Nursing Shortages

Private Members' Business – in the Northern Ireland Assembly at 3:30 pm on 24th October 2016.

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Photo of Caitriona Ruane Caitriona Ruane Deputy Speaker 3:30 pm, 24th October 2016

The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. One amendment has been selected and published on the Marshalled List. The proposer of the amendment will have 10 minutes to propose and five minutes to make a winding-up speech. All other Members will have five minutes.

Photo of Sydney Anderson Sydney Anderson DUP

I beg to move

That this Assembly acknowledges the ongoing problem of nursing shortages in Northern Ireland; recognises the work carried out by former Health Ministers and health and social care trusts to address this problem; and calls on the Minister of Health to build on these efforts by working proactively with our colleges and universities to promote nursing as a career choice and to work collaboratively with the relevant bodies to train and retain more nurses, thus reducing the total spend on agency workers and assisting long-term workforce planning.

I welcome the opportunity to bring forward this motion on addressing nursing shortages in Northern Ireland. I believe that this issue is one of significant importance that needs to be raised in the Assembly, and that is why I have brought this motion forward in my name and that of my colleagues. I also wish to declare an interest as I have family working in the nursing and midwifery professions.

It has to be recognised that the problem of nursing shortages is not unique to Northern Ireland but is a problem right across the United Kingdom and, indeed, the wider world. We all want to see the health service working properly, and we and our families all value and make use of it. Nursing shortages is an issue that has been highlighted many times in the media, and it is raised by my constituents on a regular basis. Throughout my time as an MLA, I and my colleagues have had regular meetings with the Southern Health and Social Care Trust and, at our most recent meeting a few weeks ago, addressing nursing shortages was a topic that was high on the agenda.

I would like to put on record my sincere thanks and gratitude to the dedicated nursing staff that we have right across Northern Ireland. They go above and beyond their call of duty to help and support the patients in their care, often working long, unsociable hours under significant pressure and stress. Nurses have a genuine compassion and caring nature and want to help others in need. It is not just a job to them. I feel that we must do all that we can to support them in the work that they do.

We must recognise that the circumstances and needs of our society and health service are changing all the time. We now have an ever-growing ageing population, which presents significant challenges to our health and social care services. In addition, we have witnessed an increase in the number of people with chronic conditions and have seen an increase in the number of people who lead unhealthy lifestyles. It has, in fact, been noted that the demand for health and social care services is rising by around 5% each year. Clearly, the health and social care sector has had to operate in a more challenging environment in recent years. This means that we have to be more efficient and ensure that finances are directed to the areas that are most in need.

In recent times, former Health Ministers, the health and social care trusts and other key agencies have attempted to address the ongoing problem of nursing shortages. An example of this is that, during the previous mandate, nearly 1,200 more nurses and midwives were employed. At the end of March 2016, the previous Health Minister, Simon Hamilton, also announced an increase of 100 preregistration nurse training places in Northern Ireland from autumn 2016, taking the Department's annual commission of training places to 745 nurses.

It was noted in the document, 'A Workforce Plan for Nursing and Midwifery in Northern Ireland (2015-2025)', that 21% of newly qualified Queen's University nurses and midwives left Northern Ireland in 2011-12 , compared with 10% in 2009-2010. Ulster University said that it had no official figures but believed that approximately 7% of its nursing graduates left Northern Ireland to work elsewhere in the United Kingdom over a four-year period. It has been suggested that the number of nursing graduates leaving Northern Ireland could be as high as one third. The Chief Nursing Officer highlighted the fact that many local nursing graduates were relocating to London after their studies. In some cases, they are attracted by packages additional to what they could receive in Northern Ireland, including resettlement and enhancement of their salary.

Photo of Gordon Dunne Gordon Dunne DUP

I thank the Member for giving way. Does he agree that it is virtually impossible for two nurses and two auxiliaries to deliver a proper standard of care in a ward with 17 or 18 patients?

Photo of Sydney Anderson Sydney Anderson DUP

I thank the Member for his intervention. I have heard of many similar cases. It happens regularly, but we cannot allow it to happen if we are to ensure that patients get the care that they need. I know, as I said, that nurses in those situations go beyond the call of duty to ensure that the patient comes first.

This is a serious issue and a worrying trend, especially when we have an ageing nursing and midwifery workforce, with research indicating that up to 46% are eligible to retire in some practice areas between 2015 and 2025. Those nurses and midwives will have to be replaced in the health and social care sector. In addition, from 2011-12 to 2015-16, approximately 1,600 nurses working across our trusts retired. The Chief Nursing Officer discussed the ageing profile in different disciplines of nursing and midwifery when she recently appeared before the Health Committee. She stated that there was a significant number in the over-50 age range who are due to retire, increasing from 11% in 2015 to 30% in 2018.

I understand that there are times when hospitals have to rely on bank nurses to ensure that they have enough staff to provide care for their patients. While we require flexibility in our system, it is unsustainable to over-rely on nursing banks. I am also aware that health and social care trusts have been asked to examine their reliance on agency staff. In each of our trusts, there has been an extensive increase in the amount spent on agency workers in the period from 2011-12 to 2015-16. I recognise the contribution that agency workers make to our health service in specific short-term circumstances, but it is important that our health service manages and controls that expenditure.

In an immediate effort to address nursing and midwifery shortages, international recruitment drives have taken place in recent months. The most prominent of those was the mission to the Philippines, and it was noted that, in August 2016, a total of 488 jobs were offered to nurses from that country. I recognise that nurses from overseas play a very important role in our health service at this time, and I thank them for their dedication and their efforts to date. However, such international recruitment efforts can prove problematic. For example, there is a lengthy lead-in time before the nurses arrive to work in our hospitals and communities due to language testing and other training that has to be completed, meaning that the employment of such nurses will not address the serious pressures facing the health service in the short term. Although bringing in nurses from overseas has merit, it will stretch only so far. The Southern Trust recently informed me that, even after it has been allocated additional nurses as a result of the international recruitment, it expects to have 50 nursing vacancies.

The motion also refers to working with our colleges and universities to promote nursing as a career choice. I feel that that is of significant importance moving forward. I am aware that, in 2016, over 2,200 applications were received for the 264 commissioned adult nursing and mental health nursing degree places at Ulster University. That highlights that a desire for a career in nursing and midwifery exists. It is therefore vital that the Minister builds on the progress of former Ministers to increase the number of places that are available in our universities. I am also aware that work has been commissioned to investigate whether we can have a fast-track programme for people who already possess a primary degree in the healthcare field. Potentially, this could shorten the time taken to complete the nursing training programme, and initiatives such as this could help to address nursing shortages as we move forward.

Ultimately, the fundamental issue before us is our appreciation of the nursing and midwifery professions. The work of our nurses and midwives and the responsibility that goes with their professions need to be recognised and rewarded. We need to be thankful and determined to support the professions as we move forward. It is imperative that we ensure that the health service is attractive to encourage students and newly qualified nurses into these professions, so that we retain nurses and midwives and sustain a stable workforce.

