Nurses: Training

Lord Clark of Windermere Excerpts

Wednesday 7th March 2018 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what specific proposals they have to increase the number of fully trained nurses working in the National Health Service and the associated care services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, there are record numbers of nurses working in the NHS in England, including 13,900 more acute, elderly and general nurses. To increase the future supply of registered nurses, the Government are funding over 5,000 more student nursing places for those entering training each year from September 2018. We are opening up new training opportunities to increase the number of professionally qualified nursing staff across the health and social care workforce through the apprenticeship route.

[Lord Clark of Windermere (Lab)]

I thank the noble Lord for his reply, but I do not think the Government really grasp the seriousness of the shortage of nurses. In the last two years, 33% fewer students came forward. We have a shortage of 40,000 nurses and it will take years to put that right. Can I make a suggestion to him? The best and quickest way to increase the number of trained nurses is for the Government to drop their opposition to the bursary scheme for postgraduate students. These two-year courses are cheaper; it would cost the average funder £33,500 for the two-year course, which is half as much as the average trust would pay simply to employ an agency nurse for a year to fill the gaps. Why will the Government not follow that route?

[Lord O'Shaughnessy]

My Lords, we take very seriously the need to train more nurses. There are 52,000 nurses in training and, as I have said, there is a commitment to increase the number of training places by 25%, which is obviously how we get to a long-term solution. On the issue that the noble Lord has raised about postgraduate bursaries, the policy intention is to bring these courses in line with other courses. I know that this is an issue of great concern. The Royal College of Nursing has expressed its concerns and we take those seriously. I also know that the regulations have been prayed against in the other place; they are also being looked at in the Secondary Legislation Scrutiny Committee and we await its report. I reassure him that the issue is being considered and we will respond once the committee has reported.

NHS: Charitable Donations

Lord Clark of Windermere Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord O’Shaughnessy]

I reassure my noble friend that I am not trying to make an ageist point. The point I was trying to make is that the majority of healthcare costs in a lifetime occur at two points in life: in younger children and in older age. We effectively have an insurance system where we pay through our tax and use the care when it is needed. The concern is that at a point in life when people might be vulnerable and not have support around them, and not necessarily know what is required in complex care, having had the facts about one piece of care they may feel that they should not be creating a burden on society by asking for more care. I do not think that is the right approach.

[Lord Clark of Windermere (Lab)]

My Lords, will the Minister make it quite clear—loud and clear—that virtually every hospital trust has its own charity and indeed that many individual wards have one?

[Lord O’Shaughnessy]

That is precisely the point. Any of us who have spent time in hospital will know that those charities are well advertised. As I say, they have £400 million of income, which I think makes them second only to cancer research in terms of income for health charities. I agree that they are a real asset to our health system.

NHS: Winter Crisis

Lord Clark of Windermere Excerpts

Wednesday 7th February 2018 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government what assessment they have made of the effectiveness of their planning for the winter crisis in the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, planning for winter started earlier than ever before to ensure that robust plans were in place to support NHS delivery during the challenging winter months. Despite the NHS being extremely busy and flu rates being at the highest level for years, hard-working staff treated more than 55,000 people within four hours every day in December—more than 1,200 more than last year. NHS England and NHS Improvement will publish their review of winter by summer 2018.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his reply. As he knows, NHS spending has risen by an average of 4% each year in real terms since its inception in 1948. Since this Government took over in 2010, that 4% increase has fallen to an average of between 1% and 1.5% in real terms. Can the Government not accept that some of their meanness is one of the major causes for the crisis the NHS finds itself in?

[Lord O'Shaughnessy]

I totally reject the accusation of meanness. If noble Lords look at the spending on the NHS, not only has it gone up in real terms every year while a massive fiscal retrenchment has had to take place to deal with £150 billion of borrowing bequeathed by the previous Government, but it now accounts for the highest percentage share of public spending that has ever been in place. We have found the money in difficult circumstances. We all agree that more is needed. More was found in the Budget; I am sure more will be found in the future.

NHS: Nurse Retention

Lord Clark of Windermere Excerpts

Wednesday 17th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite wrong to say that it is an unappreciated profession; nurses are deeply appreciated by everybody in this country, and that includes members of the Government.

Of course we want to reduce the number of nurses leaving the profession. It is important to point out that the number is down on two years ago, which was the peak in both number and proportion, and that the number of nurses has risen over that period. The noble Lord mentioned the pay cap. He will know, I hope, that in the Budget the Chancellor announced that he would be funding pay increases above the pay cap for nurses and other professionals on the Agenda for Change contracts, which is extremely welcome. We know that pay matters.

