11 Jan 2016 : Column 201WH

Westminster Hall

Monday 11 January 2016

[Mark Pritchard in the Chair]

NHS Bursary

4.30 pm

Paul Scully (Sutton and Cheam) (Con): I beg to move,

That this House has considered e-petition 113491 relating to the NHS Bursary.

As of this morning, the petition had 154,390 signatures, which shows the depth of feeling and the concern that student nurses have about the proposed policy. Before the debate, we had a fantastic listening exercise, which involved a number of student nurses and other representatives of the health industry, many of whom are here in the audience. Having filled the Public Gallery, we even have an overspill room elsewhere on the estate where the debate is being shown on television. It is a testament to the importance of the matter that so many Members of Parliament are attending the debate.

Stephen Pound (Ealing North) (Lab): I am in no way being critical of the hon. Gentleman, who deserves a great deal of credit for what he has done, but does he agree that instead of using the expression “the health industry”, it might be better to say “the health profession”?

Paul Scully: Of course it would be. The hon. Gentleman is absolutely right; forgive me.

Let me read the petition for Hansard. The title is “Keep the NHS Bursary” and it says:

“At the moment, student nurses do not pay tuition fees, and receive a means tested bursary during their training. We are required, by the NMC, to have done at least 4,600 hours whilst studying, at least half of which are in practice.

Student nurses often work alongside our studies, like most students. But unlike most students, we work full time hours in placement for around half the year, and spend the rest of the time in lectures, without a summer holiday, or an Easter break, as well as completing our assignments. Taking away the NHS Bursary will force more student nurses into working 70 hour weeks, as many already do, it will compromise our studies and most of all, our patient care.”

I am sure that everybody here appreciates the work that nurses do in the NHS. I have had had to go to hospital many times with my family. My daughter was born prematurely and had to have a lumbar puncture within hours of birth; my son had his thumb set after he had dislocated it playing rugby—just opposite the local hospital, fortunately—and nurses tended incredibly patiently to my mother when she fractured her hip after a fall late on a Saturday night.

We know the endless hours that nurses work and the endless patience that they show in tending to us when we most need them, and when we are at our most vulnerable. It is important that we pay tribute to them for the work that they do. We must also pay tribute to those who want to enter the nursing service. They do so as a vocation and out of love; they do not do it for preferment, large salaries or anything like that. They do it to pay back and to serve us as members of the public, and for that we are very grateful.

11 Jan 2016 : Column 202WH

Nurses do incredible work, which is more complex than ever. Many nurses are taking on more responsibilities, whether in adult nursing, child nursing, learning disability nursing or mental health nursing. Often, these days, they have to tell doctors what to do and how to lead on treatment.

Mr Jim Cunningham (Coventry South) (Lab): I congratulate the hon. Gentleman on securing the debate. Does he agree that we are not just talking about student nurses? We have problems with trainee doctors at the moment, and the situation with the education maintenance grant. There is a big problem, particularly in the medical profession—and outside it, in relation to young people—with the future of care.

Paul Scully: We can always talk about the NHS and the future of care, but we have three hours for this debate, and I suspect most hon. Members want to speak, so I will limit my comments to nurses. I will quickly outline the current system and talk about why I believe it needs to change, then we can debate exactly how it might change.

There are various elements to the NHS bursary. There is a non-means-tested grant of £1,000 per year. There is a means-tested bursary to help with living costs of up to £3,191 for students in London living away from home, £2,643 for students outside London living away from home, or £2,207 for students living at home. Other bursary elements include an extra week’s allowance for courses that run for longer than 30 weeks and three days each academic year. As we heard at the event that we held before the debate, the majority of such courses last considerably longer than 30 weeks; they are often up to 42 or 43 weeks a year. Tuition fees are paid directly to the higher education institution by the NHS. Students can also apply for a non-income-assessed reduced rate maintenance loan from Student Finance England of between £1,744 and £3,263, depending on their circumstances. That loan is reduced in the final year of the course.

Why change? The current system, as some, but not all, student nurses, prospective student nurses and those in higher education institutions that train nurses agree, does not always work as well as it might for students or universities.

Alex Cunningham (Stockton North) (Lab): Hospitals across the country rely on recruiting nurses from as far afield as the Philippines. If these new measures are introduced, does the hon. Gentleman think that that dependence will increase or decrease?

Paul Scully: I would hope that it decreased. I will touch on some of the costs of recruitment later. Students who receive bursaries under the current structure have less to live on than other students, despite the fact that their courses are longer. They face particular financial hardship in the final year, when funding is reduced. In one London university in 2012-13, 63% of the entire hardship fund went to NHS-funded students, which goes to show how much the system is of concern, and in need of investigation and reform.

Funding for nursing and physiotherapy degrees is lower than for any other subject in higher education, even though the courses put much greater demands on

11 Jan 2016 : Column 203WH

universities than many other courses in areas such as quality assurance, laboratory space and simulation kit. Universities receive less than the courses cost to deliver in many instances. There is a cap on the number of bursaries, and more than half the people who want to train to be nurses are turned away.

In changing the system from a bursary to a loan structure, the Government propose to remove the cap on places, and they expect the reforms to provide up to 10,000 additional nursing and health professional places during this Parliament. Some people who are concerned about the withdrawal of the bursary are worried about students having no money. Even now, many students, especially in London, with its high housing costs, say that the bursary nowhere near covers their living expenses.

Stella Creasy (Walthamstow) (Lab/Co-op): One thing that concerns many of us is the fact that the students we are talking about are not the same as many other students. They tend to be women or people who are returning to nursing. Does the hon. Gentleman agree that the cost of living issue—especially as those people are more likely to have dependents or existing commitments that they are trying to fund while studying—makes the change to the bursary system all the more worrying, because it will prevent even more people from being able to study to become nurses?

Paul Scully: I thank the hon. Lady for that intervention. In a little while, I will cover some of the issues that particularly affect nursing, and look at why some of the concerns about the nursing course are acute for those people. Let me conclude the remarks I was making a minute ago. The loans system, according to the Government, will cover the cost plus more, increasing the money available for living costs by about 25%. Looking at the structure, it seems that there are two avenues of concern. Some issues are particular to nurses, as the hon. Member for Walthamstow (Stella Creasy) suggested, but there is also a general student loan debate—rehearsing the student loan debate the House had some years ago, before I was elected. The issue has not affected some prospective nurses, although some have completed a first degree, and I will come on to that in a second.

I will touch on the student loan debate, although it is not something that we need to go over again, having discussed it at some length in various media and in the House a few years ago. When I talk about the debate, I always recommend that people look up Martin Lewis, the financial expert who runs the MoneySavingExpert.com website. He is not uncritical in his acceptance of the current tuition fee regime and loan structure, but he comes up with some interesting mythbusters. For anybody considering the prospect of taking out a loan before studying, he is well worth a read. He talks about not confusing the cost and the price tag of a degree because the main practical issue is how much people have to pay having graduated, rather than the top line figure of the debt. I will go into that in a second. Repayment is effectively based on salary, and repayment costs are 9% of everything someone earns above £21,000. For example, a nurse on a band 5 salary would pay about £5.73 a month in student loan repayments. It is not an up-front cost.

11 Jan 2016 : Column 204WH

Liz McInnes (Heywood and Middleton) (Lab): I thank the hon. Gentleman for his comments about Martin Lewis. May I just ask whether Martin Lewis advised the Government when they proposed the plans for the NHS bursary scheme?

Paul Scully: I am a new Back-Bench MP so I was not around then, but I know that Martin Lewis was on a Committee at some point afterwards to determine relationships, but I will take advice on that.

Dr Philippa Whitford (Central Ayrshire) (SNP): May I just clarify that figure of paying £5 a month, which is £60 a year? At £60 a year, that loan would never ever come close to being repaid over 30 years—over a whole working life.

Paul Scully: That is on a band 5 salary. I would expect nurses to increase that. The point of the student loans system is that it is a finite time period of 30 years.

Andrea Jenkyns (Morley and Outwood) (Con): I am on the current student loans system as I only graduated a couple of years ago. I am paying it back out of my salary and I am thankful for the opportunity to do that. Does my hon. Friend agree that the current system for nurses limits the number of applicants? The new system, rather than denying thousands of applicants the opportunity to study healthcare subjects at university, will release more people into the system so that we have more nurses. It will also help to sort out the problem of reliance on expensive agency staff and overseas applicants. We will have more home-grown nurses with the new system.

Paul Scully: I totally agree with my hon. Friend. The new system will certainly help with overseas applicants and agency staff and, as is the aim, it will release extra people into the profession. One concern that we need to address and that I will touch on a little bit later is about the placements and opportunities available after graduation. It is important to ensure that those opportunities are there for nurses. There is no point having a paper-based exercise if there are not enough positions for nurses.

Tulip Siddiq (Hampstead and Kilburn) (Lab): My reading of surveys and academic studies shows the complete opposite of what the hon. Member for Morley and Outwood (Andrea Jenkyns) said. The different funding arrangements for healthcare courses means that they attract applications from a diverse range of people. The average age of people applying is higher than that of most students—higher than 28. Does the hon. Member for Sutton and Cheam (Paul Scully) think that changing the funding arrangements will deter people from different backgrounds from applying for these courses?

Paul Scully: I do not believe so. There were similar predictions for students in general when the student fee loan system came in, but that did not happen. People thought that student numbers would decline. They have not; they have increased. I do not believe that diversity in university courses in general has declined and I do not see any reason why that should be the case with nursing, although I understand the concern. A number of people have raised that concern both in Twitter

11 Jan 2016 : Column 205WH

conversations that we and nurses have had and in a number of events that have been held in the lead-up to this petition debate, including the one immediately before the debate. I understand the concern but I do not see the evidence.

Helen Jones (Warrington North) (Lab): The hon. Gentleman will have heard, as I did, in the discussion that we just had with many student nurses that many of those going into the profession are mature students. Sometimes they already have debts from previous degrees or they have families to keep. If we are to maintain diversity and encourage people with considerable life experience to enter the profession, we must incentivise them to do so and not load them with more debt.

Paul Scully: I will just complete my comments regarding student loans in general, but then I will come directly to the hon. Lady’s point because it is one of the issues particular to nurses that I mentioned a little while ago. Student loans in general do not go on credit files, so the only way that a loan, credit card or mortgage company will know if someone has a student loan is if they ask for it. Obviously, for bigger loans, they tend to ask. Student debt is not accounted for by mortgage lenders in terms of the total amount owed, although they will look at the affordability of the loan and at an applicant’s outgoings. When tuition fees and student loans were first introduced, the Council of Mortgage Lenders confirmed that lenders would not use that or add that total debt to the amount owed when they considered mortgages.

Dr Whitford: Is it not the case that the Financial Conduct Authority has announced that the size of someone’s student loan will affect their ability to get a mortgage and will be taken into account?

Paul Scully: Well, I think a lot of it is down to affordability. [Interruption.] No, there is a big difference. Someone might have an amount of £50,000 or something like that, for example, but it is about the repayment. Whether someone is paying £5 or £50 a month, that is the figure that lenders will look at to work out whether they can afford to repay the loan. As I said right at the beginning, that top line figure is not the crucial one. The crucial one is actually the amount that someone will pay out of their salary each and every month.

Looking at the current case and at positions that are particular to nurses, we have talked about the fact some people going into the nursing profession may already have a degree and are doing a second one. There are mature students. The average age of those applying to study is about 28 or 29. I believe I have covered my belief on people’s concerns about the diversity of the workforce changing.

Under the current rules, people cannot usually access the student loans system if they have already done a degree to the same level. The view of the Council of Deans is that the Government should make those courses exempt from that rule. I will be interested to hear what the Minister says about whether that is the case. If it is, in the new system, people would be able to access student loans if they wanted to—that would be an equivalent or lower qualification exemption. As repayment amounts are based on salary and not on the total loan,

11 Jan 2016 : Column 206WH

the amount repaid would be the same whether someone has one or two loans. Effectively, that makes it a graduate contribution, not a traditional loan. The system is slightly different from a graduate tax, which was discussed a few years ago, because it is finite—it finishes after 30 years, and a graduate tax, as we might have had under other suggestions, would have carried on going past a graduate’s retirement. As I said to the hon. Member for Hampstead and Kilburn (Tulip Siddiq), the introduction of tuition fees and loans for other degree courses has not led to a drop in applications and has not affected the diversity of applicants.

