Joint staff side paper

on

Healthcare Student Support

Student Experience - the Case for Change

1.Foreword

1.1This paper has been developed jointly by the British Medical Association (BMA) British Dental Association (BDA), British Association of Occupational Therapists (BAOT) Royal College of Midwives (RCM) Royal College of Nursing (RCN), UNISON, National Union of Students (NUS) and Society of Radiographers (SOR).

1.2For the last two years we have worked in partnership with the Department of Health (England) to review the NHS Bursary. As the Modernisation of the NHS Bursary Review Group, and in conjunction with the Business Services Authority (BSA) and the Student Grant Unit (SGU) we have together achieved a number of successful changes which have, in part, helped to improve the student journey.

1.3However; it is clear from the high level of attrition rates within NHS Funded courses that there is still a need for a fundamental review of the way NHS students are supported throughout their courses. At present, however, there is no consistent approach to measuring attrition and no background information behind it which would enable us to identify trends, good practice etc. The collection of accurate and relevant data would assist in these discussions and we believe this should be made mandatory.

1.4Whilst we remain committed to working in partnership with Government in a post Darzi era, we want to take the opportunity of jointly highlighting some of the issues which we believe still need to be addressed and which we believe could make a genuine improvement to the student experience.

2.Introduction

2.1Given that workforce size is dependant on the numbers of ‘new’ graduates joining the profession, and that international recruitment is currently off the policy agenda, it is crucial that the NHS can attract, and retain, an even more diverse group of students into pre-registration education. In other words, attract the school leaver, the academically able, the older candidate, and those without formal qualifications –regardless of family background; and then support them through to registration.

2.3Despite exiting figures for all healthcare courses not being available; it is still quite clear that attrition rates for NHS funded students are currently at high levels and in some professions unacceptably so. 1, 2

2.4 This, coupled with the deterrent effect of student debt, will have a major impact on the number and profile of students graduating into the healthcare professions.

2.5This paper highlights the three main areas that this group feels need to be addressed as a matter of urgency:

2.6Basic Funding

  • The anomaly of a non means-tested bursary for Diploma students alongside a means tested bursary for degree students.

There is also, what appears to be3 the improved student experience of the seconded students who continue to receive a salary during their education.

  • The basic rate of funding; which is providing students with levels of financial support below accepted levels of income to keep them out of ‘poverty’.
  • The complexity of the student financial support systems

2.7Travel Allowance

  • Currently students in a number of HEIs have to travel considerable distance to attend their placements.We would like to see a single approach to travel costs which recognises all methods of travel. This allowance should also enable students to claim accommodation at a placement of the actual amount it costs, if staying away from their “home” proves to be the most cost effective method both in terms of time and the experience.
  • Where possible; for HEIs to give consideration to the type of placements offered where their students have children or a disability.

2.8Childcare

  • Funding

Currently students can only claim for registered child minders, but it is almost impossible for them to find affordable ones who will care for their children after hours e.g. when they are working late shifts, nights and weekends. As a result they tend to rely on informal care with grandparents, friends and family.

We propose a new way forward of each student receiving an allowance of £2000 is this per year or the for three years which is not linked to registered child minders but gives all students flexibility to provide safe and appropriate care for their children and which better reflects the hours and locations in which they work.

However to ensure it does not discriminate against existing students we have argued that they should have a one off opportunity to opt into the new scheme. Some students may choose to stay on the existing scheme and will be protected for the duration of their course.

Without this approach we believe it will have a disproportionate effect on women and lone parents and therefore not comply with equality legislation. The cost of this additional component would be £24 million across England. However, only one SHA is indicating that it can fund their proportion of this figure.

It should be noted that much work has been done to provide child care for NHS employees but this is not available to students.

One other solution for this is that students attend placements only between the hours of 9-5 but this is felt to be unacceptable by both practice and university.

  • Availability

For those without a family network to help with out of hours childcare there needs to be provision of additional childcare support.

2.9Overall this paper, in light of the publication of Lord Darzi’s review, seeks to make a case for change to improve the student experience. All of these measures would, we believe, have a positive impact on attrition and would therefore over time demonstrate value for money. It would also reduce the number of hours students work part time and enable them to focus more on their studies andexperience.

3.Background

3.1The Bursary Review Group has met regularly over the last two years and has achieved the implementation of several key pieces of work.

To date we have: -

  • Removed the differential payments based on age to ensure the scheme is compliant with Age Discrimination legislation.
  • Introduced Maternity leave for healthcare students who become pregnant during their studies.As a result over 800 students have benefited from this and 99% of them have returned to their studies following this period.
  • Introduced Maternity Support Leave to enable partners to participate in the care of their child at birth and in the after care of their partner
  • Introduced Adoption leave for any healthcare student adopting during their studies. Whilst no student has taken up this opportunity to date, it does ensure best practice exists within the scheme.
  • Introduced rent (as well as mortgage payments) to be an ‘allowable expense’; thus making bursary payments more equitable.

