Some student midwives are putting in 70 hours a week

These are the findings of The State of UK Midwifery Student Finance, a new report from the Royal College of Midwives (RCM).

One of the things that’s especially upsetting about the report concerns part-time work.

OK, so students these days are all working part-time. The problem when combining that with a course like Midwifery isn’t so much the “clap for the heroes” angle.

It’s that while combining those part-time jobs with placements, the NHS runs one of the country’s biggest scams – the idea that while on placement, nursing and midwifery students are “supernumerary”.

While on placement, they’re officially neither part of the regular workforce nor are responsible for a specific workload. This is supposed to allow them to focus on learning, gaining experience, and developing skills without the pressure of being fully accountable for patient care.

And while they participate in care under supervision, they are supposedly there primarily for educational purposes, ensuring their learning needs are prioritised.

Maybe I was unlucky and Watford General is some outlier, but it was pretty obvious when both of my kids were born that the place would have fallen apart without the students knocking about.

That would be bad enough if we loaned or granted them enough to live on so that they’re not also working part (or in some cases full) time for the rest of the week.

But thanks to the preposterous pact between the Department for Education (DfE) and the Department of Health (DoH), we don’t.

That’ll likely be a driver of almost half of all midwifery students in England responding to the RCM survey to say they have a paid job to earn money, and that their job has a negative impact on their studies.

Over 9 in 10 know at least someone who has dropped out of their midwifery studies because of financial problems, and eight out of ten midwifery students in England have taken on additional (commercial) debt to help make ends meet.

The “system” works like this. Midwifery is (rightly, none of this it’s all too academic thanks) a degree-level subject – so student midwives in England have the same access to tuition fee loans and maintenance loans as every other student.

Those will be the loans that haven’t been going up by inflation.

To top it up, the DoH then has a system of bursaries for different professions/courses, and a system of reimbursing expenses for students on placement.

The NHS Learning Support Fund training grant is £5,000 a year – the “nursing bursary” (re)introduced in 2019. That hasn’t gone up by inflation either.

If they have a child under 15, they may be eligible for an additional £2,000 – but lose their entitlement of up to 30 hours of free childcare.

That creates scenarios like this:

I am a second-year mature student midwife and rent privately. I am a mother of three with a husband who is unable to work due to suffering from chronic pain. All financial income comes from myself. This means that while on placement I do full time placement hours plus additional shifts which on occasion means I work 70 hours a week.

“I have missed out on time with my children, including parents’ evenings, doctor’s appointments and even struggle to fit in my own medical appointments. We still get Universal Credit, but I have over £800 deducted from the benefit each month due to receiving student finance. If this wasn’t the case, then I would have more time to focus on my studies and balance life with the children.

And thanks to DfE holding down the repayment threshold, as soon as they graduate and get a job they’ll be on Band 5 on the NHS Agenda for Change pay scale – and starting repayments immediately.

In Scotland student midwives have been able to access a £10k non-repayable bursary since 2020 – the big problem with that is that the main undergraduate scheme has now overtaken it, which means that anyone on a household income of £34k has access to the same or more in the form in the form of a loan/bursary mix.

Over 7 in 10 have taken on additional debt – over half of those in debt borrowed from friends and family, 4 in 10 used bank overdrafts, and over a quarter struggled to pay off credit cards.

In Wales midwifery students get a non-repayable bursary to help with living expenses and a means-tested maintenance grant, as well as a partial student loan – although as of this year, the partial student loan criteria will be eliminated. All healthcare students can get a full student loan which could more than double the potential amount in some cases.

It’s still hardly a bed of roses:

Student finance will pay towards childcare costs, however, the threshold is very low. In my first year and part of my second year, I was receiving this money but then my husband was given a pay rise of £500 that year and it put us over the £21k threshold. We then stopped receiving childcare costs and we were stuck for a good six months having to pay £800 a month of childcare costs.

Luckily my daughter then turned three and we received 30 hours free childcare so didn’t have that worry anymore. But for those six months it was awful, I was working a lot to cover the costs and then Universal Credit were taking half the money anyway.

It’s a wonder anyone enrols in Northern Ireland. Midwifery students can apply for a non income-assessed bursary (£5,165 per year). Those with children may be eligible for additional financial help for childcare, and depending on their circumstances, they may receive a childcare grant, parents’ learning allowance as well as child tax credits. But that’s all subject to household income and the threshold for childcare support in Northern Ireland is low when compared to other UK countries:

I am a single mature student with four children and financial struggles, which has made my journey of completing an undergraduate degree an unpleasant experience, unenjoyed by the whole family.

I must work on top of placement and university hours to help with childcare costs. This leaves me feeling burnt out and too tired to take the kids out of the house. This not only gives them an unappealing view of the working mum, but also impacts on the valuable time I spend with my children. I feel it somewhat ironic that I work to afford childcare to enable me to work on placement. And make no mistake, we student midwives work!

Oh yes and then there’s placement expenses. In England the Travel and Dual Accommodation Expenses (TDAE) rates went up last year – they can now claim 42p per mile for driving (3p a mile less than HMRC’s approved mileage rates, and up to £82.50 for B&B accommodation. I can tell you now that that’s low for plenty of places that I’ve travelled to on Wonkhe budgets this summer.

And then, obviously, there’s the usual interminable delays in accessing that money.

To address all of this, the RCM has made four recommendations for governments in England, Wales, Scotland and Northern Ireland:

• Maintenance loans for student midwives that would be forgiven after three years of service in the NHS, specific to the country in which they studied.
• Financial support that increases by inflation.
• Preserved benefit entitlements, so that the vocational burden is not borne by the whole family.
• Prompt reimbursement for the cost of student placements, which can involve high travel costs.

It says it will be discussing its findings and recommendations with the health and education departments in each of the four nations over the coming weeks and months. If nothing else it’ll be hit with multiple blame games – there’s a bit of an excuse for the hotchpotch of trying to knit together the benefits system (not devolved) with the education system (devolved) – although no excuse for the disconnect between the education system (devolved) and the health training system (devolved).

As the student above says – student midwives work. Their student funding system really doesn’t.