Nursing: Staffing

Baroness Tyler of Enfield Excerpts

Thursday 16th June 2022 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the report by the Royal College of Nursing Nursing Under Unsustainable Pressures: Staffing for Safe and Effective Care in the UK, published on 6 June.

[Baroness Tyler of Enfield (LD)]

My Lords, I am very pleased to open this important debate on the pressures facing the nursing workforce, who play a critical role in our overall healthcare system. Throughout the Covid pandemic, nurses constantly went the extra mile, and more, often at great personal cost. Indeed, I want to pay tribute to all health and social care workers who toiled through the pandemic with great self-sacrifice. We should never forget their heroic and unstinting labours. I refer to my declared interests in the register, particularly as a non-executive board member of the Royal Free London NHS Foundation Trust.

Last week, the Royal College of Nursing published Nursing Under Unsustainable Pressures: Staffing for Safe and Effective Care in the UK. It reported on the results of the RCN’s March survey, which asked staff about their last shift—that is, the last time that they were at work—and compared the results with earlier surveys from 2017 and 2020. It makes for salutary reading. The report states that recent events, including the UK’s exit from the EU and the pandemic, have highlighted and worsened long-term problems with workforce supply in health and social care. The findings highlight starkly the impact of growing staff shortages and rising demand on the ability to deliver safe and effective care.

To give a brief flavour of the report’s findings, only 25% of respondents said that their last shift had had the full number of planned registered nurses; 75% of respondents reported a shortfall of at least one registered nurse on their shift; and four in five respondents felt that patient care was compromised by not having enough registered nurses on the shift—these figures had all gone up since the previous survey. Also, only around one in five respondents agreed that they had enough time to provide the level of care which they would like.

There is a lot more besides, but these findings give us cause for real concern, in terms of morale and staff retention and in the impact on patients and their safety. Frequently, nurses felt that the quality of care that they were providing was compromised, ranging from basic personal care, such as helping patients going to the toilet, through to severely ill patients getting treatment late and, sometimes, medicines not being given at all.

It is also worth looking at the key figures from the Nursing and Midwifery Council’s annual registration report. It is clearly good news that the number of nurses, midwives and nursing associates on the register has grown to more than 758,000 given the pressures of the last two years. Almost half of newly hired nurses were recruited from abroad. Of course, international nurses and other professionals make a welcome and vital contribution to the NHS, but it raises ethical and sustainability issues when so many are coming from poorer countries that often are experiencing staff shortages in their own healthcare systems. Alarmingly, however, over 27,000 nurses left the register, a sharp rise on the previous year.

When asked in the NMC’s leavers’ survey why they left, many said that their main reasons included too much pressure and poor workplace culture. More than a third of respondents said that Covid and feelings of burnout influenced their decision to leave. Some said that they were worried about their own health, while others struggled with increased workloads and a lack of staff, reinforcing the findings by the Royal College of Nursing.

What needs to happen? As the Minister will no doubt remind us, the Conservative Party pledged in its 2019 manifesto to deliver 50,000 more nurses, and progress is being made against that target, which I welcome. However, as the Chief Nursing Officer for England, Ruth May, said recently, while the pledge was welcome, it falls short of what is needed. Analysis from the King’s Fund also supports the view that the target will simply not be enough, saying that at a national level

“recruitment is having no clear impact on actual vacancy numbers or on the shortfall of nurses in the NHS”.

It went on to explain that the underlying cause of nursing shortages was that demand for nurses was increasing more quickly than supply, for reasons that it described as “complex, longstanding and varied”. However, it cited the pandemic and new targets to increase diagnostic and elective activity, which have created new demands and exacerbated workforce shortages that long pre-date Covid-19. The King’s Fund recommended a regular assessment of demand for and supply of nurses in the NHS over the next five to 10 years as the only way of tackling the backlog of care and dealing with these shortages and with rising patient demand, now and into the future.

Workforce planning is clearly crucial, and we need to see an emphasis on university nurse training programmes and the very welcome degree apprenticeship scheme, but so is a strong focus on retention, with so many nurses experiencing burnout and significant numbers intending to leave. Unfilled vacancies increase the workload pressure on staff, and it quickly becomes a vicious cycle leading to high levels of stress, absenteeism and turnover. As we know, reliance on bank and agency staff as short-term stopgaps has huge and unsustainable costs.

What is needed for nurses to make them want to stay? Clearly, pay is critical, but my view is that the NHS must focus on becoming a more attractive employer. This means tackling head on concerns expressed about bullying and discrimination, offering more opportunities for flexible working, and strengthening more people-focused and inclusive leadership. It must also include more black and minority-ethnic nurses in senior positions. In short, it requires a fundamental change in the culture to create an environment in which staff want to work and make their careers.

In talking to front-line nurses during the pandemic and more recently, I have been struck by a simple message of “We just need to get the basics in place”. While well-being support and initiatives are welcomed, the nurses I spoke to said they just wanted to know that there would be somewhere they could sit and recover at the end of a long shift, that hot food and drinks would be available during the night when many catering services are closed, that there would be someone to speak to in a non-judgmental way after dealing with difficult cases, that leave could be taken, that there would be flexibility around rotas to help with family responsibilities and support with childcare, and that they would not have to pay an extortionate amount for car parking. I think we all agree with that.

Are these things too much to ask for the nurses who look after us and our families when we are most vulnerable? In short, it means working with nurses on what really matters to them. The nurses I spoke to said that nursing can be a great job and a highly rewarding profession, but we must get the basics right so that they feel they are valued and properly supported.

Finally, I want to turn briefly to wider workforce planning issues. Like many other noble Lords, I was bitterly disappointed when calls, supported by many inside and outside Parliament, for independent, long-term workforce projection data to be routinely published went unheeded in our lengthy debates on the Health and Care Bill earlier in the year. Like many others, I believe this modelling is key to putting the workforce back on a sustainable footing, ensuring safe staffing levels and supporting more strategic spending decisions. Given this glaring gap in the Health and Care Act, it is ever more critical that workforce planning is properly addressed in the forthcoming long-term NHS strategy.

The Secretary of State for Health recently told the Health and Social Care Select Committee that while the strategy is expected to include data on workforce requirements by speciality and to provide a gap analysis to inform training plans, he could guarantee only that the conclusions would be published. He said the plan may not be published in full, including the workforce projection data. He also told the committee that the number of people waiting for NHS care stands at 6.7 million. Surely we need to know whether the NHS will have sufficient staff to meet growing demand and how many more professional staff will be trained, along- side plans to create new roles and use technology to work in different ways. Is the Minister able to explain why it may not be possible to publish the workforce plans in full, and can he confirm the dates for the publication of Health Education England’s updated Framework 15 document, looking at long-term strategic trends and drivers in healthcare, the update to the 2019 NHS Long Term Plan and the 15-year workforce strategy setting out the number of staff the NHS will need?

As we all know, the NHS faces many acute pressures and challenges such as GP recruitment, which is well off track against the target, ambulance waiting times—we heard the appalling case in the news this morning of a 94 year-old gentleman who waited five hours after a bad fall and it tragically proved fatal—building new hospitals, unacceptable A&E and cancer treatment waiting times, delays in discharging patients due to lack of social care, and the list goes on. Having the right highly skilled, dedicated and motivated workforce, both clinical and managerial, lies at the root of them all. I very much look forward to hearing contributions to this debate from other noble Lords and the Minister’s response.