Education (Student Support) (Amendment) (No. 2) Regulations 2018

Lord Willis of Knaresborough Excerpts

Monday 21st May 2018 Lords Chamber

[Lord Puttnam (Lab)]

My Lords, I will probably not be quite as brief as the noble Baroness, Lady Garden, but I support the Motion of my noble friend Lord Hunt. In doing so, I hope to help the Minister with some experiences from the past, which I think are very germane.

My noble friend Lord Hunt and I entered this House on exactly the same day: 5 November 1997. He came as someone with great authority and experience in the National Health Service; I came from a terribly different world, with the specific job of working for the right honourable David Blunkett—now the noble Lord, Lord Blunkett, then the Secretary of State for Education. We had a crisis in teaching and with teachers. I commend to the House the front page of the Times Educational Supplement from 6 April. It states:

“Missing: 47,000 secondary teachers. In a system already struggling to fill the gaps, some are thinking the unthinkable: is it time for teaching without teachers?”


I would add this: is it time for nursing without nurses?

The situation is very serious because any possibility that the Minister and his department have of resolving the problem depends entirely on the pipeline supplied by the teaching profession. That has a time factor attached to it, which is very important. It took the Blair Government—I worked constantly at the department for education—six years to get back to equilibrium after the teaching crisis. We were short of around 47,000 teachers—ironically, almost exactly the same number that we are short of today.

Here is the problem: a demographic bulge will hit us in 2024. At that point, we will be short of something close to 50,000 secondary teachers. It is totally predictable; we can see it coming. It happens to be coming at a time when the number of graduates entering the profession is, necessarily, quite light because of an inverted demographic. I am sure that the noble Lord, Lord Willis of Knaresborough, will understand and attest to the figures I am giving. We had an enormous problem. This Government have an enormous problem, and the less they solve their educational pipeline problem, by ensuring that there are enough teachers in the system, the worse the nursing problem will get.

I commend the past to the Minister. We learned a powerful lesson between 1997 and 2003. Unless the Minister wants to revisit a similar lesson in the National Health Service, he must address this issue now.

[Lord Willis of Knaresborough (LD)]

My Lords, I thank the noble Lord, Lord Puttnam, for reminding us of those days, which were both terrifying—I say that as an ex-educationalist—and exciting. Meeting the challenge, based on an evidence base, enables you to move forward. I declare an interest, having worked for the past few years for Health Education England since its formation as a non-departmental body, following the 2012 Act.

What I find terribly sad about this SI is the lack of evidence behind the move. I do not know, and I suspect very few people in this House know, whether the move to an all-graduate profession—treating nursing graduates the same as teaching graduates or graduates going into law or other professions—should be done on a loan system. There is an argument for that, but in reality, we have absolutely no evidence to demonstrate that it will be effective, particularly at undergraduate level. Like many Members of the House, I look forward to the student funding review, because at least we will get that evidence base, which will be put before both Houses.

I find what I think is behind this deeply disappointing. Your Lordships spent many months debating the Health and Social Care Act 2012. There were a lot of fierce arguments. One of the reasons why the then coalition Government put forward the proposals was to take many of the decisions, particularly about staffing and education, out of the political arena and give them to an NDPB, to allow them to plan ahead. Health Education England was created for that very purpose. This is doing the exact opposite. It is pointless having an organisation which is there to plan a workforce and then taking away the means by which it can generate that workforce, be it at undergraduate or postgraduate level. It saddens me that after some of the excellent things that have been introduced—I declare an interest as having been involved with the nursing associate proposal—the belief is still peddled that this is somehow substitution. It should not be, it is not and it must not be a substitution. The noble Lord, Lord Hunt, is absolutely right to make that point: we do not want to move back to a lower quality simply to produce more people.

Will the Minister give us an idea of the quality, particularly at undergraduate level? I am sure that he will say that while we might not have as many applicants, we still have as many actual posts and that the quality of people applying for those posts is going up. I can find no evidence at all in the HESA survey that that is actually happening. If it is, I will celebrate it, and I am sure the Minister will tell us. The issue I want to raise—it is why I have spoken in this debate—concerns one of the great areas of weakness at the moment, and that is our ability to recruit and retain mental health nurses. This is a massive issue, and not simply for traditional reasons but because the demographics and the epidemiology show that ever more of us who, like your Lordships, have an average age of 70-plus are likely to have a mental health problem as part of their comorbidities as they get older. Few of us can deny that.

