NHS: Working Conditions

Lord Clark of Windermere Excerpts

Wednesday 5th July 2017 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what proposals they have to improve working conditions for NHS staff.

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

My Lords, the Government are improving working conditions for NHS staff by recruiting record numbers of doctors and nurses over recent months. Furthermore, we are helping trusts to become employers of choice through more flexible working, improving staff health and well-being, and tackling bullying of and violence against NHS staff.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his reply, but it indicates to me that the Government are still in a state of denial. He talks about recruiting extra nurses. Has he seen the report last week that showed that for the first time ever there were more nurses leaving the profession than joining it? How does that stack up with his assertion that they are recruiting more nurses? Does he not accept that it is only on account of the dedication and commitment of all NHS staff, including doctors, nurses and ancillary staff, who on occasion work in appalling conditions, that the service is as good as it is? Why do the Government, as a first step, as a gesture, lift the pay cap so that the nurses and the doctors can have a salary that they deserve?

Brexit: Nursing Staff

Lord Clark of Windermere Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord O'Shaughnessy]

I reiterate the point that the Prime Minister made yesterday about the welcome, and indeed the offer of settled status, not just to nurses but to any other EU citizens and workers in the country. It is absolutely not the case that they are unwelcome—quite the opposite. They are as valued as much as any other person working in the health service. The noble Baroness mentioned housing, and she is right, of course, that housing is a huge issue for everybody. Indeed, one thing that I want to look at in the next few years is how we can take surplus land that sits within the NHS and make sure that some of it is used to provide the kind of key-worker housing that nurses, doctors and, indeed, other members of the public sector can use, so that they are able to come into the service and support our hospitals.

[Lord Clark of Windermere (Lab)]

My Lords—

[Baroness Manzoor (Con)]

My Lords—

--- Later in debate ---

[Lord O'Shaughnessy]

I completely agree with my noble friend, who speaks from experience. It is important not to peddle a myth of unwelcomeness, when it is clearly the case that nobody has said that they are unwelcome. No one in government has said that they are unwelcome; nor has the BMA, the RCN, or anyone else for that matter. They are valued as highly as any other member of the medical profession.

[Lord Clark of Windermere]

My Lords, does the Minister accept that any fall-off in the number of nurses and doctors from the EC poses a real risk to the health service? Does he accept that, while the number of nurses in training may be increasing now, the Government were wrong in the coalition period after 2010 to cut the number of nurses in training in the UK?

[Lord O'Shaughnessy]

The critical point is to have enough nurses and, indeed, enough medical staff. Of course, where they come from is going to be dictated by various circumstances. As I have discussed already, language controls have been introduced in order to focus on patient safety. We do need to increase the number of nurses in the health sector. That has happened since 2010. There has been an increase. There are more in training. But clearly there need to be more as we have a growing and ageing population.

NHS: Shared Business Services

Lord Clark of Windermere Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord O'Shaughnessy]

To date, the cost of dealing with this problem is around £6 million. Clearly there is a contractual relationship between NHS SBS and various bits of the NHS. It needs to be established clearly, independently and objectively where the culpability lies for any incurrence of costs, both with the problem in the first instance and in dealing with it. Once that has been established, costs will be fairly and correctly apportioned to whoever caused the problem in the first place.

[Lord Clark of Windermere (Lab)]

Has the Minister seen the reports that managers moved many of the documents out of sight and actually destroyed many of them? If that is the case, it is very serious. If it were a wholly private company, its directors would be suspended pending investigation. If it is the case that documents were deliberately destroyed, will the most serious action be taken against the directors of that company?

[Lord O'Shaughnessy]

Clearly, if there were such an incidence, the noble Lord is quite right that it would be dealt with very strongly—but it is important to point out that there has not been evidence that that has happened. Documents were destroyed that sat within SBS, but they were not part of the backlog and they conformed, as we understand it, to the protocols around destroying old papers when they have gone past a certain time limit. So there is no evidence that what the noble Lord described has happened in this instance—but, as he points out, if it had happened it would be of the utmost seriousness.