I hope that the issue of dealing with nursing shortage is one that we can all support and on which we can find common cause. As an Assembly, we are often criticised for what we do or do not do. It is imperative that we all get behind the nursing and midwifery professions as they face many difficulties and challenges right now and will do so in the future if those are not presently addressed. I call on the Minister to move on the issue, and I look forward to her comments later in the debate.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party 4:15 pm, 24th October 2016

I beg to move the following amendment:

Leave out all after "ongoing" and insert "pressures facing nursing and midwifery staff in Northern Ireland; is concerned about the number of vacant nursing and midwifery posts across each health and social care trust; acknowledges that staffing shortages have exacerbated pressures in the health system, impacted on the working conditions of staff and affected patient outcomes; and calls on the Minister of Health to work proactively with our colleges and universities to promote nursing and midwifery as a career choice and to work collaboratively with the relevant bodies to train and retain more nurses and midwives.".

I very much welcome the opportunity to speak on this important issue, and I am pleased to propose the amendment. It incorporates midwives into the original motion, which focused solely on nurses.

First, I want to put in place my party's gratitude and respect for our hard-working nurses and midwives. Nurses are the backbone of the health service, a health service that is under severe strain. We all know that, when we are under severe strain, it is the backbone that feels it first and feels it worst. Let me be clear — I hope that everyone is clear — that supporting the motion and amendment is in no way a criticism of the heroic, often thankless, work that nurses do. Last week, a call for the Minister's intervention to improve services was twisted by some here and portrayed as an attack on those who deliver that service.

What we want to do is attract and retain more nurses and midwives to the profession to help to shoulder the massive workload and responsibility of those already doing the job. The motion highlights the ongoing problem of the nursing shortage here. This is not a situation that has developed overnight, and, yes, efforts have been made over a number of years by trusts and previous Ministers to address it. Indeed, such efforts are still ongoing, but the fact is that it has not been fixed yet. It needs to be fixed and fixed now.

I speak to nurses regularly — nurses who work in hospitals, in care homes or in the community — and the common theme that emerges is that nurses and other healthcare workers feel overworked and undervalued. When I looked at the information pack ahead of the debate, it was clear to me that the sentiments that nurses express to me reflect a wider picture. While some statistics in the pack actually showed an increase in the number of whole-time equivalents, they certainly do not tell the story of nurses' increased workloads. Those increases in workload, unfilled vacancies and recruitment freezes in the workplace all contribute to additional stresses on workers already operating in an extremely stressful environment. It is so bad that, according to the Royal College of Nursing, almost one fifth of newly qualified nurses will probably look for another job elsewhere in the next 12 months. Imagine if that were to happen: the impact of that on patient care in Northern Ireland would be devastating.

Today, I, along with many other MLAs, dropped into an event upstairs hosted by the Patient and Client Council (PCC).

The PCC is the patients' voice. It would certainly concur with the view expressed in the amendment that existing shortages have affected patient outcomes.

While we applaud and support past and current initiatives to increase the nursing workforce, such as the overseas nurses recruitment drive, we have to question the potential impact of Brexit on nursing levels. Prior to the referendum, concerns about this were voiced by Jeremy Hunt. There may be damage caused by losing some EU workers who work in Health and Social Care. Uncertainties around visas and residency permits could cause some to return home and some not to come here in the first place, with an unpredictable impact on hard-pressed front-line services.

Despite significant investment in the health services, there is an acknowledgement that current structures are not fit for purpose. In Northern Ireland, standards of care have been called into question due to the weak infrastructure underpinning the current provision of care. I know that the Minister will address that tomorrow with the long-awaited publication of Bengoa. It is hugely important that we enhance the quality of education and training for healthcare assistants and increase progression routes into nursing. We also have to look at progression routes in nursing. With the increased emphasis on community nursing, we have the bizarre anomaly in the Western Trust where a dedicated, skilled and experienced community nurse has to go back to working in a hospital for two years before, or if, they are to progress from being a grade 5 to a grade 6.

The Chief Nursing Officer has told us that nurses are suffering because of inconsistent decision-making by the trusts and the board. They are worried that they are being ignored. There are also genuine concerns that the bank system is being used as a mainstream recruiting mechanism rather than the flexibility tool that it was originally designed to be. More permanent nurses will, obviously, reduce the spend on agency workers and assist long-term workforce planning. Nurses are also being called in to do extra administrative duties.

An ageing workforce, as referred to by the motion's proposer, is a major worry. There is a big group in the over-50 age range that is due to retire in the very foreseeable future. Nowhere is that more pronounced — this brings me to the amendment — than in the area of midwifery. According to the royal college, Northern Ireland faces a shortage of 100 midwives by 2017. That is next year. Forty-one per cent of midwives are aged between 50 and 60. There is growing concern in the trusts that, inevitably, there will be an insufficient number of midwives to staff our already bursting maternity units due to an inadequate number of midwives being trained to replace those who are about to retire. We really are heading towards a midwife crisis.

With severely limited job prospects on completion of training, many midwives are forced to leave here to seek job opportunities elsewhere, where they are able to obtain permanent employment and progress in their career. Elsewhere, they can earn the experience they require and will also be paid substantially better than those employed here. We need to get new midwives in now so that they can benefit from the experience of that older cohort who are due to leave.

Maternity services here are performing extremely well given the circumstances in which they are operating, but that is due largely to the selfless dedication of midwives and other maternity staff. However, those who have the capacity to go the extra mile for mothers and babies day after day are feeling undervalued and overworked. A survey of midwives who have left or who plan to leave found that over half were unhappy with staffing levels. Around half are not satisfied with the quality of care that they are able to give. Most worryingly of all, only 9% of midwives who had left or were about to leave said that they felt that midwifery is valued by the Government. That is something that we really need to address, and we can start that today by supporting the amendment.

We need midwives to know that we value them, not only for bringing our babies into the world but for their vital role in maternal mental health care. We need to see the full implementation of the Northern Ireland maternity strategy. The most obvious way to make our nurses and midwives feel valued is through fairly rewarding their invaluable work. We welcome the Minister's announcement last week on the 1% pay increase but cannot ignore the disparity that still exists between here and other regions. The motion and the amendment describe nursing as a career choice, but, for so many, it is much more than that. It is a true vocation. People do it because they care. They devote and dedicate their lives to helping others but feel that this good nature is taken advantage of and taken for granted. They often have to work several unpaid hours every week.

I urge the Assembly to support the amendment. It is time for us to care for our nurses and deliver for our midwives.

Photo of Catherine Seeley Catherine Seeley Sinn Féin

I thank my colleagues in the DUP for bringing forward the motion today, which we will, of course, support. Last week was International Nurses Week, and a local nurse posted a comment on social media marking this. She noted that:

"being a nurse means you carry immense responsibility. You make a difference to the life of those you enter. Some bless you, others curse you and, sadly, some even assault you. You see people at their worst, at their best, life begin and life end."

I contacted that nurse in advance of this debate. She told me that nurses are mostly drained and hopeless and that they face more and more strain and pressure every day. Watching their backs at every turn in a blame culture, enjoying very little positive feedback or recognition, despite working their fingers to the bone and bladders to bursting point. She described her children as spending early mornings and late evenings in childcare, all the while their mum or dad is saving lives or, at the very least, making lives better. She said how degrading it can be but explained that the guilt that they feel about letting society down keeps them going to work, tirelessly, every day. Although this story is not unique to the North, there is no doubt that our nurses are under immense pressure. It is important that we, as their representatives and their Government, respond to that in a manner that inspires hope and confidence whilst recognising, acknowledging and commending the invaluable work that they do.

