That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.
I am a nurse. My daughter is a nurse. Nursing is in my family and fundamentally informs who I am and what I do. Last November, I triggered a debate about investing in nursing higher education. I am here today to again carry the burning flag for the nursing profession, the wider health and care workforce, and society.
I will start by directly addressing the notion that we should not seek to further clarify the Secretary of State’s legal duties and powers. I have heard that the latest legislation sought to remove political interference in our health system. I have heard people say, “Don’t make health a political football.” Lastly, I have heard that changing the legislation to give the Secretary of State accountability for the workforce would put health and care back under political control—as if our ability to access health and care was ever out of political control.
I am sorry, but those are laughable positions. Which- ever side of the fence we sit on, it is a serious point that health is fundamentally political. It can never not be political, in terms of what we can access and what happens to people. Our great health service was created within a political agenda, and creating it was a fundamentally political act. Supporting our health and care service to thrive will never not be a political decision. Let us be proud of our history, recognise that health is political, and find a solution to the problems we face.
Now that I have addressed those weak positions, let me state that I, and many others across the political spectrum, take no issue with the idea that there should be explicit clarity in the law about the Secretary of State’s responsibilities. I am not alone in my gratitude for all that our health and care staff do. They work constantly to provide quality care by putting patients at the heart of what they do. In the NHS and the independent sector, nursing accounts for one in 10 of the labour market of the whole of England. We are, and ought to be, a fundamental force to be reckoned with.
Thanks to the scale and urgency of the workforce crisis, many people have been looking into these issues—some of us would say for far too long, and to poor result. We have a long-term plan for the NHS and an interim NHS people plan, so we have seen some movement in the way that agencies work together. However, we have no understanding of what the social care sector needs, and no assurance of workforce funding, which is entirely dependent on the forthcoming spending review and subject to the whim of a new Prime Minister. We do not have a workforce strategy that meets health and care service requirements, or that projects the future needs of the people who live in this country.
The vacancy rate has reached alarming levels, with almost 40,000 nursing vacancies in the NHS in England alone. That is not the full picture. The extent of the vacancies within social care and public health is unclear because it is not mandatory to collect workforce data. It is not possible for services designed with staffing built into their planning to run safely and effectively with so many missing staff.
Fewer people are joining the nursing profession and more are leaving. Since the referendum on the UK’s membership of the EU, more than 10,000 EU nurses and midwives have left the UK workforce. I will not be drawn on Brexit in this debate. However, while we are trying to find our way through the referendum result, frontline staff are propping up the health and care system with no credible assurances that the situation will be resolved. Our professionals are holding on as best they can, but we need to be realistic about what we can reasonably ask of them. They are starting to vote with their feet, and there is not yet the accountability to help us navigate the future that is to come.
This crisis has come about because there is no clarity in the existing legal powers and duties that would ensure that enough staff with the right skills are in the right place at the right time to provide safe and effective care. That is true not just of nursing but of every profession working within our commissioned, taxpayer-funded services, including nurses, medics, psychiatrists, physiotherapists, psychologists, paramedics, pharmacists, social workers, support workers, occupational therapists and dietitians. Literally no one—no one person—is accountable for growing and developing our health and care workforce to meet patients’ needs, now and in future.
The Secretary of State’s current legal duty is to provide a comprehensive service. The Government may say that the Secretary of State has oversight of the workforce through those general duties and powers. With all due respect, the Secretary of State’s responsibilities are too broad to understand what aspects of workforce provision they include. There are also no particular workforce duties within the range of national organisations responsible for service design and delivery. In a health and care system as complex as ours, it is easy for everyone to lose sight of ensuring that we have enough people. Clearly, that is exactly what has happened.
Surely two reasons for the number of vacancies are low pay in the public sector generally and the lack of bursary provision to recruit new nurses. Does my hon. Friend agree that there is a golden opportunity for many mature women, whose children have grown up, to enter that profession? Recently, even ambulance drivers had to pay extra for their certification—I had a debate on that a couple of months ago.
