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Fighting for the future of nursing



As the Government announces the end of training student bursaries, nurses are warning that this will make university courses unaffordable  

From August 2017, student nurses starting undergraduate degree-level training in England will no longer have tuition fees and living expenses funded through the NHS bursary. Instead, they will need to take out a student loan, which they will pay back from their salary. The Government says that cutting the bursary will remove the cap on nursing student numbers. But student nurses are furious and the Royal College of Nursing (RCN) worries that this will harm nurse recruitment and the diversity of the profession.

What is the NHS bursary and how is it changing?
The NHS bursary is a monthly payment to help with day-to-day living costs for students following an eligible course. It also includes tuition fees, which are paid directly to the university. The bursary is means tested, so the amount that students receive is calculated according to their income, or their parents’ or spouse’s income.1 The bursary is paid to students on approved courses in nursing, midwifery, medicine, dentistry and several health professions, including chiropody, occupational therapy and dietetics.
The Government has announced that, from next August, new nursing, midwifery and allied health professional students in England will no longer receive NHS bursaries.2 Students in Scotland, Wales and Northern Ireland will still be able to apply for them.
Students will have to pay tuition fees, which the RCN said can be up to £9,250 a year.3 Loans are paid back once the student starts earning over £21,000 annually.
The Government said the changes would “enable universities to provide up to 10,000 additional nursing, midwifery and allied health training places by 2020, so more applicants will have the chance to become a health professional”.2
However, some were not convinced. The RCN and 20 other healthcare organisations have written to the Government, saying: “The Government’s proposals on student funding for nursing, midwifery and allied health professionals are an untested gamble with the future of the workforce that has not been properly risk assessed.”4
Additionally, Nursing in Practice teamed up with The Nursing Times and Nursing Standard to write a letter to the Prime Minister Theresa May, urging her to rethink the bursary cuts: “Though we are editors of rival publications we stand united in asking you to think again over student bursaries if you wish to leave an NHS legacy to be proud of.” See page 27 for the full letter.

How did we get here?
The Government announced plans to reform the NHS bursary in the 2015 spending review. The proposals attracted immediate opposition from student nurses and others, and led to lobbying of the Government, public protests, petitions and rallies.
Newly qualified nurse Danielle Tiplady, a former student at King’s College London, set up a change.org petition that attracted 108,000 signatures, after “getting really angry one day in the library”. She and her fellow students organised protests, and thousands of supporters marched through London in June, to hold a rally outside the Department of Health in Whitehall, at which supporters including fashion designer Vivienne Westwood spoke. Westwood said: “We are here specifically to fight for the economic conditions necessary for nurses to survive and thrive. We want them to be happy… the Government aims to sabotage that. It will lead to the breakup of the national health [service].”5
Tiplady was part of a delegation to the then Parliamentary Under Secretary of State for Quality at Department of Health Ben Gummer. “I went with the RCN and Unison to talk to Ben Gummer, but I felt he didn’t listen. We tried really hard,” she said.
David Morgan, a third-year mental health student nurse at Birmingham City and RCN Students Committee Member for the West Midlands, agreed: “It all started to snowball. We did everything we could. We met almost everybody – we couldn’t meet Jeremy Hunt. I wrote to so many MPs.”
He said it was a “massive” disappointment when the Government dismissed their pleas.
The Government went ahead with a 12-week consultation, which ended on 30 June 2016 after attracting 1,743 responses. On 21 July, the Government responded to the consultation, making additional changes.6 These included:

  • Additional funding to support travel expenses and secondary accommodation for students attending work placements.
  • Additional funding for childcare allowances.
  • Allowing postgraduate students in 2017 to access bursaries while the Government decides how best to change their funding.

However, the Government’s response made it clear that the reforms will go ahead. The document says: “The purpose of the consultation was to invite views on the successful and fair implementation of bursary reform rather than ask about their principles” and responses that called for bursaries to be retained “have not been considered further”.6

