Education (Student Support) (Amendment) (No. 2) Regulations 2018

Lord Clark of Windermere Excerpts

Monday 21st May 2018 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw the House’s attention to my interests as listed in the register and I congratulate the noble Lord, Lord Hunt, on securing this debate.

I should like to put my contribution in context. At lunchtime I came back from Geneva, where I had been at the World Health Organization working with the International Council of Nurses, representatives from the Nursing Now campaign and the Chief Nursing Officer of the WHO in looking at the future of the profession. One of the big discussions was on the need to increase the number of nurses worldwide and to ensure that we have health security across the globe. A major topic of discussion was, not surprisingly, the re-emergence of Ebola in the Congo. At least one Health Minister asked me how, as a country, we could really justify a recent advertisement from, I believe, the Home Office, encouraging nurses with a two-year graduate qualification to come to this country.

The noble Lord, Lord Hunt, has outlined the key concerns over extending the normal student maintenance regime to nursing students undertaking programmes at postgraduate level. As others have said, these programmes take two years, including theory and practice, and enable successful students to register as nurses with the NMC. I do not need to remind noble Lords that this is an intensive programme with significant periods of work in a practical setting.

The aim of introducing new systems of funding was to increase the number of nursing students, yet on undergraduate programmes this was not achieved in the 2017 intake, where a fall took place, particularly in applications for mental health and learning disability nursing courses. Why should there not be a similar fall in the number of students entering the postgraduate programmes this year if the change takes place? In effect, this would result in an even more significant drop in the number of nurses qualifying in 2020, in that the undergraduate numbers due to qualify in 2020 will be much lower than originally planned. If we could boost the postgraduate intake numbers for 2018, this could provide additional nurses ready for registration in 2020—just as they will be so desperately needed according to the NHS Five Year Forward View.

Therefore, does it not make sense to delay the implementation of the regulations while a systematic review of post-18 education funding is undertaken and retain the current system of funding for the group due to commence in 2018? This would provide us with an opportunity to run a campaign to increase the numbers for this year in the way that campaigns have been conducted to attract people to social work and teaching programmes in areas where there are similar staffing challenges.

We know that sufficient levels of registered nurses are critical for the health and social care system to ensure patient and client safety. The sombre reading of both the Francis report and the learning disabilities mortality review reminds us that not only do we need to retain our current staff but that we must train new nurses to further enhance the quality of our provision.

Graduates who enter postgraduate nursing programmes add value to our workforce, bringing a range of life skills. In particular, many mature entrants come into mental health nursing through the postgraduate route, and yet we know we are not meeting the numbers required to meet mental health services workforce demands.

I recognise that the Government have offered a new pay deal for nurses that may improve retention and recruitment and plan to offer golden hellos in some hard-to-recruit areas for nurses entering the profession, both of which I have expressed my support for and hope will be effective. However, until the new degree apprenticeship routes into nursing at both undergraduate and postgraduate level are properly designed and funded through the apprenticeship levy, I urge the Government to think again and to wait to introduce the reform we are discussing today.

NHS Providers reminds us that plans to boost the NHS workforce will take years to deliver, but to change this decision for at least one year would result in a larger cadre of nurses qualifying in only two years. I urge this because society expects us as policymakers to ensure safe healthcare in the NHS. This, I argue, cannot be achieved without a sufficient supply of newly qualified nurses and allied healthcare professionals.

[Lord Clark of Windermere (Lab)]

My Lords, I find the Government’s approach to NHS staff very perplexing indeed. They continually pay tribute to them, and I think they do understand the commitment of the workforce, yet repeatedly they take action that makes the life of nurses and other staff even more difficult than it is at the moment. At the same time, they make it more difficult for those nurses to guarantee the safety of patients in our NHS.

I congratulate my noble friend on drawing this SI to the attention of the House and allowing us an opportunity to debate this critical issue. In making my case today, I accept the points made by the noble Baronesses from the Liberals and the Cross Benches—they were absolutely right in the points that they made. But let us remind ourselves of the serious situation we are in. The points I am going to make now are agreed right across the National Health Service; points which every royal college and every responsible organisation in the health service agrees with.

The first point has been raised already: we are 40,000 nurses short, and the Government have a real responsibility for that. The number of nurses and midwives leaving the profession is greater than the number of those entering the profession—that is a recipe for disaster. We have critically relied not only on nurses from the far ends of the globe but especially on nurses from the European Union. Since the Brexit vote, they are deserting the National Health Service, and who can blame them?

