Nursing: Higher Education Investment

Eleanor Smith Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith (Wolverhampton South West) (Lab)]

I beg to move,

That this House has considered investing in nursing higher education in England.

It is a pleasure to serve under your chairmanship, Mr Davies.

I am proud to speak on an issue close to my heart. Before I entered Parliament, I was privileged to work as a nurse for almost 40 years, and last year my daughter graduated as a nurse. Nursing is an incredible profession, a fulfilling career and full of opportunities for those who choose that rewarding path. Nurses are the most trusted profession in Britain, a position they have held for years, with 96% of the public trusting nurses to tell them the truth. It may come as little surprise to hon. Members that politicians are the least trusted. Let all of us in this House show political leadership now and listen to what nursing students and nurses are telling us. They are telling us what must happen to meet the needs of communities across England.

Everywhere there are people, there are nurses, but they are not necessarily doing what we might think they are doing. Yes, nurses connect with patients and families to understand what people need, but they are also diagnosing, prescribing, performing surgery, creating care plans, delivering treatment, overseeing clinics, managing hospitals, working as chief executives and designing primary care services.

[Mr Jim Cunningham (Coventry South) (Lab)]

My hon. Friend mentioned that nurses are valued, but if the Government really valued them, they would give them a decent wage increase and restore the education maintenance grants and, if necessary, bursaries as well. Does she agree that that would demonstrate how nurses are really valued in this country?

[Eleanor Smith]

I do agree, and my hon. Friend will hear me refer in my speech to what he has just said.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I congratulate my hon. Friend on securing this important debate, and I commend what my hon. Friend the Member for Coventry South (Mr Cunningham) said about the proposition that we need to pay our nurses properly to value them truly. Does my hon. Friend the Member for Wolverhampton South West agree that it is important that we have specialisms too, and that one specialism we require more of across the country is Parkinson’s nurses?

[Eleanor Smith]

Absolutely. That is where nursing is important. Nurses are becoming specialists in Parkinson’s, Turner syndrome and sickle cell, all of which are specialisms that will be required in the future of nursing.

Nurses are working in cutting-edge research on ethics, safety, improvements to care and new ways of working. They are leading from the frontline, and as professionals they should be at the heart of strategic policy making. Nursing is at a critical junction in our healthcare and systems, yet the Government are without an independent chief nursing officer after the removal of that critical leadership post from the heart of the Department of Health and Social Care. That is an insult to the nursing profession.

How many of my right hon. and hon. Friends are regularly contacted by their constituents about health and social care issues—people struggling, writing about services being reduced or cut, unable to access support without help? Increasingly, that is happening because there are not enough staff to run things safely. Across the country, nurses are clear that staffing for safe and effective care is their most important priority and their biggest worry.

[Dr David Drew (Stroud) (Lab/Co-op)]

Does my hon. Friend accept that in the specialisms in particular—in my own area, the problem is with learning disabilities—there are such reduced numbers going through training because of the loss of the bursary, that it will have a huge impact on care homes and other forms of care delivery? Does she see that as a total tragedy?

[Eleanor Smith]

I do, and I will talk about that in my speech and touch on the lack of nursing students coming into those particular areas because of the bursary’s disappearance.

[Rachael Maskell (York Central) (Lab/Co-op)]

My hon. Friend is making a very sound speech. Does she agree that it is a completely false economy that, as a student nurse told me just today, of the 45 recruits to mental health nursing in his cohort, under the new financial regime only 18 remain on the course in its second year? We desperately need those nurses—what a price to pay!

[Eleanor Smith]

My hon. Friend is totally right. Again, I will address that point in my speech, but it is noted. I am glad that my hon. Friends are intervening, because it shows the importance of this debate on nursing and the lack of it. I am glad the nurses came to my hon. Friend and told her what it is like. The situation is beyond shocking. There are almost 42,000 vacant nursing posts in the national health service in England. Without policy and funding intervention, that will grow to almost 43,000 by 2023.

