NHS Workforce: England

Sharon Hodgson Excerpts

Wednesday 17th July 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

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.

--- Later in debate ---

[Mrs Hodgson]

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]

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.

[Stephen Hammond]

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 Hodgson]

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]

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.

Resolved,

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