Let me go right back to 2010, when this Government assumed office. That is when they started making massive errors, from which they have not recovered. Neither, critically, has the National Health Service. In an Answer to me, the noble Viscount, Lord Younger, pointed out that, when they assumed office, there were more than 97,000 entrants to nursing courses. The coalition Government’s first response was cut, cut, cut, and by 2012 the figure had dropped from over 97,000 to 75,000, a drop of 22,000 nurses entering the profession in one year alone. The figure improves marginally but does not get much better for many years. When I say the Government are 40,000 nurses short, it is because of their mistake in 2012 in cutting the numbers of young people and older students entering the nursing profession. We have never recovered from that.

I accept the point that the Government want to widen the area of recruitment—I will come back to that—but, having made the mistake in 2012, only two years ago they scored another own goal by abolishing the bursary scheme and introducing a charge of over £9,000 a year for people training for the nursing profession. Last year that led to a drop of 705 students. I admit that is not the same as the 22,000 drop the Government were responsible for in 2012 but we cannot afford any drop whatever. Now, having created a serious recruitment policy, they are introducing even more costs into the system by this SI we are discussing today. It is affecting older graduate entrants, those who do postgraduate courses and usually graduate after about 18 months or two years, which is the quickest way to get qualified nurses, as we have already heard.

However, the Government do not seem to have learned anything. The point from the Liberal Front Bench was well made when the noble Baroness pointed out that the cost of training a postgraduate student was £33,500—a lot of money—but we should not forget the cost of the agency nurses needed to fill that vacancy. That £33,500 cost is less than the average annual premium paid by trusts for a full-time equivalent nurse filling a post that is vacant because of shortages. It is a false economy and yet the Government do not seem able to see the picture in the round, which is the position we should be looking at.

There are other ways in which the Government could ease the nursing situation. Instead of bringing forward SIs such as those we are discussing at the moment, if they have got a bursary scheme, as they have, why do they not write off the cost of repaying the student loan for nurses who have spent a number of years in the National Health Service? One of the Minister’s predecessors said that the Government were looking at a similar proposal for doctors but I never saw whether it materialised. However, that would be one way of equalising the situation.

Many nurses from European Union countries and other National Health Service workers have got permanent residence status to live in Britain. After five or six years, they were entitled to apply for permanent residency, and they got it. To me, and to most nurses, permanent residency means just that: you have residence in this country which is permanent, but the Government will not admit that. They say that the permanency may not be honoured after Brexit. That is a terrible thing to say. A British Government are breaking their word to people who work in the health service and give so much. Why not say that those people who have permanent residency can remain in this country permanently? That would do a lot to retain the confidence of EU nurses.

I shall finish with a word about financing nursing apprenticeships. As we have heard, the Government’s target of 1,000 apprentices in nursing has not only fallen short, it has fallen ridiculously short. The Minister may have more up-to-date information than either I or the Royal College of Nursing have, but its figures show that there are not 1,000 apprentice nurses, there are 30. Of course, one of the difficulties lies in the whole concept. An apprenticeship requires a mix of work on the ward and work in the classroom at university, but that is exactly what undergraduate nurses do at the moment. Over the three-year period, 50% of their time is spent working—I emphasise that word—on the wards. Why should they pay more than £9,000 when apprentices may get that for nothing—or is it nothing? The universities which provide the classroom opportunities for these apprenticeships tell me that they have no alternative but to charge for them. I do not think that the apprenticeship levy will cover it because they are talking in terms of £7,000 a year for apprentices to do the university courses for their apprenticeship. I wonder who is going to pay that £7,000. Is it to be the student, or is it the trusts which are already hard pressed, or is it the Government? Most of us would agree that it ought to be the Government. It is their baby, their scheme and how they see the gap being filled—their salvation to ease the nursing shortage. It is the Government’s responsibility.

We are debating a statutory instrument which shows how ill thought through and chaotic the Government’s policies are when it comes to nurse training in this country.

NHS: Winter 2017-18

Lord Clark of Windermere Excerpts

Wednesday 18th April 2018 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what assessment they have made of the effectiveness of their plans for the NHS in dealing with the pressures during the winter of 2017-18.

