NHS Long-term Workforce Plan Statement The following Statement was
made in the House of Commons on Monday 3 July. “With permission, Mr
Speaker, I wish to make a Statement on our long-term workforce plan
for the NHS. This week marks the 75th birthday of the NHS. We
should celebrate its achievements, its founding principles and its
people. From doctors and dentists to pharmacists and physios, NHS
staff devote their lives to caring for others. I am sure
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NHS Long-term Workforce
Plan
Statement
The following Statement was made in the House of Commons on
Monday 3 July.
“With permission, Mr Speaker, I wish to make a Statement on our
long-term workforce plan for the NHS.
This week marks the 75th birthday of the NHS. We should celebrate
its achievements, its founding principles and its people. From
doctors and dentists to pharmacists and physios, NHS staff devote
their lives to caring for others. I am sure the whole House would
agree that the NHS holds a special place in our country due to
the care offered by the people who work for it.
It is said that, in 1948, the NHS had fewer than 150,000 staff
and a budget of around £11 billion. Today, the NHS employs closer
to 1.4 million people with a budget of more than £160 billion.
The transformation of the care offered by the NHS through
advances in medicine is reflected in the fact that people now
live 13 years longer than on average in 1948. Today, alongside
the increase in the number of staff, the range of treatments and
the improved patient outcomes, demand on the NHS has also
increased. People live longer, they live with more complex
medical conditions, and we are also dealing with the challenges
left behind by a once-in-a-generation pandemic.
One in four adults live with two or more health conditions.
Although our population is forecast to grow by around 4% over the
next 15 years, the number of those over 85 is forecast to grow by
more than 50%. In addressing the challenges both of today and of
the longer term, it is right that we have a recovery plan focused
on the immediate steps as we rebuild from the pandemic, and
longer-term plans to ensure that the NHS is sustainable for the
future. This will ensure that the NHS is there for future
generations in the way that it has been for us and our families
over the past 75 years.
We have already set out detailed recovery plans to reduce long
waits for operations, improve access to urgent and emergency care
and make it easier to see GPs and specialists in primary care. On
electives, we have virtually eliminated the two-year wait, which
we did this summer, and cleared more than 90% of 80-week waits
from their peak at the end of March—in marked contrast to the
much longer waits we see in Wales, where the NHS is run by
Labour.
On urgent and emergency care, we are investing £1 billion in
5,000 additional permanent beds, alongside expanding virtual
wards to improve discharge from hospital and investing in
community services to prevent admissions, especially for the
frail and elderly. On primary care, we are investing more than
£600 million, including in improving technology to address the 8
am rush. We have already exceeded our manifesto target by 3,000,
with 29,000 additional roles in primary care to enable patients
to access specialists more quickly, and we are reducing burdens
on GP surgeries through the development of the NHS app and
improving the range of services offered through Pharmacy First,
enabling pharmacists to prescribe drug treatments for seven minor
illnesses.
Alongside the recovery plans, we are taking action to improve
prevention through early diagnosis of conditions, whether through
the 108 community diagnostic centres that are already open or the
43 new and expanded surgical hubs planned for this year. Our
national rollout of our lung cancer screening programme has
helped to transform patient outcomes, turning on its head the
previous position where 80% of lung cancers in our most deprived
communities were detected late, with 76% now being detected
early.
Alongside the immediate measures we are taking to deal with
demand in the NHS, as we celebrate the 75th anniversary we are
also investing in the NHS to make sure it is sustainable for the
future. Last month, I announced to the House the largest-ever
investment in the NHS estate, with more than £20 billion
committed to our new hospitals programme.
Today I can confirm to the House that, for the first time in the
NHS’s history, the Government have committed to publishing a
long-term workforce plan, setting out the largest-ever workforce
training expansion in the NHS’s history, backed by £2.4 billion
of new funding. The plan responds to requests from NHS leaders
and has been developed by NHS England. I would like to take this
opportunity to thank Amanda Pritchard, the chief executive of NHS
England, and her team, and colleagues within the
Department of Health and Social Care, and the more than 60 NHS
organisations that have engaged closely in the plan’s
development, including many of our royal colleges.