My hon. Friend is right, and I will touch on the removal of bursaries later.
A huge amount of effort has been required to try to fix this mess. There has been progress in the NHS, but it is too little and too slow. It does not include social care and deals only with the immediate context. Many of us in this House are here to challenge the position that the existing so-called responsibilities are clear and robust enough for use by the Government and the health and care system, and for the public to have confidence that the Government can be held to account—now and in future, since the pressures on the system will continue to grow and change.
Yesterday, many of us met nursing staff, having been brought together by members of the Royal College of Nursing, who are all passionate about patient care and public safety. I am moved by their advocacy for the profession, patients and society. I also feel their desperation in the situation they face, trying to keep people safe in challenging environments. Given that professionals have been raising the alarm for decades, hopefully our demands for an end to the boom-and-bust cycle in the workforce will be met.
Even the High Court recognises how vague the current powers and duties are. The legal dispute between the Secretary of State and junior doctors over their contract resulted in a judicial review in 2016. The Court judgment said that, as stated in the National Health Service Act 2006, the objective of “protecting the public”, with a duty on the Secretary of State to take appropriate steps, leaves
“considerable leeway to the Minister as to ways and means”
of running the service.
Anyone who looks at the content of the law can see clear holes and gaps. In addition to the Secretary of State having no explicit responsibility, we have other problems with the duties and power of the national guidance. For example, Health Education England is the organisation responsible for developing our workforce, but its hands are tied because it does not have sufficient legal powers or funding to invest properly in the educational provision needed to grow our workforce. HEE can do planning but not supply, which ought to be the responsibility of the Government. The current legal framework is simply not fit for purpose.
I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing this debate on an issue that she and I have discussed—her office is near mine in Norman Shaw North—and both care deeply about.
I am glad to see the Minister in his place. He knows my constituency well and understands the challenge of getting to it. In fact, he was the first MP ever to visit me in the heady days before 2010, when I stood as a parliamentary candidate because I thought that coming to Parliament would be a great way of changing the world. I have since learned that that is probably not the case.
The credit should really sit with the people who work in the NHS. In particular, I pay tribute and send my thanks to those who work in West Cornwall Hospital in Penzance, Helston Community Hospital—or cottage hospital, for those of us who grew up there—and other places where NHS staff and others do a fantastic job in really difficult situations, as we have heard. They make sure that people who arrive for whatever reason get the best possible care.
I was keen to take part in the debate because I recognise that things need to be done. We must take responsibility for the way things are at the moment, and although I understand what the legal responsibility is and the reason for the debate, I want to understand a bit more about the solutions, too. I have never thought that all the solutions can be created, thought up or delivered here in Westminster or in any Government Department. Although real progress in integration and improving services on the ground needs to be enabled through legislation, support and encouragement, people in health and social care in Cornwall have got together and worked extremely hard for many years to deliver a system in which pathways and integration are much better than when I welcomed the Minister off the train.
One problem of many is the workforce, which is undoubtedly a challenge. There is also no doubt that the NHS 10-year plan is a fantastic document, but it depends heavily on workforce. I know that the Minister will agree and will want to ensure that we have people in place. We may not participate in this Chamber, but across Parliament, the bunfight, debate and arguments about the NHS go on, and have been taken up by people in local campaigns and the media. That has created an environment in which people choose not to nurse or do anything else in the NHS because they are misinformed. I know of lots of people who would have gone into or considered going into nursing or social care, but will not do so because the NHS is a political hot potato.
Karen Lee (Lincoln) (Lab)
On the hon. Gentleman’s point about people not joining the NHS to nurse, the lack of bursary is a significant issue. If someone wants to train, the bursary is really important.
I am addressing the point the hon. Member for Wolverhampton South West made about the importance of working cross-party, as we will in this Chamber. I will come to the bursary later.
