Ministers could end free university education for student nurses in a bid to boost the numbers joining the NHS workforce, under proposals put forward by national education bodies.

  • Education bodies propose replacing bursary with loan system for student nurses
  • Plans put forward in submissions to the government’s spending review
  • Universities would be allowed to create extra places to boost workforce

It has been reported in recent weeks that the Treasury is considering changes to the £5bn education and training budget held by Health Education England as part of next month’s comprehensive spending review.

HSJ has seen proposals that could bring the end of free education for nurses, midwives and allied health professionals, with students expected to take out loans to cover tuition fees. This would allow universities to create additional places rather than be dependent on the numbers commissioned by HEE each year.

Moving to a loan based system, which is already the case for medicine, pharmacy and dentistry students, would allow universities to expand the number of places they provide because the costs would be covered by the student loan instead of being limited by the existing NHS funded grant system. It would also mean higher cash support for students than the existing NHS bursary. The NHS Business Services Authority told HSJ it expects to spend £450m in 2015-16 on the current NHS bursary.

While students would leave university with substantial debts it is not possible to say how many extra places could be created although any increase is likely to be incremental and in partnership with local NHS providers, which provide placements for nursing students for 50 per cent of their time at university.

The idea has won backing from the Council of Deans of Health and Universities UK, which said the current system leaves the NHS dependent on what it can afford, contributing to recurrent workforce shortages. Both bodies have included the proposal in their submissions to the spending review.

Following the Francis report into poor care at Mid Staffordshire Foundation Trust, demand for nurses increased by 21,000 in just 12 months. NHS trusts also recruited almost 6,000 nurses from overseas up to September last year.

Dame Jessica Corner, chair of the Council of Deans of Health, confirmed it had asked the government to make changes to the existing system, which she said was “fragile and vulnerable” to service pressures. She said: “It has been a fact over decades that every time there are funding pressures in the NHS that is passed directly on to the numbers of nurses and health professionals that are trained.

“The current system of workforce planning attempts to estimate the precise numbers of nurses, midwives and AHPs that are going to be needed in three years’ time… It is almost impossible to do that and it creates inflexible outputs years later.

“We think [changing the system] would potentially smooth that out so that you don’t have that ebb and flow, which doesn’t correspond to what the NHS needs. It would also allow numbers to expand, although I can’t see it being a massive expansion; I don’t think that would make sense. But it would allow some expansion from where numbers are today and prevent some of the contractions that haven’t been very helpful or correct.”

Dame Jessica said replacing the bursary system could also improve conditions for student nurses. She said: “At the moment nurses and AHPs suffer quite a lot of hardship while they are studying because of the bursary scheme being relatively underfunded compared to a traditional university student living cost loan. So there is an advantage to them in terms of actually being able to live on a maintenance loan worth up to 38 per cent more depending on whether you live in London or not and that is not an insignificant increase.”

She said the NHS could consider paying back the loan of nurses who commit to a set period of time.

Dame Jessica stressed the proposals were not a threat to HEE. She said: “You would want to retain [HEE] to be the system steward and have oversight and intelligent modelling of the workforce, which is what they do for medicine, pharmacy and dentistry already. That is a very important role.”

In its submission to the spending review, Universities UK said: “The NHS faces severe domestic skills shortages in a number of professions, and the existing grants based system is unable to meet the costs of increasing student numbers to meet national need. The proposed change would allow for a sustainable increase in student numbers.”

It also said the change would help tackle a growing funding gap of 8-12 per cent for universities providing these courses.

The Treasury and Department of Health have been approached for comment.

This story was updated at 12.10pm to reflect additional information from the NHS Business Services Authority.