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NHS Workforce: England
Wednesday 17 July 2019

(4 months, 3 weeks ago)

Westminster Hall
Department of Health and Social Care
Eleanor Smith Portrait Eleanor Smith (Wolverhampton South West) (Lab) - Hansard
17 Jul 2019, 2:15 p.m.

I beg to move,

That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.

I am a nurse. My daughter is a nurse. Nursing is in my family and fundamentally informs who I am and what I do. Last November, I triggered a debate about investing in nursing higher education. I am here today to again carry the burning flag for the nursing profession, the wider health and care workforce, and society.

I will start by directly addressing the notion that we should not seek to further clarify the Secretary of State’s legal duties and powers. I have heard that the latest legislation sought to remove political interference in our health system. I have heard people say, “Don’t make health a political football.” Lastly, I have heard that changing the legislation to give the Secretary of State accountability for the workforce would put health and care back under political control—as if our ability to access health and care was ever out of political control.

I am sorry, but those are laughable positions. Which- ever side of the fence we sit on, it is a serious point that health is fundamentally political. It can never not be political, in terms of what we can access and what happens to people. Our great health service was created within a political agenda, and creating it was a fundamentally political act. Supporting our health and care service to thrive will never not be a political decision. Let us be proud of our history, recognise that health is political, and find a solution to the problems we face.

Now that I have addressed those weak positions, let me state that I, and many others across the political spectrum, take no issue with the idea that there should be explicit clarity in the law about the Secretary of State’s responsibilities. I am not alone in my gratitude for all that our health and care staff do. They work constantly to provide quality care by putting patients at the heart of what they do. In the NHS and the independent sector, nursing accounts for one in 10 of the labour market of the whole of England. We are, and ought to be, a fundamental force to be reckoned with.

Thanks to the scale and urgency of the workforce crisis, many people have been looking into these issues—some of us would say for far too long, and to poor result. We have a long-term plan for the NHS and an interim NHS people plan, so we have seen some movement in the way that agencies work together. However, we have no understanding of what the social care sector needs, and no assurance of workforce funding, which is entirely dependent on the forthcoming spending review and subject to the whim of a new Prime Minister. We do not have a workforce strategy that meets health and care service requirements, or that projects the future needs of the people who live in this country.

The vacancy rate has reached alarming levels, with almost 40,000 nursing vacancies in the NHS in England alone. That is not the full picture. The extent of the vacancies within social care and public health is unclear because it is not mandatory to collect workforce data. It is not possible for services designed with staffing built into their planning to run safely and effectively with so many missing staff.

Fewer people are joining the nursing profession and more are leaving. Since the referendum on the UK’s membership of the EU, more than 10,000 EU nurses and midwives have left the UK workforce. I will not be drawn on Brexit in this debate. However, while we are trying to find our way through the referendum result, frontline staff are propping up the health and care system with no credible assurances that the situation will be resolved. Our professionals are holding on as best they can, but we need to be realistic about what we can reasonably ask of them. They are starting to vote with their feet, and there is not yet the accountability to help us navigate the future that is to come.

This crisis has come about because there is no clarity in the existing legal powers and duties that would ensure that enough staff with the right skills are in the right place at the right time to provide safe and effective care. That is true not just of nursing but of every profession working within our commissioned, taxpayer-funded services, including nurses, medics, psychiatrists, physiotherapists, psychologists, paramedics, pharmacists, social workers, support workers, occupational therapists and dietitians. Literally no one—no one person—is accountable for growing and developing our health and care workforce to meet patients’ needs, now and in future.

The Secretary of State’s current legal duty is to provide a comprehensive service. The Government may say that the Secretary of State has oversight of the workforce through those general duties and powers. With all due respect, the Secretary of State’s responsibilities are too broad to understand what aspects of workforce provision they include. There are also no particular workforce duties within the range of national organisations responsible for service design and delivery. In a health and care system as complex as ours, it is easy for everyone to lose sight of ensuring that we have enough people. Clearly, that is exactly what has happened.

Mr Jim Cunningham Portrait Mr Jim Cunningham (Coventry South) (Lab) - Hansard
17 Jul 2019, 2:15 p.m.

Surely two reasons for the number of vacancies are low pay in the public sector generally and the lack of bursary provision to recruit new nurses. Does my hon. Friend agree that there is a golden opportunity for many mature women, whose children have grown up, to enter that profession? Recently, even ambulance drivers had to pay extra for their certification—I had a debate on that a couple of months ago.

Eleanor Smith Portrait Eleanor Smith - Hansard

My hon. Friend is right, and I will touch on the removal of bursaries later.

A huge amount of effort has been required to try to fix this mess. There has been progress in the NHS, but it is too little and too slow. It does not include social care and deals only with the immediate context. Many of us in this House are here to challenge the position that the existing so-called responsibilities are clear and robust enough for use by the Government and the health and care system, and for the public to have confidence that the Government can be held to account—now and in future, since the pressures on the system will continue to grow and change.

Yesterday, many of us met nursing staff, having been brought together by members of the Royal College of Nursing, who are all passionate about patient care and public safety. I am moved by their advocacy for the profession, patients and society. I also feel their desperation in the situation they face, trying to keep people safe in challenging environments. Given that professionals have been raising the alarm for decades, hopefully our demands for an end to the boom-and-bust cycle in the workforce will be met.

Even the High Court recognises how vague the current powers and duties are. The legal dispute between the Secretary of State and junior doctors over their contract resulted in a judicial review in 2016. The Court judgment said that, as stated in the National Health Service Act 2006, the objective of “protecting the public”, with a duty on the Secretary of State to take appropriate steps, leaves

“considerable leeway to the Minister as to ways and means”

of running the service.

Anyone who looks at the content of the law can see clear holes and gaps. In addition to the Secretary of State having no explicit responsibility, we have other problems with the duties and power of the national guidance. For example, Health Education England is the organisation responsible for developing our workforce, but its hands are tied because it does not have sufficient legal powers or funding to invest properly in the educational provision needed to grow our workforce. HEE can do planning but not supply, which ought to be the responsibility of the Government. The current legal framework is simply not fit for purpose.

Some people might say that Simon Stevens, the chief executive of NHS England, should be accountable for not addressing the workforce needs. The development of the long-term plan provides another clear example of the ambiguity and conflicting expectations playing out in practice. In June 2018, the Prime Minister said:

“Growing demand and increasing complexity have led to a shortfall in staff. So our ten year plan for the NHS must include a comprehensive plan for its workforce to ensure we have the right staff, in the right settings, and with the right skills to deliver world class care.”

That was a clear signal of the Government’s commitment that the long-term plan would address the workforce crisis. On publication, NHS England acknowledged significant workforce issues but said that staffing was additional to service planning and was outside the £20 billion financial package that Simon Stevens was given. Again, NHS England does not have any explicit legal duties that relate to the workforce, so it is not obliged to act.

Just last week, Simon Stevens said there is a need for a

“much bigger upturn in the pipeline of new nurses… There has been a big debate about bursaries and their removal, which as we look at the way the student loan system is working, that is clearly back in play as a big question we’ve got to answer as a nation.”

