NHS Workforce: England

Karen Lee Excerpts

Wednesday 17th July 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

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

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

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

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

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

[Karen Lee (Lincoln) (Lab)]

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

[Derek Thomas]

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

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

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

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

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

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

--- Later in debate ---

[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this important debate.

I will start by talking about my lived experience of staff shortages in the NHS. I worked as a nurse from 2003 until 2017, when I entered Parliament. For the majority of that time, I worked on an in-patient cardiac unit at Lincoln County Hospital. Today, I want to paint a picture of a nurse’s working day and how difficult that becomes when we have staff shortages. First, however, I pay tribute to all the staff at Lincoln County Hospital—not just the nurses, but all the staff—and to NHS staff who deliver our healthcare right across this country in local communities and in hospitals.

I keep in touch with my former colleagues and still hear at first hand how staff shortages affect them—some stories are quite scary. As an MP over the past two years, I have witnessed an awful lot of patronising pats on the back. I exclude today’s debate from that, but we often hear from Members how wonderful our NHS staff are, and yet that does nothing to address staff shortages or to make their working conditions any better. That is what they want; they do not want patronising pats on the back. The 40,000 nursing vacancies are evidence of that stark truth.

As a nurse, when I went on shift, I would be allocated eight cardiac patients. They would have been treated for heart failure, recently had a heart attack or been waiting for an angiogram, or perhaps they were being treated for endocarditis, which is a serious infection of the heart. The staffing was meant to ensure that a single nurse took either the male or the female team, with an extra nurse working between the two sides to support the multitude of tasks that delivering good patient care means. In reality, we often did not get that third nurse, and had to manage without. Some shifts felt like a marathon combined with a sprint—I kid you not, Mrs Moon, it really was that bad. I did love it though.

The medical management of my group of patients would be varied. Many patients were diabetics, meaning that we had to check blood sugars, four times a day for some and twice for others. If four or five out of eight of a nurse’s patients were diabetics, that was quite a task. We could even get something called “sliding scale”, which meant we had to check them every two hours. Sometimes, honestly, we just chased our tail the whole day.

Many patients needed intravenous antibiotics, which were really time-consuming to prepare, even more so if a patient had a line, a Hickman or a PIC—a peripherally inserted central catheter—because it had to be done aseptically; it just took ages, and the nurse was running around the whole time. As well as that, staffing was routinely topped up with bank or agency staff. I am not knocking them, because we would not have managed without them, but they were not allowed to do IVs, so when we had agency staff on the other side of ward, to be honest we would end up doing quite a proportion of their work as well. That made it really difficult.

Many patients were prescribed controlled drugs, so first thing in the morning, at 8 o’clock, we might have had two or three CDs to do—but trying to get someone else to check the CD was a nightmare. There were just not enough hands on deck, which meant that people were sat waiting in pain for analgesia when they had gone all night and were due that dose. Sometimes a patient needed a blood transfusion, which was a really tricky process. They had to be monitored the whole time, but, again, that was done for one person and there were eight patients, so the nurse was running around all the time. It felt unsafe and the nurse felt really bad because they wanted to deliver good, safe patient care.

A patient might be close to death and need to be monitored, because the nurse could tell visually whether they were in pain, but there were seven others to look after. The relatives wanted someone to sit and talk to them, which of course the nurse wanted to do, but they did not have the time. In addition, there were other tasks such as changing dressings, monitoring pressure areas, and speaking to social workers, physiotherapists and occupational therapists about assessments, as well as discharging patients. The doctor might say to a patient, “You can go home today”, but the nurse had seven others to look after. All the patient wanted was for the nurse to do their paperwork and get their meds from the pharmacy. They sat waiting impatiently and the nurse felt bad because the patient could not go home. When the nurse eventually got them out, another patient was straight into their bed and the admission paperwork had to be done. The tasks were endless, but that was the job. We did it and we loved it, but we have to have enough staff to do it properly.

No nurse can deliver care without the healthcare support workers, so this is not only about nurses. The housekeepers make the tea but because the nurses do not have time to sit and talk to the patients and their families, the nurse goes to the housekeeper at the end of a shift and says, “Has anybody told you anything that I need to know?” It is team work. If there are not enough staff to carry out the different roles, staff simply burn out and cannot deliver the care that patients need. Towards the end of my nursing career, in the two years before I came to Parliament, I worked in out-patient clinics because I thought it might be a little easier, but it was not. It never is, but I was starting to get burn-out and I did not want that to happen because I loved the job too much.

We used to work 12.5 hour shifts. We would start a day shift at seven in the morning. At about half nine, if we were lucky, we got a cup of tea, but we literally had only five minutes. At around two o’clock we got our lunch. We had half an hour and we were meant to have another break at teatime, but we never, ever got it because we were running around trying to finish all our jobs, chasing our tails and trying to get everything done. So we would have a break of about half an hour in twelve and a half hours. Then, just when we thought we were going home, it would turn out that the bank staff, the agency staff, had not turned up and we could not simply say, “I am off home.” We had to wait until somebody had been found somewhere else in the hospital and somebody was moved from a different ward. Then the handover took half an hour. Instead of going home at half seven or eight o’clock, it could be nine o’clock and we would be back again at seven the next morning. People simply burn out.

