Nursing Workforce Shortage: England

Mohammad Yasin Excerpts

Tuesday 3rd March 2020 Westminster Hall

[Mohammad Yasin (Bedford) (Lab)]

I beg to move,

That this House has considered the nursing workforce shortage in England.

It is a genuine pleasure to serve under your chairmanship, Ms McDonagh. I start by recognising the skills and expertise that nurses bring. Nursing shortages impact on patient care and staff wellbeing. Wherever there are people, there are nursing staff. They work in public services, across the NHS, social care, public health and the independent sector. They are with us at every stage in life, from birth to death. I am grateful for all that health and care staff do in my constituency and across the country.

This debate was secured in response to petitions handed in by nurses from the Royal College of Nursing, calling on the Government to fix the workforce crisis. I am pleased to be their voice—and that of everyone who works in the health profession—in Westminster today, and call on the Government to do all they can to tackle nursing shortages, which have huge knock-on effects on our NHS and wider health and care system, as well as on patient safety and staff wellbeing.

There are about 40,000 nursing vacancies in health and care services in England. In my region, the east of England, the nurse vacancy rate is 10.7%, which amounts to more than 3,600 nurses. Worryingly, the vacancy rate for mental health nurses in my region is even higher, at 15.3%. Nurses are crucial in health promotion and improving population health, yet the numbers of health visitors, school nurses, community nurses and district nurses have dropped at a rapid rate and are in long-term decline. We need to see significant growth in the NHS cancer workforce as well.

I expect that the Minister will tell me that almost 8,000 more nurses work in the NHS since this time last year. Although that figure is correct, it must, as with all stats, be viewed in the relevant context. That is a growth rate of just 0.4%, which is nowhere near the scale needed to provide enough nurses now or in the future. The pace of growth is not sufficient to reassure patients that we have a workforce ready to meet their needs, and it is nowhere near the rate needed to cope with the increasing demands that are predicted to be placed on the NHS by our ageing population.

For every NHS nurse employed in hospitals last year, there was an equivalent of 214 admissions. Patient need is rising faster than the growth in our nursing workforce. Social care and public health are also without thousands more nurses. It is difficult to calculate the number of vacancies in those settings because the data is incomplete. We have no understanding of plans to support and fund social care, which I hope the new Minister will confirm are a priority.

Nursing shortages directly impact on patient safety. Even with the small increase in staff numbers, hospitals and other services are struggling more than ever. Last week, the RCN published findings from a survey of emergency care nurses, who are increasingly forced to provide care in corridors. Some 95% of survey respondents said that patient dignity is compromised, and 92% worry that patients may be receiving unsafe care. December saw the worst performances on record for A&E departments in England, with every single department failing to meet the four-hour waiting time target. Those stats should alarm us all. Chronic underfunding has led us to this point.

Trust papers from Bedford Hospital, a district general in my area, show just how intense the pressures are on our frontline workers. Staff are doing as much as they can to keep patients safe and to provide high-quality care, but the situation is outside their control. Staffing shortages are systemic, and addressing them requires political will and action.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

The hon. Gentleman mentions staffing shortages. My vast and remote constituency, which has a large and ageing population and is the most remote mainland constituency in the UK, has problems not only with recruitment but particularly with retention. Health is devolved to the Scottish Parliament and Scottish Government, but as and when the UK Government develop an approach to keeping people in the most remote and rural areas, where they are needed most, I hope that that intelligence will be shared with the Scottish Government.

[Mohammad Yasin]

The hon. Gentleman is absolutely right. There are nursing shortages in every part of the country, and nurses are struggling to provide good care. I will come to that point in a moment.

Nursing shortages also impact on staff wellbeing. One testimony from an emergency nurse describes the realities of working in the profession:

“When I witnessed elderly patients being assisted onto bed pans while on ambulance trolleys, surrounded by paramedics, other patients on trolleys, and relatives all squashed in a freezing corridor…I realised that I can no longer preserve or protect my patient’s dignity, and that I am failing them as a nurse. Dignity is the first thing that the patients are stripped of when in a queue in a dark, cold corridor, closely followed by safety.”

Sharon, a community nurse who recently responded to a House of Commons digital debate on this Westminster Hall debate, said:

“I have worked in my locality for four and a half years. In that time, we have never been fully staffed. This puts enormous pressure on the whole team and many people have left because of it. Often, we are rushed, we forget things, and we cannot give the quality of care that we would like as we are just too thinly spread. Many of us end catching up on our notes or management at home, working way over our contracted hours. We are exhausted, frustrated and disappointed.”

This is an appalling situation for all concerned, and I know from these responses that this happens daily in hospitals up and down the country. Talk of a winter crisis is meaningless when staff and patients experience crisis every day, all year round. We must all focus on fixing this.

There is a long-term plan for the NHS, but its ambitions are dependent on having enough nurses. We have no funded workforce plan, even though it was promised by the Government when they announced the funding allocations back in the summer of 2018. Will the Minister tell us when the long-promised NHS people plan will be published, and whether it will include bold and funded policies to recruit, train and retain vital nursing staff to meet the needs of our population?

Nursing students in England can receive grants of up to £5,000 a year, and for some they can go up to £8,000. However, these do not reflect the true cost of living. Just as importantly, tuition fees are also a huge burden on nursing students, and it is important that this is addressed in the forthcoming Budget. As a father of four, I believe that financial barriers to education must be removed.

