NHS: Staff

Lord Clark of Windermere Excerpts

Thursday 30th November 2017 Lords Chamber

Moved by

[Lord Clark of Windermere]

To move that this House takes note of the impact of Her Majesty’s Government’s fiscal policies on the recruitment, retention and conditions of NHS staff.

[Lord Clark of Windermere (Lab)]

My Lords, I am looking forward to this debate. I think it will be an excellent debate, with a wide array of speakers representing a great deal of experience right across the health and care service.

We all know that the NHS is one of the living institutions of our country, loved, appreciated and needed by its people. In spite of the difficulties facing it, the service it provides is second to none as the British people seek medical attention and healthcare. Year after year, surveys show that it is regarded internationally as the most efficient organisation anywhere in delivering healthcare.

I shall be a little provocative in what I am saying at this moment. I know it causes some discomfort to some Members on the Benches opposite that a state institution employing 1.3 million people can compete successfully against private medicine. When I say that, I do not include the Minister because I know he is committed to the health service, but I believe there are people in the Conservative Party who find the NHS uncomfortable. It was interesting that the Secretary of State chanced his luck when he alleged recently that the NHS was actually invented by the Conservative Party—a case utterly rebutted by my noble friend Lord Pendry on 2 November in a letter to the Guardian, so I do not need to take that further.

I trust that when we on this side speak today, the Minister will understand the strength of opinion that the Government are slowly but surely allowing the NHS to deteriorate. Several years ago, when I began to question Health Ministers on the NHS, the situation was precarious. Now it is getting almost desperate. The bottom line is that the Government are not providing sufficient funds to meet the demands of an increasing and ageing—we must take those two facts together—population, and that no clever words can hide the fact that they are breaking their manifesto policy to increase spending on the NHS in real terms year on year. If you look at the anticipated spending, you can see that that will not be the case.

I mentioned 1.3 million employees. Those employees are proud to work not for the health service but in it. The service is at its most efficient only when it works as a team. Everyone is interdependent. I feel at times that the Government do not really appreciate that fact. If there is one thing lacking in our NHS, it is that it has no central workforce planning, and that is of real concern.

At the moment, almost all employees feel the same—demoralised and undervalued. They give their all, and more and more people are treated. But the staff feel that their treatment by the Government shows that they are not regarded highly enough. They feel that they are the individuals who suffer most from the Government’s now out-of-date austerity programme. Wherever we look—whether at consultants, doctors, nurses, midwives, healthcare assistants, physiotherapists, radiotherapists, GPs, clerical staff, porters, ambulance drivers, dentists or the scores of other occupations in the health service—it is the same story. The Minister must know this because I know he talks to staff. They feel demoralised and undervalued. Yet, these are the very people who keep our NHS going. It is because of them that patients still get a good service. However, it is slowly getting worse again. We are finding, in spite of the best efforts of staff that waiting lists are growing month by month. Increasingly, deadlines for cancer treatment are being broken. In spite of the Government’s bold declarations, the future for mental health services does not look as good as it should.

Following the Budget, I noticed that initially the press lauded the Chancellor for what he appeared to be giving the NHS. However, after examination of the small print, the general public, the press and those involved increasingly realise how short-changed they were by the Chancellor. They took on board Jeremy Corbyn’s comment that the money, was “well short” of what is needed. Sir Bruce Keogh tweeted that the Budget,

“plugs some, but def not all, of NHS funding gap … Worrying that longer waits seem likely/unavoidable”.

Sir Malcolm Grant, chair of NHS England, said that the money,

“will go some way towards filling the widely accepted funding gap … we can no longer avoid the difficult debate about what it is possible to deliver for patients with the money available”.

NHS Providers stated that,

“tough choices will be needed and trade-offs will have to be made … It is difficult to see how the NHS can deliver everything in”,

the forthcoming year. I understand that just today the NHS England board is discussing what will happen—whether we will have rationing in health. This is against the background of the speech by Simon Stevens, chief executive of NHS England, who on 8 November said that an extra £4 billion was needed in 2018-19.