Education (Student Fees, Awards and Support)(Amendment) Regulations 2017

Lord Clark of Windermere Excerpts

Thursday 27th April 2017 Lords Chamber

Moved by

[Lord Clark of Windermere]

That this House regrets that the Education (Student Fees, Awards and Support) (Amendment) Regulations 2017, which pave the way for students of nursing, midwifery and allied health professionals to receive loans rather than bursaries, have already been seen to discourage degree applications by a quarter, at the same time as Brexit has already reduced European Union migrant nursing and midwifery registrations by over 90 per cent; and that these factors risk turning an increasing problem in the National Health Service into a chronic one that potentially puts at risk safe levels of staffing (SI 2017/114).

Relevant document: 26th Report from the Secondary Legislation Scrutiny Committee

[Lord Clark of Windermere (Lab)]

My Lords, it is particularly appropriate that the final debate of the Parliament in this House is on a matter of such concern to the British people: our National Health Service. If there is one group of people who always top the approval ratings among the British people, it is nurses. I will not say where we politicians are.

It is widely accepted that the National Health Service provides real value for money. In fact, we get health on the cheap in this country. We spend less on health than any other member bar one of the G7 nations, and I am not sure that that can continue for much longer. I think we will have to spend more on health, with our ageing population and the growth of what is technologically possible.

In a sense, we have been helped in this debate by the report of a Select Committee of this House on The Long-term Sustainability of the NHS and Adult Social Care. It draws to our attention how we have failed over the years to have long-term planning for organising staff. We must remember that approximately 150,000 people work for the health service. It is a fascinating organisation. It is a labour-intensive organisation—which applies in one way to nursing—married to and working alongside cutting-edge technology and science. It works, and we must continue to ensure that it works. The key is the staff at every level.

Anyone who follows the press or talks to doctors, nurses or the other health professionals knows that our National Health Service is in deep trouble and is functioning safely only due to the work level of the staff and their intense dedication to the service in which they work. That cannot continue indefinitely. Repeatedly, the royal colleges of nursing, midwifery and all the other medical disciplines tell us that we are getting towards breaking point. The strain is intense; the morale is low.

Let us take just nursing. Currently, we are about 24,000 nurses short—I think there is no disagreement with that. That affects not only our National Health Service but another big issue at the moment, the after-care service. A number of care providers, nursing providers and Care England have contacted me to say that they have had to close beds because they cannot get nurses to staff them. We tend to neglect that, and I mention it only in passing today because I want to concentrate on the health service.

I gather that the Government have had a report available to them in March which is not yet public which suggested, on a worst figure scenario—I emphasise that—that by the early 2020s we would be not 24,000 but 42,000 nurses short. Morale is not helped by the fact that nurses were not well paid to start with. They are highly qualified. All nurses are now graduates. They have to do professional work. Increasingly, they are doing work traditionally done by doctors. They are able and skilled do it, and we benefit greatly from that. The 1% annual pay increase which they have had to accept since 2010 is having a massive effect on morale, especially when people are having to work so hard.

We get by only because we import nurses from overseas. We have traditionally done that—I am not just blaming the Government in this case—but the problem is now acute. Of those nurses from overseas, 20,000 originate from European Union countries. Despite effort and pleading by me and others, we cannot get the Government to commit to those 20,000 people who work so hard in our National Health Service being allowed to stay in Britain. That will be easy to do: we need only to tweak the residency rules. That could be done without causing any problem, yet it would be of great benefit in retaining those nurses. I believe that we should offer them permanent residency in this country, as they have dedicated so much effort to providing healthcare for our population but, at the end of the day, we must train more home-grown nurses. The supply is there, because for every person who is accepted on to a nursing course at university, twice as many people apply. There is the quality and quantity of individuals who want to train nurses. The reason why they are not is because the Government have insisted on a cap on the numbers. Universities are not allowed to accept more nurses than has been agreed with the Government. By imposing this cap, we are exacerbating the problem.

I challenge the Minister that we are only really talking about saving money. That is what is dominating the Government’s approach to the training of nurses.

To recap a little, the bursary system that has been developed meant that nurses who went into training did not pay fees. The quid pro quo was that most of them went on to work in the care services or the National Health Service. That system worked well and was fully subscribed. Under the proposals we are debating today, those individuals will have to pay £9,000 per year in fees for three years which, with their living costs, will mean that nurses enter their profession not well paid and with £50,000 minimum hanging on their shoulders. I doubt that that is a sensible approach.

