The surprise election has reignited the debate over the removal of student nurse bursaries, only a few months since the policy was officially confirmed. Student nurses in England currently receive a bursary to fund their study and help with living costs. The current government has removed this funding, effective this year, while Labour this week has announced plans to reintroduce it if the party gains power in June’s general election.

The government said that it removed the bursaries to increase the number of nurse training places, to help deal with the well documented shortfall of nurses, midwives and health visitors. It might seem counterproductive to deal with a shortage of nurses by increasing the amount it costs someone to train as a nurse, so it’s worth revisiting how the bursary system limited the supply of new nurses.  

The NHS Bursary Scheme was funded by Health Education England (HEE), which itself is funded by the government. The number of nurse training places available each year was limited to how much they could afford to fund. This number wasn’t enough to supply the quantity of nurses needed by the health service, but it couldn’t be increased because of constraints on government spending (as a result of ongoing government policy to reduce the national budget deficit). The government wanted to increase the number of places available, but was unable to do so with the money available.

As a result, despite nursing being a hugely popular course, receiving applications from 57,000 people in 2015, and despite growing demand for staff, the number of nurse training places remained at just over the 20,000 mark. UCAS data indicates there has been broadly no growth in places since 2010, while demand on the health service has been ever increasing.

But a more affordable training scheme for the government means a transfer of burden to students. And from this year trainee nurses will need to take out maintenance and tuition loans like other students. The removal of bursaries was controversial and many have questioned whether the number of people willing to take on these debts to train as a nurse will be sufficient to fill the promised extra training places.

It’s an important question, and the figures from UCAS in January this year showed that the number of people applying for nursing-related courses was down on the same time in 2016 by 23%. But, as I wrote in a blog last summer, nursing was such a popular course, with more than two applications for every place in 2015, the number of applications would have to fall by more than half for training places to go unfilled.

Of course, it’s not all about the numbers, and there are a few things that should be carefully monitored to ensure the removal of nurse bursaries helps to increase the size and strength of the workforce.

Firstly, nurses aren’t just trained by universities – at least half of their training is through hands-on placements in hospitals and other clinical settings, and some of the savings from removing the bursaries should be spent on providing these additional placements.

Removing central funding of training places is also a risk, as it takes away central control over the number of nurses that are trained. This must be closely monitored to ensure shortages do not appear in certain specialisms or in certain places.

Ultimately it is too early to know for certain the impact of removing the bursary. It is likely to increase the number of training places available, which is not only desirable but necessary to help fill the nursing shortfall, caused by years of undersupply and which is at risk of worsening if Brexit affects international recruitment.

However all this relies on maintaining demand for places, by making sure nursing in the NHS remains an attractive career. The best way to achieve this is a long-term and coordinated workforce strategy, looking at staffing levels, training, recruitment and pay. These are issues which will most likely be debated in this election campaign, but which must be looked at holistically by the next government.

Whether or not an incoming administration reinstates the nurse bursary it will be crucial to monitor the number of training places available and ensure a policy is in place to create an adequate supply of nurses for the NHS.

Comments

Louise Irvine



I think this article ignores the reality of student nurses’ training. I wonder if the writer has spoken to any student nurses? They don’t just do “clinical placements”. That makes it sound as if they are supernumerary, observing and being taught. On the contrary, they are actually working. Student nurses must do 4500 hours of training over three years, half of which is practical work. They are part of the clinical workforce, but don’t get paid for it. So student nurses are not like other students. University students generally are not expected to provide thousands of hours of free labour as part of their training. The bursary went some way to compensating for this. With the abolition of the bursary and being treated like any other student i.e. incurring debt to pay for their training. Student nurses would be perfectly entitled to refuse to do unpaid clinical work. Then where would we be? It would exacerbate the already terrible staffing problems. The government could easily have increased nurse training places and kept the bursary. The only reason they didn’t was to stay within their arbitrary chosen and totally unnecessary spending restrictions. We must recognise that training to be a nurse is not a private thing but a social good and therefore the costs should be shared between state and individual. I find the notion that it doesn’t matter that applications are down - that there will still be plenty of applicants for nursing courses, so the workforce should increase - rather naive. The main issue is nurses leaving. You are assuming that there will be an increase in input but that numbers leaving will stay the same. But its just as likely that numbers leaving will increase, especially as pay and conditions are deteriorating. To recruit and retain an adequate nursing workforce needs a change in attitude from one of disregarding nurses’ concerns to valuing and supporting them. Treating nursing students properly - recognising the real contribution they make to the nursing workforce - would be an important step in that change of attitude. And that, in the end, is what is needed to build the nursing workforce we need.



Toby Watt



Hi Louise,

Thanks so much for engaging with us on this issue and I agree it is a tricky one, with more than one point of view.

There are many issues associated with this, not least of which the need to make sure that nursing remains an attractive career. Certainly those who chose to become student nurses after August will be worse off than those that have gone before them. This is why the government must design a feasible long-term and coordinated workforce strategy, looking at staffing levels, training, recruitment and pay together, in order to treat nurses and other medical staff in the best way possible.

While the number of nurses leaving the profession is a problem it will be exacerbated if we don’t train more. The current government’s economic policy exists, whether it is arbitrary or not, and given this, the removal of the bursary was a way of increasing the number of nurses we train. To improve the quality of life for student nurses, as well as practicing nurses that are leaving the workforce, more funding is needed.



Mjs



I think comment above is good ; this article is articulate but seems very divorced from reality and I'd guess not much input or contact with any nurses.



Kate King



If the government paid more attention to the welfare of their hard working nurses, for example by not cutting their salaries in real terms for years, and by recognising that they need to continue to employ more experienced staff by allowing more highly paid jobs (median pay for a nurse is £24k) then they wouldn't be losing so many and they wouldn't be forcing student nurses into years and years of debt with little hope that their salaries are going to be increased to cover this extra cost.



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