Yet only the Government seem to deny there is a problem. To pluck a number of key employees, we are short of 40,000 nurses. Recruitment from the European Union has all but dried up. Wages have been frozen at 1% since 2010, leading to a reduction in salary of 10.1% for nurses by this year. Unsurprisingly 70% of nurses reported feeling financially worse off, with 24% saying there were thinking of leaving their job because of money worries. The Government claim that there are 13,300 more nurses than in 2010 and 11,800 more doctors in hospitals. However, we have to question those figures. I do not dispute that they apply in hospitals but when looking at healthcare, we are talking not only about primary care in hospitals but aftercare—the care service. I have letters from care providers saying that they have had to close down some of their institutions because they simply cannot recruit nurses. There are insufficient nurses in this country.

It is no better for doctors. The BMA found a 13% decrease in applications to medical schools since 2013. Last year, there were 7,660 medical students beginning their course, compared with nearly 8,000 in 2010. GP numbers are falling. Almost one-third of GP partners are unable to fill vacancies. Only 13% of partners report that they do not need to fill vacancies, and figures show an actual decrease in the number of doctors working mainly as GPs. The result is that patients are having to wait longer and longer to get an appointment, increasing the demand on A&E departments in our hospitals, which are already under great stress. There needs to be some joined-up thinking.

Even if we go to the top of the tree and look at consultants, we find what I can only describe as a dire situation. The NHS has a shortage of consultants and would-be consultants. During the past year, 1,542 consultant posts were advertised, but only 853 certificates of completion of training issued. Not surprisingly, 45% of the advertised posts were left unfilled. There simply were not the qualified candidates. Ninety-five per cent of doctors in training report that poor morale is having a negative impact on patient safety in their hospital, with half reporting a serious or extremely serious impact.

I do not really need to continue. Perhaps I could sum up this point by citing the president of the Royal College of Physicians, Professor Jane Dacre, who neatly summed it up in her response to the Budget. She said that it,

“felt like we had been given short-term sticking plasters rather than the long-term sustainable plan our patients need”.

It is all very depressing. The Government take the view that it is really not their fault, but a lot of it is. I have to ask: why, when they came to office in 2010—with their coalition partners, but they were by far the leading partner—did they cut nurse training numbers by 22,000? It takes a long time to build up the shortfall that has been allowed. Why, at this critical moment when we do not know whether we have enough nurses or doctors—the Government say we have; I say we have not—why risk the numbers by abolishing the bursary scheme? It is a risk, and the Government know that there are fewer nurses going into training this year than in previous years. I do not have the precise figures but all the universities that I have contacted, with one exception, have found a considerable decrease. If there is no problem with nurses, why was it announced yesterday that we are to step up our recruitment of 5,500 more nurses from India?

I am being a bit critical of the Minister. I hope he will not take it personally but take this opportunity to write to me to correct the information. Last week, in a straightforward Question about agencies, I asked,

“what are the names and locations of the agencies registered to supply nurses to NHS trusts in England”?

It was a straightforward Question, but the Minister’s reply can be described only as gobbledegook. He said:

“Agency rules require that agencies are on NHS Improvement-approved frameworks and these frameworks monitor and approve agencies for supply to trusts. The approved framework operators are Crown Commercial Service, NHS Collaborative Procurement Partnership and HealthTrust Europe”—


I think HealthTrust Europe is an American company. The Answer continues:

“In addition to agencies on approved frameworks, trusts in exceptional patient safety situations can utilise the ‘break glass clause’ and work with an off-framework agency. Using an off-framework agency should be a culmination of a robust escalation process sanctioned by the trust board. Trust boards have primary responsibility for monitoring the local impact of the agency rules and ensuring patient safety”.


I spent a lot of time trying to understand it, and I have understood a bit of it. I have also found out—the latest figure I could get for any particular week—that there are 50,000 applications to use the “break glass clause”. Are those 50,000 nurses from agencies included in the Government’s figures?

[Baroness Chisholm of Owlpen (Con)]

My Lords, may I quickly say that there has been a mistake over the timing? If everybody speaks for 13 minutes, we will go two minutes over time. If possible, will your Lordships stick to 12 minutes? When the clock says 12 minutes, will noble Lords please sit down?