Actually, I will come to that part of my speech now as the hon. Member for Lincoln (Karen Lee) has mentioned it. I was one of the MPs who signed a cross-party letter requesting a royal commission for the 70th year of the NHS, because I believe that although we do not have all the solutions, we should set the tone. That would help to open the door of opportunity for those who work in the NHS. I will come to the bursary, which I have already raised with the Minister; I asked him to look in particular at the impact on mature students. Podiatry in Plymouth, for example, will not be taught from September onwards. In the south west, where the incidences of diabetes and other vascular problems are significant, we need podiatrists, so that is a major problem. The reason given is that most people who go into podiatry do it later on in their careers, and one of the challenges arising from the removal of the bursary and introduction of student loans—I voted for that and regret doing so—is that those who take out the loan immediately lose all welfare and can no longer get housing benefit.
For someone with a young family who wants to study, the student loan, or the grant available for mature students, is just not enough. The Minister is aware of my view because I have raised it before, and there is work to do on that. It is not about financial incentives; it is about making it affordable for people to go and do a fantastic job. As the hon. Member for Wolverhampton South West rightly said, some people bring so much to health and social care and we need to ensure that we take away every possible barrier without creating unintended consequences. I am sure that the Minister will be pleased to address that point later.
I will talk briefly about how Cornwall is responding. I have been very keen to see what we can do in Cornwall to make sure that people can turn up, get training and work and train on the job. For people in Cornwall, most opportunities for training are outside the area, but as we know, people who go into some professions, including in the NHS, tend to stay where they train. That has always been a problem for Cornwall, which has struggled to recruit the people we need. We have set up a health and care academy using the apprenticeship levy. The academy can offer people training and jobs as healthcare assistants. There, they can do 12 hours per week working and studying through the Open University, and will become qualified nurses after four years. As they are already settled in the area and have family there, they are very likely to work for the NHS for the rest of their careers.
I get what the hon. Gentleman is saying, but I worked for 40 years in the health service and it was because I saw its deterioration that I came to Parliament to say, “This is what’s happening.”
I said that in humour, which is why I talked about my own skill—or lack of. It is a curious thing, though, to hear people talking about the crisis in staffing when so many of them are in this place.
On a more important note, we are in a tricky situation with the challenges around the apprenticeship levy. In Cornwall, we hope to train 200 nurses using the apprenticeship levy over the next two years—that would address the shortage—but we have to recognise that funding is needed and I know that the Minister is looking at that now.
I will when I have finished this point. Whatever the solution, we must recognise the added pressure on existing staff.
Paul Girvan
On that point, it is all very well getting nurses into and through training, but in Northern Ireland the NHS is haemorrhaging nurses who are not leaving the profession, but going into agency work, getting paid two and a half times more than they were and working the hours that they want. Not only is workforce planning impossible when people can just work when they want, but we lose continuity of care in wards.
I appreciate that valuable intervention. I had a conversation with the former Secretary of State for Health about how, when the student loan was introduced, there might have been a way in which students had all their loan written off if they gave seven years’ service to the NHS. The advantage of that, to be honest, is that people who had done seven years after qualifying would probably have settled down by then, entered into a home purchase and perhaps had family, so they would have been, first, less likely to clear off to another country and, secondly, kind of tied into the NHS where they were.
In part, that addresses the problem the hon. Gentleman raises. Yesterday, I met a newly qualified nurse from the south-west who found that on Christmas day she was the leading NHS nurse, supported only by agency staff. That must stick in the back of NHS staff’s throat, when they know that extra pay is available to agency staff. Efforts have been made to address that, and there must be ways to do so, but that is what we are getting at today—the workforce challenge.
If we have a workforce challenge, other things will happen, such as agencies springing up and the demand for them. We have to get to a place where working for the NHS as a nurse employed by the local trust is the best and most rewarding place to be, and appreciated by all. We simply do not say often enough how great such people are. We can do so many things locally and nationally to rebuild value, trust and appreciation in those people. The challenge for Health Education England is to look at how we fund local innovative ideas, ensuring there is enough money, as well as flexible support, to find solutions. I discussed that with Simon Stevens, and he seemed alert to the challenge.
