Nurses
The next item of business is a debate on motion S1M-3078, in the name of Malcolm Chisholm, on action to recruit, retain and value nurses, and two amendments to that motion.
The delivery of health services for patients requires a combination of sustained investment and reform—investment in staff, equipment, facilities and new treatments, and reform of ways of working and service organisation in collaboration with patients and front-line staff. Often, in recent weeks, I have seen and read commentators suggest that investing in capacity and investing in reform are two alternative strategies for improving the national health service. Investing in staff has even been portrayed as investing in a bottomless pit that would leave few resources over for reform. That is nonsense. At the heart of that nonsense is a real misunderstanding of what we mean by reform in the NHS. I shall say more about that in next week's debate.
Investing in staff is central to investing in reform. Front-line staff know their patients best; they know what their patients want and how they could make changes to improve their patients' experience. The key to reform is allowing them to do that. By "them", I refer to the whole health care team, and I thank and pay tribute to the invaluable contribution of every member of that team.
However, this is international nurses week. Nurses and midwives are central to the delivery and reform of both health care and health improvement. The central message to nurses from today's debate is, "We value you and we will seek to value you more and more in the weeks and months to come." There is no doubt that we need many more nurses in the NHS. Since 1997, there has been a rising trend in the number of qualifying nurses. I hope that that trend will continue when new national work force statistics are announced tomorrow. However, we must step up our efforts and ensure that we listen and respond to the needs of the thousands of nurses already working within the NHS.
That is why it has been so important to me to meet hundreds of nurses at the national convention that we held last November and at the six local conventions that we have held throughout Scotland during the past two months. That is why it is so important to me to continue to talk to nurses throughout Scotland. In the past few weeks, I have met emergency nurse practitioners in Aberdeen; nurse endoscopists in Ayr; infection control nurses in the Borders; sexual health nurses in Edinburgh; nurses working with the homeless in Perth; and nurses on medical wards, surgical wards and in primary care throughout Scotland.
Tomorrow, in Inverness, I will have the privilege of joining others to celebrate the success of Scotland's first 11 family health nurses. That is an example of partnership at an international level, as the World Health Organisation is helping to test the delivery of a new model of care, which incorporates disease prevention and health promotion as well as caring for those who are ill. That offers exciting potential for the development of community health services in Scotland.
Following the national nursing convention in November, we drew up an action plan called facing the future, which is based entirely on views that were expressed at the convention. We established a strong national implementation group, called partnership in action, which I am honoured to chair. At the November convention, we announced £1.5 million for recruitment and retention initiatives. That was increased to £5 million at the first local convention in Glasgow at the end of February. At the Glasgow convention, I also announced the immediate funding of six return-to-practice schemes, which will enable 150 nurses to return to work in NHS Scotland. The funding will cover costs, expenses and child care; 60 of those nurse returners are already in place.
We are aware of the need to repair the damage that was done by previous short-sighted decisions to cut student nurse intakes; those are the life-blood of future supply. We have driven up student intakes; 10,000 more nurses will qualify in Scotland by 2005, which is 1,500 more than previously planned. As part of the facing the future initiative, I have increased intakes yet further. There will be another 250 extra students in this academic year. We have increased student bursaries by 10.4 per cent and there will be a further increase later this year.
Will Malcolm Chisholm give way?
In a moment. I need to make more progress first.
We want all those who qualify to secure employment within NHS Scotland, if they wish to do so. We have therefore announced that we will guarantee a year's employment on qualification, from autumn 2002. There are potentially 1,500 newly qualified nurses due to graduate across Scotland by October; they will be the first to benefit from that guarantee. The most noticeable recruitment difficulties for nursing and midwifery are in certain specialities and geographic locations. We know that those difficulties could be addressed largely by a more sophisticated approach to work force planning. In January, the Executive issued a consultation paper on our proposals for new work force development centres, as part of our positive response to the report of the Scottish integrated work force planning group, which is mentioned in the Scottish National Party's amendment. Of course, we are supporting that report and carrying forward its recommendations.
The centres will establish work force plans based on solid research and will deliver integrated work force planning, effective recruitment activity and better collaboration throughout the service. That is a central part of our wider work force planning strategy, which is now centre stage for us. A fundamental part of improved work force planning must be a better understanding of nurse work loads. I have announced plans to establish a group to undertake a thorough study of nurse and midwifery work loads, which will ensure that future work force planning is well informed and that the developing role of nurses is not accompanied by an ever-expanding work load.
My question relates specifically to nurses' bursaries. Given his experience of speaking at various conferences, the minister will surely accept that the biggest deterrent to recruitment of nurses is the level of remuneration and the penalties that young nurses face when trying to qualify. Ten per cent of very little is still quite little. Will the minister today commit himself to considering further increases to nurses' bursaries?
There will be a further increase in bursaries this year. I am aware of the issue that Tommy Sheridan raises, and I am sure that it will come up at the special convention for student nurses that we will hold in June.
As well as improving recruitment and increasing future supply, we are delivering other improvements that will help to retain nurses and midwives in the service. We have doubled the number of nurses who will participate in leadership programmes, to ensure that every health board in Scotland will have nurses trained in clinical leadership who can provide effective leadership in clinical teams.
Our introduction of nurse consultants not only improves nurse career prospects, but ensures that nurses have more influence at a higher level in clinical settings. In recognition of the fact that nurses and midwives should be at the heart of planning and decision making for the NHS, I announced a few weeks ago that a nurse director should be appointed to each of the 15 NHS boards. I expect that to be achieved by the end of next month.
Nurses are important leaders of change. That is why we are doubling the number of nurses on leadership programmes. Today I can announce further measures to develop and support nurses throughout their careers. There will be a £1.75 million boost to NHS investment in skills development for nurses and midwives. That extra investment, on top of the money that is already being spent at local NHS level, will be a major step towards ensuring that all nurses get the continuing professional development that they deserve through their careers. We will consult nurses on the best possible use of that money in the interest of staff and patients.
Will the minister give way?
Time will not allow me to take an intervention. I have only one and a half minutes left.
Flexibility is another key issue that has been raised at nursing conventions and elsewhere. Flexibility is about the NHS providing the care that patients want, at the time and in the place that they want it. It also about staff—in this case nurses—being able to find work that they want to do, at the times they want to do it, and in roles that they want and to which they are dedicated. We are committed to driving forward that agenda through training, spreading best practice and ensuring that the partnership information network guidelines on family-friendly working are implemented effectively.
Last but not least, I will address the issue of pay. Many of the hundreds of nurses around Scotland to whom I have listened in the past few months have raised the issue of pay. However, they have also mentioned continuing professional development, working conditions, work load, career structures and flexibility as issues on which they would like to see action. I, too, am concerned about pay. I am pleased that, since 1997, we have made some progress in that area through sustained above-inflation pay awards. However, I want to see further sustained progress on pay.
The agenda for change negotiations are taking forward the issue at United Kingdom level. I believe that most nurses support that. Nurses want progress to be made on pay alongside progress on service development. I agree with them. They certainly do not want the local pay that is supported by the SNP, which would set nurse against nurse and do nothing to solve the problems that we are addressing today. Because I know what the SNP's pay agenda is, I will not support the SNP amendment; nor will I support the Conservative amendment.