--- Later in debate ---

[Lord Clark of Windermere]

My Lords, I thank the Minister for his reply. I began the debate by commenting that, having seen the list of speakers, I expected a first-class, thoughtful debate. I have not been let down. I thought that the debate was excellent. I want to single out, if I may, the noble Baroness, Lady Emerton. I felt privileged and honoured to hear her contribution. More than anything, I love the fact that she has retained the enthusiasm for and belief in the NHS that she took into her nurse training in 1953. I thank her very much for allowing us to share that. We have all certainly gained from it.

I hope that the Minister agrees that this has been a thoughtful debate. I have learned quite a lot from it and I hope that he has too. I hope that he will take up the spirit that came from three sides of this House—if we can have three sides here—because there is unease with our health service. However, we want the Government to succeed because we want the NHS to succeed.

Motion agreed.

Nurses: Tuition Fees

Lord Clark of Windermere Excerpts

Wednesday 29th November 2017 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government whether they will write off the tuition fees of nurses who spend a number of years working in the NHS or related public care services.

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

My Lords, there are currently no plans in place to write off tuition fee loans for nurses who take up work in the NHS. Substantial financial support is available for nurses in training. With the increase in the student loan repayment threshold introduced by the Department for Education, from April 2018 a newly qualified nurse will not pay back their loan on earnings up to £25,000 a year.

[Lord Clark of Windermere (Lab)]

My Lords, when we have a shortage of 40,000 nurses, when the Government’s introduction of tuition fees has resulted in fewer nurses entering training, and on the very day it is announced that we are having to import 5,500 nurses from India, is it not crucial that we incentivise everything we can to get British students into nursing? Would my proposal about working in the NHS not help that?

[Lord O'Shaughnessy]

My Lords, nurse training places have been discussed a number of times in this House. I am sure noble Lords will be keen to know that, while there has been a small percentage drop-off in places year on year, the numbers recruited this year are comparable to 2014-15. That is common with the introduction of tuition fees for other courses and we would expect it to rebound. In the long run, the intention is to grow more of our own nurses and to recruit from the United Kingdom, which is why there will be an increase of 25% in the number of clinically funded training places for nurses—5,000 extra—from 2018-19 onwards.

NHS: Deficit

Lord Clark of Windermere Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord waits patiently. I pay tribute to the quality of the report and we have already accepted some of the ideas set out in it. Now that the Budget is over and the Treasury can turn its mind to additional things, we will be responding to the report very soon.

[Lord Clark of Windermere (Lab)]

My Lords, in his Budget Statement today, the Chancellor referred to the fact that he was establishing a working party of the department and the unions to look at salaries in the NHS, but he was a bit vague when it came to the funding of the outcome. Can the Minister give an assurance that the Government will fund whatever is agreed by the department?

[Lord O’Shaughnessy]

The Chancellor has confirmed that he will fund an Agenda for Change, as it is known, pay deal on the condition that the pay award enables improved NHS productivity and is justified on recruitment and retention grounds.

NHS: Winter Staffing Levels

Lord Clark of Windermere Excerpts

Thursday 26th October 2017 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have to increase staffing levels in the National Health Service to meet anticipated demand during the forthcoming winter period.

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

My Lords, providing appropriate staffing over winter is essential. NHS England and NHS Improvement have worked together to make sure that every major consultant-led emergency department has a robust plan to meet demand. This includes necessary staffing levels. In addition, the department has provided £100 million to relieve pressure on urgent and emergency care specifically to allow primary care streaming and improve patient flow in A&E departments.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his reply. Those are soothing words, but I am afraid not really matched by the reality on the ground. It is clear that we face a dire prospect this winter on account of the Government’s poor labour planning over the years they have been in power. We know that we are 40,000 nurses short, GP numbers are tumbling and adult social care staff numbers have fallen from 70,000 to 48,000 in four years. Last year, 45% of the consultant posts advertised were not able to be filled. We really are in a very difficult position.

I ask the Minister a very specific question: is it true that the Government have given the go-ahead for vulnerable patients who are not fit to be discharged to their home to be discharged to third parties? They will be allocated to homes where the hosts have no medical expertise and for which they will get paid £1,000 a month.

[Noble Lords]

Too long!

[Lord Clark of Windermere]

This is my final question. Will the Government not listen to medical opinion and drop this preposterous scheme?

