The Health Foundation has asserted that it is essential for any plan to abolish bursaries to be accompanied by a contingency plan to deal with a predicted fall in the number of applications for training places.
Despite massive opposition, the Department of Health has already indicated that it will proceed with proposals to replace bursaries with student loans.
This is despite opposition from bodies including the Royal College of Nurses, Unite, the Patients Association and NHS Clinical Commissioners (NHSCC).
In a blog post, Toby Watt, a finance analyst at the Health Foundation, said that there is currently “an overwhelming demand” for nursing training, with UCAS data showing that 57,000 students applied for 21,450 places in 2015.
Watt believes that if reforms are unable to deliver an additional 3,300 health professional training places on an annual basis, as has been promised by the government, an average of 2,046 of these will be for nurses, leaving 2.4 applicants for every training place.
Yet many healthcare analysts believe that the new system will discourage applicants from entering the nursing profession, particularly those from economically disadvantaged areas.
London Economics and Unite have estimated that the scrapping of bursaries will cause a 71% increase in costs for students, possibly dissuading some individuals from training to qualify as a nurse.
Watt asserted that the situation is uncertain, and that the nursing stock of the NHS could be seriously damaged.
“We can’t be certain what the future holds. The removal of the bursaries must therefore be accompanied with a plan for what happens if the number of applicants does fall by 60% or more. Training more nurses is essential, and this reform will help liberalise the labour market so it can react more efficiently and help meet the growing demand for clinical staff. However, the long-term success of these reforms will depend on nursing becoming an attractive career option.”
Already some of the most authoritative bodies involved with the healthcare system have made predictions regarding the impact of the bursary scheme.
NHS Improvement has estimated that the shortfall of nurses needed as a result of the new policy could be as high as 189,000.
And some critics have suggested that the scrapping of bursaries will lead to 40% of potential candidates aged over 25 deciding against entering the profession.
NHSCC has also warned that an increase in student nurses is not necessarily a good thing because new applicants could be chosen “based upon the ability to pay rather than the key values and skills required in the nursing profession”.
Nonetheless, the government continues to insist that this policy will be followed through, despite the seemingly large impact on the nursing profession and ultimately the NHS.
The leader of the UK Independence Party (UKIP) has repeated the view that the NHS could effectively be privatised should voters choose to stay in the European Union.
Nigel Farage is particularly concerned about the Transatlantic Trade and Investment Partnership (TTIP); a much criticised trade deal between the United States and Europe.
Farage believes that this would enable the NHS to be privatised “through the back door”, repeating the opinion of many economists.
Speaking on his weekly phone-in on LBC Radio, Farage asserted that the TTIP agreement would enable “giant American corporations to bid for contracts within the National Health Service”.
Farage added: “There are many people that fear that this could be the privatisation of the National Health Service through the back door. So the trade union movement, who have been fairly uncritical of the EU for the last 25 year or so, are suddenly up in arms about this.”
However, those who support the idea of a publicly-funded and accountable health service have also pointed out some of the hypocrisy in the remarks of the UKIP leader.
Farage had previously stated in 2012 that the NHS should be funded “through the marketplace of an insurance company”.
And last year he said political leaders would “have to return” to the debate about funding the NHS through an insurance-based system run by private companies.
But the position of Farage has been largely supported by research into the trade agreement.
Legal analysis instigated by the Unite union already concluded that the TTIP agreement would inevitably lead to the privatisation of elements of the NHS, and that this would ultimately be irreversible.
There is a massive political debate, of course, taking place on the European Union, and trade agreements such as TTIP are central to this ongoing dialogue.
But considering that both of the two major political parties have indicated that they will support the ‘yes campaign’ for European integration, it is certainly likely that the UK will ultimately remain part of the Eurozone.
Farage has been a frequent critic of the whole concept of the European Union, describing it as economically disastrous, bureaucratic, anti-democratic and unaccountable.
Indeed, UKIP itself is largely defined by its opposition to the European Union, and was initially viewed as a single-issue party, and to some degree, protest group.
Nonetheless, it does appear that those who supports the NHS should be weary of the implications of TTIP and other similar arrangements, especially in a climate of health service financial vulnerability.
Health services in England need “a dedicated fund to finance and drive forward essential changes”, according to a new report launched this week by the Health Foundation and The King’s Fund.
The report – ‘Making change possible: A Transformation Fund for the NHS’ – arrives as the Department of Health releases its 2014/15 accounts which reinforce the financial challenges facing the NHS at this time.
The purpose of the Fund would be to enable the shift to new models of care as set out in the NHS five year forward view, as well as helping to unlock the efficiency savings required to balance the books.
The report explains that the Fund would not only deal with the current urgent need for service change but would, in the long-term, become a fundamental part of the NHS and the way it is funded.
Key findings from the report include: (i) the NHS needs a single body (whether within an existing organisation or newly created) to oversee the investment for transformative change in the NHS. It should have strong, expert leadership which is credible to clinicians and managers; (ii) the Transformation Fund requires £1.5–£2.1bn a year in dedicated funding between now and 2020/21.
“While we recognise that it is challenging to provide additional funding for the NHS in the context of other services receiving cuts, the alternative is to risk a decline in quality and safety in NHS-funded care and a reduction to the services currently available”, said Anita Charlesworth, Chief Economist at the Health Foundation. “Without more resources specifically for transformation, the NHS will be unable to become more productive and the bill for additional running costs will only get larger. The Transformation Fund should become a fundamental part of the DNA of the health service from here onwards.’
Richard Murray, Director of Policy at The King’s Fund, added: “The fundamental task is to get a workforce of more than one million people to work differently. This would be a huge challenge at the best of times but is an even bigger task when services are under such intense pressure. This cannot be done within the existing resources – dedicated funding is required to deliver the changes needed.”
A new report comparing performance across high-income countries finds that the UK can and should do better in preventing unnecessary hospital admissions and improving survival from some of the biggest killer diseases – a conclusion endorsed by NHS Confederation chief executive, Rob Webster.
Published by the Nuffield Trust and the Health Foundation, ‘Focus on: international comparisons of healthcare quality’ is a comprehensive study of the quality of care in the UK health system and how it compares with that of similar countries over time.
Although the report demonstrates that the UK’s performance has improved on almost every measure since the start of the millennium, it also finds that the UK lags behind most other countries in several areas of care, including higher rates of preventable hospital admissions, lower cancer survival and higher mortality rates from heart attacks and strokes.
“This useful piece of research highlights some of the real achievements made by the NHS in recent times, including on cancer screening, reducing heart attacks, flu vaccination and antibiotic prescribing rates”, said Mr Webster. “The report shows the UK has improved on almost every measure and is testament to the hard work being done by health and care staff across the NHS.
“The report also highlights areas where we can and must do better – not least around survival rates for common cancers. This may be a problem with late presentation and lifestyle factors – as shown in many director of public health reports across the UK.
“To address these big challenges our members will need to work closely with partners in local government and the voluntary sector to develop a new relationship with the public. At the same time we will need to transform how we provide care so that the modern health service meets 21st Century health needs. We can climb the mountain Nigel Edwards describes but only if we do it together and if local government has the resources to support the public’s health.”
The report can be accessed via the Health Foundation website.