I move,
That the Parliament pays tribute to the vital contribution made by all members of health care teams across Scotland but, in this International Nurses' Week, recognises the central role of nurses and midwives in delivering high quality patient care and supports the significant investment and action to recruit, retain and value nurses and midwives being delivered through Facing the Future and other initiatives.
I thank nurses, midwives and health visitors for the enormous contribution that they make to patient care and the national health service. I also pay tribute to the Royal College of Nursing for its value nurses campaign. The wording of the Scottish Executive motion that we are debating today is a testament to the effectiveness of the RCN's consistent lobbying on many of the major issues that affect the nursing profession. I congratulate the college on placing the issue of recruitment and retention of nurses firmly on the political agenda.
Recruiting, retaining and rewarding nurses must be a key priority. Today there are 1,000 fewer nurses working in our health service than in 1995. There are 11,500 registered nurses who no longer work in the NHS. There are 2,000 nursing vacancies in Scotland—an increase of more than 500 since March 2000. The drop-out rate among nursing students is 25 per cent.
It is interesting that the minister raised the spectre of local pay bargaining. I spoke to nursing students at lunch time today and they expressed their real concerns about the number of newly qualified Scottish nurses who are lured away to England or further afield by the promise of more money and better career opportunities. That is the reality and the scale of the challenge that we face.
To be fair, the Government has taken some very positive initiatives. The announcement of the free return-to-practice pilot scheme for 150 nurses is a step in the right direction, but the scheme is open to only 1 per cent of the 11,500 nurses who could benefit from it. If we are to avert the crisis that primary care and acute care face in attracting nursing staff, free return-to-practice courses should be available to all nurses who wish to return to the profession.
The pledge to put a nursing director on every NHS board is a positive development, of which I know that nurses in England and Wales are envious. That step marks progress for nursing and the NHS. The minister is to be congratulated on abandoning the somewhat intransigent attitude of his predecessor on that issue.
There are issues on which much more progress needs to be made. If it is clear—and it certainly is—that the public value nurses highly, why do we reward nurses with pay scales that are lower than those of other professions? Their starting salary is 10 per cent lower than that of police constables and 11 per cent lower than that of teachers. When nurses are in education and training that prevents them from supplementing their income with part-time employment, which other students routinely do, why are they expected to survive on bursaries, which, despite increases, are unable to support a decent standard of living?
Why do qualified nurses face often inflexible working patterns with long shifts and unsympathetic rotas, which force them out of the NHS and into agency nursing where they can access the part-time working and flexible hours that they need? Why do many qualified nurses choose not to return to nursing practice?
Only today, the general secretary of the RCN said:
"to attract nurses and keep them for the long term, the government needs to invest seriously in the workforce through pay, careers structure and employee friendly practices."
We must work to increase pay rates for nurses to reward them properly for the work that they do, to level the playing field with other professions and to give us a competitive edge in our ability to recruit and retain nurses. Tackling low pay in the nursing profession is fundamental to addressing the crisis that it and the NHS face. That, and nothing else, is the SNP's agenda on pay—to improve the quality of pay that we give our nurses and to attract more people into the profession.
Nursing is a low-pay profession. A nurse's starting salary of £16,000 remains below the national average of £17,000, and the low-pay culture that exists at the start of a nurse's career continues even as promotion and length-of-service awards come into play. The majority of consultant nurse posts, of which there are fewer in Scotland than there are south of the border, are advertised at the bottom of the pay scale. If valuing nurses is to be more than rhetoric, it must mean tackling low pay in the profession and rewarding nurses for taking on expanded roles and increased responsibilities. I am sorry that the minister has chosen to see a hidden agenda in the SNP's amendment, because it is quite simply about rewarding nurses better for the work that they do. Without that commitment, I fear that the Scottish Executive's commitment is nothing more than rhetoric.
Flexible working is another issue on which the Executive has had too little to say, but which is a huge issue for many nurses who are in practice or seek to return to practice. Trusts find it difficult to offer flexibility, yet many nurses cannot practise without it. The huge increase in the number of agency nurse staff reflects that. Options such as self-rotas, in which nurses organise their rotas collectively to accommodate child care or other difficulties, should be encouraged. In a profession that is 95 per cent female, many nurses need a level of flexibility that is not available. The flexibility initiative is a crucial strand of the facing the future initiative, which must seek meaningful practical solutions to the issue if we are to enable nurses to remain in or return to the NHS.
More must be done to improve opportunities for nurses' professional development. A third of nurses get no financial support from their employer for continuing professional development and nearly half get no time off for training. The fact of the matter is that the NHS needs nurses. It needs their skills, their input and insight, and their invaluable contribution to patient care, and it needs many more of them. Nurses are fundamental to the effective running of the health service. It is the Government's job to make nursing an attractive profession to draw new recruits into and to enable nurses to continue their career where they want to continue it—in the national health service.
Tackling low pay and delivering flexible working for nurses are not options; they are absolutely essential elements of a successful strategy to value nurses and value the NHS. I hope that we can reach some consensus in the chamber this afternoon on all those issues, because we owe nurses a great deal and all of us in this Parliament have a duty to start delivering for them in action, not just in words.
I move amendment S1M-3078.1, to insert at end:
"; notes that a newly registered nurse's salary, at £16,005, is 9.7% less than that of a newly qualified police constable and 11% less than that of a qualified teacher; believes that addressing low pay levels is central to addressing the problem of recruiting and retaining nurses; further welcomes the work of the Scottish Integrated Workforce Planning Group, and notes that the development of an adequately resourced workforce planning strategy is essential if NHS employers are to offer nurses the flexible working patterns and meaningful career paths that they are entitled to expect from a 21st century employer and that will enable them to continue working in the NHS."
Another week, another health debate, and this week another health minister, too. I welcome this debate on recruiting, retaining and valuing nurses, given that nurses provide 80 per cent of direct patient care. I must apologise, Presiding Officer, because I have to leave early to catch a train for the three-and-a-half-hour journey to Inverness, so I am afraid that I shall have to leave after my speech.
In speaking to my amendment, I note that the information and statistics division figures for 2000 show that nursing and midwifery staff numbers have fallen by 244 since Labour came to power and that hospital nurse numbers are down by 740. It is interesting to note that the new nurse numbers are due out tomorrow, as the minister said, and it would have been more appropriate to have this debate next week in the light of the latest figures.
Understaffing and sickness levels lead to even more pressure for existing staff, which affects nurse retention and morale. That problem is exacerbated by the fact that half of school nurses, practice nurses and health visitors are eligible to retire within the next decade. That is serious in itself, but it is even more serious given the predicted demographic patterns for elderly people and the need for more care at home.
Too often we hear, as we heard from the SNP today, that the NHS is too rigid in employing staff, and nurses are no exception. However, I give credit to Highland NHS Board, which seems at least to be facing up to the issue. In last week's Inverness Courier, I noticed an advertisement for a research nurse at grade E for 15 hours a week, staff nurses at grade D for 15 hours and 20 hours a week, and a nursing auxiliary for 15 hours a week. That is the kind of flexibility and family-friendly policy that we have all been asking for to bring back the many trained and experienced nurses who are not currently working in the NHS.
