Clause 35 Report on assessing and meeting workforce needs 6.56pm
The Minister for Health (Edward Argar) I beg to move, That this
House disagrees with Lords amendment 29B in lieu. Madam Deputy
Speaker With this it will be convenient to consider the following:
Lords amendments 30B and 108B to words restored to the Bill,
Government motion to disagree, and Government amendments (a) to (i)
in lieu. Lords amendment 48B in lieu, Government motion to...Request free trial
Clause 35
Report on assessing and meeting workforce needs
6.56pm
The Minister for Health ()
I beg to move, That this House disagrees with Lords amendment 29B
in lieu.
Madam Deputy Speaker
With this it will be convenient to consider the following:
Lords amendments 30B and 108B to words restored to the Bill,
Government motion to disagree, and Government amendments (a) to
(i) in lieu.
Lords amendment 48B in lieu, Government motion to disagree and
Government amendment (a) in lieu.
Government motion to insist on disagreement with Lords amendment
80, insist on Commons amendments 80A to 80N in lieu, and disagree
with Lords amendments 80P and 80Q.
The Lords amendments before the House today relate to the NHS
workforce, reconfigurations, modern slavery and the adult social
care cap. In respect of amendments 30B and 108B on
reconfigurations, I am grateful for the constructive debate on
these issue across both Houses. This House has twice voted
strongly in favour of the ability for the Secretary of State to
call in reconfiguration proposals when needed, and it remains a
key principle that decisions on how services are delivered should
be subject to ministerial oversight. However, my right hon.
Friend the Secretary of State and I have listened carefully to
the debates throughout the Bill’s passage, and as a result we
have proposed a series of amendments to minimise bureaucracy and
ensure transparency.
The first set of changes would mean that the NHS had to notify
the Secretary of State only about those reconfiguration proposals
that were deemed notifiable, which we will define through
regulations. We intend to align that definition with the existing
duty on NHS commissioners to consult local authorities where
there is a substantial development of variation in the health
service. We also propose to remove the requirement for
commissioners and providers to inform Ministers of
“circumstances that are likely to result in the need for the
reconfiguration of NHS services”.
Taken together, these changes will mean that the NHS will need to
notify the Secretary of State only about proposals that are
substantive and of great importance to people.
Secondly, we will give local authorities, NHS commissioners and
anyone else the Secretary of State considers appropriate a right
to make representations to the Secretary of State when he has
called in a proposal for reconsideration. We expect this to
include any relevant provider. The Secretary of State will be
required to publish a summary of the representations he receives,
and we will set out in statutory guidance further detail on how
local bodies, including providers, will be engaged.
Thirdly, transparency is vital to ensure that these powers are
always used by Ministers in the clear interest of the people we
all serve. We will therefore require the Secretary of State to
provide the reasons for his decisions and directions when he
makes them. Finally, we have heard throughout these debates that
it is vital that decisions are made expeditiously and expediently
in order to give certainty to local bodies so that
reconfigurations can be made quickly to improve the quality of
services received by patients. We are therefore introducing a
requirement that, once a reconfiguration proposal has been called
in, the Secretary of State must make any decisions within six
months. We believe that this set of changes addresses the key
concerns raised in this House and the other place, and I commend
it to the House.
I turn to Lords amendment 48B, and the Government’s amendment in
lieu, on modern slavery. We share the strength of feeling
expressed in both Houses on ensuring that the NHS is in no way
inadvertently linked with modern slavery and human trafficking
through its supply chain. That is why the Government brought
forward an amendment in the first round of ping-pong to create a
duty on the Secretary of State to undertake a thorough review of
NHS supply chains. I am pleased to announce today that we are
going further. The Government’s amendment in lieu of Lords
amendment 48B will require the Secretary of State to make
regulations with a view to eradicating the use by the NHS in
England of goods or services tainted by slavery or human
trafficking. The regulations can set out steps the NHS should be
taking to assess the level of risk associated with individual
suppliers, and the basis on which the NHS should exclude them
from a tendering process.
I particularly commend my right hon. Friend the Member for
Chingford and Woodford Green ( ) for his consistent and
vocal campaigning on this issue. I am delighted that he has
confirmed his support for the amendment in lieu. I look forward
to working further with him and his supporters to bring these
measures forward.