As I said, I met nurses from the south-west yesterday, and they were concerned about safety on wards and retention of nurses. We have this bizarre circle spiralling downhill: if nurses do not feel safe, they go to do something that might not be nursing. Unfortunately, in places of low unemployment, lots of other work and employment opportunities are available, often paying more.
3:06 pm
Karen Lee (Lincoln) (Lab)
It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this important debate.
I will start by talking about my lived experience of staff shortages in the NHS. I worked as a nurse from 2003 until 2017, when I entered Parliament. For the majority of that time, I worked on an in-patient cardiac unit at Lincoln County Hospital. Today, I want to paint a picture of a nurse’s working day and how difficult that becomes when we have staff shortages. First, however, I pay tribute to all the staff at Lincoln County Hospital—not just the nurses, but all the staff—and to NHS staff who deliver our healthcare right across this country in local communities and in hospitals.
I keep in touch with my former colleagues and still hear at first hand how staff shortages affect them—some stories are quite scary. As an MP over the past two years, I have witnessed an awful lot of patronising pats on the back. I exclude today’s debate from that, but we often hear from Members how wonderful our NHS staff are, and yet that does nothing to address staff shortages or to make their working conditions any better. That is what they want; they do not want patronising pats on the back. The 40,000 nursing vacancies are evidence of that stark truth.
As a nurse, when I went on shift, I would be allocated eight cardiac patients. They would have been treated for heart failure, recently had a heart attack or been waiting for an angiogram, or perhaps they were being treated for endocarditis, which is a serious infection of the heart. The staffing was meant to ensure that a single nurse took either the male or the female team, with an extra nurse working between the two sides to support the multitude of tasks that delivering good patient care means. In reality, we often did not get that third nurse, and had to manage without. Some shifts felt like a marathon combined with a sprint—I kid you not, Mrs Moon, it really was that bad. I did love it though.
The medical management of my group of patients would be varied. Many patients were diabetics, meaning that we had to check blood sugars, four times a day for some and twice for others. If four or five out of eight of a nurse’s patients were diabetics, that was quite a task. We could even get something called “sliding scale”, which meant we had to check them every two hours. Sometimes, honestly, we just chased our tail the whole day.
Many patients needed intravenous antibiotics, which were really time-consuming to prepare, even more so if a patient had a line, a Hickman or a PIC—a peripherally inserted central catheter—because it had to be done aseptically; it just took ages, and the nurse was running around the whole time. As well as that, staffing was routinely topped up with bank or agency staff. I am not knocking them, because we would not have managed without them, but they were not allowed to do IVs, so when we had agency staff on the other side of ward, to be honest we would end up doing quite a proportion of their work as well. That made it really difficult.
It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the hon. Members for Wolverhampton South West (Eleanor Smith), for Lincoln (Karen Lee) and for St Ives (Derek Thomas) on their eloquent speeches.
The crisis in the NHS workforce is deeply concerning. Its effects are felt nationally, locally and personally. Like others here, I want to pay tribute to the people working at every level of my national health service within the south lakes: the hospital in Kendal, Westmoreland General Hospital, and the district generals that we travel to in Barrow and in Lancaster. Of course, there are the GPs, dentists, paramedics and those providing mental health services. They do an outstanding job, but it is particularly challenging in rural areas, where we have specific problems with workforce planning and supply, which are at the heart of the problems that we are challenged by.
There are several key elements to workforce planning, including accessible and high quality training, as well as affordable training, as has just been mentioned so eloquently. Effective recruitment is another. Alongside both of those is the issue of staff retention. The Secretary of State must surely be held to account for each of those. The huge shortages in the NHS workforce are felt heavily in numerous areas of healthcare provision in the local communities in Cumbria, and I briefly want to touch on a few of them.