We must accept that nursing students’ courses at universities are very different from most courses. It is not just lectures and library work. At least half the time of nurses in training is spent on the job, on clinical training. In most hospitals, most patients could not determine who is a student nurse and who is a qualified nurse, because student nurses are doing the work of trained nurses, except in a few technical, specialist areas.

[Lord Forsyth of Drumlean (Con)]

I am most grateful to the noble Lord. On his point about the number of nurses who previously got bursaries and about financial controls on the bursaries, what proportion of those applying were unable to get bursaries and, therefore, unable to get training places?

[Lord Clark of Windermere]

As I understand the question, anyone accepted on to the course got a bursary—so they all got the bursary. I am pretty sure that I am right on that. But the point I was making about the course being different was not only that it is more intensive and about working on the job—the course is also longer. The average course length at universities for nursing, midwives and allied health professionals is 39 weeks a year, much longer than the average student course. So it is a different course; they have no opportunity, or little opportunity, to do any extra-curricular work, because of the nature of the job. Yet while they are working on wards, they work as a team.

In essence, the Government are insisting—for, I think, the first time in decades—that nurses pay for working in the health service. They are paying £9,000 a year to work as unpaid nurses. That is absolutely scandalous. Even before the new system came in, going back 50 years, you were accepted on a nursing course and went to the hospitals where you were trained. There was a mixture of blocks in the hospital and working on wards; that is how it traditionally went, but the nurses did not have to pay to perform those tasks. It is outrageous that this Government are insisting that nurses should pay for their own training.

The Government’s justification for this change is to increase the number of nurses being trained, which we all welcome—we all want the number of nurses to be increased. It would help in so many ways. Virtually every hospital now survives by using agency nurses, paying far more by the hour than the NHS staff nurses get paid. We could save billions of pounds if we had sufficient nurses to staff our NHS and aftercare services. So what I am arguing for makes financial sense. The Government say that they are prepared, if nurses pay for their own education—and this is perhaps the point that the noble Lord was making—to lift the cap, so the universities could train as many students as they want. I hope that works; I want the system the Government are proposing to work. But then we come to the problem that it is easy enough for the universities to expand their lectures and provide library facilities; the difficulty comes when the National Health Service has to provide mentors, tutors and practical oversight of students when they work on wards and in clinical situations. There is no provision, as far as I can see, by the Government to provide extra money to hospital trusts to perform that critical part, which is at least half the cost of nurse training.

I want the proposal to work but it is highly risky. We are dependent on nurses from the European Union—and the latest figures are that there was a 90% fall in the registration of nurses from European Union countries since last December, which is an ominous sign. Then we have the figures from the Government, which show that the number of applicants to health courses was down by 23%. I accept the Government’s point that those were applicants, not people who had actually been accepted on to a course. What worries me is that, if it follows through, and if the Government do not get students prepared to enrol at universities, we will find that we make no inroads at all into the shortage of 24,000 nurses.

--- Later in debate ---

[Lord O'Shaughnessy]

I am not going to speculate on the impact of that. What I can tell the noble Lord is that, despite the scare stories that numbers will have been affected, there have been more EU-based nurses in the past year. That is the point that I wish to get across.

The real issue at stake is whether the number of staff in the NHS is increasing to meet the growing demands on it, and here the Government have a strong record. Over the past year, the NHS has seen record numbers of staff working in it. The most recent monthly workforce statistics show that, since May 2010, there are now over 33,000 more professionally qualified full-time equivalent staff in NHS trusts and clinical commissioning groups, including over 4,000 more nurses.

Health Education England’s Return to Practice campaign has resulted in 2,000 nurses ready to enter employment and more than 900 nurses back on the front line since 2014. There has been a 15% increase in the number of nurse training places since 2013, plus the introduction of up to 1,000 new nursing apprenticeships and the creation of nursing associate roles—the kind of non-graduate nursing roles that my noble friend Lord Forsyth pointed out as being such a crucial part of the mix. These all form part of our plan to provide an additional 40,000 domestically trained nurses for the NHS. These new and additional routes into the nursing profession will allow thousands of people from all backgrounds to pursue careers in the health and care sectors and, critically, allow NHS employers to grow their own workforce.

