§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jim Murphy.]
2.17 pm§ Vera Baird (Redcar)At the last election, we pledged that 20,000 nurses would be recruited to the national health service by 2004. The biggest constraint, we said, facing the NHS was no longer financial resources but human resources. Consequently, the Government have since deployed a highly successful recruitment campaign to get new nurses into the NHS.
At Redcar and Cleveland college in my constituency, there is an access to nursing course. It is an intensive course, and takes a year. Successful students receive a level 3 qualification, enabling them to seek university experience. Redcar and Cleveland is a highly successful college, and led by its respected principal, Mr. Old, it has concentrated efforts on widening access to further and higher eduction.
The Redcar constituency is in Teesside and suffered for generations from post-industrial decay, inner-urban poverty and social deprivation. It has the well recognised health inequalities that go with that total picture. Unemployment is 7.6 per cent., or more than twice the national average. Clearly, Mr. Old and the college's efforts, and those of his staff in widening access, are particularly appropriate.
Last year many people who enrolled in the access to nursing course were women over 21, and many were single parents. They were benefiting from the new deal for single parents, which was aimed at getting exactly this target group into work. Their tuition fees are paid, as are their fares. They get some extra benefit and a book allowance.
In addition, such students make the most enormous personal effort. Many of them have been out of education for a decade. Many did not do particularly well or make much effort when they were at school. They will not have seen themselves as studious, nor even, in Redcar, as people who would ever have a job, let alone a profession. Many will have started the course with real excitement but with real doubt as to whether they could make it. If they had children, they had to juggle the role of parents with entry into the unfamiliar and daunting world of study.
The college is good at student support, and 36 students passed. Historically, 80 per cent. of the successful students on Redcar and Cleveland's nursing course have gone on to complete their nursing training, principally on the nursing courses at Teesside university. This year, only five of the 36 got a university place to carry on their training to become nurses. There are universities further afield, but there are at least 50 miles to travel in each direction, and the Redcar and Cleveland college intake mainly comprises people who need to study locally because of family commitments. As part of the "making a difference" programme, the courses at Teesside university were designed to be exceptionally family friendly. Its nursing diploma and degree courses are very good and highly sought after; they are graded "excellent in quality" by the Department of Health.
The university allocates places by setting selection interview criteria and offering a place to each person who passes—it does not cherry-pick the stars. I am assured by 581 the university that the reason for Redcar and Cleveland college's low admission rate was not the quality of this year's applicants—the problem is that there are not nearly enough places, because it is massively oversubscribed. This year, there are 401 places for which there were 1,740 applications.
Oddly, in the context of the continuing campaign for nursing recruitment, the university was given no extra funding this year to increase its number of places. There are 401 places on the nursing training course this year, just as there were last year. Both the director and the deputy director of the school of health and social care tell me that although they have to be innovative with clinical placements, they could never take all the applicants—but they could increase their places by another 50 a year. It is startling that funding for expansion of this high-quality course, in an area of highly successful recruitment of a target group into training, in a place of high unemployment with a shortage of nurses, has just stopped.
Health care assistants are an excellent source of recruitment to nursing. As trust employees, they already have a good insight into the role of the nurse, so wastage is very low. Often, the employee does the practical part of their training with the home trust, so the local rewards are reaped early in the training process and the benefit is likely to be permanent. Tracey Christon is a health care assistant. She is a 28-year-old Redcar resident, a single parent with one little girl. She has worked at East Cleveland community hospital for 10 years. She is very good, and almost as soon as she went there her ward manager told her that she would make a good nurse. Tracey felt too young at 18 to be sure what she wanted to do, but by three years ago she had decided. She studied for national vocational qualifications and quickly got to level 3. She was rightly encouraged, in all good faith, by her ward manager and by Lanbaurgh primary care trust, her employer. She was told that if she got a place at university, she could be seconded on her salary to train, then come back to work as a nurse.
This year, Tracey got a place at Teesside university on the nursing diploma course. But four health care assistants applied for secondment from Lanbaurgh PCT, and only two secondments were available. Tracey was not offered a secondment. Neither was another applicant, not a constituent of mine, but no doubt just as distressed, feeling just as rejected and feeling, too, that the whole nursing recruitment campaign had misled them. The chief executive of the Lanbaurgh PCT tells me that if he could have four secondments, he would definitely want them. He clearly has faith that all four of his employees should be advancing their careers exactly as they wish.