3.2 We also have welcomed the annual increments to the bursary allowance.

3.3 The Government have already gone some way to improving the student experience by making these changes. However, with attrition rates running as high as 48.7%1 for courses in some of the health professions it is clearly time to look at ways of addressing this crisis.

4.Economic Factors

4.1This section will look at the economic factors facing students today and help to focus on why we need a new fairer system which better meets the financial needs of healthcare students.

4.2Inflation

  • The Retail Price Index (RPI) has which excludes mortgage interest payments and other associated housing costs rose steadily from 2.2% in December 2005 to 4.3% in May 2008. It has been well in excess of 4% every month since December 2006, peaking at 4.6% in June 20084
  • The main contributors to the surging level of the RPI were housing costs (which rose 10% in the year to June 2007), fares and other travel costs (which rose 8.3%), household goods (5.1%),food (4.8%), tobacco (4.8%) and fuel/light (4.7%).
  • The extent of inflation, being at least 1% over the governments target triggered a letter from Mervyn King, Governor of the Bank of England setting out how it intends to control prices.
  • The Consumer Price Index (CPI) has risen from 3.3 in May 1.9% to 3.8% in June 2008,
  • City analysts continue to revise their projections of inflation upwards as RPI is expected to continue to rise throughout 2008 peaking at 4.7% in October.
  • All forecasters predict continued rises in the price of oil along with a 20% increase in food, electricity and gas prices

4.3Mortgage costs

  • Many students are coming out of fixed rate deals; which means either moving onto the lenders variable rate; or trying to re-fix the term of their mortgage. Either way; this means that students have to use an increasingly large part of their bursary to cover their housing costs.

4.4Rent costs

  • Accommodation for Students ( the UK’s No 1 student accommodation website, has just published its latest research into the nationwide cost of rented student accommodation based on 37,000 properties in over 60 university locations across the UK. It reveals that the current average weekly rent for a student in the UK is £60, 7% higher than last year’s figure of £56. In cities and privately rented accommodation these figures are higher

4.5Transport

  • Rail fares that are regulated by the government, including season tickets, rose by an average of 4.8%since January 2008. The remaining 60 per cent of fares, including tickets bought on the day, rose by 4 – 7%. Between May and June 2008 fuel rose by 5.3 pence per lire to stand at 117.6 pence compared with 1.3% for the same period in 2007.

4.6Energy

  • Gas bills will rise by 43 per cent in the next 12 months and electricity by 21 per cent, an average £360 per home, because of a sudden surge in market prices, industry experts are warning. Wholesale gas prices, the prices energy companies buy at, soared to a record high in June, taking the increase since the beginning of the year to 76 per cent. The average gas and electricity bills a year will have to increase to £1,410, almost £500 more than a year ago.

4.8Food

  • The jump in food prices of 9% on average from May 2007 last year pushed consumer price inflation to 3.3% in May from 3% in April, according to the Office for National Statistics. The cost of living is now the highest since 1990 with half of the increase accounted for by food prices.
    Staple goods have increased in price by nearly a fifth since May 2007 along with cooking oils and fats. Meat and bread were up by 9% with fish and vegetables rising by 7%.
  • Rising food and fuel prices, as well as increased taxes and other household bills, mean the average family must cope with inflation that is twice as high as official estimates, according to new research by The Daily Telegraph and moneysupermarket.com, the price comparison website. Taking all these factors into account, the Real Cost of Living Index (RCLI) is rising at 9.5 per cent.

4.9Childcare

  • The Childcare Trust found that the typical cost of a full-time nursery place for a child under two is £159 a week in England, that is over £8000 a year; a rise of nearly 5 per cent in 2007.
  • In some parts of the country, particularly London and the South East, the cost of a nursery place is much higher - typically £200 a week in London or £179 a week in the South East5

4.10NHS Finances

  • The published NHS accounts revealed in June 2007 that the organisation had swung from a net deficit of £512m in 2005/6 to a net surplus of £510m a year later.
  • The gross deficit shrank from £1.3bn to £911m down while the gross surplus rose to £1.42bn. In addition, the proportion of NHS organisations fell from 33% to 22%.

5.Incentives

‘A New Deal for Welfare’

5.1 The Government Green Paper ‘A New Deal for Welfare – Empowering People to Work’ identifies two core aims;

5.2 To help 300,000 single parents to find jobs and to move 1 million people off Incapacity Benefit and into paid employment.

5.3 Both these aims have to be underpinned by opportunities for increasing skills.

5.4 Training has to seem an attractive proposition compared to the alternative; if funding and childcare issues are not addressed high attrition rates will continue.