I also noted the pay scales for a nurse at grade E—from £17,000 to £20,000—and I could not help noticing the post that was advertised at the bottom of the group, for an audio typist
"providing secretarial cover throughout the Directorate, moving between the General Office, Medical Secretaries Office, Clinical Genetics Department and Nursing Administration."
The salary for that full-time post was £9,000 to £11,000. Although I fully support the emphasis on recruiting, retaining and valuing nurses, let us not forget the whole NHS team, including essential administration, secretarial and laboratory staff. Let us bear it in mind that one of the Beatson consultants cited the fact that he had to do his own typing as one of the reasons for walking out. Nurses are at the forefront of breaking down restrictive practices and old-style professional boundaries. They are prepared to take on more responsibilities and are capable of doing so, but we should not take advantage of their good will and commitment to care.
Recently, more emphasis has been placed on specialist nurses for multiple sclerosis, epilepsy, asthma and diabetes. At a recent Health and Community Care Committee meeting, Dr Roberts, a neurologist from Ninewells hospital, stressed the need for more specialist epilepsy nurses for counselling and support. That would also help to free up consultant time for crucial diagnosis and assessment of new patients. However, it is a matter of concern that 20 per cent of specialist asthma nurses do not hold the appropriate qualification. I welcome the additional money that has been allocated today for training, because we cannot expect nurses to take on more responsibilities without giving them the training and support that they need to carry them out.
Last week, nurse shortages in Orkney led to the proposal to close Macmillan House, which caters for terminally ill cancer patients, and St Magnus day hospital, which offers rehabilitation for patients such as stroke victims. In a large city, there is a larger pool of qualified staff for bank and agency nursing. In Orkney and other remote areas and islands, the flexibility simply does not exist.
The proposed closure has been averted temporarily, but the decision arose following staff resignations and retirements that coincided with training sessions for five nurses on family health nursing. I have spoken to the local member, who has stated his concerns and, I understand, has spoken to the Minister for Health and Community Care. I quote from The Orcadian on 25 April, when the Stromness doctors said:
"The staff retention, recruitment, job security, educational needs and working conditions have been consistently ignored by senior management of NHS Orkney with the inevitable results that we now see."
Ironically, there was no shortage of Macmillan nurses, but they were moved to acute wards.
The Orkney crisis could be replicated elsewhere in Scotland if we do not tackle nursing shortages. All parts of the NHS team need to be valued, not only nurses.
I move amendment S1M-3078.2, to leave out from "and supports" to end and insert:
"notes with concern, however, the recent decrease in nurse numbers; acknowledges that better staffing levels and conditions will lead to better morale and therefore higher levels of nurse retention, and therefore urges the Scottish Executive to promote a more flexible system that would recruit and retain appropriate numbers of nurses and midwives to serve Scotland's needs."
I am pleased to speak in the debate to acknowledge the work that Scotland's nurses do in international nurses week and throughout the year, and to highlight what we need to do to recruit, retain and retrain Scotland's nursing work force.
Nurses account for one half of the NHS work force and deliver 80 per cent of the care that it provides. They are the backbone of the NHS and must be valued as key members of the NHS front line. I am glad that the minister has agreed that nursing directors will be on the new unified NHS boards to ensure that the nurses' voice is heard at every possible level in the service.
I congratulate the RCN on its successful value nurses campaign. Over the summer recess, I took the opportunity to support the campaign by spending time shadowing some of our nursing staff as they went about their work with homeless people at the Access Point project in Edinburgh, with a community detoxification nurse in Bannockburn and with a nurse manager on a night shift at the Royal hospital for sick children at Yorkhill in Glasgow. From the comments that members have made so far, it is clear that nurses undertake an incredible range of tasks and duties on our behalf.
On those occasions and many others, including yesterday when I met nursing sisters from Forth Valley NHS Board, I have found that nurses are keen to talk about their professional needs and how we can recruit more nurses. Pay and conditions remain major issues. Although pay remains a matter for the United Kingdom independent pay review body, I hope that the Executive will do all that it can to press the case for progress to be made.
Will Margaret Smith give way?
I will not give way. I have no time. I have only five minutes.
There will be no debate if she does not give way.
Order.
In areas in which the Scottish Executive has the power to make a positive difference to conditions, it has been listening to the RCN's campaign and has made some progress. The minister outlined that progress today, which includes studies of work loads and new work force development centres. Over the past months, Susan Deacon and Malcolm Chisholm have made welcome announcements that will impact positively on nurses. The minister has announced £5 million for nurse recruitment and retention initiatives this year. That will cover return-to-practice schemes, 250 more student nurse places and a guaranteed minimum of one year's employment for 15,000 newly qualified nurses and midwives.
Scotland has the highest attrition rate for nurses in the UK. A quarter of nursing students will not finish their courses. We must ask ourselves why that is and put in place mentoring schemes, as well as better information for potential nurses about what the job is really about. A 10 per cent increase in student bursaries, which was announced last July, and an end to the anomalies between degree and diploma students are both welcome and should go some way towards encouraging people to go into nursing training. However, as Tommy Sheridan said, there is still a long way to go.
Nurses work against a backdrop of increased work load for a number of reasons. With people spending less time in hospital before being discharged into the community, the average in-patient is in need of greater acute care than ever before. A shortage of nurses also means that nurses have to do extra shifts to cover the gaps.
We welcome the work of the Scottish integrated work force planning group. We need innovative approaches to make working more flexible, and we must do all that we can to encourage nurses to remain in the NHS team, either as contracted members of staff or as members of NHS banks. We must learn from the practice of nursing agencies so that we can offer staff the flexibility that they need at certain times in their lives, for example when they need time out or reduced hours to care for children or elderly relatives. Initiatives such as the acute trust nursing bank in the Forth Valley NHS Board area are to be applauded.
Susan Deacon held a nursing recruitment and retention convention last November, which I was pleased to attend. That spawned the facing the future implementation group and a series of meetings, the purpose of which was to examine specific areas of concern for nurses, including recruitment and retention. Continuing career development and training were the main issues that nurses consistently raised. In particular, 40 per cent of nurses have to pay the cost of continuing professional development themselves, while a further 40 per cent have to attend courses in their own time. Other nurses may be supported financially by their trust or board, but they know that organising cover so that they may attend courses is difficult, particularly in remote and rural areas.
We should do more to encourage career development. There are far more consultant nurses in England than in Scotland. We should give some thought to the fact that, when nurses embark on a career path, for example with NHS 24 or in specialist nursing grades, general ward nursing is possibly being left short of nurses at G grade and other senior staff.
One of the most welcome statements that the Executive has made recently was on the return-to-practice pilot courses. We need to roll out those courses across Scotland and reach out to the 10,000 qualified nurses who are currently not working in the NHS.
The success of all the policies that are set out in "Our National Health: A plan for action, a plan for change" and in Executive document after Executive document relies on nurses. Freeing up general practitioners' time, delivering on waiting times, improving public health, increasing nurse prescribing and providing nurse-led clinics are only a few of the things for which we rely on the flexibility of nurses.
I value this opportunity to say yet again how much we rely on nurses, and I look forward to the Executive making further progress on the issue.
We now come to the open debate. We are obviously tight for time, but I will allow speeches of four minutes with some extra time for interventions.
I agree with other members that it is highly appropriate for us to hold this debate during international nurses week.
