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Health and the humanities – what does it all come down to?

More students are studying nursing than ever before. But given low pay and high rates of career attrition, would they have been better off studying English? Lydia Dye-Stonebridge hasn't got it all figured out just yet.
This article is more than 1 year old

Lydia Dye-Stonebridge is a former policy manager.

For what my opinion’s worth, I unequivocally support the place nursing, and allied health more broadly, holds in the academy.

Nursing, after all, is now the most common reason for attending university.

I also happen to support the provision of English as a graduate myself, another discipline that currently engenders mixed views as to whether it belongs or not.

I’m poor, but I’m kind

The parting gesture of the erstwhile universities minister was to put on record that English degrees, as well as their other humanities siblings, deserve respect. It’s helpful, as I’ve had to work hard over my life to challenge a viewpoint to the contrary. I’m sure nurses and other health professionals can empathise.

So why are Wolverhampton, Sheffield Hallam, Roehampton, De Montfort and Huddersfield planning undergraduate course closures and consolidations in the humanities, joining London South Bank, Hull, Cumbria, Aston and Sunderland?

I have a theory; money. Most of these institutions have grown their nursing and allied health programmes, which carries incentives I’ll discuss in a moment. This pattern plays out at Sheffield Hallam, London South Bank, Cumbria, Sunderland, Huddersfield, Roehampton, Wolverhampton and to an extent, Hull.

Aston and De Montfort are outliers; they have primarily expanded places in business, a low unit-cost subject with strong applicant interest and uptake. Health, however, has a greater collective impact in terms of growth across these institutions (+255 per cent since 2007, vs +27 per cent), hence the focus.

It’s also worth bearing in mind that these institutions collectively educate about one quarter of the health workforce, with London South Bank and Sheffield Hallam accepting two of the three largest national cohorts.

I’m sick, but I’m pretty

So, how does health pay, you ask?

Health has a different funding arrangement to most other disciplines. Because Whitehall (hopefully still) wants a functioning NHS, there are a range of incentives for universities to increase the supply of places, both through traditional routes and apprenticeship arrangements. Health also qualifies for high cost subject funding, and the NHS foots the bill for some costs associated with training while on placement.

Health students come with other benefits. They have stellar employment prospects, and health is a known draw for people from widening participation backgrounds. This can help with fee limits and other Office for Students measures.

Health students also tend to make less of a demand on stretched university resources, as they are in placements half the time.

In contrast, all you get from English students are people who lurk in the library, rewrite GCSE curricula, go on to issue vexatious white papers about levelling up, and get fired on a whim by an outgoing PM thirsty for revenge (other career paths are available).

I’m here, but I’m really gone

The question, though, is the ultimate return on taxpayer investment. In 2020-21, nearly 200,000 people left the NHS. According to research conducted by the King’s Fund, the number of nurses and health visitors in England leaving their jobs within the first three years has risen nearly 50 per cent since 2013-14, standing at 28 per cent. This includes the first cohort who took on student loans.

So, what’s being spent on educating this fragile health workforce? This is just an illustration, but it could be:

  • A minimum of £596 million per year on fee support: 30,185 nursing acceptances in England x (£9250 fee + £5000 minimum training incentive + £5500 average maintenance loan)
  • Add the high cost supplement from the Office for Students, currently £27 million for nursing midwifery, and allied health
  • Lose up to one-third due to non-completion: £208 million per year
  • Lose a further tenth due to early workforce exit: £40 million per year

There are also other costs not captured here, but I’m an English graduate, not an economist. It does strike me, however, as a lot of taxpayer money to spend and not end up with quite what you or they wanted.

I’m tired, but I’m working, yeah

Now for one microsecond indulge the idea that, in contrast to nursing, courses like English – and while we are at it, history – are a total waste of time. In England, this would be about 18,000 people blowing a collective total of £265.5 million a year.

This amount isn’t far off what could be lost in nursing investment, except – as a reminder – this waste is imaginary. We know from LEO data that average salaries in these subjects are similar to those in health five years out, and according to the IFS, often outpaces nursing over one’s lifetime.

