The National Health Service
Eleanor Smith Excerpts(4 years, 6 months ago)
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Eleanor Smith (Wolverhampton South West) (Lab)
I am pleased to follow the amazing speech from the hon. Member for Telford (Lucy Allan). In the Queen’s Speech, the Government did not mention the long-awaited social care Green Paper or lay down any plans for how they would tackle the social care crisis. Instead, they simply said that they would
“bring forward proposals to reform adult social care in England to ensure dignity in old age”,
failing to mention working-age adults, people with mental illness and carers, who also rely on care. Everyone in this House knows that the current social care system is in crisis. It faces serious challenges as more people need care, but chronic underfunding means that fewer people receive it, and for those who need it, every day is a struggle.
Recently, the Care & Support Alliance conducted a survey of more than 3,000 people with social care needs. It found that one in five respondents went without meals due to lack of care and support; one in four struggled without basic support to do things such as get out of bed in the morning, get dressed or go to the toilet; and more than one in three felt lonely and isolated because of the lack of care and support.
Social care plays an important part in managing hospital admissions for people with mental illness. According to the independent review of the Mental Health Act 1983, around half of all delayed discharges from mental health wards are the result of difficulties in securing appropriate housing and care packages.
Jim Shannon (Strangford) (DUP)
I wonder whether the hon. Lady is aware of the figures that I have received. Some 850,000 children and young people have a clinically significant mental health problem; one in 10 children between the ages of five and 16—three in every classroom—has a diagnosable mental health problem; and 75% of mental health trusts do not have enough in their budget to look after them. Does she agree that in his response the Minister should deal with the massive issue of children’s mental health? It needs to be addressed.
Eleanor Smith
I do agree with that. The Royal College of Psychiatrists would back up the hon. Gentleman as well.
Organisations such as the Royal College of Psychiatrists have said that the ambition in the long-term plan to reduce the length of stay in adult acute in-patient mental health settings cannot be achieved without improved social care.
It is important to acknowledge the role of carers in supporting people with social care needs. Their own mental health can be at stake due to the pressure, the lack of support and the lack of information. According to a report by Rethink Mental Illness, only one in four carers—23%—feels well informed and respected as a partner in care. A similar proportion, 24%, receive no carer’s assessment, despite it being mandated under the Care Act 2014.
When the social care of patients is not met, not only does their independence suffer; so too does their health, which has a detrimental effect on the NHS. If the NHS is to deliver the ambitions of the long-term plan, a stable and effective social care system is needed. That is why we need to join up services from home to hospital and have a properly integrated NHS and social care service. It is a fact that if the integration of health and social care services did take place, more would be achieved and money would be saved, as the resources would be used jointly. That would ease the access and workforce pressures that continue to present significant challenges across all care sectors.
If the Government really want to tackle this crisis, they must reinstate the levels of access to care that we had before 2010 under the last Labour Administration.
Oral Answers to Questions
Eleanor Smith Excerpts(4 years, 9 months ago)
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Afzal Khan (Manchester, Gorton) (Lab)
Eleanor Smith (Wolverhampton South West) (Lab)
The Minister for Care (Caroline Dinenage)
All councils have a statutory duty to look after people’s care and support needs in their areas. In total, between 2016 and 2017, and in 2019-20, the Government have given councils access to £10 billion more social care funding.
Caroline Dinenage
There is no doubt that the system is under pressure, but that is why the Government have been putting an enormous amount of money in and giving councils access to additional funding to be able to address the growing need—up to £10 billion over the past three years. We know that people are living longer and living with much more complex conditions. This situation is only going to get worse, so we do need to find a more sustainable way to deal with it in the long term. The hon. Gentleman will be interested to know that Manchester will receive an additional £42.9 million for adult social care funding in 2019-20.
Eleanor Smith
Figures from the Care and Support Alliance and Age UK show that at least 1.4 million older people in England are not receiving the care and support they need. We know that this figure will be much, much higher owing to the number of working-age disabled people who are being denied the care and support they need to lead better lives. Speaking as co-chair of the all-party parliamentary group on adult social care, how much longer do we need to wait until the Government publish the long-awaited Green Paper on social care and finally start to show some much needed leadership in this vitally important area of public policy?
