The Blog

Reforming NHS Bursaries Is an Important Step to Produce a Sustainable National Health Service

It is clear that reforms like these are needed to create a financially sustainable and self-sufficient NHS. We cannot buckle to the non-reformist mind-set, which would happily see the status quo continue at the expense of patients across the country.

At the London Assembly Transport Plenary, Labour proposed a motion which called on Sadiq Khan, the Chair of the London Assembly and the Chair of the Health Committee to write to the Secretary of State for health calling on the Government to:

"Put an immediate halt to the proposals to end NHS bursaries, until a long term and viable option has been identified which promotes the value of graduate and university degree educated health professions".

Given the make-up of the political parties on the Assembly, the motion was inevitably carried.

However, the Conservatives voted against the motion to demonstrate our support of the Government's proposed reform. Here are some reasons why.

1. The current system of providing bursaries to nurses, midwives and allied health professionals is financially unsustainable and contributes to the current NHS workforce shortage.

Last year, the estimated cost of NHS bursaries was £1.123 billion. These bursaries are funded from general taxation and cannot be recovered from the student once they graduate.

This means that the number of students that can be trained to become nurses, midwives and allied healthcare professionals, is determined by the amount of money the Government is able to raise via general taxation.

This creates an artificial cap regarding the number of nurses, midwives and allied healthcare professionals that can be trained to work in our National Health Service.

The result is that we have currently a situation where 2 out of 3 prospective nursing applicants are being turned down for a place at university.

This affects London's NHS negatively. For example, in London, it has been calculated that 10,000 nursing posts remain unfilled.

There is a clear consensus regarding the need to reform the NHS. However, with this motion, Labour positioned themselves as the anti-reformers, putting the sustainability of the health service at risk.

Surely it is up to us to promote measures that facilitate an increase in employment, encouraging aspiration, rather than maintaining the status quo?

A consequence of us not being able to train the number of NHS staff needed to fill the current workforce shortage is that our health service increasingly relies on expensive agency workers and/or overseas staff to plug the gap.

The cost of hiring agency staff to cover posts is placing an increasing financial burden on trusts across the country. For example, last year, the agency staffing bill was approximately £3.3 billion. Furthermore, three quarters of trusts breached their agency price caps.

The resources spent on agency staff are resources that could be spent on patient care and increasing pay for nurses.

It has been calculated that through implementing this reform, which would give universities the freedom to offer more course places to prospective students, an additional 10,000 university places could be created by 2020.

By training more nurses, midwives and allied health professionals, we will be able to reduce the current cost incurred on the health service through having to employ agency staff.

It is important not to lose sight of the end game regarding this reform and others. We are trying to create a health service which is both financially sustainable and able to deliver world class health care.

2. Labour's motion claimed that there is a high risk that a loan system will be an obstacle to people from poorer backgrounds and those changing careers later in life.

This specific point reminds me of the same flawed argument Labour championed in the tuition fees debate during the last coalition government. They were wrong then and they are wrong now.

For example, a record number of students secured university places last year.

In fact, the percentage of students from disadvantaged backgrounds entering higher education increased from 13.6 per cent in 2009 to 18.5 per cent in 2015. This represents the highest number of people from disadvantaged backgrounds obtaining in university than ever before.

Had the Government taken Labour's misguided advice and reversed its plans to reform tuition fees, universities would have less money to offer places to prospective students.

This means that we would have fewer people from disadvantaged backgrounds obtaining university places.

It is irresponsible to maintain a policy that places a barrier on the number of people that can obtain higher education, especially as there is such high demand for nurses across London and nationally.

The proposed reformed system contains measures to mitigate the financial burden that may be placed on prospective students. It is designed to enable a qualified nurse to afford repayment.

By scrapping the bursary and replacing it with a loan, the Government will be able to commit a 25 per cent increase in financial support for students living costs while they are training.

In addition, the contribution students make to repay their loans will only be made once they have secured their first job and are earning above a certain income threshold.

The loan scheme is mindful of the reality that students face daily. For example, if a student's income drops below £21,000, their debt repayment is halted and if it has not been fully repaid after 30 years, it is written off altogether.

In addition, the current childcare and dependant's allowance offered by the Government is generally higher than those under the current bursary scheme.

Labour's motion to the Assembly also suggested that the reform could specifically deter mature students from applying to university courses. However, looking at the UCAS data following the tuition fees debate, the number of full-time mature students now significantly exceeds previous levels.

Therefore, the evidence suggests, contrary to Labour's claims, that mature students and those from poorer backgrounds are not being deterred from entering higher education as a result of the introduction of student loans, regardless of the cost of living in London.

Labour underestimates the personal agency of people in struggling communities. The loan does not act as the terrifying barrier that my Labour colleagues perceive it to be. This is because people see the loan as an investment in themselves, an investment which does not force them to pay a lump sum up front.

Upon completing their qualification, they can be very confident that they will secure a job and begin repaying their loan at an affordable rate.

For struggling communities, access to student loans is a powerful tool to tackle unemployment and alleviate poverty.

Furthermore, these reforms are not being proposed in the midst of unanimous criticism.

In fact, the proposals have received the endorsement from medical and educational institutions. For example, Professor Dame Jessica Corner, the Chancellor of the Council of Deans of Health said:

"We recognise that this has been a difficult decision for the government but are pleased that the government has found a way forward. Carefully implemented, this should allow universities in partnership with the NHS to increase the number of training places and also improve day to day financial support for students while they are studying. The plan means that students will have access to more day to day maintenance support through the loans system and recognises that these disciplines are higher cost, science-based subjects."

In addition, Universities UK has said:

"We support increasing health professional student numbers and will work with Government and the NHS to secure the sustainable funding system"

The NHS, particularly in London, is in dire need of reform. Labour's motion essentially asked for more money to prop-up a system which contributes to the NHS' workforce shortage, making the NHS less sustainable going forward.

The workforce shortage we see today suggests that the current approach of relying on the public to foot the bill for NHS bursaries falls short of producing the number of nurses, midwives and allied healthcare professionals our health service needs.

It is clear that reforms like these are needed to create a financially sustainable and self-sufficient NHS. We cannot buckle to the non-reformist mind-set, which would happily see the status quo continue at the expense of patients across the country.

Before You Go