7.00pm
(Wealden) (Con)
I congratulate the Minister and the Department on taking this
extraordinary step. The public may believe that we already do not
use slave-made goods, but unfortunately we do. It is remarkable
that the Department has taken this step, and it is incredibly
important that we look at Xinjiang in particular, where Sir
Geoffrey Nice QC determined there has been a genocide, as there
was in Bosnia. The sanctioned MPs and all our colleagues in the
inter-parliamentary alliance on China will work with the
Department to ensure we have no Uyghur slave-made products in our
NHS.
I paid tribute to my right hon. Friend the Member for Chingford
and Woodford Green, but my hon. Friend the Member for Wealden (Ms
Ghani) has also taken a keen interest in this issue. The
Secretary of State and I will continue to work closely with
others across Government to ensure that our measures to eradicate
modern slavery in NHS supply chains are effective and targeted,
and reflect best practice.
On Lords amendment 29B, the Government are committed to improving
workforce planning and are already taking the steps needed to
ensure that we have record numbers of staff working in the NHS.
In July 2021, the Department commissioned Health Education
England to work with partners on reviewing the long-term
strategic trends for the health and regulated social care
workforce over the next 15 years. We anticipate the publication
of that work in the coming weeks.
(Strangford) (DUP)
Will the Minister give way?
Very briefly, as I am conscious that we have limited time.
If the right hon. Member for South West Surrey () were to pursue the matter, my
party and I would be minded to support him. Although I understand
from the figures in the press today that there are significant
numbers of new nurses coming into the NHS, there is still a large
shortfall. Will the Minister confirm for Hansard in the Chamber
today that every step is being taken to recruit the nurses needed
to address the issue of workforce safety?
The hon. Gentleman is right to highlight the work we are already
doing, which I will address in a moment, and the number of nurses
we have recruited. I believe we have now recruited 29,000 or so
en route to our target of 50,000 more nurses by the end of this
Parliament.
(Bromley and Chislehurst)
(Con)
Will my hon. Friend give way?
I will make a little progress, if I may—a few more paragraphs—as
I am very conscious of allowing time for Back-Bench colleagues to
speak.
Building on this work, we recently commissioned NHS England to
develop a workforce strategy. We will set out the key conclusions
of that work in due course. In addition, we have committed
ourselves to merging Health Education England with NHS England to
bring together responsibility for service, financial and
workforce planning in one organisation. We will continue to grow
and invest in the workforce. There are record numbers of staff,
including nurses, working in the NHS.
I am grateful to the Minister for giving way. He will know of my
interest as chair of the all-party parliamentary group on stroke,
and he will be aware of the particular concern of the Stroke
Association and others about the number of qualified therapists
to provide the therapy people need after a stroke. Will he commit
himself to that being part of the workforce strategy and to
moving swiftly? This is already a pressing problem for stroke
survivors who are not getting the care they need.
I reassure my hon. Friend that my right hon. Friend the Secretary
of State has made it clear that he wishes the whole health and
care workforce landscape to be considered by Health Education
England.
The growth in our workforce comes on the back of our record
investment in the NHS, which is helping to deliver our manifesto
commitments, as I said to the hon. Member for Strangford (), including our commitment to 50,000 more nurses by
the end of the Parliament. The spending review settlement will
also underpin funding for the biggest ever intake of
undergraduate medical students and nurses.
Although I might not be able to say anything sufficient to fully
convince my right hon. Friend the Member for South West Surrey
(), I put on record my gratitude
to him not only for the insight, expertise and knowledge he has
brought to our debates on this issue but for the typical courtesy
he has displayed throughout our interactions and conversations. I
do not know what he will say in a moment, but I have tried to
pre-empt him. I hope that he may be tempted to stick with it.
I hope that the House will recognise that the Government are
already doing substantial work to improve workforce planning, and
that placing a requirement such as Lords amendment 29B on the
statute book is therefore unnecessary.
(Batley and Spen) (Lab)
Will the Minister give way?
Very briefly, but I am sensitive to Madam Deputy Speaker’s
instruction to be brief.
I thank the Minister for giving way. More than 100 organisations,
including the Royal College of General Practitioners and the
British Medical Association, have expressed their support for
Lords amendment 29B. Does he agree that the only way to ensure
that we recruit and retain the talented staff that our NHS and
social care sector desperately need is through a long-term
workforce plan in consultation with the experts in the field,
such as health and care employers, unions and integrated care
boards?
That is exactly what we are doing through the work commissioned
by my right hon. Friend the Secretary of State, which is why
Lords amendment 29B is unnecessary.
(Winchester) (Con)
Will the Minister give way?
I fear that I cannot, but my hon. Friend may catch me during my
winding-up speech. I want to make progress, as about 10
Back-Bench colleagues wish to speak.