In Middlesbrough and Eston PCT, the other PCT in my constituency, there is an urgent need for practice nurses for GP practices. There are eight secondments for those in Tees this year. The area has at least three PCTs. The chief executive of the Middlesbrough trust tells me that he would like to have all eight for his own trust, so critical is the need for practice nursing training.
Teesside has a shortage of nurses. It is an acute problem because, as I have said, in common with other socially deprived areas, it has considerable health inequalities. As at 30 March, the South Tees trust had whole-time equivalent vacancies of 50.6 nurses. Tees and North Yorkshire, which has been succeeded, save for the mental health functions of the two local PCTs that I have mentioned, has 27.2 whole-time vacancies. North Tees 582 and Hartlepool and its PCT have 54.9 in total. That excludes all the nursing care in nursing homes and the whole of the independent sector.
Further—I think that this is commonplace—in particular in district and community care nursing, nurses are ageing. There is an estimate from the Royal College of Nursing that nationally a quarter of these nurses are due to retire in the next five years. I do not have any local figures for that.
South Tees has recently carried out a successful recruitment drive and brought 12 Spanish nurses over to work. Hartlepool has recruited some nurses from the Philippines. I appreciate the difference between recruiting qualified nurses for remedial work and recruiting for training. The university deputy director of the health and social care school tells me that it will continue to fail to meet local targets for training and recruitment if it does not recruit overseas.
I have no criticism of overseas nurses. If I have the good fortune to come across any of the new Spanish people who have moved into Redcar, I shall no doubt drive them out with my appalling south American Spanish. I shall try to persuade them to offer me paella. They will add real interest to the Teesside culture. However, we have high local unemployment. The context of a group of local people who are desperate to become nurses, of many nursing places that we are desperate to have filled, of insufficient funding for university places and insufficient secondments for health care assistance, suggests that some cogs are coming loose or even falling off the wheel of the machine in my area.
The County Durham and Tees Valley workforce development confederation plans the work force needs and supplies and commissions the education and training for all the health trusts in its area. I have spoken to two people from the confederation. They tell me that the transition from the old trusts to the new may have meant that historical data on demand for secondments have been mismatched. They say that the confederation has been a victim of its own success in recruiting among health care assistants. They say that all the health care assistant secondments in the confederation's area have already been taken up. They say that they will respond by looking elsewhere in the budget to see whether they can help Ms Christon.
The two representatives say that the confederation needs to become more sophisticated in meeting the demand. They say also that overall the confederation is meeting its targets, but they appreciate that there are areas in which that is not happening quickly enough. They make it plain that they too are working within a budget and have limited room for manoeuvre.
I am grateful to have received briefings after obtaining this debate from the RCN and from Unison, the health care assistants union, and also for the information that I have quoted which was given me by all the health care stakeholders to which I have referred.
I am not in a position to define whether the problem, and it is a local one, is one of too few resources or of inaccurate targeting. I do not know whether it is both or neither. However, I ask the Minister to give attention to this issue. There are a number of people in my constituency who have been thwarted in their ambition to serve the community in which they live as qualified nurses. They have been led to believe by our recruitment 583 campaign that they are needed. My research has made it clear to me that these people are needed to maintain the high quality of health care on Teesside.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)I congratulate my hon. and learned Friend the Member for Redcar (Vera Baird) on raising an extremely important issue, not only in her area but for all communities that are trying to ensure that the extra resources for the national health service are spent wisely and well in recruiting the extra staff that we need to deliver services to those whom we represent.
As my hon. and learned Friend said, funding for the NHS is improving at a remarkable rate. The problem facing us is not money to deliver improved services, but the capacity of the work force. That is not only nurses but doctors, therapists, physiotherapists and occupational therapists—the entire range of professions that work in the NHS. All of them are under tremendous pressure, mainly as a result of the cuts in training places that have taken place over the past 10 years and longer. We are now trying to catch up as rapidly as we can, by expanding the number of available training places.
It is clear that to deliver the services that patients and the public rightly demand, we must be focused about where we spend the extra money—
§ It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed,That this House do now adjourn.—[Mr. Jim Murphy.]