Caroline Dinenage
First, I pay tribute to the hon. Lady for her work in the APPG on adult social care. It is really important that we have an APPG that represents this really important issue. As I said, the fact that we have an ageing population is a growing issue that we have to face as a nation, and, in fact, as a world. Her area of Wolverhampton will receive an additional £22.1 million for adult social care in 2019, but we know that that is not a long-term solution and we will be publishing a Green Paper at the earliest opportunity.
NHS Workforce: England
Eleanor Smith Excerpts(4 years, 9 months ago)
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Eleanor Smith (Wolverhampton South West) (Lab)
I beg to move,
That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.
I am a nurse. My daughter is a nurse. Nursing is in my family and fundamentally informs who I am and what I do. Last November, I triggered a debate about investing in nursing higher education. I am here today to again carry the burning flag for the nursing profession, the wider health and care workforce, and society.
I will start by directly addressing the notion that we should not seek to further clarify the Secretary of State’s legal duties and powers. I have heard that the latest legislation sought to remove political interference in our health system. I have heard people say, “Don’t make health a political football.” Lastly, I have heard that changing the legislation to give the Secretary of State accountability for the workforce would put health and care back under political control—as if our ability to access health and care was ever out of political control.
I am sorry, but those are laughable positions. Which- ever side of the fence we sit on, it is a serious point that health is fundamentally political. It can never not be political, in terms of what we can access and what happens to people. Our great health service was created within a political agenda, and creating it was a fundamentally political act. Supporting our health and care service to thrive will never not be a political decision. Let us be proud of our history, recognise that health is political, and find a solution to the problems we face.
Now that I have addressed those weak positions, let me state that I, and many others across the political spectrum, take no issue with the idea that there should be explicit clarity in the law about the Secretary of State’s responsibilities. I am not alone in my gratitude for all that our health and care staff do. They work constantly to provide quality care by putting patients at the heart of what they do. In the NHS and the independent sector, nursing accounts for one in 10 of the labour market of the whole of England. We are, and ought to be, a fundamental force to be reckoned with.
Thanks to the scale and urgency of the workforce crisis, many people have been looking into these issues—some of us would say for far too long, and to poor result. We have a long-term plan for the NHS and an interim NHS people plan, so we have seen some movement in the way that agencies work together. However, we have no understanding of what the social care sector needs, and no assurance of workforce funding, which is entirely dependent on the forthcoming spending review and subject to the whim of a new Prime Minister. We do not have a workforce strategy that meets health and care service requirements, or that projects the future needs of the people who live in this country.
The vacancy rate has reached alarming levels, with almost 40,000 nursing vacancies in the NHS in England alone. That is not the full picture. The extent of the vacancies within social care and public health is unclear because it is not mandatory to collect workforce data. It is not possible for services designed with staffing built into their planning to run safely and effectively with so many missing staff.
Fewer people are joining the nursing profession and more are leaving. Since the referendum on the UK’s membership of the EU, more than 10,000 EU nurses and midwives have left the UK workforce. I will not be drawn on Brexit in this debate. However, while we are trying to find our way through the referendum result, frontline staff are propping up the health and care system with no credible assurances that the situation will be resolved. Our professionals are holding on as best they can, but we need to be realistic about what we can reasonably ask of them. They are starting to vote with their feet, and there is not yet the accountability to help us navigate the future that is to come.
This crisis has come about because there is no clarity in the existing legal powers and duties that would ensure that enough staff with the right skills are in the right place at the right time to provide safe and effective care. That is true not just of nursing but of every profession working within our commissioned, taxpayer-funded services, including nurses, medics, psychiatrists, physiotherapists, psychologists, paramedics, pharmacists, social workers, support workers, occupational therapists and dietitians. Literally no one—no one person—is accountable for growing and developing our health and care workforce to meet patients’ needs, now and in future.