Clive Lewis (Norwich South) (Lab): One of the chief concerns that many student nurses have when listening to these proposals is that, unlike many other students who can take second jobs to help pay back their student loan, student nurses are sometimes working up to 40 hours a week for the NHS. They have no opportunity to make any other money to be able to pay off a student loan, but that is not taken into account. Student nurses are very different from any other group of students, which is not taken into account by the proposal.

Paul Scully: The hon. Gentleman has not listened to what I have said, because the whole point about the loan system is that the loans will not kick in until after a student has graduated, so the repayments will not start until that point. Student nurses will not be making any repayments while they are studying and doing those placements, but I absolutely take the point that nursing is a very different proposition from a normal degree in so much as placements take up 37 or 38 hours a week and beyond, which is a considerable strain on nurses.

Paul Blomfield (Sheffield Central) (Lab): The hon. Gentleman cites the example of the introduction of fees for other university students, but does he acknowledge that the impact has been patchy and that the one group that has been significantly discouraged from going into higher education as a result of those fees is mature students? Mature students are particularly well represented among nursing, midwifery and allied professions, which we encourage.

Paul Scully: It is beholden on us to explain the system to mature students, because I see no reason why they should be discouraged.

Ruth Cadbury (Brentford and Isleworth) (Lab): The hon. Gentleman says that he sees no reason for mature students to be discouraged, which perhaps demonstrates that the Department has not done a full impact assessment. What impact assessment did the Department do before the Chancellor made these proposals in the autumn statement?

Paul Scully: The hon. Lady is asking the wrong person. Perhaps the Minister will respond to that question a little later.

The idea of placements came out of our discussion prior to the debate with the student nurses, who have taken time out to come to London today from as far as Liverpool and elsewhere. We talked about bursaries, and it would be a more honest description to call them a salary because these people are working hours in what are supposed to be supernumerary positions but are

11 Jan 2016 : Column 207WH

often not. There are student nurses sitting in the Public Gallery, and we have one person here from Brighton who explained how he was saving children’s lives prior to Christmas—it is not a supernumerary position when someone is working with babies at that point. We have other people who are working with patients on a range of issues in critical roles, so we need to be straight about the pressures on nurses and how we reward them.

Alex Cunningham: I thank the hon. Gentleman for giving way to me for a second time. He is talking about bursaries being like a salary. Student nurses are doing real work when they are training on the wards, so are they entitled to some sort of payment for the real work that they are doing while they are training on the wards?

Paul Scully: Absolutely. We are talking about bursaries, but I would rather be straightforward and call it what it should be, which is a salary.

Alex Cunningham: Will the hon. Gentleman give way?

Paul Scully: I will not give way. I am aware that I have been talking for quite a long time, and I am sure that a lot of hon. Members want to speak. With placements, student nurses have less time than other students to do another job because, although it is 50% placement time in theory, they are effectively working 37 or 38 hours a week, so it is difficult for them to have another job to raise money for their living costs, especially as their courses last for 42 weeks a year—many other courses last for only 30 weeks a year.

Gavin Robinson (Belfast East) (DUP): Will the hon. Gentleman give way?

Paul Scully: I will give way to the hon. Gentleman because I have not yet given way to him previously.

Gavin Robinson: I am grateful to the hon. Gentleman, who is being generous with his time. He is making a key argument for introducing a salary for student nurses to remove the burdens and the levels of debt, rather than charging them tuition fees. Does he agree that the right argument is that bursaries were introduced to incentivise people and to encourage those who would otherwise be dissuaded from training for this noble vocation, thereby removing the burdens and the over-reliance on overseas students? Our Health Minister in Northern Ireland, Simon Hamilton MLA, has decided that he will not remove or scrap the bursary for just those reasons.

Paul Scully: I would rather that we re-examined the overall system and reconsidered how we work with student nurses to give them a fair salary. I would rather it be more straightforward, open and transparent, rather than calling it a bursary. Bursaries are effectively gifts, which can be taken away. If someone is working hard in a position that is not supernumerary, we need to examine that. At the end of my speech, when I talk about the petition, I will say that this is the start of an exercise. This is a welcome time to have the petition, because student nurses and the 154,000 people who signed it can

11 Jan 2016 : Column 208WH

help to shape the policy over the next academic year ready for whatever is in place for the 2017-18 academic year and beyond.

Andrea Jenkyns: We have talked about nursing being a vocation, but does my hon. Friend agree that teaching and being a doctor are also vocations? This proposal puts nurses on the same system as for teachers and doctors—nursing is a vocation, too.

Paul Scully: Absolutely.

Nic Dakin (Scunthorpe) (Lab): The hon. Gentleman is spelling out the case clearly. He will recognise that the introduction of fees for the teacher training year has led to a decrease in the number of people coming forward for teacher training. Perhaps that is a lesson that needs to be learned for student nurses.

Paul Scully: I thank the hon. Gentleman for that intervention.

I will bring my comments to an end with a few questions. The system needs to change. Not everyone agrees with me, but a number of people, even people who want to keep a sense of the bursary system, believe that the bursary system is not perfect by any stretch of the imagination. The petition, and the discussion around it, is the beginning of the process feeding into that change. Even those who are not happy with the proposed loan structure can help to shape the system over the next few months—in reality, it will have to be ready for the academic year after next—so that it is ready for students applying for the 2017-18 academic year. Whatever the final structure, student nurses must understand what they are applying for, how they will be funded and what the repercussions will be for repayments. We have a few months to work on it and to raise issues with Ministers.

I have a few specific questions for the Minister that come from the petition. How will specialist courses remain viable under the change? Podiatry, for example, tends to be undersubscribed—places on podiatry courses have to go through clearing year in, year out—so it is important that we consider how we can have viable courses for the services that we need.

Will trusts, especially foundation trusts—foundation trusts have proved that they can work through their own budgets by virtue of being given foundation status—be given the freedom to help repay student loans as part of a pay package, as was suggested by the Council of Deans of Health? As a result of that, what more can we do to retain nurses in the NHS after graduation, perhaps through contract agreements, rather than seeing them move abroad? Will there be enough placements to take on the proposed increase in the number of trainees? We spoke about that a little earlier.

Matthew Pennycook (Greenwich and Woolwich) (Lab): The hon. Gentleman is being extremely generous in giving way so often. Can I press him on that point? Leaving aside the threat of deterring people from entering the profession, we get the sense from what the Government have said that the infrastructure or provisions are in place for those training places. For example, every new nurse and midwife on a training programme needs a supervised or assessed mentor. What sense is there that

11 Jan 2016 : Column 209WH

those people are in place? If he cannot answer that, perhaps the Minister can. The threat is that we will encounter a bottleneck or that the places will simply not be there, assuming that people apply in the first place.

Paul Scully: The hon. Gentleman might not be surprised to know that I cannot answer that, so I will pass it on to my hon. Friend the Minister, who I am sure will cover it when he sums up.

As I said earlier, I ask the Minister whether there will be an exemption for loans taken out to cover a second degree. Also, what arrangements will be made for placement expenses, which are a concern for many people going through the process? In Parliament a few years ago, there was some discussion about unpaid parliamentary interns, and a number of changes were made. Greater accountability through the media has led many Members of Parliament to change their practices so that, rather than just getting unpaid interns to do a load of work, they are paying a reasonable wage, even if it is not the full-on salary that someone else might get.

As I have mentioned, the people doing placements are largely not supernumerary. They mostly do full-on nursing work, to our benefit as patients. I will be grateful to hear what the Minister has to say about placement expenses.

Stephen Pound: The hon. Gentleman is being extremely generous. I am sure that I am not the only person to congratulate him on bringing this extremely important matter before the House. On the basis of my 10 years’ experience working at Middlesex hospital, may I say that nurses are in an exceptionally unusual position? They cannot simply come and do five days and then go home. Accommodation is an issue. Nurses’ homes such as John Astor House at the Middlesex are long gone. How on earth can we ask student nurses or potential student nurses to come to one of the major five teaching hospitals in London—there are now four, obviously, since the Middlesex is gone—without giving them any support or assistance with accommodation? Nurses’ homes do not exist anymore. With respect, nurses need more at the moment, not less. [Hon. Members: “Hear, hear!”]

Paul Scully: Well done to the hon. Gentleman for getting audience participation. What I will say in conclusion is that the changes will strike home by giving people more money in their pockets for living expenses. I appreciate that the housing situation in London is particularly acute, but the whole intention of the proposed change is to ensure that student nurses have more money in their pockets to cover their living expenses in a difficult situation where the budget is limited.

I will leave it at that, because I know that a number of hon. Members want to speak. I will be interested to hear the Minister’s view when he sums up.

5.3 pm

Wes Streeting (Ilford North) (Lab): It is a pleasure to serve under your chairmanship, Mr Pritchard. I am delighted that, thanks to the response of more than 150,000 people, we are having this important and timely debate, which will allow me to raise some of the issues

11 Jan 2016 : Column 210WH

outstanding from the Adjournment debate that I secured before Christmas and address those that the Government have not yet addressed.

It is encouraging to see three members of the shadow Cabinet here at this debate: the shadow Health Secretary, my hon. Friend the Member for Lewisham East (Heidi Alexander); the shadow Minister for mental health, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger); and the shadow Foreign Secretary, my right hon. Friend the Member for Leeds Central (Hilary Benn), who has shown an interest during the course of these proceedings. This weekend, the shadow Health Secretary and I, along with other right hon. and hon. Members, joined thousands of students, nurses and supporters marching through the streets of London to raise their concerns about the implications of the Government’s decision. A statement of support from the Leader of the Opposition, my right hon. Friend the Member for Islington North (Jeremy Corbyn), was well received by all in attendance.

I begin by emphasising that, often as shorthand, we have been discussing the implications of the policy changes for student nurses and midwives, but of course the changes extend to a range of allied health professionals, as I said in my Adjournment debate. It is important not to lose sight of that when discussing the Government’s proposed approach.

To recap the Adjournment debate, we are discussing the biggest shake-up in the funding of nursing, midwifery and allied health subjects since the Health Services and Public Health Act 1968. It would mean the end of the non-means-tested grant of up to £1,000, the end of the means-tested NHS bursary of up to £3,191 and the imposition of tuition fees of £9,000 a year, which would burden nurses, midwives and other allied health professionals at the start of their career with huge debts of at least £51,600. Thanks to the repayment threshold, now shamefully frozen at £21,000, they will begin to pay back those debts immediately on starting their career and will face an average pay cut of £900.

Given that such professionals are required to work at least 2,300 more hours across the course of their degree, it is an absolute disgrace that we are seeking to balance the books on the backs of the front-line staff who form the backbone of our NHS. No wonder so many NHS professionals across the board are angered by the Government’s approach. It seems to be a trend under this Government. We are seeing it not just in the treatment of nurses, midwives and allied health professionals but in the Government’s intransigent approach to the junior doctors dispute, in which people could go out on industrial action, not out of choice but out of apparent necessity.

To follow on from the Adjournment debate, a number of questions are still outstanding. My concerns about the Government’s approach involve both the policy content and the process that they are choosing to follow. I asked the Minister during the Adjournment debate whether he could confirm that the Government would consult on the principle of policy changes, not merely their implementation. He told the House that

“we will not consult on the principle, because that has been decided”.—[Official Report, 14 December 2015; Vol. 603, c. 1379.]

Yet, as I will go on to outline, many fundamental aspects of the policy and the detail underpinning it have not yet even been considered by the Government. I am surprised that Ministers are confident embarking on

11 Jan 2016 : Column 211WH

such a radical course of action without having thought through the consequences properly. I have asked the Minister what analysis the Government have conducted of students receiving NHS bursaries for tuition and maintenance costs, but have received no answer. I do not believe that the analysis has yet been conducted. I am sure that it is under way, because he has confirmed that the Government will publish an impact assessment alongside the consultation, which he expects to start next month, but was that impact assessment conducted before the Government embarked on this approach, or is the Chancellor just shooting in the dark to balance his books?

Louise Haigh (Sheffield, Heeley) (Lab): Is my hon. Friend aware of research by the trade union Unison showing that nine out of 10 student nurses surveyed said that they would not have gone into training if the new proposals had been in place? Given that this month London issued a critical alert after its vacancy rate jumped 26% to 10,000, should the impact assessment not cover the impact on the recruitment and retention of nurses in our system?

Wes Streeting: Those statistics concern me greatly. I should probably have said at the outset of this debate that I am a member and supporter of Unison. I also draw the House’s attention to my entry in the Register of Members’ Financial Interests. For completeness, I should also say that I am a former president of the National Union of Students and have a long-standing interest in such issues.

