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Nurses: Loss To Nhs

Volume 490: debated on Thursday 3 December 1987

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My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government what steps they are taking to reduce the loss of qualified nurses from the National Health Service.

The Parliamentary Under-Secretary of State, Department of Health and Social Security
(Lord Skelmersdale)

My Lords, central initiatives include a joint National Health Service/Department of Health and Social Security working group on equal opportunities for women which is aiming to find better ways of retaining existing staff. The Nursing and Midwifery Staff Negotiating Council is reviewing the nursing clinical grading structure with the aim of making a more flexible structure which can recognise individual skills and responsibility. The regional health authority chairmen have commissioned a study to examine factors influencing recruitment and retention and to suggest improvements. A career development project group has been set up to examine the scope for more attractive career goals for nurses.

My Lords, I thank my noble friend for that encouraging reply. However, it is only partially encouraging, given the size of the problem. Is he aware that at present 30,000 nurses are leaving the National Health Service each year and that 6,000 student nurses leave before completing their training? Very often they leave because of low pay, poor conditions of work and low morale. Can the Minister say whether there is any substance in the reports in several of today's newspapers concerning proposed increases in nurses' pay?

My Lords, the figure of 30,000 qualified nurses leaving the health service every year is, I am advised, substantially correct. However, that must be seen against the background of an increase in the total number of nurses of 53 per cent. over 1981. It is frequently claimed that one-third of student nurses fail to complete their training. I am advised that that is not true. In England the figure is 21 per cent. wastage. I therefore do not understand where the Royal College of Nursing obtains its figure of 6,000. My figures suggest that the number is of the order of 4,800.

My Lords, are we not seeing a major crisis within the National Health Service, with health authorities in every region short of nurses, not because there is a shortage of nurses but rather because there is a shortage of funds? In London the nurse shortage approaches 25 per cent. and according to the Auditor General half of all operating theatres are closed because of staff shortages. Is that not failing the National Health Service and the public that it is designed to serve?

My Lords, I have pointed out to the House before that one cannot conjure nurses out of thin air. I accept that there are some shortages in some specialties. There are also shortages in some geographical areas and London has a particular problem.

I apologise for not answering the second part of the noble Baroness's supplementary question. The report in today's Sun is pure speculation.

My Lords, is it not high time that we looked closely at the problem of living accommodation for nurses, bearing in mind the number of occasions on which nurses are attacked on the streets on their way to duty during unsocial hours? Is the Minister aware that on a number of occasions when a London teaching hospital sought to appoint somebody from the provinces to a senior nursing post, that person, male or female, has had to turn the post down because he or she cannot find affordable accommodation? Should we not make an effort to restore some of the nurses' homes which I believe were sold off or used for other purposes?

My Lords, the National Health Service has been given the freest reign in retaining nurses' accommodation. Clearly we recognise that especially in areas of high-cost housing the ability to offer affordable residential accommodation of an acceptable standard is an extremely useful adjunct to recruitment and retention of staff. We are therefore reviewing the availability of accommodation and the measures which might be taken to assist staff to enter the private housing market. I am aware that some hospitals are currently revamping or building accommodation for nurses. That will help to solve that particular problem.

My Lords, is the Minister aware—I am sure that he is—that many district health authorities are freezing recruitment of nurses below establishment? That causes great pressure on working nurses and deters those who might be considering coming back.

Yes, my Lords. I am aware that some district health authorities have taken that step. However, when one is a manager in such circumstances—which are very difficult indeed—one has to balance the number of beds with the number of staff.

My Lords, is the Minister aware that thousands of fully trained nurses are leaving the National Health Service for the private sector, the United States, Arab countries, Australia and so on? Is he also aware that those nurses have been fully trained and have gained their experience in the National Health Service at the taxpayers' expense? Will he consider passing to his right honourable friend the suggestion that it is about time a levy was made on the private sector and on recruiting agencies so that the British taxpayer can recoup some of the money lost in training nurses when they leave the service to go elsewhere?

My Lords, with great respect, I do not think that so long as nurses remain in this country the money is wasted. It does not matter either to me or to my right honourable friend where nurses practise in this country so long as they do practise.

Having said that, a study of the movement of nurses and nursing skills between the two sectors estimated that about 1,400 nurses a year join the private sector from the National Health Service. Naturally nurses, like anyone else, are free to seek employment where they choose. We do not intend to restrict that basic right. However, we are currently considering ways in which the private sector's contribution to the training of health care professionals can be expanded. Our aim is to increase the total number of skilled staff available both to the National Health Service and to the private sector.

My Lords, is the noble Lord aware that the answer is to offer better pay and better conditions?

My Lords, it was this Government who set up the Nurses and Midwives Review Body and who have accepted every one of the four recommendations which it has proposed since then. That body will be reporting in about March of next year and we shall carefully consider what it says.

My Lords, when the community charge is brought into effect, will my noble friend undertake that in view of the high standing of the profession of nursing the Government will either pay student nurses a full-time working wage or treat them as students as regards the charge?

My Lords, as far as pay is concerned, my noble friend will understand that neither I nor my right honourable friend the Prime Minister can make any guarantees until the Nurses and Midwives Review Body has reported. However, I should point out that starting salaries for student nurses are considerably higher than student grants and that overall the real income of nurses has increased by 30 per cent. since 1979; in real terms, it fell by 21 per cent. in the five years up to 1979. That demonstrates the Government's commitment to maintaining nurses' living standards.

My Lords, will the noble Lord tell the House whether the committees to which he referred in his Answer to the Question have been given a deadline to report? In a matter of such urgency is it not desirable that there should be a deadline? Can we be assured that when they have reported we shall not be told, as we were in answer to a Question concerning the Severn Barrage the other day, that a further in-depth study will be required?

My Lords, I was not present to hear my noble friend's answer as regards the Severn Barrage. However, there is absolutely no delay in the reports that I have mentioned. The Government will take the quickest action on their recommendations once these bodies have reported.

My Lords, does the Minister agree that it would improve the morale of nurses and help to reduce the loss if, for example, a great hospital like the Great Ormond Street Hospital for Sick Children did not have to go out with a begging bowl in order to raise £30 million for urgent rebuilding? I believe that the Government have spent considerably more than £30 million on the advertising campaign for the flotation of the BP share issue.

My Lords, I think the noble Lord is trying to address two different problems. What I am trying to address today is the problem of recruitment and retention of nurses, and I do not believe that the hospital building programme has anything to do with that.

My Lords, does the Minister agree that one of the reasons why nurses leave their posts is in order to get married? And very good wives they make!

My Lords, I do not know whether the noble Lord speaks with more experience than I do on this particular matter. However, I am advised that some 30,000 nurses leave the profession each year. That figure includes over 2,000 staff who are retiring and those who are leaving to have a family. About 10,000 return after breaking service, and the balance is made up by the output of the training schools; namely 22,000 in 1986.

My Lords, as one who attempts to be a citizen of the world (as I did when I was a member of the Labour Party, but it seems to have turned from that opinion of late) may I ask whether my noble friend agrees that it is a splendid thing that we provide trained nurses for other nations which are not so well equipped? That is a situation in which we should rejoice rather than be sorrowful that the nurses are going elsewhere.

My Lords, I find that a very difficult question to answer. As someone who did voluntary service overseas in a third world country, I agree with the noble Viscount. As regards nursing recruitment from this country to places like Australia and the United States, I am afraid that I disagree with him.