Plans to scrap bursaries for student nurses, midwives and allied health professionals and replace them with loans were announced by the chancellor, George Osborne, in his spending review.
The measures will allow the cap on the number of student places to be lifted and the government claims this will enable the NHS to provide up to 10,000 extra training places this parliament. The move has been condemned by unions, but could making students pay for training be the medicine the health service needs to cure its chronic nursing shortage?
The changes will come into force in 2017. The government hopes they will save the Department of Health around £800m in funding that it currently uses to support 60,000 student nurses in England through their three-year degree courses.
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Unions fear a loan system will be an obstacle to people from poorer backgrounds and career changers. Midwifery in particular attracts a large number of mature students over 29 – many of whom bring with them vital existing experience of childbirth – but are already saddled with debt from a first degree.
Jon Skewes, director for policy, employment relations and communications at the Royal College of Midwives, warns the risk is that the proposals will wipe out a whole cohort of students.
He explains: “The real question is, will people take two sets of students loans out at a time when the cost to their families from housing and childcare are at their highest? It could financially kill the person coming in to do the second degree and mean the average age of people studying midwifery moves towards the more common degree age of 18 years old.”
According to Skewes, there is an estimated shortage of around 2,600 midwives in England alone. The country’s ever-growing population means the need to fill those places is a “ticking time bomb” and cutting off a large demographic from vital funding is a “high stakes” gamble.
“The majority of people are aged 45-plus, so if we don’t get the supply right, then we are heading for an even worse shortage of midwives,” he adds. “That will impact on the care that women and their families will receive.”
Janet Davies, chief executive of the Royal College of Nursing, also voiced deep concerns that people from lower income backgrounds will be put off applying for training at university. She claims that, despite the loan system already well established among students on other degree courses, nursing students face very different challenges.
The requirement to undertake clinical placements during non-term time, for example, means they have little time to do paid work, which many of their university peers might do to help pay off their loans and support themselves.
Scrapping bursaries has, however, been welcomed by Universities UK and the Council of Deans of Health, which speaks for university faculties in nursing and midwifery. The two bodies have been pushing the Treasury to scrap the system, which has led to a cap on the amount of training places the government can afford to make available.
Dame Prof Jessica Corner, chair of the Council of Deans of Health, claims there is a huge demand to study nursing – up to 10 applicants for each of the 20,000 places a year – and does not believe the change to loans will have an impact on the number of applicants. She adds that the change will also help universities fund courses – many institutions receive less for these training programmes than they actually cost to deliver. It’s a situation which Corner claims has become “unsustainable”.
A full consultation on the plans has been announced to discuss how the measures might be implemented. Corner hopes the issue of how to avoid deterring mature and poorer students will be raised as part of that process. One suggestion is to consider possible incentives to ease the financial burden on these students.
She says: “There is a real opportunity for us to start talking about that with the NHS trusts and employers. For example, some sort of ‘golden hello’ arrangement when people start their first job that helps with the costs of their loan repayments. It wouldn’t be expensive for NHS trusts. That would help reassure potential students worrying about the future.”
Early evidence that introducing self-funded nursing courses may have a positive impact on staff numbers can be seen at the University of Bolton, which introduced a loan system for its students earlier this year. The undergraduate nursing degree course was launched in February 2015 in partnership with the Lancashire teaching hospitals NHS foundation trust. The university was the first in the country to offer student nursing places commissioned by Health Education England and now also has ties with NHS trusts in Bolton and Manchester.
There are 50 places available on the three-year full-time programme, developed to tackle the shortage of nurses in the area. After successful completion of the course, each graduate is given the opportunity to take up a trust entry-level staff nurse post.
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Jane Howarth, dean of the university’s School of Health and Human Sciences, says there has been a “healthy interest” in the programme and a “good response” in terms of applications. She welcomes the government’s move to scrap the bursary system and can’t understand why it has taken so long to come up with this solution.
She says that being a small provider enabled the university to be innovative when looking for a solution to local nurse shortages.
“It [introducing student loans] was a gamble because we weren’t sure whether people would ever choose to pay or to take out a loan to become a nurse,” she admits. “We have been pleasantly surprised … and it doesn’t appear to be a barrier to students.”
Corner adds: “My passion is for the nursing profession and for patient care. If these changes result in us having sufficient money to recruit a higher number of nurses, midwives and health professionals then I will be very happy.”
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Source:Will scrapping nurse bursaries help or worsen NHS staffing crisis?