Finally, on the adult social care cap, the Government have
announced our plan for a sustainable social care system. It is
fair, affordable and designed to end the pain of unpredictable
care costs by capping the amount anyone needs to pay at £86,000.
Without clause 140 there would be a fundamental unfairness: two
people living in different parts of the country, contributing the
same amount, would progress towards the cap at different rates
based on differences in the amount their local authority is
paying. We are committed to levelling up and must ensure that
people in different parts of the country are benefiting to the
same extent, and our provisions support this. Amendments 80A to
80N also make crucial changes to support the operation of
charging reform, as these changes were lost by the removal of
clause 140 in the other place.
Lords amendments 80P and 80Q insert a regulation-making power to
amend how
“costs accrued in meeting eligible needs”
is determined in section 15 of the Care Act 2014. However, if
regulations were made using this power, they would result in
anyone entering the care system under the age of 40 receiving
free personal care up to that age. As local authority
contributions would count towards the cap under these changes, a
35-year-old with average care costs would reach the cap and not
have to pay anything towards the cost of their care, yet a person
who enters care the day after their 40th birthday would need to
contribute towards the £86,000 cap over their lifetime. We
believe this is unfair. Our plan already includes a more generous
means test that means more people will be eligible for state
support towards the cost of care earlier, enabling them to keep
more of their income.
The changes introduced in the other place also threaten the
affordability of our reforms. Lords amendments 80, 80P and 80Q
would clearly affect financial arrangements to be made by this
House and, as such, have financial privilege. These new Lords
amendments would cost the taxpayer more than £1 billion a year by
2027-28. Ultimately, this would mean we need to make the same
level of savings elsewhere, making the system less generous for
other users. I hope I have been able to provide some reassurance
that we believe our approach is still the right one, and I ask
the House to disagree with the other place’s amendments.
Finally, I put on record my gratitude to my hon. Friend the
Member for Aberconwy () and the noble of Cotes for their
constructive and positive engagement during the Bill’s passage on
ways to strengthen co-operation between the UK Government, the UK
Statistics Authority, the Office for National Statistics and the
devolved Administrations, and for their passion for strengthening
the Union. I am pleased we are taking forward that work, albeit
outside this Bill. I am stimulated by their important work.
We have sought throughout the passage of the Bill to be pragmatic
and to listen to this House and the other place in either
accepting their amendments or addressing them in lieu. I hope the
House recognises that this approach continues to characterise our
work, save where we sadly cannot agree with the other place in
respect of its amendments on both the workforce and social care
caps.
Several hon. Members rose—
Madam Deputy Speaker ( )
The problem we have is that this debate has to finish at 7.55 pm.
This means that, after the shadow Minister has spoken, I will
have to impose a time limit to get in a lot of Back Benchers. The
time limit will start at four minutes.
I call the shadow Minister, .
(Bristol South) (Lab)
Thank you, Madam Deputy Speaker. This Bill has been significantly
improved. It delivers changes to the 2012 legalisation the NHS
called for. Some other issues have been addressed by ministerial
assurances and many valuable new clauses have been added. I am
pleased that much of what we argued for in the six weeks of the
Bill Committee has finally been accepted. On two issues—the
Secretary of State’s powers on reconfiguration, and procurement
and modern slavery—the Lords have wrestled important concessions
that we support. As a former senior NHS manager, I know that
reconfiguration is necessary, important and often difficult; it
is often wrongly associated purely with cuts and taking something
away. We are interested in improving outcomes for people, and
that sometimes requires difficult change. For two decades, a
comprehensive process has existed, which includes local people,
is informed by expert assessments and operates pretty well.
Throughout Committee, and during numerous debates, I have heard
no sound argument to change it, but the Government seemed
hellbent on doing so, and it is only at the eleventh hour that
they have finally agreed to some changes.
If I listened to the Minister correctly, he says that now the NHS
will have to notify the Secretary of State when there is
something notifiable. That is going to be as clear as mud for
everybody, isn’t it? We look forward to the regulations. The
point is that the Government’s initial plan inhibits improvement.
If NHS managers and, in particular, clinical leaders know that
the Secretary of State is hovering, they will be less likely to
promote changes that may be clinically necessary but politically
difficult. It appears now that the Secretary of State finally
agrees and does not want this big pile on his desk, and although
the amendment is far from perfect, it does enough for now. On the
procurement issue, I commend the work of many people from across
both these Houses and the excellent case that has been put
forward. Labour has been pushing for measures such as these for
many months, and I think the intentions of the Government appear
to be aligned to a shared view of what is required.
