The next item on the agenda is the Plaid Cymru debate on the nursing bursary, and I call on Rhun ap Iorwerth to move the motion.

Motion NDM6103 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

Believes that the Welsh Government should retain the nursing bursary as part of a wider programme to support more people from low income backgrounds into careers in the Welsh NHS.

Motion moved.

Diolch yn fawr iawn, Lywydd. Well, we’ve tabled today’s motion for a very simple reason: we believe the nursing bursary to be valuable and we’re seeking clarity from Welsh Government about their intentions in relation to the future of that bursary. We know that the UK Government has made the decision to scrap the bursary in England and that set alarm bells ringing in Wales, and in Scotland too. But on 20 June there was a huge sigh of relief in Scotland, when the Scottish Government announced that it would not be following England’s lead and would be retaining the bursary. But three months later, we still don’t have a decision from the Welsh Government. It may well be, of course, that they’re keeping some good news up their sleeves, but the uncertainty—the long wait—is causing real concern within the NHS in Wales, and among current and potential future nurses in particular.

Nurse training must be strengthened in Wales and must be put on a firmer footing. We know that we’ll need more nurses in future. The health needs of our population, quite simply, make that an inevitability. An ageing population is something that is to be celebrated, but it’s something that we’ll need to invest in. Part of that investment is in the education of those who will look after that ageing population—all of us.

The safe staffing Bill was rightly celebrated by nurses in Wales, and the inevitable results of the passing of that Bill, of course, will be a requirement for more nurses to achieve its objectives. We’re bound to see, I’m afraid, a reduction in the numbers of foreign-born nurses choosing to come to work here, performing crucial roles within the NHS in Wales, as a result of the referendum on withdrawing from the European Union. This, incidentally, is why parties in this Chamber who claim to be serious about the future of our public services should be very wary of abandoning long-held principles in relation to the movement of people across Europe. We must recognise the concerns, of course, of many people across Wales on this matter but not be afraid of continuing to explain how our society and how our public services are enriched, in many ways, by people from outside these islands.

Why do student nurses need this extra support through the bursary? There are many reasons. I’ll go through some of them. Firstly, they tend to be older than the general student population. It’s quite possible, then, that many of them may have family and childcare responsibilities that mean higher living expenses, and scrapping the bursary could well exclude many of these students.

Secondly, nursing courses run all year round—not the usual 30 or so weeks that other students may have. This means that the option of employment outside term time is unavailable. The Royal College of Nursing points out that this is a unique position. A full calendar year, rather than an academic year, is needed in order to attain the 4,600 hours required to be completed before a nurse can be registered. That means rostered service, working within the NHS, performing an important function within the NHS as part of the training process.

Will you give way?

Certainly.

I’m grateful. Just on that point. I’ve had discussions with my health board, Hywel Dda Local Health Board, about how we can encourage more of those nurses in training to come to places like Withybush that are not traditionally seen as places where nurses train. And if we were having some security of what the future plans were from the Government, we could move ahead with some of those plans and increase the number of nurses that are available to some hard-to-recruit places from time to time.

Absolutely, because that training period and working in the NHS is a way to open the door to a future career within those areas where, perhaps, we are finding it difficult to recruit.

I think nurses deserve payment for that work that they do—for working the equivalent of a full-time job in the NHS whilst studying. Is it really feasible, for example, for them to work part time in a bar, or in a busy department store, perhaps, alongside 12-hour shifts in a hospital? Is it really morally correct that, for the work that these nurses supply whilst on placement, they should be entirely without financial compensation? What happens to a fair day’s work for a fair day’s pay if this bursary disappears?

But it’s also the consequences, of course, for the NHS and the way that it operates that we worry about. The removal of financial support for nurse education in Wales would increase the risk of poverty for nursing students, and may discourage people from this career option as a result. Therefore, there’s the possibility of failing to hit the numbers that we require to train. Wales currently has the lowest attrition rate for nursing students in the UK, and it would be foolish, I would suggest, to jeopardise this. I remind the Senedd that even delaying the decision has caused some concern. The insecurity that that creates must no doubt be hampering the ability of the Welsh Government to plan the healthcare workforce of the future.

Before I close, I’ll also ask for a comment from the Minister in light of the Diamond review publication yesterday—whether he can give an assurance that student nurses will be eligible for other means-tested support, alongside other students too, quite apart from the bursary debate that we’re having today.

The Deputy Presiding Officer (Ann Jones) took the Chair.

We’ve tabled the motion today, as I say, to indicate our support for retaining that bursary as part of a wider package to encourage people from lower-income backgrounds into the profession. Our future NHS needs that. Our future nurses deserve that. The Government needs to stop dithering on this issue and make its mind up.

