NHS: Staffing Levels

Maria Caulfield Excerpts

Tuesday 11th December 2018 Westminster Hall

[Maria Caulfield (Lewes) (Con)]

I declare my interest as a nurse who is still on the Nursing and Midwifery Council, or NMC, register. I speak, therefore, with first- hand experience about having to deal with staffing shortages during more than 20 years of working in the NHS. Staffing problems have always been there, but I welcome the debate that the hon. Member for Batley and Spen (Tracy Brabin) has secured because we must recognise the issues that many hospital trusts and community services are experiencing.

I welcome last month’s NMC figures, which show an increase of more than 4,000 nurses joining the register in the past 12 months, a significant percentage of whom were UK-trained nurses. There was also an increase of 3,000 UK nurses compared with this time last year. I welcome those figures, but that is not to say that there is not a staffing problem across the NHS.

I want to focus on some of the solutions from my experience that would make a real difference out there in the workforce. I understand the sentiments of the hon. Members for Batley and Spen and for York Central (Rachael Maskell) about the bursary scheme, but I trained on that scheme myself and it is far from the panacea that has been portrayed in recent years. We were paid a pittance—£400 a month—for the three years of our training. Yes, it paid for travel and expenses, but not for much else.

Someone training as a nurse has to do the minimum hours to get on to the register, so it is very difficult for them to have an additional job, as other students would. Often times they are mature students and have other commitments, such as children and family responsibilities, and an additional part-time job is almost impossible to hold down. Life on a bursary was tough, and it often explained the high drop-out rate during the three years.

The system I would prefer, and have always advocated, is the degree apprenticeship route. During my time in this place, I have been doing bank shifts at my old hospital with student nurses who are now on the degree apprenticeship route: it is a far better system, and we need to upscale it as a matter of course. Not only are student nurses earning while they are learning; they are part of the workforce, which is a point that the bursary scheme missed completely. Student nurses were university students, but not necessarily part of the working environment, and often found it tough to move into that environment, because they were not seen as key members of the workforce.

The degree apprenticeship route also means that when students work for hospitals or community trusts during their degree apprenticeship, they are often being paid by those trusts, which are then able to accurately predict the number of students coming through the system. That was different under the bursary system: trusts just had to wait and see which newly qualified nurses applied for their vacant posts. For long-term workforce planning, having those student nurses as part of the team means that trusts have an idea of who is likely to come forward when they qualify. There are a number of positives, and I push for the Government to roll out that degree apprenticeship system—maybe not just in nursing, but in other healthcare professional specialities.

I will briefly touch on flexible working. We are under the misapprehension that internal rotation and a shift-based system means there is flexible working for staff in the NHS, which there absolutely is not. In most areas, people are forced to do internal rotation, whether in the community or in the hospital-based system, and that is increasing as we move towards a seven-day-a-week service. If young parents with children are all of a sudden put on a week of nights with a week’s notice, and have no childcare provision, that makes it almost impossible for them to hold down their job.

In the good old days when I first started, people were able to do a permanent nights system, to do permanent weekends, or to choose to work evening shifts. That is all gone now: they are forced to do internal rotation. I say to the Minister that the NHS needs to look at a flexible working system for its staff, because if it does, it is more likely to hold on to the excellent staff who keep the NHS going.

--- Later in debate ---

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Batley and Spen (Tracy Brabin) for securing this debate. As she and hon. Members who have contributed to other such debates will know, the issues she raises are very similar to those that we discussed on 21 November in the debate that the hon. Member for Ellesmere Port and Neston (Justin Madders) has just referred to. However, it is welcome to have the opportunity to discuss them again, because such debates reflect the importance that we all place on the NHS workforce. The one thing that the hon. Gentleman and I agree on is that it is right to begin by reiterating our thanks to the NHS professional staff for their work treating patients day in, day out.

I also thank other hon. Members for their contributions. I note in particular the comment rightly made by my hon. Friend the Member for Lewes (Maria Caulfield) that we need to upscale nurse degree apprenticeship routes. I will speak about that in more detail if I have time. My hon. Friend the Member for Redditch (Rachel Maclean) spoke about the capital announcement made last week, which I was pleased to see come through. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) made some points about mental health—may I offer him a meeting at the Department to discuss those matters directly, because today I want to concentrate on other matters? The hon. Member for York Central (Rachael Maskell) made a contribution based on her valuable experience.

I should say right at the outset, as I did in our debate two weeks ago, that the Government greatly value the staff who contribute to and support the NHS. We understand its importance and are committed to ensuring that it is supported and funded appropriately, which is clearly reflected in the extra £20.5 billion a year that the NHS will get by 2023-24.

