NHS Bursaries

Wes Streeting Excerpts

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

I accept that there are differences—I will come to them in a second—but implied in the hon. Lady’s point is an acceptance that she was wrong in 2010, and she should therefore be more measured in her proposals, or lack of them.

[Wes Streeting (Ilford North) (Lab)]

It has not all been plain sailing since the reforms, not least as regards the impact on applications from mature students, who make up a significant proportion of the nursing cohort. Does the Minister not accept that there is no proposal in the consultation on how to mitigate the risk to good recruits from mature student backgrounds, who make up a significant proportion of the nursing workforce?

[Ben Gummer]

I am afraid that the hon. Gentleman is wrong on both points: more mature students are applying now than in 2010; and there are specific recommendations in the consultation to deal with mature students.

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[Wes Streeting (Ilford North) (Lab)]

I thank the shadow Health Secretary and the shadow Health team for securing this important debate this afternoon, which effectively gives us the opportunity to debate early-day motion 1081, which is set to become the most popular early-day motion in this Session of Parliament. It has been signed by Members from across the House, including Government Members, because of the concerns that people have bravely shown about the potential consequences of the Government’s proposed decision on the NHS bursary.

As I have argued before in Adjournment debates on the Floor of the House and in Westminster Hall, what we are debating this afternoon is the biggest shake-up in the funding of nursing, midwifery and allied health subjects since 1968. It was announced, without adequate evidence and planning, as part of the Chancellor’s Budget rather than being a carefully thought-through policy proposal; that is why the Government are consulting people only through a technical consultation rather than through a consultation of all stakeholders on the principle of the policy, as they ought to have done.

Although I and others will refer to “student nurses and midwives” as shorthand, it is important to acknowledge, as my hon. Friend the shadow Health Secretary did, that this will affect students of all sorts of subjects and vital workers being trained in a range of aspects of the NHS—physiotherapists, occupational therapists, chiropodists, dieticians, podiatrists, radiographers, paramedics, prosthetists and others. That is why more than 100 right hon. and hon. Members signed the early-day motion and thousands of members of the public have spoken out through the online petition.

At present, nursing, midwifery and allied health subjects are not subject to tuition fees and students on these courses receive a non-means-tested grant of up to £1,000 a year as well as a means-tested bursary of up to £3,191 a year. That recognises that students of these subjects have to work considerably long hours during their courses—not just in the libraries and lecture theatres like most students, but on clinical practice as part of a full 24-hour care cycle. Indeed, it is estimated that student nurses work at least 2,300 hours across the course of their degree. I am not sure that many of us with degrees in this House could claim to have put in so many hours when we were at university. We should recognise the effort that such students need to make to secure their qualifications.

Those who work outside course hours to fund their degrees can end up working up to 60 hours, and we should not expect them to do so: it can have a deleterious impact not just on their academic studies but on their approach to clinical practice. Under the Government’s proposals, the changes will mean that students of these subjects will be charged tuition fees in excess of £9,000 a year and, as a result, will be burdened with £51,600 of debt. They will begin paying that back as soon as they graduate, which means that nurses will take on average a pay cut of £900 a year.

As if that were not unacceptable enough on its own, will the Minister explain when he winds up how it can possibly be fair that under the proposed approach there is no recognition in the student support system of the unique demands placed on these students? The NHS bursary, as it exists, alongside the tuition fee remissions that these students effectively receive, at least recognise that for many of the students it is difficult, if not impossible, to take on the sorts of part-time work that I did when I was studying, either during my A-levels at McDonald’s or during university at the now-defunct Comet. For those students, it is simply not possible to fund their degrees in that way.

The student support system should recognise that it is more expensive to study these subjects and that the opportunities to earn extra income on top of taking the courses are not as readily available as they are for other students. It is a real mistake for the Government not to recognise that in their plan.

[Dr Wollaston]

Does the hon. Gentleman also accept that there is a serious problem with hardship on the existing bursaries, particularly given that the amount of the bursary drops in the final year?

[Wes Streeting]

I am grateful for that intervention. I shall come on to thank some of the people who have been in touch, but I will never forget the very first conversation I had with a student nurse in my constituency who sat with me in the Members’ area of Portcullis House and cried because under the existing system she struggled to meet the costs of training to be a nurse, even with the NHS bursary currently provided.