I am working at the moment at how we can provide the mental health workforce in 10 or 15 years’ time. I look around at where there is a stream of potential workers who could come in, and frankly it is at postgraduate level, using psychology graduates. I can tell the House that over the last three years, 49,466 psychology graduates have come out of our universities, yet we have a dire shortage of postgraduate mental health nurses. Instead of proposing, as my work does, that we really target these people to try to fill this gap in relatively quick time, this SI is saying that that is no longer possible, that these people with debts already from their university days—their undergraduate days—will now face having to fund work in a specialist area. Will the Government look seriously not just at narrow shortages but at wholesale shortages, which we certainly have in mental health nursing? Can we find a better way of attracting and retaining these people?

I finish with three brief questions. We are going to get, through the NHS and indeed through private sector organisations, 0.5% of their payroll being spent on the apprenticeship levy. I ask the Minister whether trusts and private sector organisations, particularly those in adult social care, will be able to use part of that levy to create in-house bursaries to support the development of staff. As yet we have not talked about the role of other sectors in bringing these people through. Will that be possible?

Secondly, if the Minister says, “Ah, no, BEIS says that you can use this money only if it is for apprenticeships”, are we able to rebadge postgraduate work in nursing, in the different fields, through the levy to provide the bursary—and, of course, fee remission—as a result of that route? There is a big pool of money coming in here, which could be used much more effectively.

Thirdly and finally, I ask the Minister, in trying to solve this conundrum, to make an assurance to this House that it is quality that we want and quality we must give to the people of the UK—particularly the people of England, to which this SI applies—rather than quick fixes in other ways, which I am sure will come down the track if we do not resolve this matter now.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, I congratulate the noble Lord, Lord Hunt, on securing this debate, and express my gratitude to all noble Lords for speaking. I always welcome the high profile that issues relating to NHS staffing receive in this House and I am always pleased to debate our approach with noble Lords, who I know are motivated by a desire to protect and promote our world-class NHS, and bring both wisdom and expertise.

I will start by explaining the overall rationale behind the reforms that the Government are making. The decision to remove bursaries for nursing, midwifery and allied health profession students and to provide them with access to the student loan system was taken by the Department of Health—as was—in the 2015 spending review. One reason for that was that this group of students had access to less money through the NHS bursary system than students in the student loan system. By moving to the loan system, these students now typically receive a 25% increase in the financial resources available to them for living costs during their time at university.

[Lord Willis of Knaresborough]

Before the Minister goes one second further, will he confirm that the bursary money was free money? They did not have to pay that back. Now they have to pay back the whole loan.

[Lord O’Shaughnessy]

If the noble Lord will let me finish, I will get to that point. Like other graduates, student nurses will be required to repay these government-funded loans only once they are in employment and earning. It is important to state that the student loan repayment terms are progressive. From April 2018, individuals will make their contribution to the system only when they are earning more than £25,000. Monthly repayments are linked to income, not to interest rates or the amount borrowed, and the outstanding debt is written off after 30 years.

I am not the Education Minister in this House, although I seem to be covering this topic not only tonight but in other forums, but it is important to underline that the reason this system was introduced into this country by a Labour Government, reaffirmed by a coalition Government and continued by a Conservative Government, is that it means that the best-earning graduates, instead of having their fees entirely paid by taxpayers, including people who have never gone to university, make a contribution to the costs incurred, whereas those who are lower-earning through their lives, including those who will perhaps never earn more than £25,000, will make no contribution. That is a more progressive system of funding than one in which everybody gets it for free, no matter how much money they make in their life.

As I said, these reforms give student nurses access to more financial support, albeit they have to pay that back if they can afford to do so later in life. It also provides a level playing field with other students. But perhaps most importantly of all, these actions released about £1 billion of funding to be reinvested in the NHS front line. As a consequence, Health Education England plans to increase the number of fully funded nurse training places by 25% from September 2018. It is important to stress that Health Education England has made that decision as an independent body to meet the need for more nurses that we all agree is there.

As the noble Lord, Lord Hunt, pointed out, this equates to around 5,000 more places each year—a major and welcome boost to our much-admired nursing workforce. My background is largely in education and I assure the noble Lord, Lord Puttnam, that we understand the urgency of this task and the parallels with education that he mentioned.