However, the reasons for these supply problems are not within Simon Stevens’s control. They include the reform of higher education for nursing, which has not grown as we were promised. The ability to boost and fund the workforce sits with the Government, and the ambitions set out in the long-term plan will not be met if we do not have trained and qualified staff to achieve those goals. Although the Government have committed to transforming services, they must also commit to building the workforce we need. To do that, the lack of accountability must be addressed.

A nurse who walks into a shift that is short-staffed has no power to safely and effectively staff services. They have no option but to carry on, yet the buck stops with them when patient care is unsafe. Nurses have no power to recruit more staff, and they rely on Parliament to ensure that the incredible position we find ourselves in is addressed; to fix things not just now, but for the future. I know how heartbreaking it is for a nurse to be unable to give the care they want to. I know the guilt we feel when care is left undone, and the stress of being unable to do our job to the best of our ability. Patients pay the highest price when the number of nursing staff falls too low.

Understanding that the health and social care system is a safety-critical industry should be the starting block for any consideration made by the Government. The Royal College of Nursing and other professional and patient organisations have a clear solution. With cross-party support, they are calling for a legal framework for workforce accountability that sets out who in Government and across the health and social care system are accountable and responsible for workforce supply—recruitment, retention and remuneration.

The Secretary of State for Health and Social Care should have explicit powers in law for the growth and development of the health and social care workforce across England. Such accountability would ensure that there are enough staff to care for the number of patients, and that there is an incredible and fully funded workforce strategy. These requirements are not an either/or position; we need both. Alongside the Secretary of State’s accountability, there are other ways in which the responsibilities need to filter down across all layers of the health system. Never again would the system be able to sidestep workforce planning when setting a 10-year vision for the future of our NHS. The ultimate aim in clarifying accountability for the workforce at Government level is to ensure that all health and social care services are of a high quality, and that they are equipped to provide safe and effective care to guarantee patient safety. The current pressure faced by the healthcare workforce puts that guarantee at risk.

Successive Governments have missed opportunities to fix the health and social care workforce crisis. Boom-and-bust approaches to workforce supply have been an afterthought, with the focus on glossy new services and sparkly new plans, rather than on worrying about the staff who are needed to deliver them. That has led to a situation in which the system currently defaults to discussing how to fix the workforce gap. We need to plan strategically for what workforce will be needed to deliver the future healthcare services that have been designed to meet the needs of the population.

An opportunity to rectify the workforce crisis is coming right towards us. NHS England and NHS Improvement have finished engagement work on the legislative changes that they feel are needed to make a success of the long-term plan. Their engagement work sets out proposed changes to the remit of the Secretary of State, but currently these legislative proposals are missing crucial accountabilities. It is down to right hon. and hon. Members to expand the proposals when the law is presented to Parliament. The legislation must include accountabilities for the workforce, because it is too clear an opportunity to miss.

A simple legal change would turn the tide for patients, and support is growing across the political spectrum for a legal fix as part of addressing the workforce crisis. I found myself at a roundtable discussion on this very matter, with a Government Member with whom I share no political allegiance. We found ourselves in full agreement that we must explicitly clarify the responsibility for putting our workforce on a sustainable footing.

As a nurse in Parliament, I commit to seeking the change that is being called for. I hope that others call on Parliament to speak loudly and clearly in adding their voices to ours, and that all right hon. and hon. Members will commit to pursuing change. This is a truly cross-party issue, and rightfully so. There is a crisis and everyone points fingers at others, but ultimately no one is responsible. There are moves to make the system better, but they must be set out in law and strengthened further. There is an opportunity to fix this cleanly and easily. We are not adding burdens, but clarifying mandates. The moment is now—we must commit to ending the workforce crisis once and for all.

Derek Thomas Portrait Derek Thomas (St Ives) (Con) - Hansard
17 Jul 2019, 2:49 p.m.

I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing this debate on an issue that she and I have discussed—her office is near mine in Norman Shaw North—and both care deeply about.

I am glad to see the Minister in his place. He knows my constituency well and understands the challenge of getting to it. In fact, he was the first MP ever to visit me in the heady days before 2010, when I stood as a parliamentary candidate because I thought that coming to Parliament would be a great way of changing the world. I have since learned that that is probably not the case.

The credit should really sit with the people who work in the NHS. In particular, I pay tribute and sent my thanks to those who work in West Cornwall Hospital in Penzance, Helston Community Hospital—or cottage hospital, for those of us who grew up there—and other places where NHS staff and others do a fantastic job in really difficult situations, as we have heard. They make sure that people who arrive for whatever reason get the best possible care.

I was keen to take part in the debate because I recognise that things need to be done. We must take responsibility for the way things are at the moment, and although I understand what the legal responsibility is and the reason for the debate, I want to understand a bit more about the solutions, too. I have never thought that all the solutions can be created, thought up or delivered here in Westminster or in any Government Department. Although real progress in integration and improving services on the ground needs to be enabled through legislation, support and encouragement, people in health and social care in Cornwall have got together and worked extremely hard for many years to deliver a system in which pathways and integration are much better than when I welcomed the Minister off the train.

One problem of many is the workforce, which is undoubtedly a challenge. There is also no doubt that the NHS 10-year plan is a fantastic document, but it depends heavily on workforce. I know that the Minister will agree and will want to ensure that we have people in place. We may not participate in this Chamber, but across Parliament, the bunfight, debate and arguments about the NHS go on, and have been taken up by people in local campaigns and the media. That has created an situation in which people choose not nurse or do anything else in the NHS because they are misinformed. I know of lots of people who would have gone into or considered going into nursing or social care, but will not do so because the NHS is a political hot potato.

Karen Lee Portrait Karen Lee (Lincoln) (Lab) - Hansard
17 Jul 2019, 2:53 p.m.

On the hon. Gentleman’s point about people not joining the NHS to nurse, the lack of bursary is a significant issue. If someone wants to train, the bursary is really important.

Derek Thomas Portrait Derek Thomas - Hansard
17 Jul 2019, 2:54 p.m.

I am addressing the point the hon. Member for Wolverhampton South West made about the importance of working cross-party, as we will in this Chamber. I will come to the bursary later.

Actually, I will come to that part of my speech now as the hon. Member for Lincoln (Karen Lee) has mentioned it. I was one of the MPs who signed a cross-party letter requesting a royal commission for the 70th year of the NHS, because I believe that although we do not have all the solutions, we should set the tone. That would help to open the door of opportunity for those who work in the NHS. I will come to the bursary, which I have already raised with the Minister; I asked him to look in particular at the impact on mature students. Podiatry in Plymouth, for example, will not be taught from September onwards. In the south west, where the incidences of diabetes and other vascular problems are significant, we need podiatrists, so that is a major problem. The reason given is that most people who go into podiatry do it later on in their careers, and one of the challenges arising from the removal of the bursary and introduction of student loans—I voted for that and regret doing so—is that those who take out the loan immediately lose all welfare and can no longer get housing benefit.

