§ Jackie Ballard (Taunton)
Last week there was an article in my regional daily newspaper about flying angels—nurses recruited from the Philippines to ease the national health service staffing crisis in the west country, which is not the only region to suffer from the problem. At the heart of the crisis is low pay for student nurses, which has led to a shortfall in recruitment and a 25 per cent. drop-out rate from many courses.
The issue was highlighted last month, when student nurses—I was pleased to see several from my constituency—lobbied Members of Parliament. Because of my concern about what I was told by constituents at the lobby, I was fortunate enough to secure this debate to draw the Government's attention to the situation. I look forward to hearing what the Minister plans to do about it.
There is currently a confusing three-tier system of funding for student nurses. That was the subject of early-day motion 569, which has so far attracted 70 signatures. As hon. Members will appreciate, they cannot all be the signatures of Liberal Democrat Members. The three-tier system has the following structure: first, those who are seconded on a salary from their trust; secondly, those who are on diploma courses, who receive a Department of Health bursary; and thirdly, those who are taking degrees, receive means-tested bursaries and are eligible for student loans. The Department apparently recognises the funding problem for the latter two groups, because it now encourages more trusts to second health care assistants to nurse education on a salary. So far, 1,000 students have taken up that offer. They retain supernumerary status on the wards.
One of the student nurses who came to see me had previously been a health care assistant on a low income, during which time she had been entitled to family credit. She is now a bursary nursing student, and has no entitlement to family credit and no help with child care costs. She is working harder than she did as a health care assistant, with much longer hours, and is financially worse off. How long does the Minister think that she and others like her can put up with the pressure for the sake of a long-term investment in her career and in the NHS?
Another student wrote to me to say:The nursing course which I am on requires me to squeeze 4,600 hours of learning into 3 years. During the period when all other students are on holiday we are studying or on clinical placements. My friends who are taking other university degrees or diplomas have nearly 3 months holiday in the summer, I get 3 weeks. During this time I will be revising for exams and working extra shifts as an HCA to make up a wage large enough to live on. On my days off I work as a care assistant. I have no choice but to do this in order to pay my bills and be able to live. The Government states that nobody should live in poverty, £4,500 a year sounds like poverty to me!
If nursing students had kept their right to a nationally negotiated salary when Project 2000 started, they would now be earning about £10,000 a year—double the current bursary. Student poverty is not the only reason that student nurses drop out of courses, but it is one of the reasons most commonly given. That poverty is caused not only by low income, but by high costs— 229WH especially in rural areas such as my constituency. For example, student nurses told me that the NHS Executive has recently changed its policy on reimbursing travel expenses to clinical placements. That has caused a great deal of confusion. One student said that she often spends £30 a week on petrol to get to her placements. That money comes out of her standard bursary.
Unison and many student nurses would like to see a return to salaried student status. They believe that it would reduce the drop-out rate and aid recruitment, and that it would increase loyalty to the NHS. The Minister is probably aware that the Royal College of Nursing takes a different view. It would prefer bursaries to be increased. It fears that students would lose their supernumerary status if they were salaried. It says that students used to be used as cheap labour and that they had little time to learn, which was why Project 2000 was implemented.
Whatever the disagreement between the unions and students on the best way forward, they all agree that the Prime Minister will not be able to deliver his promised 10,000 new nurses while the funding to support students is so low. Many nursing and midwifery students face financial hardship. They suffer more hardship than most other students because many are mature students with family responsibilities. One third of nursing and midwifery students are more than 25 years old, one third are married or have partners and a quarter of them have dependent children.
At the very least, those students need higher bursaries. They should be reimbursed for the cost of travelling to clinical placements. Will the Minister clarify the position on reimbursement? Students—especially those with child care responsibilities—need access to social security benefits. I hope that the Government agree that it is a serious problem. They will not achieve their aim of recruiting more nurses into the NHS if it is not solved. I hope that the Minister will give us some idea of the way forward.
