That this House has considered the nursing workforce shortage in England.
It is a genuine pleasure to serve under your chairmanship, Ms McDonagh. I start by recognising the skills and expertise that nurses bring. Nursing shortages impact on patient care and staff wellbeing. Wherever there are people, there are nursing staff. They work in public services, across the NHS, social care, public health and the independent sector. They are with us at every stage in life, from birth to death. I am grateful for all that health and care staff do in my constituency and across the country.
This debate was secured in response to petitions handed in by nurses from the Royal College of Nursing, calling on the Government to fix the workforce crisis. I am pleased to be their voice—and that of everyone who works in the health profession—in Westminster today, and call on the Government to do all they can to tackle nursing shortages, which have huge knock-on effects on our NHS and wider health and care system, as well as on patient safety and staff wellbeing.
There are about 40,000 nursing vacancies in health and care services in England. In my region, the east of England, the nurse vacancy rate is 10.7%, which amounts to more than 3,600 nurses. Worryingly, the vacancy rate for mental health nurses in my region is even higher, at 15.3%. Nurses are crucial in health promotion and improving population health, yet the numbers of health visitors, school nurses, community nurses and district nurses have dropped at a rapid rate and are in long-term decline. We need to see significant growth in the NHS cancer workforce as well.
I expect that the Minister will tell me that almost 8,000 more nurses work in the NHS since this time last year. Although that figure is correct, it must, as with all stats, be viewed in the relevant context. That is a growth rate of just 0.4%, which is nowhere near the scale needed to provide enough nurses now or in the future. The pace of growth is not sufficient to reassure patients that we have a workforce ready to meet their needs, and it is nowhere near the rate needed to cope with the increasing demands that are predicted to be placed on the NHS by our ageing population.
For every NHS nurse employed in hospitals last year, there was an equivalent of 214 admissions. Patient need is rising faster than the growth in our nursing workforce. Social care and public health are also without thousands more nurses. It is difficult to calculate the number of vacancies in those settings because the data is incomplete. We have no understanding of plans to support and fund social care, which I hope the new Minister will confirm are a priority.
Nursing shortages directly impact on patient safety. Even with the small increase in staff numbers, hospitals and other services are struggling more than ever. Last week, the RCN published findings from a survey of emergency care nurses, who are increasingly forced to provide care in corridors. Some 95% of survey respondents said that patient dignity is compromised, and 92% worry that patients may be receiving unsafe care. December saw the worst performances on record for A&E departments in England, with every single department failing to meet the four-hour waiting time target. Those stats should alarm us all. Chronic underfunding has led us to this point.
Trust papers from Bedford Hospital, a district general in my area, show just how intense the pressures are on our frontline workers. Staff are doing as much as they can to keep patients safe and to provide high-quality care, but the situation is outside their control. Staffing shortages are systemic, and addressing them requires political will and action.
The hon. Gentleman mentions staffing shortages. My vast and remote constituency, which has a large and ageing population and is the most remote mainland constituency in the UK, has problems not only with recruitment but particularly with retention. Health is devolved to the Scottish Parliament and Scottish Government, but as and when the UK Government develop an approach to keeping people in the most remote and rural areas, where they are needed most, I hope that that intelligence will be shared with the Scottish Government.
The hon. Gentleman is absolutely right. There are nursing shortages in every part of the country, and nurses are struggling to provide good care. I will come to that point in a moment.
Nursing shortages also impact on staff wellbeing. One testimony from an emergency nurse describes the realities of working in the profession:
“When I witnessed elderly patients being assisted onto bed pans while on ambulance trolleys, surrounded by paramedics, other patients on trolleys, and relatives all squashed in a freezing corridor…I realised that I can no longer preserve or protect my patient’s dignity, and that I am failing them as a nurse. Dignity is the first thing that the patients are stripped of when in a queue in a dark, cold corridor, closely followed by safety.”
Sharon, a community nurse who recently responded to a House of Commons digital debate on this Westminster Hall debate, said:
“I have worked in my locality for four and a half years. In that time, we have never been fully staffed. This puts enormous pressure on the whole team and many people have left because of it. Often, we are rushed, we forget things, and we cannot give the quality of care that we would like as we are just too thinly spread. Many of us end catching up on our notes or management at home, working way over our contracted hours. We are exhausted, frustrated and disappointed.”
This is an appalling situation for all concerned, and I know from these responses that this happens daily in hospitals up and down the country. Talk of a winter crisis is meaningless when staff and patients experience crisis every day, all year round. We must all focus on fixing this.
There is a long-term plan for the NHS, but its ambitions are dependent on having enough nurses. We have no funded workforce plan, even though it was promised by the Government when they announced the funding allocations back in the summer of 2018. Will the Minister tell us when the long-promised NHS people plan will be published, and whether it will include bold and funded policies to recruit, train and retain vital nursing staff to meet the needs of our population?
