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Accident and Emergency Services: Staffing

Volume 769: debated on Tuesday 23 February 2016


Asked by

To ask Her Majesty’s Government what assessment they have made of the number of shifts in hospital accident and emergency services not fully manned in each of the last three years.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so I refer to the register of my interests.

My Lords, it is the responsibility of NHS trusts to ensure that they have the right number of staff with the right skills in the right place to deliver high-quality, safe and efficient care. There are already almost 32,000 more clinical staff working in the NHS than in May 2010, including almost 6,000 more nurses and 1,280 more doctors within the specialty of emergency medicine.

My Lords, I thank the doctors who have been looking after my broken wrist. Does my noble friend agree that the problem is not that junior doctors are not working at weekends, but that there are simply not enough junior doctors on the books at this time, and that no other specialists such as therapists, radiologists and so forth are working over the weekend? What will the true cost of seven-day-a-week hospital opening be to the National Health Service going forward?

My Lords, seven-day working clearly goes far beyond junior doctors; it requires senior doctors, pharmacists, social workers, and primary care as well as acute care if we are to deliver a full seven-day service. As my noble friend knows, that is our objective over the next five years.

My Lords, does the Minister endorse the principle of Kirsty Williams’s Private Member’s Bill in the Welsh Assembly, the Safe Nurse Staffing Levels (Wales) Bill, which, having passed with all-party support, now ensures safe staffing levels in all wards in Wales? Will the UK Government follow the example of the Liberal Democrats in Wales?

My Lords, I can perhaps be excused for not following all that carefully Private Members’ Bills in the Welsh Assembly promoted by the Liberal Democrats. Safe staffing is obviously very important. I quote Mike Richards on this, who says that it is,

“important to look at staffing in a flexible way which is focused on the quality of care, patient safety and efficiency rather than just numbers and ratios of staff”.

That is extremely important.

My Lords, will the Minister tell me why the Government told NICE that they could not publish safe staffing levels for accident and emergency departments, when they accepted fully the recommendations in Sir Robert Francis’s Mid Staffordshire inquiry report, which said that safe staffing levels should be published? Will he also tell me how NHS trusts are enabled to achieve safe staffing levels when they have been told by the regulator, NHS Improvement, that they have to cut their workforce to cut their financial deficits?

My Lords, NHS Improvement never said that trusts should cut staffing levels to below safe levels. It has said that there is a right balance between efficient and safe use of staff. Getting that balance right is so important. That is what Mike Durkin, the national patient safety champion at NHS Improvement, is doing. His work will be reviewed by NICE and by Sir Robert Francis.

My Lords, will the Minister please tell us what is being done to help hospitals to have enough doctors and nurses on their permanent staff, rather than having to rely on banks and agencies?

The right reverend Prelate is right that reliance on agency and non-permanent staff has become far too high. It is something we must reduce, not just because it is very expensive to use agency staff, but because the continuity and quality of care suffers. We are taking strong action to reduce the role of agency staffing in the NHS.

Do the Government accept that demand on services is now outstripping the increasing workforce that they have tried to invest in? The workforce crisis is made worse because of the brain drain, with emergency medicine trainees being attracted to other parts of the world that often have very good working conditions. The Government therefore need to take an urgent look at the whole pinch point of emergency departments, given the increased number of patients who go to where the lights are on all the time and where they know they will be seen properly by someone who is properly trained. The crisis means that they now will often be seen by a locum and the staff are on their knees.

My Lords, the noble Baroness raises an important point, but it is not new: 24% of all doctors who work in the NHS have been trained overseas. This problem goes back over 20 to 30 years. We must train more of our own doctors. On the specific point on emergency medicine, I was surprised that, over the last 10 years, there has been an increase in emergency doctors—A&E doctors in the main—of 9% per annum, against growth in demand of between 2% and 3%. That does not fully answer the noble Baroness’s point, but, compared with other parts of the NHS, there has been greater investment in doctors and other staff in emergency medicine.

My Lords, will the Minister give us more detail on the action he has taken on the scandalous use of agency staff in the NHS? Will he tell us how long it will take to deal with this problem?

My Lords, this is a big problem, and to fully address it will take up to two years. We are addressing it in two respects: first, the number of people coming in through agencies; and, secondly, the mark-up that agencies charge, which is sometimes more than the cost of the person being supplied.

My Lords, will the Minister tell us when the Government are going to come clean about the health service and actually admit that we cannot carry on the way we are doing at the moment? Will he also tell us when we are going to have a national debate about how we fund the health and social care services in the future, and what services we will provide?

My Lords, the noble Baroness calls for a national debate but sometimes I feel that, in this House, we talk of almost nothing else. However, I understand the serious point that she makes. The fact is that the Government are committed to investing £10 billion of new money into the NHS. It is a very significant investment and is no more and no less than her own party promised at the last general election.

My Lords, the Minister has said that we have to train more of our own doctors, and on previous occasions he said that we have to train more of our own nurses. In training the nurses, we are taking a risk in abolishing the bursary system so that when those new nurses are qualified in 15 months’ or 18 months’ time they will have debts of about £40,000. What progress are the Government making in trying to reward those nurses who spend a considerable time in the health service—perhaps 10 or 15 years—so that those debts can possibly be written off?

The noble Lord will know that we are consulting on the proposals to remove bursaries and replace them with student loans. All the indications are that this will enable us to increase the number of nurses because the current system means that many young men and women who wish to become nurses are not able to do so. I think that three out of four people who apply are not able to get on the right courses. We hope that the new system will increase the number of nurses available to the NHS.

My Lords, will the Minister tell me why, when they are qualified, it is safe for young nurses to do five 12-hour night shifts on the trot when we would not allow lorry drivers to do five 12-hour nights on the trot?

My Lords, I am not aware of that. Some nurses may work five 12-hour night shifts. The standard may be for nurses to work three 12-hour night shifts because many nurses prefer to work 12-hour shifts rather than the more traditional eight-hour shifts. I do not think that it is especially good for nurses to work those long hours, nor is it particularly good for patients. Nevertheless, offering nurses the opportunity to work 12-hour shifts fits round many young people’s—particularly women’s—working lives.