I want to send out a very clear message to nurses across the North today: your Minister does care, your Minister is aware of your daily struggle, and your Minister is responding.

We do not have a problem attracting people into the nursing profession: for every nursing undergraduate place available, there are in excess of 10 other applicants. Therefore, I welcome the Minister's recent response to my question regarding the bursary in which she committed to maintaining it, at a time when the British Government intend to move to a loan. In her answer, she also outlined her plans to increase the number of nurses being trained over the coming years. Despite this, and in the immediate term, there are increased demands on nursing services due to an ageing population, increased complexity of patients, and development of new models of care. In the North, 31% of the workforce is aged 50-plus. We must respond to that knowledge now, not in later years when it is much too late and retirement sends our health service into crisis.

I welcome recent comments that the Minister intends to make the North an employer of choice by attracting nurses to work here and encouraging our students to stay here. The retention of nurses must remain a priority. The web-based nursing and midwifery career framework, used to promote the North as an employer of choice for existing and future staff, will prove crucial to that. Local recruitment initiatives are being progressed regionally, including job offers to all year-3 students in training, streamlining, standardisation of recruitment processes, and open advertising by trusts of vacancies. The increased investment in the return to nursing practice programme, delivered by Ulster University, to 48 places per year is further testament of the Government's commitment to addressing nursing shortages. I encourage the Minister to continue with the implementation of her Department's 10-year nursing and midwifery workforce plan, which will prove key in ensuring that we have an appropriately resourced and skilled nursing workforce to meet the needs of our population.

The amended motion does not mention workforce planning, so we are unable to support it. The proposer of the motion specifically mentioned midwives in his opening remarks, so we are content that the original motion includes and gives plenty of focus to midwives.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

By an extension of that logic, given that the proposer of the amendment mentioned workforce planning in his remarks, could the Member not see fit to support the amendment?

Photo of Caitriona Ruane Caitriona Ruane Deputy Speaker

The Member will have an extra minute.

Photo of Catherine Seeley Catherine Seeley Sinn Féin

I thank the Member for his intervention. I have made our position on the motion clear and given the House an explanation for it.

I am sure that today's motion will give faith and hope to our nurses — those who work endless hours, some unpaid, some without a break — that we, their government representatives, care. I say a heartfelt thank you to each and every one of those nurses on every ward across the North.

Photo of Robbie Butler Robbie Butler UUP

I welcome the opportunity to speak on the motion and the amendment. I understand the difficulties of the increasing pressures on nursing staff: my wife is a nurse and deals with these pressures daily. I have no problem with either the motion or the amendment. The only issue that I might have at home, in speaking to my wife, is that I am not sure whether she would agree that we commend any former Health Ministers for how they treated nursing. However, we will support the motion and the amendment.

It is ironic that, when reading over previous debates in advance of today, those who tabled the motion were most irritated when concerns were raised in the last mandate about the pressures facing our nursing staff. Nonetheless, party politics should not be brought into today's debate. I really hope that we have a positive discussion, but there needs to be a recognition across all the parties that there is a problem.

Nursing roles have been systematically widened, and targets have been stretched without the appropriate provision being made for staffing levels through workforce planning. The failure to workforce plan, as can be clearly seen in the spiralling reliance on and cost of agency nurses, is impacting on every aspect of our health service. It does not matter whether it is A&E or care in the community, they all face serious challenges. Whilst I am aware that there has been an increase in nursing posts over recent years, it has been in conjunction with a major increase in nursing vacancies. A long-term vacant nursing post is about as much use as no nursing post at all.

I am also aware that there have been some efforts in recent times to increase the number of nurses entering the profession, and that has included the Department of Health's recruitment drive on the international stage. Whilst I welcome the foresight of bolstering nursing levels — the nurses already in post here who were recruited from overseas play an essential part in the local health and social care workforce — the obvious disadvantages of our increasing reliance on international recruitment have been pointed out. I believe that the Southern Trust and the South Eastern Trust have relied on a small number of foreign nurses recently, but I have to express disappointment that a small number is all that we were able to attract. A cost is also attached to those recruitment drives: travel, accommodation, additional examinations and, of course, supporting the nurses to become sufficiently fluent in English. How will the Minister ensure value for money in those circumstances? As a first port of call, we should seek to utilise all our local resources before investing large amounts of money in attracting nurses from overseas.

Nursing, like midwifery, is a wonderful career. In fact, it is the type of career that people queue up to enter, often not for the money but for the pleasure of helping people in need. That is most apparent in there being a far greater number of applicants than nursing positions. The previous Minister increased the number of nursing training places slightly, but we need to realise that it only slowed down the problem rather than solving it. The pressures under which our nurses work, as well as the traumatic scenes that they witness daily, are quite immense, but rarely do they let it spill over. At that point, I pay tribute to our hard-working nursing staff. They work long hours, come home at night and go back to work the next day, putting their uniform on to do it all over again.

The current Minister has an obligation — we will, hopefully, hear more from her tomorrow — to ensure that our local health service has the capacity to meet the rising demand. That means not just that more staff are needed but that the right intervention has to be made at the right time. Nursing staff, as I am sure every consultant or person responsible for commissioning services is acutely aware, are best placed to ensure that patients are safely and efficiently progressed through their journey. It is for that reason that the Assembly has an obligation to ensure that they are supported through this work.

Photo of Paula Bradshaw Paula Bradshaw Alliance

I support the motion and the amendment, but, on balance, I prefer the text of the motion. The objective today is that, going forward, we secure concrete action.

Nursing is one of many areas of the health service in which workforce planning has been inadequate for many years. The motion is correct in its aim of reducing dependency on agency workers and emphasising long-term planning. No one is claiming that, going forward, this will be easy.

It is fair to recognise the rise in the number of nursing students, although that must be matched by a rise in the number of nurses working here. Here in Northern Ireland, our nurse training is among the very best in the world, and there is good provision for continuous professional development and return-to-nursing courses. However, the fact there is a campaign to attract nurses back to the profession indicates that education is not the only problem — perhaps it is not even the main one. Many of those qualifying do not enter the profession in Northern Ireland, although it is good that the number doing so seems to be on the rise. As I mentioned, workforce planning is a serious issue across the whole of the health and social care service, and, in fairness, it is not restricted to nursing.

It is hard to disagree with the recommendations of last year's workforce plan for nursing and midwifery: a strategic approach; a review of the workforce and the independent sector; proper forecasting; and the introduction of advanced practice programmes. However, even that workforce plan contains a lot of reviews and considerations, when what is required are concrete actions. In any case, all the workforce plans and reform reports in the world are of no use without an adequate commitment of resources.

At this moment, we should not underestimate the seriousness of the UK's decision to leave the European Union. Across the UK, it has led to an ugly expectation among a minority that the result of the referendum somehow equates to foreigners having to leave the country now. In fairness, it has to be said that local representatives, even those who were vocal in campaigning for a "Leave" vote, have been clear that the NHS simply could not function without the foreign workers doing such a great job. I think that all parties in the Assembly will join me in emphasising that nurses in Northern Ireland, regardless of where they come from, do a terrific job and make a significant contribution to the health and social care sector.

