My Lords, I congratulate the noble Baroness, Lady Tyler, on this debate and agree with a great deal of what she had to say by way of introduction. This report gives serious grounds for concern. Clearly, Covid has played a major part in the pressures that nurses feel, and they deserve our sympathy as well as our gratitude. I agree with many of the suggestions of a comparatively straightforward nature that she made, which might be able to alleviate some of these strains.
I will focus on an issue that the noble Baroness, Lady Tyler, raised: recruitment. She mentioned that we recruit more than half our additional nurses from abroad, and that the Royal College of Nursing said there was a problem as a result of Brexit. I looked at the Royal College of Nursing labour force survey, which shows that there is the same number of nurses from the EEA now as 10 years ago, so that has not been a problem—but we have recruited many more from other countries.
What I find particularly alarming is the recent news that more than 4,000 of those nurses we have recruited from other countries come from poor countries that themselves have a great shortage of nurses. That strikes me as immoral and wrong. I am not alone in saying that; people on both sides of the House have said it.
What puzzles me is why we do not go on to ask, “What is the alternative?” Surely the alternative is to train more of our own nurses. No one ever focuses on the fact that in the last year for which I could find figures in the Royal College of Nursing labour survey, we turned away 26,000 British applicants from nursing courses—a far higher proportion than are turned away from almost any other area of training or qualifications.
It used to be because we rationed the number of places by bursaries, which came from the NHS budget. I remember discussing with Jeremy Hunt why we had not increased that. He said he had reached the conclusion that his predecessors thought, “If I spend more money on bursaries and train more nurses, those nurses won’t be available until four or five years from now when I won’t be Health Secretary”. Of course, that was not the case with Jeremy Hunt and he was instrumental, along with George Osborne, in changing the rules so that thereafter nurses were trained out of student loans.
We thought that would end rationing, but it has not. I understand from those I speak to in the health service that there is de facto rationing because of the supernumerary rules and so on mentioned in the report. Training nurses is an encumbrance as far as the hospitals are concerned—they do not count as part of the workforce but subtract from it. I do not understand that. What I really do not understand is that those who clearly know far more about the NHS than I do never focus on it. They never use their great expertise and information to identify what is going wrong. Why are we rationing places in our universities and turning away people who want to be nurses and who we need as nurses, blighting their prospective careers and making them do something else instead? It is a scandal.
Of course, we know why. People say, “If you’re advocating British people being trained as nurses, that must mean you’re against immigration.” I am in favour of having the most highly qualified labour force we can and giving the maximum opportunities to people in this country who want to be nurses and do other worthwhile professions, rather than saying that we ought simply to make ourselves open to every form of immigration from the world.
I noticed one puzzling thing about this report. It contains a whole series of harrowing comments from nurses, and more than half of them come from nurses in Scotland. I could not see why. I claim Scottish ancestry and was brought up to believe that this made me racially superior, until I learnt that that was racism; now I just claim to be equal to everybody else. I have a natural love of Scotland, and I cannot believe that Scottish nurses are in any way different. I looked at all the answers, when they are broken down by whether they are in Scotland, England, Wales or Northern Ireland, and in almost every case the situation is more negative in Scotland, despite the fact that Scotland gets 25% more per head to spend on health than the rest of the United Kingdom. That makes me think that this is not simply a question of money; it is a question of morale, leadership and the whole ethos of the NHS.
Both in Scotland and in the rest of the United Kingdom, we ought to look at the sort of measures that the noble Baroness, Lady Tyler, has put forward to improve the lot and the work satisfaction of nurses, and at the same time see what we can do to recruit more British people into our universities to become nurses and stop us stealing nurses from poor countries that need those nurses much more than we do.