§ The Minister of State, Department of Health (Mr. John Hutton)
I congratulate the hon. Member for Taunton (Jackie Ballard) on her success in the ballot. She chose to raise the matter of maintenance for student nurses, an essential group of people who help to deliver on the Government's plans to modernise the NHS and to improve patient care—objectives that the hon. Lady supports.
I shall put the matter in its proper context. In the financial year 2000–01, the NHS will support about 50,000 nursing and midwifery students—about 45,000 diploma-level students and about 5,000 degree-level students. The average bursary is about £5,000 a year for diploma-level students and £2,100 a year for those studying at degree level. Additional allowances are provided for some older students, for some single parents and for those with dependants. The hon. Lady drew attention to each of those three groups. An additional allowance of £590 a year is payable to older students—those aged 26 and over—and a single-parent addition of nearly £900 a year and a dependants' 230WH allowance of between about £1,700 and about £3,000 a year are payable, depending on the number and age of dependants. The hon. Lady was particularly concerned about student nurses who had dependants. The scheme allows additional support for them.
This year, we shall spend well over £200 million on bursaries and almost £700 million on all aspects of nursing and midwifery training, of which about £500 million will be spent on pre-registration training. By anyone's reckoning, that is a substantial package of support. We recognise, however, that we need to increase the number of staff to match the expansion in services to be provided by the new NHS. We have already achieved a great deal. The latest annual work force figures show that 5,500 more nurses are working in the NHS this year than just over a year ago.
The hon. Lady referred to a crisis in nursing. We need to put the matter in context. As part of our plans to expand services and improve patient care, we are expanding the number of nurse training places by 6,000 and reversing the cuts made by the previous Government. I am sure that the hon. Lady would welcome that. Last year, more than 15,000 student nurses began training—the highest number to do so for six years. If the previous Government had matched that commitment to nurse training during their last five years in office, more than 14,000 extra nurses could be working on the wards. Sadly, that is not the case.
§ Jackie Ballard
I do not dispute the numbers of people who have been attracted to nursing courses, but will the Minister comment on the drop-out rate? He may have been planning to deal with that point, about which I asked a parliamentary question some time ago. The drop-out figures for the year in which the 15,000 people began training are not yet available.
§ Mr. Hutton
I think that that is the case, and I shall comment further on the matter in a moment. It is, however, important to be aware of the whole story. We accept that there are legitimate concerns and I know that the hon. Lady referred to them, but I want to try to set the whole picture of student nurse training in the right context.
As a result of the additional investment that we are making in the NHS, we shall be able to provide up to 15,000 more nurses to care for patients on the wards. Of course, it takes three years to train a nurse, so it will take time to reverse the previous Government's complacency and underinvestment in the National Health Service. However, more students are already embarking on the training that will deliver on this Government's commitment to improved patient care. The hon. Lady may be interested to know that the Universities and Colleges Admissions Service has recently released figures that reveal a 24 per cent. increase in people starting nursing degree courses this year. Strong indications suggest that people are willing and prepared to embark on this important career. The 24 per cent. increase is the second highest increase for any degree choice starting in the 1999–2000 academic year. The end-year figures from the Nursing and Midwifery Admissions Service show that, last year, the number of applicants for nursing and midwifery diploma courses rose by 73 per cent. to more than 32,000 people. The number of students taking up diploma courses has also risen by 18 per cent.
231WH Those are positive indications that we are at long last starting to turn a corner in recruiting these key workers into the National Health Service. They demonstrate our commitment to nurses as key to the delivery of our modernisation plans and to tackling nursing shortages. Our substantial investment in non-medical training, which amounts to some £1 billion in the current financial year, is helping us to turn the corner on recruiting nurses to the national health service.
The hon. Lady may like to know that her local education consortium in Somerset is planning to invest some £44 million in training in this financial year. That is a significant investment in the future of the national health service in her part of the country.