[Mike Hill (Hartlepool) (Lab)]

My hon. Friend is making an important speech. On the current 42,000 shortfall, does she agree that with so many European Union nationals potentially leaving the health service, that figure could well be compounded in future?

[Eleanor Smith]

That is definitely so. My hon. Friend is completely right, and with the way Brexit is going, that is understandable. People working in the NHS understand that.

Without policies and funding intervention, as I have said, the shortfall will grow to almost 43,000 by 2023, and that number is on the low side. It does not account for the one third of nurses who are due to retire in the next 10 years. It does not include nursing shortages in social care or public health. Students are being forced to plug the gaps. They should be learning, but instead they are providing care before qualification, without supervision and before they are ready—all because we do not have enough nurses. That is deeply unfair to students. It is risky for qualified nurses and it is unsafe for patients, and all because no one wants to pay for the solution.

Poor workforce planning in health and care is not new. Even in my time, policy makers pursued a boom-to-bust approach, rather than ensuring that supply was available to meet demand. Six years on from the Health and Social Care Act 2012, it is fundamentally unclear who is accountable for workforce strategy. As a result, it is not being done by anyone. Earlier this year, Health Education England held a consultation, but Professor Ian Cumming has failed to deliver a workforce strategy. We are told that it will be dealt with in the new 10-year plan. Mr Simon Stevens, the chief executive of the NHS, has been handed an additional £20.5 billion a year for the NHS by 2023-24, and it is widely understood that his long-term plan must address the extreme gaps in our nursing workforce by fixing the supply issue and providing funding.

[John Spellar (Warley) (Lab)]

I congratulate my hon. Friend on securing this important debate. I do not think it should focus only on the bursary, as some of the letters have—important though that is—but on the Government’s lamentable failure to bring in nursing apprenticeships, which provide such an important route for many youngsters from working-class areas in the Black Country, including areas in her constituency and mine.

[Eleanor Smith]

My right hon. Friend covers a point about apprenticeships that I will address in my speech, because what we are saying is that it is one of the routes, but not the only route.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

My hon. Friend is making an excellent speech on a topic that is important to us all. The Royal College of Nursing has made it very clear that the priority for the bulk of investment in nursing education must be the three-year undergraduate degree, because that is the fastest and safest route for growth at scale. Does she agree with that, and does she agree that we must not try to do nursing training on the cheap?

[Eleanor Smith]

Absolutely; I totally agree. I thank my hon. Friend for that intervention. We should not be doing the training on the cheap. I will try to address that point in my speech.

There is a huge risk that the long-term plan will be like previous plans and that Simon Stevens will not provide or fund a solution. He is spending money on services that cannot be staffed. He is creating new posts that cannot be filled, because trained and qualified registered nurses to fill those posts do not exist. I wonder whether the Prime Minister knows that nurses do not grow on trees, just as money does not. The five year forward view substantially failed to create nurses. In fact, during that time, the opposite happened: we lost thousands of nurses. I ask right hon. and hon. Members what on earth should be prioritised above growing the number of nurses.

[Vicky Ford (Chelmsford) (Con)]

I agree that this is a really important issue and we must do all we can to support the nurses of the future, but does the hon. Lady agree that it is worth recording that there are 13,000 more nurses on wards today than there were in 2010?

--- Later in debate ---

[Eleanor Smith]

I thank the hon. Lady for her intervention, but unfortunately, as someone who has worked on the wards, I have to say that we do not see it; it does not feel like that.

Simply put, there is no long-term plan without a registered nursing workforce. Whatever ambition the Secretary of State and Simon Stevens have must be matched by credible growth in the number of registered nurses.

[Karen Lee (Lincoln) (Lab)]

Will my hon. Friend give way?

[Eleanor Smith]

Yes.

[Karen Lee]

Does my hon. Friend—

--- Later in debate ---

[Philip Davies (in the Chair)]

That is not the point, if I may say so to the hon. Lady. Would the hon. Member for Wolverhampton South West (Eleanor Smith) like to give way?

