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NHS: Nursing Workforce

Volume 814: debated on Wednesday 8 September 2021


Asked by

To ask Her Majesty’s Government what plans they have to retain the nursing workforce in the National Health Service following their experiences during the COVID-19 pandemic.

My Lords, we owe a huge debt of gratitude to the nurses in all parts of our healthcare system, who have done an amazing job through the pandemic. We are on track to deliver our manifesto commitment to have 50,000 more nurses by the end of the Parliament. This includes a focus on retaining nurses already working in the NHS and social care. We are taking action through the NHS People Plan to improve nurse retention by prioritising health and well-being, supporting flexible working and improving NHS workplace culture. The signs are that these efforts are paying off.

My Lords, the training of these new, welcome recruits to the nursing profession will take some time. Immediate improvements will depend on the current staff, who feel battered and bruised following the intense pressure of Covid. Daily, nurses end up in tears at work and many are contemplating leaving. What specific plans—I stress “specific”—do the Government have to retain nurses to meet today’s growing problems in the NHS?

My Lords, I completely acknowledge the phenomenon of burnout that the noble Lord rightly points out; the NHS people recovery taskforce, appointed to tackle exactly that problem, is very much focused on it. It works in conjunction with the NHS retention scheme and has led to the appointment of new well-being guardians, which have made a huge impact. The statistics suggest that the leaving ratio, previously at 10.3%, has now been reduced to 8.3%. That is an encouraging sign, but we have a number of other measures in place to ensure that retention remains upward at a time when, as he pointed out, nurses are under huge pressure.

My Lords, a group of Nightingale scholars has informed me that nurses are experiencing greater levels of abuse verbally, on social media and physically, together with racism; they attribute this in part to the long waiting lists and their duties in encouraging Covid vaccinations and mask wearing. Will the Government commit to furthering zero tolerance against violence and racism towards NHS staff, which the scholars argue would aid retention significantly?

My Lords, the noble Baroness raises a really important point. We addressed it nearly 18 months ago, before the pandemic, when we had a crackdown on racism and abuse from patients. I would be very grateful if she could send me the details of her correspondence, and I shall look into whether we need to do more on that immediately.

Why should patients with vulnerabilities and vulnerable conditions, who have obediently had their injections, risk their lives by attending hospitals or medical facilities and encountering staff who have refused vaccinations? Will the Minister make it absolutely clear that there is no place in the NHS for vaccine refuseniks either among the medical staff or among those tens of thousands of people who seem to wander around carrying files or doing non-medical work?

My Lords, we are looking at ways in which to take testing and other treatment out of hospitals and into the community. On my noble friend’s substantive point I say that, as he may know, we have promised to have a consultation on mandatory vaccination for healthcare. We are determined to do that in partnership with the workforce, and I look forward to updating the House on our progress.

Does the Minister accept that the most important mechanism for retaining nursing staff in the NHS is by improving their wages, terms and conditions, and that the best way of doing that is by the restoration of full sectoral collective bargaining, as was the case in 2018?

I pay tribute to the noble Lord’s great experience and expertise in this matter. He will be aware that we have a social partnership forum, where we work extremely closely with the professions on how to improve retention. But I think that the motivation of those in public service and, in particular, in healthcare is much more complex than he describes. We have come to a 3% pay agreement with the nurses, and they have demonstrated huge support for the healthcare service during the pandemic, which suggests that it is more complex than he describes.

My Lords, current NHS nursing vacancies in England are now thought to be over 40,000. Nurses have recently reported concerns that a number of nursing posts at a standard that require a registered nurse or midwife are now being advertised to those not registered with the Nursing and Midwifery Council, presumably because of the shortage of nurses. What steps will the Government take to ensure that only properly qualified nurses and midwives are recruited to these posts that require registration?

My Lords, there are vacancies in nursing, as there always are. The vacancies at present are not hugely higher than they are normally and, in fact, we have more nurses today than we did two years ago. What I can report to the noble Baroness is that UCAS data shows 27,720 acceptances to nursing and midwifery courses in England as of 7 September. That is extremely good news; it shows the commitment of our graduates to the nursing profession and our commitment to making sure that more nurses are trained.

My Lords, there are concerns that in some areas there are dangerously low staffing levels as a result of nurses leaving the profession. In the Belfast trust, in the first six months of this year alone, hundreds have left due to the Covid pandemic and for other reasons. Undoubtedly, that will have an impact on tackling long waiting lists. Can the Minister assure me that the money raised under the new health and social care levy and sent to the devolved Administrations, including Northern Ireland and Scotland, will actually be spent by those Administrations for those purposes, including addressing nursing shortages? As things stand at the moment, that money could be used for other purposes.

My Lords, there are 303,900 full- time nurses in the NHS trusts and CCGs, an increase of more than 8,900 from June 2020, so the impression that the noble Lord is giving is not, I am afraid, entirely supported by the numbers. In terms of recruitment, 2021 saw a third consecutive year of growth in the number of applicants to nursing and midwifery courses, which again is very good news. As for commitment on devolved Administrations, of course devolved does mean devolved, so I am not sure that I am in the position to make the commitment that he has sought.

Does my noble friend agree that, as well as retaining nurses, we need to train enough to end the scandalous reliance on poaching nurses from poor countries? The move from bursaries to loans was supposed to end the scandal of us turning away tens of thousands of applicants for British nursing courses in this country. Can he explain why last year we again turned away more than 20,000 young British people who wanted to train as nurses in this country?

My Lords, as my noble friend will know, the training grant of at least £5,000 per academic year per eligible student is in place, plus a further £3,000 of additional targeted funding—for example, for childcare costs and students studying special subjects. That is the kind of financial commitment that we have made to meet his concerns. On the specific point that he mentioned, I say that not everyone is suited for the nursing profession; it is a really tough job, and not everyone who wants to be a nurse can be a nurse. I am afraid that the applications that we get and the sifting that we do reflects that point.

I draw attention to my interests at Whittington Hospital in the register. Thank goodness that our nurses are incredibly resilient, but the relentless nature of working for the NHS, not just in the last year but prior to the pandemic, is now taking its toll. That includes senior and experienced nurses; there must be a worry that many could take early retirement, which is a risk to the profession. The feedback that I get, to which noble Lords have referred, is that respect and regard is less evident as the pandemic continues, and I think that is exacerbated by the debate about pay. What other initiatives is the NHS considering to deal with the fragile nature of retention—for example, housing offers, travel and the working environment—and will they be funded?

The points that the noble Baroness makes are entirely right, and we share exactly the same concerns. That is why we have put in place mental health support, enhanced occupational health support, expansion of the right to work flexibly across the NHS, and the promotion of equality. On the point about older nurses, two things particularly stand out: there is significant investment in leadership through the NHS Leadership Academy, and we have bespoke support for over-50s and newly qualified nurses, recognising that they are likely to be the biggest flight risk across the NHS.

My Lords, might the Government consider upping NHS nurses’ pay rates but, at the same time, ending the practice of employing agency nurses? Frequently nurses work three days a week directly and two days a week on an agency basis, costing the NHS significantly more than full-time employee nurses.

My Lords, I acknowledge my noble friend’s concerns about that point. It is a fact of life of trying to manage complex healthcare systems that you do not know necessarily on a day-to-day basis which staff you will need and exactly where you are going to need them. Therefore, we rely on flexible working arrangements, which suit some nurses who cannot make the kind of time commitments that are needed for a full-time job. There are hourly costs to that additional flexibility, but we leave it to chief executives to balance those benefits and disbenefits to achieve their objectives.