Since 1997, Labour has delivered 20,000 new nurses across the UK and has scrapped the two-stage pay awards. However, it takes time to encourage more people to become nurses and, while new nurses are being recruited, we are still losing existing nurses from the profession. The RCN has identified three issues that we must address:
"better pay, better resources to do the work and improved promotion prospects".
That chimes exactly with the representations that I have received from nurses and midwives in my constituency. I want to share with members some of the pressures that those nurses and midwives have shared with me. They have written to me about the pressures and stress of working in wards that are not fully staffed; the lack of training opportunities; the lack of financial support, which makes it difficult to take up training opportunities; and the struggle of studying and training while holding down a responsible and stressful job at the same time.
There is general dissatisfaction with the level of pay and a sense of disappointment at the lack of career development opportunities and the lack of recognition of the new competencies and medical procedures that many nurses are now undertaking. Nurses are also worried about the impact of vacancies not being filled. There is strong concern about the use of bank nursing, about the insufficient number of fully staffed wards and medical teams and about temporary nurses being brought in to fill the gaps.
Financial support for nurses and midwives during their training is a big issue and, as Malcolm Chisholm will know, I have received many letters from student nurses at Queen Margaret University College, who are disappointed that they have missed out on the recent bursary improvements. However, they will benefit from access to the guaranteed year's employment on graduation.
A common thread runs through the representations, based not just on individuals' self-interest but on concern about how the day-to-day pressure on nurses affects patient care. Every nurse who has contacted me has raised that issue.
Will Sarah Boyack give way?
No, thank you, Ms Sturgeon.
Those concerns are a legacy of what the Tories did to the health service. The recent pronouncements of Liam Fox show the Tories' real agenda. First, they want to break the link between the NHS and health care. Then, they want to cut public spending. The statistics show that the Tory Government cut nursery and midwifery training places by 23 per cent in Scotland. Under Labour, the number of places has already risen by 8 per cent.
Gordon Brown's budget will give us a wonderful opportunity to sort out the NHS and to raise morale across the service.
Will the member take an intervention?
I will take a brief intervention.
How does Ms Boyack reconcile her fine words and the fine words of the Scottish Executive with the fact that the chancellor will take £5.8 million out of the pockets of Scottish nurses through his increase in national insurance contributions?
I have not met any nurse who is unhappy about the massive increase that everyone recognises is going into the NHS. We need to talk up the fact that the money is coming to help to raise morale in the NHS.
It takes time for new recruits to come through the system. While the key changes are being put in place, we must acknowledge the day-to-day problems in the nursing profession. It is vital that nurses are able to see real improvements taking place. I agree with Margaret Smith that the return-to-practice pilots are vital throughout Scotland. The improvement in bursaries for student nurses is a great start, but those who are switching career or who have a family to support while they go through training still face a real challenge.
Like others, I welcome the fact that the unified NHS boards contain a nursing director, which is absolutely critical if we are to change the long-term culture in the NHS. Change is happening. I know that within Lothian there is a much bigger focus on tackling low pay across the health service, and I welcome that development. It is absolutely vital that we invest in our existing and future nurses as a key part of the NHS family. It is important to say to nurses and patients that we have listened to them and that the improvements that they need are coming soon.
Let us support the motion and send a message of confidence to nurses and to the NHS across Scotland.
Nurses now take on greater roles and greater responsibilities than ever before, but the average age of nurses is increasing. The average age in Scotland is now 47. The situation is particularly acute among nurses in general practitioner practices, as fully one third of them are over the age of 55. The profession has major problems with recruiting and retaining young people. Valuing nurses would assist retention and reduce the need to recruit in ever increasing numbers.
Nurses in different parts of Scotland have different priorities: rural nurses may pay more in travel expenses; city nurses may fear violence at work when they do night shifts. I highlighted that issue in the debate initiated by Margaret Smith last September. Nurses work excessive hours for pay that is considered to be low for public service workers. The independent review's recent 3 per cent award was considered disappointing by Unison and the Royal College of Nursing.
Although the return-to-practice programme is welcome, it is merely a pilot scheme. As Nicola Sturgeon indicated, the programme needs to be much wider in scope to attract back to nursing the number of nurses that is required to fill vacancies in the long term. The return-to-practice programme will bring more qualified staff into nursing, but it will not solve the demographic problem of our more experienced specialised nurses leaving for other jobs or retiring.
The United Nations has opposed the importation of health care professionals from third-world countries. Nations such as the Philippines—where some 75 per cent of doctors who qualify and some two thirds of nurses emigrate—are denuded of professional expertise. With fewer people entering the labour force in future years, we must encourage more of our own people into the nursing profession. In fact, we could persuade people from other parts of the United Kingdom—or, indeed, Europe—to take up nursing as a profession in Scotland.
If the current reliance of NHS hospitals on agency nurses is maintained, newly qualified nurses who work in NHS hospitals may be enticed to leave the NHS and work for agencies because of the better pay and conditions that they offer. In a survey of 6,000 nurses, the RCN identified the key areas that would enhance the productivity and quality of nursing, thereby reducing absenteeism and reliance on agency nurses, lowering nursing turnover, improving morale and nurses' safety and reducing stress.
Promoting the well-being of nurses would show that we value them and would create a happier work force. We need good employment practices under which flexible working hours are promoted and the needs of nurses with families are accommodated. Employee-friendly policies that help to promote a good work-life balance for nurses are essential. Where nurses are particularly stressed, psychological help and counselling should be available. We should also ensure that bullying and workplace harassment become things of the past.
The RCN's most recent annual survey shows that dissatisfaction with nursing centres on key issues, including work load, staffing levels, hours, roles and responsibilities, having to undertake non-nursing activities and pay. The First Minister has said on the record that the SNP's idea of paying more money to attract nurses from outwith Scotland to Scotland is daft. I understand that nurses in London receive a London weighting allowance. Is not that intended to attract nurses to London from other parts of the United Kingdom? I am sure that if the minister checked, he would find that several hundred Scottish nurses work in London and that Scottish nurses work in other parts of the UK. Surely we should retain such people in Scotland.
Throughout Europe, different countries have different rates of pay. In the United States, different states pay different rates. There is no reason for us not to create a competitive edge in Scotland by providing better pay than is provided in the rest of the United Kingdom. Nicola Sturgeon has mentioned in previous debates the difficulty in replacing NHS consultants at the Beatson oncology centre, because we have no competitive edge. That competitive edge should be not only for doctors, but for nurses. If we are to have the health service that everyone wants in the 21st century, we must compete, do better and pay the rate for the job. Scotland must lead health provision in the UK and to do that, we must pay the rate for the job.
Let us attract people from throughout Europe and the United Kingdom into nursing. Let us retain the nurses we have. Let us ensure that the profession is valued as we would like it to be valued.
The contribution that our nurses make to our health care system is phenomenal. They are the backbone of the NHS and without them the NHS would crumble. Therefore, ensuring that nurses are happy and motivated is vital for good patient care and the efficient running of our health service. If things go wrong, nurses are the first to experience the problems. While we may sit in our ivory towers, they are in direct contact with patients every day. They work tirelessly to help others for comparatively little reward.