§ Ms BlearsWe have to be sure that the extra resources available for the NHS are spent in a way that delivers real tangible improvements on the ground. I entirely acknowledge that one of the key challenges that we face is the shortage of staff. If we do not have enough staff we cannot provide the services that we want, and we shall not meet our targets.
The NHS plan has set some pretty demanding targets for increasing the number of professionals working in the service. I am pleased to say that the nursing target has been met ahead of schedule, and the numbers of doctors and therapists are increasing. There are over 30,000 more nurses working in the NHS today than there were in 1997. But we know that that is not nearly enough. Our latest projection is that there will be at least 35,000 more nurses in 2008 than there are today. We set targets in the NHS plan, but we have already met those and we are now pushing on with further increases.
It is therefore crucial that we also set targets for increasing the number of training places for students. Meeting those targets is the key to delivering the longer-term sustained growth that the system really needs.
There is more to this than just increasing the number of training places. We are also investing in "return to practice" initiatives, and trying to make the NHS a better employer. Every member of staff in the NHS is entitled 584 to work for an organisation that is genuinely committed to flexible working conditions. We have already invested in child care provision to enable parents of younger children to remain in work or return to practice, and between February 1999 and March this year more than 11,200 nurses returned to practice, in addition to the new recruits that my hon. and learned Friend has mentioned.
It is worth comparing the position with that in 1997, when the number of training places for nurses had been cut, and there were fewer than 15,000 left. The shortage of nurses on the wards in many parts of the community today is in no small part the result of the short-sighted policies pursued in the early 1990s. There were too few places, and not enough people wanted to go into nursing, either. There was a real recruitment problem.
The NHS plan target is that by 2004, 5,500 more nurses and midwives will enter training each year than did so in 1999. Achieving that target will mean that over 9,000 61 per cent.—more students will start training as nurses and midwives in 2004 than did in 1997. We have already increased numbers by more than 3,000, and we are on course to achieve the plan target.
However, that is only the first step. We now have a commitment that by 2008, there will be 8,000 more students per year leaving training than there were last year. We are setting the service really challenging targets, and trying to ensure that we can recruit students right across the range of professions. That means that we need to be a bit more creative in our thinking about the skills and aptitudes that people need to train as nurses. In the past we have been a little too restrictive about the qualities that nurses need, and we need to try to encourage people who may not even have thought of going into the profession to do so. My hon. and learned Friend rightly talked about people in her constituency who may not have been in work at all, let alone considered themselves natural entrants to a profession such as nursing.
We are trying to provide more flexible pathways into both nursing and midwifery education, and acknowledge that mature people have requirements different from those traditionally associated with school leavers. Access courses provide an alternative to the traditional requirement for GCSEs, and offer a second chance to people who did not achieve good results in school. Some of the new pathways are targeted at future careers in nursing, through access courses, but others are more general and allow entry to a range of higher education courses. I recently went to look at one of the courses in the sixth form college in my constituency, and there were many young people there thinking about careers as varied as social work and radiography, as well as nursing. That whole range of professions is important to us.
My hon. and learned Friend mentioned health care support workers, who can be seconded on to nurse training courses. In such a situation, students receive the same amount of money to train as nurses as they received to work as support workers. That has proved a popular route to training. More than 6,000 people have begun training in this way since 1998, and some 2,500 new secondees are being supported each year. Alternatively, health care support workers with appropriate vocational qualifications can fast-track nurse training by missing part 585 of the normal three-year programme, and their existing skills and competences are explicitly recognised. Such initiatives are another example of creative thinking.
Several new schemes are being developed, including cadet schemes, which try to widen access to professional training. Cadet schemes target groups within the community that historically may have been excluded from a career in the NHS, and provide a first step on the ladder. Cadets are given the opportunity to gain work experience, and to gain the qualifications needed to enter the entire range of health professions. Cadet schemes have been extremely useful in promoting social inclusion, and in developing a work force that reflects the diversity of the local community by drawing on people who, traditionally, have not been involved in the NHS.
There are more part-time and flexible courses, and universities are providing evening and weekend courses to cater for students with family commitments. We are developing stepping-on and stepping-off points for nurse education programmes, so that people can study at a time that suits them, and which fits in with their caring responsibilities, for example. A wide range of alternatives are now on offer, because of the desperate need to recruit to fill nursing shortages. All of those initiatives are producing very good results, and recruitment is beginning to increase dramatically. Indeed, according to my hon. and learned Friend, the university to which she referred is the victim of its own success. It is true that many more people now see a future in nursing and in the health service generally, and the challenge is to keep up with their desire to enter the service.
