[Philip Davies in the Chair]
I beg to move,
That this House has considered investing in nursing higher education in England.
It is a pleasure to serve under your chairmanship, Mr Davies.
I am proud to speak on an issue close to my heart. Before I entered Parliament, I was privileged to work as a nurse for almost 40 years, and last year my daughter graduated as a nurse. Nursing is an incredible profession, a fulfilling career and full of opportunities for those who choose that rewarding path. Nurses are the most trusted profession in Britain, a position they have held for years, with 96% of the public trusting nurses to tell them the truth. It may come as little surprise to hon. Members that politicians are the least trusted. Let all of us in this House show political leadership now and listen to what nursing students and nurses are telling us. They are telling us what must happen to meet the needs of communities across England.
Everywhere there are people, there are nurses, but they are not necessarily doing what we might think they are doing. Yes, nurses connect with patients and families to understand what people need, but they are also diagnosing, prescribing, performing surgery, creating care plans, delivering treatment, overseeing clinics, managing hospitals, working as chief executives and designing primary care services.
My hon. Friend mentioned that nurses are valued, but if the Government really valued them, they would give them a decent wage increase and restore the education maintenance grants and, if necessary, bursaries as well. Does she agree that that would demonstrate how nurses are really valued in this country?
I do agree, and my hon. Friend will hear me refer in my speech to what he has just said.
I congratulate my hon. Friend on securing this important debate, and I commend what my hon. Friend the Member for Coventry South (Mr Cunningham) said about the proposition that we need to pay our nurses properly to value them truly. Does my hon. Friend the Member for Wolverhampton South West agree that it is important that we have specialisms too, and that one specialism we require more of across the country is Parkinson’s nurses?
Absolutely. That is where nursing is important. Nurses are becoming specialists in Parkinson’s, Turner syndrome and sickle cell, all of which are specialisms that will be required in the future of nursing.
Nurses are working in cutting-edge research on ethics, safety, improvements to care and new ways of working. They are leading from the frontline, and as professionals they should be at the heart of strategic policy making. Nursing is at a critical junction in our healthcare and systems, yet the Government are without an independent chief nursing officer after the removal of that critical leadership post from the heart of the Department of Health and Social Care. That is an insult to the nursing profession.
How many of my right hon. and hon. Friends are regularly contacted by their constituents about health and social care issues—people struggling, writing about services being reduced or cut, unable to access support without help? Increasingly, that is happening because there are not enough staff to run things safely. Across the country, nurses are clear that staffing for safe and effective care is their most important priority and their biggest worry.
Does my hon. Friend accept that in the specialisms in particular—in my own area, the problem is with learning disabilities—there are such reduced numbers going through training because of the loss of the bursary that it will have a huge impact on care homes and other forms of care delivery? Does she see that as a total tragedy?
I do, and I will talk about that in my speech and touch on the lack of nursing students coming into those particular areas because of the bursary’s disappearance.
My hon. Friend is making a very sound speech. Does she agree that it is a completely false economy that, as a student nurse told me just today, of the 45 recruits to mental health nursing in his cohort, under the new financial regime only 18 remain on the course in its second year? We desperately need those nurses—what a price to pay!
My hon. Friend is totally right. Again, I will address that point in my speech, but it is noted. I am glad that my hon. Friends are intervening, because it shows the importance of this debate on nursing and the lack of it. I am glad the nurses came to my hon. Friend and told her what it is like. The situation is beyond shocking. There are almost 42,000 vacant nursing posts in the national health service in England. Without policy and funding intervention, that will grow to almost 43,000 by 2023.
My hon. Friend is making an important speech. On the current 42,000 shortfall, does she agree that with so many European Union nationals potentially leaving the health service, that figure could well be compounded in future?
That is definitely so. My hon. Friend is completely right, and with the way Brexit is going, that is understandable. People working in the NHS understand that.
Without policies and funding intervention, as I have said, the shortfall will grow to almost 43,000 by 2023, and that number is on the low side. It does not account for the one third of nurses who are due to retire in the next 10 years. It does not include nursing shortages in social care or public health. Students are being forced to plug the gaps. They should be learning, but instead they are providing care before qualification, without supervision and before they are ready—all because we do not have enough nurses. That is deeply unfair to students. It is risky for qualified nurses and it is unsafe for patients, and all because no one wants to pay for the solution.
Poor workforce planning in health and care is not new. Even in my time, policy makers pursued a boom-to-bust approach, rather than ensuring that supply was available to meet demand. Six years on from the Health and Social Care Act 2012, it is fundamentally unclear who is accountable for workforce strategy. As a result, it is not being done by anyone. Earlier this year, Health Education England held a consultation, but Professor Ian Cumming has failed to deliver a workforce strategy. We are told that it will be dealt with in the new 10-year plan. Mr Simon Stevens, the chief executive of the NHS, has been handed an additional £20.5 billion a year for the NHS by 2023-24, and it is widely understood that his long-term plan must address the extreme gaps in our nursing workforce by fixing the supply issue and providing funding.
I congratulate my hon. Friend on securing this important debate. I do not think it should focus only on the bursary, as some of the letters have—important though that is—but on the Government’s lamentable failure to bring in nursing apprenticeships, which provide such an important route for many youngsters from working-class areas in the Black Country, including areas in her constituency and mine.
My right hon. Friend covers a point about apprenticeships that I will address in my speech, because what we are saying is that it is one of the routes, but not the only route.
My hon. Friend is making an excellent speech on a topic that is important to us all. The Royal College of Nursing has made it very clear that the priority for the bulk of investment in nursing education must be the three-year undergraduate degree, because that is the fastest and safest route for growth at scale. Does she agree with that, and does she agree that we must not try to do nursing training on the cheap?
Absolutely; I totally agree. I thank my hon. Friend for that intervention. We should not be doing the training on the cheap. I will try to address that point in my speech.
There is a huge risk that the long-term plan will be like previous plans and that Simon Stevens will not provide or fund a solution. He is spending money on services that cannot be staffed. He is creating new posts that cannot be filled, because trained and qualified registered nurses to fill those posts do not exist. I wonder whether the Prime Minister knows that nurses do not grow on trees, just as money does not. The five year forward view substantially failed to create nurses. In fact, during that time, the opposite happened: we lost thousands of nurses. I ask right hon. and hon. Members what on earth should be prioritised above growing the number of nurses.
I agree that this is a really important issue and we must do all we can to support the nurses of the future, but does the hon. Lady agree that it is worth recording that there are 13,000 more nurses on wards today than there were in 2010?
I thank the hon. Lady for her intervention, but unfortunately, as someone who has worked on the wards, I have to say that we do not see it; it does not feel like that.