It concerns me that there might be a detrimental impact on recruitment, particularly given that my local NHS trust had to fly nurses over from Portugal to fill vacancies. I have no problem with those Portuguese nurses coming over to help plug the gap, but we have plenty of home-grown talent in the form of nurses who would welcome such a job opportunity. That is felt strongly by local people in my area.

Stella Creasy: My hon. Friend is a near neighbour to Barts hospital trust, which is currently spending £10 million a year at Whipps Cross university hospital, our local hospital, such is the shortage. A hospital that is £941 million in debt due to its private finance initiative loans clearly needs to save money, yet it is having to pay £10 million for agency nurses. Does he think that the policy will make that easier or harder to deal with?

Wes Streeting: I am grateful to my hon. Friend for that intervention, and I believe it will make it harder. That concerns me, because Barking, Havering and Redbridge University Hospitals NHS Trust covers part of my constituency and the other half is served by the Barts Health NHS Trust. Both trusts are in special measures, and one issue that has contributed to that has been the inability of both trusts to recruit and retain the staff necessary to provide the timely and quality care that residents in Ilford North and other parts of north-east London have come to expect.

Alex Cunningham: It is clear that the professionals are very worried about this issue. South Tees Hospitals NHS Foundation Trust has told a midwife in my

11 Jan 2016 : Column 212WH

constituency and her nurse colleagues that it wants to extend their breaks from 30 minutes to 60 minutes, which means they will have to work an extra shift every four weeks. Many of them cannot take their 30-minute break now, and they are really worried that they will have to work even more hours because the trust will not be able to get the staff it needs if the bursary scheme does not continue. Does my hon. Friend agree that for that reason, the South Tees trust should rethink its plan, and that the Government should do likewise regarding bursaries?

Wes Streeting: I certainly agree with my hon. Friend. The Government and the NHS underestimate the extent to which staff at all levels are both working beyond their allocated shifts to plug gaps in the service and going without breaks. Given the settings that those staff work in, it is not in the interests of patients, let alone good for the welfare of the staff themselves, for them to be tired and not taking the breaks they ought to take.

Mr Jim Cunningham: One critical area at the moment is care in the community. Does my hon. Friend agree that the change to bursaries will have a big impact when we try to recruit community nurses for all sorts of illnesses?

Wes Streeting: I am grateful to my hon. Friend for raising that point, which I did not raise in the earlier Adjournment debate. Since that debate took place I have seen an article by Crystal Oldman in Independent Nurse magazine, which expressed concern about our ability to recruit nurses into community-based settings. If we are trying to prevent patients from presenting at accident and emergency, which is important to alleviate waiting times and the burden on A&E departments, it is vital that people can access timely care and support in the community. I do not believe the Government have fully considered that, but I look forward to hearing the Minister’s response.

In my Adjournment debate I also asked the Government whether they thought it was fair that students from the most deprived backgrounds should have their grants taken away while some of the wealthiest people in our society received tax cuts. I am not surprised that I did not receive an answer to that question, but it is a fair one. A lot of people wonder how, in straitened times, it is possible for the Government to find money for tax cuts for the wealthiest, but we cannot find money to ensure that people who perform vital functions in the NHS receive the support they need to get them through their training.

I asked the Minister in that debate how much debt the Government expect to write off because those indebted by the reforms are unable to pay their debts in full. That question was not answered. However, we know that in the case of the tuition fees brought in by the coalition Government, the current Government expect that the majority of students will see their debts written off, at cost to the taxpayer, further down the line.

I wonder about the Chancellor. Following him on economic policy at the moment is a bit like following a drunk driver: one minute he tells us that things are fantastic, and then the next minute he tells us that something called “the global economy” might have an impact on our domestic economy. I am glad that he has

11 Jan 2016 : Column 213WH

finally got that point, but I do not believe that he is currently being straight with the House and the public about how he intends to “fix the roof”, whether the sun is shining or not. It will be no good if some poor Chancellor 30 years down the line has to find huge amounts of money for debt write-off. This Chancellor needs to be clearer about where the money is really coming from.

On that point, I asked in the Adjournment debate which Department—the Department of Health or the Department for Business, Innovation and Skills—would meet the cost of servicing the resource accounting and budgeting charge for student loan debt. That question was not answered, although I am sure the Treasury and both those Departments have a view. It seems that the Government have not reached a clear position, and they really ought to have done so before embarking on this course of action.

I also asked the Minister about the Barnett consequentials for health education budgets in Northern Ireland, Scotland and Wales. He told the House that it was a matter for Her Majesty’s Treasury, but I am afraid that we did not get any real detail about what the impact on those nations would be.

Will the Minister also say how clinical placements will be funded under the current loans system? He tells us that he has started discussions with Universities UK about that, but we would have expected the Government to have those discussions before embarking on a policy of this nature.

I also asked the Government whether they were at all concerned that applications from mature students might fall, given the detrimental impact that the coalition Government’s student finance reforms had on mature and part-time student numbers. The Minister did not give a reply, but we have heard in interventions this afternoon that that is a legitimate concern. We keep being told that all has been well since the coalition introduced the new tuition fees regime, and that student numbers in higher education are excellent. It is true that overall student numbers have gone up, but I do not think that there has been the necessary level of analysis about whether people are being deterred from applying. It is all very well saying that the numbers have gone up, but that does not tell me whether the regime deterred people from applying. However, we know for certain that it has had a particularly detrimental impact on the numbers of mature and part-time students. The issue of mature students ought to weigh heavily on the Government’s mind before they decide to proceed down this course on nursing bursaries, because it is clear that there will be big problems for the nursing profession if mature student numbers fall.

Nic Dakin: On that point, it is important for areas such as north Lincolnshire, which struggle to attract new graduates, to be able to grow our own graduates, and mature students are a major part of that. A fall in their number will particularly affect areas such as ours, which new graduates do not see as particularly attractive.

Wes Streeting: I absolutely agree with my hon. Friend, and I have another concern. In my Adjournment debate I asked the Minister to confirm whether mature students would be eligible to apply for a second loan, and he confirmed that they would be able to do so. However,

11 Jan 2016 : Column 214WH

that does not reassure me that the change to bursaries will not have a detrimental impact. If a mature student has already taken out a significant loan for a first undergraduate degree and still has some of that loan debt outstanding, given that they are closer to retirement than the stereotypical 18-year-old entrant, will they really want to take on additional debt? There are major question marks about that, and again, the Government ought to have done the research and analysis on it before embarking on this policy direction.

I am conscious of the time and the number of Members who wish to speak, so I turn finally to the question of process. This Thursday, a Delegated Legislation Committee will be convened to debate the abolition of student grants for all students, including the cohort we are talking about today. It is absolutely appalling that the Government are seeking to use the device of delegated legislation to put through such a major change to student finance. Whatever disagreements I had with previous Labour Governments about their higher education policy, at least they were courageous enough to bring their policies to the House of Commons, put them through the House of Lords, justify them and put them in the full light of scrutiny by right hon. and hon. Members.

This use of a Delegated Legislation Committee is part of a wider pattern of behaviour by this Government, who seek to ignore scrutiny. They seem to believe that a majority of 12 on a minority of the vote gives them carte blanche to do whatever they like. The level of public outcry, not to mention the concern expressed by Members from all parties in the House, means that the Government ought to behave far more transparently.

I asked the Minister in my adjournment debate to give the House an assurance that students studying nursing, midwifery and allied health subjects would not see their tuition fees and debts hiked up even further than has been suggested, but I was not answered. We know from newspaper speculation that the Government are considering increasing tuition fees above inflation, and we also know that the Cabinet Office is trying to find ways of avoiding a vote in both Houses, which is shameful.

Similarly, I asked the Minister to give the House an assurance that we would have a full debate and a vote if the Government chose to extend tuition fees to nursing, midwifery and allied health subject courses. The Minister told the House that he could not give us a definite answer to that question yet. I hope that he can do so this afternoon, and that he will confirm that we will have a full debate in the House of Commons and in the House of Lords, and that right hon. and hon. Members and noble peers will have the chance to make their voices heard and to put the issue to a vote.

Finally, I asked the Minister to commit to meeting student representatives to discuss their concerns, and he said that he was happy to do so. I spoke this weekend to one of the organisers of the protest, Danielle Tiplady, who has done a remarkable job in campaigning on this issue and in raising awareness among her colleagues. I hope the Minister will commit today to meeting her and other student representatives, so that he can hear at first hand the powerful testimony that we heard at the demonstration at the weekend.

We should all be concerned about the direction of this policy, and I am glad to see so many right hon. and hon. Members here this afternoon. Given that there are other debates taking place, including on Syria, which is

11 Jan 2016 : Column 215WH

a really big matter that concerns all of us, it is great that we have had such a big turnout this afternoon. I hope that helps to encourage the Government to think again.

Several hon. Members rose

Mark Pritchard (in the Chair): Will Members who want to speak, even if they are on the list, please stand clearly rather than squat, in order that we can work out whether we will have to impose a time limit later? Thank you very much indeed.

5.20 pm

Maria Caulfield (Lewes) (Con): I welcome the opportunity to speak in such an important debate. I acknowledge that the changes affect all sorts of healthcare professionals, including midwives, physios and speech therapists, but I will keep my remarks mainly to student nurses because I am a qualified nurse and have worked in the NHS for more than 20 years—I was even working as a full-time NHS nurse until just after the last general election.

I trained under the bursary scheme. I was one of the second intake, after the scheme was introduced in the early ’90s, so I have first-hand knowledge of how it works. I have met student nurses, the Royal College of Nursing—the RCN—and qualified nurses to discuss some of the issues that the changes raise. I have also met the Minister to express my concerns, and have been reassured that alternatives to a student loan mechanism for entering nurse training are in the pipeline. These might be better than the nurse bursary scheme, and they will certainly be better than the proposed student loan scheme.

Let us not pretend that the bursary system is ideal—I speak as someone who went through that method of training. It started in the early ’90s as a replacement for the old-style nurse training system in which student nurses were part of the workforce and were on the payroll. Let us be honest though, the students were used as a spare pair of hands and often there was not a huge opportunity for them to learn on the job. At that time, there were two ways for someone to become a nurse. They could do a two-year course to become a state-enrolled nurse, in which role they could do only so much, or they could do a three-year course and become a fully qualified state-registered nurse, taking on all aspects of the role of a registered nurse. The bursary scheme, when it was introduced, was a move to make nursing more academic, and to create supernumerary student nurses. Or rather, that is what is supposed to happen. As my hon. Friend the Member for Sutton and Cheam (Paul Scully) pointed out, in practice, student nurses are still used as a spare pair of hands and are rarely supernumerary when they are on placement.

Student nurses were, however, taken off the payroll and the bursary scheme was introduced as a sort of income to acknowledge that, although the students were not counted as part of the workforce, they still had to do a huge number of hours while on placement, including night shifts and weekend and evening work. The bursary was supposed to compensate the students for their loss of income, but a bursary is not a wage, and it certainly does not reflect the number of hours student nurses put in during their training.

11 Jan 2016 : Column 216WH

Let us not miss the point. Someone can do a three or four-year academic nursing degree, but unless they do the clinical placement hours, they cannot register as a nurse. That is the crux of the matter. In addition, a bursary certainly does not reflect the increase in experience and skills that students gain as they go through their training. A first-year student nurse gets exactly the same bursary as someone who has almost qualified and is practically working—under the supervision of a qualified nurse—as a qualified nurse.

The bursary system undervalues the contribution that student nurses make, and it means that student nurses across the country live on little more than £3,000 a year. The system has changed over time—it was not means-tested when I was doing my training, but it is now. Let us not pretend, therefore, that the system is ideal. The bursary has never adequately supported student nurses, and I welcome the chance to change it. Let us look at other professions. I certainly do not want people sitting in the Public Gallery to suddenly rush out and change profession completely, but a trainee police officer has a starting salary of £19,000 and a trainee firefighter starts on £21,000. Airlines are now moving to in-house training. A new pilot with no flight experience training with British Airways is on £23,000 and Virgin has a similar policy, with Richard Branson saying that he welcomes those with no experience to be part of the Virgin family from day one. Yet for student nurses, who take similar life and death decisions every single day, we propose not just that they work in clinical areas for free but that they pay for their training as well.

I believe Ministers when they say that this is not a cost-cutting exercise, because the money will instead increase the number of student nurse placements. Currently, more than 50% of people who apply to become student nurses are turned away simply because the places are not there in the universities. The RCN’s figures from only last year show that there were 57,000 applications, of which 37,000 were rejected.

Ruth Cadbury: Will the hon. Lady give way?

