Consultation: Changing how healthcare education is funded

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1 66 East Smithfield T support@rpharms.com London E1W 1AW F Department of Health, Quarry House, Quarry Hill, Leeds, LS2 7UE 17 June 2016 Dear Colleague Consultation: Changing how healthcare education is funded The RPS is the professional body for pharmacists in Great Britain. We are the only body that represents all sectors of pharmacy in Great Britain. The RPS leads and supports the development of the pharmacy profession including the advancement of science, practice, education and knowledge in pharmacy. In addition, we promote the profession s policies and views to a range of external stakeholders in a number of different forums. The RPS welcomes the opportunity to respond to this consultation. The RPS understands that following the government announcement in the 2015 spending review, from 01 August 2017, all new nursing, midwifery and Allied Health Professional students will receive funding and financial support through the standard student support system rather than through the current bursary scheme. This brings the funding of training for these groups in line with other health care professions such as pharmacy and will affect the following courses: nursing - adult nursing children nursing - mental health nursing - learning and disability midwifery dietetics occupational therapy orthotics orthotics and prosthetics physiotherapy podiatry/chiropody radiography (diagnostic and therapeutic) speech and language therapy Patron: Her Majesty The Queen Chief Executive: Helen Gordon

2 operating department practice dental hygiene dental therapy Q1. After reading the list of impacted undergraduate and postgraduate courses, are there further courses which you think should be included in the scope of the reforms? If yes, what are these courses and why would the current funding and delivery models require their inclusion? No further courses are suggested for inclusion. Q2. Do you have any views or responses that might help inform the government s proposed work with stakeholders to identify the full set of postgraduate healthcare courses which would not be eligible for a postgraduate masters loan and to consider the potential support or solutions available? The RPS believes that postgraduate qualifications that are part of pharmacy foundation programmes and that support the development of advanced & specialist practice (including independent prescribing courses) of pharmacists should continue to be eligible for funding from Health Education England. Currently there is geographical variation in access to such funding. Q3. We think that operating the exemption will support the objectives for encouraging second degree students to undertake nursing, midwifery and allied health courses. Are there any other options, which do not include an NHS bursary that could be considered? It is important that those postgraduate students from other disciplines outside healthcare are supported to undertake nursing, midwifery and allied health courses if they elect to do so. Other options might include delaying the start of loan repayments and other supportive grants e.g. access to help with childcare. Q4. Are there circumstances, as set out above or otherwise, in which the standard student support system which would be available for nursing, midwifery and allied health students would be inadequate or limit participation? Why is this? We are specifically interested in cases where an individual s circumstances mean that they would not fully benefit from the increase in living cost support or to the same extent as other students. The absence of the bursary scheme may put off potential applicants (especially from mature students and lower income groups) who would otherwise wish to enter nursing, midwifery or an AHP career as a vocation because of they would now face the prospect of a large loan postqualification (albeit at low repayment rates) on top of a salary that is generally lower in comparison to other graduates outside of healthcare. Potential applicants may change their career choice on this basis with the risk that demand for nurses, midwives and AHPs is not met. For this reason, it is difficult assessing the potential impact on participation as a result of paying fees even though evidence from the wider higher education system suggests that there has not been a detrimental impact on applications to universities from lower income groups.

3 Q5. Do you agree that increasing the available support for living costs typically by around 25% or more, and enabling these students to apply for additional funding through the allowances on offer from the Student Loans Company, would ensure that we continue to have a diverse population of students? The lack of data in the equality analysis makes the continuance of a diverse population of students difficult to assess. Q6. Are there specific factors relating to healthcare students which you consider we need to take account of in relation to the discretionary maternity support provided by the student support system? As there is a sizeable cohort of students who undertake nursing, midwifery and AHP courses who are female and/or mature students it is more likely that they will require maternity support so it needs to be made clearer what support they can access and the implications for their study. Consideration should also be given to support for paternity leave. Q7. Are there any other measures which could be considered to support our principles of fair access? Further consideration should be given to and evidence to support the impact on equitable access to these courses. There are a number of health care assistants each year who progress (often as mature students) to train as nurses. Anecdotal evidence indicates that these individuals become very good nurses and that this offers a good route to obtaining a nursing degree from those from less advantaged backgrounds and/or limited prior academic qualifications. There is a concern that this route for career progression may be lost because individuals are deterred from further training because of the financial costs. Q8. Do you think that the potential options for those new part-time students commencing courses in 2017/18 will support students in continuing to undertake these courses in this transitional period? Please also refer to the response given in Q4. The funding model may not support students to continue to access these courses. Pilot projects may be a useful way forward to gather more evidence to support an appropriate funding model. Q9. Do you think that moving all new part-time students onto the Department for Business, Innovation & Skills (BIS) student support system for both tuition and living cost support through the Student Loans Company from 2018/19 will continue to encourage part-time students to undertake these healthcare courses on a part-time basis? If no please set out details of further supporting action you consider may be necessary by the government for students commencing courses from 2018/19 onwards. (Any options including the ongoing use of an NHS bursary or changes to the student support system will not be considered)

4 As further evidence would be useful to gain a fuller understanding of the impact of these proposals on equitable access and adequacy of supply to these professions, piloting the funding model would seem an appropriate way forward. Q10. Do you have any general comments on the impact of these proposals on the devolved administrations that you think the government should consider? It is not clear what the impact of the proposed funding arrangements in England will have on the devolved administrations. For instance, applicants may decide to apply to courses in the devolved nations rather than England. The potential risks of these funding proposals to the whole healthcare system across Great Britain needs further assessment. Q11. We would welcome respondents views on how, in delivering these reforms, we look at the widest possible solutions to ensuring high quality clinical placements. These views will actively inform further stakeholder engagement prior to the government response. The number of clinical placements needs to be adequate for the number of university placements to ensure that there is sufficient capacity. It is also important that the infrastructure for clinical placements supports the delivery of high quality training. If an NHS organisation is asked to support a number of clinical placements that it does not have the capacity to host, then the quality of these placements is likely to be poor and the risk is that high quality professionals will not be produced to meet patients needs. Q12. What more needs to be done to ensure small and specialist subject provision continues to be adequately provided? The viability of small and specialist subject provision may be in doubt if demand for these course decreases and universities decide to stop delivery due to insufficient income because places have not been filled. Those courses in which viability might be an issue should be identified and contingency plans put in place to ensure the continued supply of these healthcare workers. Q13. Do you have any general comments on geographical variation which you think the government should consider? There are areas of England that have greater difficulty in recruiting healthcare professionals. It is not clear whether the funding proposals will even out this geographical variation. Living costs in London may be increasing at a rate that is proportionally higher than other areas which could put off prospective students. Q14. Do you have any further comments on this consultation which you think the government should consider? The impact of these funding proposals on the supply of a sustainable workforce for nursing, midwifery and AHPs needs to be made over the long term. Much of the evidence cited as part of the impact and equality assessments stems from 2012 (when universities were able to increase their fees within the standard student support system.)

5 Yours sincerely Dr Catherine Duggan FRPharmS, PhD, BPharm (Hons) Director of Professional Development and Support