NHS Bursaries

Opposition Day – in the House of Commons at 1:17 pm on 4th May 2016.

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[Relevant document: e-petition, entitled Keep the NHS Bursary (113491).]

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health 1:26 pm, 4th May 2016

I beg to move,

That this House
recognises the contribution of student nurses, midwives, allied health professionals and other healthcare staff;
has serious concerns about the potential impact of removing NHS bursaries on the recruitment and retention of staff;
and calls on the Government to drop their plans to remove NHS bursaries and instead to consult on how they can best fund and support the future healthcare workforce.

I have been told that the Under-Secretary of State for Health, Ben Gummer, will be opening this debate for the Government. Given that the Health Secretary is sitting next to him, may I ask the Minister why we will not be hearing from his boss today? If he would like to give a genuine reason I would be happy to take an intervention, but if not I will take it that the Health Secretary simply does not want to defend his policy to the House. [Interruption.]

Photo of John Bercow John Bercow Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Speaker of the House of Commons

Order. There is a certain amount of chirruping from the Treasury Bench and elsewhere on this matter, and I simply make two points. It is entirely for the Government to decide which Minister to field, but I say gently to the Secretary of State, and to the Deputy Leader of the House, that to sit on the Bench rather than to participate while these matters are debated, is one thing—particularly in the case of the Secretary of State—but to sit there fiddling ostentatiously with an electronic device defies the established convention of the House that such devices should be used without impairing parliamentary decorum. They are impairing parliamentary decorum, and in very simple terms the Secretary of State and the Deputy Leader of the House are being rank discourteous to the shadow Secretary of State and to the House. It is a point so blindingly obvious that only an extraordinarily clever and sophisticated person could fail to grasp it.

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

Thank you, Mr Speaker. This is not the first time that the Health Secretary has chosen not to respond to debates that I have secured or questions that I have put. [Interruption.]

Photo of John Bercow John Bercow Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Speaker of the House of Commons

Order. I say to the Deputy Leader of the House: put the device away. If you do not want to put it away, get out of the Chamber. It is rude for the—[Interruption.] Order! I am not inviting a response from the hon. Lady. [Interruption.] Order! I am simply telling her that it is discourteous to behave like that—a point that most people would readily understand.

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

Thank you, Mr Speaker. I will leave my comments on that matter there.

In the past few months, Ministers and I have had a number of exchanges across the Dispatch Box about the unnecessary and dangerous fight the Government are picking with junior doctors. You might think that having totally alienated one section of the NHS workforce, Ministers would think twice about doing it again, but you would be wrong. Not content with junior doctors, the Government are now targeting the next generation of nurses, midwives and other allied health professionals: podiatrists, physiotherapists, radiographers and many more. Instead of investing in healthcare students, and instead of valuing them and protecting their bursaries, which help with living costs and cover all their tuition fees, the Government are asking them to pay for the privilege of training to work in the NHS: scrap the bursary, ask tomorrow’s NHS workforce to rack up enormous debts, and claim that this is the answer to current staff shortages.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire

The hon. Lady is making a spending commitment. Why then, only a few months ago, did she stand on a manifesto that opposed the Government’s £10 billion investment in the NHS?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

The Labour party has always made it clear that it would have given the NHS every penny it needs.

Given the approach to healthcare students I have outlined, most people would think the Government had taken leave of their senses. They would be right.

Photo of Diana R. Johnson Diana R. Johnson Shadow Minister (Foreign and Commonwealth Affairs)

My constituents in Hull are baffled by the Government’s approach. At a time when our local hospitals have to recruit nurses from Spain and other European countries, stopping bursaries that enable more people to get training seems absolutely ridiculous.

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

I absolutely agree with my hon. Friend. Indeed, the bursary acts as an incentive to get those students into training and into the NHS.

A few weeks ago, the Government launched their consultation on the technical detail of the changes—not the principle, just the detail. In his foreword, the Under-Secretary of State for Health, the hon. Member for Ipswich, claimed that the proposals were

“good for students, good for patients and good for the NHS.”

The opposite is the case.

Before I set out why the plans are so bad, it is important to remind ourselves of why our country has a nursing shortage in the first place. Shortly after the 2010 election, the coalition Government cut the number of nurse training commissions in an attempt to make short-term savings. The cuts saw nurse training places reduced from more than 20,000 a year to just 17,000, the lowest level since the 1990s. As a result, we trained 8,000 fewer nurses in the previous Parliament than we would have done had we maintained commissions at 2010 levels. At the time, experts such as the Royal College of Nursing warned that the cuts would cause

“serious issues in undersupply for years to come.”

It was right, but it was ignored by Ministers who were too focused on the short term and no doubt too distracted by their plans to launch a massive reorganisation of the NHS.

Our health service is now suffering the consequences of those decisions. New analysis by the House of Commons Library released today shows that the number of nurses per head of population fell from 6,786 per million people in 2009 to 6,645 per million people in 2015. A Unison survey published just last week found that more than two-thirds of respondents felt that staffing levels had got worse in the past year, with a further 63% saying they felt there were inadequate numbers of staff on the wards to ensure safe, dignified and compassionate care. Because of these shortages, hospitals are forced to recruit from overseas or spend vast amounts on expensive agency staff.

Photo of Paula Sherriff Paula Sherriff Labour, Dewsbury

In the years 2014 to 2015, the NHS spent £3.3 billion on agency staff. Does the short-sighted step of removing the bursary mean that beleaguered trusts may actually be more reliant on agency staff?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

My hon. Friend is completely right to point out that the problem of staff shortages leads to more agency staff having to be used, and that creates an enormous black hole in hospital finances. My fear is that the proposals will put off the next generation of nurses.

It now appears that the Government are making some of the same mistakes all over again. A report sneaked out on the day the House rose for the Easter recess revealed that the Government had commissioned only one-tenth of the extra nurse training places that experts said were needed this year. The report, from the Migration Advisory Committee, states:

“We were told that HEE—

Health Education England

“has acknowledged that, on the basis of workforce modelling alone, they would have liked to commission an additional 3,000 places in 2016-2017. Funding constraints meant that they had only commissioned an additional 331 places;
one tenth of what was actually needed”.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale

Does the hon. Lady not agree that by changing the way we run the NHS, especially in relation to bursaries and opening it up to more competition, we will get more nurses coming into the NHS, thus plugging the gap she describes?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

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 not my words, but 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?

Photo of Richard Graham Richard Graham Conservative, Gloucester

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?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

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.

Photo of Nicholas Dakin Nicholas Dakin Shadow Minister (Education)

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”?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

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.

Photo of Anna Turley Anna Turley Shadow Minister (Cabinet Office)

Does my hon. Friend agree with my constituent Zoe, who is training to be a nurse and is particularly concerned about mature students? She feels that about 50% of their time is spent in unpaid clinical placements in hospitals in the community, so they do not have the opportunity to do part-time work to support themselves as many others do. Will they not be disproportionately affected?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

I agree with my hon. Friend, and I shall make some remarks on that precise point later.

The Opposition’s purpose in calling today’s debate is that we hope the House can rally round what many would view as a straightforward and reasonable proposal— that the Government drop these plans and instead consult on how properly to fund and support the future healthcare workforce.

Let me set out why these plans are bad for students, bad for patients and bad for the NHS. The Government claim that these plans will leave healthcare students 25% better off. What they will not say is that, according to their own consultation, in order to be 25% better off, a student will have to take out a maximum maintenance and tuition fee loan for three years and would graduate with debts of between £48,000 and £59,000.

Photo of Angela Rayner Angela Rayner Shadow Minister (Work and Pensions)

Many Members will know that I had a son born at 23 weeks’ gestation who spent six months in intensive care with a neonatal nurse, Nicola Probert, who sadly died not long after my son came out of hospital. I am frightened, as many people watching this debate will be, that people like Nicola will no longer go into the profession because of the astronomical debts that they will have to take on. Does my hon. Friend agree that this is a regressive step, and that the Government should think again about it?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

I completely agree with my hon. Friend. It seems that the Government’s argument is that students will be better off because they can borrow more. The simple truth is that loan repayments will hit nurses’ take-home pay—there are no two ways about it. The current starting salary for a nurse is £21,692—just above the student loan repayment threshold which, of course, has been frozen. This means that nurses will start paying off their loans as soon as they graduate. According to Unison, based on current salary levels nurses will be faced with an average pay cut of over £900 a year to meet their debt repayments. How can that possibly be justified? Even worse, the average age of a student nurse is 28, so the current 30-year repayment period means that many nurses will be paying off loans to within years of retirement. We Labour Members say it is wrong to burden the next generation of NHS staff with a lifetime of debt and wrong to expect tomorrow’s nurses to pay the price for this Government’s mis- management of the NHS.

Does the Minister not understand that student nurses, midwives and other allied health professionals are different from other students? Can he not see that it is dangerous to assume that just because application rates remain stable after the trebling of tuition fees in the last Parliament, the same will happen with his proposals? Assuming healthcare students will respond in the same way as other students to a tuition fees hike is one hell of an assumption and one hell of a risk.

Courses for nursing, midwifery and other allied health professions are substantially different from most other arts and science degrees. Courses are more onerous—there are fewer holidays, longer days and longer term times—while students are also required to spend about half their time in clinical practice. This means 2,300 hours in the case of a student nurse, including night and weekend shifts as a normal part of their studies.

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

I have already given way to the hon. Gentleman, and I want to make some progress.

These changes will effectively charge students for working in the NHS. Of course, longer term times and clinical placements also make it harder for these students to get a part-time job to supplement their income in the way many other students do. It is not just the course that makes healthcare students unique; they are much more likely to be women, much more likely to be mature students, much more likely to have children and more likely to be from BME backgrounds.

Many nursing students have already completed one degree and turn to nursing in their late 20s or early 30s—indeed, the average age of a student nurse is 28. When I think of my own friends who are nurses and midwives, I find that three out of four took the decision to re-train, having done a different first degree.

The Minister probably moves in different circles from me, but I can tell him that if he wants a dose of reality, my friends would, I am sure, be more than happy to oblige. I understand that he may not have experienced the conversations that I had in my working-class family about the pluses and minuses of racking up debts to get a degree, but I can tell him that for many nurses, under his proposals, that consideration will be all too real. Does he not realise that for the one in five healthcare students with children, the fear of debt is greater than it is for carefree, privately educated history students bound for Cambridge? My concern about these proposals is that we ultimately end up with those best placed to pay becoming nurses and midwives rather than those best placed to care. That brings me on to why these proposals are bad for patients.