I start my contribution by thanking Plaid Cymru for tabling today’s debate on the retention of the nursing bursary in Wales. We’ve already heard how in England the UK Government decided to no longer provide bursaries for nursing, midwifery and allied health professions’ students. They are bursaries that pay for tuition fees as well—it’s not just living grants that they include. The UK Government claims that such action will allow universities to remove a cap on places for students and consequently boost the amount of nursing and allied health and midwifery students—a cap, remember, that is imposed by the Government that is funding the schemes anyway.

I’ll focus my attention on nurse education, but we must remind ourselves of the impact of the removal of the bursary on all those other professions, because they also face the same workforce challenges that this debate applies to nurses. It’s true that, in order to provide the future workforce needed for the NHS in Wales, it is crucial that there are sufficient numbers of nursing students entering the profession, and we need to continue with the increase in student numbers that we have seen in recent years—actually, approximately a 40 per cent increase since 2013, though the RCN will probably shoot me if I don’t remind everybody that there was a dip prior to that.

Student nurses spend three years undertaking nursing degree courses and, as has been pointed out by the spokesperson for Plaid Cymru, that’s not an academic year of 30 weeks; that’s an extended academic year, usually of 42 weeks. When they take their studies they spend 50 per cent of their time on a practical placement—and that’s a full working week in a practical placement. As has been pointed out, that creates huge difficulties for those to actually find alternative means of funding.

Now, the need for degree-qualified nurses is supported by research undertaken in 2014, conducted across nine European countries, which found that a better-educated nursing workforce reduced unnecessary deaths. Every 10 per cent increase in the number of Bachelor degree-educated nurses within a hospital was associated with a 7 per cent decline in patient mortality.

However, there are challenges for those interested in pursuing a nursing career, particularly as regards personal finance. For example, it’s already been highlighted that the average age of a nursing student is 29, and they’re far more likely to have caring responsibilities. An RCN survey found that 31 per cent had dependent children, 10 per cent were single parents, and 23 per cent were caring for sick or disabled or elderly relatives. Nursing students in Wales do receive a bursary from the Welsh Government, similar to that being abolished in England, to allow them to follow the ambition of following a nursing career and entering a very rewarding profession. We cannot allow the removal of this bursary because it increases the risk of poverty for nursing students and may discourage people from this career option.

The Nuffield Trust stated that many studies suggested that as demand for the courses is elastic, with higher prices putting people off, this loss of support could be made worse by the demographic profile of those applying for nursing—they are disproportionately female, older than 25 and with children. The new loan-based system of support is less generous for childcare and for people with dependents. The Department of Health’s own impact assessment shows that the original introduction of student fees had a much more significant impact upon those aged over 21 compared to younger students. And that is the national profile, as we’ve heard.

A few weeks ago I hosted the RCN here in the Senedd at the launch of their latest campaign to promote leadership within the profession and to continue the work on the nurse staffing levels. At that event, many expressed their grave concerns for the future of the nursing bursary here in Wales and the effect it would have on Welsh nursing student levels, particularly part-time students, to an extent. I also recently hosted the nine allied health professions—I won’t name them all—and they expressed the same concerns about student take-up in their professions. More than 20 charities, medical and professional bodies and trade unions urged David Cameron, the former Prime Minister, arguing that the end of the bursary system for nurses and midwives would be an untested gamble. I do not want to see that untested gamble here in Wales.

Cabinet Secretary, I appreciate that we may need to look at how we continue to support those who wish to follow a nursing career, or one of the other health professions, but it’s important to look at the model of education. Can we expand nursing education into more part-time study? Can we look at a form of—and I use this word loosely here—apprenticeship-type scheme allowing students to be employed during their studies? Should we consider health boards employing student nurses, to ensure that they receive a wage whilst they progress through their three-year extended degree programme, whilst they actually undertake practical activities on behalf of the health board? I think there’s more that we can look at and there are different models we must explore in detail, and in detail with these professions.

The Nuffield Trust says that cuts to the training or education budget are short-sighted. Shortfalls in staffing threaten the safety and quality of patient care and can ultimately cost significant sums if they fuel a reliance on bank and agency staffing. We need to retain our local nurses. We need to retain support for those nurses.

I’m very pleased to hear this debate being brought forward today by Plaid Cymru because it very much follows on from many of the debates we’ve had—it follows on from our debate last week about workforce planning. We have such a crisis in our workforce planning throughout all strata that I think that this adds to it. We will be supporting this motion.

I did think about adding an amendment to it, because what I would really like, Cabinet Secretary, would be for you to conduct a short inquiry into training support for not just nurses, but other professions within the healthcare industries that have to do significant long-term placements as part of their qualifications. So, I would use the example of a physiotherapist who will have to go out and spend four weeks here, four weeks there. It’s hard to get these placements. Very often, people have to be far away from the university or the college that they’re at, they have to find other board and lodgings, and then they have to get their travel there—the whole lot.