The Secretary of State’s current legal duty is to provide a comprehensive service. The Government may say that the Secretary of State has oversight of the workforce through those general duties and powers. With all due respect, the Secretary of State’s responsibilities are too broad to understand what aspects of workforce provision they include. There are also no particular workforce duties within the range of national organisations responsible for service design and delivery. In a health and care system as complex as ours, it is easy for everyone to lose sight of ensuring that we have enough people. Clearly, that is exactly what has happened.
Mr Jim Cunningham (Coventry South) (Lab)
Surely two reasons for the number of vacancies are low pay in the public sector generally and the lack of bursary provision to recruit new nurses. Does my hon. Friend agree that there is a golden opportunity for many mature women, whose children have grown up, to enter that profession? Recently, even ambulance drivers had to pay extra for their certification—I had a debate on that a couple of months ago.
Eleanor Smith
My hon. Friend is right, and I will touch on the removal of bursaries later.
A huge amount of effort has been required to try to fix this mess. There has been progress in the NHS, but it is too little and too slow. It does not include social care and deals only with the immediate context. Many of us in this House are here to challenge the position that the existing so-called responsibilities are clear and robust enough for use by the Government and the health and care system, and for the public to have confidence that the Government can be held to account—now and in future, since the pressures on the system will continue to grow and change.
Yesterday, many of us met nursing staff, having been brought together by members of the Royal College of Nursing, who are all passionate about patient care and public safety. I am moved by their advocacy for the profession, patients and society. I also feel their desperation in the situation they face, trying to keep people safe in challenging environments. Given that professionals have been raising the alarm for decades, hopefully our demands for an end to the boom-and-bust cycle in the workforce will be met.
Even the High Court recognises how vague the current powers and duties are. The legal dispute between the Secretary of State and junior doctors over their contract resulted in a judicial review in 2016. The Court judgment said that, as stated in the National Health Service Act 2006, the objective of “protecting the public”, with a duty on the Secretary of State to take appropriate steps, leaves
“considerable leeway to the Minister as to ways and means”
of running the service.
Anyone who looks at the content of the law can see clear holes and gaps. In addition to the Secretary of State having no explicit responsibility, we have other problems with the duties and power of the national guidance. For example, Health Education England is the organisation responsible for developing our workforce, but its hands are tied because it does not have sufficient legal powers or funding to invest properly in the educational provision needed to grow our workforce. HEE can do planning but not supply, which ought to be the responsibility of the Government. The current legal framework is simply not fit for purpose.
Some people might say that Simon Stevens, the chief executive of NHS England, should be accountable for not addressing the workforce needs. The development of the long-term plan provides another clear example of the ambiguity and conflicting expectations playing out in practice. In June 2018, the Prime Minister said:
“Growing demand and increasing complexity have led to a shortfall in staff. So our ten year plan for the NHS must include a comprehensive plan for its workforce to ensure we have the right staff, in the right settings, and with the right skills to deliver world class care.”
That was a clear signal of the Government’s commitment that the long-term plan would address the workforce crisis. On publication, NHS England acknowledged significant workforce issues but said that staffing was additional to service planning and was outside the £20 billion financial package that Simon Stevens was given. Again, NHS England does not have any explicit legal duties that relate to the workforce, so it is not obliged to act.
Just last week, Simon Stevens said there is a need for a
“much bigger upturn in the pipeline of new nurses… There has been a big debate about bursaries and their removal, which as we look at the way the student loan system is working, that is clearly back in play as a big question we’ve got to answer as a nation.”
However, the reasons for these supply problems are not within Simon Stevens’s control. They include the reform of higher education for nursing, which has not grown as we were promised. The ability to boost and fund the workforce sits with the Government, and the ambitions set out in the long-term plan will not be met if we do not have trained and qualified staff to achieve those goals. Although the Government have committed to transforming services, they must also commit to building the workforce we need. To do that, the lack of accountability must be addressed.
