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What they said: the debate on whether to replace the student bursary

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Earlier this month, nursing students in London hosted a lively and informative panel debate on the government’s controversial education funding reform plans.

The event set out to “address and influence” the forthcoming consultation paper on the proposals to change bursaries to loans for all pre-registration nurses, midwives and allied health professionals.

Save Our NHS Bursaries

What they said: the student bursary debate

Student Danielle Tiplady asks a question

It was organised by the Florence Nightingale Faculty of Nursing and Midwifery at King’s College London and took place on 15 March at the university’s Waterloo Campus.

An expert panel from academia, the NHS and the royal colleges debated the plans announced in the autumn, attempting to answer a series of questions posed by an audience of students. At the start, each member of the panel was asked to establish their position on the proposals.

Ahead of the consultation on the plans, Nursing Times thought it might be of interest for nurses and student unable to attend the debate to see what the panel said on the issue.

The panel comprised:

  • Peter Carter, independent representative and former chief executive and general secretary of the Royal College of Nursing
  • Bronagh Scott, Deputy chief nurse form NHS England for the London region
  • Jacob Smith, student representative and third year adult nurse at King’s College London
  • Howard Catton, Royal College of Nursing head of policy and international
  • Geraldine Walters, director of nursing, midwifery and infection control at King’s College Hospital NHS Foundation Trust
  • Jill Maben, professor of nursing research and director of the National Nursing Research Unit at King’s College London
  • Carmel Lloyd, head of education and learning at the Royal College of Midwives
  • Lizzie Jelfs, director of the Council of Deans of Health

 

Peter Carter

“At the moment, surprisingly, I’m in the neutral camp… I happened to be watching the television when the Chancellor of the Exchequer made his announcement back in the autumn at the time of the comprehensive spending review.

peter carter

peter carter

Peter Carter

My initial reaction was, what on earth are they up to now? With all of the problems that are besetting the NHS, the last thing you’d want to do is to disrupt something – which has its challenges.

So, my initial position was to think this is bizarre and absurd, and then I phoned and spoke to a lot of people, and people gave a different point of view.

But the root cause of this problem is the government’s failure to engage with people in order to have a good narrative about do you need this, what are the pitfalls, what are the benefits, what are the dis-benefits, and it kind of resonates with other issues, where there’s an imposition.

And what they should do of course is get all of the relevant parties together – places like King’s, the RCM, the RCN, Unison and so on – to sit down and try to have a dialogue and get some better narrative. I think it’s the absence of the narrative that’s ended up with the kind of position that we find ourselves in today.”

 

Bronagh Scott

“I’m definitely not sitting on the fence on this one… and I actually think there are tremendous opportunities being offered here with the proposal to remove the bursaries.

NHS England

Bronagh Scott

Bronagh Scott

But what I do agree with Peter about is we don’t have enough information at the minute. There’s not enough of a narrative and there’s not been enough of talking with people…

In nursing, we’ve had tremendous difficulties in recent years. Some of the unintended consequences of the bursary system [that] we have really suffered from [is] in terms of the number of places that we’ve had available for people to come into our profession. Because in most places they don’t actually have a big difficulty in attracting people to be part of the profession but we are stuck by the number of commissioned places that the universities can offer, so in many ways that is an unintended consequence of the bursary system.

I think there’s lots of opportunities for students of nursing [if] the bursaries are removed… I would encourage everybody to get involved in the consultation and… in any conversation or any opportunities that there are to influence if the decision goes the way that the bursary will be removed – be there and be involved in how to influence that for the better.”

 

Jacob Smith

“I would like to go out and say I’m categorically against the bursary cuts. This is in order to represent what I believe are the majority of King’s College nursing students and allied health professional students and midwifery students.

And I believe that it’s been a rushed, uninformed move, with a lack of an impact assessment and only now in the later stages of it are we having a consultation, a public consultation.”

 

Howard Catton

“We’re consulting with members at the moment. That will inform the RCN position. But I am going to give you some views on how I see it at the moment.

Don’t lose sight, I would say – this is a political choice and a political decision. I watched the TV and heard the commentator say the government had found £27bn down the back of the government sofa… in November last year. They kept police on the streets but they are taking away your bursary – [it’s] political choice, political decision.

Howard Catton

Howard Catton

Source: Andrew Youngson

Howard Catton

And they did that through a slight of hand, a very important sleight of hand – they’ve redefined what the NHS ringfence is. My Mum thinks that the NHS ringfence covers the care she gets in hospital but it also covers training for future healthcare professionals and it covers Public Health England and prevention work. No it doesn’t!

Student funding, education funding and Public Health England is [now] outside of the ringfence. The ringfence is just the services that are provided by NHS England. There is a big issue there about what we understand by protected NHS money. You shouldn’t lose sight of those political decisions and those political choices.

