Somewhat to my horror, I find myself agreeing with Lord Sikka, Polly Toynbee and even The Guardian. No, I haven’t gone completely mad. While I agree on the identification of the problem, my solution is radically — as it must be for continued evidence of sanity — different. 

The problem is the lack of nurses. We face a major shortage, it seems, with the number of student nurses falling by a third in parts of England.

Now, obviously, part of the problem is that the state has, for the past 80 years, taken unto itself the power to determine how many nurses are trained each year. When someone wants to cut government spending they cut the number of nurses to be trained. This also explains the shortage of doctors — government plans that number — and the house price problem. Building land was nationalised in 1947 with the Town and Country Planning Act. Nationalisation, government planning, means shortages.

But we also have the method by which nurses are trained — not just who plans the number to be trained. For all a little parp squeak by me is of value, this is something I warned about back when it was first mooted. 

As the argument ran under the Brown Terror back in 2008/9, nursing is a terribly valuable occupation. Nurses are undervalued. Therefore if we make nursing a graduate only occupation then nurses will be more highly valued. I kid you not this was the level of logic back then. This is what was done. Nurse training is now a degree. 

Given my age, I’ve seen both sides of these training courses. My carefree youth included being shacked up with a lady who entered the practical training of those days. A couple of days of learning how to wash her hands and in her second week she held the hand of someone as they died. As Terry Pratchett said about his own reportorial training, and seeing a dead body on the first day — this is back when work experience actually meant something. I’ve also had a (step-) daughter train to be a nurse and this seemed to include a first year of being taught how to use Google with actual patients being met in Year 2. 

I might be a little cynical about that second point — possibly missing a detail or two.

Still, to repeat the political objective — graduates are highly valued, nurses should be more highly valued, so make nursing a graduate profession and nurses will be more highly et cetera. It is, obviously, rather unfortunate that this was done at the same time as trying to drive 50% of everybody through the hallowed halls to a degree, thereby ensuring that the traditional graduate premium has rather disappeared. But, you know, joined-up government and all that. 

Since that silly decision, matters have grown worse. It used to be that nurses were paid during their training (“bursaries”) and now, largely, they’re not. They also now incur student loans which they have to repay (hey, it’s a degree, so of course they do).

So, we get to this: 

The number of people studying to become nurses has fallen substantially across England, with some areas recording a 40% drop in successful applications …

Well, as Polly T said 7 years back:

The second great shock, which simply defies belief, is the 19% slump in the number applying for nursing places this year, the first year when nursing students pay full fees and lose their bursaries. 

These are solvable things, obviously. Humans have designed this system. Well, okay, bureaucrats and politicians have and it’s possible there’s some overlap with Hom sap there. So, humans can undesign it too.

We could, perhaps, think of reinstating the bursaries, alleviating the graduate nurses of their responsibility to pay back tens of thousands in debt and all that. But as we all know there’s no money left. We’re bereft of the many tens of billions of pounds that already need to be paid to the train drivers. So, there’s just not the fiscal space to do that. 

Therefore we should go back to that older system. Nursing is something learnt by doing nursing. Everyone starts out as a skivvie and then learns. Some lessons coming early, like comforting the dying. We might gain more nurses that way and we’ll certainly gain them cheaper. And it isn’t obvious that we’ll gain worse nurses,

It might sound a little retrograde, conservative even, to return to a practice of the past. But then it’s not true that everything our forebears did was worse, nor the new better. We only have to check the Beatles against their second derivative, Oasis, to prove that.