A nurse who walks into a shift that is short-staffed has no power to safely and effectively staff services. They have no option but to carry on, yet the buck stops with them when patient care is unsafe. Nurses have no power to recruit more staff, and they rely on Parliament to ensure that the incredible position we find ourselves in is addressed; to fix things not just now, but for the future. I know how heartbreaking it is for a nurse to be unable to give the care they want to. I know the guilt we feel when care is left undone, and the stress of being unable to do our job to the best of our ability. Patients pay the highest price when the number of nursing staff falls too low.
Understanding that the health and social care system is a safety-critical industry should be the starting block for any consideration made by the Government. The Royal College of Nursing and other professional and patient organisations have a clear solution. With cross-party support, they are calling for a legal framework for workforce accountability that sets out who in Government and across the health and social care system are accountable and responsible for workforce supply—recruitment, retention and remuneration.
The Secretary of State for Health and Social Care should have explicit powers in law for the growth and development of the health and social care workforce across England. Such accountability would ensure that there are enough staff to care for the number of patients, and that there is an incredible and fully funded workforce strategy. These requirements are not an either/or position; we need both. Alongside the Secretary of State’s accountability, there are other ways in which the responsibilities need to filter down across all layers of the health system. Never again would the system be able to sidestep workforce planning when setting a 10-year vision for the future of our NHS. The ultimate aim in clarifying accountability for the workforce at Government level is to ensure that all health and social care services are of a high quality, and that they are equipped to provide safe and effective care to guarantee patient safety. The current pressure faced by the healthcare workforce puts that guarantee at risk.
Successive Governments have missed opportunities to fix the health and social care workforce crisis. Boom-and-bust approaches to workforce supply have been an afterthought, with the focus on glossy new services and sparkly new plans, rather than on worrying about the staff who are needed to deliver them. That has led to a situation in which the system currently defaults to discussing how to fix the workforce gap. We need to plan strategically for what workforce will be needed to deliver the future healthcare services that have been designed to meet the needs of the population.
An opportunity to rectify the workforce crisis is coming right towards us. NHS England and NHS Improvement have finished engagement work on the legislative changes that they feel are needed to make a success of the long-term plan. Their engagement work sets out proposed changes to the remit of the Secretary of State, but currently these legislative proposals are missing crucial accountabilities. It is down to right hon. and hon. Members to expand the proposals when the law is presented to Parliament. The legislation must include accountabilities for the workforce, because it is too clear an opportunity to miss.
A simple legal change would turn the tide for patients, and support is growing across the political spectrum for a legal fix as part of addressing the workforce crisis. I found myself at a roundtable discussion on this very matter, with a Government Member with whom I share no political allegiance. We found ourselves in full agreement that we must explicitly clarify the responsibility for putting our workforce on a sustainable footing.
As a nurse in Parliament, I commit to seeking the change that is being called for. I hope that others call on Parliament to speak loudly and clearly in adding their voices to ours, and that all right hon. and hon. Members will commit to pursuing change. This is a truly cross-party issue, and rightfully so. There is a crisis and everyone points fingers at others, but ultimately no one is responsible. There are moves to make the system better, but they must be set out in law and strengthened further. There is an opportunity to fix this cleanly and easily. We are not adding burdens, but clarifying mandates. The moment is now—we must commit to ending the workforce crisis once and for all.
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.
Health
Eleanor Smith Excerpts(4 years, 11 months ago)
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Eleanor Smith (Wolverhampton South West) (Lab)
I thank the right hon. Member for Chipping Barnet (Theresa Villiers) for raising her points.
Since 2010, we have seen the Government cut health services and social care by £7 billion. Because of this, we MPs have been seeing local cuts in our individual constituencies. Last week, a constituent of mine came to visit me during my surgery about a new policy that has come into effect. The policy states that a patient will no longer be given prescriptions for over-the-counter medicines for a range of health conditions, even if they qualify for a free prescription. I would say that that is a public health matter.