The provision of ambulances and ambulance crews has been hit particularly hard. It is vital that we recruit and deploy more paramedics and ambulance technicians. Rural communities such as mine suffer because of the sheer distances that ambulances have to travel to reach patients. According to the review of NHS access standards, it is the responsibility of ambulance trusts to respond to category 1 calls within seven minutes on average. That is a tall order when there are half the number of ambulances per head in the north-west of England as there are in London, despite the fact that my constituency alone is bigger than the whole of Greater London. It leaves communities living in fear for their safety and takes a serious toll on the physical and mental health of our outstanding ambulance crews. Our local paramedics and ambulance technicians are being pushed beyond their capacity. As a result, I have had an influx of local people contacting me about having to wait hours for an ambulance to arrive to give them the treatment that they so desperately need. That is why local health campaigners have been calling on the Government to deliver two new fully crewed ambulances to south Lakeland to stem the crisis and ensure the safety of the community. It is not right that people in Grasmere, Dent or Hawkshead might be an hour away from the nearest available ambulance.
20 of 35 shown
Some people might say that Simon Stevens, the chief executive of NHS England, should be accountable for not addressing the workforce needs. The development of the long-term plan provides another clear example of the ambiguity and conflicting expectations playing out in practice. In June 2018, the Prime Minister said:
“Growing demand and increasing complexity have led to a shortfall in staff. So our ten year plan for the NHS must include a comprehensive plan for its workforce to ensure we have the right staff, in the right settings, and with the right skills to deliver world class care.”
That was a clear signal of the Government’s commitment that the long-term plan would address the workforce crisis. On publication, NHS England acknowledged significant workforce issues but said that staffing was additional to service planning and was outside the £20 billion financial package that Simon Stevens was given. Again, NHS England does not have any explicit legal duties that relate to the workforce, so it is not obliged to act.
Just last week, Simon Stevens said there is a need for a
“much bigger upturn in the pipeline of new nurses… There has been a big debate about bursaries and their removal, which as we look at the way the student loan system is working, that is clearly back in play as a big question we’ve got to answer as a nation.”
However, the reasons for these supply problems are not within Simon Stevens’s control. They include the reform of higher education for nursing, which has not grown as we were promised. The ability to boost and fund the workforce sits with the Government, and the ambitions set out in the long-term plan will not be met if we do not have trained and qualified staff to achieve those goals. Although the Government have committed to transforming services, they must also commit to building the workforce we need. To do that, the lack of accountability must be addressed.
A nurse who walks into a shift that is short-staffed has no power to safely and effectively staff services. They have no option but to carry on, yet the buck stops with them when patient care is unsafe. Nurses have no power to recruit more staff, and they rely on Parliament to ensure that the incredible position we find ourselves in is addressed; to fix things not just now, but for the future. I know how heartbreaking it is for a nurse to be unable to give the care they want to. I know the guilt we feel when care is left undone, and the stress of being unable to do our job to the best of our ability. Patients pay the highest price when the number of nursing staff falls too low.
Understanding that the health and social care system is a safety-critical industry should be the starting block for any consideration made by the Government. The Royal College of Nursing and other professional and patient organisations have a clear solution. With cross-party support, they are calling for a legal framework for workforce accountability that sets out who in Government and across the health and social care system are accountable and responsible for workforce supply—recruitment, retention and remuneration.
The Secretary of State for Health and Social Care should have explicit powers in law for the growth and development of the health and social care workforce across England. Such accountability would ensure that there are enough staff to care for the number of patients, and that there is an incredible and fully funded workforce strategy. These requirements are not an either/or position; we need both. Alongside the Secretary of State’s accountability, there are other ways in which the responsibilities need to filter down across all layers of the health system. Never again would the system be able to sidestep workforce planning when setting a 10-year vision for the future of our NHS. The ultimate aim in clarifying accountability for the workforce at Government level is to ensure that all health and social care services are of a high quality, and that they are equipped to provide safe and effective care to guarantee patient safety. The current pressure faced by the healthcare workforce puts that guarantee at risk.
Successive Governments have missed opportunities to fix the health and social care workforce crisis. Boom-and-bust approaches to workforce supply have been an afterthought, with the focus on glossy new services and sparkly new plans, rather than on worrying about the staff who are needed to deliver them. That has led to a situation in which the system currently defaults to discussing how to fix the workforce gap. We need to plan strategically for what workforce will be needed to deliver the future healthcare services that have been designed to meet the needs of the population.