The noble Lord is right to focus on under-40s; that was an area that concerned me. The programme whereby we are promising to deliver 3,000 social homes for nurses is an important part of retaining staff, because we know how important housing costs are, particularly in the south of England.

Finally, we have been around the issue of bursaries a number of times, and there is no evidence that their introduction will make a long-term impact on our ability to recruit the nurses we need. Indeed, we are increasing the number of nurse training places from next year by a further 5,000.

[Lord Clark of Windermere (Lab)]

My Lords, the Minister has yet again repeated that there are 11,700 extra nurses on the ward, and compounded that by saying that there are more trained nurses in Britain than there were in 2010. Yet a Written Answer to me of just 10 days ago shows that we currently have 317,980 nurses, which is fewer than there were in 2010. Can he square that circle—or is he talking not about nurses but about nursing assistants?

[Lord O’Shaughnessy]

On the specific and most recent workforce data—if we are going to get into the specifics of nurses only—in May 2010 there were 273,071 nurses and in September 2017 there were 275,356, so that is an increase. I shall certainly look into the figures with which I wrote to the noble Lord. Of course, I intend always to be truthful. I am reading from the latest workforce stats.

As for nurses on wards, the noble Lord will know that the number has gone up. An important response to the scandal of Mid Staffordshire and the Francis report was to increase nurse numbers. We know that that has a consequence for other professions—I have talked about that quite openly—and in mental health and district nursing. That is why we want to increase the number of nurses in those areas.

NHS: Winter Funding

Lord Clark of Windermere Excerpts

Thursday 11th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I would hope that the noble Baroness would welcome the money that was set aside in the Budget. It is important to point out that in addition to that £337 million, half of which has gone to support plans that were already in place and being actioned before the Budget, there was a further £100 million to support A&E streaming, which is also a way of taking pressure off emergency services. That has had an impact, so I do not accept the accusation that the money came too late, and indeed there is still money in the pot as services come under pressure.

As regards the future, the noble Baroness will know that it was also announced in the most recent Budget that another £2.8 billion would be allocated to the NHS to help it get through the next few years. We know that the pressures are increasing because of the ageing population. The idea of that money is precisely to help the NHS get back on target on A&E waits as well as referral to treatment.

[Lord Clark of Windermere (Lab)]

My Lords—

[Baroness Watkins of Tavistock (CB)]

My Lords—

--- Later in debate ---

[Lord O'Shaughnessy]

I thank my noble friend for pointing out the fact that no Government have funded the NHS like this one. Indeed, the proportion of public spending taken up by NHS spending has been increasing in the last seven years, contrary to the views held by those opposite. On the impact of adult social care, my noble friend speaks with great wisdom. We know that money invested in the social care sector has a big impact. It already has, as he pointed out. That is why it is meaningful that the department has taken on full control over social care policies so we can push ahead with integration, which, as we know, is the right way to solve these problems.

[Lord Clark of Windermere]

My Lords, it is a question not only of money, but of planning and training staff. Did the Minister see yesterday that the head of chemotherapy at Churchill Hospital, Oxford, said that cancer treatment and chemotherapy were being delayed and curtailed because of the lack of trained nurses? Yet the Prime Minister denies this. Who are we to believe?

[Lord O'Shaughnessy]

I think that the trust has been clear that there are not going to be delays. If the noble Lord is talking about the story on the front page of the Times yesterday, the trust has subsequently been clear that it will not delay or curtail its treatments. We know that more nurses are required. That is why, as I am sure he will be pleased to know, there have been around 11,700 more nurses on wards in the last seven years.

Agency Nurses

Lord Clark of Windermere Excerpts

Wednesday 10th January 2018 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 27 November 2017 (HL3070), what assessment they have made of the operation of the “break glass clause” in the supply of agency nurses to hospital trusts from off-framework agencies.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, significant progress has been made in reducing agency staffing in the NHS. In 2016-17, the NHS spent £700 million less on agency staff than in the previous financial year. The “break glass” clause is one of a number of measures introduced to support patient safety while we seek to reduce the use of agency staff. Since a peak in April 2016, the number of nursing shifts procured from off-framework agencies has more than halved.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer on this very complicated issue. However, does he recall his Answer to my Written Question of Monday in which he confirmed that the incoming Conservative-led Government in 2010 cut the number of nurses virtually every year, sometimes in excess of 10,000, with the result that we have fewer nurses working in the health service today than in 2010? That is the cause of our reliance on agency nurses, which costs the NHS billions of pounds. This cannot continue, so will the Minister use his influence to try to ensure a proper workforce plan for the NHS so that we have sufficient staff to meet the needs and demands of the British people?

