NHS: Staffing Levels

Paula Sherriff Excerpts

Tuesday 11th December 2018 Westminster Hall

[Tracy Brabin (Batley and Spen) (Lab/Co-op)]

I beg to move,

That this House has considered staffing levels in the NHS.

It is an honour to serve under your chairmanship, Mr Hollobone. It is a pleasure to lead this debate and I thank hon. Members for being present. I know that many are eager to contribute, and the fact that they have taken the time to be here, during one of Parliament’s more eventful weeks, emphasises the strength of feeling in the House about staffing levels in the NHS. I also thank the many organisations that have contacted me, offered support and shared their research.

It is clear that the issue of staffing in the NHS is a great and growing concern to many. Indeed, the case of my local NHS trust inspired me to apply for this debate. Most of my constituents rely on the Mid Yorkshire Hospitals NHS Trust for a range of acute hospital-based and community services. The trust serves not just the people of Batley and Spen, but more than half a million people across Wakefield and North Kirklees.

[Paula Sherriff (Dewsbury) (Lab)]

I thank my hon. Friend and neighbour for securing this important debate. My constituents also use the Mid Yorkshire Hospitals NHS Trust. There are still several hundred nursing vacancies there, and that is having a significant impact on the delivery of patient care. Does she agree that the chaos of the current Brexit situation is not helping to recruit nurses, potentially from the European Union?

[Tracy Brabin]

I shall go on to discuss that in more detail, but my hon. Friend and neighbour is absolutely right. We have both been in meetings with the trust where that has proved to be of great concern to it.

--- Later in debate ---

[Tracy Brabin]

My sister is also a nurse. When someone has a nurse in the family, they understand how hard they work. My hon. Friend must be psychic, because I am about to go on to that point.

When it comes to the recruitment and retention of NHS staff, it could not be further from the truth that austerity is over. The Royal College of Nursing did not mince its words when it said:

“The UK is experiencing a nursing workforce crisis”,

particularly in England. With one in three nurses due to retire within a decade, we are looking at a perfect storm of increasing vacancies across health and care.

[Paula Sherriff]

Does my hon. Friend share my concern that, as a direct result of staffing shortages at Dewsbury and District Hospital, the midwife-led birthing unit has had to be closed several times? September was a particularly bad month for closures. That has a traumatic effect on mums-to-be, who expect to give birth there but turn up and get sent elsewhere.

[Tracy Brabin]

Capacity, particularly in midwifery, is a massive issue, and midwife recruitment is also a problem. A mum who is about to have a baby wants to make sure that they are guaranteed a bed and a midwife who will be with them throughout the process, so of course that is a concern. There are almost 41,000 vacant nursing posts in the NHS and it is estimated that that number will grow to almost 48,000 by 2023—just five short years away.

--- Later in debate ---

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Member for Batley and Spen (Tracy Brabin) on securing this debate and on highlighting the biggest challenge facing the NHS: the creeping workforce crisis that has been evolving for some time now. We are now seeing that crisis beginning, in real terms, to affect patient care.

The hon. Lady was right to highlight the fact that a lack of staff in some parts of the country means that operations are being cancelled and beds are being closed. She was also right to point out the challenges that Brexit poses to the recruitment and retention of frontline NHS staff; in the past decade, we have been increasingly reliant on European Union staff coming to work in the UK—before that, it was staff from outside the EU who provided most of the overseas workforce in the NHS. I am sure that all of us would like to put on the record our support for the excellent work that NHS staff from the UK and from all over the world do in caring for patients.

I will also do what I should have done at the beginning of my speech and draw attention to my declaration in the Register of Members’ Financial Interests, as I am a practising NHS hospital doctor working in mental health services.

[Paula Sherriff]

Will the hon. Gentleman give way on that point?

[Dr Poulter]

I will not, because of the time limit and because I want to let other people speak; I am sure that we can talk about this issue in detail after the debate.

Very briefly, Mr Hollobone, the Government have made a number of promises about NHS staffing and yet, unfortunately, those promises are failing to come to fruition. In 2015, there was a promise of 5,000 more GPs. Recently, I submitted a written parliamentary question about how much progress had been made in realising that target but I did not get an adequate answer. I would be grateful if the Minister updated us in his concluding remarks by saying how close we are to realising that target of 5,000 additional full-time GPs.

I would also like to highlight some of the challenges in community and mental health services. Very often in this Chamber, we talk about hospitals, and very often the NHS is seen through the prism of that acute sector, but the key challenge to keeping people out of hospital is doing more in the community, building up community mental and physical health services—and they are the very services that are seeing reductions in frontline staff.