My hon. Friend makes some important points about the pressures facing nursing in England and the cost of living. Does he agree that one way that this could be resolved is by supporting bursaries and offering more financial support to student nurses? The Welsh Labour Government have kept those throughout this entire period, ensuring that the bursary was not scrapped in Wales.
My hon. Friend is right. Cuts to bursaries have impacted hugely on the recruitment of new staff. The Welsh Government did the right thing in a difficult situation. If we do not look after our staff, it will be hard for them to stay in the profession. That is why we have a shortage of nurses.
As a father of four children, I believe that financial barriers to education must be removed so that everyone who wants to go to university can do so, particularly those who want to become nurses. We should encourage young people to train in these critical professions. Why are the Government putting up barriers to young people who will go on to contribute such vital services to society and saddling them with huge debts before they have begun working?
This problem has been years in the making. Such stark shortages do not occur out of the blue. In England these shortages are due to the complexities of political decisions and structural issues.
As has been mentioned, these issues are compounded in rural areas, where we have problems with recruitment and retention. A cottage hospital called Stratton in my constituency has just had its minor injuries unit closed overnight due to nurse shortages. What more can we do to promote staff retention across the whole of the UK?
The Government must listen to nurses and the Royal College of Nursing. They are pleading for the Government to act now. Getting nursing bursaries back in action might help, but the problem is now so deep that we must take urgent action to tackle it.
This problem has been around for a long time. It is not a short-term problem. It will affect us in the long term unless we act now. Who is responsible for the health and care workforce? It is shocking that no one is. There is no clarity in law on the role of and responsibility and accountability for growing and developing our health and care workforce, or the various layers that drive our health and care services.
A nurse walking on to a short-staffed shift has no option but to carry on. The buck stops with them. They carry the professional, physical and emotional impact. Nurses have no power to recruit more staff. That is true of all professionals in our taxpayer-funded health and care services, including nurses, medics, physiotherapists, psychologists, social workers, support workers and many others. The Government should be accountable for the provision of the labour market that staffs our health and care services. The taxpayer must be assured that the services they have paid for are safe and effective.
The former MP for Wolverhampton South West, Eleanor Smith, who is also a nurse, was here last summer setting out the same concerns. This is the 37th debate on workforce issues in health and care services since 2017, and it will not be the last. In recent responses to parliamentary questions, the Government have considered the merits of safe staffing legislation and ways to close the workforce accountability gap. The Royal College of Nursing has been campaigning, along with several other health organisations, for accountability to be secured in legislation, so the Government’s consideration is welcome.
The long-term plan Bill is the way to make progress on that agenda, but it must include an explicit framework for the role of and responsibility and accountability for workforce supply and planning at all levels at which decisions are made across the system, including the Government. Achieving accountability in law provides an opportunity to safely staff our health and care services in the future. I hope the Minister will commit to safe staffing legislation for England and update us on what her Department is doing to ensure that the NHS long-term plan Bill is forthcoming. Will that Bill explicitly provide for accountability for workforce provision?
I congratulate the hon. Member for Bedford (Mohammad Yasin) on securing this debate. Although this debate is about nursing shortages in England and health is a devolved matter in Northern Ireland, I believe we are experiencing the same problems in Northern Ireland that exist in Wales, Scotland—as mentioned by the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone)—and the whole of the United Kingdom. The solution must be UK-wide.
The Minister has responsibility for England, but I want to refer to things that are happening in Northern Ireland, which I believe the UK Government can change to the benefit of the devolved Administrations. We are currently facing a crisis in nursing care. Although nurses in Northern Ireland have received a pay increase, which they deserve, that does not ease the conditions in which we are asking them to work. Those conditions are the same as in England, Scotland and Wales.
During the election, nursing was perhaps the largest issue I was confronted with on the doorstep, along with the dysfunction of the Northern Ireland Assembly, which, although we are not directly responsible for it, people still wanted to talk to us about. When we got past the misinformation that had been fed to people in a deliberate attempt to skew the vote, it was clear from speaking to nurses that, although the pay issue had been an insult to them, they had genuine concerns about staffing levels—the subject of this debate. The concerns I heard on the doorstep were clear to me, as I am sure they were to all hon. Members from across the United Kingdom of Great Britain and Northern Ireland. There was a genuine concern that the everyday nurse felt guilty about taking annual leave; they felt that they were letting people down by having their hard-earned time off. That should not be so.
The health service in Northern Ireland has a registered nurse vacancy rate of 11.6%, equating to precisely 2,103 empty posts, as well as a shortage of 421 nursing assistants. The cost of employing nurses via agencies has increased from £10 million in 2012-13 to £32 million in 2017-18. I know that the last few years, with a non-functioning Assembly, were an issue regarding the employment of agency staff.
The hon. Member makes an extremely interesting point. At the last election, constituents and voters said to me on the doors that they would prefer that nurses were employed by the public purse—by the Government—rather than via an agency, which, by definition, makes a profit on the salaries for those nurses. I suggest that the general public does not like that and, if I am reading him correctly, he does not like it either.
