Nurse Staffing Levels

Lindsay Hoyle Excerpts

1st reading: House of Commons
Tuesday 8th October 2019 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I beg to move,

That leave be given to bring in a Bill to make provision about National Health Service bodies establishing nurse staffing levels.

I start by declaring an interest as a nurse and a member of the Royal College of Nursing, which is leading the campaign for safe and effective nurse staffing. Nursing is one of the most underestimated professions in the country, if not the world, because while everyone loves a nurse, with colloquial terms such as “angel”, “having a vocation”, “hero” and “caring or compassionate” being used to describe us, the true impact of nurses and nursing on the nation’s health has never been recognised. We are more than just a doctor’s assistant. Whether an experienced nurse who holds a patient’s hand as they die while assessing their level of pain or symptom management, or an advanced nurse practitioner in places such as the Royal Marsden Hospital’s clinical assessment unit who can treat patients with acute ascites and manage them by inserting a drain to deal with the symptoms or can look for the first sign of sepsis, nurses are truly saving lives.

There is increasing evidence that the right number of qualified nurses can improve patient outcomes in terms of mortality, morbidity and quality of care, and that, conversely, insufficient nurses can have a potentially life-threatening effect on patients. A study by Aiken et al reported in The BMJ looked at discharge data from hospitals for over 275,000 surgical patients in 188 hospitals across Europe, finding that a greater number of professional nurses was associated with lower odds of mortality. Likewise, Bridges et al also found in The BMJ only last year that the addition of qualified nurses makes a difference to patient outcomes—not simply the addition of healthcare workers, but qualified and experienced nurses. There is something in the skill and experience of qualified nurses that improves mortality rates, morbidity rates and quality of care.

Record numbers of nurses have joined the Nursing and Midwifery Council register, with 8,000 more nurses and midwives now registered to work in the UK, but over 43,000 nursing vacancies remain in England alone. The RCN staff survey in 2017 reported that that is having an impact on the ground, and nurses are reporting that care is going undone as a result. That is why, as a nurse and a member of the RCN, I am bringing this Bill forward to establish legally enforceable nursing staffing levels in the NHS in England, as was done in Wales in 2016 and in Scotland in June this year, when the Health and Care (Staffing) (Scotland) Act was passed.

The Bill has four main aims. First, we need to make the Government accountable for nursing levels in England. No one is accountable for nursing numbers, which is why we have such a high vacancy rate and a lack of strategic action to address the situation. How are we going to increase student nurse numbers via degree apprenticeships, which are working so well in places at the University of Brighton in my constituency, where student nurses earn while they learn in clinical placements? How are we to increase the numbers returning to practice when return-to-practice courses are difficult to access and expensive, with nurses often having to pay for them themselves? Nearly a third of our nurses in practice today are likely to retire in the next 10 years, so how are we to address early retirement? Without someone taking responsibility, none of those issues will be addressed. While individual trusts do their best to mitigate recruitment and retention challenges, no one is taking responsibility for the sheer scale of the issue across England.

That fits neatly into the second and third parts of the Bill, which relate to a fully costed workforce strategy and nursing numbers. There are currently no legally enforceable nursing numbers for any healthcare sector in England. In 2014, National Institute for Health and Care Excellence guidelines for adult wards stated that when nurse patient ratios reach eight patients to one nurse, that should act as a red flag that care is becoming unsafe. However, in the 2017 RCN staff survey, 71% of nurses report that they had cared for more than eight patients on their previous shift, with 26% reporting that they cared for more than 14 patients. We need legally enforceable numbers, so that nurses and patients can be protected from unsafe care and so that someone is held to account if that does not happen.

In England, each trust manages its own staffing numbers, and if money is tight, retention and recruitment just does not happen. To be fair to the trusts, they have no pool of nurses on which to draw, so what are they supposed to do? We need a nursing workforce strategy not only to meet short-term need, but to plan for the long-term healthcare needs of the nation. However, the Bill is about more than just ring fencing nursing numbers. It is about the skill mix, too. Having experienced qualified nurses is the key to improving patient outcomes.

As already mentioned, there is a growing body of evidence to show the difference that experienced and qualified nurses can make to patient outcomes. In my 25 years’ nursing experience, nothing can beat the continuity of someone looking after the same patient over a period that only adequate staffing numbers allows for. An experienced nurse often gets to know their patient and can spot mild changes, such as mild confusion, that could indicate the start of sepsis. They can spot that someone is not taking their medication, is slightly dehydrated or has raised sugar levels. Something as simple as constipation can lead to abdominal pain, nausea and vomiting, dehydration and, ultimately, hospital admission.

Service managers who are driven to replace nurses with healthcare assistants take a penny wise and pound foolish approach, as a qualified nurse can prevent hospital admissions, reduce the length of stays and reduce readmissions simply by using their skill and experience. Any extra paid in higher wages would be offset by savings in the length of stays and acute adverse events.

Finally, the Bill would legislate to provide training and education for all nurses throughout their career. If we want nurses to take on more advanced roles, from nurse prescribing to chest drain insertion, the Government need to ensure the training happens both by paying for it and by allowing study leave. We cannot continue with nurses using their annual leave and their days off to undertake training vital to their role.

Other countries have realised the need for change and have made legislative changes to ensure safe staffing levels. That is why I support the RCN and Dame Donna Kinnair in promoting this Bill to create a legal framework that clarifies the roles and responsibilities and the accountability for the supply, recruitment and retention of nurses in England.

Question put and agreed to.

Ordered,

That Maria Caulfield, Alberto Costa, Kate Hoey, Stephen Lloyd, Andrea Jenkyns, Andrew Lewer, Andrew Griffiths, Lloyd Russell-Moyle, Charlie Elphicke and Eddie Hughes and present the Bill.

Maria Caulfield accordingly presented the Bill.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 439).

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I do not think there will be many here, but good luck.