[Eleanor Smith]

I will take this intervention and then I would like to make some progress.

[Karen Lee]

I will be brief. There was mention of how many nurses there were on the wards. I was a nurse on a ward, and I am getting older. The drop by one third in the number of applications means that, even with the new nurses, we do not have the number of people to fill the vacancies. The Prime Minister makes great play of how much money there will be for all these nursing vacancies. If nurses are not trained and people are retiring and those places are not being filled by new nurses, how do we do it?

[Eleanor Smith]

I will address that in my speech. I thank my hon. Friend very much for that intervention.

I welcome the public commitment made by the Secretary of State at the Royal College of Nursing on 31 October to invest in growing the number of nurses through higher education, including through the long-term plan, because I feel that finally someone is paying attention. The Secretary of State has said that he will look into the possibility of introducing safe nurse staffing legislation. He has said that he will explore anything that might help to address the problem we face. I sincerely hope that the Secretary of State means it, because he and Simon Stevens have the power to fix this mess with proper funding and intervention.

That brings me to the crux of the debate. We have to grow our nursing workforce, so the only question that we need to answer is this: how do we fund what we know is the fastest and safest way to do that at scale, in the light of our crisis? Higher education is the best and most cost-effective way to ensure that we have the right number of registered nursing staff, with the right skills and experience, which patients need and deserve. New routes into nursing, which are welcome if done right, still cannot educate anywhere near enough nurses to an appropriate skill level to meet the current need, let alone the future one. It is time to fix the supply pipeline and for the Secretary of State and Simon Stevens to stand up and be counted.

In 2016, the Government removed the NHS bursary and replaced it with a student loan. The £1.2 billion that was taken out of healthcare higher education was framed as a saving, but where did it go? What did it save? Was it used to grow the number of nurses? The stated purpose of the Government’s reform was to increase the number of nursing students. It is against that goal that the impact of the Government’s reforms must be judged.

Let me bust a few myths. I expect the Minister to say, “The old bursary model placed an artificial cap on the number of nurse training places that universities could offer students.” That is factually untrue. Funding of nursing student numbers has always been a political choice. It has always been up to the Government to choose what they want to fund. I expect the Minister to say, “The loan model has not made it less attractive to apply.” In each year since the reform, applications to nursing courses have fallen. In September 2018, nearly 1,800 fewer nurses were due to start at university, compared with September 2016.

[Dr Paul Williams (Stockton South) (Lab)]

I thank my hon. Friend for the robust way in which she is laying out the case. Since the 2016 reforms, we have seen a significant reduction in the number of people over the age of 25 going into nursing. The Select Committee on Health and Social Care has looked at that. Obviously, people over 25 have brought great value to nursing. Does my hon. Friend agree that the changes that we have seen have potentially been very detrimental to the nursing workforce?

[Eleanor Smith]

I thank my hon. Friend for that intervention; he is totally right. There is a difference between the mature students who come into nursing and those who are 18. There is a great loss to those people and a great loss to us in the public sector—to hospitals, GP surgeries and, indeed, all the places where nurses work in the NHS. It is a great loss, and I will cover some aspects of that issue in my speech.

The only thing that has changed is that loans have been brought in. It is ludicrous to look at the numbers and deny that forcing nursing students on to loans has led directly to a drop in applications. That is exactly what has happened. The result is that the diversity and background of nursing students has changed radically, excluding many who would previously have been able to change their personal and economic circumstances through a rewarding career in nursing. That is the very thing that my hon. Friend was saying.

I expect the Minister to say, “There are still two applicants for every place available for a student to study nursing at university.” It is the current structures that are limiting the system from being able to capitalise on that appetite to study nursing.

