My Lords, local NHS organisations are best placed to determine the skill mix of their workforce and must have the freedom to deploy staff in ways appropriate for their locality. Some organisations have reviewed their nursing staff structures to ensure that they are delivering quality of care for patients. This has resulted in a decrease of some senior posts. However, there has been an overall increase in nursing numbers, with over 3,300 more nurses, midwives and health visitors since 2010.
I thank the Minister for that reply, but since 2010 there has been a decrease of 4,000 senior nursing posts—modern matrons, ward sisters and specialist nurses, which we all recognise, as indeed do the Government, as being universally critical to patient care. Are the Government not worried about the fact that, on the one hand, trusts are saving money by decreasing these senior nursing posts yet, on the other hand, they are spending money by increasing the pay of executive directors by 6%? What are they going to do about reversing this worrying trend, and how are they going to tackle this dangerous loss of experience and skill in our NHS?
My Lords, the figure that I have is in fact a decrease of just over 3,000 nurses in senior positions at bands 7 and 8, but that is more than made up for by the increase of over 7,500 nurses at bands 5 and 6 on the front line. On the noble Baroness’s second point, the figures that I saw emanating from the Royal College of Nursing should be looked at with some caution; the RCN has included exit packages for executive directors but not for nurses. In fact, the latest independent evidence shows that for the third year running there was no increase in median executive board pay. It is important to compare like with like there, and the figure of 6.1% as a rise for executive directors is not one that we recognise.
My Lords, does my noble friend agree that one of the most encouraging aspects of the nursing profession is the number of senior nurses who have gone on to be chief executives and board members in the NHS, bringing all the skills of nursing to the leadership of hospital trusts and clinical commissioning groups?
I agree with my noble friend. To ensure that nurses have the leadership skills, styles and behaviours that our healthcare system needs, the NHS Leadership Academy has launched the largest and most comprehensive approach to leadership development ever undertaken. More than £46 million has been invested in core programmes that will map to foundation-level, mid-level and executive-level leadership development, with two programmes specifically for nurses and midwives that started in March last year.
My Lords, given the answer that the Minister has just given to his noble friend, surely it is ironic that throughout the NHS the number of senior posts is actually being squeezed. Would he not agree that that runs counter to what Francis said post-Mid Staffordshire about the need for highly effective quality supervisory nurses? Is the reason why this is happening not that the NHS cannot afford to increase its nurse staffing levels with the amount of money that it has been given by the Government? Something has gone, and unfortunately it is these crucial posts that seem to be having to give way.
My Lords, I do not agree with that because nursing numbers are now at a record high, which cannot indicate that hospitals are being starved of resources for their nurses. I do not see it as ironic that some senior posts have been reduced, bearing in mind the effect of Robert Francis’s report which has caused hospitals to increase the number of nurses on the wards. By and large, nurses at grades 7, 8 and 9 are in managerial positions and not in front-line posts.
My Lords, can the Minister say if an impact assessment has been undertaken on losing senior nurses from the NHS and the impact it has on service standards? The noble Lord, Lord Hunt, has already made the connection with the Francis report. Can the Minister also say whether an exit strategy has been undertaken to see why senior nurses are leaving?
My general answer to my noble friend is that it is not for the Government to decide how many nurses hospitals should employ. We have not done an impact assessment. That is a matter for local hospitals to judge. They are in the best position to do that, based on the needs of their patients and local communities. What the Government should do, and are doing, is to ensure that staffing levels are available for public scrutiny and comparison on a patient safety website. That work is currently in train. It will now be much more evident to patients and the public what their local hospital is doing in terms of safe staffing ratios.
My Lords, before seven-day working comes in, are the Government ensuring that senior nurses are also taking part in the seven-day rota to ensure that their expertise is available both in hospitals and in the community to support other nurses at more junior grades?
My Lords, the work going on on seven-day working certainly includes the nursing workforce. However, I repeat that it is not for the Government to mandate what each and every hospital should be doing in terms of deploying their senior nursing staff. It is a judgment for the board of that hospital.
My Lords, the Minister is very proud of the increase in the number of nurses on the front line. Can he confirm that all these nurses are actually in hospitals? What is the comparable figure for nurses working in the community? I believe the Government’s policy is supposed to be to have more care in the community.
The noble Lord is right. The Government recognise the very important contribution that community nurses make in providing high-quality care to people within community settings. I think we have seen a reaction, as I have said, to the Francis report. Lots of hospitals say that they are going to employ more nurses on the wards. We now need to ensure that staffing levels are safe across the NHS and the community, and the Chief Nursing Officer has set up a working group which is looking specifically at what we can do to increase the number of community nurses, which we certainly need to do.
I acknowledge the valuable role played by specialist nurses in a number of disciplines but, once again, it is up to employers to exercise their responsibility to manage turnover, retention, recruitment and skill mix to ensure that they have sufficient workforce supply to meet the levels of staffing that the hospital or organisation needs. Here again, patient safety is paramount.