[Chris Elmore (Ogmore) (Lab)]

My hon. Friend makes some important points about the pressures facing nursing in England and the cost of living. Does he agree that one way that this could be resolved is by supporting bursaries and offering more financial support to student nurses? The Welsh Labour Government have kept those throughout this entire period, ensuring that the bursary was not scrapped in Wales.

[Mohammad Yasin]

My hon. Friend is right. Cuts to bursaries have impacted hugely on the recruitment of new staff. The Welsh Government did the right thing in a difficult situation. If we do not look after our staff, it will be hard for them to stay in the profession. That is why we have a shortage of nurses.

As a father of four children, I believe that financial barriers to education must be removed so that everyone who wants to go to university can do so, particularly those who want to become nurses. We should encourage young people to train in these critical professions. Why are the Government putting up barriers to young people who will go on to contribute such vital services to society and saddling them with huge debts before they have begun working?

This problem has been years in the making. Such stark shortages do not occur out of the blue. In England these shortages are due to the complexities of political decisions and structural issues.

[Scott Mann (North Cornwall) (Con)]

As has been mentioned, these issues are compounded in rural areas, where we have problems with recruitment and retention. A cottage hospital called Stratton in my constituency has just had its minor injuries unit closed overnight due to nurse shortages. What more can we do to promote staff retention across the whole of the UK?

[Mohammad Yasin]

The Government must listen to nurses and the Royal College of Nursing. They are pleading for the Government to act now. Getting nursing bursaries back in action might help, but the problem is now so deep that we must take urgent action to tackle it.

This problem has been around for a long time. It is not a short-term problem. It will affect us in the long term unless we act now. Who is responsible for the health and care workforce? It is shocking that no one is. There is no clarity in law on the role of and responsibility and accountability for growing and developing our health and care workforce, or the various layers that drive our health and care services.

A nurse walking on to a short-staffed shift has no option but to carry on. The buck stops with them. They carry the professional, physical and emotional impact. Nurses have no power to recruit more staff. That is true of all professionals in our taxpayer-funded health and care services, including nurses, medics, physiotherapists, psychologists, social workers, support workers and many others. The Government should be accountable for the provision of the labour market that staffs our health and care services. The taxpayer must be assured that the services they have paid for are safe and effective.

The former MP for Wolverhampton South West, Eleanor Smith, who is also a nurse, was here last summer setting out the same concerns. This is the 37th debate on workforce issues in health and care services since 2017, and it will not be the last. In recent responses to parliamentary questions, the Government have considered the merits of safe staffing legislation and ways to close the workforce accountability gap. The Royal College of Nursing has been campaigning, along with several other health organisations, for accountability to be secured in legislation, so the Government’s consideration is welcome.

The long-term plan Bill is the way to make progress on that agenda, but it must include an explicit framework for the role of and responsibility and accountability for workforce supply and planning at all levels at which decisions are made across the system, including the Government. Achieving accountability in law provides an opportunity to safely staff our health and care services in the future. I hope the Minister will commit to safe staffing legislation for England and update us on what her Department is doing to ensure that the NHS long-term plan Bill is forthcoming. Will that Bill explicitly provide for accountability for workforce provision?

I suspect the Minister will want to discuss the Government’s promise of 50,000 more nurses over five years. We have heard a lot about that commitment but not in detail. How will 50,000 more nurses be recruited, especially when the Government appear to be ramping up the hostile environment rhetoric and making the UK as unattractive a place as possible to come and work? The loss of many NHS workers from the EU is a tragedy.

Bedford Hospital had to recruit 237 nurses from Australia, India and elsewhere to fill vacancies left largely by EU nurses who left because of their fears for the future and the ill treatment they received in the UK. It is a testament to the hard work of the hospital’s chief executive, Stephen Conroy, that, despite those staffing difficulties, the hospital is projected to reach full recruitment of band 5 nurses for the first time in many years, but that will be achieved only by recruiting nurses from overseas.

We also need to increase capacity in clinical placements, to support nursing students at universities. How will the Government achieve that? How many nurses do the Government expect to retain? When will the Government publish their plan in full? Will the Secretary of State report on progress made in this Parliament?

This year, the World Health Organisation is celebrating the first ever year of the nurse and the midwife, at a time when the spotlight is on the nursing profession across the globe. As their elected representatives, we must stand with them and celebrate this diverse and dynamic profession. I will do everything possible to ensure that our health services are staffed safely. It must be a priority for us all. The problems are well known. The evidence continues to mount. We need decisive action, but we are not getting it from a Government drowning in Brexit uncertainty. Nursing staff need action now, as do their patients. We cannot wait any longer.

--- Later in debate ---

[Mohammad Yasin]

I thank all hon. Members who have taken part in this important debate, and thank the shadow Minister, my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), and the Minister, for their responses.

To be honest, I am disappointed with the Minister’s response. We have heard it many times before. It is time to take solid action. I ask her to read the responses to the digital engagement team’s survey, because she will be shocked by people’s comments, which should be an eye-opener for the Government. We are in crisis when it comes to nursing vacancies and getting nurses into jobs. The Government need to take action now, before it is too late. We cannot afford any more delays.

Question put and agreed to.

Resolved,

That this House has considered the nursing workforce shortage in England.