There are 33 conditions that are part of that policy, from acute sore throat, excessive sweating and period pains to warts and verrucas. My constituent is 64 and has various health conditions that stop her from working. She is on universal credit, which gives her £317 a month, which is much less than she would earn under the Government’s national minimum wage if she were working part time. Because of her low income, she has had to use up all her savings and even pawn her jewellery, which holds sentimental value, to make ends meet. She recently went to her doctors for her hay fever medication and was told that she is no longer entitled to a free prescription. I feel that that is a public health matter. When she disputed the claim, she was told that under the NHS England guidelines they could no longer provide free prescriptions for mild to moderate hay fever.
As a nurse of 40 years, I am dismayed at how poorly NHS England and the Government publicised the consultation. Many people were unaware of this and it just sums up what the Government and their Departments seem to do. Backdoor and underhanded changes: these have been the steps the Government have been taking over the last nine years to move towards privatising the NHS. It brings me to tears to see the changes that NHS England is bringing in, which affect the most vulnerable. Socioeconomically deprived groups too often face the prospect of poorer access to healthcare, a public health matter.
We know that some of the conditions mentioned in the guidance are the first symptoms of more serious conditions and, if diagnosed too late, they can cause long-term complications for the patient, a public health matter. Did NHS England take into consideration single parents and those on low income who are on universal credit? How are they going to afford to pay for medication for themselves and their children under this new policy? That is a public health matter. It is unfair to them—having the right to free prescriptions was their safety net and one less problem to think about. Is this part of the Government’s NHS 10-year plan? To punish the most vulnerable individuals in society? The Government need to review this policy again. It is short-sighted and will have repercussions for their 10-year plan within the public health agenda.
NICE Appraisals: Rare Diseases Treatments
Eleanor Smith Excerpts(5 years, 1 month ago)
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Eleanor Smith (Wolverhampton South West) (Lab)
It is an honour to follow my hon. Friend the Member for North Tyneside (Mary Glindon), and I also thank my hon. Friend the Member for Blaydon (Liz Twist) for bringing the debate to the House.
I first heard of the drug Spinraza last year when Katie Prescott contacted me about her 10-year-old daughter, Heidi. She wrote:
“I have a daughter, Heidi, with a rare muscle wasting disease called Spinal Muscular Atrophy (SMA). SMA ranges from the very severe type 1 through to type 4. Heidi has type 3 and she is fast losing the ability to walk. She is 10 years old and it’s a devastating prospect for her. For the most severe cases of SMA, life expectancy is only 2 years without access to this drug.”
There is a treatment available for SMA, and it is called Spinraza. It is the one and only available treatment for SMA, and 22 other countries, including Scotland, have approved it. However, NICE is recommending that NHS England should not fund Spinraza for any types of SMA, meaning that thousands of people in the UK with SMA are left without a treatment. This is practically a death sentence for babies diagnosed with type 1, and it means that type 2 and type 3 children are destined for a life of deterioration. The issue is that NHS England and Biogen cannot agree on the costs. We need the Government, NHS England and Biogen to sit down and negotiate an agreement that has the SMA community at its heart.
In January 2019, I wrote to the Health Secretary about this. He replied:
“NICE is an independent body, and it would be inappropriate for me to comment on its guidance”.
When I wrote to NICE for clarification, it said:
“I fully accept that we, the company and NHS England have a responsibility to bring this matter to a conclusion quickly. We are working hard to do this through discussions with the company and I am hopeful of reaching a positive outcome.”
I also asked the Prime Minister this question:
“Why can this treatment not be accessible to my constituent Heidi and other children in England with this disease?”—[Official Report, 20 February 2019; Vol. 654, c. 1462.]
She answered that the next meeting between the parties would take place in March. Since then NICE, NHS England and Biogen have met, on 6 March in Manchester, and we now await their next judgment. That comes after 14 months of appraisals, with months between the stages of the negotiation process. What is it about this country that makes it so different from Scotland and the 22 other countries in Europe that have approved the drug? What have they done to be able to do that? How have they negotiated it?