I thank the hon. Gentleman for his intervention, and that is exactly what I am saying. I know that the Health Department in Westminster does not have responsibility for recruiting nurses in Northern Ireland. The Minister in Northern Ireland now has, and he has made the first step towards addressing that issue. It is hoped that over the next couple of years the number of vacancies—over 2,100 nursing posts, as well as 400-odd nursing assistant posts, making about 2,500 vacancies in total—will be addressed. We hope that the cost of agency staff and the extra financial burden created by the fact that agencies are profit-making organisations—this is how they make their money—will be addressed in a way that helps to reduce the shortcomings.
This situation means that nurses cannot simply work their 37.5-hour working week. They are called in on days off and asked, “Can you do the twilight shift? Can you give me a couple of hours?” That is not the fault of the ward sisters; they need the floors covered and are under pressure. It is simply that we do not have enough full-time working nurses in the NHS. That means that conscientious nurses, who do not want to leave the ward or the district short, are working additional hours themselves, and not in the short term to save money for a holiday or a renovation of their house. Instead, they are consistently working overtime to help on the wards, and so they are not getting their family time, their social time and—more importantly—their rest time
I have had glimpses of this situation. Some 6,500 nurses live in my constituency, so I have regular contact with them. I got a brief glimpse of the work of a nurse during my surgery and was in awe of how they stayed on their feet, and remained both sharp and compassionate —as they do. Doing all that with no rest is simply unsustainable. So, for a better system and a better caring system with better nurses, who are more able to work within that system, we need to address the shortage of nurses.
The hon. Gentleman is making an excellent point about that young lady. There is one way that the NHS might be able to support her. NHS Property Services owns huge amounts of land around the country on the public estate, and I know that the Government are putting together a key worker policy, for there to be a 30% discount for local people in the housing policy, like a local homes discount. Does he think that if we included nurses within that category that we might be able to address some of the challenges that we face, by giving people discounts and getting them into the profession?
I thank the hon. Gentleman for that intervention. I was not aware of that proposal until now, but it certainly seems like a way of incentivising people—for some people. Let us be honest; it will not suit everybody’s circumstances, but it will suit some people’s. Whatever we can do to incentivise nurses to stay in the profession is good. I will give a third example, if I may, of the reasons why nurses are not staying in the profession, but some of the things that the hon. Gentleman referred to would be helpful.
I met one woman in her 30s in my office who wanted to go into nursing, but she could not do so because her tax credits would not allow her to stop work while she got her national vocational qualifications and other qualifications. So, reluctantly, she gave up and we lost her. She is not the only one we have lost; we have lost many more than that.
I know that in Northern Ireland this issue is not the responsibility of the Minister who is here today, the Minister for Care, the hon. Member for Faversham and Mid Kent (Helen Whately); I understand that. However, will she ask the Minister who has the portfolio for tax credits to review the circumstances around tax credits and the circumstances of those nurses who are trying to get their NVQs, and have to stop work to do so? If we are losing nurses because of an anomaly in the system, let us try to address that anomaly, to allow us to retain the nurses who want to be retained.
My mother was a nurse. That was a long time ago; my mother is coming up to 89 now. I know that for her nursing was a vocation, as it is for many other people. In today’s busy life, it is important that we try to help those who want to be in nursing for the rest of their lives to retain their position. However, that was a young girl in her thirties in my office who wanted to go into nursing and unfortunately we lost her.
We lost someone who wanted to train as an intensive care unit nurse, because the current system could not work with her and her four children. Can we do better in helping mature people to come out of retail and enter education, while still having their children cared for? There are many such people across the nation and across my constituency. There are also a great many people who are former nurses, and we should try to recruit them back into the system as well. There comes a time in their life, perhaps when their children are a bit older and they find themselves with a bit more time on their hands, so what are we doing to attract the more mature nurse into the profession that they once wished they were in?
I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this excellent and timely debate.
I speak today as the newly elected chair of the all-party parliamentary group on cancer. Currently, there are 3 million people in the UK living with cancer, and that number is set to rise to 4 million by 2030. In a survey conducted by Macmillan Cancer Support, more than two thirds of cancer patients said that they are not getting the support they need from the NHS in England, and that is because the NHS is buckling under increased workforce pressure.
The healthcare system is facing a staffing crisis that is crippling frontline services and affecting the care that patients receive. There are more than 40,000 nursing vacancies in the NHS workforce, and Government figures show that waiting times for cancer treatment and diagnosis are at record high levels.
Every day across England, NHS professionals work tirelessly to give people living with cancer as full a life as they can. They are stretching themselves and working harder every day to meet rising demand, but the harsh truth is that there simply are not enough professionals with the right skills to meet the needs of the growing cancer population. That is why I support Macmillan’s “Save our support” campaign. I was delighted to attend its parliamentary reception in January, along with nearly 140 parliamentarians who came to speak to frontline healthcare professionals and people with lived experience of cancer.