Maria Caulfield: I will not, if the hon. Lady does not mind, just because I know that so many Members want to speak.

Although not all of those 37,000 will have been rejected because of a lack of places, a significant number of them will. The current system restricts the number of student nurses that enter the profession so, in theory, the changes should increase the numbers of qualified nurses in a few years’ time. From my clinical practice I know, however, that what works in theory will have the opposite effect in reality.

My main concerns about moving from a bursary scheme to a student loan scheme are, first, that many nurses go into a degree system simply because there is no other way to become a nurse. They do not necessarily want a degree in nursing; they want to be a qualified registered nurse. If we commit to a student loan scheme, we are committing them to take on debt for years to come. As we have heard, many of them—more than 30%—are mature students, and by mature students we do not mean people in their 40s and 50s. They are people in their mid-20s and early-30s. They have young families; they are single mums; and they have a first degree and have to take on a second one just to become

11 Jan 2016 : Column 217WH

a nurse. It is a crazy situation. For someone who already has a student loan, and/or a mortgage and/or childcare to pay for, the thought of taking on more debt will definitely put them off entering nursing, and to say otherwise is madness.

The difference between student nurses and other undergraduates is that the starting salary for a nurse is £21,000. Most nurses will only ever be a band 5 or 6, and the maximum they can earn as a band 6 is £34,000—that is if they do not have a break to have children or go part time for some other reason. They will never be in a position fully to pay off their student loan. Student nurses are different, therefore, from other undergraduates, and that has not been recognised in the debate. An issue in the wider debate about graduates is that a graduate is, on average, £100,000 better off than a non-graduate, but that is not the case with nurses. Other graduates earn, on average, more than £40,000 a year, but nurses do not earn anything like that and that difference needs to be recognised when decisions are made.

We have heard how much time student nurses spend on clinical placements—more than 50% of their course, including nights, weekends and evenings—which makes it almost impossible for them to get any other income from part-time work. We must recognise that. Being dependent on a loan is not a great way of life either, but other students are able to supplement their loans by working in pubs and shops, and doing other evening work. Student nurses are not in a position to do that.

My second concern is that, if I am completely wrong and we suddenly have a huge increase in the number of student nurses, the placements will not be able to cope. To qualify as a student nurse, not only does someone have to pass their exams and essays and do the required hours, they also have to be clinically assessed by a registered nurse—not just any old registered nurse, but someone who has done their mentoring and assessing course. I know that there are student nurses now who struggle to find placements because there are not enough qualified nurses able to assess them. That needs to be taken into account as well. It is not just about increasing the numbers; it is about having the support services in place.

When I met the Minister, I was hugely reassured by what he said about other schemes that are being proposed. My plea is that he outlines those schemes so that student nurses are reassured that, in order to qualify, they will be able to use schemes other than the student loan system. Routes such as nursing associates and nursing apprenticeships are being proposed. I am probably getting a little old now—

Stephen Pound: No!

Maria Caulfield: I thank the hon. Gentleman for his intervention. Those routes sounds like the state-enrolled nurse or state-registered nurse route again, and they worked pretty well in years gone by.

Fiona Mactaggart (Slough) (Lab): Will the hon. Lady give way?

Maria Caulfield: I have almost finished, so I will not take any more interventions. The Minister told me that those routes are alternatives to the proposals that have been put forward today. I urge him to highlight those

11 Jan 2016 : Column 218WH

alternative routes and to give a timescale. If those alternatives are realistic, they need to be in place as the bursary system is phased out, if not before, so that student nurses have choices on how they become nurses. When I was running a clinical team, we used the assistant practitioner role effectively and made some great progress. Some of those assistant practitioners are in the process of becoming qualified nurses themselves.

I have a couple more points to make. One thing that we are missing is a return-to-nursing scheme. Under the proposals, money will be saved from the bursary scheme. Huge numbers of nurses go off to have children or take a break from their career, like me, and they have to do a six-month course and pay for that themselves. An efficient way of building up nursing numbers quite quickly would be to fund return-to-nursing courses, so that we can easily and quickly increase the number of nurses who can get back into the profession. They have huge amounts of experience.

It is hard to be a student nurse. Although it was a long time ago, I still bear the scars of my nurse training. Not only do student nurses have to learn and take exams, but their placement changes every eight to 12 weeks. They go to a new ward, new day unit or new community placement, and they never really feel part of any team. As soon as they start to get that feeling, they are moving on to the next team. They are struggling to survive on less than £4,000 a year and have to rely on family and friends. We are now asking student nurses to take on more debt to do their training. They may or may not come to nursing with a lot of life experience, but they are telling people that either they may die or their loved ones are dying. Student nurses witness death at first hand—sometimes that death is expected and sometimes it is not. They are kept going, however, by the thought that one day they will be a qualified nurse with that bit of paper that says, “You are registered.”

We have an extremely high turnover of student nurses. Many are leaving before they are qualified, and my concern is that, if we add to their financial pressures, the turnover will be even higher. We are spending nearly £12,000 a nurse to recruit from overseas and fill our vacancies, and I would prefer to see that money being used to sponsor nurses to get into their nurse training, whether that is through the associate route, the apprenticeship route, which sounds exciting, or through encouraging and paying nurses to come back into nursing. We need to have that Virgin philosophy, where a student nurse is part of the team from day one. I hope the Minister can give us some positive feedback from the petition.

5.33 pm

Paul Blomfield (Sheffield Central) (Lab): I am delighted to follow the hon. Member for Lewes (Maria Caulfield), who made a powerful contribution. Many of the points she made echo those raised by my constituents. She gave a devastating critique of the Government’s proposals. I am grateful to the 154,000 people who signed the petition. That reflects their concern about the Government’s proposals, and we should recognise their contribution. Without them we would not be having this debate in quite this way today. When I last checked, my constituency had the highest number of signatories to the petition. Many have written to me expressing their fears about the impact of withdrawing bursaries for student nurses,

11 Jan 2016 : Column 219WH

midwives and the allied health professions. It is important that we recognise the diversity of professions that are impacted by the Government’s proposals and the different demographics and the different factors that will have an impact.

I am pleased to have the opportunity to press some of my constituents’ concerns on the Government, and I will quote from four. Teri-Lisa Griffiths wrote to me about her mum, who is from a working-class home and was forced to leave school due to family income and family pressures. In her desire for personal development and to be a positive role model for her children, she went to university and trained as a nurse. She said

“attending my mum’s graduation was one of the proudest moments of my life and reinforced my aspirations to attend university and aim for a professional career. The proposed changes leave me dismayed at the potential implications both for the NHS and wider social mobility…With a young family to raise, my mother would never have been able to achieve this without the financial support offered through the NHS bursary.”

Susi Liles is a graduate nurse who did a first degree in sociology. She drew on that experience, saying that

“the work load for the nursing degree is much more than for a normal degree, and there are fewer holidays”.

She also said that

“you couldn’t do other work while training.”

Other Members have made that point. She pointed out that nurses simply do not earn enough money to repay the loan, and we could contest some of the figures that have been given. She said that the bulk of nurses on band 5 would not find it easy to pay rent, run a car, which is usually a necessity for shift work, and meet all the other costs of living while also repaying their loan.

Jessica Gallagher, whose mother has been a nurse for 40 years and who has been qualified herself for two years, works in an acute and emergency setting. She said:

“I truly love my job but as a ‘mature student’, I have no doubt that I would not have completed the course had it not been for the bursary support.”

Ella Williams is a student midwife in her final year. She told me:

“I have struggled financially as it’s not really feasible to have a job as well as do degrees like mine.”

Echoing the point that the hon. Member for Sutton and Cheam (Paul Scully) made in opening the debate, she also said that, unlike other students,

“although you are learning you are then almost free labour. Sometimes it is disheartening to feel you are working as hard as everyone else, but doing it for free and I think that students would feel that even more were they getting no government assistance. I completely love what I do, but…I’m sure it isn’t just me that feels as though I’m headed into a career that is misunderstood and undervalued by the government.”

All those women have two things in common in appealing to me as their Member of Parliament: they are not affected by the changes and they have no personal axe to grind. They are not individually going to lose out. They simply want to share their experience of why taking away the bursaries and introducing tuition fees will damage the NHS and the professions of which they are proud, and they make powerful points. We have already discussed the impact on mature students. They have been disproportionately hit by the introduction of

11 Jan 2016 : Column 220WH

tuition fees and the new regime in higher education as a whole. We know that they are positively disproportionately represented within nursing and in particular within midwifery and allied professions. We also know that they are more likely—my hon. Friend the Member for Walthamstow (Stella Creasy) made this powerful point—to have dependents, and the changed arrangements will hit them in that regard, too. The changes will be a particular barrier to those from lower income families. Nursing and midwifery have been an important route of social mobility for many who have ruled out university because of the cost. The package is attractive and makes stepping up into a profession more achievable.

My constituents and other hon. Members have made the point that student nurses cannot work outside the course. Before I was elected to this place in 2010, I worked at the University of Sheffield, where I was partly involved in negotiating the contract for the university to take over nursing and midwifery training. From my experience working with those students, I know that it simply is not feasible for student nurses to do what other students do in offsetting the cost of their higher education by working while they are studying, because of the intensity of the course, the time spent in clinical practice and the early, late, night and weekend shifts that are a normal part of their studies. I was under the impression that nursing students have to complete a minimum of 2,300 hours in clinical practice, but the hon. Member for Sutton and Cheam said that it was more than that. I will take his advice. None the less, it makes it impractical for them to work as other students do and it is wrong to treat them like other students.

I was unsure about the hon. Gentleman’s numbers on this, but my understanding is that, for a nurse on a band 5 salary, repaying the loan would cost about £900 a year. In practical terms, that is approaching a 5% cut in salary. The Government’s training policy in other sectors is to introduce an apprenticeship levy, and I agree with that, because it says that employers have to take responsibility for training their workforce. That is right. But what are the Government doing when they are the employer? They are saying the reverse: that the employee should take responsibility for training the workforce. They are imposing a 5% cut on nurses to meet the cost of training the NHS workforce. That is wrong.

The Government are stumbling into a potential disaster, not only for the lives of those who will not be able to pursue their dreams of a career in nursing, midwifery or the allied health professions, but for recruitment in the NHS. When I was elected in 2010, I assumed that I would disagree with the Government on a number of issues, and I have not been proved wrong. Nevertheless, I also assumed that, by and large, they would pay attention to evidence when reaching decisions and, on issues as important as this one, listen to that evidence. As has been pointed out already, so far that does not appear to be the case with regard to the serious concerns raised across the professions—those working in and managing the health sector—about the effect of the changes.

If nothing else comes out of this debate, will the Minister at least agree to publish the evidence that the Government considered when they first reached this decision? Most importantly, will he agree to a proper consultation on the full proposals, not just a technical consultation on their implementation? In his opening

11 Jan 2016 : Column 221WH

speech, the hon. Member for Sutton and Cheam said that this debate was positive because the Government had initiated a discussion that would give nurses and midwives the opportunity to shape future funding arrangements. He said that the current system is not good enough, as did the hon. Member for Lewes. They are right: it is not good enough. But why not come up with a better system, rather than a worse one? If the consultation to which the hon. Member for Sutton and Cheam aspires—one that engages with student nurses and midwives to reshape the system—is to mean anything, it must be proper, full and comprehensive. I hope the Minister will commit to that today.

5.42 pm

Mr Andrew Turner (Isle of Wight) (Con): It is a great pleasure to serve under your chairmanship, Mr Pritchard.

With an ageing and increasing population, there is no doubt that we need a stronger nursing workforce in the NHS. I am glad that the Government recognise that. What worries me, and so many others, is the proposed removal of the bursary scheme in England. In moving to a loan-based system, the Government will need to find ways to attract students to a career path that includes irregular and long hours and is often physically and emotionally demanding. We have yet to hear those proposals, although I congratulate my hon. Friend the Member for Sutton and Cheam (Paul Scully) for bringing to our attention some examples of what should be done, including having better salaries and apprenticeships rather than bursarships. The Royal College of Nursing has rightly suggested that the bursary system creates a connection between nursing students and the NHS, a potential future employer, from the start of their education. By removing that connection, we risk reducing the motivation for and attractiveness of such vital jobs in the NHS.

More rural and remote constituencies such as mine, the Isle of Wight, need to make jobs in the public sector attractive and provide motivation for qualified nurses who have student loans that need be to paid off. Most importantly, the island’s peculiarities must be taken into account, especially the fact that journeys to universities on the mainland take students two hours each way every time they travel. I hope the Minister will address that problem.

