6. Member Debate under Standing Order 11.21(iv): Nurse Staffing Levels

Part of the debate – in the Senedd at 3:25 pm on 11 December 2019.

Alert me about debates like this

Photo of David Rees David Rees Labour 3:25, 11 December 2019

Helen also highlighted the retention and recruitment strategy, which is one of the big common themes, and raised the concerns about it. Particularly, I think, she mentioned one thing. We talk very often about retention and stress, but we also forget sometimes it is staff burn-out that exists amongst many of our staff, because they put in, as Angela said, the extra hours above and beyond what they normally do and what they're contracted to do. And that helps—well, it does help them burn out, because it adds more to their commitment. They come home tired, they're spending longer hours there, because of their desire to protect and help patients. It is something we need to address.

Angela highlighted again the question of flexible working. Can we look at ways in which we can look at nurses? Can we encourage health boards to look at a flexible approach to employment? They're good, agencies, because agencies offer flexible working. Can we, as an NHS, actually offer the flexible working that agencies offer and look to ensure we can keep them within the national health service, because retention is one of the critical elements in this report? We often talk about—. We've got a general election going on and we've heard the numbers from Boris Johnson saying 50,000—20,000 of which will be retention. So, even they recognise that retention is critical to ensuring that we have a proper workforce available to deliver care in our hospital settings, in this case, and in other settings as well. You're right: is it bank nursing, is it agency nursing? Why can't we give them overtime? Why can't they just work in the place where they normally work—their regular place of work? I think we need to address this matter.

Dai Lloyd reminded us of the challenges that remain. Progress has been made but challenges remain. And I think, again, this report highlights that. It says that we are looking at the fact that health boards are discussing this Act, and they are discussing the implementation and where they're meeting their duties within this Act. But there are still many challenges to go because the workforce strategy is critical in all of these discussions. He also highlighted that the purpose of this Act is to improve care and outcomes for patients, not to improve, necessarily, nurses' lives, which is what it will do, but it's actually about the patient. Because if you get the nursing levels right, you get the outcomes for patients right, and that's of critical importance.

Caroline reminded us again of the workforce planning and I will ask her sometime, in terms of some of the comments she made, to please look at the discussions we had in committee during the progress of Stage 1 and Stage 2 of the Bill. They may answer some of the points she raised, because many of those issues were raised and I think the Member who led the Bill did it for other reasons than were properly highlighted. And there are different levels of compliance across the health boards. That is an issue. We have to address that. Because compliance was one of the issues we raised as a possibility to look at, to make sure there is consistency across Wales.

She mentions she wants an Act in every health setting, but one of the arguments we put forward on that was the evidence coming forward to support which areas of health settings were actually being focused upon. It is important, if we're going to do this, that this is evidence led. The adult acute medical wards was evidence-led, and the paediatrics is being evidence-led, so I want to look at where you're going next—where is the evidence leading us to next? Is it maternity, is it mental health, is it community nursing? We need to understand the areas you're looking at, what their priorities are and where the evidence will come from, to ensure that we are using this as an evidence-led base to ensure that the settings are right. So, that's what we have to do. It's not just the whole lot, because it sounds good to say the whole lot, but we need to make sure it's right and it goes in the right places.

The Minister has clearly indicated that he is very proud to include paediatrics. We are also very pleased to see paediatrics come along since the Bill, because one of the things we said was that we wanted more areas to be included, and that's why the regulations were put in, to allow you to do that without having to do any more additional legislation. So, that's important. Clearly, we want to go further and further. I'm very pleased to hear you're going to a robust independent evaluation for April 2021, to coincide with that, so we can actually look very carefully at that evaluation, as well as the three-year evaluation that will be taking place.

And you're right, Minister, it is good to see that you've increased the numbers from 1,053 to 1,987 since 2014—very welcome, but we need more, because one of the concerns we had when the Bill went through was do we have enough nurses to deliver in all settings, or the settings that we required. We need to train more. And I'll give an example why we need more nurses. A family friend's grandchild was having a cleft palate operation, which required two surgeons, plus theatre staff. Five minutes before that surgery was to take place, it was cancelled, because the specialist nurse that was required to be with that child after the operation had to be transferred to another part because of the skills she had. Now, you can understand that's a need, required because an emergency came in, but we therefore need more specialist nurses to ensure those things. But that's a cost to the NHS, because you had a whole team already allocated, waiting there, that then had to cancel and switch off. So, we do need to look at the number of nurses. We need more specialist nurses.

So, I'm very pleased to see 1,987, but I want more; simple as that. We need more, and we need to retain more. That's an important point. And I do agree with you, by the way, about the possible implications of an immigration policy that may impact upon recruitment from overseas. It's diabolical that anything like that could affect our NHS, and we should be fighting it every inch of the way, and I expect all Members from all parties to challenge such immigration policies, which impact upon the care our patients have in the NHS. 

I can reassure you, Minister, that every one of us in this Chamber is proud of our NHS. And we are proud of the staff in our NHS; you're not alone in that. 

Now, I'm very pleased also that the nursing bursary is still here in Wales. That's critical, because that encourages more to come along. Thank you, and keep on going with that—never ever lose it, because I think that's a benefit to encouraging more nurses to come into the profession. But we must ensure that, once they're in the profession, they're given a healthy environment to work in, a safe environment for their patients, and a stress-free, as much as possible, environment, so that they do not burn out. And that is critical. And that is what the RCN are trying to achieve and will continue to lobby on. And can I put on record my thanks to the RCN for the work they do in this area, because they have produced not just this report on the implementation of the safe staffing Bill, but also the report on workforce numbers and community nursing? They are driving an agenda to look at the nursing profession and to ensure that it grows and it actually is there to support patients. Therefore, it's critical that we continue to listen to them and work with them. 

Deputy Presiding Officer, I've never had so much time at the end of closing a session—