Will this proposal, will this change do what it says on the tin? Will it deliver another 10,000 healthcare professionals? I don’t know. I seriously think very many prospective students will be put off by taking on £50,000 or £60,000 worth of debt. You’d expect me to say that, from the Royal College of Nursing. [But] I’m not the only one. Read what the independent Pay Review Body said in their recent report… that the removal of the incentive of the bursary could have an unsettling effect on the number and quality of applications for nurse training.

So this feels like a huge roll of the policy dice by the current government, where the numbers could go down. Should we be very worried about that – yes? Are the government very worried about that – they might not be as worried as you think, if they are at the same time creating a cheap alternative supply through a new workforce named nursing associates.

Hands on hearts though, is the current system working – I think not. Is there a real opportunity to get stuck into the design of a new system – yes there is, and we should. We need to really look at issues around [loan] forgive-ability and repayment by employers and I think there are ways that you can design that… to come up with a new system.

But, at the moment, we are slightly kneecapped, majorly kneecapped by the fact that the [education] funding has disappeared and we need that funding back on the table if we are to design something meaningful that will work for the future.

 

Geraldine Walters

“I’ve got concerns about it, but I think at the moment the jury’s out because we just haven’t got enough information. So what are the concerns: well I think the money being gone without what seems to be much thought is a worry, because what I’m thinking about is am I going to have any nurses to staff the wards in four years’ time.

Geraldine Walters Jan09 3

Geraldine Walters

We know nursing students are different to other students. They don’t have quite the same opportunities to earn during their course; many more are more mature students so that’s a worry. Finally, I’m worried because nurses say to me, if this had happened when I was going into nurse training I wouldn’t have been able to do the course and I think that’s…

The reason for me why the jury is out is because the workforce planning over the last 10 to 15 years has been awful… so at King’s College Hospital my nursing establishments are okay but I’ve got so many vacancies that the nurses are really, really stressed and pushed, and that’s because we didn’t train enough students three years ago – even though the directors of nursing in London were saying that we should have done. That’s because the student numbers are a bit more to do with how much money Health Education England’s got rather than… need.

[Looking at] the current effect of loans on other students…I wouldn’t have predicted that it’s had the effect it’s had. If you look at the current green paper on higher education, there are 25,000 ore students and more students from disadvantaged backgrounds now than there were before the cap was lifted. So that is a curious statistic. We know you’ got to dig into that to find out whether it’s a distortion of the truth or not, but it would certainly be nice if we had more nurses than we thought we were going to get.

I think, which is a little bit controversial, provided that there are caveats around the ability of student nurses to earn or their limited ability to earn, provided there are caveats around that fact that nurses might have done a degree previously so they might already have debt, should nursing students who are going into professional careers be any different from any other students in the rest of the county?

So the jury is really out. I do wish we had the consultation by now to get a little bit more information about what the future holds, but that’s my position at the moment.”

 

Jill Maben

“I’m not on the fence. I was at the march against the bursary [cuts] and so I’m very much against the bursary being removed. I’m a researcher, so I want to know the evidence and I’ve looked long and hard at the evidence, and I cannot find any.

Jill Maben

Jill Maben

Jill Maben

People tell it happened in Australia so I looked at the Australian evidence. The evidence in Australia was that, yes, students there do pay for their education but they pay a hell of a lot less. They are not looking at £9,000 fees, their fees are about £3,000 – A$7,000 Australian dollars. I think that’s very, very different.

They also don’t do the same number of hours as the NHS in placement, they do about 800 or 900. As you know, here we do 2,300 – that’s very considerably different, so I think it tips the balance around who should be paying for this. We also know that junior doctors have a bursary for their clinical education so they do their three years pre-clinical and then they have a bursary for two years clinical – why can’t we think about something like that?

If the bursary isn’t working – I agree with some of my colleagues – let’s have a conversation about it, let’s not have it announced by the chancellor in the spending review that this a done deal and the money is off the table. As a profession, that really worries me – as a nurse and as a nursing professional – where has that money gone and we will never get it back.

This is political expediency and we should be seriously worried about it. I know [we don’t] necessarily want… to focus on the nursing associate [role], but it’s really interesting that we have these two things at the same time and it worries me enormously that it could reduce the number of registered nurses in our workforce.

My colleague [Professor] Anne Marie Rafferty is in the audience and a lot of her work and evidence would suggest that the greater number of registered nurses you have, you get better patient outcomes. Patients die actually if you get fewer registred nurses. That’s really important evidence and I want us to pay attention to that…”

 

Carmel Lloyd

“Suffice to say, the Royal College of Midwives weren’t impressed when the announcement was made, particularly as we’d not been consulted and our students hadn’t been consulted and our members – midwives – hadn’t been consulted.