The plan sets out three priorities: to train more staff, to
retain and develop the staff already working for the NHS and to
reform how training is delivered, taking on board the best of
international practice. Let me deal with each in turn. We will
double the number of medical school places, increase the
availability of GPs being trained by 50%, train 24,000 more
nurses and midwives and increase the number of dentists by
40%.
When it comes to improving retention, we recognise the importance
of flexible working opportunities, especially for those
approaching retirement. The plan will build on proposals in the
NHS People Plan and build on steps already taken by the
Chancellor at the Spring Budget on pension tax reform.
In respect of reform, the plan sets out policies to expand the
number of associate roles, which provide greater career
progression for existing staff and in turn reduce the workload of
senior clinicians, allowing them to focus on the work that only
they can do. Both measures will improve productivity by enabling
more staff to operate at the top of their licence. A constant
theme across the long-term workforce plan is our focus on
apprenticeships and vocational training, including a commitment
to increasing the number of staff coming through apprenticeships
from 7% today to 22% by 2031-32. That reflects the strong
commitment of the Secretary of State for Education and myself to
facilitate greater career progression through apprenticeships. It
will also help to recruit and retain staff in parts of the
country that often find it harder to recruit.
In the week in which we celebrate the 75th anniversary of the
NHS, today’s announcement confirms the Government’s commitment to
the first ever comprehensive NHS long-term workforce plan. The
plan sets out detailed proposals to train more staff, offers
greater flexibility and opportunity to existing staff, and
embraces innovation by reforming how education and training are
delivered across the NHS. The plan will be iterative; we will
return to it every couple of years to enable progress to reflect
advances in technology such as artificial intelligence so that
the numbers trained can be best aligned with patient services. It
also reflects a growing need for more general skills in the NHS,
as patients with more than one condition require a more holistic
approach.
The NHS long-term plan, backed by £2.4 billion of new funding,
comes in addition to our record investment in the NHS estate. It
ensures that we put in place the funding required for a
sustainable future for the NHS, alongside the steps that we are
taking in the immediate term to reduce waiting lists and ensure
that the NHS is there for patients. As the chief executive of NHS
England has said herself, the long-term workforce plan is a truly
historic moment for the NHS. As such, I commend this Statement to
the House.”
5.42pm
(Lab)
My Lords, I am absolutely sure that the Minister is as relieved
as anyone to see this Statement on the NHS workforce plan before
your Lordships’ House today, after many years of waiting and
promises of it being published shortly, imminently, or at some
time in a very extended spring.
The plan promises much, but it is the delivery that will count
and the difference it will make to the health and well-being of
the nation. But at the heart of it, its effectiveness will stand
or fall on how successfully it joins up with other key aspects of
the NHS and social care. It is not just about delivery: the
commitment to updating the plan every two years is essential in
the hope that it will be a lasting way out of the continuing
workforce shortages that have blighted the NHS for many years.
Ministers have a lot at stake and are investing a lot of hope in
this workforce plan, not least because the lurch from crisis to
crisis has to come to an end, with proper consideration of the
long-term challenges ahead.
This long overdue plan started and continues its life against a
backdrop of chronic NHS understaffing. It is long overdue. If it
had been launched eight years ago, it would have been enough to
fill the NHS vacancy levels—yet we have had to wait. Instead, the
NHS is short of 150,000 staff, and this announcement will take
years to have an impact, while patients continue to wait longer
than ever before for operations, in A&E, or for an ambulance.
While the plan is a positive step, it is only the first step.
Much more detail is needed on how the plan will be implemented
and what measures will be used to judge its success. What
attention is being given to training staff and key leaders in
what quality management looks like?
Retention is key, and the plan has little to say about that. The
overall staff leaving rate increased from 9.6% in 2020 to 12.5%
in 2022. The plan acknowledges the importance of retaining
workers, offering more flexibility and improving the culture in
the NHS, but it is light on detail about how it might do that. We
know that more NHS strikes are planned—and that work culture,
bullying and harassment continue to be a real issue, and nearly
one in 10 staff experience discrimination. When will there be
details on retention, pay and working conditions, such that they
can add some detail on how retention might be improved in the
NHS?