The problem is that the nursing work force is too small. Recruitment and retention problems are huge and are caused by many factors. A demoralised work force leads nurses to leave the service and does not encourage many to enter it. Understaffing leads to overworked staff who can put up with only so much for so long. Continual change leads to continual uncertainty and instability. Lack of involvement in decision making leads to feelings of being uninvolved and undervalued. The constant pressure of dealing with patients who have waited too long for treatment leads to futility and anger.
Last September, I visited Lorne and Islands district general hospital in Oban, where nurses kindly gave me their valuable time to describe the pressure. It is intolerable that a huge number of nurses are being forced out of the NHS because they can no longer take the pressure. Nurses are hugely committed to a caring, vocational profession. We can only imagine what it takes to destroy that commitment.
Some of the Executive's initiatives are good, but they do not address the fundamental problem. They are akin to rearranging deckchairs on the Titanic. Nurses are leaving because they are not being allowed to do their jobs properly. Patients are waiting far too long for admission, which leaves them more severely ill and needing more intensive treatment. That leaves them weaker and more susceptible to hospital-acquired infection, which prolongs their stay. By that stage, many patients must be exasperated with the NHS, deeply frightened and perhaps in pain. Nurses bear the brunt of all that. Their job becomes infinitely more difficult if they see too many people needlessly suffering and dying. They must continually apologise for a system over which they have no control.
Many nurses are not leaving the health service and are simply moving to more flexible and responsive systems. England appears to be the prime beneficiary of that movement, along with other European countries and Australia. It does not take a genius to work out why. In Germany, nurses are happy, well trained and content. They work in clean hospitals and see patients when they need to be seen—almost immediately. As a result, the recovery rate is faster and greater, and nurses feel that, rather than just stemming the tide, they are having a positive impact on the health of their patients. That contrasts dramatically with the situation in our NHS.
The issue is not money. Germany puts only a small percentage more of public funding into its health service than we do, and soon, Scottish health funding will be higher than that in other European countries, including Germany. The difference is that Germany has a flexible, responsive system in which a happy work force provides patient-oriented care. There is no excuse for Scotland not to have that same quality.
I look forward to the day when there will be no waiting lists, when waiting times will be short, when there will be clean hospitals and when patients will be cared for by the appropriate number of well-qualified, highly motivated nurses. The nursing profession is full of wonderful people who are doing their best under impossible circumstances. Although some of the measures that the Scottish Executive has brought in seem to be good ideas, I ask how successful those measures will be and how they will improve patient care and nurse morale when our entire NHS system is working against them.
Jamie McGrigor's contribution—or perhaps what was omitted from it—speaks volumes about the lack of consensus in Scotland on sustained and rising investment in the NHS. We will return to that theme in the months and years to come.
I welcome what the minister said in a debate that is of particular importance as it falls in international nurses week. It is obvious that ministers are aware that nurses and other health professionals are wholly thirled to investment in skills and people, so the investments in training and skills that the minister has announced are most welcome.
We have a world-class reputation for excellence in nursing, in midwifery and—increasingly—in health care education. I mention the benefits that arise nationally, across the UK and internationally from the work that is being undertaken at institutions such as Glasgow Caledonian University, which is in the constituency of my colleague Pauline McNeill. That institution is making a particular contribution to supporting the developing skills and training agenda. The programmes of its innovative department of nursing and community health, which are delivered by a multidisciplinary group, operate through the use of controlled learning environments, including skills learning laboratories. The facilities—which I urge Malcolm Chisholm and other ministers to visit if they have not yet done so—allow nursing students and nurse returners to respond to and learn from their participation in complex nursing case studies in the context of a simulated learning environment. This week, the benefits of such programmes are being discussed as far away as Jordan.
I want to mention the importance of providing nursing staff and others with designed-for-purpose buildings, which co-locate diagnostic, out-patient, day patient, casualty and day surgery services with the professions that are allied to medicine. Such buildings allow as much as possible to be done in a single visit and avoid an unnecessary series of repeated visits. Developments of that kind must be good for patients and staff, as they offer enhanced opportunities to develop new skills and allow medical and nursing staff to work together in multidisciplinary teams to meet patients' needs more effectively and to deliver convenient and seamless care.
My colleague Paul Martin and I are determined that early progress should be made on the same-day hospital at the Stobhill health campus, which is in Paul Martin's constituency. We will continue to discuss in-patient beds with Scottish ministers and the minister will have our full support in encouraging Greater Glasgow NHS Board to expedite work as soon as possible at the new £60 million facility.
I welcome the progress that has been made on nurse practitioner prescribing, which was in currency as long ago as 1987. That idea was kicked about by the Tories, just as they kicked about the NHS as a whole. Nurse practitioner prescribing has been delivered under Labour only in the past three years. Such career opportunities for nurse practitioners are part of the process of rebuilding Scotland's national health service.
Members of all parties have produced statistics on a variety of issues, such as the number of nurses who leave the profession, the number of nursing students who leave before completing their courses, nurses' ages and nurses' pay. In my opinion, the principal issue is the individual nurse and what the nurse represents in terms of hospital care.
Last week, when I visited someone in Hairmyres hospital, I found that there were major problems in the contracts for catering and cleaning. I was in a ward where the food was absolutely abysmal—I would not have fed it to a pig, never mind to a patient—and where the bathroom had been cleaned only once in a whole week. The person who stood up for the patients and who caused the most fuss was the nurse in charge of the ward, supported by her staff. She was prepared to put her neck and her career on the line for her patients. We have to recognise that kind of dedication.
The nursing profession does not just want lip service from the Parliament and the Executive about how much we value our nurses. We will have to take action to prove that we value them. Until we do, all the figures on the student drop-out rates, on the lack of retention and on morale problems will continue to get worse.
The major, although not the only, bone of contention for nurses is undoubtedly pay. The major bone of contention between the Executive and the Scottish National Party is over how we should deal with the issue of nurses' pay. The Executive believes that there is only one solution, which they allege to be a United Kingdom solution. That solution is to pay every nurse the length and breadth of the UK exactly the same.
That fails to recognise that, south of the border, special rates are already paid. Ever since the health service was created, special rates have been paid in London in recognition of higher living costs. There are also special allowances to boost recruitment and retention in areas of staff shortages—for example, among low-paid nursing auxiliaries, nurse consultants and matrons. Discretionary points will also be given to entice those who have reached the top of their field in nursing to remain in the NHS. All that proves to me that differential pay structures are not new. We should not automatically react against the idea.
We face a particular situation in Scotland. If we do not solve the nursing shortage and the morale problem, all the money that we spend on the health service will not cure its ills. That is why we believe that it would be perfectly fair and acceptable to have a differential pay structure to recognise the special problems in Scotland. Until we have one, the problems of the health service will not be properly addressed. I hope that when the minister winds up—whichever minister it is—we will be told why it is okay to have differentials south of the border but not north of the border.
If figures are coming out tomorrow, why can the minister not give them to the chamber today, rather than making us wait for the Daily Record or The Herald tomorrow morning?
I will concentrate on two points—job satisfaction and prisons.
Three things make a job worth having and attract people to it: pay and conditions; the public esteem, or otherwise, in which it is held; and job satisfaction. In the Parliament, we are okay on job satisfaction and pay and conditions, but we get zero for public esteem. As for nurses, we are beginning to address their pay and conditions. The Executive is to be congratulated on that, although there is a long way to go. In public esteem, nurses rate very highly. However, in job satisfaction, we are failing them.