I want the student support system to be more generous for these students because other students like my constituent have dreamed of being a student nurse. It is not right that financial support, or the lack of it, should be a barrier to their taking on this valuable vocation, which does so much for so many.

The Government’s policy is riddled with risk. Earlier the Minister challenged my assertions on mature student numbers. It is a fact that in the wake of the introduction of the coalition’s reforms to higher education, there was a fall in part-time and mature student numbers. The Minister claimed that there were record numbers of mature applicants to higher education; I can only assume that he was referring to last year’s figures. We should not identify a trend from one year’s figures, not least because UCAS figures for the 2016 application cycle published on 4 February 2016 show an increase in 18-year-old applicants, but a fall in most other older age group categories. I am more than happy to look at the data and conduct an evidence-based debate, but let us have an evidence-based debate and not take one year’s worth of figures and claim that there is some sort of trend.

[David Morris]

The figures that the hon. Gentleman cites are welcome, but they are different from those of the shadow Health Secretary.

[Wes Streeting]

No, I do not disagree at all with the figures cited by my hon. Friend the shadow Health Secretary. This is the problem with lies, damned lies and statistics, as Disraeli once said. We need to look at all the data in the round before we identify trends. The Minister singled out one year’s worth of application data to identify a trend.

It is also entirely possible that numbers relating to nursing, midwifery and allied health subjects account for a significant proportion of applicants to higher education and mature applicants to higher education. The Minister was talking about general applications for all subjects. We should probably ask the Library to do some work so that we can get to the bottom of the claims and counterclaims. None the less, most people involved in the higher education debate acknowledge that there are still serious challenges in access to higher education for part-time and mature applicants in the light of the coalition’s reforms. That is one of the reasons why the Government ought to tread carefully in this area.

Against this backdrop, there is a shortage of nurses. In 2011 and 2012 the number of training places was cut to the lowest level since the 1990s. Unison, the trade union of which I am proud to be a member, conducted a survey which found that two thirds of nurses believe that staffing levels were worse now than they were previously, and 63% feel that the numbers are inadequate to provide a safe degree of support on wards. That reflects feedback that I have had from NHS staff in my constituency, and it is something that the Government should take very seriously.

Since I first raised the issue in an Adjournment debate in the House, I have been privileged to meet so many nurses, midwives, other professionals and students of allied health subjects. I am particularly grateful for the campaigning that Danielle Tiplady and Kat Barber have undertaken, not least in meeting the Minister. I thank Unison, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Speech and Language Therapists, and the National Union of Students. I take this opportunity to pay particular tribute to the outgoing president, Megan Dunn, for the effective way in which she has represented students during her term in office.

The reforms reflect a big risk to nursing numbers. At the very least the Minister should commit this afternoon to a further full debate on the Floor of the House and a vote of both this House and the other place before such a radical change as the Government propose is made to the funding of these crucial subjects. There is considerable concern and the Minister should not downplay the issue. I hope he will at least commit to a full vote in the House before the change goes ahead.

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[Daniel Zeichner (Cambridge) (Lab)]

I congratulate the shadow Health team on securing this debate.

Just a few weeks ago, I found myself in a packed lecture theatre in Cambridge. I had been invited there by Giovanna Mead. She is a student nurse, and the room was packed full of her colleagues. They were angry—not for themselves, but for those in the years ahead who should be following in their footsteps. They were absolutely convinced and absolutely sure that if the Government’s changes go ahead, people like them would not be doing as they had done. They would not be embarking on the training that is so essential to the future of our NHS.

Those people are rightly furious that there seems to be a complete misunderstanding about just how different they are as a cohort from other students, and just how different their course is from other courses. There has been a complete failure to understand how their course involves being at work and sometimes, as they explained, going way beyond the call of duty. Being at work is different from just being on a course. The testimonies of these nurses and those of others across the country speak volumes. I pay tribute to the Royal College of Nursing for pulling together hundreds and hundreds of these stories. What makes the Minister so sure that he knows so much better than all these people, who are actually doing nursing and who know and understand the choices that people in their situation are likely to make?