It is a missed opportunity that there is no social care workforce
plan, especially as the NHS workforce plan identifies the impact
that delayed discharge due to difficulties securing a social care
package is having on patients and staff alike. Without such a
plan, it will not be possible to enhance the quality of care and
support provided by the NHS—they are inextricably linked. There
are currently 165,000 vacancies in social care, an increase of
52% and the highest rate on record. Average vacancy rates across
the sector are at nearly 11%, which is twice the national
average. What assessment has the Minister made of the impact that
having an NHS-only plan will have on the social care workforce?
Social care workers already seek jobs in the NHS, where pay and
conditions are better. Does the Minister share my concern that an
NHS-only plan is likely to exacerbate this situation and the
number of vacancies in the social care workforce? Does the
Minister consider that this will undermine the ambitions of the
NHS plan?
As the King’s Fund rightly observed, the projections are likely
to be based on ambitious assumptions. Yet there needs to be
realism about the investment in buildings, technology and
equipment that is needed to realise productivity gains. Can the
Minister say whether and when we can expect plans relating to the
various and absolutely crucial aspects of investment? Page 121 of
the plan sets out a labour productivity rate of 1.5% to 2% per
year. That was never achieved by the NHS or any other comparable
health system, so what assumptions are being made in relation to
achieving that?
The focus of the plan is crucial. It appears on reading to have
been seen through a rather hospital-focused lens, so will the
Minister ensure that the lens includes healthcare in the
community? At the centre of this plan has to be the patient in
all their different facets. In the consultations that took place
in the lead-up to the development of this plan, could the
Minister advise your Lordships’ House on how patient
organisations were involved and which ones were consulted?
It appears that the plan seeks to look to the longer term. As
happened in 2000, when the Labour Government of the time produced
a 10-year plan of investment and reform which included seeking
frequent staff increases, we will look to this workforce plan to
make a difference to patients and care and the health and
well-being of the nation in the same way as we saw come out of
the plan in the year 2000. I look forward to the Minister’s
response.
(LD)
My Lords, I shall try not to be too grudging, as we have been
calling for this plan for so long. I start by recognising the
enormous amount of work that has gone into this from people
working in the NHS and the department over a very long period,
but the reality is that the plan is too late for those who are
waiting for treatment today and are unable to get it, because the
investment was not made in the workforce years ago for it to be
available now on the front line. However, the plan certainly is
substantive and there is much to welcome in it, looking forward.
There are several areas where I hope the Minister can explain the
Government’s thinking further.
First and perhaps most importantly, we need a similar, sister
plan for the social care workforce. As we have discussed many
times across these Benches, health and care work in symbiosis and
both have seen too little supply to meet demand in recent years.
Can the Minister confirm that the Government have no plans to
further reduce capacity in social care by acceding to some of the
requests from his political colleagues to limit visas being made
available for essential social care staff? Can he say when the
Government intend to release a sister plan to the NHS plan
dealing with the social care workforce?
The plan also depends on ambitious productivity gains, and these
will require certain things to be put in place. First, we need
technology that will make life easier rather than more difficult
for staff. Will the Minister explain what work is being done to
understand how front-line staff in the NHS actually experience
the technology they are being provided with, to ensure that we
are not setting them back? Technology, when implemented well,
leads to productivity increases, but technology poorly
implemented can simply add to the frustrations of staff and make
their jobs more difficult.
Another key factor in productivity is good management. This is a
much less fashionable area to comment on than additional doctors
and nurses, but the evidence seems to suggest that the National
Health Service is actually quite lean in terms of its management.
Will the Minister comment on what is in the plan to boost
management capacity so that we can make savings on that other
kind of consultant, the management consultant? Far too much is
still being spent on externalising management expertise rather
than building capacity within the service.
The final area I want to comment on is retention. The plan has
hard numbers and new targets for getting new people into training
but is much less precise on how we can improve staff retention
over the long term. This is of course, quite importantly, a
matter of pay and working conditions across all grades of staff.
I invite the Minister to comment on some of the press stories we
have seen saying that there seems to be some reluctance on the
part of the Prime Minister to implement pay review body
recommendations in full, something that he himself has said we
should rely on to resolve issues particularly around junior
doctors. Certainly, understanding that pay is important and that
review body recommendations are going to be respected is critical
for retention.
