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Overseas Nurses

Volume 449: debated on Tuesday 18 July 2006

The NHS has a long history of welcoming nurses from overseas. We have also increased the number of nurses that we train in Britain by more than 60 per cent. since 1997. Those nurses should, of course, have the opportunity to progress in their careers. The Government recently changed the work permit arrangements so that in future, junior nurses from overseas can be appointed only if there is no suitable candidate from the UK or the rest of Europe.

I am grateful to the Secretary of State for that response. Given that many nurses are approaching retirement age, what assurance can the Secretary of State give that British-trained nurses alone will be able to replace them?

Vacancies are at their lowest level ever, and we are employing more than 85,000 more nurses than we were in 1997. That substantial increase has meant that newly qualified nurses have found it difficult to get jobs. The advantage of the managed migration policy is that where shortages arise—and there are shortages in specialist jobs in the NHS—they can be included in the shortage category so that employers can obtain work permits for nurses from abroad without having to show that there is no suitable domestic candidate. That is a flexible system that can respond to changes in our own labour market. Given the present situation of newly qualified staff, it is clearly right that we should take junior nursing jobs out of the shortage category.

I welcome the initiative by my right hon. Friend. Does she agree that there is no such thing as an ethical recruitment strategy from overseas, from developing countries? Countries simply recruited from underdeveloped countries to fill the gap, and they lost out in the end.

I am grateful to my hon. Friend for supporting the action that we have taken, but I do not agree about whether it is possible to have an ethical recruitment policy. On that particular issue, we have led the way—not only by making it very clear that the NHS itself and staffing agencies that work for the NHS are not allowed to recruit directly from developing countries that desperately need their own staff, but by entering into agreements with countries such as the Philippines or India whereby they train more nurses than they can possibly employ, and—certainly before we made this change—by being willing to employ those staff here. I also refer my hon. Friend to the excellent work of my right hon. Friend the Secretary of State for International Development and the investment that we are putting in—for instance in Malawi and other parts of Africa—to help countries to train the health care workers that they so desperately need to care for their own population.

Is not what the Secretary of State euphemistically refers to as managed migration a panic reaction by the Government to the sharp rises in the number of unemployed newly qualified nurses? What steps are the Government taking to ensure that those numbers do not go on rising, and that we are not ploughing resources into training nurses and offering them the prospect of work, but no jobs at the end of the training?

The right hon. Gentleman is quite right: as I said a moment ago, there are real difficulties this year for many newly qualified nurses and indeed others, including physiotherapists, in getting jobs. We have therefore been working with NHS employers, and the chief nursing officer at the Department recently issued guidelines that will make it much clearer that, for instance, the director of nursing within each trust should be working with colleagues right across the local health community—with other NHS organisations—to ensure that vacancies are created and filled wherever possible by newly qualified staff; that private agency temporary staff are reduced; and that in their place, where necessary, newly qualified staff are taken into NHS banks, where they can be offered part-time or full-time work in order to progress their training.

There are a number of practical steps being taken in different parts of the country and we will go on ensuring that that happens in order to support our own newly qualified nurses. I am not sure whether the right hon. Gentleman supports or opposes the action that we sensibly took, as the problem became clear, to ensure that we do not continue to recruit junior nurses from outside the United Kingdom and the rest of Europe. I think that that is the right step to take, and I would be interested to know whether he and his party support it.

What dispensations are available to NHS employees who are identified for redundancy or have been made redundant, with regard to recruitment and employment in independent treatment centres in organisations such as Southport and Ormskirk hospital in my constituency?

There are still several thousand vacancies across the NHS, and we have already taken steps to ensure that wherever possible, vacancies are ring-fenced for staff who are facing redeployment or even redundancy in their current positions. There is already a policy, which goes back a couple of years, of ensuring that staff who have been made redundant from NHS employment can, despite the additionality rule, seek immediate employment in an independent sector treatment centre that is also working for NHS patients.

A midwife who lives in my constituency and works at Bedford hospital arrived in this country seven years ago, trained as a nurse, became a midwife and has now been told, as part of the consultation process at Bedford hospital, that she is likely to lose her job. Nearby Lister hospital has made an announcement of 500 redundancies. My constituent has been told that her chance of securing another job as a midwife anywhere in the region is zero. Does the Secretary of State feel that my constituent, who is now applying for a job in Waitrose, has been let down by the Government, along with all the other nurses who came to this country seven years ago to train?

The hon. Lady’s constituent and many other staff are facing an extremely difficult situation at the moment, as are some of the newly qualified staff to whom I referred. I assume that her constituent has already secured settlement, as she has clearly been making a valuable contribution to the NHS here for the past seven years. However, the fact remains that every hospital that is in financial difficulties, or that simply wishes to make itself more effective, is doing everything possible to avoid compulsory redundancies. When those are unavoidable—as in some cases they are—hospitals are also putting in place every support possible to ensure that staff, who have sometimes given years of service to the NHS, are supported to get other jobs in the health service.

Will the Secretary of State admit that we have gone from a period of expansion to one of contraction for the nursing work force? Some 5,500 extra nurses were recruited the year before last, but 5,500 nursing posts are now to be lost in our hospital sector. It is not just nurses leaving education who cannot find a job, because, as my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) made clear, nurses in employment are losing their jobs. In the context of overseas recruitment, will the Secretary of State admit that? Is that not the reason why the shortages criterion has been removed not just from junior nursing posts, but from the whole of bands 5 and 6, which means that most nursing posts are affected?

We have indeed removed bands 5 and 6, which cover the jobs for which newly qualified nurses apply, from the shortage applications. I am glad that the hon. Gentleman recognises the enormous increase in the staffing of the NHS. There are more than 200,000 additional staff and more than 85,000 extra nurses—and that was made possible by the additional investment that he and the rest of the Conservative party voted against.

The hon. Gentleman talks specifically about nurses and other staff in hospitals. The reality is that as hospitals become more effective and the NHS takes advantage of changing medical practice—for example, by employing more nurses in the community and reducing the number of emergency admissions—there will need to be fewer acute beds and thus fewer staff in some of our hospitals. He really has to decide whether he believes that the NHS should use the best medical practice to give the best care to patients and get the best value from the increased investment that we have made, or whether, along with voting against the increased investment, he is also giving up on any pretence of using that investment to the best effect for patients.

It is a complete fiction that more nursing posts in the community are being created. In the last year for which we have figures, there were 500 fewer district nurse posts and 800 fewer health visitor posts. If the Secretary of State knows what is going on, she must have based her policy on a new set of work force supply and demand figures. Two years ago, the Department of Health’s work force projection said that we would be short of 40,000 nurses by the end of the decade, and that we would need to recruit 12,000 overseas nurses a year. What is the Secretary of State’s current projection?

The work force projections that the Department of Health undertakes are all based on local projections of need developed by individual hospitals and other parts of the NHS. It is already clear that when the assessments of requirements for training places were made some years ago, several hospitals overestimated their requirements. A minority of hospitals were, even at that point, overspending their budgets at the expense of other parts of the NHS, yet also taking on new staff and commissioning new training places—and now they cannot find jobs for all the nurses who have been trained. That situation is extremely unsatisfactory and unfair to the staff involved.

We still have not heard whether the hon. Gentleman thinks that we have done the right thing. The great advantage of the managed migration policy and the new system for shortage occupations is that when we see a problem emerging, as we did earlier this year, we can take action to ensure that newly qualified nurses from abroad do not continue to seek employment here. If the situation changes in future years, we can alter that. The fact is that we have substantially increased the number of training places, by over 60 per cent., so we have no shortage of nurses at the moment.