The 2017 NHS bursary reforms puts a spotlight on health care student's training efforts and the pressure of long clinical placements.
Becoming a health care professional in today's climate is very different compared to only a few decades ago. Before, a student training to become a registered professional would be provided with subsidised housing and benefits. Whereas for health care students today, they have to face more struggles to even get through their three year degree course.
According to the Royal College of Nursing, the current requirement for healthcare training, set by the Nursing and Midwifery Council (NMC), is 2,300 hours spent in a clinical placement during their degree, which must last a minimum of 4 weeks in order to obtain their professional registration. Student nurses are training with the NHS full time with the majority of their training being on placement and the rest of the time attending university.
The NHS bursary Reform found on the GOV.UK website revealed that from August 1, 2017, new nursing, midwifery and most allied health care students will no longer receive NHS bursaries. Instead, they will have access to the same student loans system that other students use.
Kara, a Clinical Education Lead for Birmingham St Mary's hospice, doesn't agree with the removal of the NHS bursary and thinks that it could affect students attitudes towards placements:
"I don't agree with the removal of the bursary for pre-reg students as feel their course is different to other non-clinical degree programs. For example, I would be surprised if someone studying a degree in Art would be required to work weekends, evenings and nights.
"Although they are supernumerary, student nurses are working long hours in a demanding environment. Also, I suspect it might change the students attitude to placements and it doesn't encourage people to commit to placement time.
"Many students are trying to hold down part time jobs to support their student loan which puts more pressure on them and financial hardship is a reality without many perks. When I did my nurse training in 1991, I didn’t have to pay for it. I could live in the nurses home quite cheaply and I got paid for being a student nurse.
"The current system does not encourage older learners who may have other loans and mortgages, which will have an impact on nurse recruitment and life skills that are brought to the role."
Nurses spend the most time with patients out of any other profession and have been repeatedly recognised as the main workforce of the NHS. They don't just care for the patients but their family as well and offer physical and emotional support. Even though nursing now requires more academic knowledge and skill, this is still not reflected in their salaries or training fees.
Kara welcomes the reintroduction of the bursary:
"It feels like the current government are making it as difficult as possible to be a student in health care. I can't see a time when students would be paid to do their training again but would welcome the reintroduction of the bursary. Even though the students I come into contact with are committed and caring, I worry abut the future of pre-reg education."
With this bursary reform being implemented, universities have seen a decrease in people applying to study healthcare at degree level. The 2017 End of Cycle Report by UCAS revealed that there has been a decrease in student applications:
"Subjects allied to medicine had the largest fall with 61,175 fewer applicants in 2017 which is a 15 per cent fall since 2016. Overall, there was 55,755 acceptances in 2017 and 45,530 of these were female. Which meant every four to five women were accepted to every man. However, the numbers accepted in Wales and Scotland, where the bursaries were kept, increased by 8.4 per cent and 8 per cent respectively."
An FOI request to The University of Liverpool revealed the numbers of applicants for the BA Hons Nursing course between 2013 to 2017. The data showed that since 2013, there has been a decrease in applicants for a BA Hons degree in nursing, which is rated as first for the subject by The Guardian League Table, by 37.5%. This is the biggest drop from the previous years with the number of applicants being 1025 in 2013 to only 641 in 2017.
There has also been a rise in the number of health care students being referred for mental health counselling with the primary presenting problems of assessed students is anxiety/stress (33%), depression (35%) and other which includes bereavement/loss, eating disorders, interpersonal/relationships, living/welfare, self-esteem, trauma/abuse and work/academic (32%).
Jane Hickey, a community matron said that the future of nursing is at great risk:
"I have been nursing for 30 years. When I trained we were paid minimum wage for working and learning in the 3-year course. The start of our course was 8 weeks in college then 8-12 weeks at a time as workers on the ward where we were used in the nursing numbers and did basic nursing under the supervision of experienced nurses.
"Nursing is a profession which involves experienced hands on care and this is best learned on the job. The future of nursing is at great risk due to the change of the degree being paid for by a grant, which will leave the newly qualified nurses with a great deal of debt. Nursing is already a profession which is struggling to recruit and this is going to deteriorate further with the new degree course."
A petition found on the Petitions section of the UK Government and Parliament named 'Pay healthcare students for payment hours' has already gained 32,707 signatures. To be considered for debate in Parliament, the petition needs to have 100,000 signatures and all petitions on this website only run for 6 months.
From looking at the Petition map, you can see that the highest amount of signatures (at the time of this article being written) come from Plymouth, Bristol East, East London, Suffolk Coastal, Birmingham, Sheffield, Liverpool Riverside, Beverley and Holderness, Kingston Upon Hull North, Leads East, Carlisle and much more which all have 150 plus signatures.
The petition asks to pay a basic living wage to health care students who have to do 37.5 hours on placement a week. Also, it says that students should receive a fair wage to help support themselves during their studies as part-time work is not always an option and so money can be very tight.
Henry, a third year Radiography student in London said how hard it is to balance university work while undergoing clinical placements:
"It's been extremely hard to study for exams and essays while undergoing clinical placements. This is particularly hard for people who have placements far away as they waste so much time travelling there and back.
"I think the fact that students now pay tuition fees is absurd especially as they spend 2,300 hours working on placement to qualify which is essentially completing the job of a staff nurse but not getting paid a wage."
Especially for health care students attending university in a city and so having to pay a higher rent cost, the small amount of money that they are getting paid is barely covering their rent and so they may have to take another job on the side to make ends meet. This can cause the healthcare workers to over-work themselves and possibly suffer from chronic fatigue which could end up affecting the level of care offered in UK hospitals.
A response to the petition by the Department of Health said:
"The NMC provide guidance on the requirement for students to have supernumerary status during clinical placements. The NMC state that the programme providers must ensure that students are supernumerary during all practice learning. Supernumerary means that the student will not, as part of their programme of preparation, be contracted by any person or body to provide nursing care.
“This compulsory training in a clinical setting makes healthcare students unique in the student population. It is our view that students' completion of high-quality clinical placements is essential to having a well-trained workforce for the NHS.
"As a result, and in addition to the expenses system already in place and run by the higher education student support system, we have made additional funding available for pre-registration nursing, midwifery and allied health profession students with the purpose of maintaining access to clinical placements and other areas associated with the compulsory study.
“We will also provide students with funding for unavoidable costs incurred for temporary accommodation with the purpose of maintaining access to clinical placements and other areas associated with the compulsory study.
“The funding reforms will not change the arrangement of students being supernumerary whilst on clinical placements and they will not be paid for their clinical learning."
The petition for paying healthcare students for their placement hours finished on April 2nd of this year and was only able to reach 33,318 signatures out of 100,000 needed to reach parliament. Health care students still have to pay the full tuition fees as other students who are studying at a higher education institute but there are still many people who hope for a re-introduction of the bursary scheme.
Photo at the top is by COD Newsroom (CC BY 2.0)