We can see that the Government have looked very closely at the
specific factors that discourage senior doctors, in particular,
from staying on as they approach retirement age. I suggest to the
Minister that similarly detailed work needs to be done to
understand the precise factors that are leading more junior staff
at earlier stages in their career to leave the profession.
Similar attention must be paid to resolving those specific issues
if we are to address the retention problem.
One way we can motivate staff to stay on is through continuous
professional development and retraining into more highly skilled
roles, yet training opportunities can be constrained by the
capacity of those delivering it. Can the Minister assure us that
training opportunities will be provided for existing staff as
well as new staff, so that we do not end up holding back Peter in
order to train Paul? It will be net negative if we lose staff
from the existing workforce through missed training opportunities
as we bring in new staff. More generally, is there an
understanding of how we are going to build up that capacity for
training existing and new staff?
When I was younger, I had a teacher who would often write on my
essays, “Okay as far as it goes”. This would annoy me, but with
the benefit of wisdom and age I have to concede that it was often
fair and accurate. Today, we might say that this plan, into which
I know a huge amount of work has gone, is okay as far as it goes.
We can be confident that it will really make a difference only if
it is delivered in full, and in particular if there is a sister
plan for the social care workforce and a real effort made on
staff retention. I hope the Minister will comment on some of
those aspects.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
I thank noble Lords. Before I answer their points, and while I
shall not repeat the Statement, it would be remiss of me not to
repeat one thing, which is about Lord Kerslake’s passing. inducted me into government
many years ago when I was a non-exec director at the Ministry of
Housing, as it was then, and I always found him a very wise head
and a very kind man. I am sure that condolences go from all of
us, and particularly from me.
I welcome the constructive responses from the opposite Benches.
As we have said, a huge amount of work has gone into this plan
from some 60 organisations, including royal colleges, and it is
an NHS document. I must admit that while I will take the
description from the noble Lord, Lord Allan, of “Okay as far as
it goes”, I prefer the description of Amanda Prichard:
“This is a truly historic day for the NHS”.
On a personal note, I am very glad not to have to answer about
how quickly it is coming any longer.
On the detailed comments, the noble Baroness, Lady Merron, said
that this is a living document, with the two-year update, and
that is a critical part. I agree with her that this is going to
be effective only if it is a live document that we continue to
review, amend and improve as time goes on. On the quality
management of staff, this comes to the point about retention.
There is no silver bullet, as we know. I liken it to the approach
we see in the cycling, in the Tour de France, with Team Sky:
there are lots of little things that you have to do and it is the
collective effect of putting those things together which really
makes the difference.
Clearly, pay is an important element of that; the point of view
of the pay review body is clearly going to be very important;
clearly, pensions are a big move; clearly, professional
development is a big part of it, not just for new staff but
absolutely for existing staff as well. It is also about the
conditions that people work in; it is not just the culture and
leadership but the place they work in as well. That is why I am
pleased that the capital parts of this are seen as very important
in driving the right culture and environment that people want to
work in: these are key to retention and driving productivity. The
new hospital programme is a very important part of that, and so
is the capital programme generally.
Equally, technology is a key part of this, as mentioned before,
and that includes front-line staff. Just on Friday, I was at
Chelsea and Westminster, where they showed me at first hand how
they found the databases they were using really helpful, with
basic patient tracking, making sure they were following them
through the whole care pathway and managing their whole journey,
so to speak. They were using it and enjoying it, if that is the
right word, and that was key.
The point about NHS management and leadership is very important;
this plan looks at the medical side, but we all know that
leadership is so important for the effectiveness of hospitals and
a key part of this.
The noble Baroness mentioned the focus on hospitals. Clearly,
hospitals are a very important part of this, but underlying that
is a key shift towards primary care and prevention. If you delve
into the details of the numbers, you will see that the level of
people who need to be trained for primary care is going up and
that they are becoming a bigger proportion of the workforce. I
think we all agree that that should be the direction of travel.
To deliver that, we will need to look at the capital estate
behind this and make sure that we have the GP surgeries and
everything else in the right places.