Simply put, there is no long-term plan without a registered nursing workforce. Whatever ambition the Secretary of State and Simon Stevens have must be matched by credible growth in the number of registered nurses.
Will my hon. Friend give way?
Does my hon. Friend—
Order. It is not for me to rule on whether people should or should not give way, but I should say that it is not really on for people just to wander into the Chamber and seek to intervene within two minutes of doing so. I say that gently, but it is not for me to decide who should be given way to; that is a matter for the speaker.
Sorry, I have been at another meeting.
That is not the point, if I may say so to the hon. Lady. Would the hon. Member for Wolverhampton South West (Eleanor Smith) like to give way?
I will take this intervention and then I would like to make some progress.
I will be brief. There was mention of how many nurses there were on the wards. I was a nurse on a ward, and I am getting older. The drop by one third in the number of applications means that, even with the new nurses, we do not have the number of people to fill the vacancies. The Prime Minister makes great play of how much money there will be for all these nursing vacancies. If nurses are not trained and people are retiring and those places are not being filled by new nurses, how do we do it?
I will address that in my speech. I thank my hon. Friend very much for that intervention.
I welcome the public commitment made by the Secretary of State at the Royal College of Nursing on 31 October to invest in growing the number of nurses through higher education, including through the long-term plan, because I feel that finally someone is paying attention. The Secretary of State has said that he will look into the possibility of introducing safe nurse staffing legislation. He has said that he will explore anything that might help to address the problem we face. I sincerely hope that the Secretary of State means it, because he and Simon Stevens have the power to fix this mess with proper funding and intervention.
That brings me to the crux of the debate. We have to grow our nursing workforce, so the only question that we need to answer is this: how do we fund what we know is the fastest and safest way to do that at scale, in the light of our crisis? Higher education is the best and most cost-effective way to ensure that we have the right number of registered nursing staff, with the right skills and experience, which patients need and deserve. New routes into nursing, which are welcome if done right, still cannot educate anywhere near enough nurses to an appropriate skill level to meet the current need, let alone the future one. It is time to fix the supply pipeline and for the Secretary of State and Simon Stevens to stand up and be counted.
In 2016, the Government removed the NHS bursary and replaced it with a student loan. The £1.2 billion that was taken out of healthcare higher education was framed as a saving, but where did it go? What did it save? Was it used to grow the number of nurses? The stated purpose of the Government’s reform was to increase the number of nursing students. It is against that goal that the impact of the Government’s reforms must be judged.
Let me bust a few myths. I expect the Minister to say, “The old bursary model placed an artificial cap on the number of nurse training places that universities could offer students.” That is factually untrue. Funding of nursing student numbers has always been a political choice. It has always been up to the Government to choose what they want to fund. I expect the Minister to say, “The loan model has not made it less attractive to apply.” In each year since the reform, applications to nursing courses have fallen. In September 2018, nearly 1,800 fewer nurses were due to start at university, compared with September 2016.
I thank my hon. Friend for the robust way in which she is laying out the case. Since the 2016 reforms, we have seen a significant reduction in the number of people over the age of 25 going into nursing. The Health and Social Care Committee has looked at that. Obviously, people over 25 have brought great value to nursing. Does my hon. Friend agree that the changes that we have seen have potentially been very detrimental to the nursing workforce?
I thank my hon. Friend for that intervention; he is totally right. There is a difference between the mature students who come into nursing and those who are 18. There is a great loss to those people and a great loss to us in the public sector—to hospitals, GP surgeries and, indeed, all the places where nurses work in the NHS. It is a great loss, and I will cover some aspects of that issue in my speech.
The only thing that has changed is that loans have been brought in. It is ludicrous to look at the numbers and deny that forcing nursing students on to loans has led directly to a drop in applications. That is exactly what has happened. The result is that the diversity and background of nursing students has changed radically, excluding many who would previously have been able to change their personal and economic circumstances through a rewarding career in nursing. That is the very thing that my hon. Friend was saying.
I expect the Minister to say, “There are still two applicants for every place available for a student to study nursing at university.” It is the current structures that are limiting the system from being able to capitalise on that appetite to study nursing.
I congratulate my hon. Friend on securing a really important debate. It is essential that the Minister addresses the issues raised. Is not the drop-out rate for student nurses a real cause for concern? A student nurse contacted me—I did go to the lobby organised by the Royal College of Nursing this morning—and gave some examples of the mounting costs under the present system. That mental health nurse was telling me about the costs of trains, taxis and accommodation. She works 37.5 hours a week on a placement. Transport to her placement is costing her £500 a month. Surely that has an impact on a person’s ability to sustain their attendance on a course and achieve the necessary outputs.
I could not have put that as clearly as my hon. Friend has. I am glad that student nurses came and explained the situation to him, because that is the very reason why we are having this debate.
With the last bit of control that they have kept since the reform, the Government fund clinical placements, but they do not match the numbers to the volume of routes that they have created. They made nursing students, apprentices and nursing associates all compete for the same places. They did choose to fund, but it was not enough. Now it is a blame game full of finger-pointing. If there are so many people interested in becoming nurses and such high levels of vacant posts, why are the Government not doing more to convert the applicants into nurses?
I expect the Minister will say, “We have introduced new routes to expand the number of nursing staff.” There are nursing degree apprenticeships that few people are taking up, because employers do not have enough cash to release people to study. Nursing associates, who were introduced in a supporting role to the registered nurse, should never be a substitute for registered nurses. These efforts have been small and unpredictable. Most importantly, they have not addressed the heart of what grows the number of nurses safely and at scale: higher education. This is workforce panicking, not workforce planning.
I expect the Minister will say, “This Government have grown the number of nurses working in hospitals,” which is factually true, but distorts the truth that the overall number of nurses has only grown by less than 1% since 2010. While there are 7% more nurses in acute settings, there are 6,500 fewer nurses in the community, 43% fewer district nurses, a quarter fewer school nurses, nearly 5,000 fewer mental health nurses and 40% fewer learning disability nurses. Despite the Government’s rhetoric about moving more care into our communities, the workforce are simply not there to deliver it. Who has overseen that? Ian Cumming of Health Education England, Simon Stevens of NHS England and the Government.
Nursing students spend 50% of their time in placement, learning in the community, a care home or a hospital, but the services are so short of staff that students are being unsafely used to plug the gaps. Due to their placements and studies, they do not have time for part-time jobs to earn extra money. Like other hon. Members, I am contacted by constituents who tell me that they always wanted to be a nurse, but money worries and the pressure they feel are making them reconsider their choice. The personal cost of becoming a nurse is turning people away when health and care services need more growth. This is disgraceful, irresponsible and short-sighted.
However, our leaders have a real chance to secure major change. Nursing students need a new deal. All that is needed is political will, and for people to stand up and be accountable. I demand the bursary is brought back. Our future nurses urgently need more financial support if the Government are ever to tackle the workforce crisis. There needs to be an extension of the hardship funds for those who need more assistance.