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

My Lords, last year the NHS started planning earlier than ever before to support delivery during the challenging winter months. Despite the NHS being extremely busy, with challenging weather conditions and flu rates at their highest level for several years, hard-working A&E staff treated more than 55,300 people within four hours per day between December and March—that is 700 more a day on average than the year before. A review of winter performance by NHS Improvement and NHS England will be published this summer.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer. Of course, we are all very thankful indeed that we have got through the worst days of the winter, and we are grateful that new plans were put in place. However, I think we all know that we got through only due to the dedication and commitment of the staff in the health service at every level, and that we face dire shortages in every sector of the health service. Is the Minister aware, for example, that 800 student nurses in 20 universities have had their grants or loans cut off or reduced due to administrative errors by the Student Loans Company, and that many of them now face financial distress, with the prospect of no or reduced support for the foreseeable future? Does the Minister accept that that is preposterous when there is such a shortage? Will he therefore step in and try to sort that out, so that no student nurses suffer?

[Lord O’Shaughnessy]

I join the noble Lord in paying tribute to the dedication of staff who have taken us through what has been the worst winter for eight years. I was not aware of the particular issue he raised; I am glad he has raised it and brought it to me. I shall take it back to the department immediately after Questions to make sure that we get to the bottom of what is going on and try to fix it urgently.

NHS: Staff Pay

Lord Clark of Windermere Excerpts

Wednesday 21st March 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Baroness for her welcome for the Statement. We, along with all Members of the House, value NHS staff and this is a proper recompense after what have undoubtedly been difficult years for them. Regarding what this means for funding for charitable and social care staff—I did not address the point when the noble Baroness, Lady Jolly, asked me about it—we will obviously make sure that any staffing issues, including salaries, are part of the Green Paper discussions. They will clearly have to take into account the higher pay that is coming down the stream for these staff.

[Lord Clark of Windermere (Lab)]

My Lords, of course we welcome this, but I must say that the Minister was selling it a bit hard when he said that the Government have managed the National Health Service well when they have made cuts in training which have exacerbated the situation.

My question is a simple one. The Minister has said that the Treasury will meet all the costs. Is that an absolute assurance? I ask that because many local hospital care trusts have found that there are hidden costs. For example, the Government are pushing apprenticeships, but what they never mention is that it is the local care trust which has to pay the university thousands of pounds a year for the apprenticeship training. Will everything be covered in this pay rise?

[Lord O’Shaughnessy]

I thank the noble Lord for giving me the opportunity to provide that confirmation. In the 2017 Autumn Budget we set aside in the reserves £800 million a year, which will fund the first year of the Agenda for Change pay deal, and obviously if the members of the NHS trade unions accept the agreement, that funding will be released. The Chancellor will also provide the additional funding required to fulfil his commitment through the 2018 Autumn Budget and make available £4.2 billion over three years to fund the deal. I hope that gives the clarity the noble Lord and others seek.

Nurses: Training

Lord Clark of Windermere Excerpts

Wednesday 7th March 2018 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what specific proposals they have to increase the number of fully trained nurses working in the National Health Service and the associated care services.

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

My Lords, there are record numbers of nurses working in the NHS in England, including 13,900 more acute, elderly and general nurses. To increase the future supply of registered nurses, the Government are funding over 5,000 more student nursing places for those entering training each year from September 2018. We are opening up new training opportunities to increase the number of professionally qualified nursing staff across the health and social care workforce through the apprenticeship route.

[Lord Clark of Windermere (Lab)]

I thank the noble Lord for his reply, but I do not think the Government really grasp the seriousness of the shortage of nurses. In the last two years, 33% fewer students came forward. We have a shortage of 40,000 nurses and it will take years to put that right. Can I make a suggestion to him? The best and quickest way to increase the number of trained nurses is for the Government to drop their opposition to the bursary scheme for postgraduate students. These two-year courses are cheaper; it would cost the average funder £33,500 for the two-year course, which is half as much as the average trust would pay simply to employ an agency nurse for a year to fill the gaps. Why will the Government not follow that route?

[Lord O'Shaughnessy]

My Lords, we take very seriously the need to train more nurses. There are 52,000 nurses in training and, as I have said, there is a commitment to increase the number of training places by 25%, which is obviously how we get to a long-term solution. On the issue that the noble Lord has raised about postgraduate bursaries, the policy intention is to bring these courses in line with other courses. I know that this is an issue of great concern. The Royal College of Nursing has expressed its concerns and we take those seriously. I also know that the regulations have been prayed against in the other place; they are also being looked at in the Secondary Legislation Scrutiny Committee and we await its report. I reassure him that the issue is being considered and we will respond once the committee has reported.

NHS: Charitable Donations

Lord Clark of Windermere Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord O’Shaughnessy]

I reassure my noble friend that I am not trying to make an ageist point. The point I was trying to make is that the majority of healthcare costs in a lifetime occur at two points in life: in younger children and in older age. We effectively have an insurance system where we pay through our tax and use the care when it is needed. The concern is that at a point in life when people might be vulnerable and not have support around them, and not necessarily know what is required in complex care, having had the facts about one piece of care they may feel that they should not be creating a burden on society by asking for more care. I do not think that is the right approach.

