Thank you, Mr Speaker ...
It’s a great privilege to have been drawn for one of these end of day Adjournment Debates … giving … as it does … a Backbencher the opportunity to debate a subject dear to their heart.
This particular debate follows a recent public meeting on Portland in my constituency … where the beds at the island’s much-loved community hospital have been closed … but more on that shortly.
We’ve heard it before … and it needs to be said again … we are facing a desperate shortage of nurses.
Health Education England believes there are 36,000 nursing vacancies in England … while the Open University says it’s 38,000 … and the Royal College of Nursing gives a figure of 40,000.
This last figure equates to an 11 per cent vacancy rate – with learning disability and mental health nursing the most affected … followed by community nursing.
These gaps may be filled by bank or agency staff on a temporary basis … but Health Education England estimates that 1 per cent remain permanently unfilled.
The knock-on effect places nurses under “relentless pressures,” according to a report this January’s by the Health Select Committee … and a feeling their “professional registrations were at risk because they were struggling to cope with demand”.
Meanwhile, any increase in nurse numbers is swallowed up by the demand for more of them.
For example … while the number of new nursing positions created between 2012 and 2015 rose 8.1 per cent… those who actually joined the profession increased by only 3.2 per cent.
The consequence? … Well, costs obviously rise.
Temporary nursing staff are expensive … with NHS Trusts paying an average of 61 per cent more for every extra hour worked compared to a newly qualified, full-time, registered nurse.
A Freedom of Information Act request by The Open University in January this year revealed that … if the hours worked by temporary staff were instead covered by regular nurses … the NHS could save as much as £560 million a year.
The independent health think-tank, The Kings Fund, revealed that … on average … NHS Trusts were spending nearly seven per cent of their salary budgets on agency staff … with the figure rising to more than 25 per cent in some cases.
Dorset Healthcare … which covers my own constituency of South Dorset … forecasts an overall spend of £4 million this year on agency staff alone.
This is down from a high of £12 million three years ago … but still represents a significant share of the healthcare budget.
As I mentioned at the start … 18 beds were closed at Portland Community Hospital last month due to a lack of nursing staff.
Almost half of all nursing positions were unfilled in the hospital this summer.
Agency staff … costing as much as £58 per hour … and £135 per hour on Bank Holidays … were still hard to find.
Trust CEO Ron Shields decided he could no longer safely keep the beds open.
And so … despite the understandable protestations from islanders … who wish to keep their frail and elderly relatives close by … the beds migrated to Westhaven Hospital in Weymouth … where the nursing staff available can be consolidated.
I suspect this situation is replicated across the country.
The crux of the matter is the recruitment and retention of nurses.
Recruitment depends mainly upon training new nurses for the future.
The numbers required are traditionally set by Health Education England … which then commissions the nursing places from further education and training establishments … including colleges … universities … and the Open University.
Standards are set and approved by the Nursing and Midwifery Council … ensuring uniformity across providers.
These establishments, in turn, invite applications, either for Registered Nurses … Nursing Associates … Nursing Apprenticeships … and Nurse First.
The first role requires a degree … the second a prior healthcare qualification … the third is a joint initiative between individual health trusts and further education establishments … while the fourth is a new initiative to fast-track high-flying graduates and follows the lines of Teach First.
The first, three year degree option remains the main route into nursing.
While many … like me … dispute the need for a degree … the Nursing & Midwifery Council says that is to misunderstand modern nursing.
Registered nurses are now an ‘officer class’, according to Geraldine Walters, the NMC’s director of educational standards … with much of the work for degree-level nursing now highly technical and demanding.
In some cases … registered nurse prescribers replace doctors and … indeed … even run their own primary care clinics in London.
So far … the two-year Nursing Associates programme, set up in 2015, has been a success.
In December 2017, 2,000 Nursing Associates were in training.
This year … it’s hoped that figure will be 5,000 … rising to 7,500 from 2019.
The Royal College of Nursing and Nursing & Midwifery Council are clear … that more recruitment and widened access into nursing training are essential … as is the diversity of training provision.