At what point do we say enough is enough? How can we fail to act when faced with student nurses trying to balance their placement, part-time healthcare assistant work and trying to finish their coursework? How can anyone begin in a profession when they are already burnt out? It is disrespectful for any of us to stand here and tell stories about how much nurses make a difference to us, without acknowledging their professional expertise and their critical role in transforming services. We have to stop making their jobs harder and pushing people to the brink. No nursing student or nurse should have to grind their teeth and keep going, knowing that shortages mean that vital care is left undone. This situation is unsafe for everyone. It is morally reprehensible.
The Prime Minister gave an extra £20 billion to the NHS. Simon Stevens holds the pen. The Secretary of State will sign off the long-term plan. There is a small window of opportunity to change the future of nursing. We can either propel it forward or drag it back. I am determined to leave my daughter a legacy. I take public service seriously; that is why I went into nursing and why I am an MP.
I look forward to hearing from the Minister how the long-term plan will deliver the workforce strategy, how it will fulfil the Secretary of State’s commitment to creating more nurses, and how Simon Stevens and Ian Cumming will be held to account over fixing the nursing supply and investing in it. This is our moment to rebuild public trust and confidence, so I end by asking the Minister: what are you going to do?
There are about seven Members seeking to catch my eye. We need to get to the Front-Bench speeches by 3.30 pm. Therefore, I will impose a five-minute limit on all speeches straightaway. I should also point out that any interventions might reduce that further, so that is in colleagues’ hands.
It is a pleasure to serve under your chairmanship, Mr Davies. It is also a pleasure to follow the hon. Member for Wolverhampton South West (Eleanor Smith), especially because she was a nurse. Incidentally, on her point that nurses are more popular than politicians, when the Houses of Parliament burnt down in the 1830s, the cheers could be heard from Westminster Bridge, where people took out their frustration with politicians.
It is wrong to approach this debate in an aggressive “them and us” spirit. We all aim to increase the funding for nurses to an appropriate and proper level. I agree that nurses do a fantastic job, but we should acknowledge those nurses who are involved in end-of-life care—in my hospital, they work closely with social care staff.
However, before addressing that, I should say that, only last week, I visited my hospital in Henley—Townlands Memorial Hospital—with the previous Minister for Health. I extend an invitation to the current Minister to visit the hospital, which has a unique way of doing business. We and the NHS see it as an exemplar in the country. We spoke to a number of nurses about the services they provide, particularly in relation to the rapid access care unit, which looks after people above a certain age very well—they typically seek treatment there. I pay tribute to those nurses.
In our conversation with the nurses, we raised the point about funding for their education. We had a very mature discussion about the lack of bursaries following Government action. As a result, there was a general agreement that the situation that existed with the bursaries was not particularly helpful to nurses seeking to become part of the nursing profession—the NHS effectively generated a cap on the number of people who applied—and that we need a system that encourages people to become nurses as well as go into other professions. We pointed out that, under the bursary system, 30,000 people who applied to become nurses were rejected, which is not a good situation.
We went on to discuss other things in relation to the nursing profession. In particular, the one thing they saw as inhibiting people from becoming a nurse was the price of housing, which is astronomical in the Henley constituency. We need a tremendous amount of affordable housing, to help people to get a start on the housing ladder, and to provide them with rented accommodation where possible.
In addition to visiting the hospital, I have worked with parish councils to encourage them to provide much smaller buses on much tighter routes to give people the ability to travel from their home to their job.
I have been told that the shortage of staff was due to EU nationals leaving, but when I raised that issue with the matron, it emerged that that was not the case at all—the shortage was due to operational reasons.
My mother is a retired nurse from the Windrush generation and my sister is in the nursing profession having studied midwifery and having been a health visitor. I value their contribution, and many other contributions, to health and social care in this country. I have some insight and understanding of the challenges that underfunding brings.
Health and social care in England is short of registered nurses. The NHS in England is missing nearly 42,000 nurses —it is estimated that, without significant funding and policy intervention by 2023, the figure will rise to almost 48,000. That is a conservative estimate drawn directly from the system-held data and should be seen as a public interest issue.
This serious underfunding for Royal College student nurses is a crisis in England and action must be taken to address it. England is now the only country in the UK without some form of bursary for the nursing degree. The First Minister of Scotland recently announced that the bursary for nursing and midwifery students in Scotland would rise to £10,000 by the academic year 2020-21. We in England are failing in that respect.
On 31 October, the Secretary of State for Health and Social Care publicly committed to investing in nursing education, stating that nursing students must
“get the support they need to complete their training so they can serve in our NHS. That is something we will specifically address in the long-term plan for the NHS”.
Does my hon. Friend agree that the important point is that the nursing course demands full-time study? Someone cannot do a part-time job while they are taking a nursing course. Unfortunately, because of the lack of maintenance grant, in most other areas of higher education students have to do part-time jobs in order to keep themselves alive, but it is not an option for nurses.
I absolutely agree with my hon. Friend and I will address that crucial issue.
What I need to know, and what student nurses, potential student nurses and England need to know, is this: when will we see the long-term plan to promote the sustainability of the NHS and when will the Government take it seriously? I ask because the number of applicants from England aged 18 decreased by 12% between 2016 and 2018, while the number of applications from those aged 25 and above from England fell by 40% in the same period. Furthermore, a decline in the number of mature students affects specialist areas of nursing such as learning disability and mental health.
In all areas of nursing, not having enough nurses means that the safety of care is a concern—it could become fundamentally unsafe. Frontline staff are compromised, and people seeking to access health and care services are not able to receive the quality of care that they need.
Nursing students spend 50% of their time in clinical practice and—as mentioned by my hon. Friend the Member for Ipswich (Sandy Martin)—nursing courses run longer than many other degrees, which means that nursing students have no opportunity to take on part-time work to supplement their income. They deserve support that recognises the exceptional nature of nursing and we need to invest in their future. If we do that, we would also be investing in our NHS and, indeed, in England.
It is clear that student nurses work long hours, which demands much from them. This can be physically, mentally and in many cases emotionally draining. It is particularly difficult when a student nurse witnesses, for example, a newborn baby dying on a paediatric ward, or when they are caring for terminally ill patients or those with complex mental health needs. If the Government consider that training and the NHS worthy of recognition, when will they properly invest in student nursing careers?
I have been lobbied considerably. My local hospital is overstretched for health and care professionals, including for doctors and nurses. It seeks to recruit from overseas but, in the context of Brexit, the growth of the domestic workforce will be ever more important. The Government and NHS England must invest at least £1 billion a year in nursing, through higher education, as part of their long-term plan for the NHS in England.
