HL Deb 22 January 1987 vol 483 cc1029-32

3.7 p.m.

Baroness Cox

My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government what policies they are proposing to alleviate the current and projected shortfalls in recruitment to schools of nursing.

Lord Hesketh

My Lords, although the number of qualified nursing and midwifery staff continues to increase, we are well aware of the situation regarding recruitment to nurse training and the difficulties that are likely to occur due to the reduction in the number of 18 year-old school-leavers with the appropriate qualifications. In welcoming the publication of the United Kingdom Central Council's proposals for the reform of nurse education and training in Project 2000, my honourable friend the Minister for Health announced on Tuesday that a major feasibility study into the extended use of the Youth Training Scheme in the National Health Service was being set up. A feature of this study is to look at the way in which such training might facilitate entry to professional nursing training and thus help to alleviate nurse recruitment difficulties.

Baroness Cox

My Lords, I thank my noble friend the Minister for his partly encouraging reply. However, is he aware of the real seriousness of the situation now confronting nursing, and that it is reaching crisis proportions owing to the fall in the number of school-leavers and the decline in the number of school-leavers who are choosing to enter nursing? Their numbers have dropped from 6¼ per cent. in 1981 to 5½ per cent. today, and only about two-thirds of them actually complete their training.

The situation is so serious that some prestigious schools of nursing, such as the Nightingale School at St. Thomas' Hospital, are having difficulty in filling the available places. Is the noble Lord aware that unless something is done as a matter of great urgency, the National Health Service will face unprecedented problems?

Lord Hesketh

My Lords, a crisis will only arise if recruitment and retention patterns remain the same. I can assure the House that action is currently being taken to overcome any problems which might arise. In addition to the feasibility study to which I have just referred, health authorities have been asked to consider increasing male recruitment and to make greater efforts to recruit mature entrants. They have also been asked to organise "Back to Nursing" campaigns to establish nurse banks and to give more opportunities for flexible working arrangements, part-time working and job sharing.

The particular difficulties in London are currently the subject of a review commissioned by the National Health Service Management Board. The management and staff sides of the Nursing and Midwifery Staff Negotiating Council are reviewing the nursing clinical grading structure. The council's aim is to develop a structure which is appropriate to current and future needs. The department is currently undertaking a special inquiry into nurse recruitment and retention problems across the country with the aim of identifying management action which may be required to overcome recruitment difficulties.

Baroness Seear

My Lords, does the Minister agree that it would be much easier to get a large-scale response to mature recruitment and a return to nursing if much better child care facilities were available and if perhaps there were some tax concessions for women who have to make use of child care facilities?

Lord Hesketh

My Lords, I am sure that the noble Baroness is possibly correct, but I do not know whether improved child care facilities are part of the Government's programme.

Lord Ennals

My Lords, may I say that some—

Noble Lords

Question! The noble Lord should say, "Is it not the case?"

Lord Ennals

My Lords, is it not the case that—

Noble Lords

Hear, hear!

Lord Ennals

My Lords, I should love to have scriptwriters at my side. Is it not the case that the Royal College of Nursing and most health authorities will be surprised at the noble Lord's response? They know that there is now a serious shortage of nurses and that a large number of wards and beds have been closed merely because of the shortage of nurses. Does he accept that in this academic year there are 6,000 fewer recruits than required in the first-year training pipeline? Does that not bode seriously ill for the future of the health service?

Lord Hesketh

My Lords, the shortage of 8,000 appears on the surface to be correct, but that figure is made up every year by people coming back into the nursing profession.

Baroness Lane-Fox

My Lords, is my noble friend aware that although those who are consumers of nursing services will be encouraged by his reply, we are nevertheless extremely worried because we realise that, with increasing longevity, unless school-leavers are encouraged to come into the service we shall be in trouble later? Is he further aware that we hope that in all this there will perhaps be some way of improving pay and conditions even more?

Lord Hesketh

My Lords, I thank the noble Baroness, Lady Lane-Fox, for her question. There are incentives to maintain nurses in the profession. The most recent pay increases from 1st July gave nurses an increase of 8 per cent. a year on basic rates at a time when inflation was running at 2.4 per cent. Even now, with inflation running at about 3.5 per cent., that represents a substantial increase.

Lord Wallace of Coslany

My Lords, is the noble Lord aware that the introduction of any scheme connected with the YTS would tend only to lower standards? At the moment, the health service's greatest need is for trained nurses. The only way to achieve that is better pay and a better career structure.

Lord Hesketh

My Lords, the department is jointly sponsoring with the Manpower Services Commission, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting and the National Health Service Training Authority a feasibility study which will explore the scope for expanding the range of opportunities available through the YTS to young people who wish to make a career in caring. One feature of the study is to look at the way such training might facilitiate entry into professional nursing training.

Lord Auckland

My Lords, will my noble friend tell the House how long that feasibility study will take? Is he aware that feasibility studies are not unusual but that they often take a long time to take effect? Will he also say what is being done about accommodation for nurses, particularly in areas where there are high rents? Is he aware that that is a serious disincentive?

Lord Hesketh

My Lords, in answer to my noble friend's first question, I do not know the exact date when the study will be finished.

Lord Strabolgi

My Lords, on the subject of accommodation, will the noble Lord take seriously what the noble Lord, Lord Auckland, has said? Is he aware that many special hostels for nurses have been closed for reasons of economy and that nurses therefore have to find their own accommodation some way away from the hospitals and go home late at night through streets as dangerous in the past few years as they were during the eighteenth century?

Lord Hesketh

My Lords, I am sure that many of your Lordships were here yesterday when we had a most informative debate during which this subject was also covered. One of the points made was that not only is there a problem over housing accommodation for nurses but that the accommodation which already exists is no longer considered appropriate. That is a feature of society and the changing age in which we live.

Lord Molloy

My Lords, will the noble Lord bear in mind what the noble Baroness, Lady Cox, has said: that the situation is reaching crisis proportions? Is the department at least prepared to consider having consultations at a regional level with the staff associations which know a great deal about this problem and which, in turn, could consult with local authorities in an endeavour to resolve the problem?

Lord Hesketh

My Lords, the department has always had a policy that the recruitment of nurses is encouraged and completely organised on a regional basis.

Baroness Cox

My Lords, does my noble friend agree that a percentage increase on a low salary is still a low salary; that newly-registered nurses still earn only about £6,500; and that many leave as soon as they have finished training?

Lord Hesketh

My Lords, under the current rates of pay the basic starting rate for a staff nurse is £7,750.

Lord Leatherland

My Lords, is it not a fact that because nurses make good wives many of them marry earlier than they otherwise would?

Lord Hesketh

My Lords, I am sure that many Members of your Lordships' House will agree with that.