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NHS bursary reforms are just one part of a larger policy challenge NHS bursary reforms are just one part of a larger policy challenge
(about 1 month later)
The NHS needs to train more of its own nurses. This is one of those all-important issues where the need to improve efficiency and quality are completely aligned.The NHS needs to train more of its own nurses. This is one of those all-important issues where the need to improve efficiency and quality are completely aligned.
The National Audit Office estimated that the NHS was short of just under 28,000 nurses, midwives and health visitors in 2014. Over recent years, the number of nurses has grown more slowly than the number of doctors and the UK has fewer nurses per capita than the OECD and EU averages.The National Audit Office estimated that the NHS was short of just under 28,000 nurses, midwives and health visitors in 2014. Over recent years, the number of nurses has grown more slowly than the number of doctors and the UK has fewer nurses per capita than the OECD and EU averages.
We are also very reliant on staff from other countries (EU and beyond). About one in seven nurses in the UK was trained abroad and the inflow (particularly from EU countries) has increased in recent years in response to recruitment difficulties. The UK’s vote to leave the EU and the resulting uncertainty over the status of existing EU nationals in our country further underlines the need for the health service to train more of its own.We are also very reliant on staff from other countries (EU and beyond). About one in seven nurses in the UK was trained abroad and the inflow (particularly from EU countries) has increased in recent years in response to recruitment difficulties. The UK’s vote to leave the EU and the resulting uncertainty over the status of existing EU nationals in our country further underlines the need for the health service to train more of its own.
Related: Will scrapping nurse bursaries help or worsen NHS staffing crisis?
The government has proposed that from August 2017, new nursing, midwifery and allied health students will no longer receive NHS bursaries. Instead, they will have access to the same loans system as other students. As a result, there will no longer be a cap on the number of places available. The government’s consultation on these proposals has just closed and these changes will have implications beyond the thousands of students who wish to train as a nurse.The government has proposed that from August 2017, new nursing, midwifery and allied health students will no longer receive NHS bursaries. Instead, they will have access to the same loans system as other students. As a result, there will no longer be a cap on the number of places available. The government’s consultation on these proposals has just closed and these changes will have implications beyond the thousands of students who wish to train as a nurse.
The impact of these proposals on the number of nurses in England depends on two things: what happens to the number of degree training places available and whether enough high-quality students will apply. The number of places depends on how universities, training providers and the government work together to expand provision.The impact of these proposals on the number of nurses in England depends on two things: what happens to the number of degree training places available and whether enough high-quality students will apply. The number of places depends on how universities, training providers and the government work together to expand provision.
How many students then apply depends on how prospective students respond. How many students will be put off and from what backgrounds?How many students then apply depends on how prospective students respond. How many students will be put off and from what backgrounds?
The question is rightly the focus of much debate. But it is important to emphasise that changing the system of nurse bursaries must be part of a wider programme to increase nurse training places and to stimulate more flexible options.The question is rightly the focus of much debate. But it is important to emphasise that changing the system of nurse bursaries must be part of a wider programme to increase nurse training places and to stimulate more flexible options.
It’s helpful to look to the experience of other countries when judging this. Shifting from a system of nurse bursaries to student loans means students will bear more of the cost of their training. It won’t always be the full cost – as repayments are dependent on subsequent earnings and not all graduates will earn enough to pay back their loan – but it will hit the pay packets of nurses who train under this system.It’s helpful to look to the experience of other countries when judging this. Shifting from a system of nurse bursaries to student loans means students will bear more of the cost of their training. It won’t always be the full cost – as repayments are dependent on subsequent earnings and not all graduates will earn enough to pay back their loan – but it will hit the pay packets of nurses who train under this system.
An analysis commissioned by Unison and the NUS argued this would cause student numbers to fall, potentially reducing the number of student nurses by 2,000 in the first year. However, economics would suggest that some potential nurses would be put off, but for that to result in a fall of 2,000 places, you have to assume there are no suitable candidates who apply for places but can’t get them because of the cap.An analysis commissioned by Unison and the NUS argued this would cause student numbers to fall, potentially reducing the number of student nurses by 2,000 in the first year. However, economics would suggest that some potential nurses would be put off, but for that to result in a fall of 2,000 places, you have to assume there are no suitable candidates who apply for places but can’t get them because of the cap.