I will end as I began. I believe that this regret Motion is misguided. The extension of the loan-based system to nursing and midwifery training is a natural development of reforms that have received cross-party support, successfully expanded higher education, dramatically improved the participation of disadvantaged groups and provided a fairer distribution of the costs of funding higher education.

Despite the pessimism of some, the decision by the British people to leave the European Union, which this party respects, has not had a material impact on the workforce. Furthermore, and paid for in part by the resources freed up by our changes to student finance, this Government have put in place a series of programmes that have successfully increased the number of staff in the NHS and provided more training places than ever, allowing us better to grow our own workforce among UK residents.

The true source of regret is that the Opposition have used this opportunity to run scare stories about both the impact of sensible funding changes we have made and the impact of leaving the European Union on the NHS workforce. I urge all Members of this House to vote against the Motion.

[Lord Clark of Windermere]

My Lords, I have listened very carefully to the Minister. I wanted to be persuaded; I am not persuaded. I believe that the Government are taking a big risk. They have gambled before. It may not be known, but in 2011, 2012 and 2013, they reduced the number of nurses in training because they thought we had sufficient. As a result, several thousand nurses were short-trained in those three years, because the Government got the figures wrong. I believe that they have got the figures wrong again. It is a big risk that we do not need to take. It is unfair on the nurse’s career, but, most of all, it is unfair to potential patients in the National Health Service. I want to test the opinion of the House.

Healthcare: Spending

Lord Clark of Windermere Excerpts

Tuesday 4th April 2017 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government whether they will increase spending on healthcare as a percentage of gross domestic product to be in line with the G7 average.

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

My Lords, since 2010 health spend has increased in real terms and is broadly in line with the EU average. This Government are giving the NHS an additional £10 billion above-inflation increase in its annual funding by 2021. We have now gone beyond that, with £425 million of new capital spending for the NHS announced at the spring Budget, and we have pledged to provide further capital at the autumn Budget.

--- Later in debate ---

[Lord Clark of Windermere (Lab)]

My Lords, I thank the Minister for his Answer, which goes a long way towards explaining why the NHS is at breaking point. Our hospitals and GPs’ surgeries are full, social care is on its knees and staff are working in impossible conditions. Those are not my words; they are the words of the BMC, which knows what it is talking about. My Question is not about Europe; it is about the G7. First, will the Minister confirm that as a country we are next to the bottom of the G7 nations in health spend? Secondly, why will the Government not commit us to meeting the average of the G7 countries, which would go a long way towards reviving our wonderful National Health Service?

[Lord O'Shaughnessy]

The noble Lord makes the point that the NHS is operating in challenging conditions, not least because of rising demand and expectations. Notwithstanding that, there is a huge improvement in performance. More operations are being performed, there are more diagnostic tests, more people are starting cancer treatment, and people say that they have never been more satisfied with the quality and dignity of care that they are receiving. Those are the points that we need to bear in mind when we talk about the fantastic work that NHS staff do.

National Health Service: Nurses

Lord Clark of Windermere Excerpts

Wednesday 22nd February 2017 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have to eradicate the shortage of trained nurses in the National Health Service and care sector.

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

My Lords, this Government have undertaken work to increase the number of trained nurses. We now have a record number of nurses working in the NHS. By increasing the number of training places for both new nurses and nurses returning to practice, we continue to support the growth of our nursing workforce in the health and care sectors.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his reply but I cannot share his wing-and-a-prayer approach to the drastic shortage of nurses we face. Bearing in mind that the NHS alone is short of 24,000 nurses, and the 23% reduction in nursing applications as of this autumn, does the Minister not agree that they should reinstate the bursary scheme at university for nurses, or at least promise nurses who qualify and spend a number of years working in the health service that they will have their tuition fees reimbursed?

[Lord O'Shaughnessy]

I am sorry that the noble Lord takes such a negative view of the changes we are making. There are actually 6,500 more full-time equivalent nurses and health visitors than there were in 2010. There has been a 15% increase in the number of training places and of course, through our reforms which he just mentioned, we are taking the cap off the amount of training places that can be offered.

Mental Health: Children’s Services

Lord Clark of Windermere Excerpts

Thursday 19th January 2017 Lords Chamber

[Lord Clark of Windermere (Lab)]

My Lords, might I press the Minister a little further on his very last sentence, when he referred to the increased availability of nursing? I know that he is aware that there is a projected 20% drop in nurse training at this stage but, for specialist nurse training, especially mental health nurse training, the drop is even larger than 20%.