However, there remain two substantial issues, workforce and the
care cap, where I hope the Government, even at this late hour,
will listen to reason. Many experts have spoken, and many ideas,
alternatives and suggestions have been put forward, but we have
had very little engagement from the Government. On these two
matters, we speak for the stakeholders, experts and Members from
all parties, who are united in opposing the Government’s
proposals. Workforce planning is a huge issue in its own right,
but it is also fundamental and cuts through everything we are
talking about on health and social care. Chiefly, the problem is
that unless we face up to the scale of the workforce challenge,
the Government will not deliver the shorter waiting times that
patients need. Until this Government break out of their
straitjacket—unless somebody can make the Chancellor see
reason—nothing is going to change for all our constituents. The
Government should start today—otherwise patients will be left
wondering why they are paying more and more in taxes but waiting
longer for care.
Time precludes my repeating all the arguments. I could simply
repeat what the Chair of the Select Committee said last time or I
could offer the wise words of the previous chief executive of the
NHS and more—who can add to the variety and strength of the
evidence? The logic of this approach escapes me. Every MP knows
that our family, friends and constituents are now in a cycle of
long waits in pain and discomfort, with worry. All that is asked
for in this Lords amendment is a proper report that sets out the
system to address the likely staffing requirements—that is so
obviously necessary. If this amendment falls, we, as legislators,
have failed. If the Secretary of State will not show leadership,
NHS England must step up and produce its own requirements and
projections. Additionally, the Local Government Association could
commission work across the country, in every local authority, on
the needs for social care and public health staff. I suggest that
every MP asks their own integrated care system and local
authority what workforce requirements and projections they have,
and how credible these plans are. Unless we do that, how can
anyone have confidence in the delivery for the people we are
elected to represent?
Finally, we come to the proposed changes to the care cap
calculations. Those were snuck in at the last moment and were not
subject to any scrutiny in our six weeks in the Bill Committee.
They have not been discussed in any detail at all. The proposals
are a less generous version of what was in the Care Act 2014 and
this is a massive step backwards. Once again, I could read out a
ring binder full of analysis and evidence provided by the legion
of stakeholders, none of it complimentary. We hear the repeated
claim, “This solves the problem of social care. It is fixed.” It
simply is not. Let us leave aside the deeply insulting attitude
that the care and support of people in need, who could live
better more fulfilled lives, is a “problem” to solve; we should
be celebrating the fact that people can live better, for many
years longer, with multiple conditions, with decent support and
care. We all know that to be true.
The proposals the Government have put forward do not deliver any
more care; they just change who pays for it. Money will go to
those with assets, and the less you have, the more they will
take. The proposals will have no real impact for years, but we
all know that people need help now. They will not improve the
quality of care by anything like what is needed and will not stop
those 15-minute visits. The proposals do nothing to assist
working-age adults who have a disability. They do not stabilise
the collapsing market for care home place provision. They do not
shorten any wait for care or reduce any waiting list. They will
have no impact on improving access to care for hundreds of
thousands of people currently excluded. They do not address the
issues around a care workforce with many vacancies and poor terms
and conditions. They do nothing to address the catastrophe of the
past decade of cuts to local government. This is not a solution
to social care. This ill-thought-out idea should not have been
pasted into the Bill. Some more informed Conservative Members
have also recognised the unfair impact on the poorest, especially
those in parts of the north; levelling up this certainly is
not.
7.15pm
To respect the views of the countless stakeholders who oppose
this measure, we have surely to try to find a way forward.
Someone sensible in the Department of Health and Social Care has
decided that changes of this impact and complexity should be
subject to a proper pilot; there are to be “trailblazers”. We do
not know much about them, but I believe we have assurances from
Ministers in the other place that everything will be considered
and the results will be made known. Will the Minister assure us
that the evaluation of the trailblazers will be published and the
impact assessments updated so that this hugely important policy
change can be properly considered by Parliament? What on earth
will be lost by allowing the evidence to inform the policy? What
we are voting on tonight is simply that:
“The regulations may not be made unless—
(a) the results of the Trailblazer pilot schemes have been
evaluated, and the Secretary of State has laid that evaluation
before Parliament, and
(b) the Secretary of State has completed a further general impact
assessment covering distributional regional analysis”.
We all think we know what that looks like, but we would like to
see the details.
In conclusion, my colleagues and I will be supporting the Lords
amendments on workforce and the care cap. The time for politics
is over; we just need common sense and the will to listen and
look objectively at the evidence to find a way forward for the
good of everyone.