Photo of Helen Whately Helen Whately Conservative, Faversham and Mid Kent

I think we are all agreed on the need for more nurses; the question is how we fund them. Will the hon. Lady tell us how much money she would take away from front-line NHS care in order to fund the expansion of nursing places that the country needs?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

We set out at the last election our clearly costed plans for how to recruit additional nurses, doctors and care staff to the NHS.

The NHS should have a workforce that reflects the population it serves—just as this place should, too. The mental health sector in particular relies on mature students and the additional life experience they bring to what is a very demanding environment.

A few months ago, I met Marina, a young woman who has not had an easy life, but who is now on a mission to become a mental health nurse. When Marina says that she thinks some of the people best placed to care for others are those who have experienced hardships themselves, I think she has a point; and when she says she would not have been able to start her training without the bursary, I believe her. Why is the Minister so convinced that the NHS can do without people like Marina in the future? Why does he think they should pay to train, and why will he not consider other options for increasing student numbers?

The quality of training that student nurses, midwives and other allied health professionals receive will also depend on the quality of their clinical placements. Government Ministers claim these changes could deliver up to 10,000 extra places over the course of this Parliament, so can they set out what capacity hospitals and other providers have to accommodate these extra students, and confirm whether Health Education England has sufficient funds set aside to fund these placements? Will the Minister be clear about how this 10,000 figure was arrived at? Is it the Government’s assessment of what the system needs, what Health Education England can afford to fund or simply a big-sounding number plucked out of the air at random?

An extra 10,000 compared with when? What is the baseline year on which we should judge the Minister’s policy? I have asked him that three times in written parliamentary questions, and each time I have not received an answer. Does he not understand that if his Department cannot even answer a simple question relating to one of its key claims about the policy, that does not exactly inspire confidence? There are so many questions that the Minister needs to answer that it is impossible to do all of them justice in a single speech.

Photo of Alex Chalk Alex Chalk Conservative, Cheltenham

As has been indicated, it is agreed that we need to expand the number of places. Thanks to this Government, however, an extra £10 billion has been put into GP services, acute services, cancer treatment and hospital care. Which of those services would the hon. Lady cut to fund the alternative bursary scheme that she has in mind?

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

The hon. Gentleman does not seem to realise that that money is plugging a very big black hole in NHS finances. I am sure that when the Minister responds to my speech, he will note that many people who apply to study for nursing and other healthcare degrees are turned away, but what proportion of those unsuccessful applicants actually meet the entry criteria? How can he be sure that his new system will deliver the required numbers of different types of nurses and other healthcare professionals in the right geographical areas? What guarantees has he given to higher education institutions that the new arrangements will fully cover the costs of delivering degrees, and what assessment has he made of the amount of un-repaid student debt that will accumulate, given that, over a lifetime, some nurses will not earn enough to repay the totality of their loans plus interest?

The proposal to scrap NHS bursaries is a massive gamble at a time when the NHS needs certainty. Put simply, it will shift the costs of training nurses, midwives and other allied health professionals from the state to the individual. If we are all happy to enjoy the benefits of the NHS, why should we not all contribute to the training of those who work in it?

I was the first member of my family to go to university. My tuition fees were paid in full, and I received a full maintenance grant. What really worries me is that people like me, and people like my friends, will be put off what could be a fulfilling and important career. We should be doing all we can to inspire today’s schoolchildren to become the nurses and healthcare professionals of the future, but, sadly, the Government are making a very good job of doing the very opposite. If Ministers want to continue to import staff from overseas, they are going the right way about it. We owe a debt of gratitude to those staff, but we want home-grown staff too.

Finally, let me return to the Government’s consultation paper. One section is entitled

“Nursing, midwifery and allied health professional students deserve the same opportunities as other students”.

Labour Members say, “No, they deserve better.” Those people should be treated differently from other students, because they are the people who will look after us when we are older, care for our relatives when they are sick and staff the NHS when this shambolic Government are long gone.

The Government should drop these proposals and think again. I commend the motion to the House.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health 1:54 pm, 4th May 2016

It is a great pleasure to respond to the motion, not least because I think that this is potentially one of the most exciting things that we will do in the NHS in the next five years to increase opportunity and quality, and the presence of nursing staff on wards. We will be able to do that because of the reform that has helped so many other students throughout the country in the last five years.

Heidi Alexander entered the House at the same time as I did. In November 2010, we sat on opposite sides of the House and contributed to a debate; many of us expressed anxiety about the outcome, not least because of the enormous pressures that we were experiencing from our constituents. Members who have been here for many years will know that that was the first occasion on which a riot taking place outside the House could be heard from the Chamber. The rioters were complaining that we were going to destroy people’s ability to go to university. We were going to make it impossible for people from disadvantaged backgrounds to go there, and we were going to set back years of progress in the closing of the inequality gap in this country.

Members on both sides of the House who spoke in that debate felt very passionately about the issue. We believed that it could be resolved by different means, but over the last five years we have been able to see the effect—and, as posited by the hon. Member for Lewisham East, the evidence—of the changes that were made. That evidence is quite clear. This year, 394,380 people were given university places in this country, 35,000 more than were given places in 2010, the year of the debate. If those 35,000 were to make up a single university, it would be the fourth largest in the country: one university, the fourth largest in one year, following the expansion of opportunity that resulted from the reforms that the House passed in 2010.

The hon. Lady made the most important point, however, when she asked how the reforms extended opportunity to the people who most needed to go to university. I regret the tone that she adopted in that portion of her speech; it was, I am afraid, beneath her. It was indeed wrong that when I was at university my fees were paid for in part by nurses paying tax on low wages. That was wrong, and we accepted that it was wrong. We also accepted that the system was not helping the people who most needed to go to university in order to escape their backgrounds.

The result that we should be looking for now is the number of people from disadvantaged backgrounds who have been helped to get into university in the last five years, and I can tell the hon. Lady that it has increased by 10,150. That is a massive increase. Had someone said back in 2010 that that would be possible, I doubt whether anyone would have given 5,000-to-one odds on it, but I can also tell the hon. Lady that 10,150 is the number of people at the University of Leicester. That is the number of people whom we have brought into the university sector as a result of the changes that we have made. We have the equivalent of one more university, full of people from disadvantaged backgrounds, as a result of the reforms that we enacted in 2010.

I know that the hon. Lady’s motivations back then were entirely honest and commendable. I also know that many Conservative Members felt likewise. But we have to accept when we get things wrong, and it is in that regard, I am afraid, that the hon. Lady, rather than us, is failing to learn from history. During the 2010 debate, in an intervention on one of my hon. Friends, she said that the proposed changes would force on students a “huge debt”, and that

“the huge debt that they could now face will act as a greater disincentive to go to university than it will for students from more affluent backgrounds”.—[Official Report, 9 December 2010;
Vol. 520, c. 579.]

The hon. Lady has made exactly the same point in today’s debate. She was wrong then, and I humbly suggest that she is wrong on this occasion. She should listen very carefully to the evidence that has been presented, not by me but by so many institutions, about the progress that has been made in reducing inequalities, and the reasons why we need to press ahead. In this instance, for one reason alone—and I will come on to others—we need to bring about the reforms to nursing bursaries.

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

Does the Minister not accept, though, that healthcare students have very different characteristics from other students, and that their behaviour will not necessarily be same as that of students affected by the reforms in the last Parliament?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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.

Photo of Wes Streeting Wes Streeting Labour, Ilford North

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?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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.

Photo of Mark Spencer Mark Spencer Conservative, Sherwood

Does this not demonstrate the Minister’s point? We have a choice: we either inspire people to aspire and give them the opportunity to enter the NHS by talking it up, or we take the opposite view, talk the NHS down by being negative, and put people off.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

I do believe that. The Opposition were wrong back in 2010, and had we followed their advice, fewer people from disadvantaged backgrounds—precisely the people Labour was elected to represent and support—would be going to university. As a result of our taking forward brave proposals, in the teeth of much opposition, we have done more for the prospects of people from disadvantaged backgrounds than any Government dealing with this matter since higher education was reformed after the second world war.

I come now, I am afraid, to the motion tabled by the hon. Member for Lewisham East. It implicitly accepts that we have made progress. The fact that it is so anaemic in offering an alternative makes it clear that there is no alternative suggestion that she thinks would achieve the aims that she and I want: an increase in the number of students going into nursing and training, and of those coming from a diverse background. It also implies that she accepts, like me, that workforce planning over the last 10, 15, 20, 30 or 40 years has failed. I can say that, whereas she is not willing to, because everything we are doing now to correct workforce numbers—for example, the 5,000 additional GPs my right hon. Friend the Health Secretary fought the last election campaign on and will be delivering in the next few years—is the result of poor commissioning decisions made not under the coalition Government, or even in the latter years of the Labour Government, but under Governments 20 and 30 years ago.

The failure to predict the number of GPs needed, and the number and types of other professionals needed, lands us perpetually in this perverse situation where we are not accepting British students on to training courses at British universities and, as a result, are not creating the numbers of domestically trained nurses we need. In response to the inadequacies in care uncovered as a result of the Mid Staffordshire NHS Foundation Trust scandal and the failure of the Labour Government to provide the number of nurses needed in hospitals across the country, we are having to import nurses from abroad and to fill nurse places with expensive agency posts. That is something we are putting right now.

Photo of John Glen John Glen Conservative, Salisbury

One of the main pieces of feedback I have had from Salisbury NHS Foundation Trust is its frustration at the reliance on agency nurses, so I welcome the Government’s moves, because they will open up supply and reduce that reliance and the significant additional costs we have seen over the last few years.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

It is precisely to help my hon. Friend’s hospital that we are introducing these reforms.

Photo of Justin Madders Justin Madders Shadow Minister (Health)

The Minister said there was no alternative to these proposals. Which of the royal colleges did he consult before coming to that decision?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

Contrary to what the hon. Member for Lewisham East said, I did consult with the royal colleges. I have spoken at length with the Royal College of Nursing and with Unison. As I would expect, we differ on key parts—though not every part—of the plan, but the royal college’s initial response accepted that the premise on which we were proceeding was, in significant part, correct. In the consultation, I want to find areas we can agree on and improve the proposals we have put before the public. We were open about the consultation and offered the full 12 weeks—many people said we would not do so, but we did—precisely so that we could listen to the concerns, proposals and exciting challenges from people across the sectors, and thereby improve the proposals we have put before the NHS.

The motion suggests a series of things, but not a proposal from the Opposition to do anything different. They are not offering the NHS any new money—they offered £4.5 billion less than we did at the last election—so I can only presume that the money would have to be found from cuts elsewhere in the service. The hon. Lady will have no credibility unless she tells the House that she will pay for the 10,000 additional training places out of taxpayers’ money, rather than by finding an alternative funding mechanism. I will not offer the House a series of suggestions that might or might not be better, or merely criticise proposals, rather than offering constructive improvements.