The NHS played a key role in the general election debate. Although the pledges on nursing numbers in the Tory party manifesto were welcome, it is imperative that we see the full NHS people plan for England published so that we can see how the Government intend to deliver on their commitment to grow and support the NHS workforce. Overall, we need a Government that get their numbers right and deliver on their promises.
It is a pleasure to serve under your chairmanship, Ms McDonagh. I am grateful to the hon. Member for Bedford (Mohammad Yasin) for securing this debate today, and also grateful for his summary of the issue. He is correct to say that the growth in nursing numbers is nowhere near enough. I agree with him on the importance of investing in the NHS and the nursing workforce.
I am also grateful for the work of the Royal College of Nursing in highlighting the issue, including the recent petition with more than 200,000 signatures that was presented to the Prime Minister in February and called for action to remedy the staffing shortages as a priority. We know that there are some 40,000 nursing vacancies in England, and one in three nurses are due to retire within the next 10 years. In Scotland, of course, this issue is devolved, and in normal circumstances I would not interfere in a debate focused on the issue in England. However, devolved Administrations do not operate in a policy vacuum. UK policies, such as those on Brexit and immigration, affect all parts of the UK, so I will contribute to the debate today. Nor do I feel alone in this matter as several of my Celtic cousins have already spoken in the debate, and the issue benefits from hearing about what happens in Northern Ireland, Wales and Scotland.
NHS Improvement reported in September last year that the latest nursing vacancy rate in England stood at 12.1%. Information Services Division statistics show that NHS Scotland’s nursing and midwifery staff vacancy rate was 6% in the same month. Qualified NHS nursing levels per head are already 46% higher in Scotland than in England. For nursing levels in England to match Scotland’s, they would need to increase nursing numbers by more than 130,000. That puts the 50,000 nurses that were promised for England into a certain context. Consequently, there may be lessons we can learn from how each of the four national health services operate, and I hope my observations on the differences between the two countries’ nursing numbers are seen as constructive and helpful.
It is a pleasure to see you in the Chair, Ms McDonagh. I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on having secured this important debate, and on the thoughtful and knowledgeable speech he has given about the challenges currently facing the nursing workforce. He made some very interesting points: the reference to nurses being there at our birth, at our death and throughout our lives was an important and moving reference to how much we all rely on nurses. He mentioned the 10.7% nursing vacancy rate in his region, which is a staggering statistic; there are actually some variations within that, because the vacancy rate for mental health is even higher, at 15.3%. Those huge variations across disciplines need to be addressed by the Government.
My hon. Friend also referred to the RCN’s survey of its members, in which a staggering 95% of nurses said that patient dignity is compromised and 92% felt worried that patients may be receiving unsafe care. That should be a red-light warning for us all about what is going on in our NHS. What he said about the professional attitude and sense of duty that nurses feel was particularly important: when a nurse is at the end of their shift but sees something that needs to be done, they carry on. They are professional, but they carry the impact of that with them, and we have been relying on their good will to keep the NHS going for far too long. Finally, my hon. Friend referred to this being the year of the nurse and the midwife, and was absolutely right to say that we should celebrate this diverse and dynamic profession.
We heard from the hon. Member for Strangford (Jim Shannon), as we often do in these debates, who gave his own perspective from Northern Ireland. He referred to the recent dispute there, and it was clear from what he said that the concern was as much about working practices as it was about pay. He was right to say that workforce challenges there are often mirrored here. The hon. Gentleman also referred to a worrying increase in the agency bill in Northern Ireland, which may well be partly related to the greater flexibility that agency work can sometimes provide to nurses. That is something we need to reflect on when we consider working practices.
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Nursing students in England can receive grants of up to £5,000 a year, and for some they can go up to £8,000. However, these do not reflect the true cost of living. Just as importantly, tuition fees are also a huge burden on nursing students, and it is important that this is addressed in the forthcoming Budget. As a father of four, I believe that financial barriers to education must be removed.
I suspect the Minister will want to discuss the Government’s promise of 50,000 more nurses over five years. We have heard a lot about that commitment but not in detail. How will 50,000 more nurses be recruited, especially when the Government appear to be ramping up the hostile environment rhetoric and making the UK as unattractive a place as possible to come and work? The loss of many NHS workers from the EU is a tragedy.
Bedford Hospital had to recruit 237 nurses from Australia, India and elsewhere to fill vacancies left largely by EU nurses who left because of their fears for the future and the ill treatment they received in the UK. It is a testament to the hard work of the hospital’s chief executive, Stephen Conroy, that, despite those staffing difficulties, the hospital is projected to reach full recruitment of band 5 nurses for the first time in many years, but that will be achieved only by recruiting nurses from overseas.
We also need to increase capacity in clinical placements, to support nursing students at universities. How will the Government achieve that? How many nurses do the Government expect to retain? When will the Government publish their plan in full? Will the Secretary of State report on progress made in this Parliament?
