NHS Staff: Oxfordshire

Justin Madders Excerpts

Tuesday 20th February 2018 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing the debate and on the powerful arguments she made about the recruitment and retention crisis affecting NHS services in her area and across the country.

As the hon. Lady said, the NHS has been a frequently raised issue in recent times, certainly since her election. I join her and the other right hon. and hon. Members who have spoken today in praise of the dedication and commitment of the staff who work in our health service. She said that we are close to a crisis in the NHS. I believe that only the dedication and commitment of staff prevent a crisis from turning into a complete catastrophe. She was also right to say that the good will of staff is propping up services at the moment. That is something that, I am sad to say, I have to keep repeating every time we have a debate: it is the good will of staff that keeps the show on the road.

I was concerned to hear that some staff had approached the hon. Lady to say that some of the levels of experience in particular wards were raising concerns about patient safety. She highlighted in particular the shortage of mental health specialists. She is right to say that the good intention to try to achieve parity of esteem will be extremely difficult to meet when there are so many shortages.

The hon. Lady diagnosed a number of issues that have contributed to causing the crisis. Uncertainty around Brexit has certainly accelerated some of the staffing challenges already in place. The abolition of the nursing bursary has also created issues, and I will come back to that later on. I agree with her that reliance on agency staff is unsustainable, and we can talk about that in a little more detail later. She mentioned the pay cap, as I think every hon. Member did; that is something else I will come back to later, but I remind her that when her party was in government it enacted that policy for a full five years.

The hon. Lady also mentioned staffing shortages in social care. It is sad to hear that those doing one of the most valuable jobs in society feel that they have a better prospect of earning a decent living in retail. That brings home the challenge we face. The issues she raised about training and professional development are also particularly relevant.

The hon. Lady was right to mention that behind all of that is the funding challenge we currently face. We are in the longest and most sustained financial squeeze in the history of the NHS, and it is inevitable that those kinds of issues will come up until we reach a sustainable funding settlement. She also raised the question of housing and the cost of living in Oxfordshire. I think most hon. Members touched on that point. She said she was concerned that unless the issues are tackled in a comprehensive way, services will be rationed. I am afraid to say that services up and down the country are already being rationed, as we have discussed here on a number of occasions.

It was a pleasure, as always, to hear from the hon. Member for Banbury (Victoria Prentis). She always speaks strongly and passionately about NHS services in her area. She said that staffing issues were a major factor in the proposals to downgrade the maternity unit at Horton. It is a sad fact that half of all maternity units up and down the country have had to turn expectant mothers away at some point in the last year, often due to staffing shortages. We currently have a national shortage of about 3,500 midwives. It was interesting to hear some of the possible initiatives to attract new obstetricians in particular. Certainly, the prospect of free beer is something that works for me, but I do not know whether the hon. Lady can wait quite as long as it will take for me to train in that profession. I think we will have to do without my particular skills in that area.

The hon. Lady raised the issue of transparency and openness. It is disappointing to hear the difficulties she has had with her local trust on that issue, but it is clear from what she has said today that she has a lot to contribute to the wider health economy in her area. She is not alone on that issue. The Government have been pushing through policies on sustainability and transformation plans, accountable care organisations and the capital expenditure processes, which are all done under a veil of secrecy. There are wider issues in play there.

My hon. Friend the Member for Oxford East (Anneliese Dodds) described the current situation as a perfect storm—an apt description. I am impressed at the way in which she has engaged with staff in the health service in her constituency to get to the real meat and bones of the issues. It was sad to hear that staff feel they are forced to leave the profession and go to work for an agency; she was absolutely right to say that forcing staff to go and work for an agency to make ends meet costs us more in the long term. There are ways in which that could be a saving for us if the pay cap was lifted.

The problems with the nursing bursary were again highlighted, particularly how they are exacerbated in the Oxfordshire area by the cost of living. Has the Minister done any analysis of the cost of living in different parts of the country and the income streams available to those undertaking nursing degrees, who, because of the way the degree is structured, do not have the option of supplemental employment?

My hon. Friend explained very well how the proximity to London creates recruitment difficulties. The stark image of staff living in a corridor highlighted to me the impact of eight years of pay restraint. She also highlighted the bureaucratic nature of recruiting overseas staff. I know immigration policy is outside the Minister’s remit, but I hope he is making representations to the Home Office about how we tackle those issues in future. My hon. Friend highlighted how, despite the Government’s various initiatives for getting people on to the housing ladder, it is still too big a leap for many. We need much more genuinely affordable housing to be built.

We also heard from the hon. Member for Henley (John Howell). I agree with him that the problem did not start in the last year. He raised the question of challenges in GP practices, particularly younger GPs not feeling able to make the financial commitments to buy into practices, but also the restrictions on operations. He was right to mention that GPs need to move with the times on technology. A number of interesting initiatives are doing that up and down the country, although we have concerns about some of them and how they may exclude patients.

Finally, we heard from the right hon. Member for Wantage (Mr Vaizey). He painted an impressive picture of how healthy the Oxfordshire area is, but a report by the Oxfordshire clinical commissioning group shows a gap in life expectancy of nine years between different parts of the county—something about which the Opposition feel passionately.

