NHS Bursaries — House of Commons, 2016-05-04
Topic: Health
Justin Piers Richard Madders (Labour, Centre-left): 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 the Member for Ilford North (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 the Member for Scunthorpe (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 the Member for Wirral West (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 the Member for Cambridge (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, the hon. Member for Totnes (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 the hon. Member for Morecambe and Lunesdale (David Morris) rightly pointed out, the Government’s record is poor. Saddling nurses with extra debt will only make the matter worse.