This year, the World Health Organisation is celebrating the first ever year of the nurse and the midwife, at a time when the spotlight is on the nursing profession across the globe. As their elected representatives, we must stand with them and celebrate this diverse and dynamic profession. I will do everything possible to ensure that our health services are staffed safely. It must be a priority for us all. The problems are well known. The evidence continues to mount. We need decisive action, but we are not getting it from a Government drowning in Brexit uncertainty. Nursing staff need action now, as do their patients. We cannot wait any longer.
I had a meeting with the Royal College of Nursing some six weeks ago in my office, and I welcome the fact that the Northern Ireland Assembly is up and running. I also welcome the fact that the Minister who has responsibility for the Health Department in Northern Ireland, Robin Swann, has committed to recruiting more nurses. I understand that 700 nurses will be recruited, which will go a long way to addressing some of the empty posts. However, that will still be only a third of the way to filling all the vacancies that exist; the other two thirds of vacancies also have to be filled.
It used to be the case that bank nurses were only used in an emergency, but now they are used ever more frequently and their use is becoming the norm. They are no longer just used in the emergency. Using them is now just the fall-back position: “Let’s just do it”. That is not good either for morale or for finances—the current finances clearly indicate that it is not. It is more costly to have agency staff in than it is to have nurses on full-time pay.
I will give another example, of a nurse who approached me in my office and asked me to clear up rumours about nurses, their employment and so on. She is a young nurse in her early 20s who has been working at the Ulster Hospital in Dundonald—the main hospital in my constituency—but she has been left as a staff nurse in charge at night on numerous occasions. What she said to me was simple; she just said to me, “Jim, keep the pay rise and please give me an extra nurse per shift.” That was her initial reaction, because she can feel the pressures of delivering this system, and was saying, “I physically can’t do it all for much longer”.
This is a lovely young girl who is dedicated and good at her job, but who knows that when she has kids she will not be able to work 60 hours a week. She is asking me to do something about that, and today I am on the path towards doing something; I am highlighting this issue. I am very happy to do so.
There must be a way of doing that. I believe that it is up to us in this House to address these two issues, which are so closely linked: getting more nurses; and making a clear way forward to allow mature people to choose nursing, not simply as their job but as their vocation and their calling.
I have concerns that the interim NHS people plan published last year contained no specific actions for cancer services. Without a clear plan for cancer, the NHS will not be able to cope with the demand caused by the rising numbers of people living with it. There are concerns that the NHS people plan will not be as ambitious and will not have the committed funding made available to ensure that it delivers for the 4 million people likely to be living with cancer by 2030.
According to a recent Health Service Journal, 20 of the UK’s largest cancer charities recently wrote to the Secretary of State to raise their strong concerns that the NHS people plan falls far short of what is needed to support the welcome ambitions within the NHS long-term plan on cancer survival and care across England. Will the Minister please confirm when the NHS people plan will be published, and will she provide assurances that the Government will provide the necessary funding and resources to ensure that it can meet its ambitious targets on cancer?
The Government’s target to have an additional 50,000 nurses in the NHS relies heavily on increasing staff retention. Macmillan Cancer Support published a report last year, “Voices from the frontline”, which underlines the important role that continuing professional development can play in supporting and retaining staff. The report reflects the views of lead cancer nurses from across England, focusing on the challenges that they and specialist cancer nurses face in accessing CPD opportunities and the impact of that on cancer care. Some 44% of lead nurses felt that their workload negatively affects the quality of care that they can give to cancer patients; 39% said that their current workload is unmanageable; and 44% say that the strain negatively affects their morale.
Macmillan professionals said that they had faced three main barriers to accessing CPD: a lack of protected time, funding, and locally available courses. Only a third of the specialist cancer nurses surveyed had protected study time to access and attend CPD training. A quarter of survey respondents reported that the availability of CPD training has worsened over the past two years.
Cancer clinical nurse specialists report that CPD is essential to the delivery of high-quality personalised care for people living with cancer. More than three quarters of respondents to the Macmillan survey were clear that having more time for CPD would help them improve care for people living with cancer. To address that, the Government should immediately return the CPD budget to at least £205 million, the level it peaked at in 2015-16 before budgets were cut, and not by 2024, which is the Government’s current plan. To ensure that the NHS has the well-trained and motivated cancer workforce it needs, will the Minister therefore please provide reassurances that the Government will return the CPD budget to at least £205 million to support the NHS people plan?
It would be remiss of me to stand here as a Welsh MP and not mention that the budget challenges we have spoken about are, as the hon. Member for Strangford (Jim Shannon) has highlighted, pan-UK issues. I understand how health services are devolved and that the challenges are ones we deal with every day, but we are losing experienced nurses quicker than we recruit them. We are on the edge of a full-blown crisis. I am very happy to stand here and say that the Welsh Government have an ambitious NHS workforce plan to train and recruit, and they have kept the nursing bursary. We need a positive action plan that will move quickly. In Wales we are moving quicker than the UK Government, so what are the UK Government doing?
