NHS Workforce: England

Debate between Sharon Hodgson and Stephen Hammond

Wednesday 17th July 2019 Westminster Hall

[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.

Healthcare: East Midlands

Debate between Sharon Hodgson and Stephen Hammond

Tuesday 30th April 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Lincoln (Karen Lee) for securing this important debate. She is a passionate advocate for the NHS in her area and made a passionate speech. I also thank the other hon. Members who spoke—the hon. Members for Bosworth (David Tredinnick) and for Sleaford and North Hykeham (Dr Johnson), my hon. Friend the Member for High Peak (Ruth George) and, of course, the hon. Member for Strangford (Jim Shannon), who has just left the Chamber—for their excellent speeches and interventions.

Although I am pleased to respond on behalf of Labour, it is with sadness that Members come here time and again to explain the impact on their constituents of the crisis in the NHS. Sadly, as we have heard, standards are slipping across the board. It was a mild winter, but despite the thankfully lower levels of flu and vomiting virus, we saw the worst performance against the four-hour A&E target since records began. [Interruption.] If the Minister cares to—

[The Minister for Health (Stephen Hammond)]

It was an improvement on last year, so it was not the worst.

[Mrs Hodgson]

Oh, right—it was the second-worst, then. Anyway, bed occupancy also rose to 95.2% this winter, well above the 85% deemed to be safe, and patients are waiting almost 4% longer in A&Es than they were two years ago. In Nottingham they are waiting 14% longer than in 2017, and in Leicester they are waiting almost 4% longer than two years ago. East Midlands Ambulance Service NHS Trust has missed its targets for responding to patients in life-threatening situations. We have heard countless stories today that demonstrate how the crisis happening in our NHS both locally and nationally is real.

It is clear that the Tories’ plans for NHS funding fall short of what is needed. The autumn Budget announcement of a cash injection for health services excluded public health budgets, training and capital, which means an increase of just 3% for health services when we have a childhood obesity crisis, cuts to sexual health and addiction services, workforce shortages and a backlog of nearly £6 billion in repairs. It is not even enough to wipe out hospital deficits.

Nottingham University Hospitals NHS Trust alone predicted a deficit of more than £40 million by the end of the financial year, and it has declared 15 black alerts since December. How will the Government’s settlement help trusts like that become more sustainable? Where is the funding to guarantee sustainable health services in the face of ever-increasing demand from a complex and changing demographic? For example, in the east midlands, the number of preventable deaths from liver disease has increased by 37%. Obesity is also a growing problem, 66% of the population being overweight. People in the east midlands are more likely to have had a depressive episode than those in the rest of the country—3.9% compared with 2.2%. In 2013-15, the average life expectancy at birth across the east midlands was 79.3 years for males and 82.9 years for females, both of which are significantly below the national average. There is also considerable variation in preventable mortality from the major causes of death across the east midlands local authorities, with an urban-rural divide. The urban areas of Nottingham, Leicester and Derby have significantly lower life expectancy than the average for England.

Money is, of course, only one of the issues surrounding the crisis in the NHS. There is a staff recruitment and retention issue, too. NHS figures show that there are 100,000 vacancies across the health service, including 31,000 across the midlands and the east of England. Therefore, 9.3% of posts in the midlands and the east—about one in 11—are unfilled.

Constituents will also be worried about the integration of services in the east midlands. In recent years, councils have distanced themselves from sustainability and transformation plans and the integrated care systems in some areas, due to a lack of democratic accountability and scrutiny from stakeholders, including concerns over cuts and privatisation. Nottinghamshire’s ICS is an interesting case: the city council suspended its membership for six months last year for those very reasons, rejoining only in April 2019 after assurances were given to improve accountability and shared decision-making processes. I am sure that Members will be keen to hear from the Minister how democratic accountability and transparency is being improved in such cases.

Residents will also be concerned about the number of community hospitals that have closed or are under threat of closure. Residents of Bakewell and Bolsover have to travel to Chesterfield or Derby for their appointments, after their hospitals closed. The loss of those community hospitals impacts on rural areas of the east midlands, isolating people further because not only will they have to travel further to appointments, but so will any visitors, so patients are suffering.

The Government have spent nine years running down the NHS, imposing the biggest funding squeeze in its history, with swingeing cuts to public health services, and social care has been slashed by £7 billion since 2010. As we have heard, the NHS is clearly buckling under the pressure as a result, and standards of care continue to plummet. I would appreciate assurances from the Minister about how the Government will get a grip on the situation in the east midlands and across the country as a whole, to reverse the extremely worrying statistics and tackle the issues we have heard about.