Nursing Workforce Shortage: England

Tonia Antoniazzi Excerpts

Tuesday 3rd March 2020 Westminster Hall

[Tonia Antoniazzi (Gower) (Lab)]

I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this excellent and timely debate.

I speak today as the newly elected chair of the all-party parliamentary group on cancer. Currently, there are 3 million people in the UK living with cancer, and that number is set to rise to 4 million by 2030. In a survey conducted by Macmillan Cancer Support, more than two thirds of cancer patients said that they are not getting the support they need from the NHS in England, and that is because the NHS is buckling under increased workforce pressure.

The healthcare system is facing a staffing crisis that is crippling frontline services and affecting the care that patients receive. There are more than 40,000 nursing vacancies in the NHS workforce, and Government figures show that waiting times for cancer treatment and diagnosis are at record high levels.

Every day across England, NHS professionals work tirelessly to give people living with cancer as full a life as they can. They are stretching themselves and working harder every day to meet rising demand, but the harsh truth is that there simply are not enough professionals with the right skills to meet the needs of the growing cancer population. That is why I support Macmillan’s “Save our support” campaign. I was delighted to attend its parliamentary reception in January, along with nearly 140 parliamentarians who came to speak to frontline healthcare professionals and people with lived experience of cancer.

The NHS played a key role in the general election debate. Although the pledges on nursing numbers in the Tory party manifesto were welcome, it is imperative that we see the full NHS people plan for England published so that we can see how the Government intend to deliver on their commitment to grow and support the NHS workforce. Overall, we need a Government that get their numbers right and deliver on their promises.

I have concerns that the interim NHS people plan published last year contained no specific actions for cancer services. Without a clear plan for cancer, the NHS will not be able to cope with the demand caused by the rising numbers of people living with it. There are concerns that the NHS people plan will not be as ambitious and will not have the committed funding made available to ensure that it delivers for the 4 million people likely to be living with cancer by 2030.

According to a recent Health Service Journal, 20 of the UK’s largest cancer charities recently wrote to the Secretary of State to raise their strong concerns that the NHS people plan falls far short of what is needed to support the welcome ambitions within the NHS long-term plan on cancer survival and care across England. Will the Minister please confirm when the NHS people plan will be published, and will she provide assurances that the Government will provide the necessary funding and resources to ensure that it can meet its ambitious targets on cancer?

The Government’s target to have an additional 50,000 nurses in the NHS relies heavily on increasing staff retention. Macmillan Cancer Support published a report last year, “Voices from the frontline”, which underlines the important role that continuing professional development can play in supporting and retaining staff. The report reflects the views of lead cancer nurses from across England, focusing on the challenges that they and specialist cancer nurses face in accessing CPD opportunities and the impact of that on cancer care. Some 44% of lead nurses felt that their workload negatively affects the quality of care that they can give to cancer patients; 39% said that their current workload is unmanageable; and 44% say that the strain negatively affects their morale.

Macmillan professionals said that they had faced three main barriers to accessing CPD: a lack of protected time, funding, and locally available courses. Only a third of the specialist cancer nurses surveyed had protected study time to access and attend CPD training. A quarter of survey respondents reported that the availability of CPD training has worsened over the past two years.

Cancer clinical nurse specialists report that CPD is essential to the delivery of high-quality personalised care for people living with cancer. More than three quarters of respondents to the Macmillan survey were clear that having more time for CPD would help them improve care for people living with cancer. To address that, the Government should immediately return the CPD budget to at least £205 million, the level it peaked at in 2015-16 before budgets were cut, and not by 2024, which is the Government’s current plan. To ensure that the NHS has the well-trained and motivated cancer workforce it needs, will the Minister therefore please provide reassurances that the Government will return the CPD budget to at least £205 million to support the NHS people plan?

It would be remiss of me to stand here as a Welsh MP and not mention that the budget challenges we have spoken about are, as the hon. Member for Strangford (Jim Shannon) has highlighted, pan-UK issues. I understand how health services are devolved and that the challenges are ones we deal with every day, but we are losing experienced nurses quicker than we recruit them. We are on the edge of a full-blown crisis. I am very happy to stand here and say that the Welsh Government have an ambitious NHS workforce plan to train and recruit, and they have kept the nursing bursary. We need a positive action plan that will move quickly. In Wales we are moving quicker than the UK Government, so what are the UK Government doing?

As a former teacher I know what it is like to inspire young people to go into the teaching or nursing profession. What are the Government’s commitments? We need to work with our young people. Once they start on their journey into a profession, we need to highlight the benefits of working in the healthcare system. It could be a 12-year journey to become a senior nurse. By that time it is a little too late, because we have not trained them up in time to deal with the current crisis. What are the UK Government’s plans to recruit from overseas? We need to deal with that.

Lastly, it is important to dispel the myth around the funding that has been made available to the NHS in England. The NHS Funding Bill, which recently passed through both Houses, does not represent new money. It was first announced by the right hon. Member for Maidenhead (Mrs May) in June 2018 and does not cover the budgets for Health Education England, which include education and training for the extra nurses that the NHS in England desperately needs.

As part of the Budget next week and the comprehensive spending review later this year, it is crucial that the Chancellor supports people living with cancer across the country and ensures that the NHS people plan and Health Education England get the funding that they need to deliver the ambitious cancer care targets in the NHS people plan.

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[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.