As a former teacher I know what it is like to inspire young people to go into the teaching or nursing profession. What are the Government’s commitments? We need to work with our young people. Once they start on their journey into a profession, we need to highlight the benefits of working in the healthcare system. It could be a 12-year journey to become a senior nurse. By that time it is a little too late, because we have not trained them up in time to deal with the current crisis. What are the UK Government’s plans to recruit from overseas? We need to deal with that.
Lastly, it is important to dispel the myth around the funding that has been made available to the NHS in England. The NHS Funding Bill, which recently passed through both Houses, does not represent new money. It was first announced by the right hon. Member for Maidenhead (Mrs May) in June 2018 and does not cover the budgets for Health Education England, which include education and training for the extra nurses that the NHS in England desperately needs.
As part of the Budget next week and the comprehensive spending review later this year, it is crucial that the Chancellor supports people living with cancer across the country and ensures that the NHS people plan and Health Education England get the funding that they need to deliver the ambitious cancer care targets in the NHS people plan.
NHS staffing per head is 26 staff per 1,000 people in Scotland, whereas England’s is 19.7. Those figures are from September and August last year—I could not get the months to match, but it sets the pattern. There are more qualified nurses and midwives per 1,000 of the population, with 8.1 whole time equivalents in Scotland versus 5.5 in England. Why is that? The number of people in Scotland choosing a career in nursing is increasing, and bursaries are undoubtedly one reason for that. Bursaries for student nurses in England were scrapped as part of the Tories’ austerity measures, a policy that led to a drop of more than 30% in nursing applications. In stark contrast, those bursaries were protected and increased in Scotland by the SNP Scottish Government, and nursing student numbers in Scotland have increased for seven years in a row. One of the big differences is that in Scotland, nurses will receive a bursary of £10,000 a year from next September, and already benefit from free tuition. The UK Government pledged a £5,000 annual grant for student nurses from this year—only half of what we are offering in Scotland—and still expect nursing students who train on the job to pay thousands in tuition fees. I believe that figure in England is around £27,750, a stark contrast to the figure in Scotland, which is zero.
Nurses in Scotland across all bands are better paid than elsewhere in the UK, which also helps to make nursing a career choice and benefits retention. Training more nurses is key to addressing this issue. The latest UCAS figures show a 2% increase in people from Scotland choosing nursing as a career, but a decrease of 4% in the English figures. Meanwhile, a report last year by the Nuffield Trust, the Health Foundation and The King’s Fund concluded that the NHS in England has no chance of training enough GPs and nurses to solve the shortages it faces. This suggests that in order to address the current and future shortages, we need to look elsewhere.
That leads me on to the topic of immigration. EU nationals make up 10% of the medical workforce, and we should be concerned about the insight into their mindset provided by the 2018 British Medical Association survey of 1,527 EEA-trained doctors across the UK, which found that 35% were considering moving abroad. Of course, only time will tell what actually comes to pass. However, immigration to the UK has fallen to its lowest level in six years according to the Office for National Statistics, and Cambridge Econometrics’ analysis states that leaving the single market will see the working-age population fall by nearly 2% by 2030, which is equivalent to 790,000 people.
The challenges with recruitment are not going to get any easier. On 15 November, the King’s Fund, the Health Foundation and the Nuffield Trust predicted that NHS England staff shortages will rise to over one in six health service posts by 2030. Clearly, we must attract skilled workers from abroad, but the UK Government’s regressive immigration plans look set to make the situation worse. At this time, details of a UK NHS fast-track visa scheme remain unclear, and I look forward to hearing those details; perhaps the Minister will enlighten us. With regard to the proposed points-based immigration system, I assume that nursing will be classed as a shortage occupation, which would require a £20,480 minimum salary. I believe it must be on the shortage occupation list, but also that it should be exempt from any salary threshold. The Library briefing for today’s debate gives us the RCN’s opinion of the points-based system:
“We are concerned that these proposals from the Government will not meet the health and care needs of the population. They close the door to lower-paid healthcare support workers and care assistants from overseas, who currently fill significant numbers of posts in the health and care workforce.”
I also echo their calls for the introduction of an immigration system that supports nursing, and to exempt nursing staff from the immigration health surcharge, which seems an unnecessary burden to put on people coming here to relieve our own health crisis.
I will finish with a quote from the RCN’s general secretary, Dame Donna Kinnair, who has said that there are
“43,000 vacancies in the NHS in England alone. Yet failure to increase nurse numbers isn’t inevitable, but a political choice. We need proper financial help for nursing students in every nation of the UK in order to ensure the supply of nurses in the future, and clear legal duties for governments and NHS leaders across the UK to ensure there are enough nurses to provide safe care to patients.”
