National Health Service: Nursing Staff

Earl Howe Excerpts

Monday 12th May 2014 Lords Chamber

[Baroness Kennedy of Cradley]

To ask Her Majesty’s Government what steps are being taken to ensure adequate levels of nursing staff in the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, patient safety is paramount. Patient safety experts agree that safe staffing levels should be set locally. Local NHS organisations are best placed to determine the skill mix of their workforce and must have freedom to deploy staff in ways appropriate for their locality. We have commissioned NICE to develop guidance on setting safe staffing levels and to endorse safe staffing tools. If hospitals do not have sufficient nurses, the Chief Inspector of Hospitals will take action.

[Baroness Kennedy of Cradley (Lab)]

As today is International Nurses Day, will the noble Earl join me and many others in this House in paying tribute to the hard work of our NHS nurses? Further, can he explain why, since 2010, the actual number of qualified nurses has fallen and nearly 4,000 senior nursing posts have been lost? What are the Government going to do about that worrying reduction in experience and skill in nursing in our NHS?

[Earl Howe]

My Lords, I readily join the noble Baroness in paying tribute to our nursing workforce, whether in acute settings, in the community or, indeed, in any other setting. In fact, if the noble Baroness consults the official statistics, she will see that there are more nursing, midwifery and health visiting staff at present than there ever have been in the history of the NHS. Since the election, more than 5,100 more nurses are working on our wards, there are more than 1,700 more midwives and more than 2,000 more health visitors. We have been able to fund these increased numbers by a reduction in administrative staff—today there are more than 19,600 fewer administrative staff. I would be interested to hear where the noble Baroness gets her figures from but, as she will have gathered, mine are completely in the other direction.

[The Lord Bishop of Oxford]

My Lords, given the court ruling last week against Thanet Clinical Commissioning Group saying that it was obliged to follow NICE guidelines unless a special factor could be determined that would justify departure, will Her Majesty’s Government give an assurance that the same test will apply to NHS trusts in regard to the ratio of nurses and patients?

--- Later in debate ---

[Earl Howe]

The guidance issued today by NICE on staffing ratios, to which I think the right reverend Prelate is specifically referring, is in draft, but the deputy chief executive of NICE has stressed that there are no floor or ceiling numbers on the required number of nursing staff that can be applied either across the whole of the NHS or in a particular ward setting. What the profession is seeking, and what NICE is looking to give it, is a reference tool or guideline that will enable it to judge correct staffing levels in accordance with the particular circumstances of a ward and the skill mix of the staff on that ward. It is a guideline rather than a mandatory prescription.

[Baroness Manzoor (LD)]

My Lords, my question relates to specialist nurses. NICE has issued guidelines in relation to TB, and I am delighted to see that Public Health England has also issued a strategy on TB, making it a key component. However, there are variations in the number of TB nurses within trusts. How are the Government and NHS England going to adhere to the ratios that have been advocated by NICE?

[Earl Howe]

My Lords, as regards specialist nurses, the Government have supported the development of a range of specialist roles within the profession. In the end it is for local NHS organisations, with their knowledge of the needs of the local population, to invest in training for specialist skills and to deploy specialist nurses. We recognise that more could be done by some local healthcare organisations in this area, and Health Education England is able to support employers with continuing personal and professional development—but within clear limits. The planning process has created an opportunity for employers, through the LETBs—local education and training boards—to prioritise investment in this area.

[Lord Turnberg (Lab)]

My Lords, the number of nurses may have gone up a little, but the main problem is the marked reduction in the number of senior nurses on wards. These are the women and men who are in charge of a ward and make sure that care is properly delivered at the ward level. Does the noble Earl consider that this particular loss is because we do not reward and value these key individuals well enough to recruit or retain them?

[Earl Howe]

My Lords, as the noble Lord will be aware, finances in the NHS are tight. However, as I said earlier, there are now 5,100 more nurses on our wards than there were in May 2010. That must indicate that nursing is still an attractive profession for the brightest and the best of our young men and women.

[Lord Willis of Knaresborough (LD)]

My Lords, will my noble friend accept that nurses do not work in isolation and that in order to deliver the high-quality care and safety that the Government rightly demand, the whole of the caring workforce needs to be properly trained and properly educated? What steps are being taken to ensure that healthcare support workers in particular—there are more than a million of them—get the training that they deserve to give patients the care that they too deserve?

[Earl Howe]

My noble friend is right. He may be aware that last month Health Education England, Skills for Care and Skills for Health launched the pilot for the new care certificate, which is taking place across a range of health and social care settings. It will test a set of standards designed to help employers to assess not only workers’ skills, but also the knowledge, behaviours and values that are required to deliver compassionate and high-quality care. That pilot will continue throughout the summer and, subject to evaluation, it is planned to introduce the care certificate next March.