For someone with a young family who wants to study, the student loan, or the grant available for mature students, is just not enough. The Minister is aware of my view because I have raised it before, and there is work to do on that. It is not about financial incentives; it is about making it affordable for people to go and do a fantastic job. As the hon. Member for Wolverhampton South West rightly said, some people bring so much to health and social care and we need to ensure that we take away every possible barrier without creating unintended consequences. I am sure that the Minister will be pleased to address that point later.

I will talk briefly about how Cornwall is responding. I have been very keen to see what we can do in Cornwall to make sure that people can turn up, get training and work and train on the job. For people in Cornwall, most opportunities for training are outside the area, but as we know, people who go into some professions, including in the NHS, tend to stay where they train. That has always been a problem for Cornwall, which has struggled to recruit the people we need. We have set up a health and care academy using the apprenticeship levy. The academy can offer people training and jobs as healthcare assistants. There, they can do 12 hours per week working and studying through the Open University, and will become qualified nurses after four years. As they are already settled in the area and have family there, they are very likely to work for the NHS for the rest of their careers.

That is really positive, but there are some challenges and I have met the Minister to talk about them. One of the challenges is that for hospitals—in this case Royal Cornwall Hospital—to provide that kind of support, they need extra cash. It is not just about the apprenticeship levy, which they want to use and not repay, but about staffing 100 nurses and 100 healthcare assistants at a time, and providing pastoral support and other elements that come with training up staff on a ward or in a hospital. An added pressure is that for a hospital without the staff that it needs, really excellent healthcare assistants are no substitute for fully qualified nurses with a wealth of experience.

There is a problem in this place. I am a skilled craftsman in the building trade but I have put my tools away, despite the desperate need for skilled craftsmen in Cornwall. In this Chamber and across the House, we have lots of GPs and talented nurses. For some reason, we decided to pitch up here instead of continuing in our valuable jobs. I think that we are part of the problem. I am not suggesting that we should all pack up and go home, although we might get more done if we did, so we should consider it.

Eleanor Smith Portrait Eleanor Smith - Hansard
17 Jul 2019, 2:58 p.m.

I get what the hon. Gentleman is saying, but I worked for 40 years in the health service and it was because I saw its deterioration that I came to Parliament to say, “This is what’s happening.”

Derek Thomas Portrait Derek Thomas - Hansard
17 Jul 2019, 2:58 p.m.

I said that in humour, which is why I talked about my own skill—or lack of. It is a curious thing, though, to hear people talking about the crisis in staffing when so many of them are in this place.

On a more important note, we are in a tricky situation with the challenges around the apprenticeship levy. In Cornwall, we hope to train 200 nurses using the apprenticeship levy over the next two years—that would address the shortage—but we have to recognise that funding is needed and I know that the Minister is looking at that now.

Paul Girvan Portrait Paul Girvan (South Antrim) (DUP) - Hansard
17 Jul 2019, 2:58 p.m.

Will the hon. Gentleman give way?

Derek Thomas Portrait Derek Thomas - Hansard
17 Jul 2019, 2:58 p.m.

I will when I have finished this point. Whatever the solution, we must recognise the added pressure on existing staff.

Paul Girvan Portrait Paul Girvan - Hansard

On that point, it is all very well getting nurses into and through training, but in Northern Ireland the NHS is haemorrhaging nurses who are not leaving the profession, but going into agency work, getting paid two and a half times more than they were and working the hours that they want. Not only is workforce planning impossible when people can just work when they want, but we lose continuity of care in wards.

Derek Thomas Portrait Derek Thomas - Hansard
17 Jul 2019, 2:59 p.m.

I appreciate that valuable intervention. I had a conversation with the former Secretary of State for Health about how, when the student loan was introduced, there might have been a way in which students had all their loan written off if they gave seven years’ service to the NHS. The advantage of that, to be honest, is that people who had done seven years after qualifying would probably have settled down by then, entered into a home purchase and perhaps had family, so they would have been, first, less likely to clear off to another country and, secondly, kind of tied into the NHS where they were.

In part, that addresses the problem the hon. Gentleman raises. Yesterday, I met a newly qualified nurse from the south-west who found that on Christmas day she was the leading NHS nurse, supported only by agency staff. That must stick in the back of NHS staff’s throat, when they know that extra pay is available to agency staff. Efforts have been made to address that, and there must be ways to do so, but that is what we are getting at today—the workforce challenge.

If we have a workforce challenge, other things will happen, such as agencies springing up and the demand for them. We have to get to a place where working for the NHS as a nurse employed by the local trust is the best and most rewarding place to be, and appreciated by all. We simply do not say often enough how great such people are. We can do so many things locally and nationally to rebuild value, trust and appreciation in those people. The challenge for Health Education England is to look at how we fund local innovative ideas, ensuring there is enough money, as well as flexible support, to find solutions. I discussed that with Simon Stevens, and he seemed alert to the challenge.

As I said, I met nurses from the south-west yesterday, and they were concerned about safety on wards and retention of nurses. We have this bizarre circle spiralling downhill: if nurses do not feel safe, they go to do something that might not be nursing. Unfortunately, in places of low unemployment, lots of other work and employment opportunities are available, often paying more.

Solutions are possible. In Cornwall, I have found that people often do not know what is available. The Royal Cornwall Hospitals NHS Trust and other trusts in Cornwall, my local college and I got together to work on an event in the college called “Work for the NHS+”, which included 15 or more different parts of the NHS, as well as some from social care. They came along to tell students and the general public what the employment opportunities were, the pay and training that could be expected, and what kind of career paths were available. In Cornwall, as in many other parts of the country, there are some fantastic members of staff and people in the NHS and social care who can inspire others. This might sound ridiculous in a debate on shortages in a ward, but when we have such individuals, we must find opportunities to get them in front of people who are thinking about which career they should choose.

I do not know much about the other challenging problem raised by the nurses yesterday, but it is right to mention it. They said that although more nurses are training, training placement opportunities are fewer. They suggested that part of nurse training now is off the ward—obviously that has happened before, but they were concerned about whether that virtual training or simulators were the same. I know that the Minister will take seriously all opportunities to get nurses trained in the best possible way, so I will not dwell on a subject that I do not know much about.

I mentioned the issue to do with podiatry, which is a real problem in the south-west. We must find ways to help professionals, whatever they do, whether therapy, physio or all the things that people to do to ensure that we stay well and do not end up in hospital. Podiatry is one of those. We must ensure that people get the training, that they can afford to do so, and that they can have a great career in the NHS or with local authorities. We need to talk to universities about exactly why they are not attracting the kind of numbers they need to justify the courses.

I should have declared an interest at the beginning: I chair the vascular and venous disease all-party parliamentary group. One thing I am being told loud and clear—I have done a lot on this—is that because we have taken the nursing bursary away from older students, they find it difficult to go on the courses that I am describing. That will have a real impact on the numbers of nurses available to do those important jobs. If we do not address that issue, in a place such as Cornwall, where diabetes is a significant problem, the pressure on urgent care will be enormous—if it is not already.

Last week, our general district hospital—the only one in Cornwall—closed to the public, because a spate or outbreak of vomiting and diarrhoea put a lot of people from nursing homes and others into hospital. In that situation, the system rallied and did some amazing work to cope, ensuring that no one who needed care was failed, but it was also an example of why we need to work equally hard, if not harder, to ensure that at the best of times and the worst of times people get the best healthcare available.

