Nursing: Staffing

Baroness Bennett of Manor Castle Excerpts

Thursday 16th June 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the right reverend Prelate the Bishop of London who, together with the noble Baroness, Lady Tyler of Enfield—whom I thank for securing this debate on the report—have covered clearly the huge issues that it raises. I want us to take a broader, global view and then look at some of the structural issues behind the immediate reality in that report.

On the global view, the World Health Organization tells us that there is a shortage of 5.9 million nurses around the world; that is nearly a quarter of the current global workforce of almost 28 million. The biggest shortfalls are in low and middle-income countries, notably in Africa, Latin America, south-east Asia and the eastern Mediterranean. I agree with the noble Lord, Lord Lilley, that we in the UK should not be taking people from other countries, particularly ones with a nursing shortage. We should be training in the UK more nurses than we need. As a wealthy country, that should be our responsibility.

The International Council of Nurses says that behind this shortfall are many structural problems, including low pay, poor conditions and—remembering we are talking about the global scale—inadequate training availability. I note that McKinsey & Company did a study which found that, in five of six nations surveyed—the US, the UK, Singapore, Japan and France—one-third of nurses said that they were likely to quit in the next year. This is not a problem simply contained within the UK.

Of course, Covid is a huge factor here; the WHO estimates that about 180,000 healthcare workers died from Covid, many of them no doubt occupationally exposed between January 2020 and May 2021. Many others would have been harmed by long Covid, burnout and mental ill-health from the difficult conditions they were facing. Looking back to 2021, a long-term study by JAMA, a US research network, found that female nurses were twice as likely as women in the general population to commit suicide. That is a very disturbing statistic.

The noble Baroness, Lady Tyler, set out very clearly that we have a problem in the UK; the Government have stepped up recruitment, but it is not even keeping us at the levels of staffing we have now. There are aspects of this job that are enormously, immensely difficult. There will always be people needing care at all hours and on weekends. It is not possible ever to make this a nine-to-five job for many people.

Nurses and midwives have to deal with tremendously difficult situations. I think of a student midwife testifying about being on a work placement in a delivery room which had just had a stillbirth. She was left, as a student, comforting the mother while other professionals in the room looked after the medical needs that needed to be cared for. Think about the fact that that student midwife is now paying to be in that situation. To study as a student midwife, that is what you do: you pay.

My thesis, which I want to explore a little today, is that the underlying structural issue is that nursing and midwifery as professions are profoundly undervalued. That is why we find ourselves in this long-term global situation. I am drawing on another Royal College of Nursing report from last year, titled Gender and Nursing as a Profession: Valuing Nurses and Paying Them Their Worth. I note that in the UK—I think this is broadly reflected around the world—this is one of the most gender-segregated professions; only about 10% of nurses are male. As this report notes:

“Nursing suffers from a historical construction as a vocation”.


Individuals, usually women, were seen to enter it because they had a calling, and the salary was almost incidental; it enabled them to keep pursuing that calling as it was just enough. We know that many nurses feel this and that, through the pandemic and at all times, they display huge amounts of good will, working far beyond their paid hours and in very difficult conditions, often without financial reward.

We have to go further even than thinking about the gendered construction of nursing. The question here is the gendered construction of care. As the RCN report I am citing says, care is seen as

“a naturally feminine skill or characteristic”

that sits opposed to professional skills and qualifications. But being able to care for anyone in even the most difficult situation is an emotional labour. This should not be taken for granted. It should be properly recognised and remunerated.

In the UK we are in a position to provide potentially global leadership. The Government should like this, as I will say that we were historically world-leading in the nursing profession, with Mary Seacole, Florence Nightingale and many other names I could cite. We helped establish the global pattern for nursing as a profession. Of course, the NHS as a large single employer has the potential to turn this situation around and truly acknowledge the contribution nurses and midwives make.

Yet over recent years we have seen austerity suppress wages. Our heavily suppressing the ability of trade unions to act in the UK has also had a huge impact on wages. It is interesting that, as the RCN report notes, there is very

“little variation in earnings across the nursing workforce”—

among registered nurses—

“despite the wide range of roles and responsibility”.

There is a huge undervaluing of all levels, but particularly the highest levels.

I am out of time. I wanted to comment on how, although only about 10% of the profession are men, they occupy 20% of the highest-paid roles, but I will leave the exploration of that for another day. I finish with a little thought experiment for your Lordships’ House. Bankers are paid an awful lot more than nurses. Why?