With the Spending Review underway, the debate on the initial education funding for nurses, midwives and allied health professionals has picked up again. These are some of the important questions to come our way over the past few days.
What is the real issue here? If this is about university funding, why not just push for that?
There are at least three presenting issues: persistent workforce shortages, the level of day-to-day living support for students and university funding. However, the underlying problem is the tie between inherently long-term investment in education and decisions made on the basis of annual recurrent NHS budgets. This makes education exceptionally vulnerable to budget pressures and short-term decisions (such as cutting the number of nursing education places in 2010-12). It also ties the whole domestic supply of these professions to the NHS, when many professionals increasingly contribute to the nation’s health and wellbeing from outside the NHS.
Is this arguing for investment in health education to be cut?
No. What we’re suggesting is a different way of using the money, seeking to increase day-to-day living support for students (albeit with loans rather than grants), protect the quality of education and allow the numbers of health professional students to increase (accepting that this would be incremental and dependent on placement capacity/partnership work with health and social care providers).
Surely this proposal has risks?
Yes. No one involved in education funding for any length of time is under any illusion that this is risk-free. But it’s important to understand the risks of the current system too: the history of student numbers yo-yoing, the risk that universities ultimately end up withdrawing from course provision, the financial hardship issues for many students in terms of the overall amount of day to day living support they receive. Added to this, employers are increasingly approaching universities to set up self-funded (loan) programmes, so the current system is already fragmenting.
If numbers are to grow, where would placement capacity come from?
Placement capacity is an important constraint and we have tried to downplay the speed at which student numbers might grow. Capacity varies between professions and across regions, and so any increase in numbers could only be agreed in partnership with local health and social care providers. Placements for nursing students are also governed by an input requirement of 2300 hours under EU law. Since the key to placements is not the number of hours but the quality of the learning experience, we’ve asked the Government to look at whether this could be discussed in the EU reform negotiations.
Which professions would this impact?
One of the problems is that the overarching funding system for health education lacks coherence. The current grant funding regime covers initial education for nurses, midwives, operating department practitioners and most allied health professions, except arts therapists and paramedics. Outside these professions, the picture is quite different. Many paramedic students are on the loan system (and most of their placement providers don’t get any funding); pharmacy students take out loans but have placement funding and medical/dental students have a mix of loans and bursaries with placement funding.
Wouldn’t change put off mature students and damage widening participation?
Nursing, midwifery and some of the AHPs do an enormous amount to open up access to higher education, often with double the average number of students from low participation neighbourhoods. It’s in nobody’s interest to damage that. What’s interesting about the data in England is that the move to student loans hasn’t reduced the numbers of students applying from lower socio-economic groups. UCAS data shows that young people from lower socio-economic groups are more than 60% more likely to enter higher education in 2014 than 2006. It’s a risk but the picture’s more complicated than intuition suggests.
The risk is different for mature students, where numbers have dropped since fee loans were introduced. This is why we’ve proposed that funding is channelled back to support applications from mature students, including ELQ exemptions which mean that students can access loans if they’ve already done a degree. We’ve also asked Government to consider loan abatement schemes, so that if someone works in the NHS for a given amount of time, their loan is repaid.
How much would people repay when they graduate?
Under current rules, on a salary of £24k a new graduate would pay back £11 per week. It’s true that this effectively has an impact on pay but as the first repayments would not be due until 2021/22, there is time to factor these into pay review body negotiations.
When might this happen? Surely it isn’t right to change the deal for existing students.
There is nothing in our proposals to suggest that this should change anything for existing students. Given that the UCAS cycle for 2016/17 entry is already underway, our view is that the earliest any kind of reform could be implemented would be for new entrants in 2017/18. This also gives time to carefully look at the risks and put in place the sort of additional funding support that will be needed in transition.
And a challenge…
It’s no bad thing to have different views on the prospect of something as significant as this sort of funding reform – there are certainly different views in our membership. There will be some for whom the prospect of this group of health students taking out loans for tuition is a step too far. But there’s a challenge to find plausible alternatives at a time when Government departments are modelling 25% to 40% cuts. This includes addressing:
- How student numbers might be maintained if the NHS starts forecasting that it needs lower numbers of registered professionals (avoiding the scenario that has unfolded since the 2010-12 cuts);
- How the student places needed for safe staffing might be sustained if the NHS decides to push instead for increased numbers of support workers;
- How to protect the education and training budget for nurses, midwives and AHPs when NHS frontline services are facing a financial black hole;
- How day-to-day living support for students can be increased, or financial hardship mitigated;
- How to sustain university engagement in these courses (and the post-registration education and research embedded with them) when the funding for a number of health disciplines has fallen far behind standard course funding;
- How the needs of employers outside the NHS can be properly reflected in the numbers of student places.