So, we’re going to support this totally, because I think nurses are key. But, my plea is that there is actually an inquiry that looks at the whole range, because, as we have talked about in our various debates, including the very good one we had last week, we need nurses, physiotherapists, clinical psychologists, occupational therapists and speech and language therapists. All these people are part of the workforce needs that we have facing us and anything we can do to ensure that these people are able to be attracted into the profession and retained within the training would be very helpful. [Interruption.] Yes, of course, David.

I thank the Member for taking the intervention. I totally agree with you. We need to look at the placements because the placements are going to be crucial in developing that practical expertise, but we also need to look at, therefore, the staffing available to mentor the students in those placements. So, there is a wide-ranging issue that needs to be addressed here.

Yes, and I thought you made some really good points in your contribution, which I think could be easily wound into the inquiry. I have to say that I stop slightly short at the notion of paying a wage to all trainee nurses, because, then, do we pay a wage to trainee doctors and dentists and vets? I think we have to look at what we can do to support people in an equitable and fair way. And, we have to do what’s best for our nation and, at the moment, our critical shortage is in the NHS, in our workforce. So, as a nation, if we deploy more of our resources into attracting people, then I think that that’s what we need to have a look at.

I think we shouldn’t be shy either about trying to widen the access not just, as you so well put it, Rhun, for more mature students—perhaps people who are wanting to swap their jobs or people wanting to progress up a career pathway, perhaps they’ve been a healthcare assistant and now they’d like to go and be a nurse—but I think we can actually look at trying to poach people from very different professions that have some kind of tie-ins. I think we need to try and poach people from abroad to come into here, and people from England, from Scotland. There are lots of things we can do to try to make it far more attractive to come into Wales, to work in the medical profession and then, more importantly, to settle here, make Wales their home, take us on as their nation and actually help to build our country going forward. So, I think this is quite a complex area.

What I don’t think, Cabinet Secretary, is that any inquiry or review into how we might be able to support nurses and other allied professionals needs to be complicated. We’ve shown it already with the independent patient funding request inquiry. We can do something small, sharp, highly focused that’s got a very clear set of references, and then we want a very, very quick outcome. Why we need it to be a quick outcome is we need to have a look at what effect it might have with the Diamond review, as Rhun mentioned, and what effect it would have on Donaldson. I think the Donaldson element is very important, because I’d like to finish by making one comment: how many times do we take students—schoolchildren—out of their schools and take them into a hospital or into a general practice to try to encourage them into these medical professions? Not actually that often. Those are the kinds of things that we could do: a short, sharp review to look at how we can make it more attractive; how we can support and put in place good packages; how we can put in place good mentoring services and perhaps even have key clusters around Wales that act as training focal points, so that people don’t have to try and fight to find their placement; and, how we can support them financially and, above all, attract more people from all walks of life into our healthcare professions, because we need them, and we need them desperately.

I would like to thank Plaid Cymru for bringing forward this debate today, and it goes without saying that UKIP will be supporting the motion. Investment in training is of paramount importance, and, like the other parties in this Chamber, we disagree totally with the UK Government’s decision to remove bursaries for nursing students in England. We implore the Welsh Government to maintain bursaries for student nurses in Wales.

Removing bursaries for student nurses not only disadvantages those from poorer backgrounds, it also prevents university graduates from entering nursing unless they can afford the £9,000-a-year fee. We want to attract the brightest people into nursing, but if you have already taken an undergraduate course, you don’t qualify for student support. Without nursing student bursaries, graduates won’t be able to enter nursing—they won’t be able to afford to enter nursing.

There is also the fairness argument. As student nurses spend 50 per cent of their time in direct clinical practice, and their final three months working full-time in the NHS, is it right that we expect them to pay up to £9,000 a year for that privilege? I don’t understand the UK Government’s reason for removing the bursaries, and I hope that the Cabinet Secretary, when he responds to the debate, will guarantee that the Welsh Government will not be following Westminster’s lead. Nurses are the lifeblood—

Will you take an intervention?

Yes, Angela.

I just wanted to briefly intervene, because you’ve made this comment—David has, I think probably Rhun has, and I’m quite sure the Minister will—but, to be frank, we all buy into devolution, do we not? So, if a devolved nation, i.e. England, chooses to get rid of bursaries, who cares? That’s what they want to do. I don’t agree with that, but I don’t quite get this fact that we have to spend so long—so much of your speech, and, indeed, others’ speeches—talking about what the English do, when what we’re trying to do is sort out what we need to do here in Wales. If they picked over every decision we make here—

It’s not another speech, Angela.

[Continues.]—in such as detail as you do there, it would be an absolute waste of our time.

It has a knock-on effect, and it has an impact on Wales. Nurses are the lifeblood of our NHS, and we should be doing all we can to encourage more people to choose nursing as a career, not make it harder for anyone to enter the nursing profession. Diolch yn fawr.

