Have you ever been so fired up about something that you can’t contain yourself and keep talking to everyone you meet about it?
That’s how I feel about NHS course fees being cut.
I’m getting everyone I know to sign this petition against the move as it’s really important to anyone who ever accesses NHS care. I'm really hoping you'll share this post, and be able to take the info with you.
It both makes me pissed off, because the government think this is an OK thing to propose, and makes me hopeful, as 150,000 people have signed the petition to show they’re not ok with it.
At the moment, the government pays tuition fees for many NHS students. Students are also given a means tested bursary (around £5,645 a year.)
The government is now changing policy, meaning student midwives will pay their way, £63,000 to be exact, via big scary student loans.
The government say that the extra money will be used to train more student midwives and nurses.
I take issue with this. In fact, I think it’s not true. I’ll explain why shortly.
First I want to talk about what these changes will mean to the student midwives and nurses on the front line.
I could tell you about how the contribution of students was acknowledged when the NHS started. How student nurses were paid the equivalent of £19,000/year to train, and how that sum trickled away over the years, until students were scraping by. And now in total reverse of the NHS’ initial values, students will pay to work and train.
I could talk about the extra expenses you don’t think of. Textbooks, laptops, emergency sandwiches because your schedule is so unpredictable, parking on hospital site, childcare, taxis when your transport has broken and you’re on call, conferences to meet like-minded midwives who will keep you afloat.
I could talk about how rental prices have been going up by 10% or more year by year.
I could talk about why you often can’t work part time to fund your studies when you’re a student midwife.
Your hours are not arranged in advance, you offer maximum flexibility, you work ten day stretches. Days on placement can mean a wake up time of 5am and a return home time of 9pm or later. Try explaining to a pub job that you can’t guarantee any particular pattern of work, and it’s likely you’ll disappear on call at some point.
I could talk about how I used to pick up the odd shift as a Health Care Assistant, and how I bow down to those student midwives who manage to do paid work beyond 2nd year.
By 3rd year the workload is simply incredible. While being assessed on your skill on placement at any time of the day or night, you simultaneously write your dissertation, revise for OSCEs (performance testing exams that could be on anything midwifery related), write up numerous reflections on practice, and more.
I could talk about the fact that other degree students can work all summer to get extra money. As a student midwife, you get 2 weeks off in summer, and you’ll have assignments to write during that time.
I could talk about the fact that Scandinavian countries invest more into healthcare, and especially into midwives, and have healthier, happier populations because of it.
I could tell you that being a student midwife is the hardest thing I’ve ever done.
The emotional challenges if plotted on a graph would look similar to CTG trace with severe variable decelerations and overshoot (if you don’t know what this means, think mountain range).
The responsibility, even in training, for two or more lives and a family’s wellbeing is almost as big as the responsibility of being a parent.
I could talk about the fact it’s so worth it. Supporting a woman’s right to become a mother on her own terms is a very worthy thing.
I could talk about the stupidity of putting professionals who need to have great wells of emotional energy for empathy and caring under huge financial stress.
I could talk about how heartbreaking I find it to think about such a genuine and hardworking group of people scrimping any more, especially around Christmas.
But instead, let’s get practical and look at the feasibility of the government’s plans.
The government says that through asking NHS students to pay their way, they’ll increase the number of nursing, midwifery, and other healthcare training places.
I can’t speak for nursing, but for midwifery this sounds like fantasy. To quote one student midwife and add some much needed comic relief:
"They’re living in a big wibbly, wobbly, swirly, pink place."
To train a midwife, you need mentors. These are midwives who’ve had training to be able to ‘sign off’ on the ability of students.
Ideally, student midwives will have good continuity of mentor as, if you’ve ever learnt anything practical, you know how hard it is to keep swapping teacher.
When I trained, the system was so stretched that I had 13 different mentors on one 6 week placement.
So one question is, even with extra money, where will extra mentors come from? How will extra money given to hospitals create extra experienced staff in a short amount of time?
And where will these extra applicants come from?
Midwifery courses are always oversubscribed, but nursing courses often recruit applicants through ‘clearing’ at the end of UCAS, meaning they aren’t simple to fill. I can’t imagine massive debt helping attract more nursing applicants.
Then there’s the demographic issue.
By cutting funding, you’ll end up selecting a wealthier group of student nurses and midwives. Ethnic diversity will decrease as people from minorities tend to be from less privileged backgrounds.
Mature students who already have one degree and perhaps are parents are less likely to take on a £63,000 debt to train as a midwife, however much they want to.
The rich diversity of the profession will drop.
As midwives serve all women, a range of midwives from different backgrounds, cultures, and socioeconomic backgrounds is best in providing empathetic, credible, individualised care.
Then there’s the drop-out problem.
1/10 student midwives drop out without completing the course – a massive waste of money and effort on everyone’s part. Many of these students say financial pressure is a big reason for them leaving – the RCM reckon the government’s new policy will mean this figure rises.
Overall, I think it’s outrageous to make healthcare students pay.
I think it’s just wrong that midwives who shoulder so much responsibility should start out their career with a massive loan. Midwives start on about £22,000/year, which is a decent starting salary.
But midwives and nurses have so much more responsibility than almost anyone else starting out in their first post degree job. And they will never be paid as much as anyone with the same amount of skill in industry.
So why is the government doing this?
I think their claim that they’ll train more midwives and nurses is an outright lie – or they don’t know what they’re talking about. Either way, it’s is not very reassuring! I suspect they just desperately need the money for the NHS. But politicians can’t just lie about how that money will be spent!
There are a few important arguments on the government's’ side.
It’s important as objective healthcare professionals to think about this.
For instance, student midwives who pay would be more able to demand a supportive education. Perhaps standards would rise. Perhaps this would even have a knock on effect on bullying, as few students would fail to realise they were paying to be bullied.
Perhaps the money will be fed back into front line issues. But we have no evidence of this, and the decision seems to have been rushed.
I think there’s an underlying feminist issue here. I think the proposal smacks of a patriarchal society not valuing ‘female’ experts like midwives.
(I know there are excellent male midwives. But the role has traditionally been female, and therefore traditionally devalued).
We live in a capitalist society. What we pay for shows what we care about. By making healthcare students pay for their education, we’re devaluing the importance of their skills.
Women’s health and wellbeing predicts the future health of society. By taking money away from student midwives and nurses and reinvesting it (god knows where) we’re taking away from the care of women and babies.
This kind of inequality can feel insurmountable. But there are things you can do.
You can write or tweet to your local MP (some are hopelessly uneducated about all this). Parliament will debate NHS course fees on 11th January 2016 - you can watch live here. And if you think funding healthcare professionals will lead to a better, brighter world for all of us please consider signing the petition - and telling as many people as your can!
Please share this post, and leave me a comment, I’d so love to hear what your thoughts are!
'What’s one specific reason you think NHS courses should, or shouldn’t, be funded for students?'
Much Love, and Happy Christmas,
Ellie and James xxx