What impact will the bursary changes have?
At present, Health Education England controls the number of places available for undergraduate nursing students through NHS workforce planning. Roughly speaking, it matches the number of training places it funds to the numbers of nurses that hospitals estimate they will need in the future. Nursing places are usually heavily over-subscribed. By allowing universities to offer more nursing places, funded by loans instead of the NHS bursary, the Government hopes to increase the numbers of nurses.
However, the plan depends on student nurses being able and willing to fund their own degrees by taking out loans. A survey by the RCN found that more than two-thirds of nurses said they would not have studied nursing if the bursary had not been available.3
Several factors mean that nurses might be less likely than other students to accept loans. Nurses are more likely to be older, with children and other commitments such as mortgages. Some 60% are mature students, according to Dr Anne Corrin, head of education at the RCN. This might deter them from taking on more debt. A high proportion also train after taking a first degree in another subject. Taking on debt to fund two degrees might put off many of these students. “Nurses don’t earn a huge amount so it’s not as if they are training to be a lawyer, with prospects of a good salary. Nurses do think twice. They are nervous about taking on debt,” said Corrin.
David Morgan is a case in point. “I’m a mature student. I was 31 when I started, with a previous degree. It was the only way I could get into nursing. I’d already got a £40,000 loan from my first degree so taking out another would be quite a lot. It has opened the door to nursing, enabled me to get onto a course and not worry about making ends meet.”
He said he was a typical example of the mental health student nurses he knows. “We’re all in our 30s, 40s, 50s and we’ve all got degrees in something. About 90% [of mental health nurses] are graduates like us, with mortgages and kids and all that, so to get into a loan, even though the repayments are quite small, it’s that psychological barrier.”
Diversity is another concern. While there might be enough 18-year-old students wishing to study nursing to fill additional places, the profession might lose the diversity of background, age and life experience it currently enjoys.
Tiplady, 29, said she already knows people who have decided not to study nursing because of the changes. “I love nursing and it’s a fantastic job but just seeing the debt would have been too daunting for me,” she said. “I have never had much money. I’m not from a background where I’m used to having money or where I’m used to having debt. I wouldn’t have done it – which is really sad.”
Both Tiplady and Morgan questioned the ethics of expecting students to pay for their tuition when they are expected to work hard on placements.
“You’re doing 14-hour shifts as a student nurse in hard settings. I did placements in high-security units and prisons. And in future you’ll be paying £9,000 to be in those settings. It’s not worth paying that to be thrown into a female prison where you’re going to get loads of abuse,” says Morgan.
Tiplady simply says she thinks it is “insulting” to expect students to pay to work.
Researchers from the Nuffield Trust questions whether the policy will have an impact on retention of nurses, who may feel less loyal to the NHS if they’ve had to fund their own training. This could encourage them to travel to Australia, New Zealand and other English-speaking countries to seek work, rather than remaining in the UK.
“These reforms come at a time of significant crisis for the NHS in staff recruitment, retention and morale. There is a risk that, if improperly executed, they could do more harm than good,” the researchers concluded.7

The next steps
Corrin conceded: “There is no doubt the bursary will go. That battle is lost.” However, she said, there is more work to be done.
“I don’t think we’ve got the final picture. The Government in its response has mellowed on some of the issues. We are working with the Government to try and make sure it’s as fair as it can be.” She said the administration of a hardship fund, and ensuring that students “are getting enough to live on” would be the focus of negotiations.
There are also questions about how placements would work under the new system, and whether there would be sufficient mentors to provide high-quality work placements for an increased number of students.
For Tiplady, the big question will be whether there is a drop in students applying to study nursing in 2017. “In January I’m going to put in a freedom of information request to UCAS – that could be the next thing. I don’t see them backing down. We need to have evidence. We have to wait until January and hope we’ll be proved wrong,” she said.

References
1. NHS Business Services Authority NHS Bursaries’ frequently asked questions. nhsbsa.nhs.uk/3946.aspx (accessed 19 September 2016).
2. Department of Health. NHS Bursary Reform. nhsbsa.nhs.uk/3946.aspx (accessed 19 September 2016).
3. Royal College of Nursing. Student Bursaries. rcn.org.uk/nursingcounts/student-bursaries (accessed 19 September 2016).
4. Letter from RCN to Prime Minister David Cameron, 17 June 2016. rcn.org.uk/nursingcounts/student-bursaries (accessed 19 September 2016).
5. YouTube video by Keep Our St Helier Hospital, 4 June 2016. youtube.com/watch?v=XZR6LDQq97k (accessed 19 September 2016).
6. Department of Health. Changing how healthcare education is funded. gov.uk/government/consultations/changing-how-healthcare-education-is-funded (accessed 19 September 2016).
7. Imison C, Dayan M. Will scrapping nurse bursaries address shortages? Nuffield Trust, July 2016. nuffieldtrust.org.uk/blog/will-scrapping-nurse-bursaries-address-shortages? (accessed 19 September 2016).