Finally, I endorse and praise the work of the “Fund Our Future” campaign and I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this debate.
It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing a debate on this very important subject and the Minister for Health on his new role.
I do not think there is anybody in Westminster Hall today who would doubt the value of nursing or the importance of good nursing and nurse training. I have worked for my entire career as a paediatrician; I am now a consultant paediatrician. Nurses and midwives have had a significant impact on both my career and my personal experiences. When I worked on a neonatal intensive care unit, many nurses influenced my career. However, there was one in particular—a lady called Mary Palfreman, a nurse in Nottingham—who had a profound effect on me, because she is such a fantastic nurse. On a personal level, I was cared for through several of my pregnancies by a midwife called Marie Robinson, who was able to balance treating me as a medic, who had more knowledge of neonates and babies than the average first-time mum, with treating me as a mum. She recognised that I was a bit of both and perhaps needed a slightly different approach from others—even a unique approach. She treated everybody as she found them, and she is a fabulous woman.
None of us, therefore, would doubt the value of a good nurse and the importance of making sure that there are adequate numbers of nurses. Nursing is a great and varied career, which is something we should be selling more. Nurses have the opportunity to nurse in many different fields. As their career progresses, they can go into administrative roles, managerial roles and specialist technical roles in the community or in a hospital, and develop a good and, at the high level, extremely well paid career.
So what should a good training scheme do? Obviously, it should provide high-quality experience, so that students develop the necessary expertise; it should provide the opportunity for continuing personal development; and it should ensure that there is an adequate supply of nurses. We have a change in demographics: the population is getting older, there are more people with complex health needs, and the population is increasing in size. So we need to ensure that the number of new nurses keeps up with both those developments and the natural attrition of nurses as people retire and so on. We also need to ensure—this is very important to me as a Conservative— that anyone who has the desire and the aptitude to train as a nurse can do so and is not limited by how much money they have or where they are from.
Looking at some of the figures, it is evident there has been a drop in the number of people applying to become nurses, but at this stage there are still many more applications for nursing than there are nursing training places. I was not a parliamentarian when the new policy was introduced, but I understand that the aim behind it was to ensure that more places were available so that more people with the desire and the aptitude could train. The figures I have been given show there are 13,000 more nurses on the wards now than there were in 2010.
In January I was a member of the Select Committee on Health when it produced the nursing workforce report that the hon. Member for Stockton South (Dr Williams) mentioned earlier. It showed specific shortages in mental health, learning disability and district nursing. I understand that the previous Minister undertook to give up to £10,000 to people training in that field to try to address the shortages. Will the Minister tell us how that is working and whether it is increasing applications? Also, the Government had recognised specific challenges for people wishing to go back into nursing or to develop nursing as a career after having children. Is the Minister looking into what support can be offered to those with disabilities and those with children to make sure that they are still able to access nurse training and become the fabulous nurses that they can be?
The issue of part-time jobs has been raised. Most of the nursing students I have worked with in my career have had part-time jobs, usually as a healthcare assistant, often on the same ward that they have worked on as a nurse, so I am not sure the point that was made entirely reflects what I have seen.
Finally, I want to mention alternative routes into nursing. There is more than one route to achieving a goal. There are opportunities for people to work as nursing associates. Some of the healthcare assistants I have worked with have done that, and they really enjoy their training. There is also the opportunity to go into a nurse apprenticeship as an alternative way of training while working. That is not for everybody, because people want different things, but it is another way in which we can increase nurse numbers without having an impact on training. I am aware of the time, but will the Minister update us on—
Order. The hon. Lady’s time is up.
I congratulate my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) on securing this debate, and the RCN student nursing campaign, “Fund Our Future”, on putting the issue firmly on the agenda. I cannot speak with her authority from experience, but I am chair of the all-party group on students and also represent a significant number of student nurses, midwives and allied health professionals in training at Sheffield Hallam University.
It is disappointing that we have to be here debating this issue again, because we have been over the argument several times. I remember the debate that we had in this Chamber in January 2016 when the Government first proposed to end the previous funding system and introduce loans and fees. I remember a powerful speech from the hon. Member for Lewes (Maria Caulfield). She talked about how hard it was to be a student nurse; how she bore the scars of her nurse training; and how nurses had to learn, take exams and also go through placement changes every eight to 12 weeks, which presented significant challenges for mature students. She also clarified that when we talk about mature students, in many cases we are talking about people not in their 40s and 50s but in their 20s and 30s—people with young families and single mums.
One of the students from Sheffield Hallam University who contacted me ahead of today’s debate was Clary Manners, who echoed many of those from her current experience. She said she gave up a well-paid job to train as a mental health nurse. She currently does 37 hours a week on placement and has a three-hour round drive there and back each day for the placement. She pays £10 in parking charges when she gets to the hospital. She takes no holidays. She has little spare time because she takes bank nursing jobs to boost her family income, but still her four children are on free school meals because of the struggle to get by on her income.
In the debate in 2016, the hon. Member for Lewes said—this view was echoed throughout the Chamber—that encouraging people to take on debt would
“definitely put them off entering nursing, and to say otherwise is madness.”—[Official Report, 11 January 2016; Vol. 604, c. 217WH.]
The then Health Minister, Ben Gummer, assured us that what the Government were trying to do—you could not make this up—was to share the benefits of the funding system for other students with nursing, midwifery and allied health students. Some of us questioned in what way a £50,000 debt was a benefit, but he was insistent that we would see an increase in applications. Now we know he was wrong. UCAS figures published earlier this year show that applications for the current year were down by a third on the same point in 2016—it is a continuing trend—and by 13% in the past year alone.
The changes have been a particular barrier to those from lower-income families, which is hugely important because nursing and midwifery has been one of the channels of social mobility available for many who do not enter conventional university. We have heard how the profession has traditionally been dominated by mature students, who have been particularly hard-hit in the fall-off in numbers. Overall, compared with when the changes to nursing degree funding were made in 2016, we have almost 1,800 fewer nurses due to start at university. I remind Government Members that although they talk about the 13,000 extra nurses now on the wards, many of them started their training before 2010 under a Labour Government. There is a pipeline for nursing supply, and the current system benefits from the pipeline that we put in place.
There are almost 42,000 nursing vacancies in England. Without action now, that could rise to 48,000 in the next five years. The Government have a responsibility to fix that, and they can do it by introducing a student funding system that is fit for purpose and that can reverse the drop in applications and encourage people to take up nursing in the way that they did previously.
It is a great pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Wolverhampton South West (Eleanor Smith) for securing the debate. I declare an interest: I am the child of two doctors, the sister of a doctor and the wife of a doctor. Through my entire life I have been humbled by how hard all the doctors, nurses and midwives in our NHS work and by their dedication to their patients and the fundamentally huge professionalism that they show every day.
