Health Bill

Baroness Rafferty Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

My questions to the Minister on this group of amendments are as follows. Will the Government’s long-awaited workforce plan set out a specific number and a funded route for learning disability nurses, together with the vacancy data that I was told does not exist? Will the department look at the Dutch model and explain why the trial funding for these posts was stopped earlier this year? Will the Minister commit to looking into reinstating the funding for these training posts? Will she write to me, and to the Committee, on whether the Government believe that a co-ordinating learning disability physician should be in place in England? People with a learning disability are dying 19 years too early. Their needs should not be left out of any workforce plan.

[Baroness Rafferty (Lab)]

My Lords, Amendment 279J seeks to increase the transparency of continuous professional development in terms of the funding and protected time allowed, and requests that the Secretary of State report on and review both those variables within six months of the passing of this Act. Continuous professional development, or CPD, is the mycelium—the material—that nourishes and sustains professional development and progression for nurses and midwives. It is also an evidence-based intervention for staff retention. Were the noble Baroness, Lady Watkins, here, she would have added allied health professions to our group, but she will speak to that point on Report.

I am sorry to say that, too often, CPD is paid for by nurses and midwives themselves or treated as an optional extra, although core to training and career development for doctors. Unlike doctors, nurses and midwives lack a predictable career pathway underpinned by training support, despite many elegant models for implementation. Funding has been at the heart of this dilemma, with fluctuations reflecting the buoyancy of the health economy, but a lack of transparency means that such funding is often shrouded in mystery regarding what is available where, when and for whom.

Our amendment seeks to place a responsibility on the Secretary of State to report on funding and, just as important, as I mentioned, on protected time for training, for the first time. This change will open the black box of CPD support from which helpful benchmarking can ensue, putting what has hitherto been hidden on a more secure footing.

[Baroness Harding of Winscombe (Con)]

My Lords, I too support my noble friend Lady Shawcross-Wolfson on Amendment 28, to which I have added my name. My first experience of workforce planning in the NHS was when I applied to be chair of NHS Improvement in 2017. I can remember asking the then Permanent Secretary, who is not in his place at this moment, if there was a plan for the workforce in the NHS. I came from retailing, where we spent a lot of time worrying about long-term people planning. I was absolutely gobsmacked at the time to be told, “Oh no, we don’t really do that here”.

Fast forward two years to 2019, when I was asked by the then Prime Minister to develop a people plan for the NHS. Again, maybe rather naively, I thought, “Good, this is an obviously sensible thing to do”. I remember speaking in this Chamber in 2022 when that people plan had not yet been published. That was not because the numbers had not been run; they had. It was because the Treasury and the Department of Health and Social Care could not agree on whether it would be a good idea to actually publish them.

I do not think it is an accident that there was a workforce plan published in 2023. It was because of the work we all did in this House with the last health Bill. I see the noble Lord, Lord Stevens, nodding his head, and the Minister was herself instrumental in that pressure that together we put on the then Government to publish a workforce plan. So here we all are again, in slightly different positions in this Chamber, but with basically the same problem that my noble friend set out so beautifully. We must not settle for what we did in 2022, which is just a commitment to publish a workforce plan. There are huge structural disincentives for any Government to publish it, as the Minister is undoubtedly feeling at this moment, which is why we have to put it in the Bill.

The first rule of solving a problem is naming it. If you do not acknowledge the problem of the escalating demands for a growing workforce in our health and care system, you cannot even begin to solve it. I am afraid that by not acknowledging it, we also lose the faith and trust of that very workforce. Go and speak to any junior doctor, and they know there is a problem with this. They know that if we do not find better ways of working in health and care, we will all be working in the NHS by the time we die. We have to name it, but I recognise the very real political problems that naming it presents.

Unless we legislate for this, nothing will change, so this is a very important group. I am sad that, once again, the people of our NHS warrant discussion in only one group in the Bill. Frankly, it should be multiple groups so that we really dig deep on how we not just plan for the numbers but change the culture and leadership in the NHS; but it is where we are for the moment. I very much hope that when we come back on Report, we will find a combined amendment. I recognise the challenge from the noble Lord, Lord Scriven, about Amendment 28 being quite speedy, but it would require a regular five-yearly update, which Amendment 253 would not. Maybe we could all align around some combination of those two amendments. I would very much welcome a discussion with the Minister, because I know that she thought deeply about this when she was sitting in another place in this Chamber.