The NHS in Great Britain is the envy of the world. We need to be careful always to remember how fantastic our system is. Last week, my brother and his wife came back from Cambodia with stories of trying to get healthcare there—they have two young children—and that reminded me of how fantastic our health service is, as are all those who work in it.

Karen Lee Portrait Karen Lee (Lincoln) (Lab) - Hansard
17 Jul 2019, 3:06 p.m.

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this important debate.

I will start by talking about my lived experience of staff shortages in the NHS. I worked as a nurse from 2003 until 2017, when I entered Parliament. For the majority of that time, I worked on an in-patient cardiac unit at Lincoln County Hospital. Today, I want to paint a picture of a nurse’s working day and how difficult that becomes when we have staff shortages. First, however, I pay tribute to all the staff at Lincoln County Hospital—not just the nurses, but all the staff—and to NHS staff who deliver our healthcare right across this country in local communities and in hospitals.

I keep in touch with my former colleagues and still hear at first hand how staff shortages affect them—some stories are quite scary. As an MP over the past two years, I have witnessed an awful lot of patronising pats on the back. I exclude today’s debate from that, but we often hear from Members how wonderful our NHS staff are, and yet that does nothing to address staff shortages or to make their working conditions any better. That is what they want; they do not want patronising pats on the back. The 40,000 nursing vacancies are evidence of that stark truth.

As a nurse, when I went on shift, I would be allocated eight cardiac patients. They would have been treated for heart failure, recently had a heart attack or been waiting for an angiogram, or perhaps they were being treated for endocarditis, which is a serious infection of the heart. The staffing was meant to ensure that a single nurse took either the male or the female team, with an extra nurse working between the two sides to support the multitude of tasks that delivering good patient care means. In reality, we often did not get that third nurse, and had to manage without. Some shifts felt like a marathon combined with a sprint—I kid you not, Mrs Moon, it really was that bad. I did love it though.

The medical management of my group of patients would be varied. Many patients were diabetics, meaning that we had to check blood sugars, four times a day for some and twice for others. If four or five out of eight of a nurse’s patients were diabetics, that was quite a task. We could even get something called “sliding scale”, which meant we had to check them every two hours. Sometimes, honestly, we just chased our tail the whole day.

Many patients needed intravenous antibiotics, which were really time-consuming to prepare, even more so if a patient had a line, a Hickman or a PIC—a peripherally inserted central catheter—because it had to be done aseptically; it just took ages, and the nurse was running around the whole time. As well as that, staffing was routinely topped up with bank or agency staff. I am not knocking them, because we would not have managed without them, but they were not allowed to do IVs, so when we had agency staff on the other side of ward, to be honest we would end up doing quite a proportion of their work as well. That made it really difficult.

Many patients were prescribed controlled drugs, so first thing in the morning, at 8 o’clock, we might have had two or three CDs to do—but trying to get someone else to check the CD was a nightmare. There were just not enough hands on deck, which meant that people were sat waiting in pain for analgesia when they had gone all night and were due that dose. Sometimes a patient needed a blood transfusion, which was a really tricky process. They had to be monitored the whole time, but, again, that was done for one person and there were eight patients, so the nurse was running around all the time. It felt unsafe and the nurse felt really bad because they wanted to deliver good, safe patient care.

A patient might be close to death and need to be monitored, because the nurse could tell visually whether they were in pain, but there were seven others to look after. The relatives wanted someone to sit and talk to them, which of course the nurse wanted to do, but they did not have the time. In addition, there were other tasks such as changing dressings, monitoring pressure areas, and speaking to social workers, physiotherapists and occupational therapists about assessments, as well as discharging patients. The doctor might say to a patient, “You can go home today”, but the nurse had seven others to look after. All the patient wanted was for the nurse to do their paperwork and get their meds from the pharmacy. They sat waiting impatiently and the nurse felt bad because the patient could not go home. When the nurse eventually got them out, another patient was straight into their bed and the admission paperwork had to be done. The tasks were endless, but that was the job. We did it and we loved it, but we have to have enough staff to do it properly.

No nurse can deliver care without the healthcare support workers, so this is not only about nurses. The housekeepers make the tea but because the nurses do not have time to sit and talk to the patients and their families, the nurse goes to the housekeeper at the end of a shift and says, “Has anybody told you anything that I need to know?” It is team work. If there are not enough staff to carry out the different roles, staff simply burn out and cannot deliver the care that patients need. Towards the end of my nursing career, in the two years before I came to Parliament, I worked in out-patient clinics because I thought it might be a little easier, but it was not. It never is, but I was starting to get burn-out and I did not want that to happen because I loved the job too much.

We used to work 12.5 hour shifts. We would start a day shift at seven in the morning. At about half nine, if we were lucky, we got a cup of tea, but we literally had only five minutes. At around two o’clock we got our lunch. We had half an hour and we were meant to have another break at teatime, but we never, ever got it because we were running around trying to finish all our jobs, chasing our tails and trying to get everything done. So we would have a break of about half an hour in twelve and a half hours. Then, just when we thought we were going home, it would turn out that the bank staff, the agency staff, had not turned up and we could not simply say, “I am off home.” We had to wait until somebody had been found somewhere else in the hospital and somebody was moved from a different ward. Then the handover took half an hour. Instead of going home at half seven or eight o’clock, it could be nine o’clock and we would be back again at seven the next morning. People simply burn out.

Working in our NHS is incredibly hard work in whatever role. It is not well paid, and in places such as Lincoln a few years ago when we had the pay freeze, it was suddenly decided that a consultation would be held and we were asked, “Do you think you ought pay for staff parking?” Of course, everyone said no, so what happened? We all had to start paying for staff parking: £15 a month for staff nurses who had not had a rise in years. It absolutely made us feel undervalued, and that is not acceptable. I am not surprised that people are leaving the profession.

I want to talk now about the crisis in our NHS and about some of the steps we must take as parliamentarians to address it. There are more than 100,000 vacancies in our NHS, including 40,000 nursing vacancies. The “Interim NHS People Plan”, released last month, acknowledges that

“shortages in nursing are the single biggest and most urgent we need to address.”

I agree with that, but there are many other things we need to address, too. It is true that 80% of shifts from over 40,000 nursing vacancies are covered by expensive bank and agency staff, which highlights the false economy of austerity. It makes no sense financially. I will say this again and again: the removal of the nursing bursary in effect means that nurses are not training. I know I will get the answer back about how wonderful nursing apprenticeships are and how other wonderful things will happen, but the stark truth is that nurses are not training. So the NHS long-term plan and the talk about all the extra places for nurses is pie in the sky if we have not got the nurses training. It will simply not happen.

I am particularly concerned that applications from mature students have decreased by 39%. People no longer have the support that I had when I trained as a mature student. I was 39 when I started my training. The RCN is calling for the Secretary of State for Health and Social Care to be accountable to Parliament for making sure that there are enough health and care staff with the right skills in the right place at the right time to care for patients, based on population needs now and in future. Support for that must be, as my hon. Friend the Member for Wolverhampton South West said, cross-party if it is to happen. This or any future Government must ensure a credible, costed workforce strategy. Our healthcare workers must feel confident of delivering the very best care, and our patients must feel happy with the care they receive. A worn-out and demoralised workforce is not what the patients or any of us want to see.