A similar motion was passed by the Assembly in January 2014, and the workforce plan followed the next year. I therefore emphasise that resources for reform need to follow, and, with that plan and countless expert reports now available to us, we need more actions and fewer considerations. Let us hope that the motion leads to those actions and to direct, tangible outcomes.

Photo of Trevor Clarke Trevor Clarke DUP

I apologise that I was not here for most of the other contributions as I had other business. I support the motion tabled in the name of my colleague Sydney Anderson. Although I have sympathy for the amendment, I do not believe that it is as strong as the motion. I do not want to get into the blame game: if we are all mature about this, we know that there is a problem in the nursing sector and in our hospitals. Many of us who visit the hospitals know the pressure that nursing staff work under. It is not a case of blaming one person or another for that; it is about finding a solution. The motion refers to including our colleges in providing more encouragement to get people into the profession.

I want to touch briefly on comments made by the previous Member to speak. As someone who voted to exit the European Union — I do not want this turning into a European debate — I fully get our past and future reliance on foreign nationals coming to work in our hospitals, because of their work ethic and the compassion that those individuals show, but we should not tie that into a debate about whether we should be in or out of Europe. It is about the professional character of some of those individuals.

Indeed, some of those individuals work outside of European countries as well. So, they have come to this country and given an awful lot, and I do not think that we should underestimate their value, the role that they have played in our hospitals and the care that they have provided to our patients.

Moving on to the motion, the difference for me in relation to the motion and amendment — I have had this conversation with Mark privately — is that I could have seen myself supporting the amendment, however, the motion goes on to talk about the reliance on agency workers. We need to be prudent going forward, and I would not wish to have the difficult job that the Minister and all Ministers have in trying to balance finding the finances with delivering services, but until we get properly funded nurses in positions, we cannot remove the over-reliance on agency staff. Agency staff are much more expensive. That is one aspect. The other is around workforce planning and having a balance going forward. It is for that reason that I support the main motion.

The Minister has a difficult task ahead to try to get the balance right. It is for that reason that I find myself in support of the motion to try to come to a position where we can remove the pressures for some of the individuals who take nursing on as a career. I have friends who are in that profession, and I understand the difficulties that they have working in it, but one thing at the heart of all this is that we should not underestimate the care that the nurses provide. Whether they have pressure or otherwise, their first and foremost position is that they are caring professionals doing a caring job for the patients whom they serve. That said, we need to encourage more people into the profession. One of the ways to do that is to open up more recruitment places and to make it more attractive looking from the perspective of our colleges. I support the motion.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

I also welcome the opportunity to speak in this debate. Any debate on the health service will be listened to very carefully by those who work in the service but also by those who depend on the health service for their treatment and care. For that reason, all of us should be measured in what we say so that no one is made to feel more insecure or vulnerable, whether they be employees or patients.

I will say again what I said last week: the best way to improve the health service is by everyone working collaboratively to bring about change. That includes political representatives in this Assembly, healthcare professionals, nurses, trade unions, patients and any other individuals or organisations that have a stake in the health service. That is what the people out there want. They want people working together. That, more importantly, is what they deserve.

Moving on to the motion, of course, there is a problem of nursing shortages in the system. Everyone knows that, and all the Members who have spoken so far have acknowledged and recognised that. Those shortages exist for a variety of reasons. First, there is a global shortage of nurses and midwives, which is impacting on health services across these islands. Patient needs are also becoming more complex in an ageing population. Added to that, there have been decisions in the past to reduce investment in preregistration nurse education. Those decisions lacked foresight and exposed a lack of vision around workforce planning. We are not going to resolve the issue of the shortage of nurses without proper investment and a clear workforce planning strategy.

It is not the case that young people are not attracted to nursing. On the contrary, as has been pointed out, there are more than 10 applications to study nursing for every place that is available. So, what can be done about shortages in the system? The Department has already increased by 15% the number of preregistration nurse training places in our universities. The Minister has also made clear that the nursing bursary will continue here. That is something that, I know, nurses are very pleased about. I am confident that the Minister will take further steps and introduce other measures to promote nursing and midwifery as a career choice and, moreover, create the conditions that will make qualified nurses want to stay and pursue their careers here. I am quite sure also that the Minister will take account of the recommendations of her Department's 10-year workforce plan for nursing and midwifery.

Nurses make up 36% of the health service workforce, and anyone who has ever been in hospital, who has had close family members in hospital or who has even visited hospital will attest to the professionalism, dedication and commitment of our nurses. It is no exaggeration to say that, without nurses, there would not be a health service. Nurses are, indeed, the glue that holds our health system together. We could not do without them. I had the pleasure of visiting the midwife-led unit in the Mater Hospital last week with the Health Minister, and I previously had some experience of there because my four-year-old daughter was born there. Although at that time it was not midwife-led, it is mainly the same midwives who are operating the unit now. It is an absolutely excellent unit, and I hope that the Minister gives full support to it.

I am disappointed that the amendment detracts from rather than adds to the motion. Any amendment should add to the motion not detract from it. It does not give a nod to workforce planning, which is absolutely essential to ensuring that we have enough nurses in the system and that they are not overburdened in their work. For that reason, we will be opposing the amendment and supporting the motion.

Photo of Gary Middleton Gary Middleton DUP 4:45 pm, 24th October 2016

I support the motion, and I agree with the comments made by my colleagues earlier. The motion has five key points in it, which I feel the House should support. Many Members have already agreed with the first of those points, which is the fact that there is a shortage of nurses and that that is an ongoing problem. We know that nurses make up a very large part of our Health and Social Care workforce and are delivering 24/7 care, 365 days of the year across a wide range of sectors, in primary, secondary and tertiary care and in our schools, prisons and workplaces, to name a few. Of course, to assist and drive further the transition of service delivery from predominantly acute hospital-based care to community-based care, more nurses will be needed. They will be needed in specialist skills areas as well to provide complex case management and advanced and specialist practice knowledge. Of course, they will need to have the confidence to work independently in the community rather than in acute hospital settings.

The second point —

Photo of Stewart Dickson Stewart Dickson Alliance

I thank the Member for giving way, and I concur with all that he is saying, particularly where he suggests that we will constantly need a new influx of nurses into Northern Ireland, whether that is through training or through trained nurses coming to us from other parts of the world or the EU. Will he agree that we should not be placing any barriers to those coming into the United Kingdom other than those of qualification? The sorts of barriers that exist in Northern Ireland to people coming here are freedom of movement and, indeed, sadly, racism.

Photo of Caitriona Ruane Caitriona Ruane Deputy Speaker

The Member will have an extra minute.

Photo of Gary Middleton Gary Middleton DUP

I do not particularly disagree with anything that the Member has said, and I think that the issue of language has also been touched on. It is important that we ensure that those who come here are able to undertake the language as fast as possible and fit into our service. Ultimately, we have to pay tribute to those who are already here and doing a fantastic job in our health service.

