PARLIAMENTARY DEBATE
Healthcare Students: Pay and Financial Support - 20 November 2023 (Commons/Westminster Hall)

I regret that I cannot stay for the whole debate, but, as chair of the all-party parliamentary group for students, I wanted to make a contribution. My hon. Friend refers to a debate that we had seven years ago, I think, when I recall the then Minister, Ben Gummer, told us that he was keen to share the benefits of the undergraduate student funding system with healthcare students, including nurses and midwives, who had previously benefited from the bursaries, and was anticipating that that would lead to better support and an expansion of the number of people coming into the service.

Does my hon. Friend recognise that those of us who argued at that stage that the changes would lead in the other direction have been validated by experience? Does she agree that we have seen more potential nurses and midwives, particularly mature ones, no longer entering the profession? Also, is she concerned—I hope that the Minister will respond to this point—about the UCAS figures for this year, which show a 16% decline in the number of people applying for healthcare courses?

It is a pleasure to serve under your chairmanship, Ms Fovargue. I welcome the Minister to his latest position on the Government Front Bench. I hope he enjoys what remaining time the Conservatives have in government in the Department of Health and Social Care. I wish him all the best over the next few months.

I am grateful for the opportunity to respond to the debate on behalf of the shadow Health and Social Care team. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for her powerful speech, and my hon. Friend the Member for Sheffield Central (Paul Blomfield) for his wise contribution. I also thank the Petitions Committee for its work in preparation for the debate.

Being a student nurse during the cost of living crisis is tough. We know that valuing our NHS workforce through fair pay and conditions is crucial to tackling vacancies, yet according to the RCN’s 2023 summer survey, almost nine in 10 student midwives in England—89%—worry about the amount of debt they are in, and 74% of them expect to graduate with debts of more than £40,000.

My hon. Friend is making a very important point, and I am sure that he will come on to say that the experience of midwives also applies to nurses and others on healthcare courses. The report by the APPG for students, which I mentioned a moment ago, highlighted the way in which the student funding model was broken, not least by pointing out that, according to Save the Student, the average loan now falls short of living costs by £439 every month. Most students are dealing with that by taking on ever-increasing amounts of paid employment, which is raising some concerns. One Russell Group university told us that a significant number of its students work more than 35 hours a week. Does my hon. Friend agree that that option is not available to most nurses, midwives and other healthcare students on similar courses, because of the structure of their courses? The Government are failing to address that issue.

My hon. Friend hits the nail on the head. We are talking about student nurses and student midwives, who do not have any spare time to dedicate to other forms of paid employment: it is physically and mentally impossible for them to do so. There needs to be greater recognition of the unique nature of these kinds of students. Many students—including me, many years ago—rely on extra support to make ends meet, but people studying in the caring professions, including nursing and midwifery, do not have that same ability. That was one reason why there was always additional support for those groups of people.

Fifty-eight per cent of respondents to the survey conducted by the Petitions Committee for this debate said that it was difficult or very difficult to afford energy, including gas and electricity, 19% said they had visited a food bank, and 26% said they were considering using one. That is a national scandal—a cost of living scandal that is having a devastating impact on our ability to recruit and retain staff in the national health service. Over nine in 10 student midwives in England—91%—know someone who dropped out of their midwifery studies because of financial problems.

The Conservative Government abolished NHS bursaries for student nurses, midwives and allied health professionals back in 2017. Students undertaking their degree since then have had to pay to train to work in the NHS. As a result, not surprisingly, the number of applications to study nursing in England fell, with applications down by almost 30% by 2019. It is not rocket science to work out what caused that. Labour said at the time that the decision to remove the NHS bursary was the wrong one, and the Public Accounts Committee, in its September 2020 report, agreed that the decision

“failed to achieve its ambition to increase nursing student numbers.”

That is just another example of a Government who have time and again failed to plan for the long term.