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

Whenever I make suggestions, they’re just ignored.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

The hon. Lady is welcome to contribute to the consultation. She is doing so now, although sadly we heard no solutions or alternative proposals. I intend to set out not suggestions, but a clear announcement of our plans, the reasons for them, and how we will enact them over the year to come.

Photo of Peter Kyle Peter Kyle Labour, Hove

The Opposition have proffered many solutions to the Government. Just last week, we suggested a cross-party solution to the doctors crisis, but it was thrown back in our Front-Bench team’s face. Here is another solution: will the Minister speak to colleagues in the Department for Business, Innovation and Skills to see whether the apprenticeship levy, which the Government are taking from all large employers, could be spent on subsidising nurses to tackle the funding challenges?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

Wes Streeting, who has concerns about the proposals, has discussed the matter with me several times and offered some useful suggestions about the detail. I have accepted his points and incorporated them into our thinking. I am very willing to listen to people from across the House when they come with helpful suggestions, and I am sure that the Minister for Skills, my hon. Friend Nick Boles, would be interested in the hon. Gentleman’s contribution about the apprenticeship levy. The way not to do it, however, is to come to the House with a series of criticisms but not one suggestion, nor any money to provide for the increased number of training places in the plan.

We should make these changes not only for reasons of social equity, though that is the foremost reason; not only to produce 10,000 additional training places in our university system; and not only because we have a broken planning system, which otherwise would remain broken—even people as intelligent as the hon. Member for Lewisham East cannot predict how many nurses, doctors and allied health professionals we will need in 20 or 30 years, or the skills they will need. Even were it not for all those things, it would still be important to do this, because of the changes it will make to the quality of training we can provide to nursing graduates. Across the rest of undergraduate training, universities have been released to innovate and improve their courses. Satisfaction levels have gone up and drop-out rates have fallen; consequently, people are getting a better experience.

We have not, however, been able to spread those advantages to nurses, who, I am afraid, remain trapped in a system that is prescriptive and does not take account of the skills that they and their future employers will need. By releasing universities from their straitjacket, we can make significant improvements to the quality of the training they provide.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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.

Photo of Richard Graham Richard Graham Conservative, Gloucester

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?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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.

Photo of Liz McInnes Liz McInnes Shadow Minister (Communities and Local Government)

The Minister talks about maintenance support, but can he clarify that that support will no longer be in the form of a grant, and will now be in the form of a loan? Does he acknowledge that that will land students in even more debt when they finally qualify?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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.

Photo of Nicholas Dakin Nicholas Dakin Shadow Minister (Education)

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?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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.

Photo of Heidi Alexander Heidi Alexander Shadow Secretary of State for Health

The Minister has urged me to be careful with my words, which I was, and I recognise that he is being careful with his, too. He is talking about newly qualified nurses. Can he confirm what the average repayment would be for the average nurse?

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

We do not currently have a figure for the average nurse, as the hon. Lady puts it. I cannot project where a nurse’s career path will take them 50 years into the future, for precisely the reasons that we have been discussing. The actual repayments—[Interruption.] I will come to Diana Johnson in a second. The actual repayments are clearly listed in the consultation document. They are clear about the amount that will be paid back over and above what existing students would be expected to pay.

The only way in which we will be able to square the circle that the hon. Member for Kingston upon Hull North mentioned is by reforming student finance. Rather than shouting from a sedentary position, she might like to know that, contrary to her suggestion that many people in her constituency were none the wiser about this reform, I talked about the reforms to nurses in her constituency a few months ago. I also talked to them about the introduction of apprenticeships and of nursing associate grades, all of which are part of the reforms that I am outlining, and they were very excited about the changes that we are making to the nursing profession. All of this is possible only within a budget that is being carefully controlled, and in which priorities are placed on where the money is spent.

Photo of Diana R. Johnson Diana R. Johnson Shadow Minister (Foreign and Commonwealth Affairs)

I am sorry; perhaps I should not have been shouting at the Minister from a sedentary position, but I am surprised that he should have come to this House and been unable to answer a basic question about the amount of money that will be lost through the scheme that he wants to introduce. Surely he ought to have those facts at his fingertips when he is standing at the Dispatch Box.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

I do have those facts at my fingertips. A newly qualified nurse will not be paying any more than he or she is paying under the current system. For those on higher pay rates, the figures are in the consultation document, and if the hon. Lady is not willing to go and look at that herself, I will write to her with the details for her ease and comfort. Opposition Members, rather than picking at points because they refuse to face the fact that they have to fund their commitments with additional money, should listen carefully to the entirety of the reforms that we are proposing.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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 were addressed in the speech of the hon. Member for Lewisham East.

Photo of Ben Gummer Ben Gummer The Parliamentary Under-Secretary of State for Health

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 agilely 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.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice) 2:22 pm, 4th May 2016

I must declare an interest due to my work in the NHS and having had the privilege of a grant being available 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.

Photo of Richard Graham Richard Graham Conservative, Gloucester

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.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

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.

Photo of Angela Rayner Angela Rayner Shadow Minister (Work and Pensions)

The hon. Lady is making an important point. Returning to something the Minister said, the frustration for me is that I was a Unison rep in homecare before coming to this place, and we were able to give unqualified women access to a foundation degree when they were healthcare assistants. They could then do a vocational degree and get into hospitals in much the same way as what the Minister claims is not currently available. It is important that that route remains open and that its users, mature students in particular, do not get disadvantaged because of the thousands of pounds-worth of debt that they would take on at the end.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

The hon. Lady makes her own point. It is important that people from all backgrounds are encouraged to enter our NHS. The UK has a diverse society and we must ensure that our healthcare staffing system reflects that and supports those from all backgrounds to enter it.

It is not enough just to increase numbers by creating an open market for training. In order to ensure a quality service, it is crucial that student placements are well planned, well supervised and well distributed between the various areas within the service, so much consultation is required. In response to the Government’s proposals, a former chief executive of the Royal College of Nursing commented:

“The last thing we need are disincentives to recruitment. We should be doing everything possible to attract applicants, as the country needs more nurses now than at any other time in its history.”

Photo of Christina Rees Christina Rees Labour, Neath

The hon. Lady is making many valid points. If someone lives in Wales and wants to study at an English university, it is proposed that the bursary will be stopped. If someone lives in England, Scotland or Northern Ireland and wants to study nursing, midwifery or an allied health profession at a Welsh university, the Labour Welsh Government will pay the bursary. Taking that to its logical conclusion, the numbers will decrease in England and increase in Wales, Scotland and Northern Ireland. Of most concern is the fact that the UK Government did not commit to undertake an impact assessment of cross-border applications before proceeding with the changes. Does the hon. Lady think that they should have?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

Once again, the hon. Lady makes her point very well. I believe we need to staff the NHS well right across the UK. Impact assessments may require consideration down the line if there is a shortage in England as a result of this policy. I hope that answers her question.

In Scotland, the SNP Government recognise the value of investing in our NHS, providing a support package that is hugely generous in comparison with that in England. The nursing and midwifery student bursary in Scotland provides all eligible students with a non-income-assessed and non-repayable personal allowance of £6,578 per year, excluding additional allowances. That can be topped up by a range of income-assessed allowances, and it comes in the context of there being no tuition fees. Therefore, there are other examples of ways to make progress in this policy area.

Under the SNP Government, NHS staff numbers have increased by more than 10,000, and the party is committed to supporting the development of a quality health service that will meet the needs of the Scottish people, not just now, but in the future. Workforce projections show that more than 1,000 extra NHS staff are expected to be recruited across Scotland this year. There has been an 8.4% increase in NHS staffing, to a record high. There are more qualified nurses and midwives per 1,000 of population in Scotland than there are in England and Wales. In the past year, Scotland has seen the total number of nursing and midwifery staff increase by more than 500 whole-time equivalents, with boards projecting an increase of more than 600 whole-time equivalents in this financial year. The number of doctors has increased by 26.7% or by 2,560 whole-time equivalents, and the number of consultants is now at a record high, having increased by 40.3%. Every newly qualified nurse is guaranteed one year of employment once they complete their studies—that commitment is not offered anywhere else in the UK. Our health Minister, Shona Robison, has also confirmed that the nursing and midwifery student bursary and allowance will be protected at existing levels in 2016-17. A review of the scheme is due to report in June 2016.

The NHS is a crucial public service, and the UK Government cannot continue to railroad their way through it. They are making significant changes and although reform may be needed to address current issues within the service, such decisions should not be made hastily and without full consideration of their impact and of potential workable alternatives. We have heard about some workable alternatives today. I therefore urge the Minister to commit to having a comprehensive consultation on the full proposals, to determine the best way to support and invest in this service and its students. This is a vital workforce, whom we depend on in our times of crisis. It is only right therefore that they should be able to depend on us during their training and when they hope to help the NHS in the future.

Photo of Natascha Engel Natascha Engel Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. Before I call the first Back-Bench speaker, I should say that we are going to have a time limit of seven minutes to start with. The debate finishes at 4.27 pm and a large number of people wish to speak.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee 2:33 pm, 4th May 2016

Let me start by congratulating the shadow Health Secretary on calling this important debate. First and foremost, it matters because of the impact on patients of a nursing workforce shortfall. When the Health Committee’s recent primary care inquiry took evidence, Professor Ian Cumming estimated that shortfall to be between 15,000 and 20,000 nurses. This is not just about the overall shortfall; it is also about shortfalls geographically and in certain key areas, particularly primary care, community care and mental health. We therefore need to look at the big picture.

The workforce shortfall adds costs. We know that the agency staffing bill was about £3.3 billion in the last year and that three quarters of trusts are still breaching the agency price caps, although we are making some progress on that, with the relevant figures being £303 million in October last year and £287 million in February this year. These resources should be spent elsewhere, on patient care. There is an over-dependence on nurses who are trained overseas. They are a very valued part of our workforce but they are often being recruited from countries that can ill afford to lose them. We will need to train more nurses—that is the prime consideration of this debate, along with how we achieve that.

I congratulate the Minister on the proposals to open up many more places to nursing students, but we should consider some unintended consequences and I wish to touch on those further in this debate. We must do this without disadvantaging or cutting off our current core nursing workforce. It is absolutely right that we pay particular attention to the impact on mature students, because we have heard the data on that: 23% of all nursing applicants are over 30; more than half are over 21; and, as Heidi Alexander said, the average age is 28. The question is whether this core mature nursing workforce are going to be deterred from applying.