Madam Deputy Speaker ( )
I call the Chair of the Select Committee, .
(South West Surrey) (Con)
Thank you, Madam Deputy Speaker. I rise to speak in support of
Lords amendment 29B. Even though I believe the Government will
reject it today and this may be the last time this House can
debate it, I will try to make my comments with the customary
courtesy that the Minister for Health attributed to me just now,
with his customary courtesy. He said that this amendment was
unnecessary, but I wish to ask the House: what precisely is
unnecessary about an amendment that simply requires independent,
regular estimates of the numbers of doctors and nurses we should
be training? What could drive the Government to want to vote down
such a harmless amendment, not once, not twice, but, including
today, three times? I will tell the House why the Government are
going to vote this amendment down. They will do so because they
know that any such independent estimate would conclude that we
need to be training more doctors and nurses. Why on earth would
we not want to train more doctors and nurses, if we looked
objectively at the challenges facing the NHS today? We last
debated this on the day the Ockenden report was published in
Parliament. That report talked about more than 200 babies’ lives
that would probably have been saved with better care. The key
recommendation in that report was for 2,000 more midwives and 500
more obstetricians, and that would not have been necessary had
this amendment been in place. We can put this right.
I immensely respect the work done by the Minister for Health and
the Secretary of State, and I am grateful for their engagement,
but I say to them, from the bottom of my heart, that not training
enough doctors and nurses is a false economy. It costs patients’
lives, it costs taxpayers’ money, it demoralises the workforce
and it lets down the people who are waiting for their NHS
operation. The Health Minister’s argument is that we will have
50,000 more nurses by the end of this Parliament and we are
training more doctors than ever, but today’s report by the King’s
Fund shows that that is a hollow claim, because even though we
are on track for our 50,000 nurses, the number of vacancies is
still not going down. In other words, more nurses does not mean
enough nurses, and we can never know what enough is unless we are
honest enough to ask ourselves the hard questions.
The lesson of Mid Staffs, Morecambe Bay, Southern Health and
Telford is that the first step in dealing with poor care is to be
honest about the issue. We now have in the NHS a workforce issue
of enormous proportions, which is why Lords amendment 29 is
supported by every NHS leader, every royal college, every health
think-tank, every union and more than 100 NHS organisations in
total. I am afraid that, by voting down a simple request for
independent estimates of the number of doctors and nurses we
should be training, the Government are actively choosing to sweep
the problem under the carpet. I say to Ministers, who have
listened to my arguments genuinely and in good faith, that NHS
and care staff deserve better after two years of the pandemic,
and the people waiting for their NHS operations deserve better,
too.
Madam Deputy Speaker ( )
I call the SNP spokesperson.
(Linlithgow and East Falkirk)
(SNP)
I will be brief, Madam Deputy Speaker.
Operational procurement is a devolved matter but, given our
interest in trade policies, we welcome the progress on
procurement to ensure that healthcare supply chains are not
linked to modern slavery and human trafficking. We support UK
Government amendment 48A in lieu of Lords amendment 48, and we
also support Lords amendment 48B in lieu. It is perhaps worth
reflecting on the fact that in Scotland half of all PPE is now
produced locally and that the overall costs of pandemic
procurement were a third less than those of the UK. Such measures
can, then, be cost-effective and help to safeguard against global
supply chain issues.
(West Suffolk) (Con)
I rise to support the compromise measure on reconfigurations and
to ask the Government to take forward the work on UK-wide
statistics with vigour and gusto.
First, on reconfigurations, it is right and reasonable that the
largest organisation in the country, which is funded by taxpayers
through the taxes that every single citizen pays, should be
accountable to Ministers who are in turn accountable to this
House. Although that principle has been accepted in the Bill
across the board and in general terms, the other place has
decided that it should not apply in the specific circumstances of
reconfigurations. It is vital that when a reconfiguration
happens, not only the clinical voices but the voice of the local
community should be heard. The two need to go together. The best
way to make happen any reconfiguration that is needed on clinical
grounds is to engage the local community and get it onside. If we
are to save lives through a reconfiguration, we can win the
argument, but only if we engage and make the argument. In my
experience, too often a reconfiguration was put on the table,
perhaps for good clinical reasons but without enough local
engagement, and in practice the process just ran into the
sand.
I welcome the six-month delay—I hope the Secretary of State will
work quicker than six months most of the time, but it is a good
backstop; I welcome the de minimis threshold, because relatively
small reconfigurations happen all the time; and I welcome the
removal of some of the bureaucracy in the amendment. To my hon.