When a child is born with a condition such as SMA, there is hope in every parent’s heart that a cure will be found—that a new drug will be developed to treat it. This is an example of that, but the drug has been denied to children suffering with SMA, and we must find a mechanism to resolve the problems. I understand that there are structural issues within NICE, which means that the treatments of conditions such as SMA end up being assessed in the same way as more common conditions, therefore making it extremely difficult for treatments to be assessed as being cost-effective. In the meantime, Heidi’s health continues to deteriorate. When I met her recently in my office, I was deeply impressed with her bravery and optimism, but her mother said to me:
“It is very frustrating that still no decision has been made. Heidi cannot walk unaided anymore and even then can only take a few steps. To know there is something that can help her, but she can’t access it, is very difficult and Heidi finds that hard to deal with too.”
Up and down the country, families like Heidi’s are fighting for treatment. Surely NHS England, NICE and the company have a duty of care and a moral obligation to give treatment to patients like Heidi when it is available. We must remember that there are human beings behind the statistics—caring families who are suffering because a medicine has been denied in this country.
Oral Answers to Questions
Eleanor Smith Excerpts(5 years, 2 months ago)
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Jackie Doyle-Price
As my hon. Friend knows, health is a devolved matter, but I am keen to share best practice with colleagues in Scotland, who face many similar challenges. In England, we will test four-week waiting times for access to NHS support in the community and we are committed to sharing that expertise, as we often do, with colleagues in Scotland.
Eleanor Smith (Wolverhampton South West) (Lab)
In the Government’s 10-year plan for the NHS, a growing share of the budget is promised for improving mental health services in the coming years. The mental health services in Wolverhampton are in a desperate state of underfunding now. I am receiving letters from my constituents telling me how they have to wait over a year or more to be treated. One woman told me:
“I personally know people who have attempted to take their own lives, thankfully unsuccessfully… but… aftercare once discharged from hospital”
is non-existent. When will people see the benefits of the 10-year plan? By the time the uplift takes place, it will be too late for some of them.
Jackie Doyle-Price
As we outlined in the 10-year plan, we fully recognise that there needs to be much more investment in community and crisis care, including direct access via the 111 service. By April, we will be able to put more flesh on the detail of how we will roll that out. I assure the hon. Lady that I am in no way complacent about the challenges we face in ensuring that our mental health services are what people should expect of them.
Nursing: Higher Education Investment
Eleanor Smith Excerpts(5 years, 5 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
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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?
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.
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—
Oral Answers to Questions
Eleanor Smith Excerpts(5 years, 6 months ago)
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Matt Hancock
Yes. My hon. Friend will have heard that we have record numbers of GPs in training— 10% up on last year. I want to see more GPs—5,000 more across the country—and, no doubt, some of those in west Oxfordshire.
Eleanor Smith (Wolverhampton South West) (Lab)
I have a constituent who has Turner syndrome, a female-only genetic disorder that affects one in every 2,000 baby girls. Owing to this, she has to take several medications every day of her life, and this is mounting up as she gets older. She works so she is not on any benefits and has to pay for her medications herself. Will the Minister consider exempting those who suffer from lifelong conditions such as Turner syndrome from paying for their prescriptions? Surely, it cannot be right that people in England should be treated differently from those in Scotland, Wales and Northern Ireland, where such prescription charges have been abolished.
Steve Brine
I would be very happy to meet the hon. Lady to discuss her constituent’s case.
Oral Answers to Questions
Eleanor Smith Excerpts(5 years, 9 months ago)
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Steve Brine
The shadow Minister is absolutely right to raise this issue, which she also raised with me in the Westminster Hall debate on the same subject introduced by my hon. Friend the Member for North Thanet (Sir Roger Gale), who has done a lot in this area. I have already spoken to Public Health England about this in respect of the girls’ programme, and I will be speaking to it again now that we have announced the boys’ programme, because the equality of doing the dual programme must be matched by the equality of its taking place in her constituency as much as in mine in Hampshire.