We have already seen an example of innovation, with the University of Bolton partnering the Lancashire Teaching Hospitals NHS Foundation Trust to start offering places where students apply through the UCAS route. They introduced 25 places in the first pilot, with the first intake being in February last year, and there were 650 applicants for those places, even though they knew that they would have to access loans. There has been a very successful second round, with an increase to 75 places this year, and so the assumption that people will simply not apply for these courses just is not correct. We need to bear it in mind that we cannot necessarily extrapolate from there to a wider increase in numbers, but I ask the Minister whether there is any room, as we start to roll this out, to retain some bursaries for our very valued core mature nursing workforce for at least the first few years, until we know what the impact is. Will he address that in his summing up? Is there any role for a period of transition? It is important that we bear in mind the potential for unintended consequences.

Two thirds of those who apply for nursing places are unsuccessful, and it is unreasonable not to increase the opportunity for those students. I very much welcome the Minister’s plan to roll out other opportunities to enter the nursing workforce. We know from the Cavendish review that one reason we lose so many from our core healthcare assistant workforce is because there are no continuing professional development opportunities for them. Very many of those people, whom we know to be fantastic at their job, are not able to progress in the way that we should be allowing them to do. The key focus for us in this House should be: what is best for patients? What is best for patients is for us to train up a more diverse workforce, through many routes. There is a case for saying, “Let’s not completely abolish bursaries in the first round. We could phase things in more slowly.”

Another opportunity we could look at to try to attract people into nursing is through recognising that the clinical component is very high in the nursing course, at about 50%. Is there any way we could recognise that with a limited grants system for those who would otherwise be deterred? Perhaps at the end of a nursing course we could recognise mature students, particularly those who have taken on a second degree. Is there a way we could allow an extra payment to go to those nurses, particularly those who are going to go on to train in specialties where there is a shortage, linked with a period of NHS service. I know that we are using such an approach in general practice to try to attract people into shortage specialties. Would the Minister also consider that in responding to the legitimate concerns about the impact on the mature nursing workforce?

In summary, there are things we are doing where we are making progress, but there are things we can recognise as being unintended consequences. I hope the Minister will also look at some of the other recommendations from the recent Health Committee inquiry on primary care and say, “What can we do, as we increase the number of these courses, to increase the exposure to shortage specialties within the training period?” Too many of our healthcare workforce are staying within acute care and we know that if they have increased exposure to primary care during their training, they are more likely to want to go into those specialities.

Finally, as we increase these other opportunities for nursing and physician associates, may I ask the Minister please to touch on registration? We have heard evidence that, sometimes, not being registered can deter people from taking on physician associates. Allowing those associates to be registered is a recognition of their skills. These should be professional qualifications, and I hope that he will refer to that in his summing up.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons) 2:40 pm, 4th May 2016

It is a great pleasure to follow 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 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.

Photo of Richard Graham Richard Graham Conservative, Gloucester

On consultation with stakeholders and so on, does the hon. Gentleman agree that when a hospital like 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?

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

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.

Photo of Rebecca Long-Bailey Rebecca Long-Bailey Shadow Minister (Treasury), Member, Labour Party National Executive Committee

Research from the House of Commons has shown that of the net savings made to the Treasury through measures taken by this Government since 2010, 86% will have come from women. Does my hon. Friend agree that these proposals are no different from those we have seen in the junior doctors’ contract dispute, and that they will adversely affect women rather than men?

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

My hon. Friend makes a very important point. It is important to remember that, and to think about how the prospect of paying off more than £100,000 worth of debt affects the calculation of a mature student looking to study a second time to become a mental health nurse. It is important to think about how a lone parent, who is hoping to become a midwife, might feel the pressure of £59,000 of repayments when considering the future of their family—that is the latest estimate of debt from the Royal College of Midwives.

It is important to wonder how a nursing student, taking part in a 48-week extended course, is expected to find part-time work to make their studies viable. Not only is the Government’s evidence base desperately weak, but research by the Higher Education Funding Council for England tells us that poorer students, lone parents and BME students—the demographics of many of the people attracted to nursing—are disproportionately dissuaded from applying to university by the prospect of large debts.

The policy fails on two fronts. The refusal to engage with experts in the field has led to a misguided policy that makes healthcare education the privilege of those who can afford decades of debt. It fails to ensure fair and equal access to healthcare education. Secondly, there is a real danger that this policy will fail to achieve its own aim of attracting future students. Everyone in health who knows about these issues will acknowledge the shortages of nurses, midwives and other health professionals, but moving the burden of payment to students is widely seen as a mistake. Deterring potential candidates by promising a lifetime of repayments immediately on graduation cannot be the answer.

I conclude by joining the calls of the Royal College of Midwives and the Royal College of Nursing for the Government to rethink the proposals and to scrap the NHS bursary. We need a thorough and inclusive consultation process so that those with experience of the system are able to contribute properly. I ask Ministers to ensure that future students at Manchester University’s School of Nursing, Midwifery and Social Work are not forced to bear the burden of a Government unwilling to listen. The Royal College of Nursing has said that the Government have not thought hard enough about the risks. Now is the time to do so.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale 2:49 pm, 4th May 2016

It is an absolute pleasure to follow Jeff Smith, and I congratulate the shadow Health Secretary on securing this debate as it highlights the current pressures that we are facing in the NHS. We start with 20,000 nurses and we lose 3,000 a year. Perhaps that is where the Migration Advisory Committee report gets its figures from when it says that we need to plug a gap of 3,000 places. The Government say that we need 10,000 new nurses a year. In stark terms, those figures show that there is a loss percentage, so perhaps we can work out how many people drop out and what it costs, and use that money in the NHS by putting it back into an apprenticeship scheme such as that proposed by the Government. It seems that the magic figure of 3,000 plays into the Government’s thinking about creating 10,000 new nurses.

The Opposition say that we lost 2,400 nurses under the previous Government, whereas the previous Government said that we have 3,000 more. Which is correct? The truth is that both are: it depends when we take the measurement. If we measure from election to election—that is, from May 2010 to May 2014—we find that the Prime Minister was correct to say that we have 3,000 new nurses. We also take into consideration health visitors and midwives, and physiotherapists to an extent. The Opposition say there was a drop of 2,400 between September 2010 and September 2014. Believe it or not, recruitment and loss are seasonal.

We have to be grown up and address these concerns. How do we do that? The answer is, quite simply, through reform. We must open up instead of having the fixed bursaries whereby we attract in the region of 20,000 nurses a year but lose 3,000 a year. I say this with all due respect to the Opposition, but under the previous Government the Opposition said that reforming education would deter people from all backgrounds—I would not say “disadvantaged” backgrounds—from going to university. I did not go to university, but my son is at university and is the first member of my family ever to go to university. That is an aspiration, and an accolade. Here we are, five years down the line, with 10,150 new places since 2010 for students going to university. We must open up that philosophy for the NHS.

What is the difference between a student nurse starting on £21,000 or thereabouts a year and a junior doctor starting on £26,000? Nurses are as valued as doctors in the NHS; I certainly feel that. Why do some have bursaries, even though we are not attracting the numbers, and why do some not have them? My own trust, which is in difficulty at the moment but has already overcome many difficulties and is out of administration—it should be praised for that—has been abroad recruiting nurses, but we could get the nurses by taking away the bursary scheme and opening it up to academia, trying to get more people in from inside the system through apprenticeships. That could plug the gap and allow us to have home-grown skills and jobs here.

Reform will plug the gap and solve the skill shortage. It will also be fair in bringing nurses into line with doctors in the profession. Mature students who want to go into the vocation of nursing and be correctly accredited through the academic route will see that as a good starting place for a career that starts at £21,000. In all honesty, the career path does not end at £21,000; it goes up the pay scale, as it does for doctors.

In conclusion, I thank all colleagues for this measured debate. This is a subject that we need to address on both sides of the House.

Photo of Wes Streeting Wes Streeting Labour, Ilford North 2:53 pm, 4th May 2016

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, 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.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health and Social Care Committee

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?

Photo of Wes Streeting Wes Streeting Labour, Ilford North

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.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale

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

Photo of Wes Streeting Wes Streeting Labour, Ilford North

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 that there will be 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.

Photo of Peter Lilley Peter Lilley Conservative, Hitchin and Harpenden 3:03 pm, 4th May 2016

It is a pleasure to follow on from Wes Streeting, who made a thoughtful speech and highlighted an important point about the different study load of those training to be nurses, compared with some of us when we were at university. I do not think that that invalidates the Government’s proposals, but it is an important point to take into account.

Like the hon. Gentleman, I congratulate the Opposition spokesman on calling the debate, which has been an important one, and I congratulate the Minister on a characteristically thoughtful, reasonable and lucid response to it. I cannot help observing that the debate demonstrates the value of having people in this House who come from genuine professions, rather than having reached here purely as a result of being political professionals. There has been considerable input from those who have studied, worked or been in the national health service.

Although it is an Opposition debate, there are some points that we can all agree on. First, we should agree that we need to recruit, train and retain enough nurses to staff our health service to meet the needs of the British people. Secondly, we can agree that it is wrong—morally wrong—to rely on recruiting nurses from poor countries, who have had to bear the cost of their training, to meet our failure to train enough nurses ourselves. Thirdly, we should not be turning away British people who want to train as nurses when we need more nurses. Surely all of us can agree on those three points. We can debate how best we finance the recruitment, retention and motivation of sufficient nurses in this country, but we should all agree that that is the objective.

My initial interest in this topic came a couple of decades ago and resulted from my first career as a development economist working in Africa and Asia. I discovered while I was in the House that we were denuding Africa of nurses. We had recruited more than one in eight of all the nurses in sub-Saharan Africa and brought them to this country. That could not be right. I lobbied against it and the then Prime Minister promised that there would be no active recruitment from Africa, but seven years later I discovered that we had recruited another 60,000 nurses. We were continuing to recruit at several thousand a year, but we were promised that that would cease.

What I blame myself for is that it took me so long to realise that the problem did not lie so much in recruiting from Africa and other poor parts of the world as in our failure in this country to train enough nurses of our own. I did not ask why we were not doing so until I was talking to people in my local NHS, who told me that they were recruiting abroad, mainly in southern Europe but also in Asia, and they were doing so despite the fact that they would have preferred to recruit and employ nurses from the University of Hertfordshire, whom they described as excellent, well trained and in every way desirable. I asked why they did not recruit more, but they said that they could not recruit enough. Even if they recruited the next several years’ worth of output, that would not meet the needs of Hertfordshire’s health service, which is why they were recruiting abroad.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

Does the right hon. Gentleman agree that it is ironic that through our international aid programmes we are assisting developing countries to pay for trainee placements in clinical establishments such as hospitals abroad, yet we do not afford the same rights to our NHS trainees here?