Friend the Minister, who has done a magnificent job on the Bill
right from the start, before it even came to this House—I thank
all his officials for their service—I say: let us take this
compromise but say clearly to the other place, “Thus far and no
further.” The principle of democratic responsibility for the NHS
and for winning the argument with the public about its local
design is at the heart of the Bill and it must stand.
In the final minute I have in which to speak, let me make a point
about statistics. Those on the Treasury Bench have decided not to
include in the Bill measures on the UK-wide measurement of health
services and on the interoperability of data in the four nations
of the UK, but I put on the record the importance—I hope the
Minister reiterates this—of getting UK-wide measurements. In
Wales, it was decided to discontinue the measurement of some
aspects, especially in respect of A&E performance. A
suspicion was raised—I am sure this could not possibly have been
true—that those measurements were discontinued so that
unfavourable comparisons with England could no longer be made. If
that were true, it would be an outrage. I very much hope that it
is not, but we should put it right anyway and measure NHS service
delivery throughout the UK on the same basis, so that comparisons
can be made, so that we can learn about and improve services
across all four nations, and so that accountability can properly
apply to the four different Governments who run the four parts of
the one NHS, which operates across this United Kingdom.
(Ellesmere Port and Neston)
(Lab)
I rise to speak to the Lords amendment on workforce—probably for
the dozenth time during the Bill’s passage. I make no apologies
for repetition because some things are worth repeating and the
importance of our workforce can never be understated. Everything
comes back to workforce: the grandest plans, strategy documents,
reorganisations, integrations and configurations will all count
for very little if the fundamental cog in the machine and the
glue that holds the whole thing together—the workforce—is not a
central part of those plans. The consistent failure to invest in
the workforce and to provide a plan for it so that it is able to
meet demand over a sustained period is at the root of many of the
challenges that the NHS faces today. We should correct that.
On Friday night, a constituent contacted me as he suspected he
had dislocated his hip and had been told that his situation did
not warrant an ambulance. Eventually, he managed to get to
A&E, but in the end he went home without receiving treatment
because it was so busy that people were standing outside the
department. That is just one example, but there are countless
others like it—the frustrated constituents who can never speak to
their GP; the many people left in agony because waiting lists are
at record levels; those whose teeth rot away because they cannot
get dental treatment; and those who receive no help for their
mental health issues because they do not reach the threshold for
intervention. Every one of those examples arises because, to a
greater or lesser extent—I would say to a greater extent most of
the time—there simply are not enough staff to meet the
demand.
There is a pattern of disconnection in respect of the action
required to meet the Government’s ambitions, let alone getting
the NHS to meet its constitutional targets. Unless workforce is
addressed in a meaningful way as part of all the plans and
strategies issued, the Government are just fooling themselves
that their plans are credible and deliverable. Even if the
Government wish to fool themselves, they are not fooling anyone
else. They are certainly not fooling us Members on the Opposition
Benches or the 100 or so health and social care organisations
that support what we are trying to achieve with the workforce
amendment.
The most recent Department-commissioned NHS workforce strategy,
the People Plan, did not include a forecast on staffing numbers.
When asked about it, , who authored the plan,
said that the strategy did not include staff numbers not
because
“the Government disagreed with the numbers”
but
“because we could not get approval to publish the document with
any forecasts in it.”—[Official Report, House of Lords, 7
December 2021; Vol. 816, c. 1814.]
Perhaps that means the Government do have figures but just do not
want us to see them. If that is right, perhaps the Minister could
let us in on the secret when he responds. If that is not right,
will he tell us what other organisation with more than a million
staff manages to operate successfully without accurate figures on
workforce projection?
In addition to the obvious arguments about why we need accurate
information on workforce requirements, it is important that we
collect such information for existing staff, because they need
hope that help is on the way. We need to show that those claps on
a Thursday night were not an empty gesture and that there is a
determination to do something about the persistent rota gaps that
mean staff are both exhausted and demoralised. Just look at some
of the challenges we face: 93,000 vacancies; a £6 billion annual
spend on agency staff; staff working extra unpaid hours; and some
40% off with work-related stress at some point or other. With all
those things conspiring together, it is little wonder that
retention is an issue, so we need to give staff hope that we have
an answer—that we have a plan. As the Select Committee report on
workforce burnout said:
“The way that the NHS does workforce planning is at best opaque
and at worst responsible for the unacceptable pressure on the
current workforce which existed even before the pandemic.”
