The Guardian view on nurses: restoring grants is not enough
The restoration of maintenance grants for student nurses, starting next September, is a welcome signal that the government is capable of facing up to past mistakes. The 323,000 registered nurses working in the NHS in England are the biggest staff group (there are 146,000 doctors). While staff shortages are an issue across the service – and increasingly understood not only as a national issue but as a global one – predictions that the current figure of 43,000 NHS nursing vacancies could rise to almost 70,000 by 2023-24 have clearly focused minds.
The abolition of the bursaries that previously paid the tuition fees of students doing a first nursing degree, as well as providing them with maintenance grants, was one of the worst decisions taken by the Cameron government (since the devolved administrations continued to fund them, this is an issue specific to England; and since 89% of nurses and health visitors are female, policies concerning them must also be viewed through the lens of gender). Applications from first-time students for nursing degrees fell from 52,740 in 2016 to 39,665 in 2019. The fall in the number of mature applicants between 2016 and 2018 was even steeper at 40%, and a particular concern in specialisms such as mental health, learning disability and midwifery, to which they are seen to bring valuable life experience.
Without qualified staff, hospitals and health trusts cannot function properly. But the new £5,000-a-year grant – which will increase to £8,000 for some students – should be viewed as an important first step on a longer road to improving nursing, and not as a final destination. Retention of staff is just as important as recruitment, since there is not much point in training and hiring people if you cannot hold on to them. The national nursing staff turnover rate has fallen from 12.5% to 11.9% over the past two years, and a rise in the number of registered nurses and midwives also offers some grounds for hope. But there are worrying trends too, including an ageing workforce (the number of nurses aged 61-65 is growing much faster than those aged 21-30), and the stream of departures of nurses from other parts of the EU.
The challenge to the health system overall from the combination of underfunding and an ageing population with increasingly complex health needs, including a much higher incidence of chronic illness, is widely acknowledged – even if successive Tory administrations have failed to tackle the crisis in social care that is a vital piece of this jigsaw. The 2012 Health and Social Care Act is widely seen to have made a difficult situation worse. But the impact of all this on nursing careers requires closer attention. Numbers are not the be-all and end-all, as health researchers such as Alison Leary have argued, and the approach to workforce planning taken by management accountants does not sit easily with the sheer human complexity of much healthcare work. While the number of “assistive” healthcare roles is rising, the extent to which senior nurses withdraw from frontline caregiving should be reviewed.
Previous ministers have reached for slogans such as “bring back matron”, which rely on stereotypes. The point is that more complex health needs create more demanding work. People are grateful when they are treated kindly. But we do patients, as well as staff, a disservice if we reduce nursing to handing out pills and holding hands. The return of grants for training should be viewed as more than a sticking plaster. Along with the restoration of budgets for later professional development, it should be viewed as a vital investment in a national human resource.