Parties with an interest in the government's review of funding for nursing tell Claire Sanders what they hope will change
NEIL TURNER The government review of funding for nursing, midwifery and other health-care students is at last under way.
The review was promised last year amid widespread concern at the shortage of nurses, high drop-out rates on nursing courses and the funding disparities for different types of health-care students.
The Department of Health says its remit is to "plan and undertake a comprehensive review of current National Health Service-funded student support arrangements" in England. The Education and Regulation Branch of the NHS will manage the review, along with a steering group, yet to be announced.
As well as nurses and midwives, NHS-funded students include those studying professions allied to medicine, such as physiotherapists, radiographers and chiropodists. Medical and dental students are not included in the review, as they are funded through the Higher Education Funding Councils.
Already battle lines have been drawn. The trade union Unison, which represents 20,000 nursing and midwifery students, wants these students to be returned to employee status and salaried. This was the situation before Project 2000, which moved nurse education from hospitals to universities just over ten years ago.
But the Royal College of Nursing, which represents about 30,000 students, argues that student nurses and midwives must remain in a bursary system.
"History shows that as employees, the lack of time to learn and the use of students as cheap labour were precisely why Project 2000 was implemented," the RCN says. The Committee of Vice-Chancellors and Principals supports this stance.
At the moment, nursing and midwifery students on diploma courses receive a non-means-tested bursary of about Pounds 4,700 outside London. This is a flat rate maintenance grant requiring no contribution from the student's income or that of their family.
All other degree-level students funded by the NHS outside London receive a means-tested bursary of about Pounds 1,800 supplemented by a student loan of up to Pounds 1,780. The NHS pays the tuition fees for all health-care students.
Additional allowances are payable to older students, single parents and those with dependants.
Students are also paid for the cost of travelling while on clinical placements.
Unison says the government has also encouraged NHS trusts to second employees, such as health-care assistants, on their current salary and estimates that there are already more than 1,000 students being funded in this way. "How can we continue to have traditional-entrant students working alongside the secondments at less than half their income?" Unison asks.
Unison argues that student nurses and midwives are different from mainstream students: "While most other students in higher education are able to boost their income during the long academic recesses, nursing and midwifery students are on campus studying or on their clinical placements working."
Had nursing students retained their rights to a nationally negotiated salary when Project 2000 started, they would now be earning about Pounds 10,000 a year, Unison argues. Employee status would bring other benefits, such as maternity leave and sickness leave and pay.
Unison insists that this would not mean students losing supernumerary status, additional to, not a replacement for, staff.
"Abuses of supernumerary status that once existed did so largely because students did all their placements at the hospital that employed them," Unison says. "This is unlikely to occur while education remains, rightly, in universities, which have of necessity to use placements across a number of trust boundaries."
But the RCN warns: "Previous work has shown that students experienced significant conflict in role between their position as learners and with their employment as trainee nurses."
It goes on: "It is likely that payment would be set at the minimum wage and would only be applicable for students in their final year. It is unlikely payment would be made available to students on placements where staffing costs have been reduced, ie the same amount of staff are still required. The end result would be a salary less than the current non-means-tested bursary."
The RCN points out that soon half of all school leavers will go on to higher education. "To exclude nurses from the student experience, from which many of their peers will benefit, would be a retrograde step for the profession and patient care."
Instead, the RCN wants higher bursaries for all, improved access to social security benefits and hardship funds, the creation of a system that recognises the diversity of all nursing and midwifery students, and the inclusion of nursing and midwifery students in employee friendly initiatives.
Bodies representing other health-care professions also have concerns. Alan Walker, director of education at the Chartered Society of Physiotherapy, the largest of the professions allied to medicine, says: "There is a problem of retaining staff in the NHS. People coming into the profession must not be so penalised by debt from their student days that they leave."
In a private members debate on maintenance for student nurses last week, John Hutton, minister of state at the Department of Health, said: "The review of student support will be wide-ranging and will include examination of the different levels of support provided for diploma and degree students; the need to ensure the widest possible access to nurse training; the issue of hardship; and the interface between our support arrangements and the benefits system."
'IT SHOULDN'T BE LIKE THIS'.
Vicky Diggle is a midwifery student at Manchester University. She is clear that she wants to be a student, not an employee of an NHS trust. She is equally clear that she wants a bigger bursary.
Ms Diggle is a diploma student, which means that she receives a non-means tested bursary. She receives about Pounds 390 a month and can afford to study midwifery only because of the support of her parents.
She says: "I live at home, so I come home at night knowing that I do not have to worry about a mortgage. Many without that support cannot afford to do the course."
As the recipient of a bursary, she loses benefits available to other students.
She cannot get free prescriptions or free dental care. She has no access to student loans or the university hardship funds, and banks are reluctant to give her an overdraft. She travels 38 miles to the hospital every day, so her travel costs are high.
But she would not want to be on a salary. "Being a student gives me protection that I would lose if I was paid by the trust I was working for. The university keeps close tabs on what we are doing and steps in when necessary. We only work certain hours and we are supernumerary, which means we are mentored on the wards and not replacing an absent nurse."
Although she is not in midwifery for the money, she believes the financial hardship is driving people away.
"I know older women with children who are really struggling. It shouldn't be like this."
"I was a health-care assistant for eight years, and if I was still salaried as a student I would be receiving twice what I get in the form of a bursary," says Lizzie Dyer, a diploma student at the University of Surrey.
She receives a non-means-tested bursary of more than Pounds 5,000 - higher than fellow students because she is over 26. But even with her husband's support, she still has to work as a part-time cleaner. She also has a large overdraft.
"I'm constantly watching the pennies," she says.
She has two children under five, and the strain of working as well as looking after them has affected her studies.
She says: "I failed one exam because one of my children was ill half-way through the module. I was shattered because my grades have generally been good and I had to retake it.
"If I was on a salary, I would get benefits as well. One of the students on my course is pregnant, and because she is not entitled to maternity leave her bursary has been frozen. We don't know if she will be able to return to the course."