The solution is not just a question of money; it is about a revolution in the health industry, if we can call it that. Because of their experience, nurses are much better than doctors at performing many duties and they should be encouraged in that. For example, the western general hospital in Edinburgh has for some years had a minor injuries clinic, which is run by nurses. I owe them a lot because they helped to save my bacon when I was taken in on Christmas eve—not on account of drink, I assure members. Other nurses looked after me very well over Christmas and the new year, when they might have been pretty grumpy. They sorted me out and now I am once again full of fight against the powers that be.
Greater job satisfaction comes through greater responsibility. We need a career structure in nursing that offers more promotion and more worthwhile jobs that still involve nursing, rather than paper shuffling. We need more in-service training. We have heard evidence from the nursing profession that it is difficult for many nurses to get in-service training.
Another issue is agency nurses. I am sure that individual agency nurses are excellent people, but I am also sure that they get less job satisfaction than nurses who continue to look after the same people in the same ward. The situation would be like MSPs being told that one week they were the MSP for Dundee East and the next week they would be the MSP for Argyll and Bute. We would not like that at all. That is the position that agency nurses are in. I hope that ministers will consider the important issues of creating a worthwhile career structure, improving training and expanding nurses' responsibility.
My second point relates to jails. The Justice 1 Committee has become the jail visiting committee—every Monday we visit a different jail. So far, to my wife's relief, we have always been let out for good behaviour. It has become apparent to me that serious efforts are being made to turn prisoners around; the issue is not just about locking people up. The health centre plays an important part in sorting out prisoners, partly because so many prisoners are on drugs. Barlinnie is the largest dispenser of methadone in Scotland, closely followed by Saughton—150 and 120 prisoners respectively get regular supplies. Drug taking is a huge issue in prisons and the nurses and the health centre have to deal with it.
Increasingly, prisons are becoming mental institutions. Many prisoners have serious mental health problems that must be attended to. The health centre is a vital part of the whole enterprise. However, such centres find it difficult to get staff. All the centres that we visited are seriously understaffed. I ask the minister to talk to his colleagues in the justice department to help to provide the important nursing services that add to the team aiming to turn prisoners around. If we do not address that issue, it will cause great problems in the future.
I declare an interest as a member of Unison. As a nurse, I am delighted to speak in today's debate. During my years in the health service, I considered myself first and foremost to be a member of the health care team. That is why I am particularly pleased that the motion pays tribute to all members of the team.
I am pleased to welcome the Executive's commitment and efforts to recruit, retain and value nurses, given that that has proved difficult in the past. "Facing the Future", the report on last year's convention on recruitment and retention in nursing and midwifery, states:
"the career journey for nurses and midwives is often ill defined and ambiguous".
I concur with that point. Perhaps the main reason for the problem is that, now, the only route into nursing is academic. Some members will know that the issue is a particular hobby-horse of mine. I believe that we are disfranchising many people who would make excellent nurses but who are unable to or choose not to follow the academic route into nursing. If we are to take the recruitment and retention of nurses seriously, we must consider making other choices available.
Over the years, one of the most important issues facing nurses has been their extended role in health care. The minister mentioned some of the specialist nurses who were recently recruited to work in our communities and to make things better for a host of people with specific illnesses.
Nursing as a career has changed and developed and nurses have been flexible enough to welcome the challenges that have been offered. However, payback for that willingness has not always been forthcoming. Career structures often leave a lot to be desired; if pathways are not clearly marked out in work force planning arrangements, that can lead to frustration. I am pleased that the minister mentioned the extra £1.75 million for skills development. That is an important area, which I hope will lead to better career pathways and more satisfaction with career development.
Flexibility is another important issue. Family-friendly policies, such as child care provision and flexible working arrangements, are sadly lacking in some workplaces, although many trusts are now working towards implementing such policies. I am particularly pleased that the Executive is monitoring the situation and will publish evidence later this year. Actions must be demonstrable. We should not just have paper policies.
Another issue that all NHS staff face is employment stability. Acute services reviews—my colleague Brian Fitzpatrick mentioned them in the context of the proposed ambulatory care and diagnostic facilities at Stobhill hospital and the Victoria infirmary in Glasgow—are much needed, but they have led to uncertainty about future workplaces and staff have not always been involved in consultation. That does not help recruitment. I know that to be the case from personal experience at the Victoria infirmary in my area. Hospitals facing closure have great difficulty in attracting staff in the short term. That must be borne in mind when acute services reviews or any changes in service provision are planned.
Attracting people into nursing in the first place is probably the most important issue. Recruitment campaigns must be imaginative and targeted at young people and those who wish to have a career change later in life. However, that applies to a large number of careers in the health service. How many people today aspire to be medical laboratory scientific officers, occupational therapists or radiographers? Probably not many, unfortunately. There are national shortages in a host of occupational groups in the NHS. We must channel our energies into addressing that problem.
I urge the minister to examine seriously the way in which we train our nurses and to consider offering a non-academic route into the profession. I am happy to support the motion and I welcome the Executive's commitment to value nurses, particularly as this is international nurses week. However, I emphasise that nurses are only one part of the team and I look forward to the day when we celebrate international porters week or the international week of medical secretaries.
I promise to be brief. I shall frame my contribution in the form of several short questions.
The Minister for Health and Community Care has been made aware of looming problems with financial support for third and fourth-year academic nursing students. Will that situation be addressed in the near future?
The incidence of surgical intervention at birth is increasing throughout the western world, but is that of concern to the Executive? The minister mentioned nurses and midwives in his speech several times, but he made no specific reference to midwifery. He did not say whether he has met midwives—he has met many other organisations. If he has not, will he meet them in the near future? Will he guarantee support for them and for the continued development of midwifery services in Scotland?
Several names are left on my screen. One member is not here, so I can give Tommy Sheridan two minutes.
I will be quick. We must make the point when we discuss the value of nurses that, although it is questionable whether an MSP is worth one newly registered nurse, it is unquestionable that we are not worth three. It is from that point of view that we must address the central priority of improving the pay of nurses in our hospitals—that is the number one priority in relation to retention, recruitment and job satisfaction. Of course, other factors contribute to job satisfaction, but pay has to be a central one.
In considering nurses' pay, we must not forget the team ethic. Medical secretaries, midwives, radiographers, porters and auxiliaries are all essential parts of the team. The yawning gap between the pay of many of those team members and that of others in our hospitals is unacceptable and has to be bridged.
The other point that I want to address in my final minute is the use of agency nurses. Audit Scotland's report into the use of agency nurses, "Temporary measures: managing bank and agency nursing staff", was published in February 2000. The commission instructed health trusts across Scotland to examine the use of agency nurses and to employ permanent staff instead of agency nurses. At the time, 562 agency nurses were employed every day in the health service; today, however, I hear that the figure has risen to 725. That means that, despite Audit Scotland's report, more and not fewer temporary agency nurses are being employed. I hope that the minister will address that issue when she sums up. How will we get more permanent nurses employed in the health service? Hospitals need to use fewer agency nurses and to stop relying on the bank hour system, which often undermines morale and lessens the desire to recruit and retain nurses.
We come to the closing speeches. I call George Lyon to close for the Liberal Democrats.
