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House of Lords Hansard
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10 January 2018
Volume 788

Question

Asked by

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To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 27 November 2017 (HL3070), what assessment they have made of the operation of the “break glass clause” in the supply of agency nurses to hospital trusts from off-framework agencies.

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My Lords, significant progress has been made in reducing agency staffing in the NHS. In 2016-17, the NHS spent £700 million less on agency staff than in the previous financial year. The “break glass” clause is one of a number of measures introduced to support patient safety while we seek to reduce the use of agency staff. Since a peak in April 2016, the number of nursing shifts procured from off-framework agencies has more than halved.

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I thank the Minister for his Answer on this very complicated issue. However, does he recall his Answer to my Written Question of Monday in which he confirmed that the incoming Conservative-led Government in 2010 cut the number of nurses virtually every year, sometimes in excess of 10,000, with the result that we have fewer nurses working in the health service today than in 2010? That is the cause of our reliance on agency nurses, which costs the NHS billions of pounds. This cannot continue, so will the Minister use his influence to try to ensure a proper workforce plan for the NHS so that we have sufficient staff to meet the needs and demands of the British people?

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The noble Lord is quite right that we need sufficient staff. He will know that when the Government came to office in 2010 difficult decisions needed to be made about the funding of all public services, because of the economic situation at the time. It is worth pointing out that, since that time, there are over 10,000 more nurses on wards, which is obviously particularly important at this time of year. In terms of the future figures, I hope he will be aware that there will be an increase in the number of training places for nursing—£5,000 a year. Indeed, Health Education England, which is responsible for workforce planning, will deliver a long-term plan to make sure that we can tackle this issue, which has been a long-standing problem for the NHS.

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My Lords, the Royal College of Nursing surveyed its members on this issue and two key things came out. One was that they wanted flexible working hours and the other was that they wanted the ability to choose a ward or specialty. It is clearly better for nurses to be employed by their trust rather than through an agency, so what are NHS trusts doing to accommodate nurses’ desire for flexible working patterns and a choice of where they work?

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On the issue of flexible working there is an important distinction between agency working and bank working. Bank working provides a degree of security and familiarity, in that the nurses employed by nursing banks often work in the same hospitals. That is one of the most important ways that we can provide the flexible working which, as the noble Baroness quite rightly said, nurses want.

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Can the Minister reassure the House on the supply and retention of psychiatric nurses, and that they are getting the excellent support that they especially need? He might wish to write to me on that.

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I will certainly write to the noble Earl specifically on psychiatric nurses. He will, I hope, be aware of the plan to recruit many more mental health staff as we seek to radically improve outcomes and delivery in that area.

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My Lords, as a former hospital chairman, I am aware that agency staff are called in only when they absolutely have to be, when there is no other alternative. I wonder whether the National Health Service has looked at offering existing nurses in hospitals the opportunity of doing some more work out of hours, as some of them would find that convenient. There is a tendency for doctors as well as nurses to look for locum and agency jobs because they are better paid.

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It is that last issue that we are trying to address. One factor is that there is now an hourly rate price cap on agency spend, precisely to drill down into that issue. The reason that the number of agency staff went up was in response to the Francis review and what it said about safe staffing levels in the service. The immediate response was to deal with that through agency staff. That was expensive, of course, which is why we have had to push down those costs. Nurses have to come from somewhere, and my noble friend is quite right that using existing nurses and support from nursing banks is one way of meeting demand with better value for money.

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My Lords, I noted carefully the Minister’s words about 10,000 extra nurses on the wards. Can he update the House on the position for community and district nurses?

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The number of those nurses has fallen—as have the numbers in mental health, which is worth pointing out—and we are trying to address this. I think I made a slip of the tongue a moment ago when I said that £5,000 more will be spent each year on training nurses; I meant that there will be 5,000 more student nursing places.

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My Lords, the Question further teases out the sometimes expensive inadequacies in workforce planning in our NHS. Under the circumstances of the winter crisis and the 40,000-nurse shortfall, clearly trusts have no choice sometimes but to take on agency staff in specialist and other services—and this is expensive. Does the Minister expect that the late funding made available for the winter crisis will be spent largely in this way? Will his department penalise trusts for using agency staff in this way?

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The noble Baroness is quite right that agency staff are sometimes used to fill vacancies—about nine out of 10 vacancies are filled in that way. The key is to make sure that they are used in a proper, planned way that is not expensive. The point about the “break glass” clause is that the rules that exist to cap agency spend can be broken where there is a need and where that need is approved by the trust for patient safety purposes. That is an important feature of the system.

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My Lords, in this present crisis, are more nurses taking advantage of the “break glass” clause?

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The number of uses of the “break glass” clause has actually fallen since April 2016, which was the peak. This shows that there has been a much more planned use of bringing in extra staff as they are needed, rather than an ad hoc response, which was what it was designed to address.

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My Lords, further to the question from my noble friend Lady Pitkeathley, now that the noble Lord’s department has had “Social Care” appended to its title, does he agree that community and district nurses must be a vital part of the interface between healthcare and social care? As he has indicated that he accepts that there are fewer of them, what is being done to ensure that there are more in the future?

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That is an incredibly important point. We know the role that district and community nurses have, particularly in the interface between hospitals and social care. I have pointed out that more nurses will be trained. That will provide an opportunity to recruit to those areas which have not seen the increases that other areas of nursing have done, including district and community.