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National Health Service: Nurses

Volume 768: debated on Tuesday 26 January 2016


Asked by

To ask Her Majesty’s Government what plans they have to ensure that there are a sufficient number of nurses in the National Health Service.

My Lords, Health Education England is responsible for workforce planning in the NHS. In 2016-17, the HEE commissioning and investment plan forecasts an additional supply by 2020 of 40,000 nurses as a result of undergraduate and postgraduate commissions placed with universities between 2012 and 2016. Moving new nursing students on to the student loans system from August 2017 allows universities to offer up to 10,000 extra nursing, midwifery and allied health degree places by 2020-21.

I thank the Minister for his answer, and we all wish the Government well in trying to make up the shortfall of nurses which is bedevilling our National Health Service at the moment. I am dubious about the abolition of the bursary scheme and think that the Government’s proposals are highly risky, but I wish the Government well. I ask the Minister for an assurance that if they proceed with the abolition of the bursary scheme, they will recognise that the cost to nurses at the end of their training will probably be approaching £50,000. Will the Government give a commitment that they will fund a payback or reward scheme so that those nurses who have spent a number of years in the National Health Service will have some of those debts written off?

My Lords, I thank the noble Lord for wishing the scheme well. It is intended to increase the supply of young men and women going into the nursing profession, with which I think everyone in this House would agree. It is true at one level to say that people receiving loans rather than bursaries will have a debt of about £50,000 at the end, but the repayment of that is, as the noble Lord knows, graduated, and only 9% of the excess over £21,000 a year will be payable, not the full amount, as he suggests.

My Lords, I have previously raised the question of the abolition of the SENs, and the Minister has told me that thought is being given to training which will not require university entrance. Are the Government making any progress on that, as there are many wonderful nurses—I am sure that we have all known some—who could never have got enough academic points to come in at the university training level?

My Lords, I completely agree with my noble friend’s sentiments. She will be pleased to know that from August of this year, Health Education England will be funding 1,000 new nursing associates, who will not be taking a degree but will effectively do a nurse apprenticeship, although they will be able to switch over to doing a degree later in their career if they so choose.

My Lords, given that hospital trusts are recruiting 5,600 nurses from outside the EU every year, that is surely much more of a pull factor than anything the Government might do with benefits. Given the fact that trainee nurses have to work on a clinical placement outside term time in which they add value to the NHS and take on responsibility, why are they not paid?

My Lords, I do not entirely follow the noble Baroness’s question. All I can say is that we are all pleased that we are able to attract nurses from overseas, but that cannot be the right long-term policy for this country. We must train our own nurses and not rely upon recruiting nurses from overseas.

My Lords, what consideration have the Government given to enabling people who want to study nursing as a second degree to have loans in the way that they will allow for those studying some STEM subjects? We have traditionally had mature entrants who are already graduates.

My Lords, we are still consulting on the details of this scheme, but I assure the noble Baroness that the loan scheme will be available for mature students doing their second degree as it is for those doing their first degree.

My Lords, last night in the education regulations debate, the noble Baroness, Lady Evans, said from the Dispatch Box that last year the cap on applications for nursing students meant that 37,000 applications were rejected, yet today the Minister quoted the figure of 10,000 extra places by 2020, which I take to mean 2,000 places a year. What about the other 35,000 a year who are presumably rejected for a nursing place? If there are ways of getting rid of the cap, why on earth are the Government not allowing many more nurses to be trained? Is it actually because they have cut the budget of Health Education England which would have to finance the placements of those student nurses in NHS trusts?

My Lords, I think the noble Lord is wrong in what he says, but I will double check. I believe that there will be an additional 10,000 placements per year, but I will check that afterwards. That is not until 2021 because the new scheme will not come into place until August 2017, which means that the first students will come out of the new scheme in 2020. We are estimating that there will be 10,000 in that year.

Do the Government recognise that the retention of nurses is also extremely important and that the loss from the profession later in life may reflect difficult working conditions and lack of support? Will the Government also note that nurses in the hospice world and specialists in palliative nursing tend to be older nurses who have left NHS employment and gone to the charitable sector precisely because they feel that they can work as they want to, fully and professionally, and have a supported working environment?

My Lords, retention and return to practice are crucial. The noble Baroness may be interested to know that Health Education England has up to 90, I think, courses that have so far attracted just under 1,000 nurses back to practice. The cost of attracting someone back to practice is some £2,000 each compared with some £50,000 for a new nurse.

My Lords, the noble Lord will be aware of the pressure that is quite rightly on trusts to reduce their agency spend. How can we cope with doing that when we are also still trying to get in nurses whose visas are being stopped, despite the fact that that restriction was supposed to have been lifted?

The cost of agency spend has risen from around £2.8 billion a year to some £4 billion this year. It is far too high. There is recognition that reliance upon agencies to this degree is also not good for quality of care. On grounds of both care and cost, we wish to reduce the spend on agencies.