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9th June 2016
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HealthChat
What is the future for Public Health and the Public's health?
From pork sausages to Porton Down.
Come and join me in conversation with PHE boss Duncan Sell-by (ho-ho)
King's Fund - June 21st, 5.30pm - Drinks, some larfs, some policy, a conversation and networking 
Safe
News and Comment from Roy Lilley
A tired looking copper folded his arms, yawned and looked on as another protest march made its noisy way along London's Whitehall.
 
'Free these, stop that, end so and so, do this, don't do that'.  When you've been in the job for as long as he's been... they all merge into one.
 
This one, however, was a bit different. 
 
The RCN were on the move.  His daughter is a student nurse.  A smiling lad shoved a leaflet into his arms.  A pretty blonde girl blew him a kiss and skipped back into the procession.  It could have been his daughter.
 
Unusual for him, he buried the leaflet into his pocket.
 
After an hour of ritual abuse shouted at the gates of Downing Street the protest moved on. 
 
Later, in the Whitehall canteen Derek picked up a doughnut and a mug of builder's.  He pulled out some change to pay and found the leaflet. 
 
Derek has two children.  David, sporty, like his Dad.  Just got a degree in physical education at Loughborough.  Derek rolled his eyes at what it had cost.  Shirley, his wife, was determined David wouldn't be saddled with debt.  Thank goodness for democracy, protests and overtime was all he could say.
 
Jane was like her mum.  All she ever wanted to be was a nurse.  Right from a little girl.  Thank goodness for the bursary was all Derek could say.
 
Reading that the nurse training bursary was in jeopardy surprised him.  We need more nurses don't we?  He folded the leaflet, carefully and took it home.  Derek never identified much with protests.  Not since he was put in hospital by a kicking from and anti-war protester.
 
This was different.
 
Different?  Are nurses different from any other student?  We used to think so.  The government picked up the tab for their degree training.  Now they won't.
 
Political decisions made to balance the books by 2020 and accumulate a surplus of 10bn, means public expenditure is cut.  Nurse bursaries are on the list.  There are 60,000 student nurses.  Cutting bursaries would save 800m.
 
The impact?
 
Cuts made to training budgets, back in 2010, means, today, we don't have enough nurses and we can't catch up.  Nurse training places are funded by HMG.  Cutting budgets means training places are limited.  That creates a pinch point.  For each of the 20,000 nurse training place there are five applicants.  If there was more money we could train more nurses... but there isn't.
 
If the men and women who want to be nurses were funded through the, normal, student loan system there would be no pinch point.  The 70 or so, accredited training establishments would be free to expand their capacity.
 
Here is a factoid that would surprise Derek.  I'm told that up to 20% of nurse graduates never enter the profession. They use their free degree to move into less demanding careers.
 
The student loan repayments kick in when the earnings threshold is reached and stop when income stops.  A substantial number of loans are written off.  Initial repayments are in the region of 7 a month.  You might argue, not a lot for a degree that is a passport to a career for life, travel and professional standing.
 
There is the no little matter of nurse placements that preclude the opportunity that other students have and who might work part-time to offset living and loan payments.
 
There may be an issue for older students. The average age of a student nurse is 29, suggesting many come into nursing later in life and may have already accumulated debt whilst qualifying previously, in something else and have a family.
 
Will there be fewer nurses? Not if the experiment in Leicester is anything to go by.  They run non-commissioned nurse training where students are responsible for their own funding.
 
They had 650 applicants for 25 places.  A lot of good people want to be nurses.
 
Students from poorer homes?  Could they manage in the same way architectural, PPE and all the other students from disadvantaged backgrounds manage?
 
My belief is that all education should be free; it's an investment in the nation's future.  Politicians don't agree and the economy isn't up to it.
 
It looks to me like Derek's overtime is safe.
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Health Chat
Duncan Selbie
Chief Executive Public Health England
In conversation with Roy Lilley
21st June - King's Fund 5.30pm
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New HealthChat
Sir Andrew Dillon
ChEx NICE
18th July - King;s Fund - 5.30pm
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>>  I'm hearing - some talk of recalibrating NHS targets.  Scotland have just started to do it.  It would seem sensible as many of the targets have been in place for some years and a lot has changed.
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