Student loans are a way to make nursing a lucrative career option and increase the nurse numbers by 10,000, writes Edmund Stubbs

Many trusts will be breathing a sigh of relief in response to George Osborne’s spending review announcement that limits on the number of university places for nurses are to be scrapped and the present bursaries replaced by student loans.

The government’s intention to increase nurse numbers by 10,000 represents hope for trusts that, due to shortages, are forced to employ agency nurses (now limited to 55 per cent more than the cost of NHS staff) and recruit a sizeable proportion of their workforce from overseas.

‘NHS may never be held to ransom by agencies again’

It is to be welcomed that arbitrary, centralised limits to nurse training have finally been abolished. Allowing more students to train will put the NHS into the position where it may never be held to ransom by agencies again. Increased competition among more graduate nurses will also make vacancies in unfavourable specialities and remote areas easier to fill.

Some of the Conservative party’s election pledges, such as creating two million more jobs and ending youth unemployment, might also become easier to achieve. A nursing degree gives its holder a set of recognised skills, enabling them to become self-sufficient for all of their working lives.

These perceived advantages come at a cost, however. For prospective nursing students the prospect of losing their bursaries and taking on a loan will come as a daunting proposition.

With an average nursing salary of under £30,000 and starting salaries of £21,000, many may feel discouraged from embarking on a degree. This lack of financial support might especially deter lower income applicants from taking out large loans which they would have to pay back over many years.

The point of abolishing nursing course limits is to allow more British people to become nurses and provide the NHS with the number of staff it needs. However, if the NHS is to obtain 10,000 extra nurses it will need to attract suitable candidates.

After pay freezes and stringent efficiency drives, NHS staff morale is at an all time low. Under the new arrangements many nurses might train with the NHS only then to work overseas or for the independent sector, doing little to counter the NHS’s current staff shortages; self-funded graduates may feel little loyalty to the organisation.

Training and loan repayment

Civitas recommends that the government does indeed abolish upfront bursaries and instead include nurse training under the student loan scheme. However, in addition, Civitas, proposes that the NHS should agree to make loan repayments on behalf of those graduates who subsequently work for it as an addition to salary.

Such a scheme offers distinct advantages. Firstly, it would protect the NHS’s investment in training staff.

After graduating, nurses on relatively small salaries would be encouraged to stay with the service by the incentive of not having to pay back their student loans. Starting their career within the NHS means that they would be more likely to remain.

The rate of loan repayments might even be increased as an incentive for nursing graduates to work in unfavourable specialities.

‘If nurses build their careers within the organisation they will never have to repay a penny of their student loans’

Were nurses to work in the independent sector after graduating, the NHS would not repay their loans. In order to compete for nurses, these independent sector providers would be pressurised to also finance student loan repayments. In effect the private sector would be paying for British nurses to train.

Additionally, during the three year period between the bursary system ending and NHS loan repayments beginning, the entire current budget for bursaries could be saved. This would release funds of around £685m each year, or just over £2bn in total; money desperately needed for the NHS’s planned transformation.

If the loan scheme were to be extended to other groups of medical professionals such as radiographers, speech therapist and podiatrists, this three year saving could reach nearer £3bn.

If the NHS is to attract 10,000 more nursing undergraduates and ensure that more nurses work directly for it rather than for agencies, the NHS needs to remain an attractive employer. The Civitas recommendations represent a means of making it so.

If nurses build their careers within the organisation they will never have to repay a penny of their student loans.

Such a scheme manages to abolish centralised limits on nurse numbers without making a job within the NHS seem any less enticing.