A couple of weeks ago I visited the palliative care team at the J’s Hospice, which helps people towards the end of their life in Chelmsford and across large parts of Essex. I give my huge thanks to the nurses there for the work that they do. As I left, I asked them whether there was one thing that would change their lives that they would really like politicians to do, and they said, “Please can you get us a car park permit so that, when we go out to meet the patients we try to care for in their homes, we do not get a parking ticket if we end up having to park in a residential parking bay?” I do not know whether the Minister can change that, but that is a real ask from them. They do amazing work. One more thing they said was that if there was a little bit of capital funding, they would love some help with some digital technology so that they do not need to go back to base to fill out their patient records.
I am also proud to have a brand-new medical school in my constituency. Anglia Ruskin University has a medical school that opened this autumn. I spoke to the acting vice-chancellor earlier in the week and he told me that things are going really well. It has its 100 students, it is brilliantly vibrant, and it is doing great work. I also asked him how the nursing courses are doing. On the good side, ARU has pioneered alternative routes into nursing. Nurse apprenticeships and nurse associateships are going really well and are very encouraging. They give people who would not necessarily have gone on to a traditional nursing course an alternative route into the career, and it is really appreciated. However, it was pointed out to me that since the bursaries went, there has been a drop in the number of applicants from eight per place to five. So there are still many more people applying for courses than places on the courses, which is good news, as is the fact that the quality of applicants is not dropping.
There is concern, however, at the fact that in some areas there are not enough high-quality applicants because of the changes. Mature students in particular are more debt-averse—that is probably the best phrase—and concerned about taking on a student loan. Those older students tend to be women. Today is a special day for women; the 50:50 Parliament campaign reminds us that women have been able to do the job we do here for 100 years. We need to make sure that women across the country can do the jobs they want to do. The change in nursing bursaries has had an effect on more mature students, especially with regard to entering adult nursing and mental health nursing. That is particularly true in my constituency, although it is less of an issue at other nursing colleges further from London.
The acting vice-chancellor of ARU says that the golden hello that a previous Minister introduced for mental health and learning disability nurses is welcome, but asks whether we could please consider it for adult nursing as well. The previous Minister, now the Secretary of State for Exiting the European Union, was prepared to give help in the form of an additional £10,000 golden hello to help people in particular targeted areas not to have to take on debt, so can we consider that for adult nursing?
The second ask from Anglia Ruskin is a higher-profile campaign. There was some publicity, and a national campaign encouraging people to consider nursing, but it did not have much visibility. Nurses are wonderful people, and they make a huge difference to all of us. As well as encouraging the idea of supporting them through financial golden hellos when they are needed, we need more publicity about the routes into nursing, and the benefits.
Order. I am afraid that I shall have to reduce the time available for the last two Back-Bench speakers to four minutes. I apologise.
Last month my mum celebrated her 95th birthday. Like many Irish nurses of her age, 75 years ago she travelled to London from Ireland to start her career in the very first generation of NHS nurses by qualifying as a state enrolled nurse at Warlingham Park psychiatric hospital. Growing up, I saw at first hand just how vital a dedicated, passionate and happy nurse was for the welfare of the patients. That is why I am incensed when I see the treatment of trainee nurses today. Let us be clear. Nursing students are exceptional. Their courses are complex, their training is tough, and they spend significant amounts of time on clinical placement, working all hours of the day and night. They deserve a tuition and living cost funding model that recognises their extraordinary efforts and the importance of those efforts.
England is now the only country in the UK without some form of bursary for the nursing degree. That has crumbled the number of nursing applications and fostered an environment that is utterly unfair to nursing students and completely unsafe for patients. The Government promised that reforms would provide up to 10,000 additional nursing and health professional training places but, since the loss of the bursary, nursing applications in England are down by a third and falling fast. In fact, the 2018 figure was the lowest since nursing courses were first included in the UCAS system.
Nursing must be made an attractive profession for all groups, and restoring the bursary is a fundamental step to achieving that. Now is not the time to experiment with funding models for nursing students. One in three nurses is due to retire within the decade. Ensuring the long-term recruitment of new nurses must be a Government priority. That, of course, is before we take account of the Brexit impact: 75% of NHS trusts have done nothing to prepare for the UK’s departure from the EU. Meanwhile, there is an alarming trend for nurses and midwives to leave the profession before retirement, citing intolerable working conditions. However, it is not a numerical conundrum. It is a national crisis. A fall in student numbers is simply exacerbating our current recruitment shortage and it is patients who are being put at risk.
Ms H, a student nurse in London, contacted me this morning:
“I’ve felt completely unsafe on many occasions because of short staffing, not just because of my personal protection but more so because of the safety of the patients that I care for”.
Her colleague, Ms Y, found a young patient on an adolescent ward with a ligature tied around her neck. Short staffing meant that there was no one to debrief, and in fact no one even realised that it was a student who found the young patient. Ms H said:
“Most weeks of my final year as a student nurse I have cut out sleeping an average of 2 nights per week. Staying awake for 36 hours is the only way I can afford to train, study, and work to sustain a living.”
And yet her main grievance is not about the present, but the future:
“It just doesn’t feel like there is really light at the end of the tunnel. Instead, we will just enter a longer tunnel of a career completely unsupported by Government.”
The warning signs are loud and clear. The conditions described today are unfit for those who selflessly care for our most vulnerable. The devastating consequences of leaving the system broken would be felt for decades to come.
I was a mature student aged 41 when I started my nurse training, and I was a single parent. I could not have completed my training without a bursary, and could not have done a part-time job because it was a full-time course and I had a child to care for. My younger single friends also needed their bursaries, because everyone had bills to pay. I was a nurse for 14 years and my colleagues are still nurses. None of us could have trained without the bursaries, and none of my friends would have gone on to be nurses as they are to this very day.
There are currently 41,000 nursing vacancies in NHS England. For the second year in a row, more nurses are leaving the profession than joining it, and one in three is expected to retire in the next 10 years. The NHS has spent £527 million plugging staffing gaps with expensive agency staff. I do not know how that makes any kind of economic sense. Added to that, the reality is that patient safety is compromised. Agency staff are not experts in their field. I have been in an arrest situation in which, out of seven trained, only three were regular nurses. It compromises patient safety. In addition, the number of European nurses registered in Britain dropped by 87% compared with 2016-17 figures. That means that there will be even fewer nurses.
The Government must stop putting lives at risk by understaffing and underfunding the NHS. People just are not signing up to be apprentice nurses. It sounds all right in theory, but does not work in practice. There is not the take-up. If we genuinely aim to train sufficient nurses the Government must join the Labour party in committing to reinstate nursing bursaries. Until that happens, no matter how many nursing jobs the Government fund, as nurses of my generation retire and numbers of the newly trained gradually decrease, we will simply not have the trained nurses to fill the places.