[Lord O'Shaughnessy]

This is something that we had the opportunity to discuss yesterday. I am aware of the concerns on this issue. The reforms are designed to take the cap off the number of places, making more places available. In the last year, something like 37,000 applicants were turned away from nursing places, which is clearly not something that we want. When there is a change in regime, clearly there may be an impact on numbers in the first year—as there have been when tuition fees have been introduced in the past—but historically that has tended to rebound.

Nurses: Training

Lord Clark of Windermere Excerpts

Tuesday 22nd November 2016 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government how many individuals completed training to become qualified nurses in England in 2015.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the latest data available from the Higher Education Statistical Agency show that approximately 23,000 nursing students qualified from higher education courses regulated by the Nursing & Midwifery Council in England in the 2014-15 academic year.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his considerate Answer and his personal commitment to the health service. I much appreciate it, but does he appreciate that the figures he has provided today mask the true picture of nursing in this country? Will he accept that the coalition Government in 2010 made a massive mistake when they made those savage cuts in nurse training? Even with the increases of late, there are still only 0.6% more nurses now than there were in May 2010, which is in spite of a 31% increase in hospital admissions. Does the Minister accept that the staff of the NHS are keeping the ship afloat? Can the Government offer some concessions to the generosity, commitment and dedication of those staff?

[Lord Prior of Brampton]

My Lords, there were 3,500 more nurses working in the NHS in 2015 than there were in 2010. In retrospect, we did not anticipate in 2010 the Mid Staffordshire crisis and the Francis report, which led to a very substantial increase in nursing levels after about 2013. The noble Lord is right; we were short of nursing throughout that period. We are addressing that now with a 15% increase in nursing places and we expect that by 2020 there will be 40,000 more nurses than there were in 2015.

Medical Students

Lord Clark of Windermere Excerpts

Wednesday 26th October 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, overseas doctors account for about 25% of the total number of doctors employed by the NHS, which is a very high number. I do not have the breakdown for the Commonwealth countries but it is an interesting question; I will research it and write to my noble friend. She is absolutely right that there are shortages in particular specialties. General practice and psychiatry are probably the two areas where there is the biggest shortage. HEE is determined to increase the intake in those areas. Certainly, the number of doctors going into GP specialty training this year is just over 3,000. That is an increase on last year but is still not enough.

[Lord Clark of Windermere (Lab)]

My Lords, we welcome the increase, but is it sufficient to meet the problem? I understand that about 100,000 overseas doctors, including European doctors, work in the NHS. Given an extra 1,500 places a year, it will take many years to reach the target. Why do we not make a gesture to those overseas doctors working in the health service and offer them permanent residence here?

[Lord Prior of Brampton]

I think it will be helpful if I quote from the Health Secretary’s speech at the Conservative Party conference, talking about overseas doctors. He said:

“They do a fantastic job and the NHS would fall over without them. When it comes to … EU nationals, we’ve been clear we want them to … stay post-Brexit”.

Let us be absolutely clear: we want overseas doctors from the EU or elsewhere to stay here post-Brexit.

NHS: Bursaries

Lord Clark of Windermere Excerpts

Wednesday 25th May 2016 Lords Chamber

[Lord Prior of Brampton]

I think that it is a good deal for the Government—as the noble Baroness puts it like that—on a number of fronts. It is good for patients because there will be more nurses. It is good for the Government because there will be less need to recruit overseas nurses and agency nurses. Of course, the noble Baroness is right that for mature students coming in, the time to repay the student loan debt will be shorter than for younger people, but the Government will still make a return on that.

[Lord Clark of Windermere (Lab)]

Is the Minister aware that nursing students spend about 50% of their time on clinical placements? Given that there is no provision in the consultation document for extra financial facilities to be made available to hospitals providing those placements, how will they cope with the overstretch that is already in the hospital mentoring system?

[Lord Prior of Brampton]

That is a good question. Nurses spend 2,300 hours of their three-year course in clinical placements in hospitals. They are supernumerary. They are clearly supervised and mentored in that setting, but they also provide a fair amount of care in those hospitals as well. I am pretty confident that hospitals will work out an arrangement with universities to ensure that they create enough clinical placements for those nurses.