An opportunity to rectify the workforce crisis is coming right towards us. NHS England and NHS Improvement have finished engagement work on the legislative changes that they feel are needed to make a success of the long-term plan. Their engagement work sets out proposed changes to the remit of the Secretary of State, but currently these legislative proposals are missing crucial accountabilities. It is down to right hon. and hon. Members to expand the proposals when the law is presented to Parliament. The legislation must include accountabilities for the workforce, because it is too clear an opportunity to miss.
A simple legal change would turn the tide for patients, and support is growing across the political spectrum for a legal fix as part of addressing the workforce crisis. I found myself at a roundtable discussion on this very matter, with a Government Member with whom I share no political allegiance. We found ourselves in full agreement that we must explicitly clarify the responsibility for putting our workforce on a sustainable footing.
As a nurse in Parliament, I commit to seeking the change that is being called for. I hope that others call on Parliament to speak loudly and clearly in adding their voices to ours, and that all right hon. and hon. Members will commit to pursuing change. This is a truly cross-party issue, and rightfully so. There is a crisis and everyone points fingers at others, but ultimately no one is responsible. There are moves to make the system better, but they must be set out in law and strengthened further. There is an opportunity to fix this cleanly and easily. We are not adding burdens, but clarifying mandates. The moment is now—we must commit to ending the workforce crisis once and for all.
That is really positive, but there are some challenges and I have met the Minister to talk about them. One of the challenges is that for hospitals—in this case Royal Cornwall Hospital—to provide that kind of support, they need extra cash. It is not just about the apprenticeship levy, which they want to use and not repay, but about staffing 100 nurses and 100 healthcare assistants at a time, and providing pastoral support and other elements that come with training up staff on a ward or in a hospital. An added pressure is that for a hospital without the staff that it needs, really excellent healthcare assistants are no substitute for fully qualified nurses with a wealth of experience.
There is a problem in this place. I am a skilled craftsman in the building trade but I have put my tools away, despite the desperate need for skilled craftsmen in Cornwall. In this Chamber and across the House, we have lots of GPs and talented nurses. For some reason, we decided to pitch up here instead of continuing in our valuable jobs. I think that we are part of the problem. I am not suggesting that we should all pack up and go home, although we might get more done if we did, so we should consider it.
Solutions are possible. In Cornwall, I have found that people often do not know what is available. The Royal Cornwall Hospitals NHS Trust and other trusts in Cornwall, my local college and I got together to work on an event in the college called “Work for the NHS+”, which included 15 or more different parts of the NHS, as well as some from social care. They came along to tell students and the general public what the employment opportunities were, the pay and training that could be expected, and what kind of career paths were available. In Cornwall, as in many other parts of the country, there are some fantastic members of staff and people in the NHS and social care who can inspire others. This might sound ridiculous in a debate on shortages on a ward, but when we have such individuals, we must find opportunities to get them in front of people who are thinking about which career they should choose.
I do not know much about the other challenging problem raised by the nurses yesterday, but it is right to mention it. They said that although more nurses are training, training placement opportunities are fewer. They suggested that part of nurse training now is off the ward—obviously that has happened before, but they were concerned about whether that virtual training or simulators were the same. I know that the Minister will take seriously all opportunities to get nurses trained in the best possible way, so I will not dwell on a subject that I do not know much about.
I mentioned the issue to do with podiatry, which is a real problem in the south-west. We must find ways to help professionals, whatever they do, whether therapy, physio or all the things that people to do to ensure that we stay well and do not end up in hospital. Podiatry is one of those. We must ensure that people get the training, that they can afford to do so, and that they can have a great career in the NHS or with local authorities. We need to talk to universities about exactly why they are not attracting the kind of numbers they need to justify the courses.