It is indeed a choice, and I hope that my Scottish comparisons and views on immigration help to inform the choices facing NHS England.
As always, it was a pleasure to hear from my hon. Friend the Member for Gower (Tonia Antoniazzi), who I congratulate on her appointment as chair of the all-party parliamentary group on cancer. She was right to highlight patients’ concerns that they are not getting the care they need, the reason for which is inextricably linked with the staffing shortfall. She was also right that it is vital that the full people plan be published as soon as possible, and to raise the concern that the plan will not include the funding it needs to meet our ambitions. Only last month, the Government introduced the NHS Funding Bill 2019-21, so we already have the parameters for funding the healthcare system over the next three to four years. Really, it should have been the other way around; we should have established what the staffing need was before we put a financial envelope around it.
My hon. Friend also referred to the excellent Macmillan report, “Voices from the frontline”, and the concerns it expresses about the lack of ability to access continuing professional development. She highlighted the impact on retention caused by cuts to the CPD budget, and the report’s references to many nurses feeling that their current workloads are unmanageable. My hon. Friend has said that we are on the edge of a full-blown crisis; I could not agree more.
I pay tribute to the 1.9 million or so dedicated and hard-working people who work across both the health and the social care sectors; it is always an honour to speak up on their behalf. Our NHS is built on its staff, and in particular our nurses and midwives who, as we have heard, go the extra mile day in and day out, despite too often finding themselves under intolerable levels of pressure. It is a damning indictment of this Government’s record that despite this being the 37th debate in this place over the past three years on workforce shortages in health and care settings, there is still no plan to address this crisis. It is not over-dramatising matters to describe it as an existential crisis, because following nearly a decade of mismanagement and underfunding, we are facing a very real recruitment and retention crisis in the NHS. Years of pay restraint, cuts to training budgets and growing pressures have left us with a chronic shortage of over 100,000 staff.
Those shortages affect patient care every single day. They manifest themselves in the NHS performance data, which month after month show hospitals with the worst performance data on record. That will not change unless the workforce shortages are acknowledged and addressed. The proportion of people being seen within four hours in A&Es is the lowest on record, and the number of people waiting four hours or more on hospital trolleys is the highest on record, as is the number of people waiting 12 hours to be admitted and the total number of people on the waiting list in England. Targets for patients to receive treatment within 18 weeks have not been met for four years now, and there is no sign that that situation will improve any time soon.
The Government need to take seriously the growing gap between the number of nursing staff and the number of people who need healthcare. As we know, the Royal College of Nursing estimates that there are about 43,000 nursing vacancies in the NHS in England alone and warns that the nursing shortfall will rise to almost 48,000 by 2023 and a mind-boggling 108,000 by the end of the decade. That is a staggering figure. To put that in context, it is more than every man, woman and child living in the Minister’s constituency—picture that. That is how much of a shortfall we could face by the end of the decade, if action is not taken.
The effect of staffing shortfalls on patients must never be underestimated, but they also have an effect on staff. NHS staff are consistently asked to take on additional responsibilities, to work harder, to do more intense shifts and to take on excessive numbers of patients. All the surveys show the effect that that has on them. It is worrying, but not surprising, that only a quarter of respondents to the NHS staff survey published last month agreed that there were enough staff for them to do their job, and that more than two thirds per week worked additional unpaid overtime. As we heard, higher numbers of emergency care nurses—more than nine in 10—are worried that patient dignity is being compromised and that patients may be receiving unsafe care.
I am sure that all hon. Members were moved by the testimony that my hon. Friend the Member for Bedford quoted. No one, patient or staff, should be in that situation. The testimony used the word “dignity” repeatedly, which should cause us to reflect on the situation that we are putting people in. I am sure that we would not want that for our family.
Staff are working in a high-pressure environment without adequate resources or support, which not only puts patients at risk but damages the mental health of staff and leads to low morale, poor wellbeing and a poor work-life balance. It is no surprise that conditions are becoming intolerable for some staff. More than 40% of NHS staff were unwell as a result of work-related stress in the last year—that is an unsustainable figure.
An analysis of NHS Digital data finds that more than 200,000 nurses have left the NHS since 2010-11; there has been a 55% increase in voluntary resignations from the NHS with staff citing a poor work-life balance as the primary reason; and the number of voluntary resignations for health reasons has increased threefold in the past 10 years. It is no wonder that the recent “Interim NHS People Plan” states that hard-pressed staff are “overstretched” and admits that people no longer want to work in the NHS. It is our pride and joy. People should positively want to go to work every day full of joy about what they are delivering for the people of this country, but the pressure is becoming too great.
It is damning that we still have no funded workforce plan, despite the Government’s promise of one when the funding settlement was first announced in summer 2018. We also still have no framework that sets out the roles, responsibilities and accountabilities for workforce supply and planning.