I turn to social care. The increase in medically trained people
can only be a good thing for social care and the sector as a
whole. However, social care is not included here. It is
difficult. We can make an NHS plan because we are the employer
behind the NHS; whereas there are hundreds, if not thousands, of
different employers in social care so it is not for us to make
that plan. However, it is for us to make sure that we increase
the supply of medically trained people, as set out in this plan.
We know how important international workers are to that; we
recognise that and the importance of visas. Notwithstanding that,
the value of this plan is that, eventually, it will reduce our
dependence on the need to recruit internationally. We will see it
go from about 25% of recruitment, as currently, to about 10%
because we are increasing the supply base and the pool of people
who can do that, rather than making a change on the visa
front.
As ever, I have tried to cover most of the points raised in the
time available. I will follow up in writing on the rest, but I
conclude by welcoming this report.
6.02pm
(Con)
My Lords, in welcoming the report, I press my noble friend on a
very interesting suggestion on page 79, where the Government
propose a “tie-in period” to
“encourage dentists to spend a minimum proportion of their time
delivering NHS care”.
There are a number of professions trained at public expense that
are in short supply, including police, doctors and teachers. Why
have dentists been selected? Is it proposed to broaden this
policy to other areas trained at public expense that are in short
supply?
(Con)
I thank my noble friend. Dentists were pointed out in particular
because so many of them go on to work not in the NHS but in
private care settings. It is out for consultation, but I think
that was the thinking behind it. For instance, even after five
years, 93% of doctors are still registered and working in the
health service; that is a lot lower in the dentist space. We are
putting investment into that group and it is clearly perfectly
reasonable to expect a return on that by a certain time.
(Lab)
My Lords, the Minister has set out the aims and objectives of the
plan, which we all welcome, but does he understand that, unless
we fix the care system at the same time, this plan is bound to
fail? It could make it even worse, with staff moving from the NHS
and away from care services. How will joined-up government
address the problem of under- recruitment and low morale in the
care service, which will make this plan either succeed or
fail?
(Con)
I would like to think, as I mentioned before, that increasing the
supply and training of the whole medical profession would help
the whole sector. This is quite close to my heart; as I have
mentioned before, my mum became a nurse later on in life and went
through an apprentice-type route, for want of a better phrase.
Having different entry points is a very positive thing. I
sincerely hope that people going into a social care environment
will see that as a building block to onward career progression
and that it will set them up to take further qualifications later
on in life, if they wish, in the nursing profession. We are
looking to expand the whole sector, and the general belief is
that that will benefit both social care and the NHS.
The Deputy Speaker ( of Hudnall) (Lab)
My Lords, the noble Baroness, Lady Brinton, is contributing
remotely.
(LD) [V]
My Lords, while this NHS plan is welcome, can the Minister say
whether this Government will undertake to commit to the plan and,
crucially, to its funding and not change the number of education
and training places, as happened last year and in too many
previous years, causing chaos in planning for doctors, nurses and
allied healthcare professionals? On hospital training places for
junior doctors after they have finished their medical school
courses, last year 790 medical graduates could not begin their
junior doctor in-hospital training because the NHS did not have
enough placements. Given that university medical school places
are already capped and highly competitive, this is a complete
waste of newly qualified medical graduates.
(Con)
It is absolutely a pipeline; some people might say, “Why are you
not doing more earlier in this plan?”, but, as the noble Baroness
says, there is no point training a lot of people at the
university end if you do not have junior doctor places later in
the system. That is why we are trying to get a sensible ramp-up
so that we can build capacity into those places, recognising the
point that the noble Baroness makes. On the numbers in the plan,
we have set down £2.4 billion for the first five years of
training and development, but the point about it being a live
plan is that we will update it every two years. Given the
data—this is an NHS document, not a Department of Health one—I
would expect those numbers to change, as I would be amazed if we
got it spot on first time. The whole point about making this an
NHS living document that we can use and which updates is that we
can all stick to the plan.
