Nursing Workforce Shortage: England

Jamie Stone Excerpts

Tuesday 3rd March 2020 Westminster Hall

[Mohammad Yasin (Bedford) (Lab)]

I beg to move,

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.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

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.

[Mohammad Yasin]

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?

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.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

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.

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.

[Jamie Stone]

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.

[Jim Shannon]

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.

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.

NHS Funding Bill

Jamie Stone Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Craig Mackinlay]

My hon. Friend makes a good point. How much do trusts spend on recruitment consultants? There is a whole panoply of expenditure on other things that the NHS, as a very big procurer, could get at competitive, keen prices.

My hon. Friend the Member for North Dorset (Simon Hoare) made a good point about the cost of medicines and repeat prescriptions. That has to be a major issue: across the country, £20 billion a year—nearly one sixth of the NHS budget—is spent on medicines, many of which are on free, repeat prescription. My wife, a pharmacist in the community, far too often sees bags full of expensive drugs come back to the pharmacy after the demise of a loved one. They have to be thrown away, and the money is completely wasted. We need to ask some difficult questions about the NHS. Let us not try to throw more money at it in the hope of a better outcome, because we need to be rather more clever. Great as it is—it has become a national institution, greatly loved—the NHS does not always do things perfectly.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I thank the hon. Gentleman for giving way, and I have been listening with great interest to the excellent contributions of new Members.

There is some evidence that NHS provision in Scotland is somewhat rackety. The hon. Gentleman has described the cost of bits of paper, and so on. Would it not be a good idea to apply the same tests to the delivery of NHS services in Scotland?

[Craig Mackinlay]

Obviously the hon. Gentleman takes a great interest in Scotland. This is a debate about England, but I think there should be a serious debate in every part of the country about whether the NHS is operating as we would operate if this were our own business, and I think that in many areas of procurement, whether the item in question is paper, telecommunications or power, the answer will be “Probably not.”

I have benefited from a couple of interventions adding to my time, but I will end by saying this. As I said earlier, the NHS does not always do things perfectly, and in that regard I reflect on the death of young Harry Richford at the Queen Elizabeth the Queen Mother Hospital maternity unit, and on what the coroner said last week. The coroner said that the death of young Harry—who died after a week, following a very difficult Caesarean—had been “wholly avoidable” and “contributed to by neglect”, and that “Harry was failed”.

We cannot just keep saying that we will learn from these things. We need to embed improvements so that our healthcare system in this country is much the best on the planet, and I am sure that the Government will deliver that.