Before I was elected here, I worked for Unison and met many student nurses, so I know that the Government fail to understand the simple truth that nursing, midwifery and allied health professional students are not like other students. One important and fundamental difference lies in the requirement that healthcare students spend a significant proportion of their studies on clinical placements. As the Royal College of Nursing points out, and as others have said,

“student nurses aren’t like other students. 50 per cent of their time is spent in clinical practice working directly with patients and their families and they have a longer academic year.”

Indeed, student nurses must spend a minimum of 2,300 hours on clinical placement during their studies—working, providing care and making a vital contribution to the health service. This often includes early shifts, night shifts and weekend shifts. In practice, the funding changes being driven through will charge students to go to work and to do a job that is desperately needed.

Furthermore, it is clear that these changes are being rushed through without proper consideration of their consequences. The Government say that they will create 10,000 new nursing, midwifery and allied health degree places, which would be welcome if it were to happen—particularly at a time when agency staff are plugging the staffing gap and draining NHS finances. It has not been made at all clear, however, that the resources are in place to support an influx of new students in clinical settings. Put simply, do the placements exist?

This concern is linked to a wider issue about the uncoupling of education commissioning and workforce planning. The potential consequences of a disconnection between university recruitment and NHS workforce planning must be addressed, and I would welcome the Minister’s comments on the risk this uncoupling poses to the ability of the NHS to best assess and plan workforce requirements.

[Wes Streeting]

One of the more interesting aspects of the Government’s proposals is to increase routes through non-degree courses. In view of the report of The Lancet in February 2014, does my hon. Friend agree that the Government should tread carefully here? Based on data across nine European countries, it suggested that every 10% increase in the number of Bachelor degree-educated nurses in a hospital is associated with a 7% decline in patient mortality. Even on the more positive aspects of the proposals, does my hon. Friend agree that the Government should tread much more carefully than they are?

[Daniel Zeichner]

My hon. Friend has made an interesting point, and I hope it is one that the Minister will address.

There are other ways in which student nurses, midwives and allied health professionals are different. As we know, they are more likely to be older, to be women, to come from black and minority ethnic backgrounds, to have children, and to have first degrees already. The average age of a new nurse is 28. Those characteristics matter, because they increase the likelihood that the changes in funding for healthcare degree places will be a disincentive to the undertaking of degrees. According to the Royal College of Midwives, the removal of NHS bursaries means that

“Women with children and those who already have a first degree will be particularly hit hard…many of these women already make up a large proportion of our current midwifery student base.”

Many students take up healthcare studies as a second degree course. Already saddled with repayments of undergraduate debt, they are hardly likely to be enthusiastic about the prospect of taking on an additional debt of £51,600. The starting salary for nurses is only £21,692, and replacing NHS bursaries with loans will mean an average pay cut of more than £900 a year for a nurse, midwife or allied health professional, given current salary levels. We know that debt particularly deters poorer students, single parents and BME students—those who are more likely to be found entering nursing and midwifery.

I think that the people who can best explain what the Government’s decision will mean are those who will be most directly affected. The Royal College of Nursing has collected their testimonials in a huge big blue book, which I have waved around hopefully during a number of Question Time sessions over the last few weeks, and which I commend to the Minister.

Let me end by returning to that packed room in Cambridge, and give some of those students a voice. Sarah from Cambridge says:

“I would not have survived without my bursary. The nurse’s salary is poor and to have debt on top is terrible.”

Amanda says:

“I am an adult learner with a husband and two children. I had my children young so was unable to fulfil a degree at the usual time… If I was to have a mountain of debt at the end it would not have been worth my while! I fear it will put off adult learners entering into the degree programme, which will mean the NHS losing out on valuable, decent people who would make fantastic nurses!”

Maria says:

“By stopping the bursary we are in danger of preventing mature students from entering training as those who already have financial commitments will struggle. This will mean that the NHS loses the chance of recruiting a great resource of potential nurses.”

Another Sarah says:

“I am really disappointed by this change, and nursing is not like any other profession so should be treated uniquely. It is really tough being a nursing student and I think that the proposed bursary changes should be considered carefully to respect the work, commitment and enthusiasm of student nurses.”

She puts it very well. If the Government will not listen to me, perhaps they will at least listen to her.