Patients watch nursing staff doing their best to look after them. Some of them used to say to me, “Do you ever stop and take a breath?”, and I would jokingly say, “No, but I still don’t get thin, do I?” They have to wait their turn longer than they should for the care that they need, and that is not what we want to see. So I really hope that the Minister is genuinely listening and does not give me the usual answers: “We have got apprentices and we have got this and we are doing that, and all this money is going in, so we will get lots of nurses and it will all be all right in five years’ time.” I want someone to take notice and listen to me as an ex-nurse and make sure that hardworking NHS staff will be equipped to deliver the care that is both safe and effective for them and for their patients.

Tim Farron (Westmorland and Lonsdale) (LD) - Hansard
17 Jul 2019, 3:16 p.m.

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the hon. Members for Wolverhampton South West (Eleanor Smith), for Lincoln (Karen Lee) and for St Ives (Derek Thomas) on their eloquent speeches.

The crisis in the NHS workforce is deeply concerning. Its effects are felt nationally, locally and personally. Like others here, I want to pay tribute to the people working at every level of my national health service within the south lakes: the hospital in Kendal, Westmoreland General Hospital, and the district generals that we travel to in Barrow and in Lancaster. Of course, there are the GPs, dentists, paramedics and those providing mental health services. They do an outstanding job, but it is particularly challenging in rural areas, where we have specific problems with workforce planning and supply, which are at the heart of the problems that we are challenged by.

There are several key elements to workforce planning, including accessible and high quality training, as well as affordable training, as has just been mentioned so eloquently. Effective recruitment is another. Alongside both of those is the issue of staff retention. The Secretary of State must surely be held to account for each of those. The huge shortages in the NHS workforce are felt heavily in numerous areas of healthcare provision in the local communities in Cumbria, and I briefly want to touch on a few of them.

The provision of ambulances and ambulance crews has been hit particularly hard. It is vital that we recruit and deploy more paramedics and ambulance technicians. Rural communities such as mine suffer because of the sheer distances that ambulances have to travel to reach patients. According to the review of NHS access standards, it is the responsibility of ambulance trusts to respond to category 1 calls within seven minutes on average. That is a tall order when there are half the number of ambulances per head in the north-west of England as there are in London, despite the fact that my constituency alone is bigger than the whole of Greater London. It leaves communities living in fear for their safety and takes a serious toll on the physical and mental health of our outstanding ambulance crews. Our local paramedics and ambulance technicians are being pushed beyond their capacity. As a result, I have had an influx of local people contacting me about having to wait hours for an ambulance to arrive to give them the treatment that they so desperately need. That is why local health campaigners have been calling on the Government to deliver two new fully crewed ambulances to south Lakeland to stem the crisis and ensure the safety of the community. It is not right that people in Grasmere, Dent or Hawkshead might be an hour away from the nearest available ambulance.

We met the Minister to raise the issue a few weeks ago. He was incredibly helpful and I thank him for his time and his response. I very much welcome the commitment to procure additional emergency ambulances. I understand that as a result of our campaigns an additional £8 million has been allocated to the North West Ambulance Service. That could be good news for south Cumbria, but only if the ambulance service allocates it in the way that we have asked. Ministers should be held to account for whether the ambulances materialise.

Mental health is another element of workforce planning that I want to raise—particularly provision for children. Four years ago the Government promised a bespoke one-to-one eating disorder service for young people in Cumbria. For young people in south Cumbria that promise remains nothing more than words. The specialists have not been recruited and the service still does not exist. I should love it if the Minister would tell me exactly when we can expect our young people to have access to the service. When will the promises be kept?

I welcome the Government’s commitment to preventive healthcare, set out in the NHS long-term plan. However, again, promises are not being fulfilled. In our area, cuts to the public health budget mean that the NHS in Cumbria currently spends only £75,000 a year on tier 1 mental health preventive care for children. That works out at just 75p per child per year. Proper investment in public health would ensure enough money for a mental health professional for every school and college, if we could recruit them, keeping young people mentally healthy and making sure that problems did not become so severe further down the line. It would also ease the burden on our massively oversubscribed local child and adolescent mental health services, and relieve the pressure on our brilliant but overworked teachers.

In our area, there is a problem with people moving out of NHS provision to work privately, particularly in the delivery of dental services. More than half of adults in Cumbria have not had access to an NHS dentist in the past two years, while one in three children locally does not even have a place with an NHS dentist. Much as with ambulances, the impact of the lack of a workforce of sufficient size is felt particularly acutely in rural areas. Insufficient NHS dentistry provision has resulted in families having to make ludicrously long journeys to reach the nearest surgery with an available NHS place. Often, people are unable to make those long journeys, or to afford to make them.

Mike Hill Portrait Mike Hill (Hartlepool) (Lab) - Hansard
17 Jul 2019, 11:16 a.m.

The hon. Gentleman raises an important issue about dentistry. There are frightening figures about my constituency showing a lack of take-up of NHS dental treatment among children in particular. That is a real worry. I wonder whether it is reflected in the hon. Gentleman’s constituency and whether he agrees that we need at least to tackle NHS provision for dental treatment for young people. It is important.

Tim Farron - Hansard
17 Jul 2019, 3:22 p.m.

Yes, the hon. Gentleman makes an extremely important point. I am certain it is felt across the country. If it is made too difficult to get to the nearest NHS dental surgery—if that is 60 or even 100 miles away, as has been the case on occasion for constituents of mine—people go without treatment, and so do their children.

Last November I managed to secure the agreement of the commissioners to increase the value of the contracts to NHS dentists in Kendal so they could see and treat more patients. “Brilliant,” we thought, “that is really good news.” When NHS England contacted our local NHS dentists they found that not one of them was able to take up their offer. I was told that the practices were already working to capacity within the staffing resources they had available, and were reporting difficulties in recruiting additional staff. Those staff exist, by the way. They are working in the private sector. The treadmill of a contract that is unfair to patients and dentists, and not fit for purpose, keeps them out of the NHS. As the hon. Member for Hartlepool (Mike Hill) says, that hits young people particularly.

The reasons for those difficulties include a contract that pays a set amount for a particular type of treatment, regardless of the number of teeth that a dentist treats. A dentist will get paid, on average, £75 for an entire course of treatment including six fillings, three extractions and a root canal. That is not enough to cover overheads. That is a serious disincentive to people entering NHS dentistry. It hits all areas, but particularly deprived areas, and has a massive impact on the size of the workforce. According to the Department’s website, the Secretary of State for Health and Social Care is responsible for

“oversight of NHS delivery and performance”

but if he is unable or unwilling to intervene to correct such absurd commissioning we have to ask what real power he has to perform the role. That is the kind of systemic problem that adds up to the workforce crisis we have all talked about and which proper accountability would go some way to solving.

The website states that the other part of the Secretary of State’s role is

“oversight of social care policy”.

