Nurses, Midwives and Health Visitors

Part of the debate – in the House of Commons at 9:33 am on 13th January 1999.

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Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health) 9:33 am, 13th January 1999

I am grateful that you, Madam Speaker, have chosen for our first Wednesday morning debate of the new year the extremely topical subject of pay and conditions for nurses, midwives and health visitors. Out there in the country, a lot of people will be pleased that we have been given this opportunity for such a debate.

First, may I perform the usual courtesy of welcoming the Minister, who has a great opportunity? In one speech, he could guarantee a successful career and make himself popular with the whole country, hugely popular with the health service and entirely popular with hon. Members on both sides of the House. I look to him to rise to an unparalleled occasion. I shall give him a few prompts and hope that he will respond appropriately.

As hon. Members know, in a couple of weeks, the pay review body will recommend what should be paid to nursing staff, midwives and health visitors for the coming year. The Secretary of State for Health said the other day that the country faces a crisis in the health service. The Royal College of Nursing, also in the past few days, has said that the crisis in terms of shortage of nurses in the health service is the worst for a quarter of a century. Midwives say that the number of registered midwives has fallen by 2,500 over the past five years, and that the number of registered and practising midwives is lower than at any time this decade.

I am conscious that the debate is about only some of the people who work in the health service. We could have had a debate a wide-ranging debate about all NHS employees. May I allay their concerns and possible jealousy? We pay tribute to all those who work directly for the health service or are contracted to it. Although I shall concentrate on the largest group in the health service, I hope that—if you are generous, Madam Speaker—we will soon be able to debate the other two large groups, which also have pay review bodies and have their futures determined in the same way: the professions allied to medicine—chiropodists, dieticians, occupational therapists, orthoptists, physiotherapists and radiographers—and related grades and, of course, doctors and dentists. I am conscious that they, equally, play a part in the team, as do those who are not yet covered by the review body procedure, such as psychologists and psychiatrists.

We are grateful to all those people, but it seemed appropriate to debate nurses, midwives and health visitors, not only because they are the largest group, but because they are the group which manifests the most severe problems of recruitment and retention. It is vital to the future of the health service that we find solutions to those problems.

The national health service employs slightly fewer than 1 million people, which makes it by far the largest employer in the country. The review body considers workers in Scotland, England and Wales and recommends for the three countries together. We are discussing the futures of about 750,000 people in these professions. Interestingly, and perhaps relevantly, about 80 per cent. of them are women. As a man, I must say that, had the gender balance in the health service been different during the 50 years of its existence, wages for nurses, midwives and other health workers would not be relatively as low. Everybody in the health service should be paid appropriately, especially those who often have the larger caring and outside-work responsibilities.

The latest available figures show that there are about 600,000 practitioners on the United Kingdom Central Council for Nursing, Midwifery and Health Visiting register, but they also show a lot of alarming trends. I shall spend a couple of moments discussing the background statistics before coming to the argument and where we go from here.

The statistics show that the number of people available, on the list and qualified to work has gone down by about 2 per cent. in the past year, which is the biggest annual decline ever reported. People in the professions are also aging rapidly. We all age rapidly, but the profile of people in these groups is changing significantly. Fewer than one in seven is under 30, and more than one in eight is 55 or over and eligible for retirement. The trend looks unhelpful, because, within about 10 years, a fifth of all nurses will be over 50 and retirements are likely to increase from about 5,000 a year to about 10,000.

That means that we must replace those at one end of the health service who are leaving because of age, but, unhelpfully, we do not appear to have the numbers coming in at the other end. The number of people coming on to the register has fallen by more than a third—from about 19,000 a year to about 12,000—and we have lost a third of that number in the past 12 months. Thus, recruitment has declined over the past 10 years but the last big decline has been in the past year.

Not surprisingly, we have had to look abroad for people to help the health service. Although that issue has been well publicised, we are talking about small numbers—of more than 500,000 employees, only some 4,500 people from overseas work in our health service. We cannot, therefore, hope to rescue the NHS by bringing people from overseas.