Royal College of Midwives

Carmel Lloyd

Carmel Lloyd

All the explanations as to why this would be a good idea actually don’t stack up when you talk to the people who are actually working on the coalface. From our perspective, we really want to look at the evidence, which doesn’t seem to be strong on the side of the government at the moment. But we do recognise that the money has gone. I think everybody needs to appreciate that and that clawing that back is actually going to be very, very difficult.

So going forward, we will actually have to work with our students, work with our midwives to find what is the best course of action which will protect the education and training that the students have, and their ability to be midwives.

We’re not at the moment faced with a associate midwife role. We have maternity support workers and, as far as we are concerned, that is the role that they do. And we’ve explained that very clearly.

We have had a steadily growing [number of] midwives over the years with the current arrangement and we cannot feasibly take any cut in those numbers of students going forward. So anything that is likely to upend that continuing grow in midwives will be detrimental to the care that we are able to provide to women and their children.”

 

Lizzie Jelfs

“We’re not on the fence and we pushed for the fundamental reform around the education funding, of which the NHS bursary is part – though it’s one of three funding streams that are interconnected…

In terms of how we came to that decision, it took me two years personally to come to that view, so I’m not expecting anyone to change their mind necessarily over the course of this evening.

Elisabeth Jelfs

Elisabeth Jelfs

Lizzie Jelfs

And in part, it’s about a perception of the way you see the risks in the current system and how much time that you think we had to stabilise and sort out the current system… That comes from my particular role involved in some of the education funding discussions at the moment, so I come with that particular perspective.

I agree with much of what’s been said in terms of the difference between students, it’s an enormous change, it doesn’t just affect nursing and midwifery – we are talking about at least 12 professions that vary in size and scope – [and] it’s complex. The risks are different between the fields of nursing and the different professions, and there is an enormous amount of nuance and complexity to this. So, in a sense we need to take fields and professions differently and understand them and the risks.

I think some of the differences between professions and other students in higher education are system issues that we may want to address that aren’t necessarily connected with the funding. So [with] a problem like the number of hours in placement, there’s a question of do you deal with that through funding or do you try and deal with that if you think it’s a root issue…

I come at the nursing associate discussion from the other end, in that one of the things that pushed us towards calling for fundamental reform was a concern that nursing associates would be commissioned out of the current nursing education and training budget for registered professionals. That discussion on nursing associates has been going on far longer, to my knowledge, than the government discussion on the funding reform around the bursary, so I’d be very, very cautious about a kind of cause and effect.

Actually from my perspective, freeing up the universities to be able to have the number of students without any restriction on commissioned places and without the funding potentially being redirected is something that’s a positive for me, so it’s another perspective on that conversation.”

 

 

 

 

  • 7 Comments

Readers' comments (7)

  • Anthony Johnson

    And Lizzie Jelfs had her feet held to the fire zero times! It's nice when king's can put on an opportunity for her to proudly promote the Deans of Health's fallacies with no pushback.

    Yes an event was held, no it most definitely was not a debate otherwise the pro-loan camp would have had to point out how non of their data is consistent or transferrable to reality. #BursaryOrBust

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  • I'm not currently a nurse but have worked in medical education for 13 years. Do I think removing the bursary is a good idea? No. London is desperate for nurses. A band 5 nurse starts on £22,000 a year. When you take out tax, NI, pension, travel and bills (rents in areas near Barts Health hospitals in London are around £700 a month for a room in a flat I understand) how much is there left to live on? Then add in student debt (which will be around £60,000). If someone came to you and asked you what they should do would you really advise them that this is a sensible decision to make?

    Geraldine Walters comments that increasing fees has not had a negative effect on widening participation. I would say that the reality of taking on the debt associated with £9000 a year fees has not yet really hit those affected and there will be a lag before graduates fully feel the impact. Many graduates saddled with such loans are currently searching for work. Poorer students have been eligible for maintenance grants but they are being removed. We don't know what the impact the removal of maintenance grants will have. We need to be looking ahead and learn some lessons from the US where student debt is having a massive affect on individuals and families and is consequently a key topic in the presidential race.

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  • Anthony Johnson

    Moira, I agree about tuition fees. The National Union of Students has data to show that mature students are always deterred by debt. That's why the number of mature students in other courses has crashed post-2011 tuition fee increases.

    If you take into consideration the average age of nursing students being 29, coupled with the 50% with dependents you realise that demographically speaking both nursing & midwifery are mature. There is absolutely no way that numbers will increase in the South East.

    There are 10,000 (17%) nurse vacancies within London. There is no one to train these students & as you say they can't afford to live here. These changes will precipitate the death of the NHS quite simply and should be fought at every opportunity.