The second point in the motion recognises the work carried out by previous Ministers. We touched on the fact that 100 additional nurse training places were made available earlier this year. That marks an 15% increase in the annual number of preregistration nurse training places, taking the number of places over the 700 mark for the first time since 2009.

That takes me on to the next point of the motion, which asks that the Health Minister build on that work. I have no doubt that she will strive to do so, and I appreciate that the Bengoa report comes out tomorrow, with the Minister's vision coming alongside that. Not to pre-empt what is to come, but I expect that nursing and the increase in nursing numbers will be a major part of that solution.

We also need to work proactively with our colleges and universities to promote nursing as a career choice. Mr Durkan referred to the fact that it is not just a career choice: people go into it to genuinely make a real difference and provide a first-class service. I do not have to go any further than my constituency to see the work that our colleges and universities do in nursing. The nurse training provided at the Magee campus is first-class. It is in the top 10 in the United Kingdom. The partnership working between the Department of Health and the universities and colleges should continue. I urge the Minister to ensure that that is promoted and that nursing is promoted as a real career choice that can make a difference in our community. There were over 2,200 applications to Ulster University this year for only 264 undergraduate places. There is an increase in demand combined with the return to nursing practice programme. These are two examples of where the universities and the Department can work together.

The need to train and retain more nurses has been mentioned. That obviously has to continue, but we also want to see the continued professional development of the nurses we already have. Finally, it is important that we refer to workforce planning, because the change in the demographics of the country continues. That is something that we have to bear in mind and work on proactively over the next number of years.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I apologise to my Upper Bann colleague for missing the earlier part of the debate.

As has been said, our nurses are the lifeline of the local health and social care service. Over the years, we have seen a sea change in what it is to be a nurse. Their role, input, scope and responsibilities have all changed dramatically. That change is saving lives. I say that as a mother who has relied on nurses to help care for my son. Like so many other families, I can name the nurses who cared for our loved ones. I want to use the opportunity to publicly thank Hazel, Rozzi, Kathryn and Alison, all of whom still play a part in my son Mark's life. They became an extension of our family, and I cannot speak highly enough about how they all went above and beyond the call of duty.

Nurses are by far the largest group of health staff. I struggle to think of a health setting where nurses are not the first, middle and last point of contact for patients on their journey. It is absolutely essential, therefore, that they, as a workforce, are supported and properly planned for. In its document, 'A New Vision of Nursing and Midwifery', the Royal College of Nursing highlights that:

"Without adequate investment in all parts of the nursing workforce, health care organisations will continue to struggle with staff shortages, poor skill mix, bed pressures, preventable morbidity and mortality, and poor provision of community health services ... Nursing is also put under pressure when management assumes that nurses will 'fill the gap' whenever there is one to be filled, be it doctor, cleaner or administrator."

The challenges facing our local nursing workforce are nothing new. Whilst we have heard much about piecemeal investments in local nursing services, the Minister and her officials know, as do the nurses on the ground, that a 6% increase over five years is insignificant in comparison with the far faster rate at which demand and indeed the scope of their role is growing.

As was mentioned by my colleague, the Department appears reluctant to tell us the number of nursing posts that are vacant. What we know is that, earlier this year, there were 850 vacancies across Northern Ireland. The number in my trust — the Southern Trust — increased from 19 to 226 in just two years.

While nurses are, of course, the public face of local hospitals, they have an equally important role in caring for people in private nursing homes. I urge the Minister to instigate an investigation to assess the challenges facing our private nursing homes. Let me give you an example. Last week, my party was contacted by a local private nursing home owner. Her sheer frustration and distress were obvious. Recently, she lost her deputy home manager and four staff who were working 36 hours a week each. She lost a further staff member on 48 hours' notice, and several more all with significant contracted hours have handed in their notice. So many nursing staff leaving was no reflection on her ability as an employer; it is simply because staff are being enticed away from our local homes to work for agencies.

Our private nursing homes are spiralling towards a crisis. They are haemorrhaging staff, particularly to agencies. Therefore, the Minister may shortly be required to take the unprecedented step of intervening to ensure that the patients and residents do not find those homes facing closure with all that entails for them personally and for their families. We do not want to see repeats of the scenes from last year. I am thinking particularly of Donaghcloney in my constituency.

Nursing staff deserve fair pay for the vital work they do. I support the royal college and all it is doing to ensure fairness. When we look at newly qualified nurses, we see that they must see a progression ahead of them, a clear stairway to career enhancement in their job. I support the motion and the amendment and urge the Minister to take action to support all our nursing staff.

Photo of Ian Milne Ian Milne Sinn Féin

I, too, welcome the opportunity to contribute to this debate on the shortage of nursing staff. It has been an ongoing problem for a number of years, as demand on health services continues to grow not just here in the North but across the world. The motion gives us the opportunity to hear at first hand what the current situation is, what impact previous measures to address the issue have had and, most importantly, what all this means in the short, medium and long term. Before I continue, I echo the comments of other Members and add my words of praise for the nursing staff and those who support them in their work. On a personal note, three years ago, my son's wife gave birth to twins who were 10 weeks premature, and I cannot praise enough the work, skill and care that the nurses in Antrim Area Hospital gave to bring those children from the point of death to being healthy boys today.

There is no doubt that nursing staff are the backbone of our health service. They are a highly skilled and dedicated workforce, and their contribution to providing a safe service and improving patient outcomes cannot be overestimated. They provide a high level of care and compassion to patients in the hospital environment and the community, working unsociable hours and often over and above expectations. The challenging circumstances they work in have been well documented and rightly so, but often that can mask the many positive and rewarding aspects of the job. I was very encouraged by the figures coming from the Ulster University that show that the level of demand for a career in nursing remains extremely high.

Continuing on that note of positivity, I welcome the 15% increase in the number of preregistration training places for this year's intake announced in March by the outgoing Minister and the commitment by the current Minister, Michelle O'Neill, to continue with the nursing bursary, which has been mentioned. Added to the increased investment in the return to nursing programme, those interventions will go some way to address the legacy left by the decision to reduce investment in nurse education a number of years ago. In the short term, however, as we heard, there are a substantial number of unfilled positions, and every effort should be made to continue to recruit staff from home and abroad to alleviate the pressures caused by the shortage. I acknowledge the nurses from, say, the Philippines and Europe and, indeed, from around the world, who have taken up work here and have made a significant contribution to the health service. They are very much appreciated and valued.

It is crucial that the necessary support and continual development be provided to ensure that nurses feel valued, respected and able to do their jobs professionally and effectively, and I welcome the Minister's commitment to that.

The standard that our nursing staff are trained to is amongst the best in the world, and that is something to be very proud of. In the midst of a global shortage, we must work hard to retain them.

As we move forward, workforce planning is central to addressing many of the issues facing the health service. Demand in the service has not only increased; it has changed, and so too has the method of delivery. The recent updated plan for nursing and midwifery highlights the impact of that. The move towards community-based care, an ageing population, an increase in the number of people presenting with complex needs and long-term conditions, and the move towards enhanced and specialised nurse-led care are some examples of that. All of them have brought their own pressures and challenges. The plan also puts a focus on the age profile of staff, the impacts of demographic changes, and a shrinking labour market. It makes a number of recommendations that it hopes will address those issues and will identify and plan for future challenges. That is the only way that we can attract, support and retain nursing staff, and it is the only way that we will deliver the healthcare that we want to see. As other Members said, we have to work together.

