NHS Nurses: Recruitment and Retention (Hansard, 24 March 1988)

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skelmersdale)
My Lords, the most common estimate for qualified staff leaving the National Health Service is 10 per cent. This means for the United Kingdom some 30,000 a year. Health authorities have been asked to mount back to nursing campaigns including refresher training and to provide more flexible working arrangements for those with family 292 commitments. Nationally, a Department of Health and Social Security and a National Health Service working party on equal opportunities for women will shortly make recommendations on managing the career break.

§ Baroness Young
My Lords, I thank my noble friend for that reply. In view of the importance to the National Health Service of the recruitment and retention of nurses, can he say whether this is a matter which is being looked at by the internal inquiry which is currently being conducted into the National Health Service? Can the Minister tell us the position regarding Project 2000?

§ Lord Skelmersdale
My Lords, I cannot tell my noble friend whether this matter will be looked at by the review. It has been looked at by the Project 2000 team. The Government expect to respond to that by Easter.

§ Baroness Seear
My Lords, may I ask the Minister what financial assistance is being given to women who want to take the back to nursing training programme? Is the Minister aware that I was informed not long ago of one woman who had taken it and who had to pay all her own expenses? Surely this is no way in which to encourage people into a very under-staffed profession.

§ Lord Skelmersdale
My Lords, it will vary in different parts of the country. The back to nursing campaigns are conducted up and down the country by the district health authorities. It is up to them to use such means, whether financial or otherwise, to encourage back to nursing campaigns.

§ Lord Ennals
My Lords, will the Minister accept the estimate of the Royal College of Nursing that there are now about 200,000 registered nurses who are in a sense the target for the back to nursing campaign? Will the Minister also accept that there are some very severe recruitment problems due to poor pay and stressful working conditions? There is also a drop-out rate of about 6,000 a year of nurses in training. Can the Minister confirm those facts?

§ Lord Skelmersdale
My Lords, no, not entirely. I observe that the United Kingdom Central Council and the Royal College of Nursing have made the estimate of 200,000. I am afraid that the Government's figures differ substantially. Our figures are some 90,000. Whichever figure is correct, this does not mean that these nurses are all lost to the profession for all time. They are mainly having a career break. This is where the point made by the noble Baroness comes in so strongly. They are caring for relatives or there are no suitable posts in the area and they are not prepared to re-train.

§ Lord Kilmarnock
My Lords, is it not the case that the London authorities alone are spending £40 million a year buying-in agency nurses? Is that not a very strong case for increasing the attractions for nurses in the National Health Service? Is it not further the case that the Project 2000 referred to by the noble Baroness is being studied by the noble 293 Lord's department at the moment? Will the department make a written reply?

§ Lord Skelmersdale
My Lords, I regretfully confirm that the number of agency nurses working in the health service at September 1987 was about 6,000; that is in whole-time equivalents. That is an increase of 15 per cent. over 1986. About 85 per cent. of these nurses are in the Greater London area. From asking questions around the special health authority hospitals, I know that there are occasions when agency nurses may be cheaper than full-time NHS-employed staff.

§ Lord Mellish
My Lords, is the Minister aware that young girls coming into the profession and training as nurses are being bombarded with propaganda from abroad, particularly from America? They are being told that when they qualify as SRNs they can earn far more money in America than they are likely to get in England. They are offered every possible inducement. What are the Government doing about that situation; can anything be done to counter it?

§ Lord Skelmersdale
My Lords, it is not the Government's philosophy to direct trained people in any particular direction even when, as in this case, they provide the training themselves. What matters is the quality of life. The recent reduction in the tax rates, thanks to my right honourable friend's Budget, means that it will be easier to keep those nurses in this country.

§ Baroness Cox
My Lords, is my noble friend aware that last year there was a successful recruitment campaign for more than 1,000 British nurses to go to the United States and 500 to go to Australia? Many of them were qualified specialist nurses. Will sympathetic consideration be given to recognising in terms of salary structures specialist qualifications and also regional shortages in order to encourage nurses to stay in service and in this country?

