NHS Workforce: England

Derek Thomas Excerpts

Wednesday 17th July 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing this debate on an issue that she and I have discussed—her office is near mine in Norman Shaw North—and both care deeply about.

I am glad to see the Minister in his place. He knows my constituency well and understands the challenge of getting to it. In fact, he was the first MP ever to visit me in the heady days before 2010, when I stood as a parliamentary candidate because I thought that coming to Parliament would be a great way of changing the world. I have since learned that that is probably not the case.

The credit should really sit with the people who work in the NHS. In particular, I pay tribute and send my thanks to those who work in West Cornwall Hospital in Penzance, Helston Community Hospital—or cottage hospital, for those of us who grew up there—and other places where NHS staff and others do a fantastic job in really difficult situations, as we have heard. They make sure that people who arrive for whatever reason get the best possible care.

I was keen to take part in the debate because I recognise that things need to be done. We must take responsibility for the way things are at the moment, and although I understand what the legal responsibility is and the reason for the debate, I want to understand a bit more about the solutions, too. I have never thought that all the solutions can be created, thought up or delivered here in Westminster or in any Government Department. Although real progress in integration and improving services on the ground needs to be enabled through legislation, support and encouragement, people in health and social care in Cornwall have got together and worked extremely hard for many years to deliver a system in which pathways and integration are much better than when I welcomed the Minister off the train.

One problem of many is the workforce, which is undoubtedly a challenge. There is also no doubt that the NHS 10-year plan is a fantastic document, but it depends heavily on workforce. I know that the Minister will agree and will want to ensure that we have people in place. We may not participate in this Chamber, but across Parliament, the bunfight, debate and arguments about the NHS go on, and have been taken up by people in local campaigns and the media. That has created an environment in which people choose not to nurse or do anything else in the NHS because they are misinformed. I know of lots of people who would have gone into or considered going into nursing or social care, but will not do so because the NHS is a political hot potato.

[Karen Lee (Lincoln) (Lab)]

On the hon. Gentleman’s point about people not joining the NHS to nurse, the lack of bursary is a significant issue. If someone wants to train, the bursary is really important.

[Derek Thomas]

I am addressing the point the hon. Member for Wolverhampton South West made about the importance of working cross-party, as we will in this Chamber. I will come to the bursary later.

Actually, I will come to that part of my speech now as the hon. Member for Lincoln (Karen Lee) has mentioned it. I was one of the MPs who signed a cross-party letter requesting a royal commission for the 70th year of the NHS, because I believe that although we do not have all the solutions, we should set the tone. That would help to open the door of opportunity for those who work in the NHS. I will come to the bursary, which I have already raised with the Minister; I asked him to look in particular at the impact on mature students. Podiatry in Plymouth, for example, will not be taught from September onwards. In the south west, where the incidences of diabetes and other vascular problems are significant, we need podiatrists, so that is a major problem. The reason given is that most people who go into podiatry do it later on in their careers, and one of the challenges arising from the removal of the bursary and introduction of student loans—I voted for that and regret doing so—is that those who take out the loan immediately lose all welfare and can no longer get housing benefit.

For someone with a young family who wants to study, the student loan, or the grant available for mature students, is just not enough. The Minister is aware of my view because I have raised it before, and there is work to do on that. It is not about financial incentives; it is about making it affordable for people to go and do a fantastic job. As the hon. Member for Wolverhampton South West rightly said, some people bring so much to health and social care and we need to ensure that we take away every possible barrier without creating unintended consequences. I am sure that the Minister will be pleased to address that point later.

I will talk briefly about how Cornwall is responding. I have been very keen to see what we can do in Cornwall to make sure that people can turn up, get training and work and train on the job. For people in Cornwall, most opportunities for training are outside the area, but as we know, people who go into some professions, including in the NHS, tend to stay where they train. That has always been a problem for Cornwall, which has struggled to recruit the people we need. We have set up a health and care academy using the apprenticeship levy. The academy can offer people training and jobs as healthcare assistants. There, they can do 12 hours per week working and studying through the Open University, and will become qualified nurses after four years. As they are already settled in the area and have family there, they are very likely to work for the NHS for the rest of their careers.

That is really positive, but there are some challenges and I have met the Minister to talk about them. One of the challenges is that for hospitals—in this case Royal Cornwall Hospital—to provide that kind of support, they need extra cash. It is not just about the apprenticeship levy, which they want to use and not repay, but about staffing 100 nurses and 100 healthcare assistants at a time, and providing pastoral support and other elements that come with training up staff on a ward or in a hospital. An added pressure is that for a hospital without the staff that it needs, really excellent healthcare assistants are no substitute for fully qualified nurses with a wealth of experience.

There is a problem in this place. I am a skilled craftsman in the building trade but I have put my tools away, despite the desperate need for skilled craftsmen in Cornwall. In this Chamber and across the House, we have lots of GPs and talented nurses. For some reason, we decided to pitch up here instead of continuing in our valuable jobs. I think that we are part of the problem. I am not suggesting that we should all pack up and go home, although we might get more done if we did, so we should consider it.

[Eleanor Smith]

I get what the hon. Gentleman is saying, but I worked for 40 years in the health service and it was because I saw its deterioration that I came to Parliament to say, “This is what’s happening.”

