Nursing Workforce Shortage: England

Helen Whately Excerpts

Tuesday 3rd March 2020 Westminster Hall

[The Minister for Care (Helen Whately)]

I congratulate the hon. Member for Bedford (Mohammad Yasin) on securing this debate. I thank him for his tone and his constructive approach to the challenges. I also thank him for giving me this opportunity to speak about a subject that I am truly delighted to have as my responsibility as a new Minister in the Department of Health and Social Care, and about which I feel very strongly—namely, the NHS workforce.

Our NHS is truly fantastic and we as a nation are proud of it. However, as we know, the NHS is really its people. The people of the NHS are the NHS—from the most senior doctor, to the newest healthcare assistant and everything in between. That is particularly true of nurses, who make up nearly one quarter of the NHS workforce, and good healthcare depends absolutely on good nurses.

The NHS should be looking after its nurses, but over many years visiting hospitals and community services—this goes back a long time—I have had too many conversations with nurses who feel that the NHS, or their employer, has not been looking after them. The biggest problem that comes up, going back over many years, is that of staff shortages.

I completely agree with the hon. Member for Bedford that the vacancy rates among NHS nursing teams are too high. They are particularly high for some specialties, such as mental health. There are variations across regions. For instance, in the north-east, Yorkshire and the north-west, the highest vacancies are in ambulance trusts. We also know that there are particular challenges in rural areas, as mentioned by my hon. Friend the Member for North Cornwall (Scott Mann), and across the nations of the UK. As we heard from the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone), there are challenges in rural parts of Scotland. We heard from the hon. Member for Strangford (Jim Shannon) about the challenges in Northern Ireland, and there are also parts of Wales that are struggling. This is not just a problem in England, but nevertheless I recognise the problem in England. We need plans to address that, and we have plans, which I will come to.

The hon. Member for Bedford also flagged up the importance of safe staffing in the NHS. I absolutely agree that our first priority must be that the NHS is a safe place for patients, and that care is safe. As he will know, trusts call on bank and agency staff, to make sure that they have enough staff to make wards safe. We must appreciate the work of those staff, who do a really important job of stepping in, but, as I have heard from many a ward sister, although they welcome having agency staff to fill the gaps, that is not the same as having a fully staffed team. That is what we really want in the health service. It will make the NHS a great place to work and enable it to provide the best possible care for patients. That is why the Government have committed to 50,000 more nurses, so that staff shortages and those high vacancy rates will be a thing of the past.

Before I talk about how we will find thousands of new nurses, I want to discuss the most fundamental thing we have to do to succeed, which is to keep the nurses that we already have in the NHS. Some hospitals and teams do not have a problem with staff retention, and some have very low attrition rates. In others, we know that staff turnover is a real problem. There is no point in the NHS training up lots of new nurses if we cannot hang on to those who have already been trained.

In order to retain nurses, we need to make sure that each day is a good day. We need to look out for each and every nurse, which is the day-to-day job of the trusts that employ nurses. I want those trusts that are struggling with high attrition rates to adopt more of the good practices of successful trusts. The Government are also going to help.

First, as we have discussed today and as we have heard directly from nurses, more investment in ongoing training and continuous professional development would make a big difference. That is why the Government have committed to giving every NHS nurse a £1,000 training budget on top of the training that employers usually provide. That extra funding should help nurses to advance their careers, to move more easily between different roles and, of course, to provide better care to patients.

Secondly, there will be a new offer for all NHS staff. It will be released alongside the NHS people plan, which will set out the support each and every NHS staff member can expect from their employer, including for professional development and for more choice and control over shifts and working patterns. As several hon. Members have said, NHS staff want more control and flexibility. The hon. Member for Strangford mentioned the importance of flexibility. Nurses may have other caring responsibilities. Some trusts are doing well in this area, others not so well. We want all employers to do what they can to give staff more flexibility and control over their working hours.

[Jim Shannon]

I thank the Minister for her comprehensive response. I know that tax credits, NVQs and time out are not her responsibility, but would she be willing to speak to the Minister with that portfolio to see whether there is any flexibility in the system to enable nurses, especially those with young children, to continue?

[Helen Whately]

My understanding is that the system in Northern Ireland is different from that in England, so I do not have the answer at my fingertips. I am, however, happy to take up the hon. Gentleman’s question and get back him.