5.44 pm

Mark Durkan (Foyle) (SDLP): It is a pleasure to take part in this important debate. I commend the hon. Member for Sutton and Cheam (Paul Scully) for introducing it as a Petitions Committee member. He had the difficult task of framing the wider debate by drawing attention to a number of the background and contextual issues in the way that he felt was fairest and on the broadest issues. Many of us are in-filling the debate with a different emphasis, taking account of some other considerations.

As a Northern Ireland MP, I am conscious that this debate is about the bursary scheme for the NHS in England. Of course, the scheme recruits students from Northern Ireland who are undertaking courses in England, and as a devolved Administration we also have our own variant of the scheme. In previous contributions on this subject, the hon. Member for Ilford North (Wes Streeting) has raised the question of whether there will be an

11 Jan 2016 : Column 222WH

immediate Barnett consequential to this change to the NHS in England. Even when we get the answer from the Treasury, it changes over time. I have served as a devolved Finance Minister, so I know that in one instance the Treasury will tell you that there is no Barnett consequential, but then a year or two later some new thinking will mean that there is and that the vice has been tightened. Its usual rule of thumb is, “We’re the Treasury; we don’t need a reason,” so it can change at will.

Although, as the hon. Member for Belfast East (Gavin Robinson) said earlier in an intervention, the current Health Minister in Northern Ireland has properly set his face against going down the same road as the UK Government on the bursary scheme, the fact is that a significant change such as this has the potential to become the predictable text of future devolved policy. It has a conditioning effect by creating a context, and even when devolved Administrations resist such policy changes it usually adds to their costs, which makes the choice not to make the change harder. There is usually policy opportunity cost elsewhere as well.

We need to ask where the rush to this policy change has come from. Two lines in the autumn statement have heralded a significant change. We are told that a consultation will start this month, so will the Minister tell us how serious, thorough and far-reaching that consultation is going to be? Will it include a comprehensive consideration of all the implications of the change and a proper consultation on all the shortcomings and benefits of the current scheme?

Those of us with concerns are not coming here with a “Little House on the Prairie” picture of how the existing scheme operates. We are not pretending that nursing students and students in the allied health professions currently have a sweet life. They clearly face many serious pressures, but we heard from the hon. Member for Sutton and Cheam that the pressures, difficulties and life costs justify the change. In my view, they justify taking great care with any change. We need to address the problems that exist without creating new problems or compounding the existing ones, for exactly the reasons mentioned by other Members, including the hon. Member for Isle of Wight (Mr Turner), who described the implications of changing to a loan-based system.

We must recognise that the roots of nursing education have historically been very different from those of other education. It is only recently that we have seen the well motivated move to ensure that nursing and the allied health professions are truly recognised as professions of degree standard. The problem is that some people take that to mean that we should treat the bursaries in the same way as any other student loan and that that should be the norm. We know, for the reasons that Members have set out, that it should not. The students in question are not just in training but in service in a real, pertinent and highly pressurised way, which means that they do not have the options for covering their maintenance costs that other people have, and that their time is much more precious. Given their life circumstances, they have responsibilities that students on many other courses do not, so we are not comparing like with like.

Where has the support for the change come from? Has it come from the professional bodies that represent nurses, midwives, physiotherapists, speech and language therapists, occupational therapists, dieticians, radiographers, chiropodists and podiatrists? No, it has not. They have

11 Jan 2016 : Column 223WH

real concerns about the implications of the change for their members and the services they work in. Has it come directly from the employers? Health service employers in Northern Ireland, including in my constituency, constantly talk about workforce problems and the huge pressure to fill places and keep services running. A new radiotherapy unit has opened in a hospital in my constituency, and there will be huge pressure on it to employ and sustain radiologists for the future. Health service employers in Northern Ireland are acutely conscious of the pressures, but none of them has said to me that they believe this change will solve the problem.

The change seems to be sponsored mostly by the Council of Deans of Health, which is responsible for education, because it will perhaps solve a problem for universities. Universities look at their numbers and their funding and ask what the change will do for their economics, given that they have a key role in educating health service professionals. It will solve a problem for them, but not for the services that are meant to be supported or the professions. We must include in the consultation those whose voices have not been listened to and who have not canvassed and pushed for this change. Their voices must be heard, which is why this debate and others like it are so important.

The hon. Member for Sutton and Cheam said that something has to give and that the bursaries need to be changed. At one point, he actually said that one reason why bursaries are not good is that they can be taken away, as though that was an argument against bursaries. It is pretty cheeky to justify a proposal to take bursaries away by saying that we should do it because they can be taken away.

Paul Scully: Forgive me, I was talking about the title and the semantics. “Bursary” is a bit of a misnomer when, as had been said, it is more like a salary, albeit an inappropriately low one.

Mark Durkan: I take the hon. Gentleman’s point, which resets the context of his comments. I gladly acknowledge that clarification.

Just as we should not presume that bursaries are a given and cannot be taken away, people cannot afford to presume that the assurances about the loans-based policy are a given. The current rate of 9% of earnings over £21,000 can change—we must remember that the registration fees for people in the nursing and midwifery service have been hiked up. The Government’s justification for that significant hike in percentage terms is that they have been raised from a fairly low base. When people hear the argument that some students will not pay much of the loan or the whole loan, many fear that more money will be sought in the future in comparative and relative loan repayments. People cannot rely on the assurances that have been given and some of the other arguments that have been made. I hope the Minister is able to convince us that the consultation will look at all those issues and that they will be answered properly.

5.55 pm

Liz McInnes (Heywood and Middleton) (Lab): It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to be able to make a contribution to this

11 Jan 2016 : Column 224WH

important debate. I congratulate the 154,000 people who have signed the petition and brought this issue to the House for discussion.

I declare an interest: I am a Unite member and an ex-Unite workplace rep in the NHS. I used to work as a healthcare scientist in the NHS. I did not receive a bursary for my training; I was employed in a supernumerary position. I was privileged to be able to do that. In my day, it was recognised that I was making a contribution to the NHS while being trained. The Government should perhaps go back a few decades and have a look at how NHS staff were treated in the 1980s, when I trained.

Members have quoted various figures about the proposed changes. From the reading I have done, I believe that under the proposed changes, students could be burdened with up to a staggering £65,000 of debt by the time they finish their training. Under the current system, the bursary allows those without financial means to study as nurses, midwives and, importantly, allied health professionals—I am grateful that a lot of Members have mentioned AHPs, because it is important that we do not forget them and their contribution to our NHS. Many trainees already struggle to make ends meet, even under the bursary system. As Members have said, the system is not perfect, and we need to look at it, but let us do it properly and put in place a system that actually works, rather than one that appears not to have been tested or consulted upon.

[Mr Nigel Evans in the Chair]

Many Members referred to the difficulty of getting part-time jobs. It was a pleasure to listen to the hon. Member for Lewes (Maria Caulfield) talk about her own experience. Given the number of hours that NHS trainees—nurses, midwives or AHPs—are expected to work during clinical placements or at university, plus all the extra hours on assignments, exams, practicals and study, there are not enough hours in the day for them to take on a part-time job.

I was interested to hear the hon. Member for Sutton and Cheam (Paul Scully) refer to Martin Lewis’s MoneySavingExpert.com website. I had a look at it during the debate to see the advice that he gives about NHS bursaries. I could not find anything particularly relevant, but I noticed that, to help students financially, he advises them to get a part-time job. That is obviously not suitable in this situation. The hon. Member for Lewes highlighted the relatively low pay that nurses on band 5 or 6 can expect to earn. Under a loan system, those people, once qualified, will be paying back that debt for their whole career. I urge the Government to consider those points, which have been well made.

Mr Andrew Smith (Oxford East) (Lab): My hon. Friend is making an excellent speech. Does she agree that the pressures will be all the more acute in high-cost housing areas such as Oxford, where nurses are already struggling, which will be a further disincentive to recruitment and retention in services that are already under enormous pressure?

Liz McInnes: I thank my right hon. Friend for his important intervention. Housing costs must be borne in mind in any discussions about changes to NHS bursaries. The days when cheap accommodation was available to

11 Jan 2016 : Column 225WH

NHS trainees are long gone. I can remember staying in a tower block in Greenwich at a reasonable rate during my training, but those tower blocks were sold years ago and are now privately owned.

Replacing bursaries with loans will reduce the diversity of those able to access a career in healthcare. I noted with interest that the hon. Member for Sutton and Cheam claimed when challenged that that would not be the case, but was then unable to quote any equality impact assessments. I would be interested to hear from the Minister what assessments have actually been performed. The NHS bursary is not a cost but an investment in the health and wellbeing of our society. To lose the bursary would affect not only prospective students but each and every citizen of this country, by which I mean England, because the proposals apply to England only.

In the Budget debate of July last year, I spoke against the change from maintenance grants to loans for young people hoping to go to university. The withdrawal of NHS bursaries, as announced in the comprehensive spending review, directly mirrors that change. As a result of the Budget proposals, our students will be saddled with even more debt. I said at the time that there was a real risk that the Government were experimenting with the future of the current generation of secondary school students, but it now appears that they are also experimenting with the future of current and potential nursing and health trainees. In short, it is an experiment on the future staffing of our NHS that has the potential to go badly wrong.

I put out a simple statement on Twitter regarding the views of the Royal College of Midwives, which opposes the proposals to remove NHS bursaries, and received this response:

“My daughter a single parent budgeted carefully b4 becoming a student nurse, may not be able to complete studies.”

That is an appalling situation into which the Government have put that student nurse. Again, that gives the lie to their oft-repeated claim to be the party of working people. Simply repeating the same line over and over again does not make it true, although that does seem to be this Government’s modus operandi on so many issues.

As with the Government’s conversion of maintenance grants to student loans, I would be interested to read an equality impact assessment, should such a thing exist, of the removal of NHS bursaries. The Government’s claim that cutting the bursary will encourage more prospective students into nursing is ludicrous, and even some Government MPs are saying so publicly. I was pleased to hear the hon. Member for Lewes on Radio 5 live yesterday stating that she would have not been able to train as a nurse without an NHS bursary. Today she hinted at alternatives, including apprenticeships and maybe even a return to the days of state-enrolled and state-registered nurses, and I hope that the Minister will be able to elaborate on them.

The Royal College of Midwives believes that the NHS workforce deserves a better future and says, interestingly, that the Government have

“taken money away from other parts of the health system, including student education, to be able to give ‘the NHS’ more money. According to the King’s Fund, spending on health activity that falls outside NHS England’s budget will decrease by more than £3 billion in real terms by 2020/21—a reduction of more than 20%.”

11 Jan 2016 : Column 226WH

The RCM then quotes the King’s Fund, which states that

“it is clear that a large amount of the additional increase in NHS England’s budget has come at the expense of other areas of health spending.”

The Royal College of Nursing is similarly opposed to the plans and refers to them as “ill thought out”. As the RCN celebrates its centenary, it calls upon the Government to listen to its knowledge and expertise, stating:

“The future of nursing must be protected. Our patients deserve nothing less.”

Unite the union also opposes the plans, highlighting the other health professions covered by the NHS bursary, including occupational therapists, physiotherapists, radiographers and speech and language therapists, to which other hon. Members have referred. Those professions are the backbone of our NHS, and we cannot allow entrants to them to train at their own expense while racking up debt. To do so would be disastrous for our NHS and for future patient care. I urge the Government to reconsider the proposals and, more importantly, to take advice from the professional bodies.

6.5 pm

Colleen Fletcher (Coventry North East) (Lab): I am grateful for the opportunity to speak. I congratulate the hon. Member for Sutton and Cheam (Paul Scully) on securing this vital debate on the e-petition relating to the retention of the NHS bursary. I praise those who created the e-petition and the more than 150,000 people who have so far chosen to sign it.

I have no experience of nursing, and I pay tribute to the hon. Member for Lewes (Maria Caulfield) and my hon. Friend the Member for Heywood and Middleton (Liz McInnes) for their experience. I have never had any interest in nursing, but when my husband was very ill last year I, like many others, gained experience of the nursing profession and how nurses go about their important work. I have nothing but admiration for nurses. However, because I do not have direct experience, I thought it pertinent to seek the views and opinions of some of the exceptional nurses who form the backbone of our NHS and who have first-hand experience of the physical, emotional, mental and financial challenge of successfully completing a rigorous healthcare course.