5.6Currently, a single parent in England with two school-age children will receive the following range of benefits:

Entitlement / per year / per week / notes
Means-tested income entitlements
Tax Credits / £4,723.10 / £90.58
Income Support / £3,154.64 / £60.50 / Assumes adult-only Income Support
Means-tested bill reductions
Council Tax Benefit / £1056 / £20.30 / You will not have to pay Council Tax as you qualify for full Council Tax Benefit
Housing Benefit / £5,214.28 / £100.00 / Full Local Housing Allowance
Child Benefit / £1630.20 / £31.35
Total Entitlements / £15778.20 / £303.42 weekly

Since there is no requirement for Childcare or transport costs

Disposable has After Housing Costs (AHC) income = £151.08 per week

but - they may also qualify for:

Social Fund

Free school meals

NHS Low Income Scheme

Home Improvements Grants

Discretionary Housing Payment

5.7A second year Diploma Nursing Student living in the identical accommodation with two school age children would have the following financial package.

Entitlement / per year / per week / Notes
Means-tested income entitlements
Tax Credits / £4,723.10 / £90.58
Bursary / £10313 / £198.30
Childcare Allowance / £8398 / £161.50 / 85% of Maximum Childcare. £206 Comprising of Nursery Fees and registered child minder to pick children up from Nursery.
Council Tax / N/A / N/A / You will not have to pay Council Tax as you are a full time student.
Housing Benefit / £0 / £0
Child Benefit / £1630.20 / £31.35
Total Entitlements / £25049.96 / £481.73

This student has transport costs to and from College totalling £36 per week; she has childcare costs of £206 per week and pays full rent of £100 per week. She therefore has (AHC) disposable income of £139.73 – but no access to the other potential awards.

6.Student Debt

6.1 Detailed Student Debt across all the combined student healthcare professions is not available at this stage; however a Universities UK study found that high levels of final debt (£15,000 or more) were associated with older students (32% of whom had higher levels, compared with 14 per cent of younger students) and those from lower socio economic backgrounds (22 per cent compared with 13% from professional/managerial class)6

6.2 Length of course obviously has an impact; with the average debt for a final year medical student being over £20,000 7 and projected to rise to over £40,000 under the new student finance system.8

6.3 Moves to encourage student mobility across the European Union as the Bologna agreement is enacted, coupled with international competition for healthcare professionals may increase nursing migration out of the UK and make European and international recruitment more difficult.

6.4 Demand for health care will continue to grow. It is, for example, estimated that by 2020 the number of UK citizens over 80 years of age will rise by 75 per cent increasing the incidence of long-term conditions.

7.Part time working

7.1 Research from Universities UK (UUK) has demonstrated that a student working 16 hours per week has up to a 60 per cent chance of getting a poorer degree than a similar non-working student6. As a result of this research many universities strongly discourage students from undertaking part time work, taking the view that any time outside formal teaching should be used for additional work and research.

7.2 The BMA’s survey of medical students’ finances7 shows that around a quarter of medical students work more than 16 hours per week during term time. The Unison Survey 20079 shows that this is the case for over 38% of healthcare students.

8.Labour Market

  • High employment rates - currently in the UK almost 10 per cent higher than the EU average.
  • The projected decline in the number of young people. By 2020 there will be 600,000 fewer 15-24 year olds in Britain.
  • The age profile of the current healthcare workforce means that there will be increased demand for newly qualified staff as the numbers retiring grows up to 2012. This coupled with reductions in international recruitment, means that a rising number of applicants will need to be attracted into nursing & other healthcare programmes just to keep workforce numbers stable.
  • The Government has pledged to move 300,000 single parents and 1 million people currently on Incapacity Benefit into paid employment by 201510

9.Widening Participation

9.1 The staff-side group11 believes that society is best served by a healthcare workforce that is representative of, and as diverse as, society itself.

9.2 The Government has made a commitment to widening participation in higher education, with various initiatives to encourage those from all socio-economic groups but in particular those from lower socio-economic groups to enter higher education. This is an aim that the staff-side group fully supports.

9.3 The most recent figures from UCAS in 200812 demonstrate that the proportion of higher education applicants from lower social class backgrounds has moved very little, with the figures showing that applications are up by only 0.7%, from 29.2% in 2007 to 29.9% in 2008. This slight upward trend can be partly explained by the inclusion of Nursing and Midwifery students into the statistics for the first time.

9.4 Some of the key themes underpinning the Government’s widening participation aims include attainment and aspiration and any initiatives addressing these gaps are welcomed.

9.5 We believe that there is much more to be done in order to have a real impact on widening participation including looking at the fundamental causes of low participation in higher education generally. For example, only 19% of those from lower socio-economic backgrounds gain two or more A-levels13 and only 30% of children from lower socio-economic backgrounds achieve five or more GCSE’s.

9.6 There are also major regional and socio-economic differences in participation in higher education. The Higher Education Funding Council for England (HEFCE)14 found that people living in the most advantaged 20% of areas were five or six times more likely to enter higher education than those living in the least advantaged 20% of areas. HEFCE also found that the proportion of those completing their courses was lower among students from low participation areas.