Thirdly, on improving the retention of staff in the NHS, we need to tackle the level of bullying and harassment. The recent NHS staff survey had some really positive results on how NHS staff feel about their work. The Secretary of State and I, however, are greatly concerned about ongoing reports of bullying and harassment that staff experience at the hands of other staff, patients and, sometimes, their families. That is simply not acceptable. We must send out a message, loud and clear, that we will not tolerate the bullying and harassment of staff, whether from other staff or from patients and their families. As a society, we should all be grateful to our NHS staff. Hand in hand with that, we absolutely will not tolerate racism, which is an ongoing problem in some parts of the NHS.

Fourthly, pay has never been the top thing brought up by nurses when I have spoken to them about their concerns, but clearly it is part of the picture. By April this year, we will have increased by 12% the starting salary for new nurses compared with three years ago. More than 200,000 nurses are benefiting from pay rises under the “Agenda for Change” pay deal. Nurses below the top of their pay band have been receiving increases of at least 9%, and those already at the top of their pay band are receiving a pay rise of 6.5% over the course of the “Agenda for Change” pay deal.

I just want to pick up on the point about returning to nursing. The issue of retention also applies to nurses who have, for many reasons, taken time out of nursing. We are very keen that more of those nurses return to work. We are supporting nurses who want to bring back their valuable experience to the NHS. I also want trusts to develop posts that will make the most of those nurses’ experience and to ensure that there is enough flexibility in their shift patterns and ways of working to fit any caring responsibilities they may have.

[Jim Shannon]

For that to happen and for them to return, there would need to be a database of all former nurses. I am mindful that there will be a statement later about the coronavirus, and a Health Minister has mentioned having a list of people who could come in and help in the event of a pandemic outbreak. If there is such a list, then there must also be a list of former nurses who have left the sector but wish to come back. Is there such a database?

[Helen Whately]

I am just digesting what the hon. Member said.

[Jim Shannon]

I talk very fast.

[Helen Whately]

I have not seen a database. The hon. Member refers to the coronavirus plans, which are very much on my mind as we talk about the immediate and longer-term plans to increase the number of nurses in the NHS. Clearly, we also have the short-term challenge of ensuring that the staff are there, and that work is absolutely in hand. Returners are an important part of it and we need to ensure that we make use of nurses who have already been trained, to boost the NHS workforce. All in all, we want to ensure that the NHS is a great place to work for nurses who return to it and for those working in it right now. The absolute foundation for ensuring that we no longer have nursing shortages is to look after the nurses that we currently have. On that foundation, we can seek to recruit and train new nurses.

[Tonia Antoniazzi]

I welcome the Minister to her place. As the chair of the all-party parliamentary group on cancer, I would like to take this opportunity to ask her to come to speak to us about the NHS people plan, if possible.

[Helen Whately]

I thank the hon. Member for her invitation. As I am new to the job, I am trying to ensure that I speak to as many stakeholders as possible. I would be delighted to talk to APPGs such as the one she chairs, as and when I can.

I turn now to the ambition to increase the number of nurses that we train. The latest UCAS stats show that there have been nearly 36,000 applications to study nursing and midwifery courses at English universities this year, which is about 2,000 more than last year. The new students will benefit from the new £5,000-a-year maintenance grant, an extra £1,000 if they study specialist subjects such as learning disability and mental health nursing—where we have shortages—and a further £1,000 if they study in areas struggling to recruit. There is also further funding available to support childcare costs, and that financial support is in addition to the learning support fund, which provides help with travel costs for placements, childcare and exceptional cases of hardship. That is all in addition to being able to apply for a student loan. Unlike other courses, students applying to nursing, midwifery and many allied healthcare professional courses as a second degree will also qualify for the maintenance grant and for student loans.

I set out the financial support we are offering because I recognise that, as the hon. Member for Bedford has said, it can be hard to afford to study nursing, particularly for mature students. We really want more nursing students. Last year, 23,630 people accepted a place to study nursing or midwifery in England. This year, I want to see more. As I have said, there has already been an increase in applicants, but it is not too late for anyone who has yet to apply. UCAS is accepting late applications up to 30 June, and from 6 July people can apply for a course through clearing.

My message goes out to anyone watching this debate who thinks that nursing is for them: please, get applying. If someone wants to become a nurse, we want to help them—no matter who they are or what their background is. However, we know that university is not the route for everyone, so there are other ways to become a nurse. For instance, the Government have developed the apprenticeship pathway, so people can go from being a healthcare support worker to being a nursing associate, and then to being a nurse. If they want, they can then move on to postgraduate advanced clinical practice and nursing. At present there are nearly 2,000 nurse degree apprentices. Although nursing associates are doing a really important job in their own right, they can become registered nurses via a shortened nursing degree.