[Lord Clark of Windermere (Lab)]

My Lords, will the Minister make it quite clear—loud and clear—that virtually every hospital trust has its own charity and indeed that many individual wards have one?

[Lord O’Shaughnessy]

That is precisely the point. Any of us who have spent time in hospital will know that those charities are well advertised. As I say, they have £400 million of income, which I think makes them second only to cancer research in terms of income for health charities. I agree that they are a real asset to our health system.

NHS: Winter Crisis

Lord Clark of Windermere Excerpts

Wednesday 7th February 2018 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what assessment they have made of the effectiveness of their planning for the winter crisis in the National Health Service.

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

My Lords, planning for winter started earlier than ever before to ensure that robust plans were in place to support NHS delivery during the challenging winter months. Despite the NHS being extremely busy and flu rates being at the highest level for years, hard-working staff treated more than 55,000 people within four hours every day in December—more than 1,200 more than last year. NHS England and NHS Improvement will publish their review of winter by summer 2018.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his reply. As he knows, NHS spending has risen by an average of 4% each year in real terms since its inception in 1948. Since this Government took over in 2010, that 4% increase has fallen to an average of between 1% and 1.5% in real terms. Can the Government not accept that some of their meanness is one of the major causes for the crisis the NHS finds itself in?

[Lord O'Shaughnessy]

I totally reject the accusation of meanness. If noble Lords look at the spending on the NHS, not only has it gone up in real terms every year while a massive fiscal retrenchment has had to take place to deal with £150 billion of borrowing bequeathed by the previous Government, but it now accounts for the highest percentage share of public spending that has ever been in place. We have found the money in difficult circumstances. We all agree that more is needed. More was found in the Budget; I am sure more will be found in the future.

NHS: Nurse Retention

Lord Clark of Windermere Excerpts

Wednesday 17th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite wrong to say that it is an unappreciated profession; nurses are deeply appreciated by everybody in this country, and that includes members of the Government.

Of course we want to reduce the number of nurses leaving the profession. It is important to point out that the number is down on two years ago, which was the peak in both number and proportion, and that the number of nurses has risen over that period. The noble Lord mentioned the pay cap. He will know, I hope, that in the Budget the Chancellor announced that he would be funding pay increases above the pay cap for nurses and other professionals on the Agenda for Change contracts, which is extremely welcome. We know that pay matters.

The noble Lord is right to focus on under-40s; that was an area that concerned me. The programme whereby we are promising to deliver 3,000 social homes for nurses is an important part of retaining staff, because we know how important housing costs are, particularly in the south of England.

Finally, we have been around the issue of bursaries a number of times, and there is no evidence that their introduction will make a long-term impact on our ability to recruit the nurses we need. Indeed, we are increasing the number of nurse training places from next year by a further 5,000.

[Lord Clark of Windermere (Lab)]

My Lords, the Minister has yet again repeated that there are 11,700 extra nurses on the ward, and compounded that by saying that there are more trained nurses in Britain than there were in 2010. Yet a Written Answer to me of just 10 days ago shows that we currently have 317,980 nurses, which is fewer than there were in 2010. Can he square that circle—or is he talking not about nurses but about nursing assistants?

[Lord O’Shaughnessy]

On the specific and most recent workforce data—if we are going to get into the specifics of nurses only—in May 2010 there were 273,071 nurses and in September 2017 there were 275,356, so that is an increase. I shall certainly look into the figures with which I wrote to the noble Lord. Of course, I intend always to be truthful. I am reading from the latest workforce stats.

As for nurses on wards, the noble Lord will know that the number has gone up. An important response to the scandal of Mid Staffordshire and the Francis report was to increase nurse numbers. We know that that has a consequence for other professions—I have talked about that quite openly—and in mental health and district nursing. That is why we want to increase the number of nurses in those areas.

NHS: Winter Funding

Lord Clark of Windermere Excerpts

Thursday 11th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I would hope that the noble Baroness would welcome the money that was set aside in the Budget. It is important to point out that in addition to that £337 million, half of which has gone to support plans that were already in place and being actioned before the Budget, there was a further £100 million to support A&E streaming, which is also a way of taking pressure off emergency services. That has had an impact, so I do not accept the accusation that the money came too late, and indeed there is still money in the pot as services come under pressure.