[Grahame Morris (Easington) (Lab)]

I congratulate my hon. Friend on securing a really important debate. It is essential that the Minister addresses the issues raised. Is not the drop-out rate for student nurses a real cause for concern? A student nurse contacted me—I did go to the lobby organised by the Royal College of Nursing this morning—and gave some examples of the mounting costs under the present system. That mental health nurse was telling me about the costs of trains, taxis and accommodation. She works 37.5 hours a week on a placement. Transport to her placement is costing her £500 a month. Surely that has an impact on a person’s ability to sustain their attendance on a course and achieve the necessary outputs.

[Eleanor Smith]

I could not have put that as clearly as my hon. Friend has. I am glad that student nurses came and explained the situation to him, because that is the very reason why we are having this debate.

With the last bit of control that they have kept since the reform, the Government fund clinical placements, but they do not match the numbers to the volume of routes that they have created. They made nursing students, apprentices and nursing associates all compete for the same places. They did choose to fund, but it was not enough. Now it is a blame game full of finger-pointing. If there are so many people interested in becoming nurses and such high levels of vacant posts, why are the Government not doing more to convert the applicants into nurses?

I expect the Minister will say, “We have introduced new routes to expand the number of nursing staff.” There are nursing degree apprenticeships that few people are taking up, because employers do not have enough cash to release people to study. Nursing associates, who were introduced in a supporting role to the registered nurse, should never be a substitute for registered nurses. These efforts have been small and unpredictable. Most importantly, they have not addressed the heart of what grows the number of nurses safely and at scale: higher education. This is workforce panicking, not workforce planning.

I expect the Minister will say, “This Government have grown the number of nurses working in hospitals,” which is factually true, but distorts the truth that the overall number of nurses has only grown by less than 1% since 2010. While there are 7% more nurses in acute settings, there are 6,500 fewer nurses in the community, 43% fewer district nurses, a quarter fewer school nurses, nearly 5,000 fewer mental health nurses and 40% fewer learning disability nurses. Despite the Government’s rhetoric about moving more care into our communities, the workforce are simply not there to deliver it. Who has overseen that? Ian Cumming of Health Education England, Simon Stevens of NHS England and the Government.

Nursing students spend 50% of their time in placement, learning in the community, a care home or a hospital, but the services are so short of staff that students are being unsafely used to plug the gaps. Due to their placements and studies, they do not have time for part-time jobs to earn extra money. Like other hon. Members, I am contacted by constituents who tell me that they always wanted to be a nurse, but money worries and the pressure they feel are making them reconsider their choice. The personal cost of becoming a nurse is turning people away when health and care services need more growth. This is disgraceful, irresponsible and short-sighted.

However, our leaders have a real chance to secure major change. Nursing students need a new deal. All that is needed is political will, and for people to stand up and be accountable. I demand the bursary is brought back. Our future nurses urgently need more financial support if the Government are ever to tackle the workforce crisis. There needs to be an extension of the hardship funds for those who need more assistance.

At what point do we say enough is enough? How can we fail to act when faced with student nurses trying to balance their placement, part-time healthcare assistant work and trying to finish their coursework? How can anyone begin in a profession when they are already burnt out? It is disrespectful for any of us to stand here and tell stories about how much nurses make a difference to us, without acknowledging their professional expertise and their critical role in transforming services. We have to stop making their jobs harder and pushing people to the brink. No nursing student or nurse should have to grind their teeth and keep going, knowing that shortages mean that vital care is left undone. This situation is unsafe for everyone. It is morally reprehensible.

The Prime Minister gave an extra £20 billion to the NHS. Simon Stevens holds the pen. The Secretary of State will sign off the long-term plan. There is a small window of opportunity to change the future of nursing. We can either propel it forward or drag it back. I am determined to leave my daughter a legacy. I take public service seriously; that is why I went into nursing and why I am an MP.

I look forward to hearing from the Minister how the long-term plan will deliver the workforce strategy, how it will fulfil the Secretary of State’s commitment to creating more nurses, and how Simon Stevens and Ian Cumming will be held to account over fixing the nursing supply and investing in it. This is our moment to rebuild public trust and confidence, so I end by asking the Minister: what are you going to do?

[Several hon. Members rose—]