Photo of George Robinson George Robinson DUP 5:00 pm, 24th October 2016

I welcome the opportunity to speak in the debate, as I have a family member who is in the nursing profession and am therefore well aware of the problems for staff and patients due to the lack of nurses in our hospitals, health centres, care homes etc. There is a shortage of nurses generally, but there is a specific shortage of specialist nurses in many disciplines, which means that those with lifelong or life-limiting conditions are impacted the most. That needs to be addressed.

I praise my colleagues and former Health Ministers and health trusts who have intervened to boost nurse numbers, and I call on our current Health Minister to follow in their footsteps.

Nurses are the front line of our health service, dealing with the most direct and basic needs that a patient has; they are vital to the success of the entire health system. If there are fewer nurses, the medical profession is less effective. Our nurses are truly unsung heroes, and I thank all of them for the magnificent and, at times, thankless job that they do. We must also take into consideration the abuse, both verbal and physical, that nurses and other health staff have to endure in their line of work from day to day.

I appreciate that the University of Ulster and the Western Trust work well together, and the extension of that close working relationship should be examined. Many graduates find work in the trust and in Northern Ireland. I often hear about the lack of nursing staff from patients and professionals, and one thing that I frequently hear is that the dependency on agency workers needs to be reduced. Agency staff are essential and help to keep wards and A&E units working. However, full-time staff are a less costly solution. I ask the Minister to look at how we can attract more young people into nursing and ensure they stay in the Northern Ireland health system when they qualify. We encourage those young people to stay and build Northern Ireland and use their specialist skills for the benefit of Northern Ireland people.

As the motion states, we must find ways to ensure that long-term planning is aimed at retaining the valuable group of young people who graduate with nursing skills. Those graduates are the future of our health service, and we must find ways of working with all relevant bodies to ensure that that future skill base is retained. We must also ensure that training and retraining are available for existing nursing staff, including time for each nurse to undertake that training, as that will enhance their skills set and possible future promotions. That will benefit staff, trusts and, most of all, patients.

As one who understands the demands placed upon our nursing staff and the struggles that they have due to staff shortages, I fully support this very worthwhile motion and ask all Members to support it too.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I very much welcome the debate and thank the Members for tabling the motion. It provides us with a timely opportunity to consider the issues we face with a shortage of nurses. I thank Members for their considered contributions throughout the debate. They all reveal a concern for and interest in nursing and midwifery that I entirely share, and I hope to respond to as many of the points raised as time allows.

I pay tribute, as other Members did, to the dedication and commitment of all our nurses, who play a vital role in the delivery of high-quality nursing care to our population across all sectors and settings. I greatly value and appreciate the work that our nurses do in the face of increased demands and the unique contribution they make to the lives of patients, clients and families daily. The evidence is clear that the number of graduate nurses has a strong effect on patient experience and outcome.

I share the concern expressed by Members regarding the challenge of nursing shortages impacting on our services. I wish to assure the Chamber of my commitment and resolve to address the problem. The situation we face reflects a nursing shortage on a global scale, which is impacting on the North of Ireland and across these islands. There are many other contributing factors, including increased demands on nursing services; demographic changes; the ageing profile of the workforce; increased patient complexity; new service models; and an underinvestment in preregistration nurse education since 2010. It is important to recognise that there is no single quick-fix solution to the shortage of nurses. However, my Department has plans under way and is proactively leading on a range of measures to address the nursing supply issues in the short, medium and longer term.

In the immediate term, I recognise that the consequences of past decisions to reduce investment in preregistration nurse education have come back to haunt us. Despite best efforts to recruit and retain nurses from anywhere on this island and, indeed, from Britain, there still continues to be in excess of 800 nursing vacancies in the system and a consequent reliance on bank and agency nurses. Nurses work in the HSC and outside it, and I am very aware of the difficulties faced by nursing homes to recruit and retain qualified nurses. It has therefore proven necessary, in the short term, to implement an international recruitment campaign in collaboration with HSC trusts in order to maintain safe staffing levels and meet service needs. I warmly welcome into the North of Ireland those talented and caring individuals from the Philippines, Italy, Romania and Greece who have been recruited through recent international campaigns and the contribution that they will make to strengthen our workforce.

My Department has continued to support the nursing and midwifery workforce through increased investment in resourcing the registered workforce. The numbers of registered nurses and midwives across the HSC have increased by 8% since 2011, which is an additional 1,076, giving a total headcount of 17,027 staff in our system. Furthermore, the implementation of my Department’s policy framework, Delivering Care: Nurse Staffing in NI, has resulted in a significant investment of £12 million allocated to trusts during 2015 for additional nursing staff for acute surgical and medical wards.

I am fully committed to local solutions, first and foremost, and I believe that investing in our local talent is strategically the right course of action, if we are to strengthen our existing nursing workforce and ensure its sustainability into the future. We are privileged to have a long-standing reputation of excellence in nurse training, and nurses educated here are sought after the world over. Furthermore, we are in the fortunate position that nursing remains a highly popular career, as we have no difficulty in attracting nurses into the profession, and I want it to remain that way. In each of the last three years, approximately 10,000 young people applied through UCAS to study nursing at universities, locally and elsewhere. There are in excess of 10 applications for each training position commissioned by my Department. When you consider those figures, combined with the low drop-out rate of less than 10%, I am sure that everyone in the Chamber will agree that attracting potential nurses into the profession is not a problem.

I share the concern that, in preceding years, investment in nurse education was reduced and, consequently, did not keep pace with workforce demands. Rectifying that situation will take some time. My Department has significantly increased investment in nurse education by commissioning an additional 100 preregistration nursing places at our local universities for 2016-17, giving a total of 746 nursing and 55 midwifery places. That takes our annual investment in nursing and midwifery to £27 million. I am giving consideration to further investment for 2017-18.

I am fully committed to supporting student nurses and midwives while they undertake their training. As I made clear to the House during questions on 18 October, I have ruled out the approach being taken in England: removing bursaries and requiring students to take on additional debt. The nursing bursary will continue in the North of Ireland.

I am very enthusiastic about providing a pathway into nursing for those already working in the HSC who wish to follow that path. In 2016-17, my Department more than doubled the intake for the Open University preregistration nursing course, which is a route that is funded for HSC staff, and more than 50 people commenced the course this year. The independent sector also utilises this route as a means of retaining staff. It is a successful way of growing our own nurses and supporting nurse retention.

I am aware of the huge pool of talent that exists among our healthcare support workers. I have increased investment in the various access courses designed for healthcare support workers that provide a route into the Open University preregistration nursing course. Investment in this group of staff can reap huge dividends in developing our own nurses and retaining them in our services.

My Department has also increased investment in the return to practice nursing programme delivered by Ulster University. It is designed to enable nurses who are out of practice and whose nursing registration has lapsed to re-enter the profession. A return to practice media campaign was launched by my Department in January 2016 to target this specific group of nurses and encourage them to avail themselves of the opportunity to return to practice and have their fees funded. Thankfully, a total of 83 nurses successfully completed the programme in 2015-16. My Department has since increased the number of commissioned places for the return to practice programme on an ongoing annual basis from 32 to 48 and will consider further targeted campaigns as necessary.