Photo of Peter Lilley Peter Lilley Conservative, Hitchin and Harpenden

It is certainly bizarre that we pay African countries to train nurses and promptly recruit them to come here, so we are getting them cheaply trained abroad. I do not mind particularly the manner in which their training is financed.

The problem faced by my local NHS was that it could not get enough nurses from the University of Hertfordshire. I spoke to the University of Hertfordshire, which said that there was no lack of applicants—it turned away three quarters of applicants to its highly regarded nursing courses—but it was not allowed to expand. It had taken me decades in this House to realise that we had a system that limited the number of people we were recruiting. I duly lobbied the Government, and it may be because of my lobbying that we now have this proposal for bursaries, though I suspect the Government reached the decision on their own evidence.

The sad truth is that successive Ministers of all parties—we should recognise that—have bucked the question of how we train enough people in this country. Ministers tend to have a time horizon of roughly the time it takes to train a nurse, so why put up with diverting resources into training when the output of extra nurses will come after they have ceased to be Health Ministers? I am glad that this Secretary of State for Health and his fellow Ministers have addressed the question. However, we should recognise that it is symptomatic of a wider problem across British business in both the private and the public sector that we have a culture that does not put enough emphasis on training. It is particularly bizarre that we allow unlimited numbers of people in universities to study art history and media studies—very valuable subjects—but restrict the numbers who can train to be nurses, when we know we have a crying and desperate need for more.

I am agnostic about the best way to finance the training of more nursing recruits. Clearly, if nurses bear the extra cost, that will have to be reflected in some way in their remuneration. The Minister told us that they will actually be no worse off, so I suppose the assumption is that they will not have to repay much of their loans. It is a somewhat artificial feature of the public finance rules, but it is a feature of them, that perhaps the only way of not borrowing the money from the public ourselves is for the nurses to borrow it and for us then to write off their loans. However, whatever the financial system—the end of bursaries and their replacement with loans is probably the only option—we have to pay nurses enough in the long run to recruit, retain and motivate them.

There is one other issue we should look at before we close the debate. There are 200,000 trained nurses who maintain themselves on the register at their own expense, but who are not currently working in the NHS or elsewhere—they may be taking time off to raise a family, and they may be thinking about coming back some time. We must be much more flexible and creative about providing patterns of work that meet the family needs of those trained, valuable, caring and experienced people if we are to bring them back into the health service. That, too, will help to meet the needs of the health service, as the Government are trying to, sensibly and wisely, in the measures they have brought before us to replace bursaries with loans.

Photo of Colleen Fletcher Colleen Fletcher Labour, Coventry North East 3:11 pm, 4th May 2016

I am grateful for the opportunity to contribute to today’s important debate. This is the second time I have raised concerns about the Government’s plans to scrap NHS bursaries in favour of a loans-based system for nursing, midwifery and allied health profession students, and it follows my contribution to a Westminster Hall debate on the same subject in January. I do not propose to reiterate in their entirety the arguments I put forward; instead, I intend to make just a few brief observations on the Government’s proposals, which have been roundly condemned by students, trade unions and professional bodies alike. They have been described by one of those bodies—the Royal College of Nursing—as “high risk”. The proposals are high risk because they take a significant gamble with the future sustainability of the NHS workforce. There are several reasons for that.

First, the proposals have the potential to deter many committed and talented prospective students from pursuing nursing, midwifery and allied health profession degrees altogether. That is due primarily to concerns over the huge level of debt associated with the change to a loans-based system. That is particularly true for more debt-averse mature students, who may have young families, caring responsibilities and a mortgage to pay, and for those for whom healthcare is a second degree.

There is a considerable problem with recruitment and retention of staff in the NHS, and the Government’s plans are likely to exacerbate that problem, so impacting adversely on the future security of the NHS workforce. This is at a time when we have an ageing and increasing population, which will require more, not fewer, front-line healthcare professionals.

Secondly, the proposals do not take into consideration the fact that nursing, midwifery and allied health profession courses are very different from most arts and science degrees. These courses are much longer, with shorter holidays, and they offer fewer opportunities for students to supplement their incomes, as people are required to spend a significant amount of time working with patients in clinical practice, with a requirement to work irregular and long evening and weekend shifts as standard. Effectively, the Government’s proposals will mean that these students—the individuals who keep our wards running and who are involved in life-and-death decisions on a daily basis—are forced to pay for the privilege of undertaking often physically and emotionally demanding work in the NHS.

Thirdly, the proposals seek to replace the bursary system, which has, for some considerable time now, fostered strong and enduring links between healthcare students and the NHS right from the start of their course. The Government propose severing that link, which risks reducing students’ loyalty to, and the attractiveness of, the NHS as a potential employer.

Those are just a few of the reasons why the Government’s plans are so high risk. There are, of course, many more, some of which have been eloquently articulated by others in the House today. I conclude by urging Ministers to drop their proposals and instead work with trade unions, professional bodies and, most importantly, the dedicated individuals who work in the NHS—the nurses, midwives, physiotherapists, speech and language therapists, occupational therapists, dieticians, radiographers, chiropodists and podiatrists—to find a fairer, more sustainable and effective funding solution.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire 3:15 pm, 4th May 2016

May I start by declaring my interest as a member of a healthcare profession allied to nursing?

Two thirds of those who apply for nursing school places are rejected and have to look at other trades or professions—that is tens of thousands of people every year. Despite the comments of some hon. Members, those are good, high-quality applicants. I took the trouble of looking at the entry requirements of the three universities that accept adult candidates on to general nursing degree courses in the south-west—Bournemouth University, the University of the West of England and Plymouth University. The typical offer is 300 UCAS points—three Bs at A-level—so there is not a shortage of applicants who are academically well-qualified and, indeed, qualified in every way. Lots of young men and women who wish to study nursing and to be nurses are being turned away.

That is a double tragedy because we have a gross shortage of nurses in this country, and nothing I have heard from the Opposition gives me any confidence that they have any plan as to how we are to satisfy the two imperatives of allowing those who want to study nursing to do so and of plugging the shortage in our national health service. At the moment, I am afraid, we are able to deal with that issue only because nurses from overseas are prepared to come here—nurses, very often, from countries that can scarcely do without them.

Historically, student nurses have been an intrinsic part of the NHS workforce. My hon. Friend Dr Wollaston will remember, as do I, that they were essential to the working of hospital wards, and one or two of the good points made by Opposition Members revolve around that issue. The question is whether, in this day and age, we are still heavily reliant on that workforce for the proper functioning of hospital wards. If we are, there is a good case to be made for allowing for that in the bursary arrangements for student nurses, because it is simply not right to expect those people to do service work and not be compensated in some way for it. I hope very much that that strand of thought will be taken up as part of the consultation.

However, the fact remains that as part of Project 2000 in the 1990s, the nursing profession decided to move away from a hospital-based training structure to a structure based around universities—that was driven by the profession itself. The debate we are having today is part of that process—the process by which nurses become graduates, in exactly the same way as anyone else, including those who are preparing, for example, to teach in schools.

When we design the finances for student nurses, it is of course important that we understand the difference between a nursing degree course and a normal degree course, as it were. We must also accept that this is a graduate profession, and that it is not right to try—as I think Heidi Alexander, who speaks for the Opposition, did—to distinguish between graduates and to say that one graduate is more worthy than another. She may have in mind a view of a typical graduate, but those graduates are also potential teachers, engineers, biomedical scientists, and all the rest. We start down a very difficult path if we try to hold up one graduate as being superior morally, or in some other sense, to others. That is a very difficult thing to sustain.

I very much support the notion of a nursing associate. I am old enough to remember state-enrolled nurses. These were nurses who would not satisfy the entry criteria for a course leading to state registration but wanted to be members of a caring occupation. Naturally enough, nursing associates will not be SENs revisited, because we now live in a very different age, but there is surely a place within healthcare and our national health service for a group of people who may not want the academic rigour that goes with a nursing degree—or indeed be fitted for it, at their stage of life—but who nevertheless want to nurse, and to enter an intrinsically hands-on, caring occupation. The important difference, though—this is where SENs, I am afraid, suffered so badly all those years ago—is that there must be a sufficiently pervious system to allow nursing associates, if they want to and have the necessary skill sets, to enter a professional nursing stream. It was a tragedy that so many well-qualified SENs were unable to develop their careers in that way. I hope that as we design the future for nursing, we keep that very much in mind.

A few hon. Members have commented on workforce planning. Historically, the NHS has been absolutely abysmal in this regard, and we need to do much better in future. We need to avoid unintended consequences of the changes that we are making. We need to ensure that the £21,000 threshold that would apply for nursing graduates does not mean that people are inclined to avoid it by working part time where they might otherwise work more full-time hours. That would be a great disservice to the overall workforce.

The 10,000 new places created must not be denuded by our offering them to applicants from overseas, because that would not be in the interests of our national health service. We need to understand that nursing graduates may be tempted to migrate as a result of the introduction of these fees. I ask the Minister, in his consultation, to think of all the unintended consequences that may develop, given our general historical tradition in this country of doing health workforce planning so abysmally.

Photo of Nicholas Dakin Nicholas Dakin Shadow Minister (Education) 3:22 pm, 4th May 2016

It is a pleasure to follow the thoughtful contribution by 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 Mr Lilley said, and about how, if we lose 3,000 nurses a year, as David Morris said, we try to keep them. That is a big issue, as well as how we recruit and retain them.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale

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

Photo of Nicholas Dakin Nicholas Dakin Shadow Minister (Education)

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 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.

Photo of Mark Spencer Mark Spencer Conservative, Sherwood 3:30 pm, 4th May 2016

Welcome to the Chair, Mr Deputy Speaker. I am glad that your first act has been to call me to speak.

It is a pleasure to follow Nic Dakin, for whom I have a great deal of respect. He always speaks with credibility and from experience. I am more than happy to acknowledge that there are many colleagues in the House with more experience than I have of working in the NHS, particularly my hon. Friends the Members for South West Wiltshire (Dr Murrison) and for Totnes (Dr Wollaston). My experience is as a customer or as a relative of someone who has been treated in the health service. I have to say that, to date, my experience has been nothing but positive. The treatment that our NHS continues to deliver to our nation is the best in the world, and Government Members can be immensely proud of that.

One of the things that I find most frustrating about our debates on the health service is the fact that the Opposition seem to think that they have a monopoly on caring for the NHS. Nothing could be further from the truth. Conservative Members care deeply about our health service and we do everything we can to support it.