I want to touch briefly on mental health. We know that the number of full-time-equivalent mental health nurses fell by 6,000 between 2010 and March 2018, including a reduction of more than 1,800 in learning disability nurses alone. The number of child and adolescent mental health service and learning disability consultant psychiatrists has also slightly declined over the past decade, and many parts of the country, particularly outside London, are struggling to fill higher registrar training posts in those services.

Perhaps more concerning is that the number of junior doctors in specialist psychiatry training—core and higher psychiatric trainees who will become the consultant psychiatrists of tomorrow—has also fallen, by 490 full-time equivalent doctors, from 3,187 in 2009 to 2,697 in March 2018. [Interruption.] The civil servants are rapidly checking my figures; they are from answers to parliamentary questions, so they are absolutely correct.

That is a woeful record of decline in the psychiatric and mental health workforce, and it must be corrected. If the Government are serious about their rhetoric on mental health, about improving the quality of provision for people with poor mental health, they need to recognise that the workforce has already declined. Even if there is the promised increase in numbers, it will be from a lower baseline than that of about a decade ago.

The only way to deliver the expansion in services that patients deserve—for example, specialist eating disorder services in Cumbria or East Anglia—is by having a much more serious approach to the recruitment and retention of mental health staff and by paying premiums to attract both doctors to work in CAMHS and people to work in parts of the country where there is a shortage of mental health staff. I look forward to the Minister’s response.

[Rachael Maskell (York Central) (Lab/Co-op)]

I congratulate my hon. Friend the Member for Batley and Spen (Tracy Brabin) on calling this vital debate.

I remember the challenging years of the mid-1990s, when I was working as a physio in the NHS. During that crisis time, I never knew when I would get home. Today’s scenario reminds me of the dying years of a Tory Government—the parallels are so strong.

In York, I read the Care Quality Commission reports in detail, and although the care given by our NHS staff is excellent, the real challenge that I pull out of the results of CQC reports is the staffing crisis. My local hospital currently has 59 doctor vacancies, and there are 580 nursing vacancies in bands 4 to 7, 312 of which are in bands 5 to 7. The trust has done everything it can to recruit. It went to Spain and recruited 40 Spanish nurses, 37 of whom left after a very short period. The reality is that NHS staffing is in crisis and that affects patient care.

Last year, the trust had to spend £8.5 million on agency staff. That pushed a trust that is already struggling because the funding formula does not work for York into further deficit, which has an impact on its control and on the resources it can get for the winter crisis—York had some of the highest levels of influenza last year. The Minister, therefore, must ensure that the money works, as well as addressing staffing.

I want briefly to look at primary care because, as we have heard, we need early intervention across all ages to keep people out of hospital. Rightly, the Government looked to increase the number of health visitors, and by 2015 the figure was up to 10,309, but since then we have seen a 23.8% fall, down to 7,852, meaning that young people are not getting the input they need. School nursing figures have also fallen by 25% since 2010. So we have a real crisis in our primary care workforce, and also in mental health, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said. Certainly we feel that in York, whether in the community or the hospital environment.

[Paula Sherriff]

Will my hon. Friend give way?

[Rachael Maskell]

I am going to continue.

The trust is doing everything it can to recruit, but it is impossible to recruit because the national pool of mental health staff is far too small. Therefore, it is vital that we consider the solution, which comes down, as has been said, to workforce planning. We need a partnership approach to planning the workforce. We need to understand the changing demographics and the increasing mental health challenges in order to put the right planning in place, but trusts will not be able to recruit unless the staffing framework is right. The removal of the bursary scheme has been seriously detrimental, particularly to the recruitment of mature students into nursing. People are giving up a job, but their staying in the profession for longer will pay dividends. Students have to pay to travel to placements, and I remember what that was like, so it is really important that they have bursaries.

Secondly on workforce planning, we need to look at how we educate healthcare professionals across the board. I remember discussions at a national level with the trade unions on that very issue, about needing to find a different way. In some countries they bring a real foundation into NHS training so that everyone works together in the first 18 months or two years of their training and has a breadth of understanding of medicine before going off to specialise. We, instead, train in traditional old silos of jobs that have clearly blended over the years, and we must look once again at how we structure that.

Thirdly, we need to look at the “Agenda for Change” package. There is no doubt that it is hard to recruit because people are poorly paid in the NHS and can be better paid elsewhere. Given the stress levels and the antisocial hours that people work, we need to look once again at the remuneration of our NHS workforce. Finally, the knowledge and skills framework has consistently been underutilised by the Government and NHS employers, and it is vital that we go back to that framework of professional development in the NHS.