My Lords, I thank the noble Lord, Lord Puttnam, for reminding us of those days, which were both terrifying—I say that as an ex-educationalist—and exciting. Meeting the challenge, based on an evidence base, enables you to move forward. I declare an interest, having worked for the past few years for Health Education England since its formation as a non-departmental body, following the 2012 Act.
What I find terribly sad about this SI is the lack of evidence behind the move. I do not know, and I suspect very few people in this House know, whether the move to an all-graduate profession—treating nursing graduates the same as teaching graduates or graduates going into law or other professions—should be done on a loan system. There is an argument for that, but in
reality, we have absolutely no evidence to demonstrate that it will be effective, particularly at undergraduate level. Like many Members of the House, I look forward to the student funding review, because at least we will get that evidence base, which will be put before both Houses.
I find what I think is behind this deeply disappointing. Your Lordships spent many months debating the Health and Social Care Act 2012. There were a lot of fierce arguments. One of the reasons why the then coalition Government put forward the proposals was to take many of the decisions, particularly about staffing and education, out of the political arena and give them to an NDPB, to allow them to plan ahead. Health Education England was created for that very purpose. This is doing the exact opposite. It is pointless having an organisation which is there to plan a workforce and then taking away the means by which it can generate that workforce, be it at undergraduate or postgraduate level. It saddens me that after some of the excellent things that have been introduced—I declare an interest as having been involved with the nursing associate proposal—the belief is still peddled that this is somehow substitution. It should not be, it is not and it must not be a substitution. The noble Lord, Lord Hunt, is absolutely right to make that point: we do not want to move back to a lower quality simply to produce more people.
Will the Minister give us an idea of the quality, particularly at undergraduate level? I am sure that he will say that while we might not have as many applicants, we still have as many actual posts and that the quality of people applying for those posts is going up. I can find no evidence at all in the HESA survey that that is actually happening. If it is, I will celebrate it, and I am sure the Minister will tell us. The issue I want to raise—it is why I have spoken in this debate—concerns one of the great areas of weakness at the moment, and that is our ability to recruit and retain mental health nurses. This is a massive issue, and not simply for traditional reasons but because the demographics and the epidemiology show that ever more of us who, like your Lordships, have an average age of 70-plus are likely to have a mental health problem as part of their comorbidities as they get older. Few of us can deny that.
I am working at the moment at how we can provide the mental health workforce in 10 or 15 years’ time. I look around at where there is a stream of potential workers who could come in, and frankly it is at postgraduate level, using psychology graduates. I can tell the House that over the last three years, 49,466 psychology graduates have come out of our universities, yet we have a dire shortage of postgraduate mental health nurses. Instead of proposing, as my work does, that we really target these people to try to fill this gap in relatively quick time, this SI is saying that that is no longer possible, that these people with debts already from their university days—their undergraduate days—will now face having to fund work in a specialist area. Will the Government look seriously not just at narrow shortages but at wholesale shortages, which we certainly have in mental health nursing? Can we find a better way of attracting and retaining these people?
I finish with three brief questions. We are going to get, through the NHS and indeed through private sector organisations, 0.5% of their payroll being spent on the apprenticeship levy. I ask the Minister whether trusts and private sector organisations, particularly those in adult social care, will be able to use part of that levy to create in-house bursaries to support the development of staff. As yet we have not talked about the role of other sectors in bringing these people through. Will that be possible?
Secondly, if the Minister says, “Ah, no, BEIS says that you can use this money only if it is for apprenticeships”, are we able to rebadge postgraduate work in nursing, in the different fields, through the levy to provide the bursary—and, of course, fee remission—as a result of that route? There is a big pool of money coming in here, which could be used much more effectively.
Thirdly and finally, I ask the Minister, in trying to solve this conundrum, to make an assurance to this House that it is quality that we want and quality we must give to the people of the UK—particularly the people of England, to which this SI applies—rather than quick fixes in other ways, which I am sure will come down the track if we do not resolve this matter now.
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