Social care policy is key to NHS workforce planning and supply in England. We all recognise that social care provision is in crisis, and that the crisis gets worse the longer we do not address it. As it grows, so does the pressure on the NHS, which is left dealing with the serious health problems of those who did not receive the routine care they needed. The Government cannot go on delaying simply because of the personal embarrassment of having failed so far. To be fair, they are not the only ones responsible. Neither are they the only ones who can come up with a solution. We need to reach across divides and look for a cross-party solution.

I have written to the Secretary of State for Housing, Communities and Local Government and to the hon. Member for Denton and Reddish (Andrew Gwynne), the shadow Secretary of State, to invite them to join me so that between us we can constructively use this deadlocked Parliament to reimagine and then redesign a social care system that could provide us with the care we might want for our parents, ourselves or, indeed, in the future, our children. I hope that we can work together to create a new deal for social care and a chance to turn this logjammed Parliament into one of the most productive in history.

The lack in the workforce has a profound impact in each of the areas I have talked about. Common themes and problems emerge: there is a lack of planning, as well as short-sightedness and a failure to invest in preventive care or to understand that providing healthcare is harder in rural areas, as are recruitment and retention. The Government must plan to overcome those specific challenges as part of their overall strategy. The Government, in not taking responsibility for the workforce crisis, are creating huge problems for generations to come. We need accountability, both for the current workforce crisis and to ensure that we invest in long-term solutions beyond the next Prime Minister, the next Government and even the next generation.

Mike Hill Portrait Mike Hill (Hartlepool) (Lab) - Hansard
17 Jul 2019, 3:26 p.m.

It is a pleasure to speak under your chairmanship, Mrs Moon. I am grateful to my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing the debate. Like everyone who knows the NHS workforce, I want to pay tribute to all the people I served, including in acute services, when I was a Unison official in public sector health. Some of the stories we heard today from colleagues who used to work as nurses or as other healthcare staff took me back to those times. I have talked to many a worker, particularly in mental health, and often they are overstretched. The work is arduous and they cannot go off shift, for the safety of the patients. More importantly, at times the environment is dangerous for staff, and I know many people, particularly in acute mental health, who have been subjected to violence in the workplace purely as a consequence of understaffing and lack of resources, yet they bravely battle on to look after the patients in their care.

There is a word that one would never expect to be associated with NHS services in a commonplace way, yet it is frequently associated with the demise or semi-demise, or shutdown or partial shutdown, of NHS units. That word is “unsafe”. It has been used time and again, especially by acute trusts, to justify the stoppage of particular patient-facing functions, including accident and emergency departments. In 2016 it was reported that in 60 towns, including Hartlepool, A&E units had closed, disappeared or been downgraded. A year later, in 2017, one in six was reported to be at risk, and a further 33 units, in 23 areas in the UK, were affected.

Even today, in the Tory heartlands of Richmond and Northallerton in north Yorkshire, the same is happening at the Friarage Hospital. It is not just A&E provision that is affected but the birthing unit at University Hospital of Hartlepool, and breast screening at nearby James Cook University Hospital in Middlesbrough. They have been mothballed or put into slow decline, with one common denominator: the services were deemed unsafe due to a lack of consultants.

The recruitment and retention of consultants is vital, of course, but so too is the recruitment and retention of nurses and other staff. I mentioned the birthing unit in Hartlepool because last year the maternity centre, at which there were once hundreds of births, reached an all-time low—just three babies were delivered at the unit, with a further five home births in the town. That so alarmed the local authority that maternity provision in the town came under specific scrutiny, with a view to promoting and boosting the use of the birthing unit and improving maternity services in the locality. In fact, the chair of the council’s audit and scrutiny committee—Conservative Councillor Brenda Loynes—is on record as saying that it was

“important to encourage more people to use the Hartlepool unit to keep the service in the town.”

Yet the will of the people, and the pride that comes from having the right to be born and registered in their own town, is continually being thwarted. Only this week a constituent told me that his partner, who was four days over her due date, had recently opted to have her baby at the University Hospital of North Tees in Stockton because there was not a consultant on hand at Hartlepool, even though they are part of the same NHS foundation trust. At her midwife appointment, his partner stated that it was a shame that there was not a consultant on hand in Hartlepool, as her preferred choice was to give birth there. The reply was, “Nobody can have their babies at the birthing centre, as they haven’t got the staff to cover it—not just consultants but midwifery staff.” To the people of my town, who thought that they had seen the back of cuts to hospital services, that will be a slap in the face.

There are 40,000 nursing vacancies in the NHS in England alone, according to the Royal College of Nursing and the other unions—GMB, Unite and Unison. We stand on the brink of a crisis in our NHS. As my brother Andrew has experienced several times, surgery and appointments are cancelled, and wards and units are closed, more often than not because of staff shortages.

Let me be clear: that is not the fault of the hard-working NHS staff, who cannot and do not drop everything at the end of their shift, in the face of short staffing and in the interests of patient safety. It is not the fault of the midwives in Hartlepool, who want to provide a service out of the local hospital. It is the fault of the Government, who have failed to get a grip of the issue and ensure that there are enough health and care staff with the right skills, in the right place, at the right time to care for patients. Their strategy for the NHS has to include taking responsibility for ensuring adequate workforce planning and funding. The Secretary of State for Health and Social Care must have a clear and explicit responsibly for the growth and development of the healthcare workforce across England. Shame on the Government for not doing so and for running the NHS further into the ground.

Mrs Sharon Hodgson Portrait Mrs Sharon Hodgson (Washington and Sunderland West) (Lab) - Hansard
17 Jul 2019, 3:33 p.m.

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this important debate, and for her excellent and knowledgeable speech. I also thank all other hon. Members who made excellent speeches. They are all very knowledgeable, and some have had long careers in the health service, which really adds to the quality of the debate.

I pay tribute to the approximately 1.4 million members of the dedicated and hard-working NHS workforce, who are responsible for making our health service one of the best in the world. This debate is absolutely not about criticising them or the NHS, as others have said; it is about criticising the Government, who have continued to undervalue the NHS workforce. NHS staff too often find themselves working under unacceptable levels of pressure following nearly a decade of mismanagement and underfunding. They are consistently asked to do more with less. That pressure has led to abhorrent working conditions. Staff shortages in the NHS have spiked consecutively over the past few years. Recent estimates suggest a shortfall of about 100,000 staff, including 40,000 nurses and 10,000 doctors. If the trend continues, it is estimated that the shortfall will more than double by 2030.

We know that staff shortfalls put patients at risk. They prevent treatment and lead to a poorer quality of care. A 2017 study concluded that lower staffing levels can lead to necessary care being missed, patients being more likely to die following common surgery, and lower patient satisfaction, yet hospitals frequently have gaps in rotas and lack medical cover, which prompts significant concern about safety. Does the Minister believe that is appropriate care for patients and their families? If those substantial staff shortages continue, we will face even longer waiting lists and a deteriorating quality of care, and money ring-fenced for NHS frontline staff and services will go unspent due to lack of staff.