The things I have just set out are all about increasing our home-grown nurse force, which is absolutely vital step in ensuring that this country has a sustainable nursing workforce. I am fully aware, however, that we will also need to recruit internationally in order to achieve the ambition of 50,000 new nurses. We cannot do that from the home-grown workforce alone. Many of us, including patients and their families, have good reasons to be grateful to nurses who have come from all over the world to work in our NHS. I am grateful to them.

As we look ahead to including international recruitment as a way to boost our nursing workforce, we do so mindful of the ethics of recruiting from elsewhere. We want to ensure that it works not just for us but for the countries that our nurses come from. We are determined to build bridges with health systems across the world, to share NHS expertise and provide staff who come to work in the NHS with a chance to learn from our health system, just as we benefit from their skills.

The hon. Member for Bedford asked how we plan to increase the nursing numbers by 50,000. In essence, the plan is to improve retention, to support returners to the workforce, to boost our home-grown numbers, and to complement that with international recruitment. In response to questions about when we will publish the NHS people plan, that will be done within the next few months. I have also been asked who is responsible for the workforce. I take the responsibility for workforce in my brief very seriously. I feel very strongly that, from day to day, the biggest determinant of the experience of any nurse or member of the NHS workforce is their employer. NHS employers are responsible for their workforce, and I am keen to see every single trust and NHS organisation investing in and supporting and valuing their staff. As I said at the beginning of my speech, the NHS is only as good as its people. They are great, and we must look after them.

I thank all hon. Members for their contributions. This has been an important discussion and some good points have been raised. The mere fact that we are having this conversation demonstrates the importance of nurses to us all and to our health system. Some hon. Members talked about a crisis in our NHS and in nursing, but we have to be careful in getting the right balance in the language we use. Yes, we know that it is tough on the frontline, but we also know that nurses and NHS staff more broadly talk about how very rewarding they find their day-to-day work, and about what a wonderful job it is. I have spoken to nurses who tell me that they would never want to do any other job, so it might be helpful to get the right balance.

The hon. Member for Gower (Tonia Antoniazzi) says that her experience as a teacher means that she knows how to inspire. I call on her and everyone else to follow that guidance, as we need to ensure that everybody knows that working in the NHS is a great career. The NHS is a great place to work. Let us not talk it down. Let us make sure that we spend time talking it up.

[Tonia Antoniazzi]

I appreciate the Minister’s comments. I would never talk down a profession that we need and depend on so much. The nurses I have come across, whether from throughout the UK or from overseas, have been absolutely wonderful. We are being positive and want to retain people, and this issue is important to us. Does the Minister agree that this is not just about our healthcare, but about our teachers and public services? We also have a commitment to our consultants, who have a lot of issues and are always overworking to ensure that frontline services continue. Their dedication is absolutely brilliant and we appreciate it.

[Helen Whately]

I thank the hon. Member for her comments. We can absolutely agree how much we value everyone who works in our public services and with the NHS, including consultants, junior doctors, nurses, nursing associates, healthcare assistants and allied healthcare professionals, as well as every single porter, administrator and member of the management team. I am sure that I have left out some individual roles—healthcare scientists, for example—for which I apologise. The whole NHS workforce has my appreciation.

[Jim Shannon]

The Minister has mentioned the Government’s commitment to increasing national health service funding. It is important to state for the record that we acknowledge the good things they have done.

[Helen Whately]

I thank the hon. Gentleman. As he says, I have spoken not only about how much we value the NHS workforce, but about our commitment to increasing NHS funding. The two go hand in hand.

A few Members have mentioned that the number of vacancies stands at well over 40,000. Although I absolutely recognise that those numbers are still far too high, the latest data shows a steady downward trend over the past year. I state for the record that as of the third quarter of 2019-20, the number of vacancies was under 39,000.

I will finish with one more piece of good news: the increasing number of nurses in the NHS. As of November 2019, the latest workforce data shows that we had 290,474 nurses in the NHS in England, which is an increase of 8,570, or 3%, since November 2018, and an increase of nearly 17,000, or 6%, since 2010. The numbers are going in the right direction. We have a long way to go but I am determined that we should get all the way to the extra 50,000 nurses in the NHS, so that nursing staff shortages will soon be a thing of the past.