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  • So, I am a nursing student (first year). I am also a mature student, having had a full career in the military prior to pursuing nursing. If the bursary were not there I would not be able to study, it’s as simple as that, because the amount of debt would be unreasonable. I could expect to spend the rest (or at least most) of my working life in debt, which is clearly unacceptable. Why would I willingly do that? I love nursing, but not to the point where after the training and education I’m financially little better off than before, but with the added bonus of a large student debt as well as the mortgage.

    On a slightly more political level, this has all the hallmarks of a policy that was doodled on the back of an envelope with no thought to the down-stream consequences. I suspect those that came up with this were looking at a number of applicants compared to number of places ratio and not much else.

    Politicians; they do ‘affable’ in order to get elected, but from then on they rarely do ‘bright’.

    Or basic research.

    The average age of my cohort is 28, which is to say that the majority of the people that qualified for a place on course are mature and have experience in other areas before they chose nursing (similar to me). With no bursary the majority of my colleagues would not be able to study and simply would not have applied. While I appreciate that the politician would say that those places can be filled by school-leavers or perhaps in extremis foreign students, I would argue that the nursing profession (and by extension those we nurse) need and is at its best with a broad range of ages and backgrounds dedicated to nursing and are able to train to do it.

    I would speculate that if the intake is financially restricted to school-leavers and those who have independent wealth expect the first year attrition rate to be far higher than it is now, with no particular gain in numbers and a less able and experienced graduate workforce at the end.

    I would argue that this is a foot/shoot moment on the part of those that thought this would be a ‘saving’ and requires serious thought as to how the prospective mature student can be brought into the service in the future, considering that they make up such a large percentage of the current intake. Other than strait outrage, we as a society need to have a discussion on who we want as our nurses and how that should be funded, but one thing’s for sure, top-down bean-counter edicts will guarantee an inferior service.

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  • What incentive is there to become a nurse when we are not renumerated as other degree level professionals and are now faced with the possibility of large debts, which in reality could take a lifetime to repay when factoring in the interest lumped on every year? I would certainly not have pursued a career in nursing if a bursary had not been available. I already have a large student debt, and had to work many hours throughout my training. I also strongly feel that the contribution student nurses make within the NHS workforce is valuable from the outset and deserves to be recognised even by the paltry bursary currently offered.

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  • So ,student nurses are supposed to study and work are they? Student nurses are not super numary, they work hard and diligently alongside their mentors and seniors. On top of this, they are supposed to self learn, sit exams and accommodate placements which are hours away from their accommodation. What for I ask myself. My daughter who is a NQ Nurse would not have been able to study away from home if we had not been able to assist her. So there are no misunderstsandings, this took sacrifices from all of us to support her away from home. If you want to stop bursaries and other enhancements, then pay the students a wage to work. In the old days students were paid a small salary but it was something. No, the government want it all ways. If you work, you should get paid and that is it! We need more nurses and we need them now. This lunacy is bound to reduce recruitment.

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  • All the available research evidence shows that employing more RNs in the nursing workforce produces better patient outcomes, so why are high profile and influential voices calling for another ancillary role - 'the associate nurse' - which is rather like reinventing the old SEN role - but this time without any evidence base whatsoever?

    One answer is that it will be cheaper to employ an associate nurse than a RN, and of course, this will be a major factor for providers in the current economic climate. Anyone who thinks otherwise is possibly deluded, or just out of touch with the current economic reality.

    Health Education England are not doing the profession any favours in allowing this newly proposed ancillary role to embed, which may only further legitimise the fatal erosion of the RN role, as hard pressed care providers may well be more inclined to employ a cheaper workforce skill mix in a post-Brexit economy. It is also very interesting that this cheapening of the nursing workforce is being pushed in England, whilst Wales is legistating for RN ratios and Scotland is doing likewise.

    As regards the proposed bursary cuts (and they are 'cuts') many in nurse education know that the Council of Dean are totally out of touch with the student nurse demographic in the universities. Many student nurses who currently enter university nursing degree programmes do so through access courses, and they are very debt averse, especially when it comes to the idea of taking out student loans for up to £50k to pay for a nursing degree. This has much to do with social class and economics, factors which are very rarely discussed in relation to student nurse recruitment strategies yet which vary between nursing and other degree programmes including medicine. Again, we see the same lack of an evidence base for making sweeping proposals to institute swinging cuts to the current higher education provision for nursing, but this time from the Council of Deans, who have pushed this Tory government to propose these changes, a situation that may well be seen as a fatal 'own goal' if / when enrollment to nursing degree programmes reduces, and the universities then ponder, after 2017, the financial viability of keeping their nursing programmes open.

    These proposed cuts will also potentially negatively affect recruitment to health visiting, district nursing and school nursing programmes, further potentially reducing the numbers of those vitally important specialist practitioners entering the future healthcare workforce. If these proposals fail to produce the advertised outcomes, the resulting workforce shortfall will be judged a catastrophic failure, and one brought on by not the government but by those charged with leading the profession.

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