I asked nurses about the funding arrangements for NHS students and the consequences of the Government’s decision to scrap bursaries and charge tuition fees, thereby passing on the full cost of training to the students themselves for the first time. Without exception, these dedicated and essential frontline NHS professionals extolled the immeasurable importance of retaining and improving the existing bursary system going forward and condemned, without equivocation, the Government’s decision to scrap it. They each wholeheartedly espoused the long-established reciprocity of the existing funding arrangements, which—albeit weighted in favour of the NHS and its patients—sees student nurses undertake a gruelling 2,300 hours of unpaid work across the NHS for the benefit of us all. In exchange, they are not charged fees for their training and receive a bursary. The arrangement recognises, whether by luck or design, the nature of the nursing course. It is longer than other university courses, with shorter holidays and a demanding work placement, all of which severely limits the opportunities to take on additional work to pay towards studies, to which many hon. Members have alluded.

11 Jan 2016 : Column 227WH

The nurses to whom I spoke impressed on me how much of an incentive the current funding model is to those applying for a place on a nursing course and how its withdrawal, to be replaced with the huge levels of debt from a loan and tuition fee system, is likely to deter would-be applicants from entering the course in future. They said that that would be particularly true for mature students, who may have young families, caring responsibilities for elderly parents and a mortgage to pay, or those for whom healthcare is a second degree. Moreover, many of those whom I contacted raised concerns that the Government had already actively and wilfully undermined the incentives of a career in nursing, even before they announced the proposed funding changes.

One in particular, Steven, who is extremely proud of being a nurse and recognises the rewarding nature of the job and the positive impact that it can have on people’s lives, said that he was none the less aware that the incentives for entering the nursing profession had been significantly diminished in recent years and would be lessened still further by the Government’s proposals, which would burden newly qualified nurses with debt of at least £51,600 and an average pay cut of £900 a year due to debt repayments. Steven told me:

“Nursing currently offers very little incentive even if students make it through the three years of training. The well documented staff shortages and increased work load, especially in the winter, coupled with five years of pay freezes, below inflation pay rises, and increased pension contributions does not inspire students to commit to three years of gruelling physical work and financial hardship.”

Given the staffing shortages in the NHS, the Government should seek to improve the terms and conditions of employment for nurses, to reward their invaluable work in extremely difficult circumstances and to incentivise more people to enter the profession, rather than exacerbating the workforce crisis as they have done in recent years and as the proposed funding changes will do in future.

I hope that the Government will listen carefully to extraordinary and dedicated nurses such as Steven and, in doing so, recognise the strength of support among health professionals and the wider public for a reversal of the proposals and for the retention and improvement of the NHS bursary. If the Government are not minded to reverse their proposals, at the very least they should pause them before rushing through such damaging changes and take the opportunity to commit to a proper consultation on the full proposals, not simply have a procedural consultation on their implementation.

At this juncture it seems apt to conclude by again quoting Steven, who told me:

“The bursary allows anyone with a caring and kind nature to achieve their dream of being a nurse; it ensures a constant stream of nurses from all backgrounds which leads to a rich and diverse workforce equipped with the skills to deliver care to our rich and diverse society.”

The scrapping of the bursary will not only jeopardise that workforce diversity, but is likely to have a negative impact on overall nurse recruitment. Ministers would do well to take heed of his stark warning.

6.12 pm

Gavin Newlands (Paisley and Renfrewshire North) (SNP): It is a pleasure to serve under your chairmanship, Mr Evans. I am grateful to have the opportunity to take

11 Jan 2016 : Column 228WH

part in the debate and I strongly support the petitioners in calling on the Chancellor to keep the NHS bursary for those students who are studying to become the next generation of nurses, midwives and other health professionals.

Before I make further progress, I should declare an interest: my sister is a nurse at my local hospital in Paisley, the Royal Alexandra, to which my mother was admitted only a couple of hours ago. My local university, the University of the West of Scotland, helps to train and educate 4,000 nursing students, one of the largest cohorts in Scotland.

Following the Chancellor’s bursary announcement, I spoke to my sister, nursing friends and nursing students to learn about the impact of that reckless decision. They were disappointed, to say the least, to learn of the Chancellor’s actions and short-sightedness, but they were not surprised. Since coming to power the Chancellor and his Cabinet colleagues have launched a direct assault on the health service and on the education sector in England. A week does not seem to go by without health workers or students protesting about polices pursued by the Government.

Following my discussions I decided to raise the issue of the bursary with the Chancellor when he stood in at Prime Minister’s questions while the Prime Minister was gallivanting around Europe in his rather pathetic renegotiation tour. I called on the Chancellor to explain to nursing students why he was removing vital support from them. Unfortunately, he was unable to provide any sort of answer, and from that performance it is clear that he will need to improve if he wants to become Prime Minister.

It is important to remember and understand why nursing students receive a different funding settlement from other students. Nursing students usually work longer hours on their course than other students and, alongside their studies on the course, nursing students work 37.5 hours each week in their placement areas. The long hours on placement ensure that nursing students follow the same duty patterns as full-time staff. From speaking to nursing students, I know how much they appreciate that education on the ward, and they benefit greatly from learning alongside qualified colleagues.

We should also remember that the majority of nursing students are women; a higher proportion are mature students; and some have children or other dependants to look after. Many students work part-time to help cover the cost of living, and most of their jobs are low paid. Based on that, we can all appreciate and understand why there is a different funding settlement for nursing and other health-related students.

If we want to improve our NHS, we cannot make reckless decisions like this one. The Chancellor’s decision to abolish bursaries should be seen as an attack on the NHS, on the health professionals of tomorrow and on aspiration—the very opposite of what the Government claim they want to achieve. Let us be clear: forcing such students to take out loans to cover the costs of their course will deter people from wanting to enter an NHS career.

A coalition that includes Unison, the National Union of Students, the Royal College of Midwives, the British Dental Association and others states that the proposed new system will lead to students accumulating debt worth at least £51,600. That is a disaster waiting to

11 Jan 2016 : Column 229WH

happen. Demand for NHS services is growing and we need more nurses and other health professionals; putting barriers in their way will lead to fewer choosing such professions. Instead of removing support for such students, we should look at whether the existing level of support is enough for them to excel in their studies and to develop their career within the NHS.

At the moment, nursing students in England receive up to £4,200 a year to support them through their studies. Given that those students are also working full-time in the ward, they will clearly be earning well below the minimum wage. We have to ask ourselves why the Government have not published the impact assessment that was carried out on the effects of their decision. Have they something to hide?

When summing up, will the Minister tell us why that impact assessment has not been published? Will he tell us what impact the changes will have on those students who come from the most deprived backgrounds? What impact will the policy have on the drop-out rate for students studying on nursing and health-related courses? Those are important questions that need to be answered. I fear that we are creating and debating policy without knowing the full impact of policy created in pursuit of the Government’s ideological obsession with austerity.

The Chancellor should seek guidance from the Scottish Government on support offered to nursing and health-related students. Whereas the UK Government want to abolish bursary support for nursing students, the Scottish Government provide £6,578 to students, which is £2,500 more than for students south of the border and all on a non-means-tested basis. Whereas the UK Government want to impose tuition fees of £9,000 on those students, the Scottish Government have abolished tuition fees and preserved the principle of education based on the ability to learn, not the ability to pay. Whereas the UK Government work against health service and education partners, the Scottish Government work with such bodies, in partnership, ever to improve the education and health services that exist in Scotland. I ask the Minister directly: will he assure me that the cut to bursaries will not result in cuts to the block grant allocation to Scotland? Finally, how will the cuts affect cross-border study?

We seem to have a tale of two Governments: a UK Government and Chancellor fixated on austerity and making life difficult for students and workers alike; and a Scottish Government working with people to protect us from Osborne austerity. However, we in the Scottish National party will not sit back and watch the UK Government attack the next generation of health professionals, including junior doctors. We support those students studying down south who dream about a career in the NHS. We will be a friend to them, a friend to aspiration and a friend to the NHS. We will challenge the cuts at every opportunity.

Several hon. Members rose

Mr Nigel Evans (in the Chair): If I heard correctly, Mr Newlands, you said that your mother had just been admitted to hospital—our thoughts are with you.

The debate will finish no later than 7.30 pm. The Front Benchers may divide up the time and should not exceed it, so that everyone gets an equal amount of time. It is customary to allow Mr Scully an opportunity to wind up right at the end. I call Philippa Whitford.

11 Jan 2016 : Column 230WH

6.18 pm

Dr Philippa Whitford (Central Ayrshire) (SNP): Thank you, Mr Evans, and it is an honour to take part in such an important debate.

There is no question but that England requires more nurses. The ratio is 5.8 nurses per 1,000 patients, the lowest in the UK, and yet NHS England cannot fill nursing posts. It is bringing nurses in from overseas and using agency nurses, so that number needs to be expanded. The approach taken is the idea of simply removing the cap, but the challenge is how enough placements will be found. As the hon. Member for Heywood and Middleton (Liz McInnes) said, how will that be funded when Health Education England is facing a massive cut? Furthermore, it is not simply a matter of funding the placements; they require the contribution of nurses and other staff on the wards who are already really busy. It is not something that can be dreamt up in an office in Westminster and happen by magic.

There is also the issue of whether, at the end of training, that unlimited number of nurses will all find jobs in our NHS. It is likely that they will not. We will therefore have wasted not just their money in the tuition fees they will pay for the cost of their training, but money invested by the Government in their training. That is short-sighted, because the Government will lose control of workforce planning, which is key, and with only 5.8 nurses per 1,000 patients, clearly that has not worked too well up to now.

There is an argument for re-expanding nurse places, which were at their height in 2004 when we had nearly 25,000 places and reached a low in 2012-13 of 17,500. At the moment, they have just crept above 20,000, but that does not even bring us back to the figures seen in 2001-02. We clearly need more places, but the idea that nursing students should take on the burden is ridiculous.

Hon. Members in the Chamber will know of my interest: I have been a doctor for 33 and a half years. If there had not been free tuition—and grants back in 1977—I could not possibly have become a doctor, let alone gone on to study surgery and work as a breast surgeon for all of those years. England is already losing out on students who have talent but not the opportunity to follow any degree, and medical degrees in particular. Now we are talking about nurses and allied health professionals—as Members have said, allied health professionals are included in that important group.

Some Members have asked about an impact assessment. We have not heard about one and it is clear that there been absolutely no consultation. The Royal College of Nursing reported that there was no consultation with it: I should have thought that that is where one would start.

We need to look at the bursary. As the hon. Member for Lewes (Maria Caulfield) explained, it is not exactly generous: £1,000 is guaranteed. Above that, it is means-tested and it reaches the dizzy heights of £3,091 only for people in London. That is not a lot of money. As my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) mentioned, the bursary in Scotland is £6,578, which is all non-means-tested and non-repayable, because we consider it absolutely crucial to invest in the people we need to run our health service.

The biggest kick for students will be having to pay tuition fees, which are currently £9,000 a year: we do not know what they will reach in the future. That instant

11 Jan 2016 : Column 231WH

debt of 27 grand will certainly put people off. Even if I had been told at the age of 18 that I did not have to pay back the loan until afterwards, the idea that someone with no support in the world, as was the case at the time, would be signing on the dotted line to take on what was almost a small mortgage would be hard. People are not going to do that.

The idea that people will not be put off is naive. It will put off the 50% of nursing students who are postgraduates and mature students, and it will put off people from poor socioeconomic backgrounds. It will reduce diversity. We have talked about the need for Parliament to reflect our population, and it is crucial too that nurses and doctors reflect the population that they serve. That will change, because becoming a nurse will be an expensive business.

We need to think about why we moved from the old days of the enrolled nurse and the registered nurse: those were the nurses I used to work with. I have to say that, from the number of stripes on their hat, I knew exactly what experience they had and exactly what they could do. Many of us thought, “Why are we suddenly doing degrees?” but when we look at where our NHS is now, we see the whole point of that, because nurses are now leaders in the NHS and the vision of the future NHS workforce is of nurses leading independent teams, being out in primary care, triaging patients and diagnosing and treating on their own. The idea of the nurse as handmaiden has thankfully long been laid to rest.

The same applies to allied health professionals. About 30% of the patients who come to primary care have a musculoskeletal problem and part of the vision of improving primary care is to allow patients access to a physiotherapist—an expert on their problem—if they have a sore back, hip or knee.

Podiatrists provide care to an increasing number of diabetics. People are probably not aware that the life expectancy of someone with a severe diabetic ulcer is poor, ranking above only lung cancer and pancreatic cancer. That is a real threat to patients, so we need podiatrists who can check feet and treat ulcers at an early point. There are only 3,000 podiatrists for the whole of England, yet student numbers have been reduced from 361 to 326.