With so many challenges currently facing the NHS, why do we want
to make it worse by refusing to accept the evidence before our
eyes? It is no coincidence that NHS satisfaction ratings are
reported to be at a 25-year low at the same time as record
numbers of NHS staff say they would not recommend working at
their own trust. Those issues are not disconnected in any way,
which is why we need to support the workforce amendment.
7.30pm
(Chingford and Woodford
Green) (Con)
I will speak briefly to Government amendment 48A, which is in
lieu of amendment 48B. Essentially, it requires the health
service to ensure that it does not use products made under forced
or slave labour anywhere in the world. That is a big statement by
the Health Department, and one that I think we all welcome—I have
certainly campaigned on this issue for some time.
In the great sweep of this health legislation, on which there are
agreements and disagreements across the board, that may not seem
to be something that will directly affect our lives, but in truth
it will resonate beyond our shores. It is already resonating
among the Uyghur, who have found themselves under distinct
pressure, with husbands often separated from wives and families
broken apart for forced labour thousands of miles away from their
homes. This measure will speak to them; it is, in a way, a sign
that Governments in the free world are taking up this real cause
and recognising that it is intolerable for us to turn a blind eye
and buy equipment, clothing and so on simply because it is
cheaper and helps our cost balance. I do not believe that it will
in the end; the trade-off between cost and the human rights of
those who have suffered so much under the heel of those
totalitarian states is an abysmal one.
Child labour is used in rare-earth mines; when we use those
rare-earth materials for the manufacture of our computers, we
turn a blind eye to it. When slave labour is used in the Xinjiang
region to produce the cotton and the cloth for our personal
protective equipment, making it quicker and easier to get, we
turn a blind eye to it. It is not just done there; it is done in
many countries around the world because it is easier and cheaper,
and we tolerate it. I therefore welcome that my right hon. Friend
the Secretary of State and the Ministers have tabled the
amendment. It will speak volumes to those who are oppressed. It
will say to them, “The free world has not forgotten you.” I am
certain that in due course the rest of this Government will do
the same, and other Governments will then follow suit. I
congratulate us for making the right decision.
(St Albans) (LD)
I will speak to the workforce amendment and the amendment on the
social care cap.
The Lords have compromised on the workforce amendment—they have
now asked for projections every three years instead of every two,
and they no longer require independent verification of the
projections—so it is deeply disappointing that the Government
have not moved to meet them halfway, especially when outside the
Government there is so much cross-party consensus that the
amendment is badly needed. I know from my constituency of St
Albans, as I am sure many Members know from theirs, that our NHS
and care staff are burnt out. They are understaffed and
overworked. Those people, who continue to turn up every single
day, need to know that the cavalry is coming, and without this
workforce amendment, they simply will not.
There have been worrying reports that NHS trusts have been
silenced when they have tried to talk about the numbers of staff
that they need to recruit, so will the Minister address this
question in his response: if the Government will not produce
workforce planning numbers, will they at least commit to not
interfere with or silence any part of the NHS or care sector that
decides that it wants to produce its own workforce projections? I
look forward to hearing the Minister’s assurances on that
point.
When it comes to the social care cap, Ministers have stated time
and again that their changes would save the Treasury £900 million
a year by 2027-28, but that saving comes at the expense of people
with fewer assets and savings, including those who will have been
paying five years of increased national insurance contributions,
which were put in place partly to fund these care reforms. The
Government continue to say that that improves on the current
situation, but they conveniently ignore that it is much worse
than their original proposal. The social care cap provision does
nothing to generate more care; it does nothing to give
protections to unpaid carers, who are often on lower incomes but
save the Government millions of pounds; and it does nothing to
help the social care workforce. I know from my constituency that
hospitality, the NHS and social care are all fighting for the
same people, and nothing in the Bill will help to improve that
situation.
(Waveney) (Con)
I am grateful to have a few minutes to say a few words on the cap
on care costs and on workforce planning.
With regard to the care cap, it is important to congratulate the
Government on tackling a problem—or attempting to defuse a
ticking time bomb—that all their predecessors shied away from.
However, there is concern that the proposals are a rushed tag-on
to a Bill that was designed for a different purpose: the
integration of health and social care and the setting up of
integrated care systems. I accept that there is a clear
correlation, but the legislation that addresses the problem of
people being forced to sell their homes to pay for their care
should have been considered and scrutinised separately and
carefully, with the objective of putting in place a system that
has political consensus and will stand the test of time. That is
what the Dilnot proposals and the Care Act 2014 achieved, and
they should be the foundation stone on which we build this new
system.