As regards the future, the noble Baroness will know that it was also announced in the most recent Budget that another £2.8 billion would be allocated to the NHS to help it get through the next few years. We know that the pressures are increasing because of the ageing population. The idea of that money is precisely to help the NHS get back on target on A&E waits as well as referral to treatment.

[Lord Clark of Windermere (Lab)]

My Lords—

[Baroness Watkins of Tavistock (CB)]

My Lords—

--- Later in debate ---

[Lord O'Shaughnessy]

I thank my noble friend for pointing out the fact that no Government have funded the NHS like this one. Indeed, the proportion of public spending taken up by NHS spending has been increasing in the last seven years, contrary to the views held by those opposite. On the impact of adult social care, my noble friend speaks with great wisdom. We know that money invested in the social care sector has a big impact. It already has, as he pointed out. That is why it is meaningful that the department has taken on full control over social care policies so we can push ahead with integration, which, as we know, is the right way to solve these problems.

[Lord Clark of Windermere]

My Lords, it is a question not only of money, but of planning and training staff. Did the Minister see yesterday that the head of chemotherapy at Churchill Hospital, Oxford, said that cancer treatment and chemotherapy were being delayed and curtailed because of the lack of trained nurses? Yet the Prime Minister denies this. Who are we to believe?

[Lord O'Shaughnessy]

I think that the trust has been clear that there are not going to be delays. If the noble Lord is talking about the story on the front page of the Times yesterday, the trust has subsequently been clear that it will not delay or curtail its treatments. We know that more nurses are required. That is why, as I am sure he will be pleased to know, there have been around 11,700 more nurses on wards in the last seven years.

Agency Nurses

Lord Clark of Windermere Excerpts

Wednesday 10th January 2018 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 27 November 2017 (HL3070), what assessment they have made of the operation of the “break glass clause” in the supply of agency nurses to hospital trusts from off-framework agencies.

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

My Lords, significant progress has been made in reducing agency staffing in the NHS. In 2016-17, the NHS spent £700 million less on agency staff than in the previous financial year. The “break glass” clause is one of a number of measures introduced to support patient safety while we seek to reduce the use of agency staff. Since a peak in April 2016, the number of nursing shifts procured from off-framework agencies has more than halved.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer on this very complicated issue. However, does he recall his Answer to my Written Question of Monday in which he confirmed that the incoming Conservative-led Government in 2010 cut the number of nurses virtually every year, sometimes in excess of 10,000, with the result that we have fewer nurses working in the health service today than in 2010? That is the cause of our reliance on agency nurses, which costs the NHS billions of pounds. This cannot continue, so will the Minister use his influence to try to ensure a proper workforce plan for the NHS so that we have sufficient staff to meet the needs and demands of the British people?

[Lord O'Shaughnessy]

The noble Lord is quite right that we need sufficient staff. He will know that when the Government came to office in 2010 difficult decisions needed to be made about the funding of all public services, because of the economic situation at the time. It is worth pointing out that, since that time, there are over 10,000 more nurses on wards, which is obviously particularly important at this time of year. In terms of the future figures, I hope he will be aware that there will be an increase in the number of training places for nursing—£5,000 a year. Indeed, Health Education England, which is responsible for workforce planning, will deliver a long-term plan to make sure that we can tackle this issue, which has been a long-standing problem for the NHS.

Nurses and Midwives: Numbers

Lord Clark of Windermere Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Baroness that there is a need for more nurses. That is why we are introducing more training places and new routes into nursing, such as the nursing apprenticeship. I know that she is particularly concerned about EU national nurses and health visitors. I think noble Lords will be reassured that between June 2016 and June 2017, there was an overall 5% increase in the total number of staff from the EU within the NHS, which is welcome. The one area, as I said, that has fallen marginally—by about 162 in practice—is in nursing and health visitors. That was significantly due to the new language test that was introduced. That is something that the NMC is looking at to make sure we are getting nurses capable of practising in this country to come here.

[Lord Clark of Windermere (Lab)]

My Lords, as the Minister knows, citizens of the EU who have spent five years working in the UK can avail themselves of the opportunity to apply for a right to remain permanently in the UK. That is now unclear. Will he announce that those who have been granted the permanent right to remain in Britain as EU citizens will be entitled to stay and work here? That would be a good way to start building confidence.

[Lord O'Shaughnessy]

My Lords, the rules as they are apply, so those who are eligible to apply for a right to remain can do so. We are talking about providing a path for those who are not yet at that point, now or in the future, to achieve settled status to provide the kind of certainty that we know. I understand that this causes some people to pause for thought about whether they should stay.