NHS: Nurses

Tuesday 1st November 2022 Lords Chamber

Question

14:54

Asked by

[Lord Clark of Windermere]

To ask His Majesty’s Government what discussions they have had with the Nuffield Trust further to their research finding, published on 30 September, that more than 40,000 nurses have left the NHS in England in the past year.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We welcome the Nuffield Trust publication and the spirit in which its analysis was conducted. Leaver numbers should be seen in the context of overall growth in the workplace. We are more than half way to delivering on our commitment to have 50,000 more NHS nurses by 2024, with nurse numbers more than 29,000 higher in August 2022 than in September 2019 and more than 9,100 higher than in August 2021.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer, but I think his figures are a little out of date now. A record number of nurses left the profession last year, and we are now 46,000 nurses short. These figures show that the Government’s plans for nurse recruitment are inadequate. Retention of staff is the key. In view of the fact that nurses have seen their pay fall by 20% in recent years, will HMG not rectify this and give nurses the pay they deserve?

[Lord Markham (Con)]

With respect, the numbers I quoted are up to date. They take into account the overall increase. We saw 36,000 leavers and 45,000 starters in the last year, so that is an overall growth of 9,000, which shows that the work we are doing to encourage people into the profession is working.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I know how much I, the noble Baroness, Lady Watkins, and the right reverend Prelate the Bishop of London enjoyed our nursing careers; we all trained at the same place. Is there not some way in which we can encourage students to come forward to this fantastic profession so that we can make sure we have a sustainable domestic workforce here in this country?

[Lord Markham (Con)]

I totally agree. I am proud to say that we have 72,000 nurses and 9,000 midwives in training at the moment. There is no cap on the number of people who can join the programme, so that is very much the spirit of what we are trying to do. Key to that was a £5,000 grant each year for nurses to attract them into the profession. It is working.

[Baroness Brinton (LD)]

My Lords, the comment about the figures by the noble Lord, Lord Clark, was entirely accurate. The Minister gave us the truth, which is that the net increase is 9,000, whereas the manifesto promise of 2019 was for 50,000 extra. Does this explain why the Royal College of Nursing reported last week that 75% of shifts did not have the planned number of nurses? When will the NHS see 50,000 extra, on top of the 2019 figures?

[Lord Markham (Con)]

To be very clear, today, there are 29,000 extra, over the 2019 figures. That is more than half way towards the figure of 50,000. I will quite happily write to noble Lords so that they can see the figures clearly in black and white, but I can assure the House that we are talking about increases in nurse numbers. We have achieved a 29,000 increase on the 2019 levels.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a registered nurse and would like to follow on from the noble Baroness, Lady Chisholm. We must grow our domestic workforce in nursing. I do not dispute the figures the Minister has given, but any nurse earning more than £27,000 who trained recently is now repaying 9% towards their student loan, on top of the 20% tax they are paying. I accept that they get a £5,000 bursary a year, but they work extraordinarily long hours compared with ordinary students. It really is essential that we find a way to retain those young nurses who have just trained by doing a debt write-off of their loan after five or six years.

[Lord Markham (Con)]

I totally agree that retention and attracting people into the profession are key. I like to think that we are looking at all these things in the round, taking into account the £5,000 grant, the service they are giving, and their conditions and pay going forward. As ever, this is a moving feast, for want of a better term, so we will keep looking at it to make sure we continue to both attract and retain the domestic and international staff numbers.

[Lord Turnberg (Lab)]

My Lords, have the Government made any assessment of the reasons why so many nurses are wanting to leave, and, if so, what remedies are being suggested by them?

[Lord Markham (Con)]

The Nuffield study was very interesting: of the reasons for people leaving, 43% said retirement, 22% said it was for personal reasons, and 18% said it was due to too much pressure. Again, in quoting those figures I accept that there is work we need to do on this. Clearly, 18% leaving due to too much pressure is something we rightly need to be concerned about. I know that is why we set up the 40 mental health and well-being hubs with a £45 million investment, to look at whether we can address some of those pressures. Most of all, though, I completely agree that we need to recruit as many nurses as we can so that we have as big a supply as possible to ensure that we continue to relieve any pressures that exist.

[Lord Kamall (Con)]

My Lords—

[Lord Lilley (Con)]

My Lords—

[Lord Kamall (Con)]

I apologise to the noble Lord but it is some time since I have spoken in this part of the House. Given that it was Black History Month last month, does my noble friend the Minister agree that we owe a great deal of gratitude to immigrants from the Commonwealth who helped to save our public services after the war? Now that we have left the EU, can he also assure us that we will no longer give priority to mostly white Europeans over mostly non-white non-Europeans, and treat all equally when we want to recruit health and care staff from abroad?

[Lord Markham (Con)]

I totally agree. My noble friend rightly states that we have had a fine tradition, right back to the beginning of the NHS, of recruiting people from all over the world, predominantly the Commonwealth. I am also delighted to say that, since we moved the cap on visas from people all round the world in 2019, the number of those who have joined has gone up from 25,000 a year to 48,000 a year. That is almost double the number and very much the result of what my noble friend said about making sure that we are welcoming people into the profession from all over the world.

[Lord Patel (CB)]

My Lords, shortages of NHS staff, whether they be nurses, physiotherapists, doctors, dentists or community nurses, results in poor service. What plans do the Government have to make primary and community care more sustainable in the long term?

[Lord Markham (Con)]

The plans are very much those that we are doing, which I believe are successful. As mentioned before, it is not just that the number of nurses has gone up by 29,000; we have seen significant increases in doctors and the other medical professions as well. We should remember that we have 200,000 more people working now within the profession than in 2010. That is not to say that we will rest on our laurels; I completely agree that we need to carry on expanding supply to ensure that we properly meet the demand.

[Baroness Merron (Lab)]

My Lords, given that the Minister has previously stressed that nurses should rely on the vocational appeal of their work for their rewards, how does this square with the reasons that he acknowledged exist as to why a record 40,000 nurses left the NHS in the past year alone?

[Lord Markham (Con)]

I am very aware of the Nuffield figures but that 40,000 includes people who have gone back into other parts of the nursing profession. The actual net number as cited by Nuffield is a 27,000 reduction, which is why we have had the growth. However, we should ensure that it is as attractive a profession as possible for people to work and progress in. That is very much what I would like to see.

[Lord Lilley (Con)]

My Lords, can my noble friend explain why we none the less turn away every year more than 20,000 applicants for nursing courses? Why does there appear to be a de facto limit on recruitment at universities for nursing, whereas they are allowed to take an unlimited number for media studies, PPE and other less worthy disciplines?

[Lord Markham (Con)]

I have been assured by officials that there is not a cap, so my only thought would be that, if people are turned down, it is perhaps because they may not have the necessary qualifications. I will check that and, if I am wrong, I will reassure the noble Lord, but my understanding is that there is no cap, and the more the merrier.