to a registered nursing grade, we will give people multiple opportunities to become nurses. That will include those who are already in the service and who want to earn while they are learning. It will take them between four and a half and six years to get to a registered nursing position from a healthcare assistant role. It will also include those who are able to take time out and do a degree to become a registered nurse, for whom we will provide additional support in the form of increased maintenance grants. Opposition Members are shaking their heads, but at what, I do not know. Are they shaking their heads at the 100,000 NHS apprentices that we are creating? Are they shaking their heads at the nursing associate roles? Are they shaking their heads at the increased maintenance support? None of those issues was addressed in the speech of the hon. Member for Lewisham East.

[Richard Graham]

Will the Minister give way?

[Ben Gummer]

I hope that my hon. Friend will not mind if I just conclude my remarks, because I know that Members from across the House want to contribute to the debate.

In my remaining minutes, I want to state why the reform is important not only for the individuals who want to become nurses, and not just for social equality and opportunity, but for the NHS. The NHS is unable to innovate like other parts of our public sector and our private sector because of the long lead times for training people. We do not have the instruments within the NHS to reflect the dramatic changes in demography and technology that change the NHS not year by year, but month by month. The great benefit of bringing in apprenticeship routes and nursing associate roles, of diversifying the skill mix and of creating quicker, more numerous routes into the nursing profession is that we can create a more diverse, flexible and agile trained workforce.

All that will be possible as a result of the changes, of which this bursary reform is part. None of it would have been possible with the reduction in funding promised by the Labour party, or a failure to wish reform upon the system. That is why I hope the House will reject the motion, which is full of suggestions and implications rather than firm plans. It says nothing about the future of the people on whom the NHS depends, and does nothing to suggest how we will increase numbers, provide additional maintenance support or, most importantly, provide opportunities for those who have not yet had any. We will do that by reforming the system, just as we did in 2010. We will ensure that we do not listen to the well-intentioned but erroneous voices of the Labour party. Had we listened to them back in 2010, tens of thousands of people would have been denied an opportunity. We are determined not to do that. We will be the party of opportunity, presenting it to people who want to be nurses or hold any other position in the NHS. This NHS will be truly national only if it provides opportunity to the many, not the few.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I must declare an interest due to my work in the NHS and having had the privilege of a grant when training to be a doctor.

The NHS is one of our most esteemed public services, but there is a long-standing shortage of qualified healthcare professionals. While the current bursary system for nursing and allied healthcare students in England may not be without issue, the UK Government’s proposed changes are concerning, as is the manner in which they have been presented, with detailed consideration of the impact somewhat lacking.

As we have heard, the UK Government have proposed changes to the current NHS bursary system. Instead, healthcare students will be required to pay tuition fees and will be subject to the same standard loans-based system to which other students in England are subjected. The UK Government have indicated that they expect the reforms to create up to 10,000 additional nursing and health professional training places over the course of the current parliament. However, that appears to be narrow-sighted. The proposed move to a system that relies on students funding themselves by taking on significant debts has raised substantial concerns among unions, professional bodies and students. One of the key fears is that such a move could be a barrier that deters prospective students from entering the profession. I stand here as the first doctor in my family, and I have to say that I would not have considered applying if it had meant racking up debt. I am particularly concerned about access to doctorate courses and postgraduate requirements. Will we create an elite workforce based not on ability, but on means?

Unison estimates that a student undertaking a three-year, 30-week course outside London under the new scheme will graduate with a debt of at least £51,600, plus interest and any overdraft and commercial debt.

[Richard Graham]

The hon. Lady’s achievement as the first doctor in her family is to be applauded by us all, but does she recognise that there are many people who do not think that university is for them? The two-year apprenticeship course offered by the new nursing associate route will provide them with a real opportunity to get into the NHS and maybe to go on to become a full nurse later on.

[Dr Cameron]

I want to see a widening of access to training schemes in the NHS, and I would hope that that would be properly funded and that we do not rely on NHS staff doing other jobs while dealing with the stress of training. We should invest in and fund them properly, letting them know that NHS staff are invaluable.

For many, loans may be higher due to the additional costs of longer courses or of courses within London. As I said, I am particularly concerned about postgraduate courses and doctorate trainees, who may not be able to afford further loans that will add to their debt. It is likely that debt could be considerably higher for the majority of healthcare students. It is naive to think that larger loans will not be a psychological deterrent, especially to those from poorer or non-university backgrounds or to mature students and career changers, who may have additional financial responsibilities or debts from first degrees or family life.