We are reducing the numbers of the very people we envisage needing in future—it is like the right hand and left hand are not talking to each other and do not know what the other is doing. As we say in Scotland, two grey cells and they are in a huff; they are not talking to each other. That needs to change. We need to look at the NHS as a whole and the people we expect to provide care in future.

As I mentioned, we have a reasonable bursary in Scotland. I would not say that our students are living the high life on £6,500 a year but, like our other students, they do not pay tuition fees. The hon. Member for Lewes cited a figure for graduates earning £100,000 more, but we must remember that that is over an entire working lifetime, so that is £2,500 a year, which is not a huge amount, and that is reduced by their debt. If students are graduating with £50,000 or £60,000 of debt from their study and living costs and so on, those extra earnings shrink to almost nothing. We will gradually reach the point at which people who might have considered

11 Jan 2016 : Column 232WH

being nursery nurses or primary school teachers or contributing to society in another way that is not well remunerated will not feel able to take on that debt.

We need to look at what we will need in future. We require physios and radiographers, who they will provide the wraparound care for our ageing population, out in the community, leading their teams and working on their own. I call on the Minister to follow the Scottish example and invest in people. That is the key.

Sadly, what we have seen recently—certainly in my short time in the House—is the debt created by the bankers towards the end of the previous decade became sovereign debt, which is now becoming individual debt. All the time in the main Chamber we hear how we cannot leave public debt to future generations, but we are putting it on future generations as individuals. We need to recognise that. People struggle to get a house, they struggle to get education and they struggle to get a job. We need to change that. In this instance, our return is a coherent, diverse, broad NHS staff made up of people who are committed to what they do. I call on the Minister to answer the many challenges raised today and to say how he will invest in the future workforce that will look after the people of England.

6.28 pm

Heidi Alexander (Lewisham East) (Lab): It is a pleasure to speak in this debate under your chairmanship, Mr Evans, and to follow the excellent contribution of the hon. Member for Central Ayrshire (Dr Whitford). I also thank the hon. Member for Sutton and Cheam (Paul Scully) for bringing the debate to the Chamber and I pay tribute to the petition’s organisers, because it is no mean feat to get 154,000 signatures.

We have had a good debate, with some excellent contributions. In particular, I pay tribute to my hon. Friends the Members for Ilford North (Wes Streeting), for Heywood and Middleton (Liz McInnes), for Sheffield Central (Paul Blomfield) and for Coventry North East (Colleen Fletcher) for their contributions. I also thank the hon. Member for Lewes (Maria Caulfield) for her insights. She was right to highlight the realities of life for student nurses, but I am afraid I do not share her optimism about the other training routes the Government are developing for nursing staff. She was also right to acknowledge that the bursary is not perfect, but it is beyond me why we should replace it with something worse.

In the short time I have, I want to set out why I think the Government are taking a huge gamble with the future of the NHS workforce and with patient safety. As others have said, the Government’s proposals affect not only nurses and midwives, but those studying radiography, radiotherapy, physiotherapy, occupational therapy, podiatry, chiropody and speech and language therapy. Many of those specialisms face recruitment challenges, and they are all integral to the NHS’s ability to continue functioning.

Before I turn to the problems with the Government’s proposals, we need to understand why the country has a problem with nursing supply in the first place. Shortly after the 2010 election, the Government cut the number of nurse training commissions in an ill-judged attempt to make some short-term savings. Those cuts saw nurse training places reduced from more than 20,000 a year to

11 Jan 2016 : Column 233WH

just 17,000—the lowest level since the 1990s. As a result, we trained 8,000 fewer nurses in the last Parliament than we would have done if we had maintained training commissions at 2010 levels. At the time, experts such as the Royal College of Nursing warned that the cuts would cause

“serious issues in undersupply for years to come.”

They were right. Hospitals are now forced to rely on recruitment from overseas or on expensive agency staff. That is a key cause of the projected £2.2 billion black hole in NHS finances.

Although the Government have tried to correct the problem and increase the number of training commissions in recent years, even today we are training fewer nurses than we were five years ago. There is therefore a problem. No one disputes that, but no one should be under any illusion about the cause.

The danger with the Government’s proposals is not only that they risk making staff shortages even worse by putting off the next generation of student nurses, but that they are ill-judged and not backed by a shred of evidence. As we have heard today, the starting salary for a nurse is just above the loan repayment threshold, which has, shamefully, been frozen. That means that nurses will start paying back their loans as soon as they graduate. As my hon. Friend the Member for Ilford North said, nurses will, on average, take an effective pay cut of £900 a year to meet their debt repayments. How on earth can the Minister justify that? Why is he so sure that burdening nurses with debts of more than £50,000 will have no impact on recruitment or retention?

If the Minister will not listen to me, perhaps he will listen to the stories of some of the student nurses themselves. Just before Christmas, I met four deeply impressive young women who were studying to become nurses—Danielle, Charli, Marina and Sophia. Those women were in their 20s, and their lives have not followed the simple path of GCSEs, A-levels and going straight to university. Danielle left school after her GCSEs, but she went back to do her A-levels. She got a job as a healthcare assistant and then decided she wanted to go into nursing. Marina had a child when she was 16. By the sound of things, she has had a pretty tough life. However, she is clear she wants to be a mental health nurse. When she says she thinks the best people to care for others are those who have experienced hardships themselves, she has a point. My fear about the Government’s proposals is that they will mean that those who end up training to be nurses will be those who are best placed to pay, not necessarily those who are best able to care.

Has the Minister read the testimonies of student nurses past and present, which the Royal College of Nursing collated? It is a hefty volume, and I recommend it to him. Natalie from Sheffield says this about the bursary:

“Without it I wouldn’t have been able to start the course...My mum gives me help when she can, but as a single parent she can’t afford to look after my sister as well as me. I think there will be a huge loss of people taking part in the course, which will further impact on the nursing shortage.”

Daniel, from south-east London, says:

“I would not have taken the course if it were another £20,000 plus worth of debt to incur. To cut the bursary is ridiculous. Student nurses are thrown into the…deep end as soon as their first placement a month into their studies, leaving less time for work that pays. If anything, the NHS bursary should be raised.”

11 Jan 2016 : Column 234WH

Vicky, from York, says:

“I would not have been able to, or chosen, to study to be a mental health nurse without the bursary for the following reasons…I am a single mum and need support for childcare costs. I have debts from a previous degree. I am a mature student at 33. I would not take on further debts which would be impossible to pay back, and would not be fair on my little girl.”

I say to the Minister that I know about the fear of debt that can be instilled in people by a working-class upbringing. I know what discussions take place in homes across the country about the pluses and minuses of people going away to university and racking up debts when they could just start earning. I know that because I experienced those discussions.

My other main concern with the proposals is that, as others have said, the Government do not seem to understand that student nurses are not like other students. Student nurses are required as a normal part of their studies to spend a significant amount of their course working with patients in clinical practice, including on night and weekend shifts. They have less holiday than other students, and they spend hours on their course caring for patients and, sometimes, keeping our hospital wards running. The changes will, effectively, charge students for working in the NHS. How can that possibly be justified? What the Minister seems to have failed to grasp is that student nurses are far more likely to be mature students. We have only to look at what has happened to applications from mature students under the new student finance system to see what a risk the proposals will be to the NHS.

That raises an important question about the kind of people we want to train to be nurses. The application process is rigorous, and rightly so, but the average age of a student nurse is 28, and many have caring and family responsibilities. Are those not precisely the people we want to attract into nursing? If so, is it not all the more alarming that those people are the most likely to be put off a career in nursing as a result of the changes?

The Minister will stand up and no doubt eloquently argue that I am wrong, and that the Royal College of Nursing, the Royal College of Midwives, Unison and various other stakeholders are wrong. However, every one of the claims I am sure he will make has been questioned by experts. The Government’s case for the changes has been put together on the back of an envelope—they did not even bother to consult anyone before announcing them. The Royal College of Midwives has said:

“The RCM is extremely disappointed that the government did not seek advice or consult with us prior to making this decision.”

The Royal College of Nursing has said:

“This decision was made with no consultation or evidence gathering.”

Talking to organisations that might know a thing or two about nursing is not just good policy making but plain common sense. Will the Minister explain why he did not talk to the Royal College of Nursing or the Royal College of Midwives before the Chancellor made his announcement?

Will the Minister also explain why the proposed consultation is only a technical consultation on the proposals’ implementation, not on the principle behind them? Surely it makes sense to have a proper, detailed look at the matter and to work with all sides to explore how we can improve the support available to student nurses and increase the supply of excellent staff to the

11 Jan 2016 : Column 235WH

NHS. By jumping to a solution that is not based on evidence or facts, the Government are taking a reckless gamble with the future of the NHS workforce, and with patient safety. I serve notice on the Minister today that the Opposition will oppose the plans every step of the way.

6.40 pm

The Parliamentary Under-Secretary of State for Health (Ben Gummer): I add my voice to those of other Members who have spoken today, to say how much I appreciate the decision of the Petitions Committee to bring the matter to the notice of the House. I thank my hon. Friend the Member for Sutton and Cheam (Paul Scully) for outlining the case as many of the petitioners see it. As both shadow Ministers—the hon. Members for Lewisham East (Heidi Alexander) and for Central Ayrshire (Dr Whitford)—said, we had a high-quality debate, and Members raised a huge range of points in a calm and collected but passionate way. I hope Members will forgive me if I address as many points as I can. I hope to finish before the end of our allotted time, so that people can get away, but I am aware of the number of different points that were raised. I am also aware of the intense public interest in this important issue, which is why I want to make sure that I address every point that was raised—including detailed points.

Many Members, including the hon. Member for Lewisham East, were here for the debate on tuition fees in 2011. It was a searing experience. It is the only time I can think of—the hon. Lady and other Opposition Members will remember this—when protests could be heard by those in the Chamber. We all remember, too, having to leave by secret exits because of the riot outside. It was understandable that, at the time, people were so passionate about the change being made. The hon. Member for Ilford North (Wes Streeting) was a central player in the great debate, and he acquitted himself with honour. He explained in great detail his side of the argument—and that of the National Union of Students—at the time of probably the most controversial change made under the coalition Government. Yet every single one of the claims made at the time—the central claims against the changes—has been proven untrue.

I want to address the core point made in the considered speech of the hon. Member for Sheffield Central (Paul Blomfield)—that the Government should make changes on the back of evidence. My contention is that that is exactly what we are doing. Since the changes made in 2011, there has been an increase in the number of students in every part of the higher education universe. Most importantly, to my mind, there has been a considerable increase in the number coming from disadvantaged backgrounds. That is precisely why, even if it were not for the reasons that I want to come on to about why what we are doing is important for the NHS and for nursing in particular, it is an important change. Nursing students are the only significant group of students not to have been included in the reforms that have so significantly benefited the rest of the university sector.

Paul Blomfield: Clearly we could have a lengthy debate—I am sure you would counsel us not to, Mr Evans—on the merits of the student loan system. I was surprised

11 Jan 2016 : Column 236WH

by the Minister’s unequivocal statement a moment ago. Will he agree that one section of the demographic that has been negatively impacted by the introduction of the new student funding regime in 2012 is mature students?

Ben Gummer: I will not agree with the hon. Gentleman’s contention. UCAS figures for mature students in 2011, the year of the change, show that there were 42,170 acceptances. That figure dropped in the following year, as did the figures for all students across the university sector. It then went up to roughly the same figure in 2013, and up again in 2014. In 2015 the figure was 48,690, so the number of mature students has increased, and in percentage terms the increase is, I believe, more than that for university students of the normal age. When we consider the core reasons for the change—expanding the opportunity to go to university, through the number of places; increasing quality, which has improved according to a number of metrics; improving student experience, which has also happened in the past few years; and, most importantly for a university system, creating a ladder of opportunity for those born with least—we see that the reforms have delivered by every one of those measures. It is precisely for that reason that, even were it not for the wider issues that the NHS confronts, I would believe what we are doing to be entirely right. It enables us to spread to nurses the same benefits that have been realised in the rest of the student population.

Paul Blomfield: I thank the Minister for giving way again. I want to challenge him on those figures, which I guess—I do not have them before me—relate purely to full-time students. If we consider full-time and part-time students, we see unambiguous evidence that the number of mature students has fallen dramatically.