I put on the record my appreciation of the role that our nurses play in delivering health care. Over the past few months, as a father, I have had the misfortune of having to attend hospital three times, as my youngest daughter has gone through a Calamity Jane phase in her life. First, she was run over by a car. Secondly, she swam back-stroke into a swimming pool wall and had to be taken to hospital. Thirdly, during a fun night at the local swimming pool, someone jumped on her and she had to be taken to hospital with a suspected broken vertebra in her neck. On all those occasions, the nurses were truly wonderful not only in dealing with my daughter's concerns, but in calming the fears of the parents, especially on the last occasion. As I said, I, too, want to put on the record how much I value and appreciate the work that our nurses do.
I will highlight some of the problems that we face in rural areas in trying to retain and recruit nurses. Many of those problems are identical to the ones that we face in trying to recruit and retain rural GPs. Nurses are required to undertake out-of-hours commitments and they have to work longer hours than is the norm in an urban situation. In places such as the isles of Lismore and Gigha, nurses live in the local community and are on call virtually 24 hours a day, seven days a week. No other health care is available; if something goes wrong, they are the ones who have to come running regardless of the time of day or night.
In many rural communities, the shortage of bank nurses exacerbates working problems. A shortage of bank staff means that less cover is available for illness, holidays or emergencies. Nurses who work in rural areas are required to be multiskilled; they need a greater range of skills in both primary and acute care work. When an accident happens, no matter how serious, nurses are the front-line staff who have to deal with the patient in the first instance. An accident in a rural area often means a flight out by helicopter or plane to get the patient to the acute hospital where they will be seen by a consultant or a doctor.
Nurses carry a huge and a heavy responsibility on their shoulders. There is a feeling among the nursing staff to whom I speak that the current reward structure fails to recognise the extra burdens and the heavy responsibilities that many of them have to carry. I hope that the Executive will look seriously at how to address that issue.
There is no doubt that the coalition has done a substantial amount of work to try to improve the recruitment and retention of nurses in Scotland. In setting up the remote and rural areas resource initiative in Inverness, the Executive has tried to address some of the specific problems that are involved in delivering rural health care. It was hoped that RARARI would come up with new and sustainable models of delivering health care in rural areas. However, after three years, health professionals feel that RARARI is not delivering on the high expectations that its introduction created. The initiative has failed to come up with a truly sustainable rural model for delivering health care. There is a feeling that too many pet projects are being funded and that there is a tendency to work with individuals instead of with organisations, which leads to a disconnection between RARARI and the Highlands and Islands health organisations. I ask the minister to examine RARARI's work and whether it is delivering on what was expected of it—that it would formulate a sustainable rural health model to overcome some of the problems that I have just highlighted.
I join other members in paying tribute to the RCN's value nurses campaign, which was successful in raising the priority of nursing and lifting the onus that we place on nurses in society.
Although the Scottish Conservatives welcome today's opportunity to debate and highlight the nursing profession, we should not forget that there are other members in the health care team. Before I go on, I should point out that we support the Executive's measures to better the lot of nurses and improve their training. There is a consensus in the Parliament that the Executive has introduced some good measures, and we wish them luck.
However, we must also remember that over the past couple of years the Scottish Executive has presided over a decline in the number of nursing posts. We have lost nurses to the south for a number of reasons. Someone has to take responsibility for that situation.
The changes to the NHS have produced a service that is more centrally controlled and suffers from more political interference than before. Although Labour boldly says that it is pro-NHS, that does not always follow. Who could forget Susan Deacon's claim that people within the service itself were exaggerating and scaremongering to get more resources? Indeed, what about Tony Blair's speech about the scars on his back?
When I was asked to take part as the Conservative speaker in the Unison hustings during the general election campaign, I found that every party except Labour had sent a representative to address Unison members. Of course, I did not get the best welcome, but at least I turned up and put my money where my mouth was.
I bet that the Unison members were not cheering at the end.
I think they thought I was new Labour, which put them off a bit.
Sarah Boyack says that nurses are delighted to pay increased national insurance contributions. Are they really? The nurses I have spoken to will not be delighted at the prospect of losing 30 per cent of next year's pay rise because of the increase in NI contributions. Indeed, as the employer, the NHS will have to find another £5.8 million to cover that increase. I do not think that nurses are unanimous in their support for that measure.
I also find Brian Fitzpatrick's comments in that respect interesting. He did not have the same principles when he voted himself a 13 per cent pay rise. Although I do not always agree with Tommy Sheridan, I agree with him on this issue. If we are going to value our public servants—
Will Ben Wallace take this opportunity to say that the Conservatives would match Labour's commitment to sustained and rising investment in the NHS? In other words, would the Conservatives match our budget booster?
The Scottish Conservatives recognise that there needs to be more investment in health care, but we do not necessarily agree that it should be funnelled into the current NHS system.
That is a no, then.
No. Why does Labour not consider taking advantage of the 1.1 per cent increase in gross domestic product in Scotland that has been completely ignored by the NHS? Other countries do not ignore private funding streams and end up with better results, morale and staffing levels. The onus is on people such as Brian Fitzpatrick to come up with proper imaginative ideas for better outcomes.
We do not believe in using nurses as a human shield when a debate on the NHS comes up. Instead, we believe that if we depoliticise the health service and leave service workers to get on with their job, they will do much better. Alan Milburn—the odious Alan Milburn, as I think John McAllion called him last week—has returned to devolving responsibility for health care decisions, with the result that there is now better retention and recruitment of nurses in the NHS in England, and often at the expense of nurses in Scotland.
The Scottish Conservatives want to go further on certain issues. We want better mapping of the location and number of specialist nurses. When I asked the minister how many nurses who specialise in epilepsy there are in Scotland, he could not tell me. How can we develop a managed clinical network, if we do not know what assets are at our fingertips to help to support it?
I urge members to support Mary Scanlon's amendment. We will support the motion but not the SNP's amendment. We believe that nurses should be valued and left alone to nurse.
I, too, should declare an interest: I am married to a nurse. One of the main problems that nurses face is the significantly anti-social hours. There must be an attempt to address that problem because such hours are not family friendly. When my wife returned to work, she started off by working what is called a twilight shift. For members who do not know what that is, I say that it means that one's wife returns home at 2.30 in the morning with cold feet. She leaves for work at around quarter to 9 at night and comes home at half-past 2 in the morning. It is not only nurses but whole families who have difficulty with anti-social hours.
Sometimes, after a late shift, my wife sets off for what is known euphemistically as an early shift. She works from half-past 1 in the afternoon to half-past 9, which means that she gets home at 10.30 and is up again at 6 in the morning to go back to work. That is not an unusual work pattern. It is little surprise that nowadays people are not so willing to accept such arrangements. There must be much more flexibility because there are often very rigid ideas about how to deliver. That reflects the management culture.
I am delighted that the minister is willing to consider that point and to fund leadership training. That should not just involve training people to sit on the management board; it should involve training people to manage staff throughout the nursing profession. Too few resources have gone into training people how to manage. For many years, managers in the NHS have been ready targets for politicians. The service must be managed effectively, but I do not think that that happens. To have staff who are content in their work and to deliver better work patterns, skilled managers are required. Resources must be put into that.