I should have declared an interest at the beginning: I chair the vascular and venous disease all-party parliamentary group. One thing I am being told loud and clear—I have done a lot on this—is that because we have taken the nursing bursary away from older students, they find it difficult to go on the courses that I am describing. That will have a real impact on the numbers of nurses available to do those important jobs. If we do not address that issue, in a place such as Cornwall, where diabetes is a significant problem, the pressure on urgent care will be enormous—if it is not already.
Last week, our general district hospital—the only one in Cornwall—closed to the public, because a spate or outbreak of vomiting and diarrhoea put a lot of people from nursing homes and others into hospital. In that situation, the system rallied and did some amazing work to cope, ensuring that no one who needed care was failed, but it was also an example of why we need to work equally hard, if not harder, to ensure that at the best of times and the worst of times people get the best healthcare available.
The NHS in Great Britain is the envy of the world. We need to be careful always to remember how fantastic our system is. Last week, my brother and his wife came back from Cambodia with stories of trying to get healthcare there—they have two young children—and that reminded me of how fantastic our health service is, as are all those who work in it.
Many patients were prescribed controlled drugs, so first thing in the morning, at 8 o’clock, we might have had two or three CDs to do—but trying to get someone else to check the CD was a nightmare. There were just not enough hands on deck, which meant that people were sat waiting in pain for analgesia when they had gone all night and were due that dose. Sometimes a patient needed a blood transfusion, which was a really tricky process. They had to be monitored the whole time, but, again, that was done for one person and there were eight patients, so the nurse was running around all the time. It felt unsafe and the nurse felt really bad because they wanted to deliver good, safe patient care.
A patient might be close to death and need to be monitored, because the nurse could tell visually whether they were in pain, but there were seven others to look after. The relatives wanted someone to sit and talk to them, which of course the nurse wanted to do, but they did not have the time. In addition, there were other tasks such as changing dressings, monitoring pressure areas, and speaking to social workers, physiotherapists and occupational therapists about assessments, as well as discharging patients. The doctor might say to a patient, “You can go home today”, but the nurse had seven others to look after. All the patient wanted was for the nurse to do their paperwork and get their meds from the pharmacy. They sat waiting impatiently and the nurse felt bad because the patient could not go home. When the nurse eventually got them out, another patient was straight into their bed and the admission paperwork had to be done. The tasks were endless, but that was the job. We did it and we loved it, but we have to have enough staff to do it properly.
No nurse can deliver care without the healthcare support workers, so this is not only about nurses. The housekeepers make the tea but because the nurses do not have time to sit and talk to the patients and their families, the nurse goes to the housekeeper at the end of a shift and says, “Has anybody told you anything that I need to know?” It is team work. If there are not enough staff to carry out the different roles, staff simply burn out and cannot deliver the care that patients need. Towards the end of my nursing career, in the two years before I came to Parliament, I worked in out-patient clinics because I thought it might be a little easier, but it was not. It never is, but I was starting to get burn-out and I did not want that to happen because I loved the job too much.
We used to work 12.5 hour shifts. We would start a day shift at seven in the morning. At about half nine, if we were lucky, we got a cup of tea, but we literally had only five minutes. At around two o’clock we got our lunch. We had half an hour and we were meant to have another break at teatime, but we never, ever got it because we were running around trying to finish all our jobs, chasing our tails and trying to get everything done. So we would have a break of about half an hour in twelve and a half hours. Then, just when we thought we were going home, it would turn out that the bank staff, the agency staff, had not turned up and we could not simply say, “I am off home.” We had to wait until somebody had been found somewhere else in the hospital and somebody was moved from a different ward. Then the handover took half an hour. Instead of going home at half seven or eight o’clock, it could be nine o’clock and we would be back again at seven the next morning. People simply burn out.
Working in our NHS is incredibly hard work in whatever role. It is not well paid, and in places such as Lincoln a few years ago when we had the pay freeze, it was suddenly decided that a consultation would be held and we were asked, “Do you think you ought pay for staff parking?” Of course, everyone said no, so what happened? We all had to start paying for staff parking: £15 a month for staff nurses who had not had a rise in years. It absolutely made us feel undervalued, and that is not acceptable. I am not surprised that people are leaving the profession.
