Select Committee Statement
We begin with the Select Committee statement. Robert Halfon will speak on the publication of the eighth report of the Education Committee, “Nursing degree apprenticeships: in poor health?” for up to 10 minutes, during which no interventions may be taken. At the conclusion of his statement, I will call hon. Members to put questions on the subject of the statement and call Robert Halfon to respond to those in turn. Hon. Members can expect to be called only once. Questions should be brief.
It is a pleasure to serve under your chairmanship, Mr Hollobone.
Apprenticeships are an incredible part of the ladder of educational opportunity. They bridge the gap between education and employment, which too often—at least in England—is a chasm crossed by only the most advantaged and best prepared young people. As that chasm becomes ever more apparent, apprenticeships are becoming less of a niche alternative to A-levels and a traditionally academic degree and more of a mainstream route into work. They use both the classroom and the workplace and provide, I would argue, a more rounded experience, with people better prepared for their chosen careers as a result.
That combination of the practical and theoretical is part of the reason that nursing, an inherently practical profession underpinned by a strong grip of science and theory, should be so perfectly matched to apprenticeships, but that is not yet the case. Nursing apprenticeships are stuck in a maze of bureaucracy, with needless stubbornness and inflexibility getting in the way of making them a success. NHS Employers told us:
“I think the particular frustration for my members is that we see our colleagues in the university sector moving as quickly as they can on the regulatory piece with the NMC; we see support from”
“unions in widening participation and support from within the profession more broadly; but we...see inflexibility in the apprenticeship levy as a matter of policy, which means that it is a very expensive way of training a nurse. It means that we cannot properly fund the time that we need to release on nursing apprenticeships.”
I was saddened to discover that only 30 people commenced a nursing degree apprenticeship last year. While one could argue that the target of 400 was perhaps not the most ambitious, we on the Education Committee are fans of quality over quantity. Since April 2017, the Nursing and Midwifery Council has approved 19 nursing degree apprenticeships, and it currently approves 61 providers to deliver nursing degrees in England. I understand that, according to Health Education England, there have been 700 starts on the registered nursing apprenticeship programme to date.
However, even by the Government’s modest target, 30 could not be considered even a qualified success. We were worried that something was going badly wrong here—that the patient was even more ill than it first seemed. That is why we have done this inquiry and taken evidence from a range of organisations in the health sector, including Ministers.
The previous Government, of which I was proud to be a part, set a target of 3 million apprenticeship starts and introduced the apprenticeship levy to incentivise large employers to play their part in what must be a national priority if we are to build an apprenticeship and skills nation. There is no employer in the country larger than the national health service. While not all apprentices in the NHS need be nurses, anyone with even the most casual acquaintance with our healthcare system will know that nurses are the lifeblood of the NHS, accounting for one quarter of the workforce—around 300,000, according to the Nuffield Trust.
We can immediately draw two conclusions: first, set against the whole nursing workforce, 30 starts is tiny. Secondly, for apprenticeships to succeed, not only in the NHS but in the country, it is vital that we have many more nurses entering the profession as apprentices. The lack of nursing degree apprenticeships shows a lack of foresight and strategic direction. As a Committee, we are keen to defend the status of degree apprenticeships against the suggestion that they should be just another part of the system. I was really disappointed to hear the director of the Institute for Apprenticeships say that he was “agnostic” in respect of degree apprenticeships.
We need to make degree apprenticeships a success, or we will never break the near-monopoly that the three-year undergraduate course has on the aspirations of many 18-year-olds. What became clear in our short inquiry was that a perfect storm of intransigent funding systems was getting in the way of realising the increase in nursing degree apprenticeships that we so badly need.
First, in establishing the apprenticeship levy, the Government quite rightly attached strict rules to what funding could be used for, but those rules do not cater for the unique aspect of trainee nurses, which is that they have been supernumerary. That is to say, they cannot be counted in determining whether a hospital is fully staffed and they cannot work unsupervised. The NMC has now decided that employers can decide whether nursing associates should be supernumerary or learn via protected learning time. Protected learning time provides for a programme of one day a week in university and one day a week in a placement setting, where they are not counted in the staff numbers, as a minimum. The NMC has said this will be reviewed in 2019.
We were told by NHS Employers that the additional cost of backfilling was
“a significant financial burden for NHS organisations wishing to offer the Nursing Degree Apprenticeship, and is proving to be a disincentive for establishing Nursing Degree Apprenticeship programmes.”
Nursing degree apprentices must also undertake off-the-job training for 50% of their hours, which has a knock-on effect for funding. I am sure that none of us here would say that was a bad idea, but none the less the NMC is holding a consultation on the supernumerary status of trainee nurses. The problem is that the numbers do not add up for the NHS to take on nursing apprentices, as opposed to other routes into the profession.
Secondly, the removal of nursing bursaries and their replacement with loans has presented a challenge, particularly for mature students. I am a strong advocate of people undertaking apprenticeships later on in life—indeed, at all stages of life. We must make it possible for somebody with a family or other substantial financial obligations to become a nurse apprentice if they wish to do so. Thirdly, the funding band for nursing apprenticeships barely covers the costs of delivering the course and is less than universities receive in tuition fees for a comparable qualification. That makes absolutely no sense at all.
Ours was a short report—41 crisp, clear paragraphs. Our principal recommendation was that the Government should permit greater flexibility in the use of the levy for the NHS. I am well aware of the arguments in favour of having a single approach to apprenticeships, partly because consistency is a virtue in itself, but also because when flexibility is permitted in one case, it will be sought in others. I accept that argument, but it is a strategic priority of the Government to have more nurses and to support the NHS, and nursing is an exceptional profession and definitely worth making an exception for. We need the professional bodies, the NHS and the Government to throw their weight behind nursing degree apprenticeships. I hope that the Department for Education and the Department of Health and Social Care will think very carefully before responding to our report.