The Open University, for example, provides for those … who for a variety of reasons … would not gain access to the profession via the traditional, campus-based route.
Since 2002…Open University has offered a four year registered Nurse Degree Apprenticeship … in addition to the straight-forward apprenticeship….aimed specifically at existing healthcare support workers … who welcome the chance to earn while they learn new skills.
So far it has trained more than 1,000 applicants as registered nurses … with 940 more currently on the programme in England and will be offering the Nursing Associate programme in the future.
One huge benefit to the scheme is that participating Trusts seem better able to retain nurses they have trained.
Compare this with the 24 per cent drop out rate for student nurses on the degree course.
And as the NHS is the nation’s biggest contributor to the 5 per cent apprenticeship levy … what better way to expand the number of nurses.
This has been badly affected by what the Royal College of Nursing says is a serious own goal – the end of the bursary scheme in August last year.
The bursary was a support package … including tuition fees … a non means tested maintenance grant … a means tested bursary itself … and other elements designed to help students with placement … travel … and childcare costs.
It was overwhelmingly popular … attracting more applicants than there were places.
It was replaced by the Student Loans Scheme … requiring students to borrow money to pay for their training.
The problem is that nursing is a vocational training and does not cater for school leavers unsuited to the profession.
Significantly … since the bursary was removed … the number of applications for nursing through UCAS has fallen by a third since March 2016.
While the Department of Health says there are 52,000 nurses in training - more than ever before – those accepted onto courses is still down by 9.3 per cent in England (and 5.8 per cent in the UK).
This threatens the pipeline of new nursing talent and … at the very least … should have been anticipated.
Much needed mature applicants … many with care experience … are also deterred by the burden of debt … and loss of earnings.
And these are exactly the people the profession needs, Ms Walters told me.
They also tend to choose careers in specialist areas worst hit by the staffing crisis such as learning disability and mental health.
New figures from UCAS show that applications for both nursing degrees and from mature students are down by 33 and 42 per cent, respectively, since March 2016.
As the latter group are the very people who would be grateful for any support given … and probably remain in the organisation until retirement … Mr Shields suggests that Trusts should provide some form of financial support in the absence of bursaries.
A recent survey by the Open University showed what effect the loss of the bursary has had on recruitment.
Only 30 per cent of nurses asked said they would have been willing to self-fund or partially self-fund their initial nursing education.
In addition … more than half of those surveyed believed applications would continue to fall.
Attracting nurses back after they’ve left the NHS is another, crucial focus for recruitment.
The Return to Practise Campaign, run by the Nursing & Midwifery Council … which provides refresher training and a re-entry route back into the NHS … has already recruited almost 2,500 former nurses and is currently registering another 1800.
However … as the Health Select Committee report states: “Too little attention has been given to retaining the existing nursing workforce, and more nurses are now leaving their professional register than are joining it.”
The Committee cites many causes, including: … workload pressures … an inability to meet patient expectations … concerns about providing adequate care … poor access to continuing professional development … poor organisational culture … pay restraint and budget cuts.
The impact of Brexit was another reason … although … interestingly … briefings from the Commons Library show that overall EU staff numbers in the NHS have in fact fractionally risen since the referendum … with EU nurse numbers falling by just .3 per cent.
Another issue is the current pension arrangements.
Senior and experienced staff, who might want to work beyond 55, are leaving because their pensions reduce in value if they stay on.
Mr Shields has recently lost two senior members of his team … and believes the Government must look at this urgently.
A partial solution to increase nurse numbers is to recruit from abroad … including commonwealth countries.
However, this was … until recently … severely limited by immigration rules which were wisely relaxed in June after an intervention by Home Secretary Sajid Javid.
In December 2017, Health Education England published its draft heath and care workforce strategy for England to 2027.
Facing the Facts, Shaping the Future anticipates a significant shortfall in nursing numbers due to an increase in the number of posts needed.
The Health Select Committee has emphasised that future projections of demand for nurses should be based on demographics … rather than on affordability alone.
A final work force strategy is expected from the Health Education England at any minute - and perhaps the Minister will have more information on this …?