[Lord O'Shaughnessy]

The noble Lord is quite right that we need sufficient staff. He will know that when the Government came to office in 2010 difficult decisions needed to be made about the funding of all public services, because of the economic situation at the time. It is worth pointing out that, since that time, there are over 10,000 more nurses on wards, which is obviously particularly important at this time of year. In terms of the future figures, I hope he will be aware that there will be an increase in the number of training places for nursing—£5,000 a year. Indeed, Health Education England, which is responsible for workforce planning, will deliver a long-term plan to make sure that we can tackle this issue, which has been a long-standing problem for the NHS.

Nurses and Midwives: Numbers

Lord Clark of Windermere Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Baroness that there is a need for more nurses. That is why we are introducing more training places and new routes into nursing, such as the nursing apprenticeship. I know that she is particularly concerned about EU national nurses and health visitors. I think noble Lords will be reassured that between June 2016 and June 2017, there was an overall 5% increase in the total number of staff from the EU within the NHS, which is welcome. The one area, as I said, that has fallen marginally—by about 162 in practice—is in nursing and health visitors. That was significantly due to the new language test that was introduced. That is something that the NMC is looking at to make sure we are getting nurses capable of practising in this country to come here.

[Lord Clark of Windermere (Lab)]

My Lords, as the Minister knows, citizens of the EU who have spent five years working in the UK can avail themselves of the opportunity to apply for a right to remain permanently in the UK. That is now unclear. Will he announce that those who have been granted the permanent right to remain in Britain as EU citizens will be entitled to stay and work here? That would be a good way to start building confidence.

[Lord O'Shaughnessy]

My Lords, the rules as they are apply, so those who are eligible to apply for a right to remain can do so. We are talking about providing a path for those who are not yet at that point, now or in the future, to achieve settled status to provide the kind of certainty that we know. I understand that this causes some people to pause for thought about whether they should stay.

NHS: Staff

Lord Clark of Windermere Excerpts

Thursday 30th November 2017 Lords Chamber

Moved by

[Lord Clark of Windermere]

To move that this House takes note of the impact of Her Majesty’s Government’s fiscal policies on the recruitment, retention and conditions of NHS staff.

[Lord Clark of Windermere (Lab)]

My Lords, I am looking forward to this debate. I think it will be an excellent debate, with a wide array of speakers representing a great deal of experience right across the health and care service.

We all know that the NHS is one of the living institutions of our country, loved, appreciated and needed by its people. In spite of the difficulties facing it, the service it provides is second to none as the British people seek medical attention and healthcare. Year after year, surveys show that it is regarded internationally as the most efficient organisation anywhere in delivering healthcare.

I shall be a little provocative in what I am saying at this moment. I know it causes some discomfort to some Members on the Benches opposite that a state institution employing 1.3 million people can compete successfully against private medicine. When I say that, I do not include the Minister because I know he is committed to the health service, but I believe there are people in the Conservative Party who find the NHS uncomfortable. It was interesting that the Secretary of State chanced his luck when he alleged recently that the NHS was actually invented by the Conservative Party—a case utterly rebutted by my noble friend Lord Pendry on 2 November in a letter to the Guardian, so I do not need to take that further.

I trust that when we on this side speak today, the Minister will understand the strength of opinion that the Government are slowly but surely allowing the NHS to deteriorate. Several years ago, when I began to question Health Ministers on the NHS, the situation was precarious. Now it is getting almost desperate. The bottom line is that the Government are not providing sufficient funds to meet the demands of an increasing and ageing—we must take those two facts together—population, and that no clever words can hide the fact that they are breaking their manifesto policy to increase spending on the NHS in real terms year on year. If you look at the anticipated spending, you can see that that will not be the case.

I mentioned 1.3 million employees. Those employees are proud to work not for the health service but in it. The service is at its most efficient only when it works as a team. Everyone is interdependent. I feel at times that the Government do not really appreciate that fact. If there is one thing lacking in our NHS, it is that it has no central workforce planning, and that is of real concern.