[Lord O’Shaughnessy]

The noble Lord knows that winter is always a more difficult time for the NHS. I hope he also knows that there are 11,000 more nurses on wards than there were in 2010. Indeed, I was looking at the data on doctors. There has been a 30% uplift in emergency doctors in that time as well. So there are more staff in the NHS—but, of course, there is much more need for winter preparedness. The NHS feels that it is better prepared than ever for winter.

On the issue that the noble Lord refers to—I assume he is talking about the story in the press today—that is, I stress, a local pilot that is being explored. I do not think it is even under way. It is being proposed by a local doctor—indeed, an emergency registrar. For it to go ahead, it is clear that any such pilot would have to abide by the very strict rules that exist on safety, safeguarding quality and so on for any care setting. The head of Age UK said that any new innovation—I think we want to encourage innovation—needs to pass the mum or grandma test. I think that is a very reasonable test to apply to something such as this.

Medical Examiners and Death Certification

Lord Clark of Windermere Excerpts

Wednesday 18th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight this point. Medical examiners are not involved in stillbirths, because the cause of death is before the point of birth. However, there is clearly a need for the involvement of coroners. I will look into the detail of that. I can tell the noble Baroness that the Government are taking the issue of stillbirths seriously. A new perinatal mortality review tool is looking at that and it is integrated into the learning from deaths scheme now going on in the NHS.

[Lord Clark of Windermere (Lab)]

My Lords, this is a very welcome initiative, but in view of the incredible shortage of medical staff in the NHS, is the Minister confident that there are sufficient staff to cover it? Are the Government looking at other ways of making staff available—for example, people may be brought back from retirement—to handle it in the initial years?

[Lord O'Shaughnessy]

That is a very good question because we are talking about a greater workload. The pilots and the early adopters have demonstrated that it is possible to do this with existing staff loads. As it is rolled out across the country, there may be a need for additional staff. I reassure the noble Lord, and indeed others including bereaved families, that any staff who are used will be registered practitioners and would be regulated by the GMC.

Health and Social Care

Lord Clark of Windermere Excerpts

Thursday 12th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The CQC report, which I am sure the noble Lord has looked at, talks about agencies and indeed nursing home providers deregistering. It also talks about the ones that are registering. There is a fairly consistent turnover in the number of those, so it is about balance. There is a similar number of providers within the market—again, with slightly fewer residential nursing and slightly more domiciliary to reflect the kind of balances of care that we have discussed.

[Lord Clark of Windermere (Lab)]

My Lords, as the figures today show that the number of registered nurses in Britain is actually falling, and bearing in mind that the existence of care beds depends upon nurses, will the Minister answer the Question that I asked earlier this week and give us a progress report on the number of students who entered nursing courses at universities this September, so that we can make a judgment on the current position?

[Lord O'Shaughnessy]

I think the noble Lord is referring to the King’s Fund report on nursing. It is important to stress that there are still greater numbers of nurses overall compared to 2010; indeed, over 11,000 more on wards. There are some particular shortages in mental health and community nursing, which have been alluded to before. In terms of the nursing numbers, he will know, because we have discussed this before, that there is a ratio of about 2:1 in the numbers of applications for nursing places. I do not have a more recent update than that. My expectation therefore is that that was the position going into September. I shall certainly write to him with the details. I emphasise that this increase in the number of training places, with funded clinical placements, is designed to address the issue that we have about the need for more nurses as we have a growing and ageing population.

National Health Service

Lord Clark of Windermere Excerpts

Tuesday 10th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The NHS is seeing more people than ever—I think that some 1,500 more people a day are being seen in A&E. A lot more people are going through the service. The truth is that there are a number of factors: there are factors around lifestyle and around ageing. The point is that we have to change. At the heart of this Question is the comment made by the chief inspector about our not having new models of care. We need to change the way in which we provide care. That means integrated care, with much more of it based in the community. That means us all taking difficult political decisions about how care is configured so that it meets changing needs related to obesity and ageing.

[Lord Clark of Windermere (Lab)]

My Lords, a major problem facing the NHS is the drastic shortage of nurses. As the Government have changed the funding of nurse training at universities and as those universities now have their students in place, can the Minister give us any figures on the number of nurses in training in this current year?