I want to talk now about the crisis in our NHS and about some of the steps we must take as parliamentarians to address it. There are more than 100,000 vacancies in our NHS, including 40,000 nursing vacancies. The “Interim NHS People Plan”, released last month, acknowledges that
“shortages in nursing are the single biggest and most urgent we need to address.”
I agree with that, but there are many other things we need to address, too. It is true that 80% of shifts from over 40,000 nursing vacancies are covered by expensive bank and agency staff, which highlights the false economy of austerity. It makes no sense financially. I will say this again and again: the removal of the nursing bursary in effect means that nurses are not training. I know I will get the answer back about how wonderful nursing apprenticeships are and how other wonderful things will happen, but the stark truth is that nurses are not training. So the NHS long-term plan and the talk about all the extra places for nurses is pie in the sky if we have not got the nurses training. It will simply not happen.
I am particularly concerned that applications from mature students have decreased by 39%. People no longer have the support that I had when I trained as a mature student. I was 39 when I started my training. The RCN is calling for the Secretary of State for Health and Social Care to be accountable to Parliament for making sure that there are enough health and care staff with the right skills in the right place at the right time to care for patients, based on population needs now and in future. Support for that must be, as my hon. Friend the Member for Wolverhampton South West said, cross-party if it is to happen. This or any future Government must ensure a credible, costed workforce strategy. Our healthcare workers must feel confident of delivering the very best care, and our patients must feel happy with the care they receive. A worn-out and demoralised workforce is not what the patients or any of us want to see.
Patients watch nursing staff doing their best to look after them. Some of them used to say to me, “Do you ever stop and take a breath?”, and I would jokingly say, “No, but I still don’t get thin, do I?” They have to wait their turn longer than they should for the care that they need, and that is not what we want to see. So I really hope that the Minister is genuinely listening and does not give me the usual answers: “We have got apprentices and we have got this and we are doing that, and all this money is going in, so we will get lots of nurses and it will all be all right in five years’ time.” I want someone to take notice and listen to me as an ex-nurse and make sure that hardworking NHS staff will be equipped to deliver the care that is both safe and effective for them and for their patients.
We met the Minister to raise the issue a few weeks ago. He was incredibly helpful and I thank him for his time and his response. I very much welcome the commitment to procure additional emergency ambulances. I understand that as a result of our campaigns an additional £8 million has been allocated to the North West Ambulance Service. That could be good news for south Cumbria, but only if the ambulance service allocates it in the way that we have asked. Ministers should be held to account for whether the ambulances materialise.
Mental health is another element of workforce planning that I want to raise—particularly provision for children. Four years ago the Government promised a bespoke one-to-one eating disorder service for young people in Cumbria. For young people in south Cumbria that promise remains nothing more than words. The specialists have not been recruited and the service still does not exist. I should love it if the Minister would tell me exactly when we can expect our young people to have access to the service. When will the promises be kept?
I welcome the Government’s commitment to preventive healthcare, set out in the NHS long-term plan. However, again, promises are not being fulfilled. In our area, cuts to the public health budget mean that the NHS in Cumbria currently spends only £75,000 a year on tier 1 mental health preventive care for children. That works out at just 75p per child per year. Proper investment in public health would ensure enough money for a mental health professional for every school and college, if we could recruit them, keeping young people mentally healthy and making sure that problems did not become so severe further down the line. It would also ease the burden on our massively oversubscribed local child and adolescent mental health services, and relieve the pressure on our brilliant but overworked teachers.
In our area, there is a problem with people moving out of NHS provision to work privately, particularly in the delivery of dental services. More than half of adults in Cumbria have not had access to an NHS dentist in the past two years, while one in three children locally does not even have a place with an NHS dentist. Much as with ambulances, the impact of the lack of a workforce of sufficient size is felt particularly acutely in rural areas. Insufficient NHS dentistry provision has resulted in families having to make ludicrously long journeys to reach the nearest surgery with an available NHS place. Often, people are unable to make those long journeys, or to afford to make them.