Working in our NHS is incredibly hard work in whatever role. It is not well paid, and in places such as Lincoln a few years ago when we had the pay freeze, it was suddenly decided that a consultation would be held and we were asked, “Do you think you ought pay for staff parking?” Of course, everyone said no, so what happened? We all had to start paying for staff parking: £15 a month for staff nurses who had not had a rise in years. It absolutely made us feel undervalued, and that is not acceptable. I am not surprised that people are leaving the profession.

I want to talk now about the crisis in our NHS and about some of the steps we must take as parliamentarians to address it. There are more than 100,000 vacancies in our NHS, including 40,000 nursing vacancies. The “Interim NHS People Plan”, released last month, acknowledges that

“shortages in nursing are the single biggest and most urgent we need to address.”

I agree with that, but there are many other things we need to address, too. It is true that 80% of shifts from over 40,000 nursing vacancies are covered by expensive bank and agency staff, which highlights the false economy of austerity. It makes no sense financially. I will say this again and again: the removal of the nursing bursary in effect means that nurses are not training. I know I will get the answer back about how wonderful nursing apprenticeships are and how other wonderful things will happen, but the stark truth is that nurses are not training. So the NHS long-term plan and the talk about all the extra places for nurses is pie in the sky if we have not got the nurses training. It will simply not happen.

I am particularly concerned that applications from mature students have decreased by 39%. People no longer have the support that I had when I trained as a mature student. I was 39 when I started my training. The RCN is calling for the Secretary of State for Health and Social Care to be accountable to Parliament for making sure that there are enough health and care staff with the right skills in the right place at the right time to care for patients, based on population needs now and in future. Support for that must be, as my hon. Friend the Member for Wolverhampton South West said, cross-party if it is to happen. This or any future Government must ensure a credible, costed workforce strategy. Our healthcare workers must feel confident of delivering the very best care, and our patients must feel happy with the care they receive. A worn-out and demoralised workforce is not what the patients or any of us want to see.

Patients watch nursing staff doing their best to look after them. Some of them used to say to me, “Do you ever stop and take a breath?”, and I would jokingly say, “No, but I still don’t get thin, do I?” They have to wait their turn longer than they should for the care that they need, and that is not what we want to see. So I really hope that the Minister is genuinely listening and does not give me the usual answers: “We have got apprentices and we have got this and we are doing that, and all this money is going in, so we will get lots of nurses and it will all be all right in five years’ time.” I want someone to take notice and listen to me as an ex-nurse and make sure that hardworking NHS staff will be equipped to deliver the care that is both safe and effective for them and for their patients.

--- Later in debate ---

[Stephen Hammond]

The hon. Lady will know that the CQC regime puts directives in place if staffing levels are not there. The local providers are then forced to address those issues. The accountability is there.

Beyond this issue, several hon. Members talked about exactly what we are doing now. There was recognition that the Government have put in place the long-term plan and the people plan. Any reading of those will see that our overarching plan for the health service looking forward recognises explicitly that getting the workforce supply right is key. That is therefore an important part of the long-term plan, which sets out the vital strategic framework to ensure that in the next 10 years the NHS will have the staff it needs. Nurses and doctors will have the time they need to care, work in a supportive culture and allow them to provide the expert, compassionate care to which they are committed.

Hon. Members rightly said that that will not be for this Government; it may well be for the Government beyond. However, the long-term plan rightly recognises by its very nature that what we need to put in place today must continue through the next 10 years to ensure that we have the staffing levels we need.

[Karen Lee]

A number of us mentioned the nursing bursary. The long-term plan talks about extra places for nurses, but if nurses are not being trained—the evidence shows that numbers have dropped by about 25% to 30% —clearly we cannot have them in place. I seek the Minister’s comments on reinstating a nursing bursary so that mature students and other students can afford to train.

[Stephen Hammond]

I will come to the number of nurses in training and related issues in a moment, to address the hon. Lady’s comments.

Associated with the long-term plan is the people plan, which clearly recognises, to reference what I said about Health Education England, the significant role of that organisation in securing the NHS workforce for the future. That is why my right hon. Friend the Secretary of State for Health and Social Care commissioned Baroness Harding, the chair of NHS Improvement, to work alongside and closely with Sir David Behan, the chair of HEE, to develop the workforce implementation plan. The interim people plan published in June set out the actions needed to change positively the culture and leadership of the NHS, making it the best place to work, which addresses the issues rightly raised about recruitment and retention.

The people plan commits to developing a new operating model for the workforce that ensures that activities happen at the optimal level, whether in individual organisations, local healthcare systems, regionally or nationally, with roles and responsibilities being clear.

On NHS workforce supply, hon. Members talked about demand for nursing and midwifery courses. The latest available evidence shows that we are starting to see a substantial rise. Data published only last week showed a 4.5% increase in applicants compared to 2018, with that being the second increase in as many years. To build on that, to ensure that we increase the pipeline of nurses coming into the profession, the Department has worked with NHS England to ensure that funding is available for up to 5,000 additional clinical placements for nursing degrees in England. The chief nursing officer for England has led work to identify and accelerate the availability of such clinical placements. It is vital that universities ensure that they take up offers and provide placements to ensure that places are filled at the end of this year’s recruitment cycle. That can happen.