Nursing Workforce Shortage: England

Martyn Day Excerpts

Tuesday 3rd March 2020 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Ms McDonagh. I am grateful to the hon. Member for Bedford (Mohammad Yasin) for securing this debate today, and also grateful for his summary of the issue. He is correct to say that the growth in nursing numbers is nowhere near enough. I agree with him on the importance of investing in the NHS and the nursing workforce.

I am also grateful for the work of the Royal College of Nursing in highlighting the issue, including the recent petition with more than 200,000 signatures that was presented to the Prime Minister in February and called for action to remedy the staffing shortages as a priority. We know that there are some 40,000 nursing vacancies in England, and one in three nurses are due to retire within the next 10 years. In Scotland, of course, this issue is devolved, and in normal circumstances I would not interfere in a debate focused on the issue in England. However, devolved Administrations do not operate in a policy vacuum. UK policies, such as those on Brexit and immigration, affect all parts of the UK, so I will contribute to the debate today. Nor do I feel alone in this matter as several of my Celtic cousins have already spoken in the debate, and the issue benefits from hearing about what happens in Northern Ireland, Wales and Scotland.

NHS Improvement reported in September last year that the latest nursing vacancy rate in England stood at 12.1%. Information Services Division statistics show that NHS Scotland’s nursing and midwifery staff vacancy rate was 6% in the same month. Qualified NHS nursing levels per head are already 46% higher in Scotland than in England. For nursing levels in England to match Scotland’s, they would need to increase nursing numbers by more than 130,000. That puts the 50,000 nurses that were promised for England into a certain context. Consequently, there may be lessons we can learn from how each of the four national health services operate, and I hope my observations on the differences between the two countries’ nursing numbers are seen as constructive and helpful.

NHS staffing per head is 26 staff per 1,000 people in Scotland, whereas England’s is 19.7. Those figures are from September and August last year—I could not get the months to match, but it sets the pattern. There are more qualified nurses and midwives per 1,000 of the population, with 8.1 whole time equivalents in Scotland versus 5.5 in England. Why is that? The number of people in Scotland choosing a career in nursing is increasing, and bursaries are undoubtedly one reason for that. Bursaries for student nurses in England were scrapped as part of the Tories’ austerity measures, a policy that led to a drop of more than 30% in nursing applications. In stark contrast, those bursaries were protected and increased in Scotland by the SNP Scottish Government, and nursing student numbers in Scotland have increased for seven years in a row. One of the big differences is that in Scotland, nurses will receive a bursary of £10,000 a year from next September, and already benefit from free tuition. The UK Government pledged a £5,000 annual grant for student nurses from this year—only half of what we are offering in Scotland—and still expect nursing students who train on the job to pay thousands in tuition fees. I believe that figure in England is around £27,750, a stark contrast to the figure in Scotland, which is zero.

Nurses in Scotland across all bands are better paid than elsewhere in the UK, which also helps to make nursing a career choice and benefits retention. Training more nurses is key to addressing this issue. The latest UCAS figures show a 2% increase in people from Scotland choosing nursing as a career, but a decrease of 4% in the English figures. Meanwhile, a report last year by the Nuffield Trust, the Health Foundation and The King’s Fund concluded that the NHS in England has no chance of training enough GPs and nurses to solve the shortages it faces. This suggests that in order to address the current and future shortages, we need to look elsewhere.

That leads me on to the topic of immigration. EU nationals make up 10% of the medical workforce, and we should be concerned about the insight into their mindset provided by the 2018 British Medical Association survey of 1,527 EEA-trained doctors across the UK, which found that 35% were considering moving abroad. Of course, only time will tell what actually comes to pass. However, immigration to the UK has fallen to its lowest level in six years according to the Office for National Statistics, and Cambridge Econometrics’ analysis states that leaving the single market will see the working-age population fall by nearly 2% by 2030, which is equivalent to 790,000 people.

The challenges with recruitment are not going to get any easier. On 15 November, the King’s Fund, the Health Foundation and the Nuffield Trust predicted that NHS England staff shortages will rise to over one in six health service posts by 2030. Clearly, we must attract skilled workers from abroad, but the UK Government’s regressive immigration plans look set to make the situation worse. At this time, details of a UK NHS fast-track visa scheme remain unclear, and I look forward to hearing those details; perhaps the Minister will enlighten us. With regard to the proposed points-based immigration system, I assume that nursing will be classed as a shortage occupation, which would require a £20,480 minimum salary. I believe it must be on the shortage occupation list, but also that it should be exempt from any salary threshold. The Library briefing for today’s debate gives us the RCN’s opinion of the points-based system:

“We are concerned that these proposals from the Government will not meet the health and care needs of the population. They close the door to lower-paid healthcare support workers and care assistants from overseas, who currently fill significant numbers of posts in the health and care workforce.”

I also echo their calls for the introduction of an immigration system that supports nursing, and to exempt nursing staff from the immigration health surcharge, which seems an unnecessary burden to put on people coming here to relieve our own health crisis.

I will finish with a quote from the RCN’s general secretary, Dame Donna Kinnair, who has said that there are

“43,000 vacancies in the NHS in England alone. Yet failure to increase nurse numbers isn’t inevitable, but a political choice. We need proper financial help for nursing students in every nation of the UK in order to ensure the supply of nurses in the future, and clear legal duties for governments and NHS leaders across the UK to ensure there are enough nurses to provide safe care to patients.”

It is indeed a choice, and I hope that my Scottish comparisons and views on immigration help to inform the choices facing NHS England.