The minister mentioned the £1.75 million of new money for skills development. I assume that that is to go towards continuous professional development—not everyone wishes to be a manager. One big gap is that nurses, because of their dedication and commitment, do continuous professional development in their own time and at their own expense for the benefit of patients and the service. I want a significant shift in that. Less discretion should be left to local management. People who are employed in skilled jobs should have the right to access training. Time and money will have to be made available for that. I hope that the ministerial team will take that on board as part of the new skills development programme.
I have a great deal of sympathy with Janis Hughes's point that there should not be only an academic approach to nursing and the other professions in the NHS in which there is a significant skills shortage—many of which she named. We should not insist that all those professions must be graduate professions. I have no problem with professions wishing to raise their skills level, but there are many professions in which the skills required are not solely academic, if they are academic at all. It must be possible to enter professions through a route that is not exclusively academic. Janis Hughes mentioned medical laboratory scientific officers.
I will finish my remarks with a comment about pay. Kenny Gibson rightly pointed out that differentials exist throughout the country. What we have not heard about in the debate is the grade drift and de-skilling that goes on. To enhance pay rates, some nurses in London will be on a grade that they would never be on in Edinburgh. They are on that grade just because they happen to be in London, and they also receive a London weighting allowance. That happens across the professions. Those of us who have worked in the NHS are well aware of that approach.
The ministerial team has the power to address such issues. It is possible for ministers to find innovative ways of addressing the pay difficulties. Donald Gorrie was totally wrong to congratulate the Executive on its contribution to changing pay for nursing staff, because the Executive has made no contribution to that. That is dealt with at the UK level, although there is scope for dealing with it here—not for the sake of making Scots nurses and midwives different, but for the sake of ensuring that the nurses and midwives who work in Scotland are satisfied.
Everybody who has spoken in the debate has recognised the fact that nurses are playing a growing role in the NHS. They are increasingly pivotal in driving our health reforms, improving services to patients and playing a major part in the development of public health and care in our communities.
Getting the right number of nurses and midwives in the right place is vital and we are taking steps to ensure that they have the right skills to meet the rapidly changing needs of the NHS today and for the future. As nurses and midwives take on expanded roles, we must ensure that we support them by helping to create the additional capacity that will be required. Action is under way to establish a framework to deliver better work force planning, which will be based on sound research into nurses' work loads.
We have already delivered significant improvements in the recruitment and retention of nurses in Scotland. We have recruited more nurses for specialties such as intensive care and cancer and more nurses in primary care and in our communities. Brian Fitzpatrick recognised the role of prescribing nurses. Up to 3,000 had been trained by April 2001 and all district nurses and health visitors are now eligible. We have also recruited more nurses in new areas such as public health, family health nursing, infection control and NHS24.
I take issue with Alex Neil's uncharacteristically intemperate accusation about the release of national statistics tomorrow. Does the minister agree that Mr Neil failed to recognise the work that has been done to restore faith in the integrity of national statistics? Does she agree that it would be wholly inappropriate to reverse agreed procedures for the release of official statistics simply to give some seeming advantage to ministers in today's debate?
I was going to say to Mr Neil that we are not delaying the release of the numbers as he may have been suggesting. We do not have them. When we asked for the debate to be held today, we were not aware that they were going to be released tomorrow.
Although there is much going on, there is still much more to do. We know that because we are listening to nurses and front-line staff who are telling us what else needs to be done. Through the national and the six local nurse recruitment conventions, we have brought together some 800 nurses and midwives and given them the opportunity to be involved in shaping the policies that affect them. Nurses in Glasgow are considering return-to-practice schemes; nurses in the Forth valley are defining flexible working; and nurses in Tayside are working to improve education and training.
One further convention is planned specifically for nursing and midwifery students, to help to identify and address issues surrounding pre-registration training. That will dovetail with other work concerning nurse cadets and the future role that health care assistants and other support workers could play in helping to create additional capacity in the service. We want there to be a consistent and managed approach to that important issue throughout Scotland.
I will pick up the point that Janis Hughes made about enrolled nurses. The reason for the withdrawal of the position of enrolled nurse was the dissatisfaction and frustration on the part of many enrolled nurses at the end of the 1980s and the beginning of the 1990s. They felt that their position was being abused and patronised within the profession. However, I recognise the points that Janis Hughes made and we will need to discuss with the nursing profession the matter of a less academic route into the profession.
I thank the minister for her comments. However, I was careful when I raised the matter not to say that there should be a return to enrolled nurses. I am an enrolled nurse and I understand the point about the lack of career progression. However, I think that we could come up with some form of agreed career structure that would give a non-academic route into the profession but would also allow job satisfaction.
I recognise that Janis Hughes is making a positive contribution to the discussion; I want the discussion to be continued with nurses.
We have added to the package that makes nursing more attractive as a career option. The package includes increases in pay for all nurses and increases in student bursaries; the pay increase for nurses is 3.6 per cent. We accepted the recommendations of the nursing pay review board, with no staging, for the fourth year. We are committed to improving pay in the short term and the long term and to modernising the pay structure.
I am the first to recognise that all the initiatives that the minister is talking about are welcome. However, will she respond to these points that student nurses made to me at lunch time? The key thing that they wanted to talk about was that many of them feel unable to stay and work in Scotland because of the low starting salaries here and the lure of better salaries and career opportunities south of the border. How will the Scottish Executive tackle that problem, so that the greater number of people that it is putting into nurse training places are not lost south of the border as soon as they qualify?
I will come to pay and the differentials that Nicola Sturgeon mentioned, if she bears with me for a moment.
We are also considering action on career and role development. Donald Gorrie mentioned the nurses who work in the minor injuries unit at the western general. I met them yesterday and know that they are developing their skills. We also see action on career progression and development and on leadership training. The Minister for Health and Community Care announced that there will be £1.75 million for skills development.
Through "Facing the Future" we have recently announced action that will lead to a further 150 experienced nurses retraining and rejoining the NHS, a further increase of 250 in the student nurse intake and a guarantee of one year's employment in NHS Scotland for all newly qualified nurses who want that. I think that Nicola Sturgeon would agree that that is a further move to ensure that nurses continue their training here in Scotland, which is important to all of us. There will be a doubling of the number of nurses participating in leadership programmes and action will be taken to give nurses and midwives a greater say in decision making, through an increase in the number of nurse consultants and through membership on the 15 NHS boards. That was welcomed by many members who spoke in the debate.
Robin Harper mentioned the role of midwives. Mr Harper will be aware that I am chairing a review of maternity services. Central to that is the safety of mother and babies. I assure Mr Harper that I will be taking forward the positive role of midwives in leading that service.
The nurse shortages that are experienced in certain specialties and in certain areas of Scotland are more to do with the need to be more effective in work force planning than they are to do with pay. That is why local pay bargaining, which has been suggested by the SNP this afternoon and has previously been rejected by staff, is not the solution.
We are working to improve the pay, conditions and morale of all nurses, not just a minority of nurses. We are playing a full part in UK talks to modernise the NHS pay system and we have made it clear that we are willing to invest in that reform.
We recognise that our health service is delivered by people in a number of professions and roles, all of whom display dedication and care. The motion refers to that and the Parliament recognises that. However, I cannot imagine that anyone will object to us taking some time today, during international nurses week, to recognise the central role of nurses.