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The new cost of patient care

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RCN chief executive Janet Davies at the bursary pr RCN chief executive Janet Davies at the bursary protest on 9 January, it’s a battle for ‘future generations’, she says

What price to follow a vocation? A nurse who completes his or her training in 2020 is set to receive an unwelcome graduation gift: £51,600 of debt.

For the government this is a price worth paying (by nurses themselves though) to train 10,000 more nurses, midwives and allied health professionals to plug the gap of 20,000 nurses the NHS is currently short of. But it’s fair to say that many of you don’t agree: 94% of respondents to a poll on the Independent Nurse website believe that scrapping student nurse bursaries will deter new entrants to the profession.

In his Autumn spending review last November Chancellor George Osborne announced his plan to scrap the NHS bursary, which funds the courses of student nurses, midwives and allied health professionals. Instead the next generation of nurses would have to apply for student loans for courses beginning in September 2017.

The news was greeted with outrage by the opposition, and has since been raised twice at Prime Minister’s Questions, and was the subject of a Commons adjournment debate led by Wes Streeting, MP for Ilford North, where he debated the issue with minister for nursing Ben Gummer. ‘This is a shocking way to treat the backbone of the NHS,’ Mr Streeting, a former president of the National Union of Students, tells Independent Nurse.

Opposition has also come from nursing leaders. Janet Davies, the chief executive of the Royal College of Nursing (RCN) says: ‘These proposals will saddle future generations of student nurses with even more debt and financial pressures and unless nurses pay improves, many graduates will never be in a position to pay their loans back.’

Cathy Warwick, the chief executive of the Royal College of Midwives, says removing bursaries would make ‘midwifery an unattainable and less attractive profession to thousands of potentially excellent midwives that our maternity services badly need.’

Student nurse Kat Webb set up a petition to call on the government to reverse the decision, which received over 154,801 signatures. This triggered another debate in parliament on 11 January 2016.

Former member of the RCN students committee and student nurse Grant Byrne said that he would have seriously considered another degree if student nurses hadn’t been eligible for bursaries. ‘Those who support it say it will bring nurses in line with other students but they aren’t like other students,’ he says. ‘No other student has to work full time, evenings and weekends with shorter holidays on top of lectures and university work.’

Support for the decision has come from the Council of Deans for Health. ‘I think it was a difficult decision for the government but I think it was the right one. The current system was simply not sustainable,’ says Lizzie Jelfs, the director of the Council.

The current system of awarding a student nurse bursary means that there is a cap on the number of students who can be admitted onto nursing degrees, and demand far outstrips supply. RCN figures from last year showed that there were 57,000 applications of which 37,000 were rejected.1

Increasing nurses
Mr Osborne’s stated motive for scrapping the bursary would remove this cap. He claims that ‘universities will be able to provide up to 10,000 additional nursing and other healthcare professionals this Parliament.’

However, Ms Jelfs says that the 10,000 new students would not exclusively be nurses and midwives but across all allied health professions which totals around 12 different professions. ‘It sounds like a large number but what that represents in terms of percentages over the final three years of Parliament would be a 7% increase each year,’ she says. ‘This is a fairly reasonable increase, but it wouldn’t be 7% spread across every profession in the same way or across every part of the NHS or social care.’

There is a resource issue on the part of the NHS here too. Can it successfully absorb this spike in the number of students? ‘Every student nurse needs a mentor and there won’t be enough nurses to mentor the increased numbers of nursing students,’ says Mr Byrne. ‘We won’t be able to resolve the crisis purely by churning out a bunch of new students.’

This could mean that students have less time with mentors or have many students at once or might not have a break between students.

Mature students
One of Mr Streeting’s main concerns was that introducing a system of student loans for aspiring nurses would deter applicants, in particular mature applicants, from applying to nursing and midwifery courses.

More than 30% of nursing students are mature (aged 21 and over) some of whom will have families or completed previous degrees. The current student loan system does not allow those with existing degrees to take out a second loan. This could prove problematic for those looking to study nursing as a second degree if loans are introduced.

Writing for Independent Nurse, Crystal Oldman, chief executive of the Queen’s Nursing Institute, said primary care would be hit particularly hard by the changes as it tends to attract older nurses. (IN, 7 December 2015, pg 16). ‘The autonomy of nursing roles in these environments requires a maturity and self-confidence... seen in those who have had some previous life and career experience.’

Mr Streeting concurs, saying that this is another concern that needs to be considered by the government. ‘We are making things doubly hard for GP practices that are struggling to recruit doctors let alone nurses. The last thing primary care needs is a recruitment crisis in nursing, I think that would be an absolute disaster.’

Ms Jelfs says that research is needed into whether there will be an impact on the number of mature students who will apply for nursing courses. She points to findings from UCAS which show that the number of mature students applying for all university courses suffered a dip when there was a major change to tuition fees in 2012. ‘Given that this is a risk we need to think about how to mitigate it and what incentives there are to sustain mature student participation,’ she says.

Alternatives
During the adjournment debate Mr Gummer said that many of the concerns raised by Mr Streeting were based around the university route into nursing. He said that the government planned to introduce a nursing apprenticeship. Nurses will be able to ‘earn while they learn from healthcare assistant level all the way to a full nursing qualification at degree level’.

Fine details such as timescale and course structure have yet to be set but Mr Gummer stated that discussions were ongoing with key stakeholders.

He has already met with Unison and the RCN and had ‘productive’ discussions around the apprenticeship and that Unison in particular was understanding that the government is trying to open up different models of nursing for different parts of the workforce.

Mr Byrne expressed concern that the apprenticeships could lead to a watering down of skills. ‘I’m glad they are recognising that auxillary nurses need a career path, but it sounds like a way to get nursing on the cheap,’ he says.

Another alternative, proposed by the right-of-centre think tank Civitas, is that student nurses take out loans during study which are then paid back by their NHS employer. It gets a welcome from the Council of Deans of Health. ‘I think some local employers will start to offer these schemes to attract graduates to the workforce and retain them,’ says Ms Jelfs.

‘There’s the question as to whether the government will support financial incentives for new graduates joining the NHS. That needs to be addressed within the consultation.’

A third option could be for the government to actually increase the number of nurses receiving the bursary by removing the cap. An investment of £30million per year could fund an extra 10,000 students. This may be an unpopular view given that NHS funding is so stretched already but when compared with the £3.3billion spent last year on agency staff, it might be an alternative worth considering.

Nurses unanimously agree that there is a need to change the way student nurses are funded, in order to tackle the nursing shortage and reduce the number of agency nurses and overseas recruitment. What the alternative would be still needs to be resolved.

There will be a consultation on the issue, but Mr Streeting is concerned that it could be a sham ‘where the government gives the appearance of listening, sends out a survey and then politely ignores everything said to them by a wide range of stakeholders’.

Since the announcement in November there has been a protest, and two parliamentary debates. If Mr Osborne thought that this proposal would fly under the radar among the detail of the Autumn Statement, he was very much mistaken.

References

1. Hansard debates. NHS bursary. http://www.publications.parliament.uk/pa/cm201516/...

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