[Lord O'Shaughnessy]

I know that the noble Lord has been concerned about this issue. I hope that he heard my right honourable friend the Secretary of State announce last week not only an increase in the number of nursing associate places, where qualification is through an apprenticeship route, but a 25% increase in the number of degree training places and funding for the clinical placements that they involve.

National Health Service (Mandate Requirements) Regulations 2017

Lord Clark of Windermere Excerpts

Wednesday 6th September 2017 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I rise to speak on this regret Motion tabled by the noble Lord, Lord Hunt, who I am sure, like me, together with all users of the NHS, will acknowledge that the NHS has a unique place at the heart of our society and is by some distance the institution that makes us most proud to be British. However, it is regrettable that the NHS has become a bit of a political football year-in, year-out.

I would like to talk about the many positive areas in the NHS and about how people are working very hard to move towards these targets. Yes, pressures, including seasonal pressures, are all in the mix, yet despite these pressures the NHS approaches its 70th year delivering outstanding care, and it is important today to acknowledge and thank all staff who work in the health service, as well as encourage and support a healthy morale for our future workforce. As we all know, the NHS depends on a strong economy. A strong NHS can contribute to the growth of that strong economy, especially in health and life sciences, not just now but in the future.

We see plenty of pluses. We are getting healthier but we are using the NHS more, with life expectancy rising by five hours a day, as the noble Lord, Lord Reid, alluded to. The need for care in a modern NHS continues to grow apace. The number of people aged over 85 has increased by 40%, and the number of patients receiving elective treatment grew from around 14.2 million in 2012-13 to 15.7 million in 2016-17—an increase of 11%. That is a fantastic result. Calculations indicate that over the next 20 years we shall see the percentage of people over the age of 85 double. I note also that the total number of people on the elective waiting list in April 2012 was 2.5 million. By March 2017 this had increased to 3.7 million—an increase of 51% and another fantastic result. I note also that when Labour left office, including Members on the Benches opposite, more than 18,000 people were waiting more than 52 weeks to start treatment. Now, the figure is under 1,700.

Only last year, the CQC in-patient survey showed continuous improvement over the past five years, with 62% of respondents saying that they were satisfied with the running of the NHS. NHS funding is being increased and we will see over £0.5 trillion being injected from 2015 to 2020, but with more cash injection the NHS must show that it can spend that cash wisely and efficiently. Therefore, I look forward to a strong and sustainable NHS fit for purpose and fit for the future, where all parties can work together, so that we have a safe, patient-focused health service that is the best in the world.

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is absolutely right to sing the praises of the National Health Service, and she is quite right to point out that we are undertaking more operations than we have in the past. She is also right to say that, as we grow older, more of us will need the health service. That is a fact that we have to face and accept and about which we have to persuade people—who do not need much persuading—that something has to be done. My noble friend Lord Reid and I served in the Blair Cabinet and we spent hours trying to bring about the political will to make sure that waiting times, which caused so much grief and pain in the 1990s, were cut. So we are talking about political will.

There is an interesting public opinion poll produced by YouGov and published today on behalf of the Royal College of Nursing. It shows that 72% of the general public believe that the NHS lacks sufficient staff to enable them to do their job properly. When we talk about altering waiting times, it is worth remembering that healthcare is a labour-intensive industry in all its aspects. We all know that, and we all know that the NHS achieves what it does only through the dedication and commitment of the staff and the hours that they work, from the consultants through to the nurses, the healthcare assistants, the porters and everyone. We have to try to assist them because they are getting towards breaking point. The Royal College of Nursing has balloted its members and is talking about taking industrial action. Therefore, we look to the Government to have the political will to act.

I accept that there is no magic wand. This Government bear a lot of responsibility because they were the key partner in the coalition that cut the number of nurses in training after 2010. The onus is now on them, and they are beginning to increase the numbers, but they must do more. However, it obviously takes a long time to train consultants, doctors and GPs. There are shortages everywhere, including a shortage of 40,000 nurses. I do not know the figure, but there is a shortage of GPs running into the tens of thousands. There is a shortage of hospital consultants and shortages everywhere.

So what do we do? It is not easy, because more nurses are leaving than entering the profession. We cannot do anything about the training, as that will take a number of years, but we can do something about retaining people in post, by persuading GPs to carry on a bit longer and persuading nurses to stay in post as it is worth while doing what they do. That is what we should be doing. It would be a great help if the 1% cap on wages could be lifted, because that has meant that the average nurse is probably 12% worse off than they were a few years ago. That would be one way of making it easier to retain people.

