NHS: Nurse Retention

Lord O'Shaughnessy Excerpts

Wednesday 17th January 2018 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask a Question of which I have given private notice.

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

My Lords, nursing numbers have increased since 2010, including 11,700 more nurses on hospital wards. To retain more of these hard-working staff and to build a workforce fit for the future, the Government are increasing the number of nurse training places by 25%, supporting new flexible working arrangements in the NHS and delivering a new homes for nurses programme.

[Lord Hunt of Kings Heath]

My Lords, even for the Minister, that is remarkably complacent. The overall number of nurses may be rising, but it has nowhere kept pace with the increasing number of patients. For years, the Government have failed to get new recruits coming through, while failed policy decisions such as the NHS pay cap and the ending of the NHS bursary have contributed to the growing crisis. Last year, 33,000 nurses left the NHS. More than half of those who walked away were under 40, and the number of leavers outnumbered joiners by 3,000. There are now more than 100,000 vacant posts in the NHS. Does the Minister accept the need to lift the pay cap, fund proper rises for nurses, restore bursaries and support this precious profession, which has been so unappreciated by this Government?

[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.

[Lord Patel (CB)]

Does the Minister agree that the real issue is the lack of long-term workforce planning of all health professions, including social care? That planning should address the changing demography of citizens and the changing pattern of disease—and involve flexible training. Does he agree that that is what is required, and that what we have now is too many individuals or organisations trying to address the workforce? While he is at it, could the Minister also put on record when the Government will respond to the Select Committee of this House’s report on NHS long-term sustainability, which was published 10 months ago?

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom and experience. He is quite right about the need for long-term workforce planning. I hope that is why he will welcome the 10-year strategy that Health Education England is launching. It is looking at diversifying the working population—for example, through the growth in the number of nursing associate training places.

On the report, I can only apologise again for the delay. I hope that at least the noble Lord will welcome the fact that in the reshuffle the health department gained social care policy. That was one of the issues on which he wanted to promote greater integration.

[Baroness Jolly (LD)]

My Lords, in the past 12 months, more than 6,000 nurses have gone on long-term sick leave, related to stress. How are nurses being helped to cope by the occupational health departments of their employers, and do the Government acknowledge that the problem is exacerbated by a 1% cap on their pay rise?

[Lord O’Shaughnessy]

I acknowledge the importance of looking at pay, which is why it was so welcome that the issue was dealt with in the Budget, with the cap being lifted for nurses and other health professionals on Agenda for Change contracts. I agree that long-term sickness is a big concern and undoubtedly having an impact on some nurses leaving. That is why the return-to-practice programme that we have is so important. Several thousand nurses have been through it; it is about providing opportunities to come back into the profession in a supportive way for those who want to do so.

[Lord Tebbit (Con)]

My Lords, can my noble friend tell me how many of these nurses who have left the NHS are now working for agencies and still in the same hospitals, on the same wards, doing the same work but costing the taxpayer rather more money?

[Lord O’Shaughnessy]

In the last few years there has been an increase in agency spend. Of course, per nursing hour that tends to be more expensive. We have managed to reduce agency spend by increasing the availability of nursing banks. Those are the people employed on flexible contracts, which is very welcome for many nurses who are looking for—as they say in staff surveys—greater flexible working arrangements.

[Lord Watts (Lab)]

My Lords, how did the Government get their planning so wrong? The demographics were known, and yet the Government have failed to plan to provide the sorts of numbers of nurses that we need. What went wrong?

[Lord O’Shaughnessy]

We know that we have a growing ageing population—I do not doubt that. We have been increasing real-terms funding for the NHS, which is going on more staff. Nurse numbers have increased and I should point out that there are more doctors and ambulance staff. There have been about 40,000 more clinical staff in general in the NHS over the past few years and more to come in the future.

[Lord Willis of Knaresborough (LD)]

Does the Minister accept that roughly 10% of our nursing workforce has left the profession this year? Many of them are new recruits or not long into their careers. It takes about £80,000 to train a nurse. Any employer with any sense would want, first, to retain them and, secondly, when they leave, to know why they have left, where they have gone and how to get them back. What are we doing to track people who leave and what are we doing to attract them back?

--- Later in debate ---

[Lord O’Shaughnessy]

The point about understanding the reasons that people leave is very important. Some hospitals use exit interviews for that; I do not know if it is a nationwide programme but I shall certainly write to the noble Lord about that as it is a good idea. As for attracting staff back, I mentioned the return-to-practice programme. I think my noble friend Lady Chisholm took advantage of a similar programme when she returned to work after having children. I come back to the issue of pay. We know that pay is important, which is why lifting the cap will make an important difference to showing how much we value these staff.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree with me that, if the National Health Service provided reasonable housing for nurses and flexible working for those with children, it would help to retain them?

[Lord O’Shaughnessy]

The noble Baroness is quite right. We know that housing costs are an issue, particularly in the south of England and cities, which is why we want to use the sale of surplus NHS land to deliver more homes specifically for nurses and other similar professionals. She is also right to talk about flexible working, which comes up time and again in staff surveys. The use of nursing banks can be very helpful in that regard, and we have seen a big switch away from agencies towards using such banks for those places that need to be filled temporarily.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, the Minister talked about the number of nurses on wards; can he say something about the numbers in accident and emergency departments? I had occasion recently to go with somebody to accident and emergency. The person in question was in dire straits and, when I spoke to the sister in charge, she said that there were waits of six, seven, eight hours every night in accident and emergency in that hospital in a major town in Wiltshire. Can the Minister tell us whether accident and emergency is being properly addressed and when he last had occasion to speak to a sister in charge about what is really happening?

[Lord O’Shaughnessy]

The kind of waits that the noble Baroness has pointed to are clearly unacceptable. People should not have to wait that long in A&E and that is why we have the target. I accept that it happens but it is unacceptable. We know that the NHS is under huge pressure at this time of year. There have been, as I pointed out, more nurses in A&E and in wards in general—indeed, there are more emergency doctors as well. But we accept that there is a need for more, because of the growing needs of the population.