Workforce planning is an essential element of ensuring the sustainability of the future nursing workforce. My Department has completed a 10-year nursing and midwifery workforce plan, and its implementation will be key to ensuring that we have an appropriately resourced and skilled nursing workforce to meet the needs of the population. The workforce plan makes a series of recommendations, including the need for a strategic approach to the supply and demand of nursing. It highlights the importance of making the North of Ireland a destination employer of choice by attracting nurses to work here and encouraging our students to stay here.

A shortage of band 5 nurses in particular is posing a significant challenge, with each trust investing heavily in time and effort to recruit nurses at this pay band in order to support the existing workforce. Encouraging local students to work here on successful completion of their training is, therefore, an important recruitment strategy. Local nursing students in year 3 of their training are now being offered permanent band 5 posts by each trust when they qualify, in an effort to encourage them to stay. I am pleased to advise that we have well-established collaborative working relationships with our universities, and my officials are in regular communication regarding nurse education and commissioning matters.

I recognise the importance of investing in post-registration education and training to build the capability of our existing nursing workforce. Education of the registered workforce directly impacts on the quality and safety of clinical services, and it improves patient outcomes through enhancing the knowledge and skills of nurses in front-line care. My Department has invested £8·5 million in the post-registration education commissioning budget for 2016-17.

I support the development of new nursing roles as the nursing profession seeks to respond to the challenges of healthcare delivery in the 21st century. I believe that our nurses are well placed to expand their roles and take on enhanced roles, blending doing so with the strong nursing values of care, compassion, dignity and respect. My Department has invested in the growth of an advanced nurse practitioner role and has commissioned Ulster University to develop and deliver this new programme from 2017. Initial pathways will be in the areas of emergency care and primary care, with paediatrics to follow.

In assisting to address the nursing shortages in the short term, my Department has commissioned the Business Services Organisation to provide regional oversight and coordination of nurse recruitment. A regional team was established in January of this year on a collaborative basis across all trusts. The international recruitment campaign has been progressing this year, with over 700 job offers made to nurses from Italy, Romania, Greece and the Philippines. The first of the European nurses arrived here in September, with more to follow in the coming months. Initially, the overseas nurses are employed as healthcare support staff whilst they undergo the necessary stages to enable them to register with the British nursing regulatory body, the Nursing and Midwifery Council. This is a lengthy process that will take several months.

Finally, I wish to assure the House that I recognise that investing in the workforce is essential if we are to effectively address the problem of nursing shortages. The short, medium and longer-term measures that I have outlined will, taken together, get us back on track and secure our valued nursing and midwifery workforce now and into the future.

Photo of Sinéad Bradley Sinéad Bradley Social Democratic and Labour Party 5:15 pm, 24th October 2016

I welcome the motion and the chance to speak to it and to an amendment that, I believe, brings added value.

Moving the amendment, Mark Durkan, my colleague, outlined how it incorporated the work of midwives. I ask the House not to just overlook that point. He referred to the heroic and often thankless work of nurses and midwives working in our trusts, and he highlighted the fact that one fifth of newly qualified nurses look for a job elsewhere. He rightly pointed out the uncertainties arising with Brexit and the visa problems that could derive from that. He looked at the problems with skills programmes and training. He referred to a 100-midwife shortage by 2017, and the inadequate numbers being retrained to make up the number when we look at the age profile of our existing cohort of midwives. In his true style, he referred, although very seriously, to the midwife crisis that is looming. He also referred to the disparity of pay, which is an issue that perhaps would not get enough attention in the time allowed today.

Robbie Butler spoke to the amendment, and he expressed his concern that the roles have widened in what it means to be a nurse or midwife and resources are subsequently overstretched. He expressed concern at the low level of nurses we have and are able to attract from overseas. No doubt that is a costly exercise, and we are not getting the return that we would hope. He said that extra nursing training opportunities had eased the problem but, as he rightly pointed out, had not yet solved it.

Also speaking to the amendment, Jo-Anne Dobson identified the role of nurses, and very publicly and in a nice way, she thanked the nurses who have helped her family along the way. I think that we would all like to express that sentiment, because we have all shared those stories. Jo-Anne, I am maybe not as good as you at remembering the names — I am impressed by that — but that is something we would share across the House. She referred to the problem of staff in private nursing homes, and those nurses who are attracted out of the private nursing home sector, creating another cohort of problems, and no doubt going to work as agency staff.

There was a bit of debate about whether the amendment brought added value or not. The original motion states:

"to train and retain more nurses, thus reducing".

"Thus reducing" are the two words. There are many things that we could add to that "thus reducing". In this instance, the motion states:

"thus reducing the total spend on agency workers and assisting long-term workforce planning."

We could add, "Thus promoting the sustainability of our nursing and midwifery workforce". We could add, "Thus reducing our need to undertake expensive recruitment exercises overseas". We could add, "Thus allowing the continuity in nurse and midwifery/patient relationships". There is plenty we could add to that.

What is in the motion is good. Nobody is arguing that that is not a valid point, but we cannot then just say that, because two words — "workforce planning" — are missing from an amendment, the spirit of that amendment has not been embraced by the House. I ask people who are uncomfortable with those two words not being in the amendment this: are you therefore saying you are happy to not acknowledge the pressures facing nursing and midwifery?

Cat Seeley, although I may not be quoting her word for word, quite rightly sent out a reassuring shot to those nurses, saying that the Minister was listening and does care. We are simply asking the House, "Please extend that to midwives". Recognise that that problem extends to midwives. Let us not be so pedantic as to hang on two words, and come in on agreement that, based on those two words, this is our flow and travel of direction. Embrace the spirit. I ask the Minister, and every Member in the House, to extend your care and support to all nurses and all midwives.

Photo of Paula Bradley Paula Bradley DUP

I welcome the opportunity to wind up the debate. First , I thank my colleague Sydney Anderson for asking me to put my name to the motion. I was more than happy to. Many Members on our Benches go home to nurses at night-time. I know that many in the Chamber do that. I can hear Mr Poots in the background heckling, and I know what he has to put up with: worse still, I know what she has to put up with. Anyway, I digress. I will go back to the subject.

I join all my colleagues and everyone in the Chamber in showing our gratitude to our nursing staff throughout Northern Ireland. As someone who worked for the health service for a number of years, I know only too well the pressures that they face. I know only too well the work that they put in and how they go over and above, day and daily, to fulfil their duties. I do not want to minimise the debate in any way by looking at all our different types of nurses in a different way; I see them all as nurses. We have very much focused on hospital-type nursing and midwifery. We also need to look beyond that, because part of the way forward for health and social care in Northern Ireland is to look at primary care. We have our district nurses, our acute-care-at-home team nurses and our practice nurses, all of whom are essential to keeping our health service going. I pay tribute to them for the work that they do. We heard at the Health Committee last week about the crisis that faces GPs in Northern Ireland, and, without those practice nurses, district nurses and acute-care-at-home teams, GPs would be in an even worse position. I do not rule out any type of nurse when I stand up and speak. I have worked across the board with them all at some stage in my time in health and social care, and I have used several of them over the years. I will go on to talk about Members' contributions in a moment, but it is very telling how many people in the Chamber have had very close contact with nursing. I thank Jo-Anne and Ian Milne for bringing up their experiences. I know about that on a personal level, too. The nurse is the one person whom you come to rely on, especially in that hospital setting. You can tell from the comments in the Chamber — Mrs Bradley is the same — just how important those services are when you have to use them.

