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Loan forgiveness scheme could help retain NHS staff

The Nuffield Trust is proposing a loan forgiveness scheme that gradually writes off the student debt of nurses and other clinical staff over ten years.

The Nuffield Trust is proposing a loan forgiveness scheme that gradually writes off the student debt of nurses and other clinical staff over ten years.

The thinktank published an analysis looking at the levels of clinical staff dropping out of training and opting out of careers in the NHS, which is putting the NHS under severe strain and costing the taxpayer. It found that one in eight nursing students dropped out during training, one in nine midwives do not join their profession after graduating and around one in five nurses have left NHS hospital and community settings within two years of joining.

The analysis also looked at the medical workforce, finding that two training posts are required to get one full-time GP due to high rates of attrition and part-time work.

The Nuffield Trust examined strategies used in other countries, including tie-in initiatives to keep staff in the NHS, paid training placements and a loans forgiveness scheme and concluded that loans forgiveness should be immediately made available to the 28,000 nurses, midwives and allied health professionals (AHPs) joining eligible public services each year.

Loan forgiveness scheme could be a solution

The scheme would gradually write off outstanding student debt – currently averaging around £48,000 per nurse – reducing it by 30% after three years of service, 70% after seven years and writing it off completely after ten years, in recognition of workers’ contribution to public services.

The proposal is outlined in detail in an accompanying paper jointly authored by Dr Billy Palmer of the Nuffield Trust, Dr Gavan Conlon of London Economics and Dr John Cater CBE, a leading University Vice-Chancellor.

The authors argue that such a scheme would increase the number of applications to clinical education courses, reduce attrition during training and grow participation in NHS, social care and other eligible services. It would be expected to cost around £230 million per year for nursing, midwifery and AHP graduates, which the authors note is less than the amount to be saved by Treasury through the incoming changes to the student loan repayment scheme. The scheme could be expanded to doctors at a cost of around £170 million per year.

Nuffield Trust Senior Fellow and report author Dr Billy Palmer said:  “These high dropout rates are in nobody’s interest: they’re wasteful for the taxpayer, often distressing for the students and staff who leave, stressful for the staff left behind, and ultimately erode the NHS’s ability to deliver safe and high-quality care.

“Simply ploughing more staff into training without thinking either about why they leave, or what might tempt them to stay, is enormously short-sighted. The government’s plans to increase clinical training places must be accompanied by a realistic plan to encourage staff to stay and reward them for doing so.

“Our proposal to write off student debt is affordable, credible and could be implemented straight away. Policymakers need to seize this opportunity and begin to stem the unacceptable levels of attrition in the NHS workforce.”

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