The future of funding for student nurses is at the centre of a row over the sustainability of the education system.
Unions have warned of the “high risks” faced by student nurses and midwives if they were to receive loans rather than grants, after universities called for an “urgent” overhaul of the funding system.
The calls for reform by the Council of Deans of Health and Universities UK have been labelled as “unprecedented”, sparking concerns they represent an attempt to changes the system in the near future.
“I don’t want students held to ransom because the universities want more money”
Unions said a move to a loans-based system – in which students would accrue debts for both their living costs, and up to around £9,000 per year for tuition fees – risked increasing financial hardship for trainees and deterring people from applying to nursing courses.
Nurses would take longer to pay off their loans than other students, claimed unions, because registrants typically earned less money than graduates from other courses.
They claimed the diversity of applicants would also reduce as those from less wealthy backgrounds – or those who have more financial responsibilities, such as older student nurses with families – would be put off.
Instead of suggesting students take on loans, universities should be calling for improvements to the current grant system, they said.
In a joint statement last week, the Council of Deans of Health and Universities UK said reform of the funding system was needed to address both the current workforce crisis facing the NHS and the financial difficulties being experienced by many students.
They claimed the current grants-based system was no longer fit for purpose because it tied universities to set numbers of students, resulting in shortages of nurses.
They also said the system was not sustainable for universities and pointed to the increasing gap – an estimated 8-12% – between the funding provided to universities by the government to cover student tuition fees and the actual cost of nursing courses.
At the same time, universities said students were losing out from the grants-based system, because the money they received for maintenance costs was not enough.
They noted student nurses typically have longer courses than other non-NHS subjects, meaning their funding has to be spread further.
The government should therefore consider transferring to a loans system, with the possibility of nurses being paid back some money once they have secured employment in the healthcare sector, they said.
Gail Adams, head of nursing at Unison, said: “It is unprecedented for the Council of Deans to issue a statement like this and there must be much more to it than we are currently aware.”
“Financial hardship consistently remains a number one concern for students”
She claimed there was no evidence a loans system would help solve the nurse workforce crisis, and warned that student application numbers would drop if it were introduced.
She added that university concerns around the amount of government funding they received towards paying for nursing courses should be debated separately from how much money students are given.
“How much universities get paid to provide student nurse training is a conversation between them and Health Education England,” said Ms Adams, adding that students “shouldn’t be condemned into poverty” as a result.
Royal College of Nursing head of policy Howard Catton said that while it was recognised there were current pressures on the funding for nurse education, there were a number of “high risks” associated with the loans system approach, in particular around debts.
“The reality of salaries for nurses means the prospect of taking on a loan would mean it could be a significant number of years before student nurses can clear their debts,” he said.
“Financial hardship consistently remains a number one concern for students – both those that have to drop out due to the demands for studying and limitations for taking on paid work and also those that remain on courses,” he added.
Mr Catton said there should instead be a debate about whether universities receive a large enough portion of money for nurse training places from Health Education England in comparison to medical professions.
“It hasn’t been a disaster and didn’t put people off going to university”
However, Council of Deans chair Jessica Corner disputed that moving to a loans system would reduce the number and diversity of people applying to nursing courses.
“We’ve got the experience nationally now of tuition fees [being increased to £9,000] and that it hasn’t been a disaster and didn’t put people off going to university,” she told Nursing Times.
“In any new system designed we would want to absolutely look at it to take account of students from diverse backgrounds to make sure it doesn’t put potential nursing applicants off.”
The Department of Health refused to confirm or deny whether it was considering changes to student nurse funding, but Nursing Times understands that the issue has at least been broached informally.
A DH spokeswoman said: “It’s important the [nursing] profession is attractive and rewarding which is why we provide financial support to student nurses including grants, bursaries and reduced rate loans.”