NHS Workforce: England — [Mrs Madeleine Moon in the Chair]

Part of the debate – in Westminster Hall at 3:06 pm on 17th July 2019.

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Photo of Karen Lee Karen Lee Shadow Minister (Home Office) (Fire) 3:06 pm, 17th July 2019

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend Eleanor Smith for securing this important debate.

I will start by talking about my lived experience of staff shortages in the NHS. I worked as a nurse from 2003 until 2017, when I entered Parliament. For the majority of that time, I worked on an in-patient cardiac unit at Lincoln County Hospital. Today, I want to paint a picture of a nurse’s working day and how difficult that becomes when we have staff shortages. First, however, I pay tribute to all the staff at Lincoln County Hospital—not just the nurses, but all the staff—and to NHS staff who deliver our healthcare right across this country in local communities and in hospitals.

I keep in touch with my former colleagues and still hear at first hand how staff shortages affect them—some stories are quite scary. As an MP over the past two years, I have witnessed an awful lot of patronising pats on the back. I exclude today’s debate from that, but we often hear from Members how wonderful our NHS staff are, and yet that does nothing to address staff shortages or to make their working conditions any better. That is what they want; they do not want patronising pats on the back. The 40,000 nursing vacancies are evidence of that stark truth.

As a nurse, when I went on shift, I would be allocated eight cardiac patients. They would have been treated for heart failure, recently had a heart attack or been waiting for an angiogram, or perhaps they were being treated for endocarditis, which is a serious infection of the heart. The staffing was meant to ensure that a single nurse took either the male or the female team, with an extra nurse working between the two sides to support the multitude of tasks that delivering good patient care means. In reality, we often did not get that third nurse, and had to manage without. Some shifts felt like a marathon combined with a sprint—I kid you not, Mrs Moon, it really was that bad. I did love it though.

The medical management of my group of patients would be varied. Many patients were diabetics, meaning that we had to check blood sugars, four times a day for some and twice for others. If four or five out of eight of a nurse’s patients were diabetics, that was quite a task. We could even get something called “sliding scale”, which meant we had to check them every two hours. Sometimes, honestly, we just chased our tail the whole day.

Many patients needed intravenous antibiotics, which were really time-consuming to prepare, even more so if a patient had a line, a Hickman or a PIC—a peripherally inserted central catheter—because it had to be done aseptically; it just took ages, and the nurse was running around the whole time. As well as that, staffing was routinely topped up with bank or agency staff. I am not knocking them, because we would not have managed without them, but they were not allowed to do IVs, so when we had agency staff on the other side of ward, to be honest we would end up doing quite a proportion of their work as well. That made it really difficult.

Many patients were prescribed controlled drugs, so first thing in the morning, at 8 o’clock, we might have had two or three CDs to do—but trying to get someone else to check the CD was a nightmare. There were just not enough hands on deck, which meant that people were sat waiting in pain for analgesia when they had gone all night and were due that dose. Sometimes a patient needed a blood transfusion, which was a really tricky process. They had to be monitored the whole time, but, again, that was done for one person and there were eight patients, so the nurse was running around all the time. It felt unsafe and the nurse felt really bad because they wanted to deliver good, safe patient care.

A patient might be close to death and need to be monitored, because the nurse could tell visually whether they were in pain, but there were seven others to look after. The relatives wanted someone to sit and talk to them, which of course the nurse wanted to do, but they did not have the time. In addition, there were other tasks such as changing dressings, monitoring pressure areas, and speaking to social workers, physiotherapists and occupational therapists about assessments, as well as discharging patients. The doctor might say to a patient, “You can go home today”, but the nurse had seven others to look after. All the patient wanted was for the nurse to do their paperwork and get their meds from the pharmacy. They sat waiting impatiently and the nurse felt bad because the patient could not go home. When the nurse eventually got them out, another patient was straight into their bed and the admission paperwork had to be done. The tasks were endless, but that was the job. We did it and we loved it, but we have to have enough staff to do it properly.

