Examination of Witnesses (Questions 100-119)
WEDNESDAY 4 APRIL 2001
SIR JOHN BOURN, KCB, MR GLENN HULL, MR NIGEL CRISP AND SIR BRIAN FENDER
100. I can remember way back in the 1990sI was first elected in 1987going to my hospital trust at the time and being told that "cost efficiency" exercises were taking place and they were telling us that three per cent cost efficiency exercises were having to take place each year. They were saying, "We are having to pay off nursing staff, close wards, shut down beds." It was as clear as the nose on anyone's face what was happening yet this did not seem to come through to the Department or the Government making decisions and it has created problems now that could have been avoided. I am not holding you responsible because you were not there but surely somebody was responsible?
(Mr Crisp) The Department of Health was working on a set of projections and assumptions about how health care provision was changing.
101. I am not calling you a liar, I am sure you know that, but I do not think that can be accurate. It was purely a cost exercise, was it not? It was purely a cut-back exercise to cut money into the Health Service. My maths is not very goodI scraped an O-level a number of years ago and the highest mark I got for maths was in GCEsbut I worked it out that if you have 99 health authorities and you work out the cut-backs over three years, each health authority was losing something like 500 nurses over a period of three years. That must have had a huge effect on the Health Service across the country. Nobody seemed to pick it out or, if they did, nobody did anything about it.
(Mr Crisp) Are you talking here about the numbers that have reduced in terms of the entrants to the programme?
(Mr Crisp) Clearly in retrospect this has given us a problem and clearly it was done at that time within the assumptions and the policies of the day.
103. Obviously you are not going to come out and say what I want you to say, so I will push on.
(Sir Brian Fender) You have got that right!
104. So when was the Department first warned what effect the reducing numbers was going to have on the Health Service?
(Mr Crisp) To be honest, I do not know when it would have been first warned. I have no doubt that there was lots of debate about the numbers of staff that were needed and so on throughout this period and you will be able to find people who have been warning of this for a long time, I have no doubt.
105. Okay. If we look at paragraph 2.17, because of the considerable shortfall since 1995 it seems to me it is going to be very difficult to reach your targets because you have also had what appears to be lack of vision by the NHS trusts. How confident are you that your targets of 5,500 extra nurses and midwives and 4,500 therapists that need to be trained each year up to 2004 are going to be achieved?
(Mr Crisp) I have got our projections in front of me and the difference between the baseline year (which was last year) and the current year (which started two days ago) is 1,600. The details are still being confirmed. Can I just say that this is places rather than entrants because it is too early to assess entrants. In the first year of that period we are looking at 1,600. That is a good start towards 4,500 over four years.
106. These targets are what you actually project that you will need to deliver an improved Health Service but really we are talking about thousands more than your target figures, unless I am totally misreading the situation. If you look at page 22, paragraph 2.25, somewhere in that paragraph it states that there are something like 10,000 posts vacant at the present time. So if there are 10,000 posts vacant at the present time and you are still wanting to recruit 5,500 nurses and midwives and 4,500 therapists over the next four years you have got to get the 10,000 recruits filled first before you start recruiting targets for 2004, or am I reading this wrongly?
(Mr Crisp) There are three figures that you need to look at. The first is the increased number of nurses in post and we want 20,000. The 5,500 extra in training every year is a contribution towards that. By 2004 we will be training 5,500 every year more than we are training at the moment, but they are not the only source of getting towards the 20,000. That is the second point, 5,500 per year, 20,000 we need in post according to our calculations. The third point about vacancies is clearly there are too many vacancies but you should not assume that the work covered by these vacancies is not being done. At the moment a certain amount of that work is being done by agency staff. There is also a balancing factor here which is numbers of agency staff.
107. I am going to move on very quickly because I want to go on to something else. I want to talk about qualifications. I am going to be accused here of wanting to take the Health Service back to the olden days but that is perhaps in line because it has just been announced we are going to bring matrons back after 30 years which is a good idea, an excellent idea. Let us just have a look at some of the qualifications that are needed to enter the health profession. What qualifications do nurses need to get into training? How many GCSEs do they need? How many A-levels do they need?