In fact, university admissions data shows that the number of applications for nurse training have exceeded the available places for a number of years. For example, in 2015, 57,000 students applied for 21,450 awarded places in England. Even with expanded training places there would need to be a fall of around 60% in applications for the proposed changes to see unfilled nurse training places.In fact, university admissions data shows that the number of applications for nurse training have exceeded the available places for a number of years. For example, in 2015, 57,000 students applied for 21,450 awarded places in England. Even with expanded training places there would need to be a fall of around 60% in applications for the proposed changes to see unfilled nurse training places.
Looking abroad, Australia has also been through a period of significant change in the funding of student nurses over the past 10 years. Enrolments in nursing across Australia in 2014 were more than double 2004 figures.Looking abroad, Australia has also been through a period of significant change in the funding of student nurses over the past 10 years. Enrolments in nursing across Australia in 2014 were more than double 2004 figures.
In England there are also examples of universities and hospitals setting up nursing courses outside the core NHS training system, which students pay for via the standard student loan scheme. These schemes have proved popular; in fact, one course at the University of Bolton was very heavily oversubscribed, with more than 650 applications for approximately 25 places in the September 2015 intake. Other local NHS employers have subsequently joined the initiative.In England there are also examples of universities and hospitals setting up nursing courses outside the core NHS training system, which students pay for via the standard student loan scheme. These schemes have proved popular; in fact, one course at the University of Bolton was very heavily oversubscribed, with more than 650 applications for approximately 25 places in the September 2015 intake. Other local NHS employers have subsequently joined the initiative.
But the Australian experience also points to some challenges that policy-makers in England might need to address. Funding remains shared between the federal government and students, and the amount students have to pay matters. Australia reduced student debt payment in 2008-09 whereas in the UK, loan interest rates are rising.But the Australian experience also points to some challenges that policy-makers in England might need to address. Funding remains shared between the federal government and students, and the amount students have to pay matters. Australia reduced student debt payment in 2008-09 whereas in the UK, loan interest rates are rising.
Related: Our grassroots campaign is fighting NHS bursary cuts
Australia also has some concerns about the standard of students applying for nursing, education capacity and clinical placement constraints. Expanding numbers without ensuring the students are of high quality and the nursing education they receive is fit for purpose would not serve the NHS well.Australia also has some concerns about the standard of students applying for nursing, education capacity and clinical placement constraints. Expanding numbers without ensuring the students are of high quality and the nursing education they receive is fit for purpose would not serve the NHS well.
Nursing attracts a very different demographic compared with many other courses.Nursing attracts a very different demographic compared with many other courses.
One of the worries about the government’s proposals is that even if places can be filled it will further change the mix of people who train to become nurses. Older people, those with families and who already have a degree (and the associated loan) will be particularly hard hit by these changes.One of the worries about the government’s proposals is that even if places can be filled it will further change the mix of people who train to become nurses. Older people, those with families and who already have a degree (and the associated loan) will be particularly hard hit by these changes.
Part of the answer to these challenges may lie in the detail of the financial support available but reforms to training might also be important.Part of the answer to these challenges may lie in the detail of the financial support available but reforms to training might also be important.
In Northumbria, the NHS has recently launched an 18-month work-based programme of nurse training for students with a previous record of academic study and substantial experience in the health sector.In Northumbria, the NHS has recently launched an 18-month work-based programme of nurse training for students with a previous record of academic study and substantial experience in the health sector.
Innovations of this sort are likely to be an important part of effective policymaking, increasing the number of nurses while making sure the career is open to people from a wide range of backgrounds.Innovations of this sort are likely to be an important part of effective policymaking, increasing the number of nurses while making sure the career is open to people from a wide range of backgrounds.
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