It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Wolverhampton South West (Eleanor Smith) for securing this important debate, to which I have listened with great interest. I will not summarise what everyone said, but cut to my speech, as there are a few other important things I want to say. We have heard questions to the Minister from both sides about the state of nursing and applications to study nursing in England. It seems passing strange to me that the Government have chosen to abolish bursaries at a time when nurses from the EU are leaving NHS England, causing even further shortages. I was particularly struck by the hair-raising stories that the hon. Member for Mitcham and Morden (Siobhain McDonagh) gave us about patient safety and nurse safety—I hope the Minister addresses that.
As has been mentioned, the situation in Scotland is quite different. In case the Minister is not aware, I shall give him some ideas about how we do things in Scotland to see whether that will help. I do so in a spirit of help, to see whether we can improve things in NHS England. In Scotland, the First Minister has just announced an increase in nursing and midwifery bursaries—the bursary will go up to £10,000 in 2021. That is part of a drive to continue the increase in numbers of student nurses we have had over the past few years. The Scottish Government also have discretionary funds for those nursing and midwifery students who are most in need, and are upping the number of places for students of nursing and midwifery in the academic year 2019-20. We recognise the importance of those nurses.
On a personal note, after what I have been through over the past year, I would not be able to stand here were it not for the support of nurses throughout the entire stage of my late husband’s treatment and the end-of-life care that he received, and I appreciate the opportunity to put on record my thanks to St Andrew’s hospice in Airdrie, of which I am a patron.
The Scottish Government’s discretionary fund will give more money to mature nursing students—that cause has been mentioned—if we use the word “mature” to apply only to those who have children. Those people need extra support and are given it. As most previous speakers have said, it is important that we attract mature students into nursing, as well as those who come straight from school. From personal experience, I think that mature students bring an extra level of care and understanding that we do not always get right away from young entrants into the profession.
Student nursing and midwifery places in Scotland will increase for the seventh consecutive year, reaching record levels with the intake rising by 7.6% to more than 4,000. Upping intake for the 2019-20 academic year is one of a number of measures to support the sustained recruitment and retention of NHS staff, but it is also important to retain our existing staff. We have heard stories about the pressures that nurses are currently under, and they must be alleviated. In addition to increased student places, almost 460 former nurses and midwives have signed up to retrain through the Return to Practice programme since 2015. The Scottish Government are funding the Open University to deliver a pre-registration programme, which currently supports around 116 nursing students. In October 2016, 10,239 students were in education—an increase from 9,936 the year before—and we will get the 2017 data next month.
I often find myself standing in this place, especially in Westminster Hall, and asking Ministers whether they have looked at the situation in Scotland, because sometimes we are more progressive. Sometimes it is easier, because Scotland has a smaller national health service, but we also value the NHS in Scotland. Earlier this decade, the First Minister announced that, in all hospitals in Scotland apart from those built under private finance initiative contracts, parking charges would be withdrawn. That has been carried out. That simple measure can help nurses, and I urge the Minister most sincerely to consider it, as well as some of the other practices that we have taken on board to increase nursing numbers in Scotland.
It is a pleasure to serve under your chairmanship, Mr Davies, and I congratulate my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) on securing this important debate. The level of interest from Members shows how important this subject is. My hon. Friend spoke from great personal experience, and I thank her and everyone else who has worked in the NHS for their contribution over many years to make it an institution of which we are all rightly proud.
My hon. Friend comprehensively dismantled the Government’s arguments on the merits of removing the bursary. As she said, it is indisputable that the number of applications and the numbers of people starting courses have fallen, and that the age profile of students has changed. She was right to say that the decision to abolish the bursary was a political choice, and not one that the Labour party would have made. Along with other Members, she highlighted areas that have fewer nurses in community and district hospitals and in settings that treat those with learning disabilities or mental health problems. Given that the pipeline for delivering nurses is not working as it should, those shortages may worsen. My hon. Friend was right to say that higher education is the best way to train enough highly skilled nurses to meet the needs of patients.
I wonder how many Members are aware that the Education Committee will shortly publish the results of its inquiry into nursing apprenticeships.
I thank the hon. Lady for her public service announcement. Let me now refer to some other contributions.
The hon. Member for Henley (John Howell) made a fair point about how the price of housing exacerbates the shortage of nurses in some areas, and all Members will be aware that earlier this year more than 1,900 nursing vacancies were advertised in the Thames Valley area, although only five were filled.
My hon. Friend the Member for Lewisham East (Janet Daby) gave a thoughtful and persuasive speech that highlighted the fact that the number of applicants over 25 has fallen by 40%, and she mentioned the impact of that in specialist areas. She was right to say that the nature of the nursing degree limits the opportunities for students to earn income outside their course demands.
The hon. Member for Sleaford and North Hykeham (Dr Johnson) made a considered contribution about her criteria for what would make a successful training course, and I will reflect on that good piece of advice.
As always, it was a pleasure to hear from my hon. Friend the Member for Sheffield Central (Paul Blomfield), who has great experience in this area. He referred back to a debate in 2016, and was right to say that this policy has damaged mature students and social mobility. Many concerns that were raised back in 2016—including by Government Members—have been ignored, or indeed come to pass.
The hon. Member for Chelmsford (Vicky Ford) gave us the benefit of the thoughts of nurses in her constituency. It is always a good idea to hear directly from those on the frontline, and she came up with some interesting practical suggestions about what could be done to make the lives of nurses easier. Along with other Members, she mentioned the impact of this policy on the number of mature students applying, and the impact that that has on particular specialisms.
My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) set out why, due to a combination of factors, now is not the time to experiment with a flawed and unproven model. She mentioned the challenge of retention, and related some graphic and moving stories from her constituents. She was right to say that if we do not fix this issue now, we will pay the consequences for decades to come.
Finally, my hon. Friend the Member for Lincoln (Karen Lee) spoke of her own frontline experience, and mentioned the expense and risk of over-reliance on agency staff. No doubt the challenges that we face and have discussed today will be exacerbated, which will place even more reliance on temporary and agency staff.
We have had a broad and wide-ranging debate. This is the Minister’s first outing in his role, and I welcome him to his place and congratulate him on his appointment. I was trying to work out whether he is the fourth or fifth Minister I have shadowed since I was appointed to my role just over three years ago, which shows that it is not just the NHS that has problems with retention.
The NHS faces a significant workforce challenge, and nowhere is that more pronounced than in nursing. England is missing about 42,000 nurses and, according to conservative estimates, without significant intervention that figure may rise to more than 48,000 by 2023. The situation is serious—other Members have described it as a “crisis”, which is absolutely right, but this crisis could have been avoided.
