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NHS: Nurses

Volume 829: debated on Wednesday 10 May 2023


Asked by

To ask His Majesty’s Government what is their assessment of whether there are sufficient NHS nurses to meet demand; and how they intend to meet this demand.

This Government have increased the size of the NHS workforce over the last decade and are committed to continuing to grow the workforce to meet the rising demand for health and care services. We are on target to deliver a further 50,000 nurses in the NHS in England by 2024 through increasing domestic recruitment, expanding nursing apprenticeships, increasing ethical international recruitment and taking actions to improve retention across the NHS.

My Lords, I thank the Minister for his Answer. He knows that the NHS is facing a desperate shortage of nurses. It is currently 44,000 and growing monthly. Our NHS depends entirely on having sufficient nurses. The members of the Royal College of Nursing recognise that the latest government pay offer fails to address the critical problem of recruitment and retention. When will the Government face up to these facts and make nurses a pay offer which offers them a long-term future in the NHS?

First, I would say that we have been negotiating with unions, the majority of which on the Agenda for Change now accept where we are. I think a lot of progress has been made in that place. We have a record number of graduates—26,000 new graduates have accepted places for next year. By all accounts, we are increasing recruitment rapidly. There are 43,000 more nurses here today than in 2019. We are doing a lot. We have plans in place to increase further and we are on it.

My Lords, the Royal College of Nursing has published figures showing that, between 2018 and 2022, 43,000 nurses left the nursing and midwifery register. We have seen this huge leaching of people moving out of nursing. What are His Majesty’s Government doing to listen to why these people are leaving and to see what we can do to retain these people who have been very expensively trained, have huge skills and are part of the reason why we have a shortage?

Absolutely, retention is key. The number I gave is net of those people leaving, so the 43,000 increase takes that all into account. We have an NHS retention program, and we are encouraging people to stay in place. It is all about training, pay and making sure the conditions are good and that we are helping them in their everyday life to set up a long-term, satisfying career structure, which we are doing.

My Lords, I apologise for trying to shout down the right reverend Prelate. Can I ask my noble friend what is being done to encourage nurses who have left for perhaps several years to come back into the profession and do a back-to-nursing course? I myself did so, and there is no reason why nurses in their 40s and 50s should not still give a lot to the profession. They can work part-time or in job shares. I think this way back in is not encouraged enough.

I thank my noble friend, and I think the whole House would wholeheartedly agree with her comments. Health Education England has a return-to-work practice which allows many different ways back in, be it full-time training, confidence classes or on-the-job situations, but flexibility is equally important, especially for people who have childcare arrangements, so that they can work the hours that work for them. What is key is that we need all these people back. They are crucially trained and experienced. The message is clear: we want them, and we are making it easy for them to come back.

For as long as I have asked questions about health, the shortage of nurses has been an issue, one way or another. How many nurses do we employ each year from English-speaking nations, such as New Zealand and Australia, and how many from the EU?

I do not have those precise figures to hand, but I am happy to supply them. International recruitment, as ever with the NHS, is a key component of our recruitment efforts, and that is why we are looking not just in English- speaking and EU nations but around the world, and we are being successful in this space.

Has the Minister seen the piece in today’s Financial Times reporting that, across the whole of the EU, 15% to 25% of hospital beds are out of use because of a shortage of clinical personnel, including nurses? The WHO forecasts that, by 2030, there will be a global shortfall in healthcare professionals of some 10 million. Does this not suggest that there is a fundamental problem here that will not be addressed just by recruiting campaigns, important as they are, and that what is required is a radical rethink of healthcare provision in the round?

Yes. Technology is a key part of that as well. Noble Lords have heard me talk about virtual wards. I have seen some excellent examples in Watford General Hospital, and we have plans to expand the number of virtual wards to use technology so that people can continue to live in the comfort of their own home knowing that they have technology support. We can make sure that we have got all sorts of solutions so that our nursing staff can go further.

The Minister knows the concern across the House about chronic staff shortages across rehabilitation and community services. I shall specifically ask him about the deeply worrying shortage of stroke nurses in hospitals and the community. The Sentinel Stroke National Audit Programme showed that in 2021 only 46% of stroke units met the minimum recommended level of senior nurses and that only 23% met the minimum nurse staffing levels on duty at the weekend. Stroke nurses are vital in the care and recovery of stroke patients in hyperacute and acute hospital units as well in multidisciplinary teams. How are the Government ensuring that ICBs follow the newly updated national stoke guidelines on safe staffing levels and addressing the very serious shortage of staff across the country?

The noble Baroness makes an important point. The role of stroke nurses and physios in this space is vital in getting people back to a healthy state. It is the responsibility of the ICBs to do that, and that is very much something that Ministers are following up with our plans with them all. Provision in this space generally is something that I am personally taking an interest in, and we are surveying all the hospitals to make sure that they are putting those provisions in place.

Thank you. Many lives are at risk through the shortage of nurses, frequently through the lack of retention. Following the spirit, wisely suggested by our King, of the importance of supporting volunteering, will HMG consider allowing volunteer Red Cross and St John nurses to help to ease the situation? I declare my interest of having been a Red Cross nurse for many years.

Absolutely. The message is very much that we want to make it as easy and productive as possible for people to help out and recruit. That is why the NHS apprentice programme for nurses is a very important part of all this, along with easy, modular ways in which people can start off as maybe a social care worker but have the qualifications so that they can get into nursing provision if they should wish.

My Lords, I declare an interest as a vice-president of the Royal College of Nursing. Recently, I spent five days in hospital. In those five days, I was cared for by one British trained nurse. The others had all qualified in Nigeria, the Philippines or India. They were superb, and I have no criticism of them at all, but is there not a concern that we are siphoning off from those countries nurses in whose training they have invested? That is very disadvantageous for them, although it may be of benefit to us. There should have been more British nurses in those teams.

We have an ethical recruitment process in place to make sure that we are only recruiting in the right way. At the same time, as I mentioned, we have more undergraduates than ever—26,000 of them—to make sure that we are domestically training up the staff to be on our wards as well.

A major reason for nurses leaving the NHS is low pay and real pay cuts. I shall refer the Minister to some numbers off the wage slip of a nurse with two children: gross pay is £30,000; income tax and national insurance are £5,600; her rent is £18,000 a year; and energy is close to £3,000. That leaves £3,400 to spend on everything else. The only way that she can make ends meet is by coming out of the pension scheme and relying on food banks. Can I invite the Minister and the Health Secretary to see if they can survive on £3,400 a year?

I am afraid I do not recognise those numbers. What I recognise is the need to ensure that we are supporting our nurses and all our NHS workers. As I mentioned before, I am glad to say that we are making progress and a majority on the staff council of the Agenda for Change unions have agreed the pay rises going forward so that we are able to get the money in their pay packets, which we have done so, hopefully, we will have a more settled situation.