Nursing: Staffing

Baroness Brinton Excerpts

Thursday 16th June 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I congratulate my noble friend Lady Tyler on securing this important and timely debate and her excellent introduction to it. Its content is perhaps no surprise to many of us who have spoken so far. Our nursing workforce continues to face unbelievable pressures in their day-to-day roles. Supported by many other clinical and non-clinical NHS staff, nurses say that the NHS must staff for safety and for effective care.

The right reverend Prelate the Bishop of London spoke movingly from her own experience and deep knowledge of the issues that nurses face. I pay tribute to all of our NHS staff, who face the most severe difficulties at the moment. The Government seem to have glossed over these in their post-pandemic policy of, “Let’s just move on”. I hope that the Minister will respond to the questions raised by other noble Lords.

The RCN report rightly looks at the impact on its members, and it makes harrowing and concerning reading, especially on the lack of enough staff on duty on a regular basis, as well as the personal comments of those who have left through burnout. The Royal College of Emergency Medicine’s Beds in the NHS report shows that the NHS needs 13,000 extra staffed beds—the emphasis on “staffed” is important.

The pandemic was an emergency, but long before 2020 we were well below the OECD average for staffed hospital beds, and some of us have been raising concerns about staffing and beds for well over a decade. The current OECD data, which covers 2017-20, shows that the UK has 2.4 beds per 1,000 inhabitants; France has 5.8 and Germany has 7.8, while Korea and Japan have over 12. To repeat, the UK has 2.4—we have lost 25,000 hospital beds since 2010. Of course, in referring to hospital beds, we mean staff as well.

The pandemic has shown us the consequences of having bed occupancy at 95% early in 2020, but the underlying problems remain. The front line of this crisis in hospitals is the ambulance services and A&E departments, but we delude ourselves if we look at only the data. The workforce is absolutely critical, and many noble Lords have spoken about how important it is to plan properly for our nursing workforce. They have mentioned the Health and Care Act and the Government’s apology for workforce planning, including their assertions that they may not publish the workforce plans in full. I echo the questions seeking to understand why that is the case.

Nurses’ role has changed greatly over the last 40 years, and their high level of education and training means that the skills they offer can help to take the burdens off doctors and other clinicians, who bore them alone in the past. Specialist nurse practitioners have transformed the lives of many with long-term conditions—I include myself in that. Community nurse roles have also changed, but their current workload means that their real benefit of having time to talk to, listen to and understand the needs of their patients at home, and then to be able to signpost extra help or resolution, is under real pressure.

So it is good that the Government have increased the number of nurse training places, but it is less good that it is still not enough, given the number of retirements and staff leaving through burnout. The King’s Fund report on the NHS workforce makes this point very strongly, noting how much the UK will have to rely on international nurses. The noble Lord, Lord Lilley, made some interesting points on international recruitment. He has specific concerns about 4,000 nurses coming from poor countries, and he is absolutely not alone in that. But there are some more ethical overseas arrangements: my local trust, West Hertfordshire Hospitals NHS Trust, had an arrangement with hospitals in the Philippines whereby newly qualified nurses would come for a period, usually of five years, to gain some extra qualifications and then return home highly qualified. Even so, while they are away, their country does not have the skills for which it trained them.

Have the Government achieved their targets, set out in their elective recovery plan, which pledged to recruit 10,000 international nurses by April 2022, and are they encouraging the type of partnership that I just described? As my noble friend Lady Tyler said, retention is absolutely vital too. What plans do the Government have to tackle retention? This is about pay, the work environment, bullying, discrimination, more leadership and support for ethnic-minority staff facing discrimination and bias, all of which we have had reports on in recent months.

The noble Baroness, Lady Bennett, made an important point about the gender construction of nursing and, indeed, care. She is right that we undervalue and underpay those in caring nursing roles. That too needs to be re-evaluated, not just by government but by society. We should not have health staff caring for people’s personal needs while on the minimum wage. There is also pressure on nurses with a lack of doctors, so we need to note that the Secretary of State for Health and Social Care has acknowledged that the manifesto pledge to have 6,000 more GPs in England by 2024-25 is not on track. Similarly, the NHS target to fund 26,000 additional roles to ease the pressure on general practice is unlikely to be achieved by that same date. That pressure causes further pressure on our nurses.

Cancer targets are still being missed every month, and waiting times remain sky high. The NHS does not think that it can get them down in the next year, despite the Government promising performance returning to pre-pandemic levels by spring 2023.

Finally—news hot off the press—today there is monthly data for May on trusts achieving the target of waiting four hours or less in A&E. The average for achieving four hours or less is now 60%. The worst three are my own local hospital, West Herts; Barking, Havering and Redbridge; and Torbay and south Devon, which achieved between only 31% and 37%. Those figures alone are shocking, but what sits behind them is a shortage of nurses, doctors and other healthcare staff writ large. I hope that the Minister can respond to these concerns and ensures that we will have a nursing profession that is fully staffed, fully trained and fully supported, as they do their absolutely vital job in our NHS.