Then there is the other point that was made by my noble friend who introduced the debate, whom I thank, about the number of nurses and doctors who have worked in the health service who are from the European Union. Can we offer them something to persuade them that we want them to stay in our country? For example, as the Minister knows, anyone from the European Union who has spent five years working in this country, which includes people in the health service, can apply for the right of permanent residency. But we cannot get the Government to say what that means. Does permanent residency mean that they can stay here, or will they be sent back to Europe? That increases the uncertainty and anxiety. I urge the Minister to go back to his colleagues and say, “All right, if we can’t or won’t make a commitment to the European Union citizens to stay in the health service, let us say that at least those who have gained permanent residency can stay”. That would help the issue.

I return to my basic point. This now requires political will. I do not doubt the Minister’s commitment. I know where the Minister stands and how much he believes in the health service. He has made that quite plain in a number of debates that we have taken part in. But we need political will and we are looking to the Minister to try to argue his corner and punch above his weight and give every support that he can to try to make health staff in the health service more satisfied so that they stay in their jobs and help us to reduce waiting times.

[Baroness Masham of Ilton (CB)]

My Lords, I want to ask the Minister about the better care fund, which is for health and social care working together, which also comes under the mandate. The better care fund document was not available for scrutiny purposes, as it was not published until 15 days after the instrument was laid before the House. All relevant documentation should be available. Without that, effective scrutiny is not possible. What is the present situation, as this deals with some very vulnerable people?

Brexit: Risks to NHS Sustainability

Lord Clark of Windermere Excerpts

Wednesday 12th July 2017 Lords Chamber

[Lord Clark of Windermere (Lab)]

My Lords, I am delighted to participate in this debate and to follow the noble Lord, Lord Cormack, and his clear, erudite and free-thinking contribution to the debate. I especially congratulate the noble Lord, Lord Warner, on allowing us an opportunity to debate this issue. When he approaches anything, he approaches it in a meticulous manner. Securing this debate today and concentrating our minds on sustainability and the risks involved with Brexit is a useful exercise for us to undertake, so I thank him for that.

I approach the debate with some hesitation, and I am sure that other noble Lords will feel likewise. At one level, none of us wants to say or do anything that will shake people’s confidence in the National Health Service. It is indeed the most efficient health service in the world, and it still delivers a wonderful service to the general population of the United Kingdom. I would hate to think that anything that I might say might cause distress to patients. However, as the noble Lord, Lord Cormack, hinted, as parliamentarians we are privy to information that is not available to other people. I suspect that I know quite a lot more about what goes on in hospital than even the Minister, whom I hold in the highest regard. I understand his sincerity and his commitment to the NHS, but so much of his information is, naturally, fed to him by his civil servants—I understand that, and I am not attacking civil servants. I looked after the Civil Service in my previous existence.

As the Minister may have noticed, I have tried to take a different approach to collecting information. Of course I accept the facts and look at the statistics but over the years, through my friends and associates, I have tried to build up contacts in the health service. People who work in the health service and in hospitals give me the picture as they see it—how it actually is—and it is up to me whether I believe it or not. I have to say that the picture is far worse than I had imagined, and I will try to develop some of those points today.

However, I start with a point raised by the noble Lord, Lord Warner—Euratom. I spent seven years as a director at Sellafield and I suspect that I know a little more about nuclear reprocessing than perhaps most of the general public do. I simply do not understand the Prime Minister’s obsession with leaving Euratom. Perhaps she does not understand what it is—Euratom is a legal entity separate from the European Union—yet she took a decision on it, apparently against the advice of other Cabinet Ministers. I hope that after this debate the Minister will feel empowered to feed the information up to the Secretary of State.

The issues surrounding Euratom are very serious, and I want to spell them out in words of one syllable because that is the only way that I can understand them. Quite simply, leaving Euratom could—I emphasise “could”—restrict the UK’s access to radioisotopes, which are critical to scans and treatment for cancer. It is as serious as that. We do not have reactors in this country capable of producing radioactive isotopes. We import them largely from France, Germany and Holland, and the control and safety monitoring of those isotopes is carried out by Euratom. By cutting our links with Euratom, we expose ourselves.

