Bishop of London speaks in a debate on nursing

The Bishop of London spoke in a debate on nursing staffing on 16th June 2022:

The Lord Bishop of London: My Lords, I thank the noble Baroness, Lady Tyler, for securing this timely debate. This issue is close to my heart. I draw noble Lords’ attention to my interests as set out in the register, specifically as a former government Chief Nursing Officer for England.

In my role as chair of a health inequalities action group, and as a Bishop with oversight of a diocese that includes some of the best hospitals in the world, I have had the privilege over the last few months of listening to a wide range of nurses. They have talked about their continued passion for high-quality nursing care, the wonderful teams of which they are a part, the innovations that are happening and their pride in their work.

However, they also speak about what lies behind the figures set out in the Royal College of Nursing report: about the impact of the last two and a half years of being tired and having gone into work day after day despite the fears for their own health and that of their families, and about how they had to innovate on their feet and go beyond what they had ever expected to do. They undertook roles that they had never imagined they would. They coped with staffing levels that were well below what was required and worked longer hours than they should have done. They did what was required, and we are grateful.

They went on to speak about the continuing pressures from increased patient dependency as a result of the pandemic; about the challenge of people presenting much later with progressive disease because of late diagnosis, so patients are sicker in our hospital beds; about the increased level of vacancies; about nurses who had gone home to other countries during the pandemic and not returned; and about nurses retiring early because of the pressure that they had been under. They spoke about how they would do what they have always done: make do, and do what is required.

We have heard some figures from the report. A couple that came to my sight are that, first, only 28% of respondents said the skill mix was appropriate to meet the needs and dependency of patient safety and, secondly, as noble Lords have heard, four in five respondents felt that care was being compromised while one in five said they were unable to raise their concerns. This all has a cost, not just to the quality of patient care, which we have heard about, or the deferred cost to the NHS. Nurses are paying the cost with their mental, physical and spiritual well-being.

As a Christian, I believe that each of us is precious and made in the image of God, with a sacred dignity and value that should be respected. Individuals are to be cherished, not just used and exploited. As a former government Chief Nursing Officer, I recognise the challenge of ensuring that the number and skills of those providing healthcare meet the needs of the population. I am sure the Minister will tell us how many more nurses are in the system, but that does not ensure that the workforce meets patients’ needs, particularly in light of the fact that patient acuity is growing. As someone who was given the objective of finding 60,000 nurses, I understand how this requires a whole-system approach, which is why I believe the Government should do what is required of them.

The Health and Care Bill gave the Secretary of State a duty to report on workforce systems and publish a report, at least once every five years, which describes the systems in place for assessing and meeting the workforce needs of the health service in England. NHS England and Health Education England must assist in the preparation of this report, if requested to do so by the Secretary of State. Will the Minister say when the Secretary of State will publish their report? Five years from now will be too late.

We heard during the passage of the Health and Care Bill that this accountability fell short of what many of us felt was essential, and the outcome of this shortcoming is seen in the royal college’s report. It is unfortunate that the Government did not take the opportunity in that Bill to embed accountability for workforce planning and supply with the Secretary of State. I believe this is the only way we could ensure that severe staff shortages and patient safety issues are resolved and addressed in a sustainable way, right across the healthcare system.

As we have heard, the Government need to ensure adequate funding for increasing the number of nurses whom we train and, as the noble Lord, Lord Lilley, says, this will take time. The truth is that one of the limiting factors is that our wards are not properly staffed today. It is hard to support and train nurses when the level of patient dependency is higher than the skill mix provided, and it is right that nurses are concerned about this. Will the Minister reassure the House that any overseas recruitment, to make up for lost time in training new nurses, is ethical?

As we have heard, we also need to retain nurses. That is where the most critical action is required at this point. The Government could consider a number of easy changes, which we have already heard about, to promote retention. There are some simple ones: for example, raising the payment per mile travelled in the course of a nurse undertaking their work. The Government could ensure that the pay rises given are realistic and that there are adequate funds for continual professional development and clinical supervision. I also hope that they could put in place clear mechanisms for staff to raise their concerns when staffing levels are not good enough. No nurse wants to work an understaffed shift: there is a cost to them and to their mental health and spiritual well-being. If a nurse is unable to raise that concern, they are even more conflicted.

We have asked much of our nurses over the last two and a half years, and they have done what is required. I hope that the Government will now do what is required of them.


Extracts from the speeches that followed:

Baroness Bennett of Manor Castle (GP): My Lords, it is a great pleasure to follow the right reverend Prelate the Bishop of London who, together with the noble Baroness, Lady Tyler of Enfield—whom I thank for securing this debate on the report—have covered clearly the huge issues that it raises. I want us to take a broader, global view and then look at some of the structural issues behind the immediate reality in that report.

On the global view, the World Health Organization tells us that there is a shortage of 5.9 million nurses around the world; that is nearly a quarter of the current global workforce of almost 28 million. The biggest shortfalls are in low and middle-income countries, notably in Africa, Latin America, south-east Asia and the eastern Mediterranean. I agree with the noble Lord, Lord Lilley, that we in the UK should not be taking people from other countries, particularly ones with a nursing shortage. We should be training in the UK more nurses than we need. As a wealthy country, that should be our responsibility.

The International Council of Nurses says that behind this shortfall are many structural problems, including low pay, poor conditions and—remembering we are talking about the global scale—inadequate training availability. I note that McKinsey & Company did a study which found that, in five of six nations surveyed—the US, the UK, Singapore, Japan and France—one-third of nurses said that they were likely to quit in the next year. This is not a problem simply contained within the UK.

Baroness Brinton (LD): The right reverend Prelate the Bishop of London spoke movingly from her own experience and deep knowledge of the issues that nurses face. I pay tribute to all of our NHS staff, who face the most severe difficulties at the moment. The Government seem to have glossed over these in their post-pandemic policy of, “Let’s just move on”. I hope that the Minister will respond to the questions raised by other noble Lords.

The RCN report rightly looks at the impact on its members, and it makes harrowing and concerning reading, especially on the lack of enough staff on duty on a regular basis, as well as the personal comments of those who have left through burnout. The Royal College of Emergency Medicine’s Beds in the NHS report shows that the NHS needs 13,000 extra staffed beds—the emphasis on “staffed” is important.

The pandemic was an emergency, but long before 2020 we were well below the OECD average for staffed hospital beds, and some of us have been raising concerns about staffing and beds for well over a decade. The current OECD data, which covers 2017-20, shows that the UK has 2.4 beds per 1,000 inhabitants; France has 5.8 and Germany has 7.8, while Korea and Japan have over 12. To repeat, the UK has 2.4—we have lost 25,000 hospital beds since 2010. Of course, in referring to hospital beds, we mean staff as well.

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