At the moment, almost all employees feel the same—demoralised and undervalued. They give their all, and more and more people are treated. But the staff feel that their treatment by the Government shows that they are not regarded highly enough. They feel that they are the individuals who suffer most from the Government’s now out-of-date austerity programme. Wherever we look—whether at consultants, doctors, nurses, midwives, healthcare assistants, physiotherapists, radiotherapists, GPs, clerical staff, porters, ambulance drivers, dentists or the scores of other occupations in the health service—it is the same story. The Minister must know this because I know he talks to staff. They feel demoralised and undervalued. Yet, these are the very people who keep our NHS going. It is because of them that patients still get a good service. However, it is slowly getting worse again. We are finding, in spite of the best efforts of staff that waiting lists are growing month by month. Increasingly, deadlines for cancer treatment are being broken. In spite of the Government’s bold declarations, the future for mental health services does not look as good as it should.

Following the Budget, I noticed that initially the press lauded the Chancellor for what he appeared to be giving the NHS. However, after examination of the small print, the general public, the press and those involved increasingly realise how short-changed they were by the Chancellor. They took on board Jeremy Corbyn’s comment that the money, was “well short” of what is needed. Sir Bruce Keogh tweeted that the Budget,

“plugs some, but def not all, of NHS funding gap … Worrying that longer waits seem likely/unavoidable”.

Sir Malcolm Grant, chair of NHS England, said that the money,

“will go some way towards filling the widely accepted funding gap … we can no longer avoid the difficult debate about what it is possible to deliver for patients with the money available”.

NHS Providers stated that,

“tough choices will be needed and trade-offs will have to be made … It is difficult to see how the NHS can deliver everything in”,

the forthcoming year. I understand that just today the NHS England board is discussing what will happen—whether we will have rationing in health. This is against the background of the speech by Simon Stevens, chief executive of NHS England, who on 8 November said that an extra £4 billion was needed in 2018-19.

Yet only the Government seem to deny there is a problem. To pluck a number of key employees, we are short of 40,000 nurses. Recruitment from the European Union has all but dried up. Wages have been frozen at 1% since 2010, leading to a reduction in salary of 10.1% for nurses by this year. Unsurprisingly 70% of nurses reported feeling financially worse off, with 24% saying there were thinking of leaving their job because of money worries. The Government claim that there are 13,300 more nurses than in 2010 and 11,800 more doctors in hospitals. However, we have to question those figures. I do not dispute that they apply in hospitals but when looking at healthcare, we are talking not only about primary care in hospitals but aftercare—the care service. I have letters from care providers saying that they have had to close down some of their institutions because they simply cannot recruit nurses. There are insufficient nurses in this country.

It is no better for doctors. The BMA found a 13% decrease in applications to medical schools since 2013. Last year, there were 7,660 medical students beginning their course, compared with nearly 8,000 in 2010. GP numbers are falling. Almost one-third of GP partners are unable to fill vacancies. Only 13% of partners report that they do not need to fill vacancies, and figures show an actual decrease in the number of doctors working mainly as GPs. The result is that patients are having to wait longer and longer to get an appointment, increasing the demand on A&E departments in our hospitals, which are already under great stress. There needs to be some joined-up thinking.

Even if we go to the top of the tree and look at consultants, we find what I can only describe as a dire situation. The NHS has a shortage of consultants and would-be consultants. During the past year, 1,542 consultant posts were advertised, but only 853 certificates of completion of training issued. Not surprisingly, 45% of the advertised posts were left unfilled. There simply were not the qualified candidates. Ninety-five per cent of doctors in training report that poor morale is having a negative impact on patient safety in their hospital, with half reporting a serious or extremely serious impact.

I do not really need to continue. Perhaps I could sum up this point by citing the president of the Royal College of Physicians, Professor Jane Dacre, who neatly summed it up in her response to the Budget. She said that it,

“felt like we had been given short-term sticking plasters rather than the long-term sustainable plan our patients need”.

It is all very depressing. The Government take the view that it is really not their fault, but a lot of it is. I have to ask: why, when they came to office in 2010—with their coalition partners, but they were by far the leading partner—did they cut nurse training numbers by 22,000? It takes a long time to build up the shortfall that has been allowed. Why, at this critical moment when we do not know whether we have enough nurses or doctors—the Government say we have; I say we have not—why risk the numbers by abolishing the bursary scheme? It is a risk, and the Government know that there are fewer nurses going into training this year than in previous years. I do not have the precise figures but all the universities that I have contacted, with one exception, have found a considerable decrease. If there is no problem with nurses, why was it announced yesterday that we are to step up our recruitment of 5,500 more nurses from India?

