Until 2017, students studying nursing in England received a bursary and paid no fees. The bursary was paid by the NHS and was a remnant of the days when nursing students were employed by the hospitals where they trained. By the end of the 1990s, all nursing education moved to universities, but the bursaries remained.
The UK government’s decision to stop bursaries in England was met with protests, especially by the Royal College of Nursing. Proponents of the bursaries argued that it would exacerbate current nursing shortages. We need to attract more candidates, not drive them away, they argued, especially older women from lower socio-economic groups.
Only the bursary system did not solve nursing shortages and it was not flexible enough to respond to changing demands. When we needed more nursing students, the NHS did not necessarily have the funding to provide bursaries. Contracts between universities and the NHS had a cap on the numbers of nursing students funded.
I propose four reasons why bursaries for nursing students aren’t needed.
1. We can’t afford it and they don’t need them
The NHS can no longer afford the scheme, especially with the proposed expansions in the numbers of nursing students. Nursing students, along with other university students, have access to student loans that cover their tuition fees and provide them with a living allowance.
Nurses, almost uniquely, are virtually guaranteed a job on graduation and if they earn £24,000 annually – the middle of the lowest pay band for a staff nurse – they only need to repay £11 a week.
2. Nursing students are not employees
It is often thought that nursing students are working as employees of the NHS while they are in hospital. They are not. They are “supernumerary”, which means they are not included in the workforce. This recognises that they are students and that they are there to learn. They may have less opportunity than other students to work and earn money to support themselves, but this is surely offset by almost guaranteed employment on graduation?
3. Nursing is not a vehicle for social engineering
Some worry that older women from lower socio-economic groups, those who have had families or are seeking a late or second career, will find it hard to study nursing. But are these concerns justified? The initial introduction of student loans did not reduce the numbers of applicants from lower socio-economic groups to university. Why should it affect nursing?
We need a nursing workforce that is diverse in gender, ethnicity and age. But someone entering nursing late may only work for a short time in the NHS. This is not good value for money if that money is being spent by the NHS.
Nursing and the NHS do not exist as vehicles for social engineering where everyone who ever wanted to be a nurse can become a nurse. Both nursing and the NHS exist to provide a service: patient care.
4. We’ll get the most motivated students
While bursaries were available, both nursing students and nursing lecturers reported that some students were only studying nursing for the bursary. They had no intention of entering nursing on graduation and, in fact, many nursing students never enter nursing.
With an end to bursaries and an end to the cap on numbers, we have a much more flexible system that can respond to the need for nurses. The issue remains the availability of places for nursing students in the NHS. But universities can now negotiate with any part of the NHS they wish – not just their local hospitals – and can pay the NHS for training places. This should provide the flexibility needed and an incentive to the NHS to provide, and even compete to provide, the best training places.