The effect of staff shortages is already evident. We have already seen care homes shut, an increase in agency hires, and chemotherapy treatments postponed because of a lack of staff at hospitals across the country. The effect that staffing shortfalls have on patients must not be underestimated, but we must also remember the effect on the staff themselves. NHS staff are consistently asked to take on additional responsibilities, to work harder, to do more intense shifts and to take on an excessive number of patients. Working in an already high-pressure environment without adequate resources or support not only puts patients at risk but damages the mental health of staff, leading to lower morale, poor wellbeing and a poor working life.

Working life is becoming intolerable for some of our NHS staff. It is no wonder that 20,000 nurses have left the NHS since 2010, and that the NHS has seen a 55% increase in voluntary resignations, with staff citing a poor work-life balance as their primary reason for leaving. The number of voluntary resignations due to health problems and stress has increased threefold in the past 10 years. The recent interim NHS people plan states that people are “overstretched” and admits that people no longer want to work in the NHS. What steps will the Minister take to ensure that NHS staff are retained once they are trained and experienced?

The standards of protection and safety that are rightly expected by staff and enshrined in the NHS constitution are being abandoned. On top of the cuts to staff wellbeing services that have consistently been made across England since the introduction of the Health and Social Care Act 2012, the number of understaffed shifts and overworked practitioners is forcing staff to take time off work and has led to increased requests for employed staff to take on extra shifts. That risks their health and can lead to increased locum use to cover staff rota gaps and vacancies. Staff shortages can have a significant impact on patient and professional safety.

It is welcome news that NHS Improvement will monitor trusts’ use of safe staffing guidelines. However, five years after the Francis report, the action taken on safe staffing simply is not good enough. The exodus of dedicated staff over the past 10 years, staff shortages, long waits for treatment, and frequent cancellations of operations demonstrate that the National Institute for Health and Care Excellence’s suspension of work on setting evidence-based staffing rules in 2015 was a mistake.

One way of ensuring the system has the number of staff it needs would be for England to follow the approach that is taken in Wales and is planned in Scotland, which is to legislate for safe staffing levels, yet the Government have continuously refused to bring forward legislation on safe staffing levels. Will the Minister reconsider that?

It remains unclear who is responsible for interventions in the workforce supply, as the Government certainly seem to be abdicating responsibility. The Government must consider seriously the legal proposals put forward by NHS England and NHS Improvement to amend the Health and Social Care Act to ensure that the workforce crisis is meaningfully and explicitly addressed. Can the Minister explain what impact workforce accountability requirements would have on the current legal framework? Surely the fact that Scotland and Wales have explicit accountability for the provision of the workforce across health and social care but England does not will lead to unequal progress and quality of care across the country and, inevitably, to a postcode lottery for patients.

We cannot tackle this problem if the pool of talented medical professionals in Britain continues to shrink. Safe staffing is not just a numerical issue; it is about having enough staff with the right skills, experience and knowledge. The UK trains only 27 nursing graduates per 100,000 of population, compared with the average of 50 across other OECD countries. The Government have continually undermined incentives to join the NHS workforce, which is demonstrated by their treatment of junior doctors, their introduction of salary caps, their cuts to bursaries and funding opportunities for students, and their hostile approach to those who travel from overseas to join the NHS. Does the Minister recognise that restrictive migration policies act only as a further barrier to tackling the NHS workforce crisis?

Does the Minister also recognise that the Health Education England budget has been cut by 17% in real terms since 2013-14? Applications to nursing training have fallen by 30%, particularly since the nursing bursary was removed. The NHS long-term plan set out some ambitious targets, such as diagnosing 75% of cancers at an early stage by 2028, expanding emergency service care and increasing the availability of mental health services. However, without a long-term, fully funded staffing plan for the NHS, those targets are impossible to reach.

The Government’s warm words and commitments to increase the number of NHS staff working and in training “as soon as possible” are appreciated. However, legislative action must be taken to ensure that patients and staff are not exposed to unsafe staffing levels, which can have dire consequences for patient outcomes and workforce retention. I look forward to the Minister’s response.

Stephen Hammond Portrait The Minister for Health (Stephen Hammond) - Hansard
17 Jul 2019, 3:43 p.m.

It is a pleasure to see you in the Chair, Mrs Moon. I look forward to responding to the debate, which has been interesting, and I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing it.

I listened carefully to my hon. Friend the Member for St Ives (Derek Thomas). He will be pleased to know that I will be happy to write to him about podiatry; there are some interesting issues about new plans that are being put in place. He will recognise that there are more applicants for university nurse training places this year than in the previous year.

I was pleased to hear the contributions from the hon. Members for Lincoln (Karen Lee) and for Westmorland and Lonsdale (Tim Farron). I have responded to the hon. Gentleman about ambulances. He will know that there are eight posted in the Cumbria and Morecambe Bay areas, but I am looking with him at procurement there and will be looking to see where the North West Ambulance Service places those ambulances. He questioned whether promises are being fulfilled. I guide him to the implementation framework. He also talked about planning and investment. That is why there is a long-term plan and a people plan, and why moneys are going in to back them up. I also listened carefully to the hon. Member for Hartlepool (Mike Hill).

I say to the hon. Member for Washington and Sunderland West (Mrs Hodgson), let us start by agreeing with each other. I think both of us, and everybody in the Chamber and across the House, would recognise and praise the work of everybody who works in the NHS—I have been pleased to do that on every occasion I have responded to a debate in Westminster Hall or on the Floor of the House. The hon. Lady rightly mentioned that the interim people plan recognises the pressures that are being put on staff. What she failed to say, of course, is that not only do we recognise that but there is a whole chapter on addressing those issues and making the NHS the best place to work. She talked a little about junior doctors and nurses in training, failing to recognise that we have just done a deal with the junior doctors that includes a four-year pay deal and resolution of the number of issues they had with the contract review. There are now more applicants for nurse training places than there were in the previous year.

Like many other Members, I attended the RCN member-led event yesterday and heard at first hand about the aims of the campaign from many nurses working in the NHS. I met again a number of the people I met at an event for nurses in training back in November. At the heart of the campaign, as everybody recognises, is the RCN’s intention to ensure that the needs and requirements of the NHS workforce are prioritised. I fully support the RCN’s focus on the importance of the NHS workforce—recruitment and retention—but I am not convinced that legislation is always the answer, and I am not convinced that changing legislation will necessarily bring about the changes and focus the RCN seeks.

However, given that the hon. Member for Wolverhampton South West secured the debate in recognition of the Secretary of State’s legislative duties in relation to workforce, it is probably right that I set out exactly what the legal position is. Through the Care Act 2014, the Secretary of State delegated to Health Education England powers to support the delivery of excellent healthcare and health improvement for patients and the public in England by ensuring that the current and future NHS workforce has the right number of staff with the right skills, values and behaviours at the right time and in the right place to meet patients’ needs.

The Care Act 2014 sets out in detail Health Education England’s remit and range of responsibilities, including its duty to ensure an effective system of education and training for the NHS and public health. Beyond the detail of the legislation, HEE provides leadership for the education and training system, and ensures that the workforce have the right skills to be able to deliver excellent healthcare in the right numbers. HEE was established to deliver a better healthcare workforce for England and is already accountable for ensuring that there is a secure workforce supply for the future. It has responsibility for promoting high-quality education and training that is responsive to the changing needs of patients and local communities.

