A float against a tariff that doesn’t pay the bills

On Tuesday the Department of Health and Social Care announced that from this academic year, eligible nursing, midwifery, dental hygiene, dental therapy, and allied health profession students in England with full access to the NHS Learning Support Fund will be able to apply for a fixed advance towards the travel and accommodation costs of their clinical placements. Up to now they’ve had to fund all of those eligible costs themselves while their claims are processed.

Health minister Alison McGovern said:

No student training to care for patients should be held back because they cannot afford the upfront cost of getting to a placement.

The bad news is that the advance gets recovered from the placement expenses the student would otherwise have received later, so there’s no extra support in it – and those expenses don’t cover what a placement actually costs.

What the money actually covers

Whether it arrives as an advance or as a reimbursement, what an eligible student can claim is actual temporary accommodation costs up to £82.50 a night for a hotel, B&B, or rented room, or up to £37.50 a night for staying with friends or relatives – nothing for staying with a parent.

The mileage rate for using a car is 42p a mile – 13p below the 55p approved mileage rate that HMRC applies to the first 10,000 business miles in 2026–27.

Only the excess over the normal cost of getting to university counts, so a student who already pays £10 a day to reach campus and £8.50 a day to reach a placement on the other side of the city gets nothing, however much further away it is.

Accommodation is only claimable when a student keeps paying for their normal term-time accommodation as well, so anyone who gives up one room to afford the placement one is out. Parking is subject to the same excess-cost calculation.

Those rates were last set in September 2023, and on the Office for National Statistics retail prices index (RPI), prices rose 10.8 per cent between then and July 2026.

The £5,000 training grant – available to eligible full-time students on qualifying nursing, midwifery, dental hygiene, dental therapy, and allied health profession courses, with a proportional rate for part-time study – was set in September 2020 and hasn’t moved either. Pharmacy and healthcare science students don’t get it.

On the same RPI measure, £5,000 in July 2026 had the purchasing power of about £3,510 in September 2020 money.

So when the department says the new arrangement will mean students “no longer have to cover expenses themselves before claiming the money back,” that’s only true up to the value of the advance and the amount the tariff will eventually reimburse.

The float, in other words, is a float against a system that doesn’t pay a student’s actual costs. And then there’s the small print.

Prove you don’t need it

The new arrangement is set out in the NHS Business Services Authority’s 2026–27 guide to Travel and Dual Accommodation Expenses (TDAE), the scheme’s name for placement expenses. It’s a float rather than a grant – eligible students can opt for £200 towards travel, £400 towards accommodation, or £600 towards both. Subsequent expense claims are set against the advance, and a student can ask for another one once the outstanding balance has fallen to £50 or less.

The eligibility condition is the bit the press release didn’t mention. To access an advance, the guide says, “you must have already had your first full TDAE claim approved” – and the £400 and £600 options won’t appear in the claims system unless a previous claim included temporary accommodation.

Every student, then, still has to self-fund enough eligible costs to make one full claim – the advance only becomes available once they’ve shown they can bridge that first gap – and the option closes at the end of term two of the final academic year.

Pharmacy and healthcare science students, who were given access to the expenses scheme last year but not to the rest of the Learning Support Fund, can’t access the advance either, though the department says it intends to “explore” that in future.

I mean for goodness’ sake. The guide’s own worked example has two students sharing a £2,500 flat for 30 nights during a six-week placement. On the facts stated, each student owes £1,250, or £41.67 a night – well below the £82.50 individual cap. In that example, a £400 accommodation advance covers about 10 nights of each student’s share.

The float changes when some of the money arrives – it does nothing about the amount to which the student is entitled.

What it’s a float against

The tariff was set in September 2023, when the then health minister Will Quince announced a 50 per cent cash uplift across the board – from 28p to 42p for car mileage, 20p to 30p for pedal cycles, £55 to £82.50 for commercial accommodation, and £25 to £37.50 for non-commercial accommodation. The department said the equivalent NHS Bursary rates had been unchanged since 2015 and the Learning Support Fund rates since that scheme began in 2017.

On RPI, the £55 cap set in September 2015 would have needed to reach about £80.17 by September 2023 just to stand still. It went to £82.50 – a real-terms increase of about 3 per cent on the 2015 value dressed up as a 50 per cent “cash boost”. Eight years of rising prices were repaid almost to the penny, and little more.

Then nothing again. On the 10.8 per cent increase in RPI between September 2023 and July 2026, the £82.50 cap is now worth about £74.49 in September 2023 money and would need to be about £91.37 to have kept pace. The 42p mileage rate would need to be about 46.5p.

Measured from September 2015, the £55 cap would need to be about £88.79 by July 2026 – so three years after the great catch-up, £82.50 is already worth around 7 per cent less in real terms than the £55 it replaced was worth in 2015.

The pattern is a long freeze, a one-off correction announced as generosity, and another freeze that starts eating the correction as soon as it’s introduced. The expenses guide, Learning Support Fund rules, and bursary scheme rules contain no automatic annual uprating mechanism for these figures. The numbers move by ministerial decision or not at all.

Moved, but not enough

Three years ago I went through the rest of the 2023 package and found a set of figures that had been frozen for years. Some have now been uprated, so I’ve done the sums again.

The training grant – the main element of the NHS package for eligible full-time students, is confirmed at £5,000 again in this year’s rules, its seventh academic year at that figure. RPI rose 42.4 per cent between September 2020 and July 2026, implying a real-terms loss of 29.8 per cent.

The other main component of a student nurse’s income is the ordinary Student Finance England maintenance loan, which is the Department for Education’s responsibility rather than the health department’s. For 2026–27 the maximum is £10,830 for a student living away from home outside London, up 2.71 per cent on last year.

In 2020–21, the year the training grant arrived, that maximum was £9,203. Had it tracked RPI from September 2020 to July 2026 it would now be about £13,106, so the maximum loan has lost roughly 17.4 per cent of its value over the same period in which the grant lost 29.8 per cent.

Then there’s the word maximum – in 2026–27 the full loan only goes to households with residual income below £25,000, a threshold set in 2008 that hasn’t changed since. Using annual-average RPI for 2008 and the July 2026 index, it would now be about £48,800, and every year the line stays put, more students are assessed as too well-off for full support.

Two departments, two frozen numbers, one student – and none of the published material sets the training grant and maintenance loan together against assessed living costs while students undertake lengthy periods of unpaid work on a ward or in another clinical setting.

All the feels

The press release quotes Caitlin Greenlagh, a third-year diagnostic radiography student at the University of Cumbria, saying the advance will make rural and coastal placements “feel” more accessible, and that word is carrying most of the announcement.

A rural placement costs what it cost last week. The student still pays everything above £82.50 a night, still pays any gap between 42p a mile and what the journey costs, and still has to self-fund the costs behind their first full approved claim – all against a training grant worth 29.8 per cent less in real terms than when it was set.

Cash flow and adequacy are different problems that hit different people. Once the first full claim has been approved, the float helps an eligible student whose reimbursable money will arrive eventually but isn’t there when the next placement starts. There are plenty of those students, so it’s not nothing.

It doesn’t solve the problem for a student whose actual placement costs exceed what TDAE will reimburse under the excess rule and the caps – and the announcement is written as though both groups have been helped in the same way.

The release ends by promising a 10-year NHS workforce plan later this year. In an ideal world it would turn its attention to whether the NHS Learning Support Fund and NHS Bursary figures will ever be linked automatically to inflation – or whether the next real-terms correction arrives in 2031, at 50 per cent, with a press release about “listening to students” or “tackling the cost of living”.