It is fair to say, from the right hon. Gentleman’s comments, that the local NHS leadership are not on his Christmas card list. He gave a pretty damning assessment of their ability to engage, but of course the structures we are currently working under were brought in under the Health and Social Care Act 2012, which led to the removal of the Secretary of State’s responsibility for much of the system and to the fragmentation with which we are all grappling. I applaud the right hon. Gentleman for his efforts to try to bring everyone together, but he should consider whether the legislative framework we currently work under is fit for purpose. The way in which he has brought people in the NHS together is important and we should be doing more of that. In this particular area, that should be not just on the health economy, but on the wider issues, particularly those relating to cost of living and housing.

As we have heard, the potential impact of the recruitment and retention crisis was brought into stark focus by the issue that sparked the debate: the leaked email from the head of chemotherapy at the Oxford University Hospital’s NHS Foundation Trust that found its way on to the front page of The Times. That memo confirmed to staff that the trust was down on nurses at the day treatment unit by approximately 40%, and as a consequence that the hospital was having to delay chemotherapy patients’ starting times to four weeks. It also stated that there was no prospect of an improvement in the situation for 18 months to two years.

More worrying was a proposal to reduce the number of chemotherapy cycles available to dying patients, which is totally contrary to National Institute for Health and Care Excellence guidelines, as well as the national cancer strategy. We were therefore relieved to hear that the trust has now backed down from those suggestions.

[Anneliese Dodds]

To be clear, as other Members have mentioned, those were not live proposals. The problem was that the trust had to scope out the full range of potential action, given the challenge it was facing. However, the proposals were not something that it wanted to do—quite the opposite. I just wanted to underline that.

[Justin Madders]

I thank my hon. Friend for that point. I was not trying to imply that the proposals were live, but the fact they were being considered is of huge concern, which Members have rightly raised. It will be helpful if the Minister could look at what caused the proposals to even be discussed, because they are contrary to so many of the principles and guidelines that we want in our NHS. I hope he will be able to assure us that those kinds of dramatic measures are not being considered in other areas.

The impact of recruitment and retention issues at the trust extends far beyond chemotherapy. In January, 2,159 patients waited for longer than four hours to be seen in A&E, falling well below the 95% target—a measure that the Health Secretary described as “critical for patient safety”. Even more worryingly, since December eight cancer operations and 26 heart operations were cancelled either the day before or on the day itself. Although that is at the upper end of operation cancellations, it is sadly a story that we now hear up and down the country. Cancelling an appointment at short notice causes immense frustration. It is sometimes unavoidable, but we know that it can have devastating consequences and put patients at unnecessary risk, not to mention the emotional impact. On the practical side, cover has to be arranged, spouses and family members have to arrange their own time off, and sometimes even national or international travel is required.

Staffing shortages are not behind every cancellation, but they will be a factor in many, and the vacancy rate at the trust tells us that it is an increasing problem. As we heard, vacancies at the trust for nurses, midwives and nursing support workers have almost doubled in the past year, from 5.99% in October 2016 to 10.8% in October last year, leaving about 400 whole-time equivalent vacancies. As we have heard from hon. Members, local factors have undoubtedly contributed to that. A 2017 study by Lloyds bank listed Oxford as the most expensive city in the UK, with average house prices 10.7 times average annual earnings. As we have heard, there is some support for the introduction of an Oxford weighting-type arrangement.

There is also a national context to look at, with housing costs being exacerbated by the pay cap. It is clear that, although that is probably at the sharper end of the pressures, Oxford’s issues are being repeated up and down the country. We now know that, after eight years of this Government, more nurses are leaving the NHS than joining. That position is particularly sharp in the Thames valley area, where there were 39% more leavers than joiners between September 2016 and September 2017.

While almost all trusts up and down the country have been unable to fill vacancies, Oxford’s is probably one of the more acute situations. However, much of it was completely predictable. One of the first decisions the Government took in 2010 was to cut the number of nurse training places by 3,000, which has led to about 8,000 fewer nurses nationally. We then had the Health Secretary’s farcical decision to take on the junior doctors, which has led to a demoralised workforce.

Then, to cap it all, as Members have said, came the decision to scrap nurse bursaries, which is possibly the most ill-conceived decision the Government have made—and there is plenty of competition for that particular award. We warned at the time that, far from providing more nursing places, the move would lead to a drop in the number of applications, with the biggest impact being on mature students, who bring a huge amount of experience from outside the profession.

As we have heard, statistics show that there was not only an 18% drop in applications in 2017, but a 2.6% decline in England in the number of students accepted on to courses. Among mature students, 13% fewer of those aged between 21 and 25 were accepted. That decision is discriminatory and stands in stark contrast to the Government’s aims on social mobility. Those are not just my words—they are in the equality assessment undertaken by the Department for Education. However, instead of learning from that lesson, Ministers have decided to scrap NHS bursaries for postgraduate students as well.

Alongside that disastrous decision, we have had the counterproductive capping of pay, which has led to hard-working NHS staff losing money in real terms at the same time as their workload has increased. We have heard encouraging noises from the Government recently, but we have seen no firm action. Perhaps the Minister can provide some clarity when he responds. The Nursing Times reported this week that the Treasury apparently still needs convincing that a rise in wages should be “meaningful”. Will the Minister send his Treasury colleagues a transcript of the debate, to persuade them that a strong case is being made for an increase?

Across Oxfordshire and the whole of our NHS, a recruitment and retention crisis is exacerbating a situation that has already reached crisis point. The Government need to act, realise their mistakes and urgently give hard-working NHS staff the belief that their work is valued and the confidence that their concerns are being listened to.