As Members have said, we are facing a perfect storm, with recent trends showing that more nurses are leaving the profession than joining it, the ongoing uncertainty over Brexit, the fact that one in three nurses is due to retire within the decade, and the catastrophic decision to scrap bursaries for nurses, midwives and allied health professionals. According to the Royal College of Nursing,
“without enough nurses, care is fundamentally unsafe, frontline staff are compromised and people seeking access to health and care services are not able to receive the care that they need.”
The RCN also reports that services are sometimes so short-staffed that nursing students are inappropriately used to plug gaps in the workforce and have to look after patients before they are qualified to do so. That is an extremely worrying development.
This is a crisis of the Government’s own making. Before I come on to the current policy context of higher education funding, I will say a little about the circumstances leading to the decision to undertake the reforms back in 2015. As my hon. Friend the Member for Wolverhampton South West said, workforce planning has not traditionally been a great strength of the NHS.
One of the first decisions of the coalition Government back in 2010 was to cut the number of nurse training places at university. In 2010-11, 20,092 places were funded, but that fell sharply to 17,741 in 2011-12 and dropped again to 17,546 in 2012-13. At that stage, David Green, vice-chancellor of the University of Worcester and a former chair of the west midlands group of universities said:
“We are heading straight for a national disaster in two to three years’ time.”
The RCN also warned that the cuts would cause
“serious issues in undersupply for years to come.”
Those warning were not heeded by the Secretary of State at the time, and a completely predictable and preventable crisis in the nursing workforce was created. Had the coalition Government only maintained the levels set by the last Labour Government, 8,000 additional nurses would have been trained in the last Parliament alone.
In the midst of this completely manufactured crisis, the abolition of undergraduate nurse bursaries was announced. I ask the Minister to consider whether that response to the crisis was the correct move. In just two lines in the 2015 autumn statement, with no consultation and no evidence base, the Government committed themselves to a huge gamble with the future of the NHS workforce and with patient safety. The then Minister described the proposal as
“potentially one of the most exciting things that we will do in the NHS in the next five years to increase opportunity and quality, and the presence of nursing staff on wards.”—[Official Report, 4 May 2016; Vol. 609, c. 196.]
We were told at the time that our many concerns were misguided, and that the changes would lead to an additional 10,000 training places being provided. However, as we have heard, the opposite has happened. As of September 2018, almost 1,800 fewer people are due to start nursing university courses in England. The number of mature students has plummeted by some 15%, which as we have heard has had a particular impact on specialist areas. There has been a 12.9% reduction in the number of mental health nurses since 2010.
As my hon. Friend the Member for Stroud (Dr Drew) said, there has been a shocking 40% reduction in learning disability nurses. Learning disability nursing celebrates its 100th anniversary in 2019. It will be an astonishing failure of the Government’s if they allow it to disappear altogether. That reduction comes at a time when the needs of people with learning disabilities has never been more paramount, with premature mortality resulting from complex health conditions and people being detained in assessment and treatment units for far longer than necessary.
We warned at the time that this policy would have precisely the effect that is has. After meeting with representatives from the profession and looking at the evidence, the Government carried on. On the other hand, they did not formally consult the Royal Colleges before announcing their plans. I know that there has been some dialogue since then, and I will be grateful if the Minister will set out his recent discussions with the sector about the impact of the bursary cut and what steps the Government are taking to deal specifically with the crisis in learning disability and mental health nursing, which have been particularly hard-hit by the changes.
As various Members have said, the new Secretary of State recognised the crisis by saying
“simply put: we need more”
nurses, and that:
“That is something we will specifically address in the long-term plan for the NHS”.
That plan is due to be published any time now, and we will examine it very closely. However, if the Secretary of State is serious about tackling the workforce crisis and increasing the nursing workforce, he needs to make a key element of the strategy the reintroduction of NHS bursaries. It remains our policy to do so, and there has not been a single jot of evidence since they were removed to dissuade us from our initial view that their abolition was short-sighted, damaging and, ultimately, self-defeating. In a written answer on 19 April this year, the former Minister indicated that the Department would publish an update on the effect of the plans later this year. Will the Minister advise us of where that is up to?
Although I have referred to a lot of large numbers to highlight the overall impact of the policy, it is important to hear, as we have from some Members, about the impact on individuals. I do not know if the Minister had the opportunity to attend the RCN drop-in earlier today. If he did not, I convey to him how well the students I spoke to conveyed how difficult it is to work what they and I consider to be unsafe hours to make ends meet; how the inclusion of the student loan in income for benefits calculations leaves families worse off; and how the students notice that, each time they return to the lecture theatre, there are fewer and fewer of them. What assessment has the Department made of the attrition rate of university courses since the abolition of the bursary?
In conclusion, the uncertainty created by Brexit means that the reliance on recruitment from the EU that we have seen in recent years is no longer an option to shore up nursing numbers. Our NHS staff cannot keep giving more at the same time as we give them less. The Government need to fund our future and invest in nursing higher education. They simply cannot afford not to.
It is a great pleasure to serve under your chairmanship, Mr Davies, as I make my first speech in what I regard as one of the most important ministerial roles in the Government. I thank the hon. Member for Wolverhampton South West (Eleanor Smith) for securing the debate. It has been a passionate debate that has reflected the importance that so many people—clearly everybody in this Chamber—place on NHS professionals. It has recognised that high-quality education and training for nurses is fundamental to ensuring that the highest level of nursing care is given to patients. I obviously recognise that the hon. Lady, having served in the NHS for more than 40 years, has first-hand knowledge of the difference that nurses can make to individuals and families.
The hon. Lady raised several points in her speech, many of which I will address. However, she quite rightly opened by saying that we need and must have staffing that is safe for effective care. No one in the House would move from that. She asked several questions, including on bursaries, mature students and the number of people in training, which I will come to, but also made several points about the long-term plan, which it is important to talk about that at the beginning.
The long-term plan will contain a chapter on NHS professionals and workforce planning, which I recognise will be the most important chapter. The hon. Lady will know that Health Education England undertook a consultation on the strategy for the workforce, which was published in draft last year. HEE also undertook a full consultation on the priorities for the health and care workforce, which concluded in the summer. The “Talk Health and Care” platform has been introduced, which the Government particularly expect to inform the work that NHS England is leading on the long-term plan.
It is also particularly important—it is potentially by accident—that the debate takes place on the day that the RCN produced a document, to which the Secretary of State and I have committed to respond. The shadow Minister is right: I deliberately took the time before the debate to meet a number of the students. I heard at first hand a number of their concerns, and I said to them—the hon. Gentleman will perhaps understand this, given his remarks about retention at the start of his speech—how important I think retention is, not only of nurses but of Ministers as well.
