A ‘loan forgiveness’ scheme should be introduced for nurses, midwives and allied health professionals who stay in the NHS after they qualify, according to a proposal in a report by the Times Health Commission.
The commission – an expert panel set up by the newspaper in January 2023 to investigate evidence-based solutions for the UK’s healthcare issues – also called for primary care reform within a 10-point plan contained in its report.
Under the suggested loan forgiveness scheme, student debt – which currently averages around £48,000 for each nurse – would be reduced by 30% after three years, 70% after seven years and 100% after 10 years for those who stay in the NHS.
According to the report – which also recommended extending the scheme to doctors – the policy would cost £230 million a year to cover nursing, midwifery and allied health professionals. However, the commission noted that this would be partly offset by incoming changes to the student loan repayment system.
The report said: ‘The investment looks highly affordable when set against the benefits of improved retention and lower attrition rates during training.’
The Times Health Commission cited research by the Nuffield Trust showing that one in eight nursing students drop out during training, one in nine midwives do not join their profession after graduating, and one in five nurses have left the NHS within two years.
‘The plan would increase the number of applications to courses while also giving an immediate solution to the workforce crisis by encouraging newly qualified staff to stay in the NHS, resulting in a significant reduction in expensive agency staff,’ the report said.
Responding to the proposal, Pat Cullen, general secretary and chief executive of the Royal College of Nursing, said: ‘Though we support student loans being written off, self-funded fees should be abolished too.
‘Our health service will continue to fall over the precipice while there’s little incentive to become a nurse and those registered want to leave for better paid, less stressful jobs,’ she added.
The report also included a proposal to create a network of new community health centres with outpatient clinics, diagnostic services, community nurses, pharmacists, mental health professionals and physicians’ assistants working alongside family doctors.
This would be combined with reform of the GP contract to focus on wider health outcomes rather than ‘box-ticking’, as well as the breaking down of barriers between primary and secondary care, the commission said.
Responding to the proposal, Professor Philip Banfield, British Medical Association council chair, commented: ‘A move to focus more on primary care, and crucially general practice, makes sense.’
However, he added that it was not necessary to ‘reinvent the wheel before getting the basics right’.
Professor Banfield said: ‘Yes, we need to slash bureaucracy and allow GPs to focus on health outcomes rather than ticking boxes, but we also need to massively invest in practices and staff.’
To inform its report, The Times Health Commission – whose panel of 21 included former RCN president and professor of nursing policy Dame Anne-Marie Rafferty – held regular evidence sessions with expert witnesses including nurses, midwives, doctors and scientists.
‘Our evidence to the commission showed sky-high tuition fees deter people from entering the profession,’ the RCN’s Ms Cullen said.
‘We all want a solutions-focused health service, with prevention at its core, initiatives to ensure efficiency and investment in social care. This report sets out how that could be achieved, and any prospective government should take heed in this election year,’ she added.