I want to touch on the nursing degree. I am of an age that I remember it way back before it was a nursing degree, and I remember working with all the nurses who had to go through their nursing degree. I am very encouraged by what the Minister is saying about the pathways, especially the Open University pathway. We all know so many high-quality healthcare support workers or healthcare assistants and the invaluable work that they do and the level of nursing that they provide on the wards. I would like the Assembly, in any way possible, to pull all that experience together and enable them to progress through a nursing career and a nursing pathway. I am also encouraged about the fast-track programme, whereby we look at people who have other health-related degrees and fast-track them through nursing. There are some very welcome things there.

My colleague Gordon Dunne, who has left, made an intervention on safety and staffing levels on wards during Mr Anderson's speech. I am sure that the Minister takes that extremely seriously, given that we are hearing information that, because of a reduction, there are only two healthcare assistants and two nurses to manage wards. We need to identify that pretty quickly in our hospitals and in our trusts, because that should not happen. We know the pressures that those nurses are under and how that type of unsafe working can lead to mistakes and an increase in sickness among staff.

I will move on to some of the comments that were made. I thank Mr Anderson again. He and a lot of Members said that the problem was not unique to Northern Ireland. We are seeing an increased need and a reduction in nurses worldwide. He said that when he meets his trust — I am sure that we are all the same — the issue of our nursing and medical staff is brought up time and time again. I believe, even from the tone of the debate, that we all take this seriously and want to see and effect change.

Mr Anderson also mentioned that the needs of the service had changed over time. Mrs Dobson brought that up as well. The role of nurses is diversifying all the time. That is due to, among many things, the number of people with long-term conditions and multiple co-morbidities, which has led to changes in what nurses have to deal with and how they work.

Mr Anderson also brought up the age of the workforce in nursing and especially in midwifery, which has become a great problem and needs to be addressed. He mentioned, too, the reliance on agency staff — many Members pulled it into the debate today — which costs our health service a vast amount of money. There are vacancies for nurses in care homes and other parts of the health sector that cannot be filled, and that is very much to do with the overuse of bank nurses. Some nurses have decided that that is a better course for them. I cannot blame them, because they can choose their hours, decide what days they want to work and get paid slightly better. We cannot throw the blame on nurses. Why would you work unsociable hours, weekends and night shifts, when, through banking, you can pick and choose what you do? We need to address all those things, as everyone said, through workforce planning for the future.

I find the amendment to be a rather good one — I do not think that any of our Members said that it was not — but we felt that it did not address some of the specifics. We are not knocking it; we certainly have not done so. I hope that the tone from these Benches has not been heard in that way. I think it was Mr Butler who said that he did not want to politicise this; in fact, he was the only Member to politicise things when he talked about Health Ministers not doing anything. I wonder whether that includes his Health Minister when his party held it, but, at this stage, I will not know the answer to that. I am glad that it did not become a political football in the Chamber. Time and again, when we debate health in here, that is not how any of us want to take it forward.

I will just touch on a few more contributions if I can fit them in. Catherine Seeley talked about International Nurses Day and the feelings of being drained and hopeless of the person she spoke to. That is certainly not what we want to hear of our health and social care staff. They are the people who, when we are feeling drained or hopeless or go to visit loved ones in that state, we want to comfort us. We forget that no one is comforting them through their trials.

I have already touched on some of what Mr Butler had to say, so I will move on to Mrs Bradshaw. She was absolutely right when she said that we needed to reduce our dependency on agency workers. She also said that workforce planning was a major issue across the entire health and social care service. That, again, is entirely correct: it is not just nursing that we need to look at but everything else as well.

I was delighted to hear that Mr Sheehan had been in my wonderful constituency of North Belfast, at the Mater Hospital, for whatever reason it might have been. I thank him for his contribution. I know that I am getting to the end now and need to wind up. I thank everyone who took part, especially those who told their personal stories. I was glad to hear Antrim Area Hospital getting a mention for the work that it has done for Mr Milne and his family. There is an overall consensus in the Chamber that we cannot thank our nursing and healthcare staff enough for the work that they do for us.

Photo of Caitriona Ruane Caitriona Ruane Deputy Speaker

Perfect timing.

Question put, That the amendment be made. The Assembly divided:

<SPAN STYLE="font-style:italic;"> Ayes 34; Noes 57

AYES

Mr Agnew, Mr Aiken, Mr Allister, Ms Armstrong, Mr Attwood, Ms Bailey, Mrs Barton, Mr Beattie, Mr Beggs, Ms S Bradley, Ms Bradshaw, Mr Butler, Mr Carroll, Mr Chambers, Mr Dickson, Mrs Dobson, Mr Durkan, Dr Farry, Ms Hanna, Mr Kennedy, Mrs Long, Mr E McCann, Mr McCrossan, Mr McGlone, Mr McGrath, Mr McKee, Mr McNulty, Ms Mallon, Mr Mullan, Mr Nesbitt, Mrs Overend, Mrs Palmer, Mr Smith, Mr Swann

Tellers for the Ayes: Mr McGrath, Mr Mullan

NOES

Mr Anderson, Ms Archibald, Mr Boylan, Ms Boyle, Mr M Bradley, Ms P Bradley, Mr K Buchanan, Mr T Buchanan, Ms Bunting, Mrs Cameron, Mr Clarke, Ms Dillon, Mr Douglas, Mr Dunne, Mr Easton, Mr Frew, Ms Gildernew, Mr Girvan, Mr Givan, Mr Hamilton, Mr Hazzard, Mr Humphrey, Mr Irwin, Mr Kearney, Mr Kelly, Mrs Little Pengelly, Ms Lockhart, Mr Logan, Mr Lynch, Mr Lyons, Mr McAleer, Mr F McCann, Ms J McCann, Mr McCartney, Mr McCausland, Mr McElduff, Mr McGuigan, Miss McIlveen, Mr McMullan, Mr McQuillan, Mr Maskey, Mr Middleton, Mr Milne, Lord Morrow, Mr Murphy, Ms Ní Chuilín, Mr O'Dowd, Mrs O'Neill, Mr Poots, Mr Robinson, Ms Seeley, Mr Sheehan, Mr Stalford, Mr Storey, Ms Sugden, Mr Weir, Mr Wells

Tellers for the Noes: Mr Anderson, Mr Robinson

Question accordingly negatived.

Main Question put and agreed to. Resolved:

That this Assembly acknowledges the ongoing problem of nursing shortages in Northern Ireland; recognises the work carried out by former Health Ministers and health and social care trusts to address this problem; and calls on the Minister of Health to build on these efforts by working proactively with our colleges and universities to promote nursing as a career choice and to work collaboratively with the relevant bodies to train and retain more nurses, thus reducing the total spend on agency workers and assisting long-term workforce planning.

Adjourned at 5.44 pm.