No nurse can deliver care without the healthcare support workers, so this is not only about nurses. The housekeepers make the tea but because the nurses do not have time to sit and talk to the patients and their families, the nurse goes to the housekeeper at the end of a shift and says, “Has anybody told you anything that I need to know?” It is team work. If there are not enough staff to carry out the different roles, staff simply burn out and cannot deliver the care that patients need. Towards the end of my nursing career, in the two years before I came to Parliament, I worked in out-patient clinics because I thought it might be a little easier, but it was not. It never is, but I was starting to get burn-out and I did not want that to happen because I loved the job too much.

We used to work 12.5 hour shifts. We would start a day shift at seven in the morning. At about half nine, if we were lucky, we got a cup of tea, but we literally had only five minutes. At around two o’clock we got our lunch. We had half an hour and we were meant to have another break at teatime, but we never, ever got it because we were running around trying to finish all our jobs, chasing our tails and trying to get everything done. So we would have a break of about half an hour in twelve and a half hours. Then, just when we thought we were going home, it would turn out that the bank staff, the agency staff, had not turned up and we could not simply say, “I am off home.” We had to wait until somebody had been found somewhere else in the hospital and somebody was moved from a different ward. Then the handover took half an hour. Instead of going home at half seven or eight o’clock, it could be nine o’clock and we would be back again at seven the next morning. People simply burn out.

Working in our NHS is incredibly hard work in whatever role. It is not well paid, and in places such as Lincoln a few years ago when we had the pay freeze, it was suddenly decided that a consultation would be held and we were asked, “Do you think you ought pay for staff parking?” Of course, everyone said no, so what happened? We all had to start paying for staff parking: £15 a month for staff nurses who had not had a rise in years. It absolutely made us feel undervalued, and that is not acceptable. I am not surprised that people are leaving the profession.

I want to talk now about the crisis in our NHS and about some of the steps we must take as parliamentarians to address it. There are more than 100,000 vacancies in our NHS, including 40,000 nursing vacancies. The “Interim NHS People Plan”, released last month, acknowledges that

“shortages in nursing are the single biggest and most urgent we need to address.”

I agree with that, but there are many other things we need to address, too. It is true that 80% of shifts from over 40,000 nursing vacancies are covered by expensive bank and agency staff, which highlights the false economy of austerity. It makes no sense financially. I will say this again and again: the removal of the nursing bursary in effect means that nurses are not training. I know I will get the answer back about how wonderful nursing apprenticeships are and how other wonderful things will happen, but the stark truth is that nurses are not training. So the NHS long-term plan and the talk about all the extra places for nurses is pie in the sky if we have not got the nurses training. It will simply not happen.

I am particularly concerned that applications from mature students have decreased by 39%. People no longer have the support that I had when I trained as a mature student. I was 39 when I started my training. The RCN is calling for the Secretary of State for Health and Social Care to be accountable to Parliament for making sure that there are enough health and care staff with the right skills in the right place at the right time to care for patients, based on population needs now and in future. Support for that must be, as my hon. Friend the Member for Wolverhampton South West said, cross-party if it is to happen. This or any future Government must ensure a credible, costed workforce strategy. Our healthcare workers must feel confident of delivering the very best care, and our patients must feel happy with the care they receive. A worn-out and demoralised workforce is not what the patients or any of us want to see.

Patients watch nursing staff doing their best to look after them. Some of them used to say to me, “Do you ever stop and take a breath?”, and I would jokingly say, “No, but I still don’t get thin, do I?” They have to wait their turn longer than they should for the care that they need, and that is not what we want to see. So I really hope that the Minister is genuinely listening and does not give me the usual answers: “We have got apprentices and we have got this and we are doing that, and all this money is going in, so we will get lots of nurses and it will all be all right in five years’ time.” I want someone to take notice and listen to me as an ex-nurse and make sure that hardworking NHS staff will be equipped to deliver the care that is both safe and effective for them and for their patients.