Intended for healthcare professionals

Rapid response to:

Opinion

Forgiving medical student loan debt could help protect the future of a diverse NHS workforce

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1144 (Published 22 May 2024) Cite this as: BMJ 2024;385:q1144

Rapid Response:

Student loan forgiveness for healthcare degrees is an opportunity the NHS can’t afford to ignore

Dear Editor,

The student loan forgiveness policy discussed in Lynn’s article [1], is not just a sensible strategy but an affordable one for the public. ‘Waste Not, Want Not’ estimates the cost at £170 million for each cohort of medical students and £230 million for nurses, midwives and allied health professionals [2]. £400 million per cohort seems a large expenditure at first glance, but in context of the annual NHS budget of 164.9 billion [3] it is only 0.24%. Furthermore, £10.4 billion is spent on covering gaps with temporary staffing [4], a problem which is in part caused by the issue this policy seeks to address. If student loan forgiveness reduced this staffing bill by a modest 5% per year it would be a cost neutral investment, and anything more would save the taxpayer money.

The 2012 loan changes made medical education less affordable by introducing the double jeopardy of both higher tuition fees and interest rates. The new ‘RPI plus up to 3%’ rate led to students potentially facing rates of 12% due to rapid inflation, requiring government intervention to install temporary caps [5]. Still, these caps are high - today at 7.8%[6] - and since 2012 interest on ‘plan 2’ loans has frequently been over 5% [6], significantly more than pre-2012 loans [7]. As a Welsh student in 2012 I benefitted from subsidisation of higher tuition fees, so my debt has mostly been affected by the changes to interest compared to earlier graduates. Today I owe more than when I graduated, despite nearly £10000 of payments. I only have sympathy for those who faced the full brunt of the fees, who must face an even bleaker picture. It is easy to see why this harsh reality could put someone off a career in medicine, or make them consider leaving it for higher pay.

Student loan forgiveness represents not just value for the student but value for the public. It also sends the message that the UK values and invests in its healthcare workforce, at a time where morale is low [8]. I hope that whichever government finds itself in charge following July 4th recognises this policy for the success it would be for NHS staffing. We can’t afford for them not to.

References
[1] Lynn E. Forgiving medical student loan debt could help protect the future of a diverse NHS workforce BMJ 2024; 385 :q1144 doi:10.1136/bmj.q1144.
[2] Palmer W, Rolewicz L, Dodsworth E. Waste not, want not. Nuffield Trust. Sep 2023. https://www.nuffieldtrust.org.uk/sites/default/files/2023-12/Waste%20not...
[3] HM Treasury. Spring Budget 2024. March 2024. https://assets.publishing.service.gov.uk/media/65e8578eb559930011ade2cb/...
[4]LaingBuisson. Temporary recruitment and staffing: healthcare UK market landscape report 16 January 2024. www.laingbuisson.com/shop/temporary-recruitment-and-staffing-healthcare-1ed
[5] Adams R. Student loan interest rate to be capped at 7.3% in autumn, says DfE. The Observer. June 2022. https://www.theguardian.com/education/2022/jun/11/student-loan-interest-...
[6] Student Loans Company. How interest is calculated - Plan 2. April 2024. https://www.gov.uk/guidance/how-interest-is-calculated-plan-2
[7] Student Loans Company. How interest is calculated - Plan 1. September 2023. https://www.gov.uk/guidance/how-interest-is-calculated-plan-1
[8] NHS England. NHS staff survey 2023. May 2024. https://www.nhsstaffsurveys.com/static/8fce170a75e46bc5b531253d2966c04b/...

Competing interests: I am a medical school graduate who funded my education through the receipt of a student loan, and have ongoing financial commitment to repayments as part of this.

10 June 2024
Andrew R Graham
Anaesthetics Core Trainee
Department of Anaesthetics, Morriston Hospital, Heol Maes Eglwys, Treforys, Cwmrhydyceirw, Swansea SA6 6NL