Students applying for nursing or midwifery courses in 2017 will already be aware that they are no longer eligible for government bursaries, which have been scrapped by the Tories in a bid to save £800m of public spending. While this change will result in financial uncertainty for many students, the removal of bursaries could spell even greater uncertainty for the National Health Service in the next few years.

Under the bursary system, Health Education England funded a fixed number of places based upon local ‘workforce plans’, designed to fulfil the needs of the NHS locally. The government argues that by removing a cap on the number of funded places, the removal of bursaries could result in an increase of 10,000 places by 2020. Yet some experts disagree. Estimates by London Economics suggest that because of the removal of bursaries, nursing admissions could fall by 6-7 percent in the first year alone, leading to “a significant increase in staff shortages in the medium term”.

There is a distinct shortage of nurses and assistant health practitioners within our health service – a shortage of 15,000 to be precise – so it seems counter-productive to be cutting investment at a time when we should be attracting applicants to study nursing. It is hard to see the logic in shifting the financial burden from the taxpayer to individual students, considering that, on average, 70 percent of students never fully repay their loans, meaning that the taxpayer ultimately foots the bill anyway.

But even if the government’s forecasts turn out to be correct, there is no telling what types of nurses and allied health professionals are likely to be trained under the new system. Without the financial guarantee which bursaries provide, universities may be tempted to cut the numbers of less popular, specialised courses like child psychology, while expanding upon popular courses such as physiotherapy. HEE warns that,

If the commissioning of education is not efficient and effective, then attrition potentially goes up, people leave the courses or graduate with the wrong attitude…this impacts on the tax payer in a number of ways.”

By replacing workforce plans designed to meet the needs of the NHS with a system driven by market values, it is possible that an unfunded system could result in a shortage of highly valued and specialised nurses and AHPs, while unneeded specialities become flooded with new graduates. As none of this training will have occurred with specific vacancies in mind some graduates may find themselves struggling to find a job, despite having incurred thousands of pounds of student debt.

The political choice to detach recruitment from the needs of the NHS runs the risk that many graduates may end up taking jobs elsewhere. One particular weakness of government-funded places was that graduates could take up jobs within the private sector or abroad, with absolutely no obligation to work within the NHS after they graduated. But whilst the bursary system was far from perfect, the new system does even less to incentivise people to study nursing in the first place and to pursue careers within the health service.

What is particularly uncertain is who exactly will be responsible for meeting the workforce needs of the NHS once funded places have been completely abolished. If HEE remains ultimately accountable for NHS staffing, it will have to look at other non-financial incentives and soft ‘nudging’ to convince people to take up nursing in spite of the associated debts.

While the rest of the NHS is supposedly getting to grips with Sustainability and Transformation Plans and the devolution of healthcare, the removal of nursing bursaries seems to relinquish some of the control which would make local workforce plans easier to plan and carry out. The full effect of these bursary cuts will not be felt until 2020, when the first cohort of students who enrolled in 2017 will finish their courses. If Labour were to win the next general election, therefore, they could find themselves having to explain an NHS workforce crisis conceived under the Tories.

This was first published by the Fabian Society in Anticipations winter 2016

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3 Comments

  1. John says:

    The Tories are out to destroy the NHS.
    They want it replaced by a privately funded healthcare system.
    They don’t care if there are insufficient nurses in future.
    This is an attack on the NHS.
    People must be made to understand that.

  2. Alan Rogers says:

    The Tories are quite happy to pay the salaries of clerics who deliver religious care in hospitals despite the evident ability of the religion industry to collect charitable donations. Chaplains cost over £20 million per year in England …. quite a lot of bursaries for nurses. The State does not need to subsidise the religion industry it is quite able to fund itself.

    1. John says:

      Absolutely right.
      The government is not just neo-liberal in orientation.
      They are seeking a neo-feudalist future for us all.
      Vote them out every time you can!

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