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NHS: Immigration Rules

Volume 762: debated on Wednesday 24 June 2015


Asked by

To ask Her Majesty’s Government what their response is to the Royal College of Nursing report concerning the impact of immigration rules on the employment of foreign nurses within the National Health Service.

My Lords, ensuring we have the right number of nurses is vital. That is why we are taking the issue of nursing recruitment seriously and have prioritised and invested in front-line staff, so there are over 8,600 more nurses on our wards. Health Education England’s workforce plan for England for 2015-16 forecasts that, following further increases in the number of training commissions, the proposed levels for nurse training will deliver over 23,000 more nurses by 2019.

My Lords, the noble Lord will know that the RCN report estimates that as a result of the migration rules around 7,000 nurses will be forced to leave the NHS because they do not reach the £35,000 per annum employment threshold. Despite the modest increase in the number of training places, is he confident that that gap can be filled, alongside dealing with the current recruitment crisis, the extra nurses needed for seven-day working, the extra nurses needed for improved patient-staff ratios and the Government’s indication that they want to rule out the use of agency nurses in future? When will all those policies be adopted alongside the 7,000 reduction in overseas nurses?

My Lords, the Royal College of Nursing figure I saw was closer to 3,000 than 7,000, but in a sense that is not what is important. What is important is that over the long run we train our own nurses in this country. Although we recruit some exceptionally wonderful nurses from places such as the Philippines, it does not seem a good long-term strategy to rely on recruiting nurses, often from third-world, quite poor countries, so I am very pleased that we are going to train 23,000 new nurses over the next five years. That is the right answer to any short-term, temporary shortage.

My Lords, surely the central point is that we should review the policy of recruiting nurses from overseas, as I think my noble friend is indicating. Should we not in a bipartisan way now concentrate on training our own nurses in this country rather than permanently taking them from other countries, for example, in Africa, which often desperately need their care?

My Lords, I agree with my noble friend; it cannot be right for a rich country such as ours to recruit nurses from much poorer countries. I will just say that the Philippines, for example, produces more nurses on a deliberate basis than it needs for itself, so that they can go overseas, usually for temporary periods, not permanently. Interestingly, over the last five years, the number of non-EU overseas nurses working in this country has reduced by 41%.

My Lords, if we need more home-grown nurses, what are the Government doing to address the flood of nurses leaving the profession, and the appalling attrition rate during training? My noble friend Lord Willis’s report on the Shape of Caring review showed that every year 20% of student nurses do not complete the year, and 40% of nurses do not complete the first five years in the profession. Since it costs £78,000 to train a nurse, is that not a terrible waste of money, and could we not do more to support student nurses to finish their training?

The noble Baroness makes a strong point. The drop-out rate of nurses is between 20% and 30%; it varies hugely from one nursing school to another. I am told that the peak of the drop-out rate is after their first clinical placement, which indicates that the way some nursing schools recruit their students is far from satisfactory. I hope that Health Education England will change the way it remunerates some nursing schools to ensure that they recruit the people with the right qualifications, temperament and vocation before they offer them places.

My Lords, the Royal College of Nursing’s underlying concern in its report was the safety of patients due to shortage of nurses. The royal college is greatly concerned that there has been a cutback in training places because of the inclusion of overseas nurses over the last three years. Can the Minister see whether the report will result: first, in an increase of nurses in training back to the level of three years ago; and secondly, in revisiting the levels of safe staffing?

As usual, the noble Baroness is more than familiar with the latest developments in the world of nursing. Health Education England is committed to commissioning an additional 23,000 nurses over the next four years. On safer standards of nursing, I know that she has taken a keen interest in the work that has been done around nurse staffing levels in relation to the numbers of patients. It is the Government’s view that the actual decisions about safe staffing should be taken at a local level, based on the acuity of patients on the ward, and should largely be up to the judgment of the ward sister and senior nurses within the hospital.

My Lords, I declare an interest as chairman of Milton Keynes Hospital NHS Foundation Trust. How are we to reconcile the dilemma that we have just heard about from the Department of Health and from Monitor—cutting back on agency staff—with the impact that this legislation will have on nurses in our hospital and in many others? It will affect not just nurses; lots of people who work in hospitals, whether in ophthalmics or pharmacy, will have the same kind of issue. How do we reconcile the fact that we are trying to run a hospital that ensures the best experience for patients while this will have the opposite effect?

The noble Baroness makes a strong point. There is a dilemma, but we have to differentiate between the long term and the short term. In the long term, it is very important that we develop enough nurses for our own healthcare system. In the very short term, there will be ups and downs. Unquestionably, in the light of the Francis report into the awful happenings at Mid Staffordshire, there has been a spike in demand for nurses, particularly those to be employed in acute hospitals. That has caused short-term difficulties, leading to problems with the agency staffing that she referred to. It is worth pointing out that last year 3,500 nurses—largely from the Philippines—came from overseas to this country. In the short term that provides an escape—a way out, if you like—but it is not a permanent solution.