Until 2017, students studying nursing in England received a bursary and paid no fees. The bursary was paid by the NHS and was a remnant of the days when nursing students were employed by the hospitals where they trained. By the end of the 1990s, all nursing education moved to universities, but the bursaries remained.
The UK government’s decision to stop bursaries in England was met with protests, especially by the Royal College of Nursing. Proponents of the bursaries argued that it would exacerbate current nursing shortages. We need to attract more candidates, not drive them away, they argued, especially older women from lower socio-economic groups.
Only the bursary system did not solve nursing shortages and it was not flexible enough to respond to changing demands. When we needed more nursing students, the NHS did not necessarily have the funding to provide bursaries. Contracts between universities and the NHS had a cap on the numbers of nursing students funded.
I propose four reasons why bursaries for nursing students aren’t needed.
1. We can’t afford it and they don’t need them
The NHS can no longer afford the scheme, especially with the proposed expansions in the numbers of nursing students. Nursing students, along with other university students, have access to student loans that cover their tuition fees and provide them with a living allowance.
Nurses, almost uniquely, are virtually guaranteed a job on graduation and if they earn £24,000 annually – the middle of the lowest pay band for a staff nurse – they only need to repay £11 a week.
2. Nursing students are not employees
It is often thought that nursing students are working as employees of the NHS while they are in hospital. They are not. They are “supernumerary”, which means they are not included in the workforce. This recognises that they are students and that they are there to learn. They may have less opportunity than other students to work and earn money to support themselves, but this is surely offset by almost guaranteed employment on graduation?
3. Nursing is not a vehicle for social engineering
Some worry that older women from lower socio-economic groups, those who have had families or are seeking a late or second career, will find it hard to study nursing. But are these concerns justified? The initial introduction of student loans did not reduce the numbers of applicants from lower socio-economic groups to university. Why should it affect nursing?
We need a nursing workforce that is diverse in gender, ethnicity and age. But someone entering nursing late may only work for a short time in the NHS. This is not good value for money if that money is being spent by the NHS.
Nursing and the NHS do not exist as vehicles for social engineering where everyone who ever wanted to be a nurse can become a nurse. Both nursing and the NHS exist to provide a service: patient care.
4. We’ll get the most motivated students
While bursaries were available, both nursing students and nursing lecturers reported that some students were only studying nursing for the bursary. They had no intention of entering nursing on graduation and, in fact, many nursing students never enter nursing.
With an end to bursaries and an end to the cap on numbers, we have a much more flexible system that can respond to the need for nurses. The issue remains the availability of places for nursing students in the NHS. But universities can now negotiate with any part of the NHS they wish – not just their local hospitals – and can pay the NHS for training places. This should provide the flexibility needed and an incentive to the NHS to provide, and even compete to provide, the best training places.
‘Student nurses graduate with £54k of debt, shouldn’t we pay them a wage instead?’
The Government claims students are “supernumerary” and “not contracted to provide nursing care”.
Student nurses are the unseen workforce and vital to patient care.
While I am pleased for the thousands of students who will soon be starting their journey to become a registered nurse, it comes with a stark reminder.
In November 2015, ministers announced the NHS Student Bursary and tuition fee payment would be cut in a plan to increase the number of available student places.
Suffice to say, this hasn’t worked.
Instead, we have seen a consistent decline in the number of student nurses qualifying. Official figures from the Universities and Colleges Admissions Service (UCAS) show an overall decline in applications of 8% since 2015.
There is no debate that nurses need to be degree-level educated – but are student loans the best way to fill an ever-widing gap in our workforce?
The unseen workforce.
Student nurses are the unseen workforce and are sometimes vital to the delivery of safe, compassionate, person-centered care.
Completing over two-thousand hours of hand-on, direct clinical practice over three years – is it fair to ask them to accumulate up to £54,582 (plus 6.3% annual interest) of debt?
With a starting salary of £24,214, this is a debt the majority of nurses will never pay off.
The Government claims that because student nurses are “supernumerary” and “not contracted to provide nursing care” they need to be treated like all other higher education students.
While is it true that the Nursing and Midwifery Council (NMC) mandates that student nurses are considered ‘supernumerary’ – how realistic is this expectation? We hear stories of student nurses, trainee nursing associates and healthcare support workers being used to fill nurse staffing gaps on an almost daily basis.
A self-perpetuating cycle.
With an estimated 40,000 unfilled nursing vacancies in the NHS alone, health and social care services in England are stuck in a self-perpetuating cycle.
Chronic under-investment in services has led to an increased demand on staff and subsequently affected recruitment and retention rates. Universities then fail to recruit enough nurses to meet the current demand and so the cycle continues.
The Royal College of Nursing has called on the Government to invest at least £1b per year into nursing education and come up with a long-term plan after its plan to increase numbers has failed to work.
Matching the proposed apprentice wage while student nurses are on placement would go some way towards alleviating the financial burden the government has placed on student nurses.
A fresh start?
I’m excited and I’m nervous. I qualified as a nurse just 15 months ago. I left a career in IT of “quite a few years” – I decided I needed a fresh start.
Now I’m sat on a train heading to my first ever RCN Congress. I’m a voting delegate and will be honoured to carry that responsibility for my branch.
I’m also excited to finally be meeting people that I’ve solely (or mostly) only ever connected with online.
Finally, I’m looking forward to the various debates and resolutions. Listening to the speakers will further inform my views and I might even share a thought or two myself – fortunately speaking in public does not generally worry me (I’ll be the one with the ukulele).
A brief glance back to this time last year when certain “irregularities” were noticed by some members around the pay deal and communications regarding it.
The train of events that followed uncovered a number of poor practices regarding transparency and accountability and our current council were elected to address these.
I also mentioned I am nervous.
Recently, it has become clear that further “irregularities” have occurred – and questions will be asked.
Tomorrow morning is the Royal College of Nursing’s Annual General Meeting – an opportunity for members to ask questions. An opportunity for the council to demonstrate its commitment to openness, transparency, and accountability. An opportunity for a fresh start.
I genuinely hope the answers to the questions I raise are clear and dispel the concerns many of us have.
And if they don’t? Well, that’s why I’m nervous.
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