A new NHS careers service is also helping to feed more students into nurse training. The service was launched in April 1999 and initially covers nurses, health visitors and midwives. It uses modern technology to provide an inquirer-led service that is both accessible and objective. A call centre operation offers provision for simple inquiries for help and information and for more detailed inquiries dealt with by professional advisers. It handles about 1,000 calls a week.
Another key part of our recruitment and retention strategy is pay modernisation. For the second year running, the Government have accepted in full the recommendations of the Nurses and Midwives Pay Review Body, this time for 2000–01. That will mean an increase in basic pay of at least 3.4 per cent. for all nurses., and some groups of staff will receive substantially more. After years in which pay rises were staged, it is right that the awards should now be paid in full. Together with last year's award, we have provided nurses who are completing their training with a greater increase in pay in real terms than they have received at any time since 1987–88. Starting pay for newly qualified nurses in grade D will rise from £17,325 to £17,915 in inner London and from £14,400 to £14,890 in locations outside London, including the hon. Lady's constituency. Our decision to implement the award in full recognises that nurses deserve a fair pay award, especially after they coped so magnificently with the huge pressures of the winter. The pay award will also help the NHS to recruit and retain more staff, which will mean that it can treat patients more quickly.
Equally—this relates to the hon. Lady's comments—we recognise the need to provide student nurses with the support that they need throughout their training. That is why the NHS bursary scheme continues to provide more generous financial support than is available for people in mainstream higher education. In contrast to what happened under the previous Government, bursary rates are being increased again by the rate of inflation from September. That will be the third successive annual increase. We are committed to maintaining the level of the bursary. It is worth pointing out to the hon. Lady that, prior to 1998, there had been no increase in the bursary rate for three years. The Government have acted decisively to improve the bursary arrangements.
We recognise the hard work and commitment required of student nurses, who undertake an exceptionally demanding education and training programme. The hon. Lady mentioned some of the pressures on student nurses.
§ Jackie Ballard
I thank the Minister for giving way again. He said that the bursaries were more generous 232WH than the funding available to other students. I am sure that he would accept that the hours of work and study required of student nurses are quite different from those of other students.
Does the Minister know the gap between the bursary level, even with dependants' allowances, for someone with one or two children, and what the same person would receive in income support, which the Government would consider the basic level that anyone would need?
§ Mr. Hutton
If the hon. Lady wants detailed figures and calculations, I shall have to write to her.
While the bursary scheme continues to provide effective support for students, we know that more needs to be done, particularly to tackle the difficulties experienced by some groups during the training period. We want to ensure the widest possible access to nurse training programmes, so that the future NHS work force will be diverse and fully representative of the communities that they serve. We want a system that provides adequate support in all circumstances, so that no one suffers undue financial hardship as a result of choosing to train as a nurse. That is why, as I am sure that the hon. Lady knows, the Government are currently undertaking a comprehensive review of the NHS support package for trainee nurses, to ensure that the best support continues to be provided.
The review of student support will be wide ranging and will include examination of the different levels of support provided for diploma and degree students; the need to ensure the widest possible access to nurse training; the issue of hardship; and the interface between our support arrangements and the benefits system. We shall also consider student accommodation and travel expenses.
The enhanced level of support available to diploma students was introduced to stem the year-on-year decline in the number of young people entering nursing training. To date, to safeguard recruitment, those differences have been maintained. Student nurses, of course, face particular pressures that other groups of students do not, such as their short vacations and their extensive involvement in clinical placements. Older students, and those with dependants, can also face particular difficulties in gaining access to nurse training. For that reason, student nurses are already provided with enhanced support in comparison with other higher education students. In addition, the NHS meets student liability for tuition fee contributions in full. That is normally worth £1,025 a year. We want to continue to provide the necessary support to guarantee the future supply of those key workers.
Hon. Members, and certainly the hon. Lady, will be aware of adverse publicity in the professional press, and from some professional bodies, following clarification of the rules on travel allowances for students attending clinical placements. There have been no changes in the rules since 1 September. Any students who incur additional travel costs—when compared with their normal daily travel costs—can continue to claim them in full.