It is worth saying that every Labour party election leaflet since the second world war has said, “We’ve got 24 hours to save the NHS before the Tories come into government.” It repeats that message every time. If we look at the facts, however, we will see that the truth is that the Prime Minister was the only party leader to enter the 2010 general election saying that he would protect the NHS budget. Others did not. In 2015, the Prime Minister was the only party leader who committed to the extra £8 billion support funding for the NHS when other Opposition parties would not back that figure. Today that figure has increased: this party is now backing the NHS with an extra £10 billion. We are also delivering on the aspiration of people like me, who are either customers or relatives of people who use the NHS, to get a high-quality service seven days a week.

Whenever we debate this issue, the difference between the two parties is one of credibility. The only way we have been able to deliver the extra £10 billion of funding to the health service is by having a credible economic plan that stands up to scrutiny. The great British public understand that and what it means to have a credible plan that can be delivered in government.

As a number of colleagues have said, we agree on a lot of things. No one can deny that both the Government and the Opposition acknowledge that we need more nurses, but we differ on the credible plan to deliver them. Members on both sides of the Chamber have made speeches today acknowledging the need to deliver extra nurses, but it is only Government Members who have a credible plan to make it happen. We cannot just hope it happens, or state that it will happen, without saying where the extra money will come from. The consequence of that would be to withdraw cash from front-line services, such as existing doctors, nurses, operating theatres and wards, and put it into training.

If we want to increase the number of nurses coming into the NHS, we should not restrict the number who can be trained. It seems obvious that the way to raise the number of nurses is to lift the artificial cap on the number that we can train. I welcome the fact that the Government are considering and consulting on their options and looking to ensure that there is no artificial cap, so that we can train as many people as are inspired to go into the nursing profession.

I reiterate my admiration for those people. People leaving full-time education enter nursing not because they want to be rich but because they care and they see it as a vocation. We need to support people who have that calling and who aspire to look after those in society who find themselves ill and in need of support. We must find a system that allows them to aspire to that, whatever their background and wherever they come from. They must be able to go through their training and reach the point where they can follow their vocation.

The arguments that are being deployed against the Government’s suggestions appear similar to the ones that we heard about student loans. We were told that those from a deprived background or from more challenging areas would be put off and would not be able to find a way through the system. We need to reflect on the evidence, which shows that the opposite has happened—the number of people from challenging backgrounds going to university has gone up, even though we were told that they would not be able to go.

At the end of the process, we need an NHS that can adapt and change. There is enormous social pressure on it, and there is the challenge of getting a balance between adult social care and healthcare as society gets older. When cash is short, we must spend it on front-line services—on the doctors, nurses and drugs that can improve the lives of people who need the support of the NHS. I look forward to the consultation, and I know that the team in the Department of Health will look at the responses. I hope that we get to the right place, and that we have more nurses at the end of the process.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West 3:37 pm, 4th May 2016

I am pleased to hear that Mark Spencer values the NHS so highly, but he might like to reflect on the fact that the coalition Government legislated to allow all NHS hospitals to make up to 49% of their money from private patients. Perhaps he will review his opinion of his party’s performance when he starts to see the number of private patients in his local hospital increase and the number of NHS patients decrease.

The Royal College of Nursing and the Royal College of Midwives are concerned that abolishing nurse bursaries and free tuition will break the historic link between the NHS and trainee nurses. I share their concern, and I believe that the Government’s proposal is part and parcel of wider changes that they are seeking to make to the culture of the NHS. They are turning the emphasis away from training people to be part of the NHS family, in which they can work with dedication throughout their working lives, towards training them to work in a fragmented health marketplace. If the plans go ahead, the nurses of the future may no longer feel the same obligation to work in the NHS and could be more inclined to work abroad or in private hospitals to pay off their debt. Who could blame them? They will feel that the Government have deserted them.

The Minister was unable to tell us what the average repayment would be, so I will let the union Unison give him the answer. It states that debt repayment will effectively mean a pay cut of more than £900 a year. The question arises of whether the changes will deter people from training to be nurses in the first place. The Royal College of Nursing and other bodies such as the Royal College of Midwives, the College of Podiatry and the Royal College of Speech and Language Therapists think that they will. The Government’s own consultation document estimates that a trainee nurse who takes out the maximum tuition and maintenance loans for three years will graduate with debts of between £47,712 and £59,106. Who would want to embark on a lifetime of caring for others with a debt of that size?

That brings us to the concern that the measures will lead to further shortages. We are all aware of the shortages in our hospitals. The coalition Government allowed the number of training places to fall from more than 20,000 to just 17,000 in 2011 and 2012, the lowest level since the 1990s. As a result, over 8,000 fewer nurses were trained in the 2010-15 Parliament compared with 2010-11. Those cuts in training places have meant that nurse numbers have failed to keep pace with demand. According to calculations by the House of Commons Library, the number of nurses per 100,000 population has fallen from 679 in 2009 to 665.

There are real concerns that removing NHS bursaries will only make matters worse. As was mentioned by my hon. Friend Nic Dakin, the independent 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. In addition, the reduction of net pay in the early years, as nurses repay their loans, will make the employment package and medium to long term reward offer an important factor in attracting high calibre students who are choosing between courses and career options.”

The Secretary of State should definitely focus on that.

The Royal College of Nursing is also concerned that there is a risk that the changes could result in an uneven distribution of students across nursing specialties and geographically across the UK. Health Education England currently commissions student places for four branches of nursing: adult, children, learning disabilities and mental health. Without workplace planning by a central body, there could be insufficient numbers across the four branches, as some may be more popular than others. There has been no indication of whether there will be any control over which sectors nurses train for in future or whether that will simply be determined by—of course, under this Government—the market. That could leave some sectors with even greater shortages than at present.

Tuition is currently paid for by Health Education England. Under the current system, no students have to pay tuition fees and fees are not means-tested. Students also receive a non-means-tested grant of £1,000, or £1,000 pro rata for part-time students. Students also qualify for a maintenance grant or bursary, which is means-tested, as well as additional allowances when a term lasts longer than 30 weeks, and help with the costs of clinical placements. I believe that that is the appropriate way to deliver NHS nurse training. If we are to continue to have a state-run public NHS, free at the point of need, we must continue to provide bursaries for our NHS nurses. It is the very least that we owe them.

Photo of Helen Whately Helen Whately Conservative, Faversham and Mid Kent 3:42 pm, 4th May 2016

If we ask any patients about their experience in hospital, one thing they are sure to talk about is the nurses who looked after them. In doing so, they are usually talking about both nurses and healthcare assistants—in my experience, patients do not tend to make a distinction. We know that nurses have far more interaction with patients, day to day, than with doctors. Nurses’ quality and time are absolutely critical to patients’ experience.

Nurses are also critical to outcomes for hospital patients. Good nursing can be the difference between life and death. We have known that since Florence Nightingale, we were reminded of it by the inquiry into Mid Staffordshire and the Francis report, and we can see it from recent research into stroke outcomes. It will be clear to anyone who has looked at how Salford Royal has such good outcomes and such a good reputation—a lot of that is because of the focus on extraordinarily high standards of nursing.

The excellent NHS that I believe we all want needs excellent nurses. It also needs enough of them. This afternoon, people have talked about how we need something in the order of perhaps 10,000 to 20,000 more nurses—the numbers range widely. We also know that we need a shift in nursing skills, as we will need more nursing care for older people and people with long-term conditions, as well as more mental health nurses.

Right now, however, there are not enough nurses in our system, and hospitals across the country have vacancies. We know that they use large numbers of agency staff, and international recruitment is important to many hospitals, including those serving my constituents in Kent. I am not confident that more of the same will solve the problems, and neither was the nursing department of a London university that I spoke to last year. It said that it needed more funding per nurse place, but recognised that asking for more money for their nurses could mean taking money from front-line care in the NHS. That was not a good answer, and the department was open to a new funding model.

Last summer, the Council of Deans of Health and Universities UK stated that the

“current funding system is no longer working for either students or universities.”

Universities have to subsidise the cost of nursing and physio degrees from other courses, and NHS-funded nursing students have less to live on than others, even though they often study longer, more intense degrees with more hours, and are therefore even less able to do other work outside their qualification. We know that we need more nurses, and that the current funding system is not working.

How should we get more nurses? Around 2008-09, when plans were being drawn up for the Centre for Workforce Intelligence, I remember hearing that the answer was better workforce planning, with lots of skilled experts doing fabulous modelling of future workforce demands. I remember being a sceptic about that then, because when we consider the history of the NHS, and systems around the world that have centralised planning for the healthcare workforce, we find that it is almost always wrong. There are periods of over-supply and of under-supply—right now, we are in a period of under-supply, with all its knock-on consequences. Doing things better and having more experts sounds great in theory, but in practice we have seen that it does not work.

A much better answer is to set universities free to offer more places to all those students who, as we have heard, want to study nursing but are currently being turned away. I hope that we will have more nursing applicants, and that that career will become even more attractive, particularly as universities work more closely with employers on what is needed, and we must consider more of the specialist skills and expertise required within nursing by our care system now and in future.

To do that we must uncouple the funding of nurse training from the NHS, and take away the constraint that every £1 spent on training an NHS nurse is £1 potentially taken from front-line care, because that puts a premium on avoiding excess nurses. That is the right direction of travel, and it is also important to increase maintenance grants for nurses so that they do not struggle with their living costs as currently happens. There should be more routes into nursing. The nurse associate role is welcome, as is the apprenticeship route so that nurses can work and train in parallel. We know that that is appealing to more mature students who need an income and who want to be more hands-on during their training, and for whom a university environment has less appeal. Having worked for some time with healthcare assistants, I would like more recognition to be given to their role and qualifications, and I recognise the opportunity to support them even more to train to become qualified nurses.

We must invest more in continuous professional development for nurses. We know that we need a more flexible workforce that can adapt to future demands, yet in times of financial pressure, the investment and time given to ongoing training are often squeezed. Let us use this opportunity to try to shift that balance, and repurpose the workforce to meet the system’s demands and needs.

I would also like more attention paid to the appeal of nursing and the experiences of nurses in work. I have heard many nurses on the frontline say, “This weekend, I’ll be on my own—I will be the only permanent nurse on this ward. I will be working alongside agency nurses who do not necessarily know this ward, and it will make this weekend really difficult.” We badly need to put an end to that. The only way to do that, alongside the ongoing work to reduce the use of agency staff, is to increase the number of nurses who have been trained to work in the NHS.

I am out of time, but to sum up I think the direction of travel is absolutely right. Let us make sure that we get the details right on how the proposals are put into practice.