Eleanor Smith (Wolverhampton South West) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
We urgently need more black, Asian and minority ethnic donors to save lives through the gift of organ donation. That is a priority for the Government. Last week, I launched a national campaign to address myths and barriers and bring attention to the life-saving power of organ donation. It is crucial that these messages be properly tailored to enable everyone to participate.
Eleanor Smith
In 2017-18, only 1 33 people from the BAME community in this country donated an organ. While they are still living, BAME people make up a third of the people on transplant waiting lists and have to wait over a year longer than white patients. I know that the Government announced a new campaign, following NHS Blood and Transplant’s annual report on organ donation, within the BAME community, but it fails to address many of the recommendations in my report “Ending the Silent Crisis”, published in June. I sent a copy to the Minister, along with a request for a meeting, but I have yet to receive a response. Will she agree to meet me after the recess to discuss the recommendations in my review?
Jackie Doyle-Price
I am sorry the hon. Lady has not received a response, because I instructed my office to say I would agree to meet her. I commend her work in this area, because it is very important that we tackle this injustice. Central to that is reaching out to those communities and engaging with them in a way that inspires them. We have found in our work over the last year that there is a sense of distrust among some minority ethnic communities towards health providers. I will be bringing out some tools in the autumn and would encourage all Members to reach out to their minority ethnic communities to tackle the fact that, as she says, a third of people on transplant waiting lists are from black and Asian communities and that we need more donors.
BAME Blood, Stem Cell and Organ Donation
Eleanor Smith Excerpts(5 years, 10 months ago)
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Mohammad Yasin
I agree with the hon. Lady. BAME donors make up 15% of the stem cell register; black donors make up just 1.2% of potential donors on the British Bone Marrow Registry. I hope the Minister shares my concerns about those statistics and that she will commit today to agreeing in full to the recommendations of the review by my hon. Friend the Member for Wolverhampton South West.
Eleanor Smith (Wolverhampton South West) (Lab)
I thank my hon. Friend for securing this timely debate. My review, “Ending the Silent Crisis”, is about the lack of stem cell and organ donation in black and minority ethnic groups. I hope that the Minister will look at the review’s recommendations, take them on board and come back to us on them.
Mohammad Yasin
I thank my hon. Friend for her hard work on the review and I look forward to working together on the issue.
It is clear that increasing the number of BAME stem cell donors requires a many-sided approach, but one of the most important things that can be done is to integrate information about donation into the formal curriculum, which the review recommends. We already know that education works. For example, Anthony Nolan and other blood disorder charities have had great success working with schools, universities and colleges across the UK. Just last month, I wrote a letter to all schools with a sixth form in or near my constituency to ask whether they would consider using an assembly or personal, social, health and economic lessons to teach students about the importance of donating stem cells, blood and organs. I am delighted that one of the schools has already agreed to do so.
Since the Hero Project started in 2009, more than 32,000 people have signed up to the Anthony Nolan stem cell donor register, and approximately 16% of them are from a BAME background. The Hero Project recognises that the different religious views about organ donation are one of the barriers preventing people from signing up to the organ donation register. Anthony Nolan and other blood disorder charities recognise and respect those diverse views and tailor their message to suit different interpretations of faith. They focus on what people can do to help, not on what they cannot do.
The review found that the three main barriers that prevent people from signing up are a lack of knowledge or awareness, religious permissibility and a lack of trust in medical institutions. The opt-out system for organ and tissue donation, with additional safeguards, is welcome, but there must be an awareness campaign that is mindful of the cultural sensitivities relating to organ donation and addresses the significant pressure on NHS Blood and Transplant’s capacity to accommodate any rise in organ donations.
It is vital that we get more young people from BAME backgrounds, such as students, to sign up to the stem cell donor register, because the research shows that the younger the donor, the more likely the patient is to survive. What steps will the Minister take to ensure that all students aged 16 and above have the opportunity to learn about the importance of donating stem cells, blood and organs? There is a real desire in the BAME community —especially among the younger generation—to turn this issue around.