My ministerial colleagues and I are also aware of the problems affecting predominantly rural areas, such as the south-west, where the hon. Lady's constituency is 233WH situated, and some of the smaller health care professions, in which opportunities for theoretical and practical training can be widely spread geographically. In developing our policy relating to travel expenses, our aim is to be fair to all students while safeguarding recruitment and ensuring that we do not impose an unacceptable administrative burden on students, universities or the NHS student grants unit.
I recognise in particular the importance, and the value to the NHS, of attracting mature students, single parents and those with dependants into nurse training. I am also aware of the particular difficulties faced by some of those students, many of whom have increased financial commitments, in accessing nurse education programmes. We want to find ways of ensuring the widest possible access to training in future, regardless of the individual circumstances of the student. This year's review of student support will therefore include examination of the interface between student support arrangements and the benefits system. The hon. Lady mentioned that matter.
The Department's officials are working closely with the student grants unit, education consortiums and the higher education institutions to ensure that we have in place an effective method of paying support to student nurses. Since taking on additional responsibilities in September 1999, the student grants unit has authorised payments to approximately 17,500 nursing students and those studying in the professions allied to medicine totalling about £38 million. That is a significant achievement for the unit's 25 staff. The centralisation of responsibility for the assessment and payment of bursaries at the student grants unit has been of real benefit to students, both in terms of providing a single point of contact for advice and as a way of ensuring equal treatment for all NHS-funded students.
We also want to ensure that nurses are provided with high-quality and affordable accommodation when and where they need it. My right hon. Friend the Deputy Prime Minister recently published his Green Paper on housing and announced the starter home initiative. Nurses will be helped to buy their own homes in areas where housing is costly.
The initiative will make a real difference, but we want to go further still. At the recent Royal College of Nursing conference, my right hon. Friend the Secretary of State for Health announced his appointment of John Yates as a new national nurse housing co-ordinator. His remit is to secure more affordable homes for more nurses. The accommodation will be in new high-quality developments—flats, apartments and houses—which 234WH will help to attract still more nurses to the profession. Surplus NHS assets will be used to kick-start investment in new homes for nurses. The new co-ordinator will spearhead a range of new partnerships with housing investors, councils and the Housing Corporation, to build affordable new accommodation for nurses in high-cost areas. That might go some way to meet the hon. Lady's concerns.
We want to ensure that as many student nurses as possible complete their training and go on to work in the NHS. Attrition rates from nursing courses vary from year to year, from university to university and between the branches of nursing. Figures from the English National Board for Nursing, Midwifery and Health Visiting show a continuing downward trend in overall attrition for diploma level students. That development is welcome. Those students make up the majority of the nursing student population. The figures compare favourably with those for other forms of higher education. It is our intention to ensure that we have in place a system that provides all students with appropriate financial support throughout their training, thus, we hope, minimising the loss of students from training courses.
We also intend to strengthen nurse education; the strategy was set out in the document "Making a Difference—Strengthening the nursing, midwifery and health visiting contribution to health and healthcare." We intend to continue to support other initiatives, such as the encouragement of former staff back into the profession. Implementation of the strategy will help to ensure the delivery of high-quality midwifery education, which will help to meet the needs of patients and clients in the 21st century. We are ensuring that nurses and midwives are properly prepared to contribute fully to a modern NHS and we are modernising career frameworks to provide more satisfying and rewarding careers.
Once qualified, today's nurses enjoy better pay and can look forward to more flexible shift patterns, improved career development and a service that rewards them fairly for taking on the additional responsibilities that we want them to undertake. Our initiatives to recruit more nurses, to encourage more former staff back into the profession, to support nurses properly throughout their training and to ensure that qualified staff are properly rewarded are clear signs of the Government's commitment to nurses, to services and, most important, to patients. Tomorrow's qualified nurses will form the backbone of the NHS and will help to deliver on the opportunity that we now have to modernise the health service and to provide the care that nurses know that their patients deserve.