Photo of Gavin Newlands Gavin Newlands Scottish National Party, Paisley and Renfrewshire North 3:50 pm, 4th May 2016

I am pleased to be able to contribute to the debate; I only hope that my somewhat scratchy throat holds out. With that in mind I have curtailed my remarks, and, with apologies to colleagues, I will not be taking interventions.

My contribution today marks the third occasion on which I have spoken on this issue and called on the Government to keep the NHS bursary for students in England who are studying to become the next generation of nurses, midwives and allied health professionals. The bursary is absolutely vital to ensure enough people are able to start and complete a nursing degree: the Royal College of Nursing and the BMA say so—and, perhaps more importantly, my sister says so. Luckily for student nurses in Scotland, the Scottish National party also says so.

I am very much aware that this debate is about the removal of the bursary offered to students in England; however, the SNP has said that it will be an ally to progressive voices in this place fighting Tory austerity. The Scottish Government provide bursary support, and will continue to do so. We want that same level of support to be offered to all eligible nursing students, regardless of where they study. As well as receiving representations from my sister, I have met nursing students based at my local university, the University of the West of Scotland. UWS helps to train and educate 4,000 nursing students, one of the largest cohorts in Scotland. It does a fantastic job in helping to equip tomorrow’s health workers with the skills, education and qualifications they need when working on the ward.

It has been over five months since I posed a question on this very issue to the Chancellor, when he stood in at Prime Minister’s questions. Unfortunately, his answer did not provide the commitment that nursing students were demanding. After a few months of contemplation, and notwithstanding the Health Minister’s opening remarks, I urge the Chancellor and his party colleagues to consider abandoning their plans to remove the NHS bursary.

The Royal College of Nursing, which has a membership of about 435,000 nurses, midwives, health visitors, nursing students and healthcare assistants, has made representations to the SNP, outlining its complete opposition to the Government’s plans. It must be highlighted that it is not only students in England who are pleading with the Government to abandon their plans. The vast majority of other medical professionals, students and workers in Scotland are demanding that the NHS bursary package is retained.

It is important to understand why nursing students receive a different funding settlement from other students’. I know only too well the long hours my sister and her colleagues spent studying when she was at university. Nursing students study and work longer hours on their course than other students. They spend a considerable amount of time on the ward, learning alongside fully qualified nurses and other health professionals. I am aware that the students value the time they spend working in hospitals and I also know that they are put through their paces while on the ward. Replacing the bursary package with a maintenance loan will effectively mean that students are paying the Government for the privilege of working when on placement.

We need to be mindful that the majority of our nursing students are women who are older than the typical student. The RCN suggests that the average age of nursing students is 29 and many have caring responsibilities. In addition, it is not uncommon for these students to work part-time, alongside studying and despite the particular demands of the course. It is only right and proper that they should have a funding support package that meets their particular circumstances. As we have heard, a coalition including Unison, the National Union of Students, the Royal College of Midwives, the British Dental Association and others, states that the new system will lead to students accumulating debt of £51,000.

Many dream about working in our NHS. Instead of putting roadblocks in their way—let us be clear: the removal of the NHS bursary will deter people from choosing to study to become a health professional—we should be looking to incentivise and encourage people from all backgrounds to consider a career in our NHS. This point was made by the Royal College of Midwives, which said:

“The cuts are likely to deter many potential students from entering the profession which is not good news for the future of midwifery in the UK...The axing of student bursaries will inevitably make midwifery an unattainable and less attractive profession to thousands of potentially excellent midwives that our maternity services so badly need.”

The Chancellor and the Health Secretary may claim that the current system is unaffordable, but I disagree. I encourage them to look at the Scottish Government for guidance on how to support the health workers of tomorrow.

In contrast to the UK Government’s desire to abolish bursary support for nursing students, the Scottish Government will provide over £6,500 to them. The UK Government previously operated a means-tested system; the Scottish Government will continue to offer the bursary to all of these students—without means-testing. Where the UK Government sanction charges of up to £9,000 a year for a university education, the Scottish Government have preserved the right of a free education. Where the UK Government work against the health service and education partners, the Scottish Government work with these bodies, in partnership, to ever improve on the education and health services that exist in Scotland.

There are 41% more qualified nurses and midwives per head of population in Scotland than there are in England. Yet despite that, we have committed to increase nursing and midwifery student numbers by 5.6% in the next academic year. On average, there are 1,000 extra nurses in training in each and every year in comparison with the previous Scottish Executive.

The Government need to stop attacking the health service and those who work in our wards and clinics. If the Prime Minister is serious about running a one nation Government, he needs to listen and engage with the concerns being raised by nursing students and others right across the health and university sectors.

Photo of Daniel Zeichner Daniel Zeichner Shadow Minister (Transport) 3:55 pm, 4th May 2016

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.

Photo of Wes Streeting Wes Streeting Labour, Ilford North

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?

Photo of Daniel Zeichner Daniel Zeichner Shadow Minister (Transport)

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.

Photo of Justin Madders Justin Madders Shadow Minister (Health) 4:02 pm, 4th May 2016

This has been a high-quality and comprehensive debate. I have to say that I have a small amount of sympathy for the Minister for Community and Social Care, because, as we all know, this policy was not devised in his Department, but hastily put together on the back of a fag packet somewhere in the Treasury following the Chancellor’s £2 billion raid on the Department of Health budget. It looks very much like a case of “Cut first and ask questions later.” I say that because in just two lines of the autumn statement, with no consultation and no evidence base, the Government have committed themselves to a huge gamble with the future of the NHS workforce and with patient safety.

I pay tribute to my hon. Friend Wes Streeting for leading the campaign with his early-day motion. His record in this area is unparalleled. He explained expertly why many student nurses are in a different position from that of other students, and expressed the concern that he and many other Members feel about the deterrent effect that the Government’s proposals will have on future numbers. Other Members spoke in similar vein, including my hon. Friends the Members for Manchester, Withington (Jeff Smith) and for Coventry North East (Colleen Fletcher), as well as my hon. Friend Nic Dakin, who pressed the Minister on what estimate had been made of the number of loans that would be written off. He did not receive a reply; I trust that the Minister for Community and Social Care will be able to fill in the details.

My hon. Friend Margaret Greenwood, who came to this place with a strong reputation as a health campaigner, spoke with great authority about the pitfalls of the proposals. My hon. Friend Daniel Zeichner, who also has great experience in this area, asked a very pertinent question about the capacity of the health service to take on the extra students. The Chairman of the Health Committee, Dr Wollaston, made an important contribution, and I hope that the Minister will respond directly to some of the very real concerns that she raised.

The Government are presiding over the worst A&E figures since records began, the biggest financial crisis in the history of the NHS—three quarters of trusts are now in deficit—and a crisis in morale across the workforce, with a Secretary of State too belligerent to listen. They have already alienated a generation of junior doctors, and now they risk doing the same for our future nurses and midwives, as well as many other health professionals. Why are they looking to unsettle a huge section of our NHS workforce at a time when good will is more important than ever?

We have several concerns about this policy, many of which hon. Members have aired today and to which the Government are yet to give any credible answer. First, let us look at the actual problem the proposals are trying to address—not the black hole created by the Chancellor but the shortage of nurses in the NHS. Be in no doubt, the Government are entirely responsible for that shortage, because they decided to reduce the number of nurse training places. Had they maintained the level set by the last Labour Government, 8,000 more nurses would have been trained in the last Parliament alone. When we hear, therefore, about spiralling agency costs and staffing shortages, let us remember the cause—not the nurses, the trusts or the patients, but the Government’s chronic mishandling of the NHS.

The proposal, with all its risk and uncertainty, will, in the Government’s most optimistic scenario, deliver 10,000 more nurses, midwives and other health professionals. When they say the proposal could deliver up to 10,000 more staff, they really are looking at the glass half full. The figure comes with so many caveats that, if it were a used car, I would not even take it for a test drive. The Government’s own equality assessment acknowledges that there could be an adverse impact on parents and carers and that childcare costs could have a significant influence on participation. It is worth picking up a few quotes from their impact analysis and evidence document, to get a flavour of just how flaky the proposal is. It says that the

“precise impact is difficult to estimate with certainty”, that “Behavioural change is uncertain”, that

“there may be some uncertainty over applications in the very short term” and—my favourite—that there

“is no robust set of information to make this assessment.”

In other words, the Government are saying they have done an assessment but have absolutely no idea what the impact of the policy will be. If that does not amount to a huge gamble, I do not know what does.

If the Government will not take heed of their own assessments, they might listen to the Royal College of Nursing, which has said that

“there is a risk of people being put off from applying to nursing degrees, because of concerns over debt.”

It, like many Members, is particularly concerned about the impact on mature students. As we have heard, the average age of a student nurse is 28. The RCN has said:

“There is a worrying lack of assessment of the potential for the changes to act as a disincentive for some students, such as mature students or those from lower income backgrounds.”

Research by the trade union Unison shows that nine out of 10 student nurses surveyed said they would not have gone into training had the new proposals been in place. That is not a trivial number. If the numbers put off turned out to be even half that, the implications for the NHS would be catastrophic. So where is the evidence to reassure us that it will not happen? There is not any. The Minister prays in aid the experience across the general higher education sector, but he knows that he is not comparing like with like. The evidence from the mature student experience does not support his case. In fact, the Higher Education Statistics Agency says that between 2011 and 2015 the number of mature students fell by 17%.

Let us be clear about what the policy really means for nurses. Owing to the Government’s reprehensible decision to freeze the student loan repayment threshold at £21,000 from 2017, all future nurses are facing a real-terms pay cut. According to Unison, based on current salaries, the average nurse, midwife or allied health professional will lose over £900 a year to meet their debt repayments. Staff retention is a huge issue across the NHS, including in nursing, and as David Morris rightly pointed out, the Government’s record is poor. Saddling nurses with extra debt will only make the matter worse.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale

I did not say that the Government’s record was poor; I pointed out that we needed reform, which is what we are here to discuss. I am disappointed in the hon. Gentleman’s approach, because we have had a very constructive debate today.

Photo of Justin Madders Justin Madders Shadow Minister (Health)

I thank the hon. Gentleman for his intervention. If he is stating the facts, then I interpret them as being a poor record for the Government; that is more about the facts than about the way in which he presented them.

Let us be clear: we are talking about a debt that nurses are never likely to pay off. They will graduate with debts of between £50,000 and £60,000. Many of the mature students who take nursing as a second degree will find themselves with more than £100,000 of debt. Let me repeat that figure so that it sinks in: our country is looking down the barrel of a policy that will saddle nurses with a six-figure debt. They are not bankers or lawyers; the people who keep the NHS going will be earning just a fraction of what they earn. We already have the highest level of student debt in the English-speaking world, which is not a record we should be proud of, and these proposals will only make matters worse.

