The Minister for Health (Stephen Barclay)
I pay tribute to my hon. Friend the Member for South Dorset (Richard Drax) for his assiduous campaigning on behalf of his constituents and for securing the debate. Its importance is reflected by the fact that my hon. and learned Friend the Solicitor General and the Under-Secretary of State for Wales, my hon. Friend the Member for Eastleigh (Mims Davies), were in the Chamber to listen to the points that my hon. Friend the Member for South Dorset raised.
My hon. Friend spoke passionately about the training of nurses in England and the pivotal role of training in ensuring that we have a workforce to deliver first-class services in the NHS. With a budget in which two thirds of our spend goes, quite rightly, on our workforce, the importance of that workforce is absolutely critical. Indeed, that was reflected by my right hon. Friend the Secretary of State when he set out his three key priorities for the NHS after taking over that post. He particularly emphasised the importance of the workforce within those priorities.
Nick Thomas-Symonds (Torfaen) (Lab)
I apologise, Mr Deputy Speaker, for not being here at the start of the debate. A number of constituents who have contacted me are clearly concerned about the fact that the demand for nurses is not quite being matched by recruitment at the moment, particularly in the areas of learning disability and mental health. What specifically can the Government do, in addition to what they are doing, to really focus on those two specialist areas?
Stephen Barclay
The hon. Gentleman makes a valid point. I think that we all recognise that learning disability has traditionally been one of those areas in which it is harder to recruit, compared with, for example, midwifery, where the number of applicants to training places is a lot higher. I do recognise that there is an issue.
Let me give just one example of what we are doing. When we looked at the situation in postgraduate training, particularly for more mature applicants, one of the issues was the possible impact on the area of learning disability. That was why we put in place golden hellos, with a budget of up to £10 million, to provide an incentive for applicants taking the postgraduate route into nursing to go particularly into the areas of learning disability, mental health or district nursing. That is one of the measures that we put in place to address the hon. Gentleman’s very valid point, but I am not suggesting that that alone fully deals with the issues that we need to look at, and we are paying very close attention to the situation.
I now turn to some of the specifics in the very well-put speech made by my hon. Friend the Member for South Dorset. He quite rightly highlighted the cost of agency staff within the NHS, suggesting that there could be more than half a billion pounds of savings if those staff were permanent. It is fair to say that the cost of agency staff is a key issue, and he was very fair in putting on record that Dorset HealthCare has reduced its agency staff spend over the past three years from £12 million to £4 million. That has not happened by accident. This is something that the Government have been prioritising nationally, and I pay tribute to the NHS Improvement’s work in placing a cap on agency spend in 2015, which very much addresses his point. Indeed, we have seen agency costs come down nationally by £1.2 billion since 2015, which shows the progress made under this Government.
My hon. Friend also understandably put on record his concerns about local beds moving from Portland Community Hospital to Weymouth. He mentioned the chief executive, Ron Shields. As he will be aware, Ron Shields has pointed out that twice as many patients using those Portland Community Hospital beds come from Weymouth, 6 miles away in my hon. Friend’s constituency, than from Portland. Clearly there is a benefit for patients if twice as many of those using the hospital are from Weymouth and the beds move to Weymouth. On average, four beds are taken by islanders, so it is a relatively small number, but I appreciate that it is an issue for those on the island.
However, there is a wider patient benefit, particularly for those from Weymouth. There is a benefit for all patients who move to Weymouth, because they can access a wider suite of services, including the services of a consultant with specialist expertise in elderly medicine, as part of a wider range of professional support. It is also important to emphasise to my hon. Friend’s constituents that the site is not closing; services are being reconfigured to reflect changes in the way in which healthcare is delivered. Again, that is happening nationally. As patients present with more complex needs and multiple conditions, we need to look at how we address that and how we deliver care more in the community, which is what patients want and is better for them, as well as how we better embrace technology, which is a key priority of my right hon. Friend the Secretary of State.
Richard Drax
I am listening carefully to my hon. Friend’s reply. He is absolutely right: Mr Shields instinctively would like to keep community hospitals. In rural parts of the country, and certainly in South Dorset, with an ever-increasing number of elderly people moving there, there is very much a feeling of, “Where are they all going to be?” Experience in the past has shown that the best place for an elderly person to recover is near their home in a cosy community hospital. The system works. As the beds go for the reasons I have explained—Mr Shields rightly had no choice but to do it, and it is true that the hospital will remain open—those fears will not just disappear overnight.