The demographic of students on nursing, midwifery and allied health professions courses tends to be different from other student populations, as we have heard. They are more likely to be women, from black and minority ethnic backgrounds, parents or mature students. It is therefore likely, and a real concern, that abolishing bursaries will reduce diversity, foster inequalities and discourage potentially high-quality applicants.

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[Jeff Smith (Manchester, Withington) (Lab)]

It is a great pleasure to follow the hon. Member for Totnes (Dr Wollaston), as I have a lot of respect for her. Indeed, she commands respect across the House, and it is important that we listen to her views. It is also important that we listen to the views of others, including those of her colleague the hon. Member for Lewes (Maria Caulfield), who said:

“Speaking as a nurse, I would struggle to undertake my nurse training given the proposed changes to the bursary scheme.”—[Official Report, 5 January 2016; Vol. 604, c. 15.]

Clearly, the changes have not been thought through.

As a south Manchester MP, I am very proud to represent a large number of Manchester University students, including many of our nurses and midwives of the future. Indeed, the School of Nursing, Midwifery and Social Work at the university was the first institution in England to offer a nursing course, and it remains one of the top 10 universities in the world to study that same degree today. For the 2,000 students currently studying there, as well as for those weighing up their future with healthcare education in mind, the proposals on student bursaries will do nothing to instil any confidence that the Government understand the perspective of student nurses or potential student nurses.

I want to use my brief remarks to raise two main points. The first is the disappointing lack of consultation with organisations such as the Royal College of Nursing, and the second is the effect that this policy will have on potential students and patient care. Ensuring that access to these professions remains fair, that their funding is sustainable and that the Government consult experts from the sector are vital factors in securing the interests and the confidence of future healthcare professionals. Those roles are the lifeblood of our national health service, and we all have a stake in their future.

One big concern that we have consistently raised is the Government’s reluctance to engage with stakeholders. We have heard from charities, representative organisations, and think-tanks that the evidence base for these proposals is at best uncertain, and at worst non-existent. The very real fear is that the proposals will reduce the numbers of people entering nursing studies. Even the 12-week consultation that the Minister was lauding earlier takes the form of a technical questionnaire on the implementation of the proposals rather than a real consultation on the substantive policy.

[Richard Graham]

On consultation with stakeholders and so on, does the hon. Gentleman agree that when a hospital such as the Gloucestershire Royal shows strong support for the concept of nursing associates and wants to run a pilot project for them, we have to assume that it sees real value in those associates in terms of providing good nursing for its patients and my constituents, and that that must be as telling as anything in a formal consultation?

[Jeff Smith]

I thank the hon. Gentleman for his intervention. Parliamentary questions have shown that the Department of Health failed to consult the Royal College of Midwives, the Royal College of Nursing and Unison before the policy was announced in the autumn statement last year. It is not just the Labour party that is worried about this, but the Royal College of Midwives, the Royal College of Nursing, the College of Podiatry, the Royal College of Speech and Language Therapists and the NHS Pay Review Body, as well as Members across the House. It is little surprise, then, that the result fails to understand the unique characteristics of the sector and the hard-working professionals that work in it. This is a process that has been driven by short-term financial savings at the cost of tackling the big questions of how we adequately fund our NHS for the decades to come.

What about the effect of this policy on the nurses and midwives of the future? At the centre of any policy on healthcare education must be the students themselves. In this case, they are diverse: older than most—the average age is 28—and overwhelmingly female. There are greater numbers from black and minority ethnic backgrounds. We should not forget that completing a degree necessitates 2,300 hours of clinical practice over three years. Any legislation that we need to design to encourage students in the future and to guarantee high-quality care for patients must recognise those types of people. They are people like Katie, a nurse in my constituency, who wrote to me about her concerns about the prospect of debt. She said:

“It is particularly worrying for mature students, many of whom have dependants, and it could deter them from joining the profession altogether. I can relate to this as three of my close colleagues are mature students and have stated on multiple occasions that, without the bursary, nursing school would not have been an option. Student nurses are not like other students: 50% of their time is spent on unpaid clinical placements in hospitals and in the community and there are simply not the same opportunities for part-time work as other students. I could not have completed this course without the bursary. Studying nursing requires participation in extra-curricular activities. This is in line with a recent national initiative: revalidation…Therefore, finding time for part-time work becomes very difficult, and many of my friends have been turned away from part-time jobs as our weekly schedules, working shifts and time for completing university work are often sporadic. The bursary covers my rent and without that I would not be able to support myself and nor would my family.”

We need to take such views on board when looking at a new policy.