I am delighted that the Minister met the RCN and nursing students this morning. Will he confirm that hearing the voices of students themselves is absolutely vital in making decisions on the future?
Of course it is important. As my hon. Friend will know, as Members, and particularly as Ministers, we get all sorts of briefings, which are very helpful and contain lots of numbers, but not real-life experience.
My hon. Friend the Member for Henley (John Howell) talked about the experience of nurses at his hospital. He made the point quite powerfully that there are several common issues that we need to address, but several other issues that are not necessarily common to every experience. It is right that we consider the issues they raise.
One of my constituents who is a student nurse has been to see me. She is struggling with her student nursing loans. She has two children, and she was literally in tears while telling me her stories about how difficult it is for her—the Student Loans Company is demanding the money back. She is working and has children, and cannot afford to pay back those loans. Does the Minister think that situation is tenable?
I will talk about that issue in more depth later, but if the hon. Lady wishes to write to me, I will look at her constituent’s case. I will point out that the learning support fund already offers a number of opportunities, including child dependants allowance, travel costs and an exceptional hardship allowance. I hope her constituent knows about and is taking advantage of those opportunities.
The hon. Member for Ellesmere Port and Neston asked whether the Government will publish an update on the impact of the reforms. That is currently being worked on with education and health organisations and stakeholders. We will look at the most appropriate way of making sure that, following receipt of the proposals by the RCN, and in the context of the long-term plan and the chapter on workforce planning, the higher education funding review takes place and feeds into that update. We will set that position out in due course—I dare say that the hon. Gentleman and I will debate it in due course as well.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) described what an excellent training scheme should look like, which was very helpful and powerful. My hon. Friend’s experience as a clinician is invaluable, and hopefully my speech will address a number of the points that she raised. I listened carefully to the asks of my hon. Friend the Member for Chelmsford (Vicky Ford). Some are in my power and some are not, but she made a point about mature students, and the Government recognise that the number of mature student applications has dropped across the wider higher education sector as well as in nursing. We are working with organisations in the sector to see how we can attract more mature students and whether specific funding can be targeted more effectively towards those students via the learning support fund.
It does not really need saying that, at the national level, the Government understand how important nurses are. We are committed to making sure that the nursing workforce is properly supported and funded. In her contribution, the hon. Member for Wolverhampton South West made the point that funding to the NHS is increasing: by 2023-24, it will receive £20.5 billion a year more than it currently does, and the Government expect the long-term plan to set out a strategy for the NHS to ensure a sustainable supply of nurses, rolling that supply across the whole range of pathways. We expect NHS England to clearly set out its commitment to the nursing workforce in the long-term plan, and ensure that there is a clear way for that plan to be implemented. A number of significant interventions are already in place to boost the supply of nurses, including training more nurses, offering new routes and enhancing reward packages. As an hon. Friend pointed out, there are over 11,900 more nurses on our wards than there were in May 2010.
However, the Government, and I as the new Minister for Health, should never be complacent, so I will set out a few other things that I regard as priorities. Our priority is to get more nurses on to our wards. As has been referred to, the education funding reforms, which moved student nurse funding into the student loans system, were introduced to unlock the cap that constrained the number of pre-registration nursing training places. Those reforms allow more students to gain access to nurse degree training courses. We have announced funding for 5,000 more clinical training places to make sure that those placements can be put in place. We have also increased midwifery training places by more than 3,000 over the next four years, and in 2017, there were 22,575 acceptances—the second-largest number since nursing became a degree-only profession.
It is also important to note that the loans system gives more cash when compared to the bursary system—effectively, up to 25% more. A mature student with two children will receive up to an extra £7,500 a year. I recognise that a number of other things need to be, and should be, put in place and known about more widely. The Government have also targeted support for healthcare students on courses through the learning support fund, which provides additional non-repayable grants. Up to £1,000 is available for eligible students in childcare allowances and hardship funding provisions. None of that, of course, was available under the bursary scheme. More nurses are in training, and the Government are working with Health Education England and the university sector to ensure that students continue to apply for nursing courses up to the end of clearing this year. I am pleased to say that, this year, we have seen a 6% increase in the number of 18-year-olds applying for courses and being accepted.
As an hon. Friend pointed out, there continues to be strong demand, specifically for younger people. I have made the point that we need to address the issues faced by more mature students who wish to enter, or re-enter, the profession. That should be a key priority in the long-term plan. The Government, and I as the new Minister, recognise that we need to do much more to continue to encourage people to apply for nursing courses, particularly more mature students. Therefore, my officials are actively engaging with the Royal College of Nursing, the Council of Deans of Health, and Universities UK—all of those organisations have a role to play. The Government will be consulting on the detailed proposals on future funding for higher education that the RCN has put forward today. I said this earlier, but I want to recommit and make it clear that we regard those as serious proposals, and will be writing to the RCN to engage on those proposals. We will start that work straightaway.
I appreciate that the Minister is new to his post, and that it may be more appropriate for him to write to me in response to this point. I wonder whether he will address the attrition rates question asked by my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders). There is a relationship between the falling number of applications, the funding regime, and the higher attrition rates. Does the Minister have numbers on that, and what consideration are the Government are giving to it?
Inspiration has just reached me. As the hon. Gentleman will know, Health Education England recently published a report on attrition rates on nursing courses—I made the point earlier that the rate of attrition among all people applying for university places has gone down. However, I will write to the hon. Gentleman. The report published by Health Education England describes how attrition rates on those courses have fallen considerably over the past few years, but I will write to him to be absolutely clear. He may then choose to make that letter available.
“The nursing workforce” report, which was published by the Select Committee on Health in January, identified that 30% of students due to complete in 2015-16 or 2016-17 did not complete within that period. Significant variability between different training institutions was also identified. Will the Minister commit to looking at why some institutions have such high attrition rates compared with others?
That is an extremely important point. There is not necessarily a universal reason why particular institutions have worse attrition rates than others, and that may well be key to retaining people who wish to stay in the profession.
In my last minute, I will finish on this point: NHS England, NHS Improvement and Health Education England are all working with trusts on a range of recruitment, retention and return-to-practice programmes. Some of those have met with some success: NHS Improvement’s retention programme works directly with trusts to support improvements in retention. However, I want to make clear that, as the newest member of the Government and of the Department, I regard the retention of our NHS professionals as a priority, and I am looking forward to making a contribution not only to things like the “Talk Health and Care” platform, through which there has already been positive engagement, but on this matter more generally. Retention is key, and we want to make sure nurses understand that we recognise how important they are. The long-term plan will set out a strategy to ensure a more sustainable future supply of nurses. They work incredibly hard, and it is absolutely right that this Government will commit to ensure that funding is dedicated to the supply—
Motion lapsed (Standing Order No. 10(6)).