§ Lord Skelmersdale
My Lords, my noble friend is quite right, and this is another strand of the Government's policy. This is why we have asked the nurses and midwives' pay review body to do exactly that, with special emphasis on regional variations where there are regional shortages.

Lord Winstanley
My Lords, does the noble Lord recollect that in a recent discussion on this subject on a Question asked by the noble Baroness, Lady Cox, he gave some very encouraging information about the provision of affordable living accommodation for nurses? As I am always anxious to afford Ministers an opportunity to give good news, can he tell us anything else about developments on that front?

§ Lord Skelmersdale
Not at the moment, my Lords, but I can confirm that in areas such as Greater London high costs for living acommodation can make recruitment and retention especially difficult. We have therefore welcomed the announcement by the Nationwide and Anglia Building Society of a 294 scheme to provide low-cost 100 per cent. mortgages to help National Health Service staff cope with high housing costs in London. We hope to seek agreement to extend this scheme once it gets fully off the ground.

Lord Wallace of Coslany
My Lords, does the noble Lord remember that yesterday I mentioned the drain of nurses to the private sector and overseas? I proposed once again that a levy should be imposed to recover costs, which might help to give the nurses in the health service a better deal on pay and conditions.

§ Lord Skelmersdale
Yes, my Lords, I recall the noble Lord saying that and I recall specifically not answering him. However, it is important that we look at the level of nurses across the whole hospital and community sector, private and public. I am not sure that a levy would be the right way to go about this, but I know that my right honourable friend the Secretary of State for Social Services has recently suggested that the private sector itself should enter into discussions for nurse training.

§ Baroness Robson of Kiddington
My Lords, does the noble Lord agree that, as mentioned by the noble Lord, Lord Ennals, the number of student nurses leaving the profession due to excessive pressure because wards are not fully staffed is perhaps one of the most worrying aspects of the problem? Looking to the future, we shall not have a sufficient number of nurses and therefore we should concentrate on properly staffing the wards in which the students work.

§ Lord Skelmersdale
My Lords, I agree with the noble Baroness, but I would point out that at the moment in England there are 23,700 leavers, who are more than replaced by 7,100 nurses returning to nursing, together with 22,650 from the schools of nursing. That is a total of 29,750.

§ Lord Ennals
My Lords, is the noble Lord not concerned about the information he gave the House about a trend towards agency nurses? Whether or not they are cheaper—and I was surprised by what he said—does he not agree that it is far better for a hospital to be staffed by full-time regular employees than by people who may be in for a week or two according to what their programme is? Does that not show the importance of being able to attract by good pay and conditions new nurses into the health service?

§ Lord Skelmersdale
My Lords, the noble Lord misunderstood what I said. I said that I was concerned about the trend but I pointed out that there are occasions when agency nurses can be cheaper.

§ Lord Sefton of Garston
My Lords, arising from the question asked by the noble Lord, Lord Mellish, does the Minister accept that the Chancellor was right to give incentives in the form of tax cuts to the higher paid in order to keep them in this country? If he accepts that as right, can we not do the same for the nurses, or is this another example of the double standards of the Government?

§ Lord Skelmersdale
My Lords, I regret to say that the amounts of tax reductions for the higher paid have very little to do with nurses. What does have to do with nurses in terms of the Budget reductions is that the average female nurse will now have nearly an extra £3 in her pocket every week.

§ Lord Kilmarnock
My Lords, can the noble Lord give us chapter and verse for his rather—

Noble Lords
Next Question!

§ The Lord Privy Seal (Lord Belstead)
My Lords, if the noble Lord will forgive me, it is the House itself which has agreed through the Procedure Committee that we ought to get through Questions in 20 minutes. We shall not do so today because we have another Question to come, but I think that the moment has come to go on to the next Question.