[Derek Thomas]

I said that in humour, which is why I talked about my own skill—or lack of. It is a curious thing, though, to hear people talking about the crisis in staffing when so many of them are in this place.

On a more important note, we are in a tricky situation with the challenges around the apprenticeship levy. In Cornwall, we hope to train 200 nurses using the apprenticeship levy over the next two years—that would address the shortage—but we have to recognise that funding is needed and I know that the Minister is looking at that now.

[Paul Girvan (South Antrim) (DUP)]

Will the hon. Gentleman give way?

[Derek Thomas]

I will when I have finished this point. Whatever the solution, we must recognise the added pressure on existing staff.

[Paul Girvan]

On that point, it is all very well getting nurses into and through training, but in Northern Ireland the NHS is haemorrhaging nurses who are not leaving the profession, but going into agency work, getting paid two and a half times more than they were and working the hours that they want. Not only is workforce planning impossible when people can just work when they want, but we lose continuity of care in wards.

[Derek Thomas]

I appreciate that valuable intervention. I had a conversation with the former Secretary of State for Health about how, when the student loan was introduced, there might have been a way in which students had all their loan written off if they gave seven years’ service to the NHS. The advantage of that, to be honest, is that people who had done seven years after qualifying would probably have settled down by then, entered into a home purchase and perhaps had family, so they would have been, first, less likely to clear off to another country and, secondly, kind of tied into the NHS where they were.

In part, that addresses the problem the hon. Gentleman raises. Yesterday, I met a newly qualified nurse from the south-west who found that on Christmas day she was the leading NHS nurse, supported only by agency staff. That must stick in the back of NHS staff’s throat, when they know that extra pay is available to agency staff. Efforts have been made to address that, and there must be ways to do so, but that is what we are getting at today—the workforce challenge.

If we have a workforce challenge, other things will happen, such as agencies springing up and the demand for them. We have to get to a place where working for the NHS as a nurse employed by the local trust is the best and most rewarding place to be, and appreciated by all. We simply do not say often enough how great such people are. We can do so many things locally and nationally to rebuild value, trust and appreciation in those people. The challenge for Health Education England is to look at how we fund local innovative ideas, ensuring there is enough money, as well as flexible support, to find solutions. I discussed that with Simon Stevens, and he seemed alert to the challenge.

As I said, I met nurses from the south-west yesterday, and they were concerned about safety on wards and retention of nurses. We have this bizarre circle spiralling downhill: if nurses do not feel safe, they go to do something that might not be nursing. Unfortunately, in places of low unemployment, lots of other work and employment opportunities are available, often paying more.

Solutions are possible. In Cornwall, I have found that people often do not know what is available. The Royal Cornwall Hospitals NHS Trust and other trusts in Cornwall, my local college and I got together to work on an event in the college called “Work for the NHS+”, which included 15 or more different parts of the NHS, as well as some from social care. They came along to tell students and the general public what the employment opportunities were, the pay and training that could be expected, and what kind of career paths were available. In Cornwall, as in many other parts of the country, there are some fantastic members of staff and people in the NHS and social care who can inspire others. This might sound ridiculous in a debate on shortages on a ward, but when we have such individuals, we must find opportunities to get them in front of people who are thinking about which career they should choose.

I do not know much about the other challenging problem raised by the nurses yesterday, but it is right to mention it. They said that although more nurses are training, training placement opportunities are fewer. They suggested that part of nurse training now is off the ward—obviously that has happened before, but they were concerned about whether that virtual training or simulators were the same. I know that the Minister will take seriously all opportunities to get nurses trained in the best possible way, so I will not dwell on a subject that I do not know much about.

I mentioned the issue to do with podiatry, which is a real problem in the south-west. We must find ways to help professionals, whatever they do, whether therapy, physio or all the things that people to do to ensure that we stay well and do not end up in hospital. Podiatry is one of those. We must ensure that people get the training, that they can afford to do so, and that they can have a great career in the NHS or with local authorities. We need to talk to universities about exactly why they are not attracting the kind of numbers they need to justify the courses.

I should have declared an interest at the beginning: I chair the vascular and venous disease all-party parliamentary group. One thing I am being told loud and clear—I have done a lot on this—is that because we have taken the nursing bursary away from older students, they find it difficult to go on the courses that I am describing. That will have a real impact on the numbers of nurses available to do those important jobs. If we do not address that issue, in a place such as Cornwall, where diabetes is a significant problem, the pressure on urgent care will be enormous—if it is not already.

Last week, our general district hospital—the only one in Cornwall—closed to the public, because a spate or outbreak of vomiting and diarrhoea put a lot of people from nursing homes and others into hospital. In that situation, the system rallied and did some amazing work to cope, ensuring that no one who needed care was failed, but it was also an example of why we need to work equally hard, if not harder, to ensure that at the best of times and the worst of times people get the best healthcare available.

The NHS in Great Britain is the envy of the world. We need to be careful always to remember how fantastic our system is. Last week, my brother and his wife came back from Cambodia with stories of trying to get healthcare there—they have two young children—and that reminded me of how fantastic our health service is, as are all those who work in it.