Thank you. I call the Cabinet Secretary for Health, Well-being and Sport. Vaughan Gething.

Thank you very much, Deputy Presiding Officer. I’d like to thank Members for taking part in this important debate today. I can confirm that the Government will support the motion.

It is important to recognise that NHS bursary arrangements cover a wide range of professions and not solely nurses—that was a point highlighted by David Rees. The Conservative Government’s decision to remove the NHS bursary in England will have a significant impact on the costs of supporting those who wish to study health-related subjects, but I welcome the different approach taken by Angela Burns in rejecting the Conservative approach in England.

The bursary arrangements meant that students from the rest of the UK choosing to study in Wales were funded through the arrangements in Wales, and that approach was reciprocated by the other UK Governments. That will now change. We in Wales, though, committed to keep the current arrangements for 2016-17, and we have. The decision taken by the UK Government to remove bursaries in England has resulted in a number of difficult cross-border flow issues that we are currently working through.

I’ve been consistent in my view, both in talking to elected Members and stakeholders, that health-related students cannot be fully considered in isolation to the wider student support arrangements. You’ll be aware, of course, of the Diamond review published yesterday, and so I will be working across Government, and in particular with the Cabinet Secretary for Education. We’ll be considering the recommendations of the Diamond review carefully, because this Government is committed to making sure that finance is not a barrier to a career in nursing.

It’s worth remembering again a point made by both Rhun and David, that the average age for a nurse trainee is 28 or 29 in Wales. These are people with responsibilities, in the main, when they start a career in nursing. So, we need to consider the best way to support people who are likely to have those wider responsibilities.There is a really good example of healthcare support workers, a number of whom are now training to become nurses, in a career pathway as healthcare support workers. Many of them want to go on to become nurses, and we encourage that. That group of workers will mostly want to keep working whilst they’re studying. Again, they have responsibilities and giving up the income they currently have is a potential issue for them. And that’s why—and this is the point that David Rees made—we need to consider how we support and enable full or part-time study, and how we widen access. Again, I recognise the point that Rhun ap Iorwerth made there as well.

Those are really important points to consider about who we want to be nurses in the future, and particularly those people who have experience in other parts of the caring industry, but also personal experience of being carers, and at various points in their lives may want to transfer that experience into a career in nursing. So, for the future, I will want to consider how we use incentives to both work and train in Wales, and how the ability to encourage people to train in Wales could play a part in the support system that we fund.

Thanks for giving way. Just for clarification, we’re grateful that you’re suggesting that you will support the motion today, but can you just confirm that you are affirming what is in the motion in relation to 2016-17 only, and that beyond that is up for discussion still?

I’ll come back to that point directly, as I come to a close, because I think it’s really important to set out the principles that we have, and the fact that we will want to support nursing students. We are not taking the approach that has been taken in England. Obviously I’ll need to consider the final budget settlement in doing that as well, and that’s been a consistent conversation that I’ve had with nursing representatives since taking office.

I won’t undertake the short but formal inquiry suggested by Angela Burns, but I do look forward to working with stakeholders in both the NHS and education, and of course RCN and Unison, as major stakeholders within the nursing profession, as we work through our proposals for the future. In terms of timescale, I’m happy to confirm that I expect to make a statement that sets out our plans and sets out our path in Wales this autumn. I do recognise that there’s a need to provide some certainty for people both in education and within the health service, and those considering a career in nursing, so I look forward to updating Members in the relatively near future.

Diolch yn fawr iawn. Thank you very much, Cabinet Secretary. I have a very short period of time just to sum up. Firstly, to thank the Members that have spoken for this motion today. David Rees was absolutely right in pointing out that it’s a breadth of people and not just nurses—including allied health professionals—that benefit from the bursaries. Thanks also to the Conservative health spokesman, and, yes, I would echo the need to make sure that we have good evidence-based approaches to planning ahead for our workforce in future. That’s a key issue. Thank you to Caroline Jones.

To the Cabinet Secretary, I think what we’ve heard is that you accept in principle that you’d like the bursary to continue in some way or other. I think we have a guarantee for a year. That is disappointing to me, and it’ll be disappointing to some of the nurses who will be listening today, because of course we are looking for guarantees for the long term. I’m grateful to hear that there will be a statement in the very near future—I think ‘autumn’ makes it probably the next five or six weeks—and I look forward to that statement giving more assurances for the long term.

It is the long-term health of the Welsh NHS that all of us here are interested in, and that long-term secure NHS workforce has got to have at the heart of it nurses that are well-trained, that are supported through that training, and of course recognising that much of that training is a valuable contribution in itself to the day-to-day work going on in the NHS. I look forward to a more long-term positive outlook from the Minister in due course.

Thank you very much. The question is to agree the motion. Does any Member object? No objections. Therefore the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.