The full range of HEE’s responsibilities, deliverables and accountabilities are described in its annual mandate, which the Secretary of State is required to approve. The most recent edition of that mandate and HEE’s latest annual business plan summarise what it is doing and its achievements. I am pleased to say that, as those who have had the chance to read it will have noted, the mandate for 2019-20 was published last week.

The hon. Member for Washington and Sunderland West made a point about legislation for safe staffing, but there is already a commitment to safe staffing and to ensuring that the NHS aims to be the safest healthcare system in the world, as it should be. Part of that must come from transparency in staffing levels, which is why the care hours per day data were introduced in 2016. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 require hospitals to have the right staff in the right place at the right time, and appropriate staffing levels are a core element of the Care Quality Commission’s registration regime. As the hon. Lady will know, all providers of regulated activities must be registered with the Care Quality Commission and meet the registration requirements. The safe staffing requirement is therefore already there, and accountability mechanisms are in place.

Mrs Sharon Hodgson Portrait Mrs Hodgson - Hansard
17 Jul 2019, 3:50 p.m.

The Minister says that accountability is already in place. Staffing levels may be required and desirable, but what happens when they cannot be met because the staff are not there? Where is the accountability?

Stephen Hammond Portrait Stephen Hammond - Hansard
17 Jul 2019, 3:50 p.m.

The hon. Lady will know that the CQC regime puts directives in place if staffing levels are not there. The local providers are then forced to address those issues. The accountability is there.

Beyond this issue, several hon. Members talked about exactly what we are doing now. There was recognition that the Government have put in place the long-term plan and the people plan. Any reading of those will see that our overarching plan for the health service looking forward recognises explicitly that getting the workforce supply right is key. That is therefore an important part of the long-term plan, which sets out the vital strategic framework to ensure that in the next 10 years the NHS will have the staff it needs. Nurses and doctors will have the time they need to care, work in a supportive culture and allow them to provide the expert, compassionate care to which they are committed.

Hon. Members rightly said that that will not be for this Government; it may well be for the Government beyond. However, the long-term plan rightly recognises by its very nature that what we need to put in place today must continue through the next 10 years to ensure that we have the staffing levels we need.

Karen Lee Portrait Karen Lee - Hansard
17 Jul 2019, 3:52 p.m.

A number of us mentioned the nursing bursary. The long-term plan talks about extra places for nurses, but if nurses are not being trained—the evidence shows that numbers have dropped by about 25% to 30% —clearly we cannot have them in place. I seek the Minister’s comments on reinstating a nursing bursary so that mature students and other students can afford to train.

Stephen Hammond Portrait Stephen Hammond - Hansard
17 Jul 2019, 3:54 p.m.

I will come to the number of nurses in training and related issues in a moment, to address the hon. Lady’s comments.

Associated with the long-term plan is the people plan, which clearly recognises, to reference what I said about Health Education England, the significant role of that organisation in securing the NHS workforce for the future. That is why my right hon. Friend the Secretary of State for Health and Social Care commissioned Baroness Harding, the chair of NHS Improvement, to work alongside and closely with Sir David Behan, the chair of HEE, to develop the workforce implementation plan. The interim people plan published in June set out the actions needed to change positively the culture and leadership of the NHS, making it the best place to work, which addresses the issues rightly raised about recruitment and retention.

The people plan commits to developing a new operating model for the workforce that ensures that activities happen at the optimal level, whether in individual organisations, local healthcare systems, regionally or nationally, with roles and responsibilities being clear.

On NHS workforce supply, hon. Members talked about demand for nursing and midwifery courses. The latest available evidence shows that we are starting to see a substantial rise. Data published only last week showed a 4.5% increase in applicants compared to 2018, with that being the second increase in as many years. To build on that, to ensure that we increase the pipeline of nurses coming into the profession, the Department has worked with NHS England to ensure that funding is available for up to 5,000 additional clinical placements for nursing degrees in England. The chief nursing officer for England has led work to identify and accelerate the availability of such clinical placements. It is vital that universities ensure that they take up offers and provide placements to ensure that places are filled at the end of this year’s recruitment cycle. That can happen.

Mrs Sharon Hodgson Portrait Mrs Hodgson - Hansard
17 Jul 2019, 3:55 p.m.

I acknowledge the 4% increase—it is a small increase—but figures show that the numbers are still down 29% from 51,830 in 2016, when the bursary that covered training was removed. Even with that small increase, we are still 15,000 short of the figure when the bursary was axed.

Stephen Hammond Portrait Stephen Hammond - Hansard
17 Jul 2019, 3:57 p.m.

The figures show an increase in applicants this year. The hon. Lady will know that there are 1.4 applications for each place, and she will have heard me say that we are creating additional clinical placements to ensure that more nursing places are available. I recognise that there has been a drop, but I hope that she applauds the 4.5% increase in applicants this year. That is key.

A number of Members rightly talked about additional nursing roles and support. Health Education England is leading a national nursing associates programme with a commitment for 7,500 nursing associate apprentices to enter training this year. That builds on a programme that has already seen thousands start training in 2017 and 2018.

The RCN is leading work focused on the legislative framework for all professional groups. I should set out that work on the people plan also included examining options for growing the medical and allied health work- force, including the possibility of further medical school expansion, increasing part-time study, expanding the number of accelerated degree programmes and greater contestability in allocating the 7,500 medical training places each year to drive improvements in the curriculum.

For allied health professionals, the long-term plan sets out a commitment to completing a programme of actions to develop further the national strategy, focusing on implementation of the plan. There will be a workforce group to support that work and make recommendations, including on professions in short supply, which would address the podiatry point made by my hon. Friend the Member for St Ives. That is essential.

I do not think that anyone should be in any way complacent, and the Government are clearly not complacent. Many hon. Members will have heard me say that, as well as training the workforce for the future, it is important that we support and retain the current workforce. The interim people plan is committed to reviewing how to make increases in a number of factors. One such factor is national and local investment in professional development and workforce development.

There are examples of good practice in this area across the NHS, and I was particularly pleased when I visited Leeds Teaching Hospitals NHS Trust to see how a group of band 6 nurses had created their own in-house training programme, boosting management skills and leading to greater collaborative ways of working. That example of best practice makes the case for national investment in such programmes and for national funding for continuing professional development.

Everyone recognises the need to recruit more staff, but it is also fair to put on the record the fact that the number of staff working in the NHS today is at an all-time high—it is the highest it has been in the NHS’s 70-year history. Since 2010 there has been a significant growth in qualified staff. [Interruption.] I hear a sigh from Opposition Members, but it is worth making the point that there are now 51,900 more professionally qualified staff, including 17,000 more nurses working on wards. That is a simple fact; it is a piece of data, and we cannot get away from it. I do not suggest that one should be complacent in any way, but we should recognise that there are more nurses and doctors, and the Government are committed to delivering on our promise to ensure that the NHS has the right staff with the right skills in the right place at the right time to deliver the hugely valuable, excellent care that patients deserve.

Question put and agreed to.


That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.