In this NHS workforce crisis, we have deteriorated to the point where we now have over 100,000 vacancies, including 40,100 nursing vacancies. We have waited so long for the NHS workforce plan, and now we finally have it. Labour has been calling for a workforce plan for years, and I am glad that the Government pinched the plan of my hon. Friend the Member for Ilford North (Wes Streeting). Since its publication, though, not much has happened. It makes clear the scale of the neglect—a wasted decade of drift and inaction, impacting not only on staff but on trainees.

Placements are an important part of nursing and healthcare courses. They provide the vital supervised training that allows students to gain the necessary skills and experience to meet education outcomes and work in clinical settings. Labour knows the value of placements, which is why increasing them is an important part of our plan to expand the NHS workforce. We will focus on ensuring we have the roles, trainees and senior professionals needed to tackle the challenges we face and seize opportunities, drawing on a diverse range of skills and inspiring people around the country to pursue a career in the NHS and caring professions. We will also work with health staff and their trade unions to review existing training pathways and explore new entry routes to a career in the NHS, including high-quality apprenticeships.

The childcare sector is under huge strain. While some healthcare students may be eligible for parental support from the NHS learning support fund of £2,000 a year, that is dwarfed by the ever-increasing cost of childcare. It leaves many studying parents vulnerable to childcare costs, particularly considering the hours needed to fulfil placement requirements. It has been reported by openDemocracy that some nursing students considered leaving their courses because of financial pressures related directly to childcare costs. That is, sadly, a trend across our economy. The cost of childcare is pricing parents, especially women, out of the professions they love.

Does the Minister agree that adequate support for a profession as critical as nursing or midwifery should not depend on where a person studies but should be the same across the board? What assessment has he made of support at all stages of training for studying parents, in order to build an effective and inclusive workforce in our NHS? The 11,000 people who signed the petition will be looking for a response from the Government, so does the Minister regret the decision to abolish NHS bursaries? What additional support can healthcare students expect, given the current cost of living crisis?

Two in five student nurses and three in five student midwives said that they considered leaving their course last year, so we must take this seriously, especially given the threat to the future of the NHS workforce that it poses. Already students have cited the placement experience and lack of support as major factors in their leaving their course. The Conservative-made crisis in the NHS only makes this worse. We might have expected in this month’s King’s Speech to hear of something to deal with the worst NHS crisis in its history, but there was virtually nothing.

The energy price cap has increased by half this Parliament, the cost of living crisis is hammering healthcare students, and we have a flagship energy Bill that

“wouldn’t necessarily bring energy bills down”.

Whether we are talking about the NHS or the cost of living crisis, this Conservative Government look like they have thrown in the towel. They are divided, weak, out of ideas and out of time. Every day that goes on, it is British people, our public services and our patients who pay the price. For Labour’s part, we know that our healthcare staff are our national health service’s most valuable asset, and we know how vital it is to ensure that there is a pipeline of future talent coming through. That is why the next Labour Government will put their workforce plan at the heart of their plans to restore, renew and rejuvenate our national health service.

It is a great pleasure to see you in the Chair, Ms Fovargue, for my first Westminster Hall debate in my new role. I am grateful to the British public for raising the important issues covered in the three petitions we are considering today, and to the hon. Member for Battersea (Marsha De Cordova) for opening the debate. I also thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his contribution and his qualified welcome to me in my new role, and the hon. Member for Sheffield Central (Paul Blomfield) for his interventions during the debate.

Our students are the future of our NHS, so it is imperative that we not only support them throughout their studies, but ensure that as many as possible go on to successful careers in healthcare. The Government recognise the unique nature of healthcare degrees, the intensity of the courses and the additional financial pressures that clinical placements can cause, which is why we are doing as much as we can with the funding available to us to ensure that clinical students have the financial support they need to succeed.

Two of the petitions focus on pay for student placements. While they are on placement, student nurses, midwives and allied health professionals make valuable contributions to clinical teams, but the purpose of such placements is student development, not meeting staffing needs. They exist to give students the opportunity to learn and to acquire the skills and experience they need to graduate and join the professional register. That is why we believe that clinical placements should not be described as jobs. Students are not contracted to provide care and do not hold contracts of employment, so while we recognise the significant contribution made by students, the Government do not plan to introduce pay for students on placement at this time.