As has been mentioned, last month’s NHS Funding Bill was an opportunity for the Government to show their commitment and set out plans for a proper costed strategy for the workforce but, frankly, it was a publicity stunt. Despite every trust chief executive reporting that understaffing is their biggest challenge and a hindrance to delivering safe care, there was nothing in the Bill on protecting and enhancing training budgets. I acknowledge that staffing shortages are the responsibility of multiple decision-makers across all levels of the health and social care system, but ultimately, they are outside the control of frontline staff and trusts. The Government need to act to ensure that there are enough skilled staff to ensure safe and effective care.
The standards of protection and safety that are rightly expected by staff and enshrined in the NHS constitution appear to have been abandoned by the Government. Things have become so bad that NHS England has recommended that the Government review
“whether national responsibilities and duties in relation to workforce functions are sufficiently clear.”
The public are concerned and want action too. In a recent YouGov poll, 80% of respondents in England agreed that
“the Government should have a legal responsibility to ensure there are enough nursing staff to meet the country’s needs”.
The Royal College of Nursing, other royal colleges and health organisations are all calling on the Government to take action to ensure clear workforce accountability in law. Unfortunately, there has been a continued failure of leadership to bring forward the required legislation to guarantee and enshrine safe staffing levels in the NHS in England. That has left us lagging behind Scotland and Wales, which have already established explicit accountability for workforce provision.
It is vital that, as the royal colleges are calling for, an NHS long-term plan Bill for England sets out a framework of explicit roles, responsibilities and accountabilities for workforce supply and planning, through all levels of decision-making. Like other hon. Members, I am keen to see the detail of the Bill and whether it will contain the long-awaited commitment to safe staffing, in addition to a bold and fully funded workforce strategy. I welcome the Minister to her place; perhaps she will indicate when that Bill might be introduced when she responds.
The election promise of 50,000 more nurses in five years is all well and good, but without a plan for how that will be delivered and maintained in the long term it is pie in the sky. As it is British Pie Week, I cannot think of a more apposite metaphor. We all know that that figure does not stand up to even the most cursory inspection. It is not 50,000 extra nurses, but the retention of 19,000 existing nurses and the recruitment of an additional 31,000. As has already been clearly set out, retention is a huge challenge that the Government are failing on.
The Minister will no doubt tell us there has been an increase in the number of nursing staff in the last year. Of course, in such desperate times, any increase is welcome, but as my hon. Friend the Member for Bedford said, it is a miniscule 0.4%. Let us be honest: the scale and pace of the increase is not happening fast enough. There are also concerns that the figures do not reflect what is really happening on the ground, because they were taken at the optimum time to capture the new registrations before the impact of annual departures is felt.
The Government’s failure to train enough nurses will not be reversed by the recent announcement of maintenance grants for nursing students, as the grants will cover only living costs, not tuition fees. Many student nurses are slightly older and may have family responsibilities, yet the sum on offer from the Government to support them through their training is slightly less than £100 a week.
Evidence shows that, since the Government scrapped the bursary scheme in 2016, applications to study nursing have dropped by 25% in England. As we and many others repeatedly warned at the time, that was bound to happen. Adequate funding for nursing students is crucial to attract more people to study nursing. I hope, again, that the Government listen to us when we say that the U-turn is only partial and not enough to undo the damage done. It is still the case that the prospect of accruing large debts is a huge disincentive for those who want to train in nursing, especially prospective mature students who may already shoulder debt from a previous degree in another subject.
With Labour’s analysis showing that the first cohort of students who started their nursing degrees in 2017 will graduate with £1 billion in tuition fee debt, everything possible must be done to remove the financial burden for prospective students. If the Government are serious about recruiting more nurses, they need to match our commitment to bring back the nursing bursary in full, including the abolition of tuition fees.
I agree with my hon. Friend the Member for Bedford that the new maintenance grants must be increased to cover actual living costs. Given that the Government have admitted the error of their ways in removing the bursary in 2016, I hope that the Minister will set out whether any maintenance loan debt incurred by students between 2017 and 2019 will be written off.
I cannot end without mentioning immigration. The NHS plans to increase the international recruitment of nurses to reduce workforce pressures, but, at the same time, the Government are planning to raise the health surcharge that those staff have to pay. Unison and the RCN are calling for nursing staff to be exempt from the immigration health surcharge. Those staff already make their contribution to the NHS by working in it. Alongside their colleagues, they often go beyond their contractual hours to keep the service from crumbling under the pressure. It is indefensible to continue to apply the surcharge to them.
The RCN also calls for nursing to remain on the shortage occupation list and for nurses to be exempt from the salary threshold when the points-based immigration system comes into force. Given the challenges outlined today, could the Minister set out when responding what representations she has made to the Home Office about bolstering the workforce and ending the uncertainty and red tape in international recruitment? Nursing is a global recruitment market, and a challenging one at that. If the Government’s workforce strategy is over-reliant on international recruitment, it will fail, particularly when barriers are put in the way of recruitment. The myriad of reasons that have been set out about failing to improve retention rates will not lead us to a better place.