(Sir Brian Fender) It is not done like that.
108. It is not done like that?
(Sir Brian Fender) No. I think what you need to do is to assess the student. Remember quite a lot of nurses are mature students. The average age is relatively high so you want to look at their previous work experience as well as their educational qualifications in judging whether they are going to make a good nurse.
109. Fine. That is what I was hoping to come on to. What about the youngster who is leaving school?
(Sir Brian Fender) It is kind of a good news story there. We have seen over the last really only two or three years, a short period of time, an increase, a really significant increase, from just over 3,000 to 6,600 of students with A level qualifications. The number with A level qualifications is going up strongly.
110. This is the point I want to make before I finish. Is there not an argumentagain being a little bit of devil's advocate in what I am sayingto say that perhaps the qualifications that are asked for are too high? If you go back to 30 years ago when nurses went into the profession, they were not expected to be academic geniuses, they were expected to be able to do a nursing job. Are we not debarring lots of what could be competent nurses, student nurses, going into the profession simply because they have not got the academic standards?
(Sir Brian Fender) No, I think we do not have evidence of that. I think what we have got from the figures is that universities and colleges are taking this broad view, which I think you would like them to take, about looking at the nurse's potential aptitude and making judgments that way rather than mindlessly or mechanically responding simply to their formal qualifications.
Mr Steinberg: I would love to go on but my time is up.
111. Sir Brian, the report says that the NHS puts £705 million a year into training of nurses under the health care professional. How much does the private sector put in?
(Sir Brian Fender) As far as I know they do not.
112. Where do they get their nurses from?
(Sir Brian Fender) They get their nurses from the publicly funded students.
113. So money from the NHS funds, in a sense, the sum total of new nurses under the health care professionals coming into the Health Service and it is, in effect, the trainer?
(Sir Brian Fender) Yes. Of course it is possible that the private providers are recruiting staff directly in from elsewhere who have not flowed through the UK higher education system. Generally the experience elsewhere, not just in this country but in other countries, is that the public funding contributes a disproportionate amount to the training of health professionals of all kinds.
114. How many nurses leave? How many nurses who have been trained in the NHS take up posts overseas?
(Sir Brian Fender) I do not have that information.
115. Any ideas, Mr Crisp?
(Mr Crisp) No, I do not know.
116. How many nurses trained by the NHS are agency nurses?
(Mr Crisp) Again, I do not have that number here.
117. Let me put it the other way. How many agency nurses have been trained by the NHS?
(Mr Crisp) My guess is that it must be a vast majority.
118. Virtually all of them?
(Mr Crisp) I would think so.
119. I was a little perplexed you see because when I set off looking at the figures, even if we want to go back to 1996 when there was something of a 50 per cent increase year on year in the number of nurses being trained, I wondered where they had gone. I wondered whether there was some kind of fictitious hospital in the Scottish Isles which was over staffed with nurses and which had more radiographers than they needed rather than my local general hospital which is, by and large, short of nurses.
(Mr Crisp) Yes. Actually the figures in the last few years for nurses in employment in the NHS have gone up. In the last census, which was taken on September 30, there were 6,200 more nurses working in the NHS, this is head count, than on September 30 the year before. So we have actually been seeing an increase in the number of nurses working in the NHS for a variety of reasons. Part of them are about training more people as we have said earlier, partly for recruiting them back in.
7 Note by Witness: It is expected that the number of entrants over four years will be 5,500, not 4,500. Back
8 Note by Witness: While there is an indication from data from the Higher Education Statistical Agency of a small increase in the number and proportion of nursing and midwifery diploma entrants with A levels, this is on a much smaller scale than that reported in the Minutes of Evidence. Back
9 Note by Witness: There were in fact, 6,300 more nurses working in the NHS, not 6,200. Back