Stephen Barclay
My hon. Friend is right that being cared for close to home is in patients’ interests. I would actually go a step further and say that most patients want to be cared for and supported at home, if possible, because they are more likely to be mobile and to get up to make a cup of tea in their familiar surroundings. If that is not possible, they want to be in a community setting, but in that community setting it is better that they have access to a wider suite of services, including a consultant specialist, so that we can avoid the 43% of patients on average who are currently being treated in probably the most expensive part of the NHS family, the acute setting, where they are, for example, at greater risk of infection, notwithstanding the fact that since 2010, under this Government, the rate of hospital infections has halved. Even so, there can be muscle deterioration, or what one clinician called “PJ paralysis”. Staying in acute hospitals is often not in the best interests of an elderly patient, so treating them at home or in a community setting with the right support to reduce their length of stay is in their interests.
The crux of my hon. Friend’s remarks was a challenge as to what the Government are doing to tackle the need to recruit more nurses as we face a growing demographic. I remind him, as he is well aware, that the Prime Minister has committed to more funding for the NHS—a £20 billion-a-year additional funding package. There is a commitment to staff in the NHS through “Agenda for Change”, and the Government are introducing an increase in pay for nurses.
We are looking at additional pathways such as the nursing associate programme, which my hon. Friend referenced. There are 5,000 places this year and 7,500 next year. The programme enables people who perhaps thought they would not have the opportunity to be a nurse and were trapped in a particular role to have a ladder of opportunity and to move from roles such as healthcare assistant into that of nursing associate, with the option of then progressing into a nurse role.
We need to look at the nursing degree apprenticeship, and we are using the apprenticeship levy that the Government have introduced through the tireless work of the Minister for Apprenticeships and Skills. Again, that provides a great opportunity for people to progress within the NHS. We should also look at the measures the Prime Minister has taken on tier 2 visas—removing the cap—and recognise that attracting talent from overseas is an important part of addressing the concerns about recruitment raised by my hon. Friend.
We are looking at measures to give giving staff greater flexibility, such as through e-rostering, and using technology to provide greater certainty. There are also measures in relation to returning to work. Since 2014, 4,800 nurses have started on the return to practice programme to bring that talent back into the NHS. The Government are taking a whole suite of measures, because we recognise that there is a need for more nurses, exactly as my hon. Friend said.
Richard Drax
The Minister is being most kind and generous in giving way. Will the bursary return? I would have thought that the bursary was more likely to attract home-grown talent. I am not saying that nurses from abroad are a bad thing, because they are not—they all do a wonderful job—but we are always trying to train our own. If the Minister brought back the bursary, I would have thought that was more likely to attract people from this country.
Stephen Barclay
The problem with the bursary scheme was that it involved a cap on the number of places, so a massive number of people who wanted to be nurses were rejected and denied the life chance of being a nurse. The removal of the cap has allowed us to increase the number by 25%—an additional 5,000 places. That is 5,000 people who will have the opportunity to train as a nurse who did not have such an opportunity under the bursary scheme. It is also means that while they are training as a nurse, they will have a higher maintenance grant through the Student Loans Company than they did previously under the bursary system. I appreciate the concerns raised about the bursary, but this Government are all for giving people the opportunity to progress, life chances and the opportunity to increase their skills. The removal of the bursary scheme has allowed us to offer more people the opportunity to become a nurse, rather than fewer, as was the case under the bursary.
I do not want to choke off the opportunity for someone who aspires to be a nurse, but we should recognise that people want to progress at different stages of their lives. That is why the right option for some is to be a nursing associate. Some people may want to stay as a nursing associate, some may want to progress to being a nurse, and some may want to do a nursing degree apprenticeship. It is important that we offer the flexibility that people increasingly want in society so that they can pursue their careers at different rates and at different times.
The Government have taken a whole range of measures. I mentioned the “Agenda for Change” pay award, under which the pay of a healthcare assistant will go up by 26%, or nearly £4,000, over the next three years. A nurse with between three and four years’ experience will receive a 25% increase, which is more than £6,000 over three years, and a band 6 paramedic with between three and four years’ experience will have a £4,000 rise over three years. Again, as my hon. Friend mentioned, that recognises the hugely valuable contribution that staff make to the NHS.
I touched on the fact that we are looking at specific areas in which we recognise that there are issues and referred to the postgraduate golden hellos as a way of targeting recruitment. I have also said that we have lifted the cap on tier 2 visas. Under the existing arrangement, 40% of tier 2 visas were actually going to the NHS, but we have none the less lifted the cap.
I pay tribute to my hon. Friend’s campaigning on behalf of South Dorset. He is always assiduous in speaking to Ministers and raising concerns on his constituents’ behalf. We are repurposing services, but we are moving beds to where there will be better support, and these are some of the changes that will deliver an NHS fit for the future. I am happy to continue discussions with him so that we ensure the NHS continues to serve his constituents with first-class care.
Question put and agreed to.