To put this issue in context, half a million scans are performed every year in Britain using imported isotopes and, on top of that, over 10,000 cancer patients have treatment involving their use. I just think that it is too big a gamble to take a decision on what I can only think are ideological grounds. That is a big, big error and I hope that the Government will rethink their position.

Going back to the basic issue, I suppose there are two basic problems. One is clearly finance. We spend less on healthcare than any of the other G7 nations, with one exception. I believe that the Government should make a commitment to go for at least the average spend on health among the G7. That would give us an opportunity in the years ahead to start an expansion.

A second problem is staffing—at every level. Throughout the National Health Service there is a panoply of overwork, low morale and staff working in what I can only describe as desperate conditions. Nurses finish their shifts in tears time after time. They are frustrated because they simply do not have the time to perform their job—their vocation of care—and they feel that they let the patients down, simply because they are understaffed. I have heard reports of nurses working a 12-hour night shift—that is the average length of a night shift—without being able to stop to have something to eat. That is happening regularly. The Minister might say, “Ah, but the numbers are made up with agency nurses”—and they are. But one only has to think about it to realise that, as the reports I get confirm, agency nurses can do the mundane things but most of them are not familiar with the work of the hospital or ward in which they are working. So even with the numbers increased by agency nurses, the onus on the regular staff of the hospital is increased.

It is not only about nurses, where we are 40,000 short of what we need, let us consider doctors. Where I live, the north Cumbria trust has 48 vacancies for consultants—we cannot get any consultants or nurses to work on the west coast of Cumbria. Right next to Sellafield, the largest industrial site in Europe, there is no hospital of any quality within an hour-and-a-half’s drive. That is the seriousness of the problem.

For the first time ever, more nurses are leaving the profession than joining. The worry is that the greatest drop was among the English or British-trained nurses, which was far higher than among the European-trained nurses.

I hope the Minister will consider looking again at the abolition of the bursary scheme if the indications at the beginning of September show that there is going to be a fall in the numbers. We cannot stand another decrease in the number of nurses. I say this to the Government because they need reminding: their track record is not good. They were the Government who cut nurses’ training by 10% in the years following 2010, and it has taken us a long time to recover.

I end with a thought on the residency of European Union-educated nurses. From exchanges with the noble Baroness, Lady Williams, I understand that after five years of working in the health service, or any permanent employment, European Union citizens can get the right to residency. Then, after a further year—six years in total—they are entitled to UK citizenship. That seems straightforward, but what concerns the nurses and the European Union is this: can those rights be withdrawn willy-nilly by any British Government in the future? That is a serious problem that the Government have to address in order to reassure people working in the health service.

[Lord Winston (Lab)]

Before my noble friend sits down—

Older Persons: Care and Human Rights

Lord Clark of Windermere Excerpts

Tuesday 11th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I certainly pay tribute, as the noble Lord does in the foreword of the report, to the growing trend towards strengthening the protection of older persons’ human rights. He is also right to highlight today and in the report that there are still widespread negative stereotypes. The Government are proud to lead the world in tackling age discrimination, and we published in February a strategy called Fuller Working Lives on that purpose. We are taking many actions to fulfil the requests in his report; one particular one that I would focus on from a health perspective is the fact that, by 2020, all medical curricula will include training for geriatrics, so there will be that additional support throughout the entire NHS.

[Lord Clark of Windermere (Lab)]

My Lords, I, too, congratulate my noble friend on producing such a brilliant report. One theme running right through the report is that ageism, like sexism and racism, is simply wrong. Does the Minister agree with that? In his response to the report, will he make it clear that the Government will not support ageism in general legislation or in any rules affecting this House?

[Lord O'Shaughnessy]

Rules affecting this House will, of course, be decided by its Members, who are probably the least likely group in the entire country to be ageist. The noble Lord is quite right to highlight this incredibly serious point. Any form of negative stereotyping or discrimination is, of course, wrong. I mentioned a couple of things that the Government are already doing and a lot is going on to counter any kind of discrimination. This Government have got more older workers into employment and are tackling the discrimination in the workplace that, unfortunately, still takes place.