I am being a bit critical of the Minister. I hope he will not take it personally but take this opportunity to write to me to correct the information. Last week, in a straightforward Question about agencies, I asked,

“what are the names and locations of the agencies registered to supply nurses to NHS trusts in England”?

It was a straightforward Question, but the Minister’s reply can be described only as gobbledegook. He said:

“Agency rules require that agencies are on NHS Improvement-approved frameworks and these frameworks monitor and approve agencies for supply to trusts. The approved framework operators are Crown Commercial Service, NHS Collaborative Procurement Partnership and HealthTrust Europe”—


I think HealthTrust Europe is an American company. The Answer continues:

“In addition to agencies on approved frameworks, trusts in exceptional patient safety situations can utilise the ‘break glass clause’ and work with an off-framework agency. Using an off-framework agency should be a culmination of a robust escalation process sanctioned by the trust board. Trust boards have primary responsibility for monitoring the local impact of the agency rules and ensuring patient safety”.


I spent a lot of time trying to understand it, and I have understood a bit of it. I have also found out—the latest figure I could get for any particular week—that there are 50,000 applications to use the “break glass clause”. Are those 50,000 nurses from agencies included in the Government’s figures?

[Baroness Chisholm of Owlpen (Con)]

My Lords, may I quickly say that there has been a mistake over the timing? If everybody speaks for 13 minutes, we will go two minutes over time. If possible, will your Lordships stick to 12 minutes? When the clock says 12 minutes, will noble Lords please sit down?

--- Later in debate ---

[Lord Clark of Windermere]

My Lords, I thank the Minister for his reply. I began the debate by commenting that, having seen the list of speakers, I expected a first-class, thoughtful debate. I have not been let down. I thought that the debate was excellent. I want to single out, if I may, the noble Baroness, Lady Emerton. I felt privileged and honoured to hear her contribution. More than anything, I love the fact that she has retained the enthusiasm for and belief in the NHS that she took into her nurse training in 1953. I thank her very much for allowing us to share that. We have all certainly gained from it.

I hope that the Minister agrees that this has been a thoughtful debate. I have learned quite a lot from it and I hope that he has too. I hope that he will take up the spirit that came from three sides of this House—if we can have three sides here—because there is unease with our health service. However, we want the Government to succeed because we want the NHS to succeed.

Motion agreed.

Nurses: Tuition Fees

Lord Clark of Windermere Excerpts

Wednesday 29th November 2017 Lords Chamber

Asked by

[Lord Clark of Windermere]

To ask Her Majesty’s Government whether they will write off the tuition fees of nurses who spend a number of years working in the NHS or related public care services.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, there are currently no plans in place to write off tuition fee loans for nurses who take up work in the NHS. Substantial financial support is available for nurses in training. With the increase in the student loan repayment threshold introduced by the Department for Education, from April 2018 a newly qualified nurse will not pay back their loan on earnings up to £25,000 a year.

[Lord Clark of Windermere (Lab)]

My Lords, when we have a shortage of 40,000 nurses, when the Government’s introduction of tuition fees has resulted in fewer nurses entering training, and on the very day it is announced that we are having to import 5,500 nurses from India, is it not crucial that we incentivise everything we can to get British students into nursing? Would my proposal about working in the NHS not help that?

[Lord O'Shaughnessy]

My Lords, nurse training places have been discussed a number of times in this House. I am sure noble Lords will be keen to know that, while there has been a small percentage drop-off in places year on year, the numbers recruited this year are comparable to 2014-15. That is common with the introduction of tuition fees for other courses and we would expect it to rebound. In the long run, the intention is to grow more of our own nurses and to recruit from the United Kingdom, which is why there will be an increase of 25% in the number of clinically funded training places for nurses—5,000 extra—from 2018-19 onwards.

NHS: Deficit

Lord Clark of Windermere Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord waits patiently. I pay tribute to the quality of the report and we have already accepted some of the ideas set out in it. Now that the Budget is over and the Treasury can turn its mind to additional things, we will be responding to the report very soon.

[Lord Clark of Windermere (Lab)]

My Lords, in his Budget Statement today, the Chancellor referred to the fact that he was establishing a working party of the department and the unions to look at salaries in the NHS, but he was a bit vague when it came to the funding of the outcome. Can the Minister give an assurance that the Government will fund whatever is agreed by the department?

[Lord O’Shaughnessy]

The Chancellor has confirmed that he will fund an Agenda for Change, as it is known, pay deal on the condition that the pay award enables improved NHS productivity and is justified on recruitment and retention grounds.