I was touched by the action of the Bandhan Bedford Group, a group of Asian professional women in my constituency who helped to add 300 new names to the stem cell register. They organised a stem cell drive this month in Bedford, with support from the blood cancer charity DKMS, to help Kaiya Patel, a five-year-old girl who I understand is still waiting for a lifesaving match for her rare and aggressive form of leukaemia. I know that similar drives are taking place around the country, but this is a race against time. It has been reported that, to have a chance, Kaiya needs a transplant within the next two months.
There is a strong will out there to increase the life chances of people from a BAME background. I hope that this timely review, which highlights the scale of this silent crisis, is enough to spur the Government into assisting communities with a more co-ordinated approach. This blatant inequality must end.
Jackie Doyle-Price
That is a point well made. It is the same for blood, of course—donors do not have to die to give blood. People who give blood do so regularly because they get into the habit and it has become normal. Perhaps we need to do a lot more about stem cell transplants.
I am particularly moved to be having this debate today because only this weekend I lost a very good friend of mine to lymphoma at the age of 47. That brings home how cancer and illness can kill people at a very young age. It will be in honour of my dear friend David Furze that I will do something to reboot stem cell donation.
On the barriers to more donation, some have serious concerns about faith and religious beliefs. Tackling those concerns is a big challenge for us in Government, because of the element of trust. The hon. Member for Bedford mentioned that quite often people do not trust medical professionals, but they trust Government even less. We must find innovative ways of getting that message out. We need the right messengers. Dare I say, the people in this Chamber are among the right messengers? Most of us have respect in our communities and are able to show leadership in our communities. We can go out, speak, raise awareness and encourage donation. I have given NHSBT the challenge to do exactly that.
Eleanor Smith
Other organisations are also trying to do that, such as the African Caribbean Leukaemia Trust, but they get very limited resources. One of my recommendations is about sharing resources with groups that are already organised and going out to the community, because with limited resources they can do very little.
Jackie Doyle-Price
The NHSBT strategy has that in mind. Recently, we had a faith summit where we worked with the individuals who are able to go out and give those messages. The approach must be organic. I have also tasked NHSBT to work with me to develop an MP’s toolkit to help us to go out in our constituencies and develop the right networks and links. The hon. Lady is right to say that people from these communities will listen to their elders and other representatives, and that is why we need to work through those people. We are doing that with a number of organisations.
Turning to stem cell donation, all hon. Members articulated beautifully the real disparity of access to appropriate treatment. It is only by building and diversifying the UK stem cell register that we will be able to provide the best match for patients. Hon. Members have raised the issue of an international register; the Department funds Anthony Nolan’s efforts in this area. Members of the World Marrow Donor Association already promote global collaboration. We will continue to support that as best we can, working with Anthony Nolan and NHSBT.
NHSBT continues to grow both its cord blood banks and bone marrow donor registers, with the explicit intent of increasing the number of black and Asian donors. Overall, we have paid more than £20 million to NHSBT and Anthony Nolan specifically for stem cell donation since 2015. So far, we have made some progress in increasing donations from black, Asian and minority ethnic backgrounds, but not nearly enough to address the disparity. We will all continue to make our efforts count in that area.
I pay tribute to the initiative of the Bandhan Bedford Group that the hon. Member for Bedford mentioned. If there is a good local champion that captures local imagination, real progress can be made. We all need to encourage those sorts of activities.
Turning to blood, there is a real need for black donors and donors from the Asian community to increase supplies, not least because they are more likely to suffer from diseases that will require blood transfusions, specifically sickle cell anaemia. We are undertaking initiatives to increase the number of black and Asian blood donors. We are holding “know your type” events in high population areas, where people can learn their blood type with a finger prick test. That will help NHSBT to manage its blood stocks and develop a database of exactly the type of blood that there is a shortage of.
We are supporting others, such as the music of black origin awards, to reach audiences. Those who watch “Britain’s Got Talent”—I watch it—will have seen the B Positive choir, who did so much to raise awareness and were absolutely fantastic.