The much anticipated consultation on planned changes to the student funding system for nursing and midwifery in England, which would see bursaries replaced by loans, has been launched today.
The consultation – titled Reforming healthcare education funding: creating a sustainable future workforce – will run until 30 June and was launched on Thursday afternoon.
It follows an announcement in the chancellor’s autumn spending review, predicted by Nursing Times, that the government was planning to reform nurse education funding.
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George Osborne said replacing bursaries would remove the current limit on the number of course places that Health Education England could afford to fund, leaving universities free to offer as many as they wanted to.
He claimed the proposed change, which is due to come into effect in August 2017, would create up to 10,000 more nursing, midwifery and allied health professionals training places by the end of the current parliament.
However, the move was criticised by many nurses, especially students currently in training, who argued that it would deter people from choosing nursing as a career, especially mature students and those from poorer backgrounds. As a result, a series of marches and protests have been held in Whitehall.
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Announcing the start of the consultation on the move today, the government said that two thirds of people who applied to become a nurse at present were not accepted for training.
It also said moving to a system of loans would offer students typically around 25% or more financial support while they study.
Under the plans, a student who chooses to take a maximum tuition and maintenance loan for three years would graduate with student loan borrowing of between £47,712 and £59,106 depending on the course studied, location and whether or not the student lives in the parental home.
Repayment would be required to start once a graduate was earning £21,000 and constitute 9% of income over that figure. Repayments would stop if their salary dropped below £21,000 a year and the balance written off if they have not paid back their loan after 30 years.
Existing students who started their course before 1 August 2017 but temporarily suspended their studies until after that date would remain on the NHS bursary system for the “full duration of their course and not be transferred onto the student support system part way through”.
Commentators had previously noted that nursing students were more likely to be older than other students with an average age of 29-30. As a result, they might already have a degree in another subject, which under the rules for other students would preclude them from taking a second loan, and potentially a family, bringing with it associated costs.
The government noted that, for nursing and midwifery courses, it would put in place an exemption to enable students with previous degrees in other disciplines and associated loans to “access the standard student support package” for a second time.
However, it stated that it did “not see a case for any additional general support for mature students per se”, because full-time mature student numbers had now “significantly exceeded previous levels” under the loans system was introduced for other subjects.
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It acknowledged that “childcare costs could be a significant influence on participation” in courses. But it said it did “not consider that there is a case for generally providing additional financial support beyond what has been provided for in the standard system” for nursing students with dependents.
Meanwhile, students on full-time postgraduate masters’ courses which are one or two years in length would be able to borrow up to £10,000 over the duration of their course. The loan would not be means tested.
Health minister Ben Gummer said: “Since the wider reforms to higher education our universities are offering more places and those from disadvantaged backgrounds are more likely to access an undergraduate degree.
“Our proposed reforms will extend these benefits to nurses, midwives and allied health professionals, who have so far been excluded from these benefits,” he said.
“It is vital that the changes are implemented in the right way, which is why I would encourage as many people as possible to contribute to the consultation,” he added.
Lisa Bayliss-Pratt, director of nursing at Health Education England said: “We encourage everyone with an interest in delivering these services to patients in the future to make their voices heard in response to this consultation.”
“We are concerned that the changes will act as a deterrent to aspiring students”
But Unison’s head of health Christina McAnea described the consultation as “meaningless” and claimed that the government had “already made up its mind” to replace bursaries with loans and fees.
“Replacing the bursary system with loans will put off many potential students, not encourage more people into our caring professions,” she said. “Many will be saddled with huge debts for the rest of their lives.
“The UK already has to import staff from overseas just to keep the NHS going, and nothing in this consultation will change that,” said Ms McAnea.
She added: “The government has published a woefully inadequate equalities impact assessment on the move to student loans. This is a complete reversal from five years ago, when ministers said that a move to a loan-based system would hit women hard, especially those from diverse backgrounds.”
The Royal College of Midwives restated its opposition to any changes that will result in midwives potentially graduating with debts of over £60,000.
Louise Silverton, the RCM’s director for midwifery, said: “Women with children and those who already have a first degree will be particularly hit hard if these proposals go ahead as many of these women already make up a large proportion of our current midwifery student base.
“With potentially catastrophic debts and little prospect of earning to offset these costs, we are concerned that the changes will act as a deterrent to aspiring students and will drastically reduce the number of applicants for pre-registration midwifery programmes,” she added.
Unions representing student nurses and midwives said they would be holding a national lobby of parliament on Wednesday 25 May.
In contrast, organisations representing universities have initially backed the proposed changes.
Professor Dame Jessica Corner, chair of the Council of Deans of Health, said: “Getting the detail right before implementation will be critical if the funding changes are going to work for students, universities and ultimately for health and social care.
“We know that there are particular issues that need to be addressed as part of this consultation, including securing placement funding and capacity and ensuring that student participation levels and course viability are preserved,” she said.
Professor Corner added: “Over the next few months the council will be consulting widely with its members to inform its response to this consultation. We will be urging all course providers to engage in this process to ensure a comprehensive response from across the sector.”
Labour’s shadow health minister, Lord Hunt, described the plans to scrap the bursary as a “huge gamble with the future of the NHS workforce and with patient safety”.
“Ministers need to drop these proposals as soon as possible and stop the staffing crisis in the NHS from getting any worse,” he said.
To accompany the start of the consultation, the Department of Health has also published an “equality analysis” and “impact assessment” (see PDFs attached below).
The government’s plans in summary
- From 1 August 2017, new students will no longer have their course fees paid by Health Education England nor a bursary provided by the NHS Business Services Authority, but will have access to the standard student support system provided by the Student Loans Company to cover the cost of their tuition fees, and means tested support for living costs
- A student who chooses to take a maximum tuition and maintenance loan for three years would graduate with student loan borrowing of between £47,712 and £59,106 depending on the course studied, location and whether or not the student lives in the parental home
- The terms of repayment for the loan will be the same as all other graduates who have taken out a student loan. At present, repayment starts once a graduate is earning £21,000 and the repayments are 9% of income over £21,000
- At present, newly qualified nurses earning £21,700 will pay back around £5.25 a month. If their salary drops below £21,000 a year, then their repayments stop. If they have not paid back their loan after 30 years the balance is written off
- Under the current loan rules, potential students who already have a degree in another discipline would not be eligible to access student support for a second time. For nursing and midwifery courses, the government will put in place an exemption to enable these students to access the standard student support package
- Students on full-time postgraduate masters’ courses which are one or two years in length would be able to apply for a Postgraduate Masters Loan. Students would be able to borrow up to £10,000 over the duration of their course. This loan would not be means tested
- Existing students who have started their course before 1 August 2017 but temporarily suspend their studies will remain on the NHS Bursary system for the full duration of their course and not be transferred onto the student support system part way through
Source: Department of Health consultation