As the hon. Member for Ellesmere Port and Neston quoted me saying in our last debate, we expect NHS England to set out clearly its commitment to the workforce in the long-term plan. The plan will address how to open up the profession to more people from all backgrounds and ensure that they get the right support throughout their training. To answer his question: yes, when the long-term plan is published, he will see the workforce embedded in it and in our strategy. We also expect NHS England to deliver a clear implementation plan to guarantee the future of the workforce. The NHS employs a record number of staff—more than 1.2 million in 2018, which is more than at any other time in its 70-year history—with significant growth in newly qualified staff since 2010.

Let me repeat what I said two weeks ago:

“the Government, and I as the new Minister for Health, should never be complacent”.—[Official Report, 21 November 2018; Vol. 649, c. 372WH.]

We are not. We are absolutely committed to ensuring that nursing remains an attractive career so that the NHS can build on the record numbers of nurses on our wards. Actions already taken to boost the supply of nurses range from training more nurses and offering new routes into the profession to enhancing rewards and pay packages, and there are now 11,000 more nurses on our wards than in May 2010.

NHS England, NHS Improvement and Health Education England are working with trusts on a range of recruitment, retention and return to practice programmes to ensure that the required workforce is in place to deliver safe and effective services. We should note that NHS Improvement has had some real success with its retention programme. Retention seems to me one of the key issues for the Government to focus on, and that will be reflected in the long-term plan. NHS Improvement’s programme continues its direct work with trusts to support improvements in retention, with a focus on the nursing workforce and the mental health clinical workforce. So far, 35 trusts have been involved and the initial evidence is positive and encouraging, with more flexible working programmes and greater support for older workers. It is therefore right that that programme be expanded further to all remaining NHS trusts in England.

[Maria Caulfield]

Revalidation is a new system for nurses to retain their registration, but it is a very difficult and stressful process for nurses who may be part-time or part of a hospital bank. I was lucky because my NHS trust, the Royal Marsden, is extremely supportive to its bank workers, but will the Minister ensure that bank nurses are supported through the revalidation process to keep them registered?

[Stephen Hammond]

I am listening carefully to my hon. Friend, and I will ensure that that work is undertaken.

As I have said today and on previous occasions, the priority is to get more nurses on our wards. There are currently 52,000 nurses in training, and we have announced a policy change that will result in additional clinical placement funding to make 5,000 more training places available each year. My hon. Friend made the point that nursing bursaries were not always the panacea that everyone suggests; students on the loans system are at least 25% better off than under the previous system. However, we recognise that students incur additional costs as a result of attending clinical placements, so we have introduced a learning support fund with a child dependants allowance, reimbursement of travel costs and an exceptional hardship fund. When I spoke to nurses at Barts last week, I listened carefully to the points they made about the need for help with travel in particular, and I am looking carefully at that issue.

The hon. Member for Batley and Spen raised the RCN proposal. Yesterday, as I had promised I would, I responded to the RCN in a formal letter to Dame Donna, and I look forward to meeting her to discuss her proposals in the near future—hopefully the very near future.

We are increasing the number of midwifery training places by more than 3,000 over the next four years. There continues to be strong demand for nursing places, with more applicants than places, but I am under no illusions, nor am I complacent. We need more people applying and we need to increase that route. A number of routes are open. HEE’s programme covers all fields of nursing; its RePAIR—reducing pre-registration attrition and improving retention—programme explores effective interventions to ensure that people are supported through their whole student journey from pre-enrolment to post-qualification.

The hon. Member for Batley and Spen was right to mention the number of new routes into nursing. In particular, she will have noted the report published last week by the Select Committee on Education on the nurse degree apprenticeship. We are working with the Department for Education to carefully consider the Committee’s recommendations and I will respond in due course.

I want to turn to the story of doctors. In the NHS today, it is true that there are 18,200 more doctors in trusts and CCGs than there were in 2010. My hon. Friend the Member for Central Suffolk and North Ipswich raised the matter of the additional 5,000 doctors. This year, we have recruited 3,473 GP trainees, against the target of 3,250. That is an increase on last year, but we are determined to meet the commitment of 5,000. To ensure that that is possible, we have rolled out an extra 1,500 medical school places. By 2020, as he knows, five new medical schools will be open to deliver that expansion.

In the whole of this discussion, it is only right that I recognise that the Government value the professionals. It is key that we ensure that NHS staff are well remunerated. It is absolutely right that we have given NHS staff a well-deserved pay rise. All staff will receive a 3% pay rise by the end of 2018-19.

There is a lot more I might have said. The hon. Member for Batley and Spen raised a number of local issues, including ambulatory care. If she cares to write to me or to catch me, I would be happy to have a longer discussion with her. I thank her and all hon. Members for the points they have made in the debate. I also stress, as I have done today to staff at North Middlesex, and last week, that making sure that we have an NHS long-term plan that sets out a strategy for the NHS and ensures a sustainable supply of clinical workforce—doctors, workers and others—is key, and it is key to delivering our ambitions for the NHS. I thank the staff for all that they do.