From August, nursing, midwifery and most allied health students will no longer have their tuition fees paid by the NHS, nor will they receive maintenance bursaries. This will undoubtedly affect the number of students opting to study these subjects. And it will negatively impact NHS England staffing levels in three years’ time.
Many nursing students are mature students and having their fees paid has been an incentive to study. At Bournemouth University, we have a large number of mature students who have a mortgage and dependent children, so they may be reluctant to take on more debt. Taking away the bursary could prevent many talented people from becoming tomorrow’s nurses, midwives, physiotherapists, occupational therapists and speech-and-language therapists, to name just some of the healthcare degrees that will no longer be funded by the government.
The Royal College of Nursing (RCN) confirms that nursing and midwifery student applications across England are down by 23% this year. This doesn’t necessarily mean that the places on these courses won’t be filled, as they are often oversubscribed, but it’s a worrying dip, nonetheless.
If the government – whoever they may be after June 8 – is serious about securing an NHS workforce for the future, they need to be serious about investing in it now.
Inventing new roles
There are over 55,000 EU nationals working as nurses and doctors in the NHS. As a result of Brexit, fewer nurses from the EU are applying for jobs in the NHS. And the RCN confirms that student nurse applications from EU citizens are down 7% this year.
New healthcare roles have been created in an attempt to counteract the changes to student funding and to Brexit, such as the new nursing associate role. A nursing associate is more junior than a registered nurse, but they can go on to become a registered nurse either by completing a degree-level nursing apprenticeship or by taking a shortened nursing degree at university.
The government has also expanded the range of apprenticeship schemes, such as nursing-degree apprenticeships and apprenticeships which support the development of advanced-practice nurses. But none of these initiatives is a quick fix.
In fact, with the introduction of the apprenticeship levy, introduced for all large organisations since April 2017, the government hopes to train 100,000 apprentices in the NHS by 2020. These apprenticeships will include nursing associates and healthcare assistants (a position below nursing associates). This means that all organisations, not just the NHS, who have an annual wage bill of £3m or more will have an apprenticeship levy of 0.5% of their total wage bill deducted to pay towards the government’s apprenticeships scheme. However, paying for a three-year degree apprenticeship by the NHS Trusts will far exceed what the levy will pay for.
Nursing shortages will not just be bad for patients, they will be bad for nurses too. A study, published in JAMA, showed that a poor nurse-to-patient ratio can result in an increase in patient mortality and have a detrimental effect on the health and well-being of the nurse, leading to job dissatisfaction and more nurses quitting.
The NHS cannot survive the continued and worsening workforce shortage and retain its reputation for high-quality patient care. So, unless incentives are introduced, such as fees paid for those with a first degree to enter these programmes at the postgraduate level, or assistance with childcare, or similar incentives that would encourage candidates to enter healthcare professions, the workforce crisis in the NHS can only continue to spiral out of control.