Ben Gummer: The numbers do relate to full-time students. I concede that, in the case of part-time students, there have been, for a longer period than the time since 2011, problems in maintaining a rise consistent with that across the population. The Chancellor has accepted that fact, which is why he devoted specific attention and funds in the spending review to supporting part-time mature students. However, in this case we are talking about a nursing degree that is, for the vast majority, a full-time one. For the majority of nurses—I believe the figures are not quite those given by the hon. Member for Central Ayrshire, although I do not have them to hand—their degree is a normal undergraduate degree, taken before maturity. For all those people, I want the same benefits that have been provided across the rest of the university sector. The hon. Member for Sheffield Central was a Member in the previous Parliament, as was the hon. Member for Lewisham East, and they made exactly the same claims then as they do now about a reduction in opportunity, a reduction in number of applicants and a reduction in all the areas where we want universities to perform. I am afraid they have been proved wrong and the Government have been proved right, and that is why it is important that we extend those benefits to nursing.

I will address in terms the process by which we have come to this decision, about which the hon. Member for Ilford North raised some detailed questions, and our intention for the wider reform of training routes into nursing. It is important that hon. Members should see

11 Jan 2016 : Column 237WH

the changes that we are making to university training as part of a wider reform enabling us to increase both numbers and the quality of courses, as well as improving the student experience for nurses entering nurse registration by whatever route. The policy has been worked through in considerable detail in the Department of Health. There has been consultation with leading nursing professionals. The Department of Health is advised by a number of chief nurses. All were consulted and involved in working up policy in this area, which is entirely how it should be.

We have been very open about the fact that we want a full and detailed consultation about how the proposals should be implemented. We want that to be thorough and to involve everyone, whether they oppose or are in favour of the changes, so that we get the detail right. While I will maintain that the overall policy direction is correct for the reasons I have given, it is important to make sure we implement the detail correctly. If we do not get it right, it could have a perverse impact. If we do, this could be an important moment for the nursing profession, because we will be able to do something that previous Governments have not been able to do. Even in the wildest spending realms of the imaginations of some colleagues of the hon. Member for Lewisham East, it would not be possible to commit the resources to expand the training places that the route we have decided on will make possible.

The Opposition must answer a central point when they set out their opposition to the proposal. The fact is that we want to give more training places to people who want to become nurses. Last year, there were 57,000 applicants for 20,000 places. We want to expand the number of places so that people get the chance to become a nurse, but within the current spending envelope—even if we were to increase it more significantly than we propose to over the next five years, and certainly far more significantly than the Opposition propose—it is not possible to do that.

Dr Whitford: Does the Minister not accept, on the basis of invest to save, that if agency nurses are costing the NHS £2 billion, such an investment in future nursing would, in actual fact, save money in the long term?

Ben Gummer: I agree with the hon. Lady that one key thing we have to do is ensure we have a permanent workforce and do not depend across the service on agency and locum nurses and doctors. However, part of that is ensuring we have the workforce numbers trained to be able to fill places. In the past, we have failed to predict workforce numbers with any accuracy, which is something all Governments are guilty of.

No matter what happened to training places, the changes required across the service because of the impact of Mid Staffs on our understanding of safe staffing ratios has meant an increase in the requirement for nurses. At the moment, in the very short term, that requirement has to be plugged by agency and locum nurses, but we want to replace them with a full-time permanent staff that is sustainable. I hope the Opposition are able to bring an alternative view—I would be interested to hear it—but if we are to increase the number of training places, we have, simply put, to be able to afford to do so. The surest way of expanding places is to repeat

11 Jan 2016 : Column 238WH

exactly what we did for all other university degrees back in 2011, which has seen a massive expansion in training places.

The other point that the hon. Member for Lewisham East and her colleagues must address if they wish to oppose this reform is how they would afford not only the expansion in training places, but the maintenance support for nurses going through training. I completely agree with the hon. Member for Central Ayrshire and my hon. Friend the Member for Lewes (Maria Caulfield): the current bursary funding is not generous. It is certainly not sufficient for many, especially those with caring duties, to maintain themselves, but how can we find the increase while ensuring we expand places at the same time?

Through reforming bursaries, we are ensuring that we can increase the cash amount by 25%—something that, again, could not be funded out of the existing envelope, even though we are increasing NHS spending more than any other major party promised at the last election. We are therefore able to provide the support that people going through nurse training are rightly asking for.

Paul Blomfield: The Minister makes great play of the comparison between the reforms introduced in 2012 for other undergraduates and this reform. I admire the way he talks—I say that without any irony—about sharing the benefits of the current scheme with student nurses, midwives and allied professions. I am not quite sure they would describe a £56,000 debt as a benefit. Putting that to one side, does he not recognise the sharp difference between other undergraduates and those studying nursing, midwifery and allied professions in terms of the commitment to clinical placements, the shift patterns and everything else that will prevent them from being able to take employment in order to offset the cost of their education?

Ben Gummer: That is the case at the moment. The hon. Gentleman must answer the question of precisely how we increase support for people who are working in clinical learning placements. Converting the bursary regime means that we can increase that support by 25%.

It is easy for the hon. Gentleman to make a play to the gallery about how the reforms might work, but I ask him again to look carefully at the experience of other students and at the 47,000 applicants who are unable to secure a place because of the constriction in places. He is not able to give those people an answer about how we expand places without resources that I imagine he is not willing to commit from his position. The best way of giving those people the opportunity is reforming the education system. I am afraid that it is simply not credible for the Opposition to decry the proposals, which is their right, without providing an alternative of how we might fund the additional places and the maintenance of those who are in position.

Heidi Alexander: The Minister talks about the ratio of applicants to nursing students. Will he say what proportion of the applicants who failed to secure a place met the entry criteria to the course? What guarantee can he give that removing the bursary will increase the number of successful applicants?

11 Jan 2016 : Column 239WH

Ben Gummer: I will write to the hon. Lady with year-by-year figures, where available—pass rates change every year. The nursing training course is one of the most over-subscribed of all undergraduate courses. Compared with other undergraduate courses, whatever metric we use, it is a significantly over-subscribed course. We know that a significant number will not receive a course, even though they have met the criteria.

Dr Whitford: If the cap is completely removed, the Government will lose any ability to plan a workforce for the future. If all 47,000 applicants are given a place, what will happen when they come out at the other end? There will not be the placements to train them, and there will certainly not be the jobs. Is this just a way of having a flood of cannon fodder nurses, so that their pay can be frozen?

Ben Gummer: The hon. Lady mentioned in her speech, as did the hon. Member for Ilford North, the need by some trusts to recruit from abroad and to use locum and agency nurses. I hope she will understand therefore the internal logic of our argument: even at the moment, we are not able to fill places from the domestic supply of nursing graduates. It is precisely our wish to expand that supply. Planning the workforce will, in large part, be controlled through the placements that Health Education England buys from universities on behalf of the taxpayer and the NHS.

Several hon. Members raised the issue of clinical placements, on which we are now in deep discussions with Universities UK. The hon. Member for Ilford North raised that issue, as did my hon. Friend the Member for Lewes. I urge them both to look at the example of the University of Central Lancashire, and its relationship with Central Manchester University Hospitals NHS Foundation Trust and Bolton NHS Foundation Trust. They are delivering innovative and exciting ways of providing new placements outside the scope of the existing placement scheme, even without any Government support or change in the rules.

There is an appetite for delivering additional clinical placements, and we will see how that progresses in our discussions with Universities UK. All the while, it is important to point out that the Nursing and Midwifery Council has to register nurses at the end and ensure that the degrees are satisfactory. All of this will have to abide by the NMC’s recommendation that the placements are up to scratch, so we are constrained, quite rightly, in anything we might want to do by what it decides in that regard.

Heidi Alexander: The Minister gave the example of the University of Central Lancashire. Does he accept that one reason that pilot is successful is that individuals are guaranteed a job at the end of it, which would not be the case for the students to whom he proposes applying these more general changes?

Ben Gummer: In the course of taking interventions, I am skipping around the points that hon. Members have raised, which I want to address. The hon. Lady is right that the University of Central Lancashire has worked up a really good course, which is partly about job security at the end of it. It is exactly the kind of scheme we are looking at to improve attrition rates,

11 Jan 2016 : Column 240WH

which were another point that my hon. Friend the Member for Lewes raised. We have to do better to help nurses complete their courses, and again, that metric has improved across the rest of the university sector since 2012. I hope that in freeing up nurse training a little through our reforms, we will be able to provide better incentives for foundation trusts and NHS trusts to have an end-to-end training offer for student nurses—if not modelling the one that the University of Central Lancashire has brought in, then a variant on it.

There is a lot of exciting thinking out there in universities, foundation trusts and NHS trusts about how we can implement the reforms to make nurse training better, expand the number of places and solve their workforce problems. My job is to release that thinking. I cannot do it within the straitjacket of the existing system, but I can through the reforms I am able to make.

Dr Whitford: Is the pilot in Lancashire that has been described not an argument for better manpower and workforce planning, rather than for simply throwing things open to the winds, which is what is proposed?

Ben Gummer: I was merely making the point that there is a lot of exciting thinking out there, outside the workforce planning that we are doing. Through our reforms, I hope to be able to encourage more of that. I know that there is some very innovative thinking in my part of the country. People want to get on with it in the NHS and university sectors, but at the moment they cannot, because of the constraints on how nurses are trained and recruited.

I turn to the issues raised by my hon. Friend the Member for Sutton and Cheam, who introduced the debate on the petition. He asked four specific questions. One was on specialist courses, and the shadow Minister repeated that point. Some specialist courses have suffered shortages for many years. For several years, the Higher Education Funding Council for England has been dealing with the wider attribution of training funds and university tuition funds across the sector, and it will take on responsibility for making sure that very small and specialist courses are properly funded and promoted. In liberating the universities sector a little, I hope that we will be able to excite interest in some of the more specialist courses, which have been suffering for several years, and better match foundation trusts’ workforce requirements with universities’ ability to deliver.

My hon. Friend asked whether foundation trusts will be able to pay back loans as an inducement. I do not know whether that will be possible for foundation trusts specifically, but they are free to offer pay premiums to aid their recruitment—they have been able to do so for many years. I imagine that will continue.

My hon. Friend asked about the number of placements and the financing of them. That will be determined by the consultation and in discussions with Universities UK. He also asked about the arrangement for placement expenses, and I have heard his point. I know it is a unique problem that is specific to student nurses—although to some extent, it also applies to student teachers—and again, we want to look at that in detail in the consultation to ensure that we get the implementation right. That is why it is not just a matter of pure detail; it is about how the policy works as implemented.

11 Jan 2016 : Column 241WH

The hon. Member for Ilford North raised a number of points in addition to the ones he raised in his Adjournment debate. I apologise for not having answered all of them previously; I had a short time and he raised a huge number, with his usual eloquence. However, I hope I can answer some of his specific points on this occasion.

The hon. Gentleman asked about the problems of recruiting into community-based settings. There is a shortage in that specialty, which has traditionally suffered from problems in recruiting. I am well aware, just as he is, of the need to improve recruitment into community settings and primary care settings if we are to get the proper integration of primary and secondary care, and more importantly, of social care and the NHS. That is one of the key challenges facing us in the years ahead. Health Education England has a scheme under way called “Transforming nursing for community and primary care”, which it launched just over a year ago, precisely to incentivise nursing applicants into that specialty. Again, I hope that universities will respond positively, as they have in the case of other courses, so that they step up to the workforce demands placed on them as a result of the reforms that we are making.

The hon. Gentleman asked what the amount of debt to be written off was. The long-term loan subsidy—he will understand the phraseology—remains at 30%. That is the figure that the Treasury has set. As a consequence of that and because of, as he put it, reliable reports from newspapers, which he imputed to be fact, he asked whether there would be an increase in student fees above inflation. I can say to him that there are no plans at all to increase student tuition fees above inflation.

The hon. Gentleman asked whether I would be willing to meet those who disagree with my point of view and that of the Government on this matter. I would, of course, and I have done already. I would be delighted to meet anyone whom he wishes to bring to me, including the demonstrators he mentioned.

The hon. Gentleman began his speech, however, by talking about a burden of debt. It is important for all of us here to remember that the loan is an attachment against earnings, which is time-limited and limited according to the ability to earn, so it is not like debt such as a mortgage. We made the same argument back in 2011 and 2012, and it is important that we use language correctly in this place. We saw an uptake in university courses after the 2012 reforms. Once prospective students understood how the financing worked, how they would pay back the tuition fees and that it was not a debt that would saddle them in the same way that a mortgage or hire purchase agreement might, as was suggested at the time, university applications increased significantly. We all have an interest in this place in making sure that the number of people going into nursing increases. It is important, therefore, that even if we disagree with the policy, we do not misrepresent it.