Plans to replace healthcare bursaries with loans branded ‘hell of a risk’

Ministers are taking “one hell of a risk” by assuming application rates for healthcare students will remain stable once NHS bursaries are scrapped, Labour has said.

Shadow health secretary Heidi Alexander insisted it is “dangerous” for the Government to believe its plans to replace bursaries with loans will have a similar effect on numbers as the previous coalition administration’s decision to treble tuition fees up to £9,000 a year.

Ms Alexander told the Commons that she fears the next generation of nurses, midwives and other health professionals will be put off by the changes.

The Government believes replacing bursaries with loans will free up around £800 million a year, create extra nursing posts by 2020 and help students from all backgrounds take up the role.

But the idea has resulted in thousands of student nurses and midwives marching through London and elsewhere in protest, while unions have also criticised the move.

Labour wants the Government to drop its plans and examine other ways to fund student nurses, midwives and allied health professionals.

Opening an opposition day debate, Ms Alexander said: “We 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 mismanagement 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 it is dangerous to assume that just because application rates remained stable after the trebling of tuition fees in the last Parliament, the same will happen with his proposals?

“I say to him that 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 professionals are substantially different to most other arts and science degrees.

“Not only are the courses more onerous, fewer holidays, longer days and longer term times but students are also required to spend about half of their time in clinical practice – 2,300 hours in the case of a student nurse, including night and weekend shifts as a normal part of their studies.”

She added: “These changes will effectively charge students for working in the NHS and, 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, as many other students do.”

Ms Alexander said healthcare students are much more likely to be women, have children and be from black and minority ethnic backgrounds – with the average age of a student nurse said to be 28.

She told health minister Ben Gummer that the fear of debt is greater for the one-in-five healthcare students who have children than a “carefree, privately educated history student bound for Cambridge”.

Ms Alexander went on: “My concern about these proposals is that we ultimately end up with those who are best-placed to pay becoming nurses and midwives and not those best-placed to care.”

But Mr Gummer defended the plans and cited statistics showing that the number of people going to university rose significantly since tuition fees were put up by the coalition government as evidence that the changes will not act as a barrier.

He said: “This year there were 394,380 people accepted on to places in this country.

“That is 35,000 more people accepted on to university places than in 2010 when we had that debate.”

Mr Gummer continued: “The results that we should really be looking for are – what has helped people from disadvantaged backgrounds get into university in the last five years?

“I can tell you this. That in the last five years the numbers of people going to university from disadvantaged backgrounds has increased by 10,150 – a massive increase over the last five years.

“Had someone said that would be possible back in 2010 I doubt anyone would have given 5000-1 odds on that happening, but I can tell you this: 10,150 people is the size of the University of Leicester.”

Meanwhile, Mr Gummer labelled Labour’s motion on the issue “anaemic” because he said it failed to offer any alternative to the changes.

He said: “In this motion there is the suggestion of a whole series of things apart from one thing, which is the Opposition’s proposals to do anything different because what they won’t do is to offer new money to the NHS.

“They were offering £4.5 billion less than we did at the last election, so it’s not going to be in new money so it would have to be in cuts elsewhere in the service, I can only presume.”

The Government predicts its changes will create 10,000 more training places for healthcare students.

And Mr Gummer said even disregarding many of the reasons for pursuing the changes, like a desire for “social equity” and the creation of those extra training places, it would still be important to implement the reforms “because of the changes it will make to the quality of training that we can provide to nursing graduates”.

He also rejected claims that the changes would leave students hundreds of pounds worse off when they graduate and start to repay their debt.

“It just is not the case,” he said.

“We anticipate that a newly qualified nurse will be paying roughly £90 per year more, about the same as they are currently paying because of the way that student payment finance is graded.”

But Dr Lisa Cameron, the SNP MP for East Kilbride, Strathaven and Lesmahagow, described the Government’s plans as “narrow sighted”.

She said: “The proposed move to a system which relies on students funding themselves by taking on debts has raised substantial concerns amongst unions, amongst professional bodies and amongst students.

“One of the key fears expressed is that such a move could be a barrier which deters prospective students from entering the profession.

“I have to say as I stand here the first doctor in my family that I would not have considered applying if it had meant racking up such debts.”

Dr Sarah Wollaston, chairwoman of the Health Select Committee, called on the Government to retain some bursaries for mature students who make up a large proportion of nurses.

While she welcomed measures by the Government to open up nursing to more people, she warned it must to do so “without disadvantaging or cutting off the core nursing workforce”.

She said: “Is there any room, as we start to roll this out, to retain the first few years at least, until we know what the impact is, some bursaries for our very valued core, mature nursing workforce?

“Whether there is any role for us to have a period of transition, because I think it is important that we bear in mind the potential for unintended consequences here?”

She put forward a series of recommendations to take into account the large amount of clinical work student nurses perform.

She said: “Is there any way that we could perhaps recognise that with a limited grant system for those who would otherwise be deterred from payment?”

“Or perhaps at the end of a nursing course recognising, particularly for mature students 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 and train in shortage specialities linked with a period of NHS service?”

Conservative former minister Andrew Murrison suggested student nurses that still form an important part of a hospital’s workforce should be paid or receive some kind of financial compensation through the bursary scheme.

He said it was “simply not right” for them to do such work for free.

Dr Murrison said: “The question really is whether in this day and age we are still heavily reliant upon that workforce for the proper functioning of hospital wards.

“Because if that is the case then I think there is a good case to be made for allowing for that in the bursary arrangements that we make for student nurses.

“Because it is simply not right to expect them to do service work and for them not to be compensated in some way for doing that.”

Former cabinet minister Peter Lilley said it was “morally wrong” to rely on recruiting thousands of nurses from developing countries who bear the cost of their training.

The Conservative MP said the problem arises from UK universities not being allowed to expand their student nurse programmes.

“My initial interest in this area came a couple of decades ago and resulted actually from my first career when I was a development economist working in Africa and Asia,” he said.

“And I discovered while I was in the House that we were denuding Africa of nurses.

“We had in this country recruited more than one in eight of all the nurses in sub-Saharan Africa and brought them to this country.

“That couldn’t be right, and I lobbied against it and the then-prime minister promised that there would be no active recruitment from Africa but some years later I discovered that we had recruited another 60,000 and were continuing to recruit at several thousand a year but we all promised it would cease.”

Shadow health minister Justin Madders described the Government’s strategy on the issue as “cut first and ask questions later” as he attacked ministers for overseeing an apparent shortage of nurses in the NHS.

He said: “This Government is entirely responsible for that shortage because it decided to reduce nurse training places.

“If it had maintained the levels set by the last Labour government we would have had 8,000 more nurses trained in the last parliament alone.

“When we hear about spiralling agency costs and staffing shortages, let’s be clear what the cause is, it’s not the nurses, it’s not the trusts, it’s not the patients, but it’s this Government’s chronic mishandling of the NHS.”

Mr Madders also questioned whether the plans would deliver the 10,000 extra training places promised by the Government.

“That figure of 10,000 extra comes with so many caveats and warnings that if it were a used car I wouldn’t even take it for a test drive,” he said.

But health minister Alistair Burt told the House the debate had followed a “not unusual” pattern of the Government proposing changes, prompting Labour to “react with horror”.

He said: “The assumption is made that because the student loan comes in and the access there will be to a loan because of the change people just won’t want to do it.

“There is no evidence to suggest that that is correct and using it as a scare story is not helpful in terms of the recruitment we want to see.”

A Labour motion calling on the Government to drop its plans to scrap NHS bursaries was defeated by 277 votes to 158, a majority of 119.

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