The Lord
My Lords, we on these Benches very much welcome this workforce
plan, in particular the expansion of places for training with a
range of clinicians and the shift of gaze towards community care
and prevention. Our anxiety very much mirrors that of the noble
Baroness, Lady Merron, and the noble Lord, . We notice that page
23 of the report says:
“This Plan is predicated on access to social care services
remaining broadly in line with current levels or improving”.
That is a jolly big assumption given that the Care Quality
Commission report tells us that there are vacancies of 10.7% in
adult social care and of 13.2% in the home care services. Without
an equivalent plan for social care, in our view this admirable
workforce plan is unsustainable, so will His Majesty’s Government
publish an equivalent plan for social care?
(Con)
As I mentioned previously, the NHS plan is something that we or
the NHS can publish, being the employer. With there being
hundreds, if not thousands, of employers in social care, it is
clearly a different situation. What we can do is make sure that
we put the investment into the sector, so that there is pull
through in the number of places. Over the next few years, we are
looking at an increase of up to £7 billion, which is about 20%.
We know that, of that £7 billion, around 65% to 70% flows through
to staffing and wages. We are seeing a massive investment on our
side, which we are looking to lots of employers to fulfil. By
increasing the number of medically trained people, we will be
increasing the supply base to fulfil that demand.
(Con)
My Lords, I too thank and commend my noble friend the Minister,
the Secretary of State and the leadership of the NHS for
producing an extremely good plan. It is historic, not because it
is the first time such a plan has been written but because it is
the first time in 20 years such a plan has been published. The
Minister has commented a couple of times that this is a living
plan—one that will be updated at least every two years. Could he
confirm that those updates will be published every two years, and
that this House will be able to debate and discuss them?
(Con)
That is absolutely my understanding. For it to be a living
document, people clearly need to have input and to be able to
debate it in exactly the way we are doing here today.
(Lab)
My Lords, I remind the House of my membership of the GMC Council.
The GMC has warmly welcomed the plan and its role in the
expansion of medical education, the development of physician and
anaesthesia associates, and the apprenticeship programme. I want
to follow on from the point made by the noble Baroness, Lady
Brinton. The key point the GMC has made is that it is absolutely
essential that there are sufficient clinical and educational
supervisors, particularly for the F1 grade—newly qualified
doctors going into postgraduate training. NHS trusts will have to
release more of their doctors to provide this. Is the department
in touch with and talking to the chief executives of NHS trusts
to ensure that, as the pipeline develops, there will be
sufficient clinical supervision? This is essential in order to
get the quality of doctors that we need.
(Con)
The noble Lord is correct that it is essential. I emphasise that
this is an NHS document, and the whole point is that it does not
look to go “zoom” on recruitment. There is absolutely the
understanding that this is a pipeline that has to be built brick
by brick. There is no point front-loading the number of
university places if, as the noble Lord mentions, there is no
follow-up behind it in clinicians. The plan has been developed
from the bottom up, including with clinicians and the trusts.
There is an understanding that they need to build their own part
of the pipeline towards this as well.
(Con)
I welcome this ambitious and comprehensive workforce plan and I
concur with other noble Lords on the issue of social care. On the
specific issue of medical school places, while I strongly welcome
and commend the Government for responding to the campaign of many
people—including Policy Exchange and its excellent Double Vision
report, published earlier this year—my concern is the waste of
resources and the talents of those thousands of A-level students
who do not get university places to study medicine. While I
welcome the focus on degree apprenticeships and the
regionalisation of medical education, is there any chance that we
could speed up the process? Another eight years to double the
number of medical places is an awfully long time—it is almost the
equivalent of two Parliaments.
(Con)
As for the A-level point and those people not being able to go on
to universities, that is what the different routes are about. The
different pathways that we are talking about include nursing
associate training places, which we want to see increased to
10,000, and similarly with physician associates. While we all
understand that having a university education is a fantastic
medical grounding, there are many other ways to get there. I am
sure we all have very good examples of fantastic clinicians who
did not have a degree.
(Lab)
I refer to my interest as chair of the General Dental Council. I
welcome not only the whole document but the specific commitment
within it to increase the number of dental training places by 40%
by the beginning of the next decade. Does the Minister accept
that simply increasing the number of dentists will not solve the
problems of NHS dentistry if dentists decide that it is more
lucrative for them to practise privately rather than through the
NHS? This is only part of the process. If the solution to dealing
with the problems of NHS dentistry is to essentially create a
tied class of dentists who have trained and are therefore
expected to work in the NHS, I am not sure that this will be
sufficient.
