NHS: Staffing Levels

Dan Poulter Excerpts

Tuesday 11th December 2018 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Member for Batley and Spen (Tracy Brabin) on securing this debate and on highlighting the biggest challenge facing the NHS: the creeping workforce crisis that has been evolving for some time now. We are now seeing that crisis beginning, in real terms, to affect patient care.

The hon. Lady was right to highlight the fact that a lack of staff in some parts of the country means that operations are being cancelled and beds are being closed. She was also right to point out the challenges that Brexit poses to the recruitment and retention of frontline NHS staff; in the past decade, we have been increasingly reliant on European Union staff coming to work in the UK—before that, it was staff from outside the EU who provided most of the overseas workforce in the NHS. I am sure that all of us would like to put on the record our support for the excellent work that NHS staff from the UK and from all over the world do in caring for patients.

I will also do what I should have done at the beginning of my speech and draw attention to my declaration in the Register of Members’ Financial Interests, as I am a practising NHS hospital doctor working in mental health services.

[Paula Sherriff]

Will the hon. Gentleman give way on that point?

[Dr Poulter]

I will not, because of the time limit and because I want to let other people speak; I am sure that we can talk about this issue in detail after the debate.

Very briefly, Mr Hollobone, the Government have made a number of promises about NHS staffing and yet, unfortunately, those promises are failing to come to fruition. In 2015, there was a promise of 5,000 more GPs. Recently, I submitted a written parliamentary question about how much progress had been made in realising that target but I did not get an adequate answer. I would be grateful if the Minister updated us in his concluding remarks by saying how close we are to realising that target of 5,000 additional full-time GPs.

I would also like to highlight some of the challenges in community and mental health services. Very often in this Chamber, we talk about hospitals, and very often the NHS is seen through the prism of that acute sector, but the key challenge to keeping people out of hospital is doing more in the community, building up community mental and physical health services—and they are the very services that are seeing reductions in frontline staff.

I want to touch briefly on mental health. We know that the number of full-time-equivalent mental health nurses fell by 6,000 between 2010 and March 2018, including a reduction of more than 1,800 in learning disability nurses alone. The number of child and adolescent mental health service and learning disability consultant psychiatrists has also slightly declined over the past decade, and many parts of the country, particularly outside London, are struggling to fill higher registrar training posts in those services.

Perhaps more concerning is that the number of junior doctors in specialist psychiatry training—core and higher psychiatric trainees who will become the consultant psychiatrists of tomorrow—has also fallen, by 490 full-time equivalent doctors, from 3,187 in 2009 to 2,697 in March 2018. [Interruption.] The civil servants are rapidly checking my figures; they are from answers to parliamentary questions, so they are absolutely correct.

That is a woeful record of decline in the psychiatric and mental health workforce, and it must be corrected. If the Government are serious about their rhetoric on mental health, about improving the quality of provision for people with poor mental health, they need to recognise that the workforce has already declined. Even if there is the promised increase in numbers, it will be from a lower baseline than that of about a decade ago.

The only way to deliver the expansion in services that patients deserve—for example, specialist eating disorder services in Cumbria or East Anglia—is by having a much more serious approach to the recruitment and retention of mental health staff and by paying premiums to attract both doctors to work in CAMHS and people to work in parts of the country where there is a shortage of mental health staff. I look forward to the Minister’s response.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is an honour to serve under your chairmanship, Mr Hollobone. I, too, declare an interest as a longstanding NHS worker of more than 30 years.

Healthcare is not delivered by machines or buildings; it is delivered by people. People are the core of the NHS. The problem relates to workforce, and it is hitting all four nations. Although Scotland has the highest ratio of every group of healthcare staff per head of population, we too face challenges. We have a 4.8% nurse vacancy rate in Scotland, but in England it is more than 11.5%. The Royal College of Nursing says that there are 41,000 nurse vacancies at the moment, and if action is not taken, that will rise to 48,000.

As other Members mentioned, since the introduction of the bursary in 2015, there has been a one third drop in applications. Acceptances in England have gone down by almost 4%, whereas in Scotland they have gone up by almost 14.5% over the same period. The bursary is having a huge impact, particularly on mature students, who might already have a degree and have therefore also been hit by the removal of the post graduate bursary that allows a nurse to be trained in just two years.

There has been a 15% drop in mature students, which is hitting those with mental health issues and learning disabilities in particular, as those specialities tend to attract the more mature nurse student. There has been a 13% drop in mental health nursing staff and a 40% drop in nurses looking after those with learning disabilities. That makes those services unsustainable.

Brexit is affecting the workforce, as it is every other aspect of life. There has been a 90% drop in European nurses registering to come and work in the UK, and a trebling of EU nurses who are leaving the UK register. That does not help to solve the problem, and those nurses cannot be totally replaced by UK staff in enough time. It does not matter that the Government come out with warm words if the Home Office’s actions make people feel insecure. Friends of ours who have been GPs for more than 20 years in Scotland applied for citizenship for their children. The eldest and youngest children were granted it; the middle child was refused. What are they now talking about? “Maybe we should go back to Germany where we’d be safe.”

From every angle, the Government are taking actions that are making staffing levels worse. The former Secretary of State for Health, the right hon. Member for South West Surrey (Mr Hunt), used to go on about the lack of junior doctors and consultants as a cause of excess deaths among those admitted at weekends. Actually, the only staffing impact proven through research is on the ratio of registered nurses to patients—not healthcare assistants or others.

[Dr Poulter]

I am sure that most of us had great concerns about the previous Secretary of State’s use of statistics, but a mental health study was carried out and the highest morbidity rates were in the middle of the week, not at weekends, which rather disproved the assertions that he was making.

[Dr Whitford]

We pointed that out repeatedly at the time. It has been shown time and again that quality, well-trained, experienced nurses—not so much agency nurses or healthcare assistants—who know a ward are the bedrock of every single service in healthcare.

Brexit is having an impact. Even though in Scotland our Government have promised to pay settled status fees for all those working in public services, we have already lost, according to the British Medical Association survey, 14% of our doctors. England has lost almost 20%. We cannot reach a point where England has 50,000 nurse vacancies. That would be unsafe. The Government need to take action and, like the Scottish Government, put the bursary back, get rid of tuition fees, and make it sustainable for people to train to become nurses. If they do not do that, the sustainability and safety of the NHS in England will deteriorate further.