The Government and the professional bodies that set the rules for student placements have made it very clear that if the students are not there, the setting should still be clinically safe and procedures should be able to be conducted. All student placements should be in addition to regular staffing; they should not be used to fill gaps in staffing rotas. That is not to suggest in any way that students on placement do not make a significant contribution—I think we all agree that they do, and I pay tribute to them for the contribution they make—but in all settings, if the students are not there the employed staff should be able to continue to deliver NHS services in the way that we all want.

We do not wish to introduce pay for students on placement, but we do intend to continue to listen to students’ concerns about the cost of training and to consider what we can do to support them, building on the work we have already done. Since September 2020, all eligible nursing, midwifery and allied health professional students have benefitted from a non-repayable, non-income-assessed training grant of at least £5,000 per academic year from the learning support fund. On 1 September this year, we announced a 50% increase to the travel and accommodation payments available through the learning support fund, ensuring that students are appropriately reimbursed for travelling to clinical placements.

The Government are not just supporting the more traditional routes into education and training. As we set out in the first ever NHS long-term workforce plan, we are expanding alternative routes into healthcare, enabling people from diverse backgrounds and those for whom a traditional university degree is not possible, or is not the right thing for them, to bring their unique skills and perspectives to the NHS. We are now offering blended learning courses, allowing students to take some of their courses online, and more than a quarter of nurses’ mandatory practice learning hours can now be delivered via innovative simulation. We are also continuing to expand our apprenticeship offer, allowing students to study towards a degree while also learning on the job. As set out in the long-term workforce plan, we will deliver a huge increase in the number of clinical staff apprenticeships; we intend to get them up from 7% today to 20% by 2032. That is building on the success of our existing registered nursing degree apprenticeship programme; more than 10,000 students have started on that course since 2017.

We are providing a more diverse set of pathways into healthcare careers in order to open up more opportunities for staff to progress and move into new roles. Thanks to an increase in the number of associate roles, such as nursing associates, it will be possible to join the NHS as an apprentice healthcare support worker and go on to qualify as a registered nurse.

I would like to pick up on a point made by the hon. Member for Sheffield Central, who talked about the UCAS figures showing a 16% decline in applications. The drop in applications compared with previous years reflects an expected rebalancing following the unprecedented demand for healthcare courses during the pandemic. At the June application deadline this year, there were 44,000 applicants for nursery and midwifery courses in England, which is an increase of 12% compared with this time in 2019. The latest data shows that over 22,000 students have accepted places on nursing and midwifery courses in England, which is an increase of 6% compared with the same time in 2019. If we look at allied health professionals, 2,200 more graduates enrolled on paramedic science courses overall in England in 2021-22 than did so in 2019-20, which represents a 30% increase.

Let me address the second issue raised today: childcare payments for student midwives, nurses and paramedics during their placement hours. The Government understand how important childcare is for studying parents, and we believe that they should have every opportunity to continue in education and achieve their aspirations. As the Minister for Skills, Apprenticeships and Higher Education set out in our response to the petition, the Government provide a range of financial support to students with children. They are eligible for 15 hours of free early education for three and four-year-olds, and full-time students on undergraduate courses who have dependent children could also be eligible for the childcare grant and the parents’ learning allowance. The childcare grant covers whichever is the lowest: 85% of childcare costs or a fixed maximum amount of around £190 a week for one child or £320 for two or more children. The parents’ learning allowance of up to £1,915 a year does not have to be repaid; it is paid in three instalments—one at the start of each term—and goes directly into students’ bank accounts. What is more, as part of the learning support fund, my Department offers all eligible nursing, midwifery and allied health professional students an additional non-repayable and non-income-assessed grant of £2,000 per academic year towards childcare costs.

Using the budgets available to us, the Government will continue to provide students who have children with as many opportunities and as much support as possible to allow them to pursue a career in healthcare. As we set out in the first ever NHS long-term workforce plan, a robust and resilient education and training system is critical to the future of our NHS, because, by having the right people with the right skills in the right places, we can deliver first-class care for patients, now and into the long-term future.