It would be an error to put nurses into the same category as other students, but I think that the Government are making that error. Student nurses’ courses take up much more of the year, meaning that they have much less opportunity than other students to work while they study. They are also required to spend 50% of the time working with patients in clinical practice, including on evening and weekend shifts. That requires a real commitment of at least 2,300 hours over the length of their course, during which they do difficult jobs at unsocial times. Now the Government are asking them to pay for the privilege of doing that. This policy is like some kind of perverse extension of workfare. Last year, there were 10,000 unfilled nurse places in London alone. Is getting people to work for free really the answer to that?

The Government really need to raise their game to improve retention among nurses. The situation has been getting steadily worse over the past few years, and nearly 9% of nurses left last year. Some might have gone to work elsewhere in the NHS, but many have left the profession altogether. Surely sorting that out would provide a more effective solution to our problems than taking a punt on an untested plan. There appears to have been no dialogue with providers, who seem unaware of the oncoming rush. Each student nurse has to be clinically assessed by a registered nurse who has done their mentoring and assessing course, but no assessment appears to have been made of the capacity for trusts to take on those extra responsibilities.

It is clear that this policy, with all its flaws, was announced with no consultation, no engagement with the sector and no evidence basis. With such a high degree of uncertainty, surely it would have been sensible to consult on the principle before embarking on the policy. But not this Government; they know best, even though they do not seem to know their own record in this area. When I asked the Minister a simple written question on how many nurses had qualified in the last five years, I received the following response:

“The Department does not hold information on the number of nurses who qualified in the last five years”.

What an absolute shambles!

Anyone would think that with such a gap in the available evidence, the Government would have gone out of their way to undertake a full consultation and to seek out evidence before announcing the policy, but no. The Royal College of Midwives, the Royal College of Nursing, the Royal College of Podiatry and the Royal College of Speech and Language Therapists are all respected institutions with years of experience and a wealth of knowledge in this area, but not one of them was asked to make a formal input into this policy before it was announced, contrary to what the Minister has said today. When he was asked, in a Westminster Hall debate on 11 January, who he had consulted, he said:

“There has been consultation with leading nursing professionals.”—[Official Report, 11 January 2016;
Vol. 604, c. 237WH.]

He said nothing about the royal colleges. I hope that we shall be able to clear this up. I ask him to tell us exactly who he did consult, and to place in the Library a copy of the advice that he received following the consultation.

Let us not pretend, now that the consultation has been published, that it is a meaningful consultation on the principle or the detail of the proposals. It simply asks a few technical questions on how to implement the changes. You can have any colour you want as long as it is black. It is frankly an insult to the public, to patients and to the profession. The Government should withdraw this proposal and instead commit to a full consultation on how to improve the support available to student nurses, how to increase the number of nurses in the NHS and how to improve retention. I urge all Members who genuinely care about the future of our health service, who have concerns about the potential deterrent effect of these proposals, and who are not prepared to gamble recklessly with our nurses, to join us in the Lobby today and send a clear message to the Government that it is time to think again. I commend the motion to the House.

Photo of Chris Matheson Chris Matheson Labour, City of Chester

Pick that one out of the back of the net!

Photo of Alistair Burt Alistair Burt The Minister of State, Department of Health 4:14 pm, 4th May 2016

And where has Christian Matheson been during the debate? [Interruption.] Oh, I beg your pardon, but that is not as good as being here in on the Floor of the Chamber in real life.

Thank you very much, Mr Deputy Speaker, for this opportunity to respond to the debate. I thank Heidi Alexander for raising the important question of the development and expansion of nurse training in England. I thank colleagues for a good debate, with discussions informed by those with close connections with the NHS, either personally or through family.

I pay tribute to all those who work and train in hospitals, who fill the posts that we have been speaking about, and who are the subject of our debate. They are not only nurses and midwives; several colleagues made specific references to allied health professionals, such as those in dietetics, occupational therapy, orthotics and prosthetics, physiotherapy, podiatry and chiropody, radiography, speech and language therapy, operating department practice, dental hygiene and dental therapy—all important components of the NHS. We recognise the importance of the work done in our hospitals, and we thank them for their effort.

This has been a not unusual debate in which the Government propose changing something and the Opposition react with horror. Whether the Government’s arguments are good or bad, that is how it goes. There have been a variety of Opposition arguments—some good, some less good—but whenever change is proposed, there is a set of reactions. As for the poorest reaction, I say this to the hon. Member for Lewisham East with great sincerity: please do not go down the class route. It was absolutely unnecessary to try to pick out what people might have heard in various places as they were growing up and graduating. I am the son of a doctor and a teacher, so there were public health workers in my household. The sense that I got of public service and commitment was possibly shaped then. I do not think that the experience was any different from that of the hon. Lady, or of Luciana Berger, who had a private education at Haberdashers’ Aske’s School for Girls. I see no evidence in the hon. Lady’s obvious commitment to mental health and everything else that her conversations shaped her poorly in any way. To suggest that the Under-Secretary of State for Health, my hon. Friend Ben Gummer, may not have picked up the same sort of information, and that that may have impacted on his care and work as a Health Minister, was pretty low. The hon. Member for Lewisham East should not go down that road again.

The two main arguments presented today against what we are trying to do have been about deterrents, or the idea that the occupations are somehow unpalatable and that people will not go into them. On deterrents, I am old enough to have been here for the original debates on the introduction of student fees. Everyone protesting against them at the time said that no one would ever go to university again, and that people from poor backgrounds would never go to university. The same arguments come up every time the subject is raised, and the same arguments have been proved false time and again. What is not false is the damage done at the time of the debates when it is suggested to those who want to aspire to higher education, and to take themselves in a different direction, that it will somehow be made impossible, and that they should not want to do it. Those arguments have been used time and again, and they have been used again today. They were wrong then; they are wrong now.

Photo of Debbie Abrahams Debbie Abrahams Shadow Minister (Work and Pensions)

What is unique about this situation, as has been mentioned several times, is that a disproportionate number of the nurses using the bursary scheme enter as mature students, including three of my nieces. If bursaries were not available to them, they would not have gone on to train as excellent nurses.

Photo of Alistair Burt Alistair Burt The Minister of State, Department of Health

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 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.

Photo of Nicholas Dakin Nicholas Dakin Shadow Minister (Education)

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?

Photo of Alistair Burt Alistair Burt The Minister of State, Department of Health

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 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.

Photo of Paula Sherriff Paula Sherriff Labour, Dewsbury

My local Mid Yorkshire Hospitals NHS Trust is, by its own admission, in the midst of a nursing crisis, with about half the wards staffed at below the minimum staffing level for nurses. Does the Minister think these proposals will help or hinder that?

Photo of Alistair Burt Alistair Burt The Minister of State, Department of Health

I say in all honesty to the hon. Lady, who is knowledgeable about health matters and has been to see both me and the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich, that the proposals help. At the moment, the problem with nurse training in this country is that it is limited. The universities cannot take all the people who want to be nurses; they have to turn them away—37,000 of them. This scheme opens up the opportunity for more people to train, and for more people to come into nursing through the nursing associates route. If Paula Sherriff is looking for a straight answer on whether this will provide more nurses and help her local hospital, I can say: yes, it will. That is why these proposals are being made.

I wish to set out briefly the details of the basis for the reforms, just for those who were not able to attend the whole debate, and then answer one or two questions that were raised. To deliver more nurses, midwives and allied health professionals for the NHS, a better funding system for health students in England and a sustainable model for universities, we need to move nursing, midwifery and allied health students from grants and bursaries on to the standard student loans system. Putting more funding into the existing system was not a sensible or viable option for the Government, if we are also to increase the number of student places, live within our budget, and ensure that the NHS can use the extra £10 billion-worth of additional investment for front-line care by the end of the Parliament.

The subjects that we are talking about are extremely popular with students. In 2014, nursing registered as the fifth most popular subject on UCAS, and in that year there were 57,000 applicants for 20,000 nursing places. Rather than denying thousands of applicants a place to study health subjects at university, surely it is better that the new proposals ensure enough health professionals for the NHS, while cutting the current reliance on expensive agency and overseas staff, and giving more applicants the chance to become a health professional. Part of the reason why we need to modernise the funding system is that student nurses, midwives and allied health students currently have access to less money through the NHS bursary than students using the student loan system do. Under a move to the loan system, these health students will receive an increase of about 25% in the financial resources available to them for living costs during the time they are at university.

It is not possible to pick out all the speeches made today, but I would like to make reference to some. Dr Cameron discussed issues affecting postgraduate students, which are important. The majority of healthcare students undertaking these courses will be able to access a BIS postgraduate masters loan, although we acknowledge in the consultation that some courses currently fall outside the BIS postgraduate loan package. We are working with BIS and the Treasury on their higher education and lifelong learning review, and we will address these matters in the Government’s response to the consultation, so she is right to raise that issue.

My hon. Friend Dr Wollaston, the Chair of the Health Committee, said straightforwardly that we need to train more nurses. That is our bottom line; it is what we are trying to do. On transition, she said that it was important to listen to needs, and she spoke about getting more professionals away from the acute sector and into primary care. As she knows, that is a major interest of this Government, and these proposals will help in that regard.

My hon. Friend David Morris was straightforward. He talked about his trust recruiting from abroad, but said that it would like to recruit more at home. It will be able to do so under these proposals.

My right hon. Friend Mr Lilley talked about what he discovered when he spoke to his local university and trust. He discussed the morality of taking more nurses, and student nurses, from overseas. It is important to recognise that our proposal will ease that situation to some degree. He also spoke about the important issue of the Ministers’ dilemma: of whether to put money into training now, knowing that the benefit will come some years later. It is important for any Government to recognise that more money must go into the training of doctors and of the people about whom we are talking today. There will be a return later.

I am conscious of time, and I am sorry that I cannot cover more speeches. Let me say this: the NHS never sleeps or stays still. As our country changes, so does the NHS; it must. It is always comforting to resist change, even when the status quo is not good enough; however, the need for innovation, which will be challenging and resisted, is imperative. This Government have given the NHS that commitment, and we will promote the finance, planning and innovation that were denied by the Opposition. We will not allow so many people to be denied the opportunity of becoming a nurse. We will not allow those on hardship funds and bursaries to fail to get access to more finance. We will not allow them to be—

Photo of Alan Campbell Alan Campbell Opposition Deputy Chief Whip (Commons)

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put.

The House divided:

Ayes 158, Noes 277.

Division number 263

See full list of votes (From The Public Whip)

Aye

No

Question accordingly negatived.