However, we must recognise that, even allowing for the massive expansion in the NHS, we do not have a blank cheque. Sponsoring health care assistants is a fairly expensive way of training new nurses, costing almost twice as much as traditional recruitment routes. NHS trusts pay 20 per cent. of the cost, and the remainder is met from centrally held education and training funds. As with the rest of the NHS, hard choices sometimes have to be made about what can and cannot be funded, and about the rate at which such places can be funded. Another sponsored place for a health care assistant could mean one less place for, say, a radiographer; indeed, there is a huge shortage of qualified radiographers. Such choices always have to be made. Sponsoring health care assistants is an expensive route, but it does attract those who perhaps would not have been drawn in before.
My hon. and learned Friend mentioned a constituent of hers who works at Langbaurgh primary care trust, and who successfully completed an access course at Redcar college. She was one of four applicants for two sponsored places at her trust, but she was unsuccessful on that occasion. I do hope that she will not be put off from pursuing her career of choice, and that she will be successful next time around. The NHS needs dedicated staff, whether they are working as health care assistants, therapists, scientists or nurses. I should point out that, although only two places were available at that PCT, just a single place was available last year. Wherever we can, we want to encourage those who have completed access courses and shown genuine good will and personal commitment. There is a career for them in the national health service, and we want them to secure their places through the system.
586 My hon. and learned Friend also pointed out that the workforce development confederation commissioned only eight training places for practice nurses, and that Teesside and Middlesbrough primary care trust could have used all eight places. In fact, eight practice nurses were commissioned for Teesside and eight for Durham. The 16 places form part of 88 places that the WDC has created through its community pathways scheme. Chief executives of the trust were involved in the commissioning plans. Although I accept that my hon. and learned Friend's PCT could use many more people, there is a genuine attempt to involve the PCTs in drawing up work force plans so that they can help to shape the decisions. They have a financial stake because they have to pay the 20 per cent. secondment costs. The trusts are therefore key partners in trying to ensure that that happens.
My hon. and learned Friend mentioned vacancy rates. In her area, they are lower than the national average and to some extent, they reflect increasing recruitment throughout the NHS. More nurses are working on the wards and vacancy rates are falling.
There is anxiety in some areas about the ageing work force, especially health visitors, district nurses and school nurses. That is important, and the workforce development confederation needs to take account of the demographic and age distribution of the work force to try to ensure that people come through when they are needed.
The health care assistant to which my hon. and learned Friend referred was one of 35 people who completed the access course at Redcar college and hoped to go on to take a nursing degree at Teesside university. Four people were given places, but the others were unsuccessful this time. That was due to the popularity of the course at Teesside; there are more applicants than places. The workforce development confederation is continuing its discussions with the university to ascertain whether it is possible to increase the places.
However, we are not simply considering getting students on the courses. There are knock-on effects, including the number of lecturers, places and practical placements that the university can provide. High quality placements in the field constitute a key element of the course. They are not easy to organise and they should be viewed as part of the full picture. Increasing training capacity takes time. It is not simply a question of providing more funding, but establishing all the other elements to which I referred.
The picture of nurse training is generally healthy, although I accept that my hon. and learned Friend has difficulties locally. The non-medical element of this year's training budget is £1.3 billion; the budget for nurse training is £850 million. It has increased by more than 75 per cent. since 1997. The County Durham and Tees Valley workforce development confederation funded 15 per cent. more nursing places this year than last year. There are 20 per cent. more sponsored places, although they are more expensive. The university offered and filled 169 places for courses starting in September and 188 for courses starting in January.
We are now training more nurses nationally than we have done for a generation. There are more qualified nurses than ever on our wards and nurse vacancies are down. We have turned the corner, and the NHS is beginning to experience the benefit of our increased 587 investment. However, I am the first to agree with my hon. and learned Friend that, although we have made progress, much remains to do, and we must not squander the energy, enthusiasm and the determination of people in local communities who are considering a long-term career in nursing. We must do everything in our power to ensure 588 that the places, encouragement and financial and practical support exist, and that those people become part of the NHS work force, which will provide world-class services to people in our local communities.
§ Question put and agreed to.
§ Adjourned accordingly at seventeen minutes to Three o'clock.