You can even earn close to a six-figure salary if you are an English or History degree-holding MP, whether or not you are able to hold down a Cabinet post for very long.

I want to be clear that I’m not making the point that this £248 million (or so) is wasted by those studying nursing. Even partial study imparts important research and communication competencies that can be carried elsewhere.

But what I want to question is why universities feel it’s okay to junk humanities programmes, where the lifetime return on investment, not to mention resilience, is evident.

I’m sane, but I’m overwhelmed

The issue is that the intakes across history, English and languages at these institutions are tiny – in most cases, fewer than 100 students. This most likely pushes the unit cost far higher than the fee cap.

Some of these institutions, like London South Bank or Cumbria, never had a strong uptake, so asking them to build these programmes would require substantial investment (Lake District Writers’ Workshop, anyone?). But some like Hull, Sheffield Hallam and Roehampton once had healthier programmes, so there’s a question about why recruitment tanked and whether interest could be revived.

But let’s face it, courses like allied health and business are popular and pay their way. Maybe it’s best to just direct those who are fascinated with our stories towards a Russell or Open. But, if we do that, do we get one step closer to a point where the term “university” ceases to designate a place that advances all forms of human knowledge? Where local choice is split between health and humanity?

Or, are we prepared to not just say that we value the humanities, but offer funding to prove it?

3 responses to “Health and the humanities – what does it all come down to?

  1. Really interesting – and a good challenge. (For transparency’s sake, my first degree was English too. Never regretted it – but it took a long time before I realised the skills it had given me that I took for granted – analysis, argument, writing for different levels/audiences – and of course the pleasure of studying something I was deeply interested in.)

    I don’t think anything you’ve said is inaccurate – so what follows are some additional questions/thoughts.

    1. What’s the size of the intake pool? It would be useful to see the numbers (hello DK) for English at A level, BTec and other. My sense is that English as a subject for A level study is suffering from the Government’s valorisation of STEM, and rubbishing of humanities and creative arts.
    2. Who has grown their provision? There has been a major expansion in selective university Home UG intakes in recent years. How has this impacted on English? Have the intakes onto English in RG universities expanded markedly from a more or less static pool, and so decreased the numbers available to other university groups? Is that why it tends to be these groups of universities that are considering reducing their provision.
    3. Variations on a theme: my observation is that often when a course is struggling to recruit, the first instinct of the department is to create more choice: English AND x, English WITH y, etc etc. Often these variations on a theme recruit poorly, and/or cannibalise the main provision, weakening it still further. Then comes the retrenchment – back to basics – and it’s often these offshoots of courses that are being pruned in an attempt to strengthen the main provision.
    4. Does B3 (or the threat of B3) have an impact? I’m at a university that has a large Creative Arts provision, as well as Humanities. Graduate employment within 15 months is far more challenging in these areas than in STEM and Health (for example) – and indeed the career trajectory (as you point out) tends to be different. Of course for middle class students at universities seen as prestigious by the big graduate employers you can read whatever subject you want – the university’s lustre will do much of the work – but this often doesn’t work at other universities. There was some suggestion (at least initially) that some of the decisions on cutting English courses was being driven by B3 employability concerns.

    1. “There was some suggestion (at least initially) that some of the decisions on cutting English courses was being driven by B3 employability concerns.”

      It absolutely is – the sector expects proceed to be used to defund large amounts of programmes so there will be overlap between small numbers (in this context less than a 100) and proceed data.

      Close that course and you can get another 100 international PGT students in the Business School – who don’t figure in any of this data.

  2. “The issue is that the intakes across history, English and languages at these institutions are tiny – in most cases, fewer than 100 students. This pushes the unit cost far higher than the fee cap.”

    It’s a space and economies of scale question as well. A lot of administrative processes have the same fixed burden if you have 1000 students or 100 so 1000 makes a better contribution.

    Then from a space perspective – your 100 English students will all be taking up multiple modules – often six students in a classroom designed for 30. If you close that course you lose the administrative burden plus you now have a room available to stick another 30 international PGT students in.

    Finally there is a question of organisational complexity – it’s clear many are reconfiguring to fewer but bigger business units.

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