I also raise a more general point which is nothing to do with
dentistry specifically. Could the Minister tell the House what
proportion in any one year of the number of people entering the
workforce are expected to go into the NHS? My calculation
suggests that they are expecting the figure to go up from 10% of
those entering the workforce to 15%. What will incentivise that,
and will it be addressed through the various pay processes that
we have already referred to?
(Con)
I thank the noble Lord for the work he does as chair of the GDC.
He will know that this is something that is quite close to my
heart, given that my better half is a dentist. I completely agree
that it is about far more than just the training places. I think
the House has heard me discuss this before, but if we are serious
about dentists who have been in practice for 10 years setting up
their own clinic, maybe in an NHS Digital desert, we must give
them guidance and support, as it is quite an ask to do that. We
plan to produce and publish a dental plan in the not-too-distant
future, in which I hope and trust that a lot of these points will
be covered.
The noble Lord is correct; I do not know the exact maths behind
it, but we spend roughly 12% of our economy on the health sector
and so it is not surprising that roughly that number would be
expected to go into the NHS workforce. In some ways, that shows
the magnitude of everything we are talking about today. Probably
one in eight of all people leaving school will end up in this
sector—that really is a number worth thinking about and pondering
over. As we all agree, it shows why this plan is timely and why
it must be a living document that is continually adjusted as we
go forward.
(Lab)
My Lords, I welcome this historic document. I concur with some of
the concerns expressed by my noble friend on the Front Bench.
Nevertheless, I believe it to be very significant. It addresses
many important areas, such as apprenticeships and training, all
of which I welcome. I could carp and say that we will check
against delivery, and of course we need to. I hope we will have a
proper debate on this plan at some stage, and I would welcome an
assurance from the Minister on this. It merits a much longer
debate; it is probably one of the most important issues that this
House has discussed.
I am interested in dentistry because I recently visited my local
dentist—a man of principle who converted a private practice into
an NHS practice. I always get him to do my teeth, and he cleaned
and scraped them and did all the necessary things, and he then
took X-rays. I went to the desk to pay and the charge was £28.50—
I could not get a plumber to come out for those prices.
If you do not reward NHS dentists—that dentist’s son and daughter
are both practising dentists—they will inevitably go into private
practice. If we are serious —I believe we are—about doing
something, of course we have to look at the charges. I do not
want to end on a negative note. I agree with those who have said
that this is one of the most important issues that this House has
discussed in a long time, and I welcome the Government’s
actions.
(Con)
I thank the noble Lord. He is quite right to say that we need to
check against delivery and he is quite right to hold us to
account on that. Personally, I am happy to commit whatever time
we need to debate this because I completely agree on how
important it is. As I say, it is quite sobering when you think
about the figures: as we said, we expect one in eight school
leavers to go and work in this sector, so we almost cannot spend
too much time on that.
As I say, the dental plan will be published shortly, and making
sure that the balance is right, and that it is seen as an
attractive option to be an NHS dentist versus working in the
private sector, is absolutely an important part of that as
well.
(CB)
My Lords, I very much welcome this plan and in particular the
fact that we will start to deliver more homegrown healthcare
workers; in fact, the WHO has applauded us for these moves
because there is such an international shortage, not because
overseas workers are not welcome here.
I want to ask one question. I very much support the concept of
apprenticeships, but professional workers on registers, be that
nursing, medicine, physiotherapy or paramedicine, expect
apprenticeships to be degree-level apprenticeships, accepting
that the entire workforce will not be graduates but that
registered clinicians should be. Can the Minister please clarify
that issue?
(Con)
I thank the noble Baroness. The whole idea of the apprenticeship
is that the standard that you are training to is absolutely the
same, albeit obviously you are getting there via a different
route. However, as regards the capability, training and knowledge
of that person, clearly, whichever route they have come from,
they need to be at that same required level. That is why the
royal colleges have been such an important part in the
development of this whole plan.
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