My concerns are twofold. First, clause 140 is extremely unfair to
those with limited assets and modest incomes. The changes may
save the Government hundreds of millions of pounds, but they do
so at the expense of those on low incomes and those who live in
parts of the country where house values are lower, such as
Lowestoft in my constituency. Secondly, there is a worry that
working-age adults with disabilities will be unfairly penalised,
hence the introduction by the other place of a provision to
address it. I acknowledge the Government’s worries about the cost
implication of that additional provision, but that iniquity needs
to be addressed.
On workforce planning, there is a staffing crisis both in the
NHS, where there are 110,000 full-time equivalent vacancies, and
in social care, where there are another 100,000 vacancies, high
staff turnover and very limited respite for unpaid and family
carers. Those deficiencies cascade through the health and care
system, creating bed-blocking in hospitals and impeding the
efforts made to reduce waiting lists. There is an urgent need for
strategic planning to address this crisis. There is concern that
framework 15 is not working because of inadequacies in the
collection of data, lack of assessment of workforce numbers, and
unresponsiveness to societal shifts.
Since we last considered the issue last month, the other place
has sought to address the Government’s concerns and, as we have
heard, has made reasonable concessions. There is a crisis that
must be addressed, and I hope that at this very late stage the
Government will accept this reasonable amendment, so that we can
get on with this much-needed work.
(Wirral West) (Lab)
Amendment 29B goes much further than the Bill’s current
provisions on workforce reporting, which are extremely weak. It
would require the Government, at least once every three years, to
lay a report before Parliament describing the system in place for
assessing and meeting the workforce needs of health, social care,
and public health services in England. What could be more
reasonable? One has to wonder why the Government do not support
amendment 29B. Surely any Government who were committed to
running the NHS as a public service would see these provisions as
crucial.
The Royal College of Physicians has pointed out that clause
35
“will not set out how many health and social care staff are
needed to meet demand”
and has stated that, without long-term projections, which
amendment 29B would provide, there is no way to assess how
changes in workforce trends, such as retirements or working part
time, will impact the delivery of healthcare. The Royal College
of General Practitioners has spoken of unsustainable pressures
driving GPs out of the workforce and threatening to destabilise
general practice.
Just a few weeks ago, the Royal College of Nursing said that
nursing staff are exhausted and that staff shortages are
undermining their efforts to give safe and effective care—a
sentiment reflected by a nurse I met on bank holiday Monday. That
is hugely concerning. As the RCN has said, there is a clear
evidence base showing that staffing levels have a direct impact
on the safety and quality of patient care. When I met members of
the RCN last year, they made clear to me the increased stress
levels that nurses are experiencing as a result of staff
shortages and the impact that is having on the care they so
desperately want to deliver.
According to the Health Foundation:
“In the next 25 years, the number of people older than 85 will
double to 2.6 million”
in England, so demand for social care is increasing and we need
to know that there will be enough doctors, nurses and social care
workers to meet people’s needs. The “Strength in Numbers”
campaign, a coalition of more than 100 health and care
organisations, says that we must put
“measures to adopt a sustainable long-term approach to workforce
planning on a statutory footing.”
Without credible, up-to-date numbers, the system cannot plan.
I support Lords amendment 29B. I urge the Government to think
about those NHS staff who are working so hard and are so
stretched by the amount of stress they are under because they do
not have enough colleagues around them, and to listen to the
clinicians who are calling on the Government in this regard.
(Central Suffolk and North Ipswich) (Con)
I draw the House’s attention to my declaration in the Register of
Members’ Financial Interests as a practising NHS doctor. I
welcome the Government’s concessions on modern slavery and
procurement and on the reconfiguration of NHS services. However,
I remain concerned about two issues: the care cap and
independence in the staffing assessment process.
To touch briefly on the issue of the care cap, a number of years
ago I took through this House the Care Act 2014, as a Minister in
the coalition Government. We based that Act and the care cap on
the Dilnot proposals. I continue to be concerned that the current
proposals deviate from the Dilnot proposals, in that those with
lower or more moderate net assets will be asked to pay
disproportionately more than those with greater assets. That is
something I find very difficult to accept. It deviates from the
principles of the 2014 Act and the Dilnot proposals, and I hope
that even at this late hour the Government will reconsider their
position on it.
I rise in particular to speak in support of Lords amendment 29B
and the comments by my right hon. Friend the Member for South
West Surrey (). It is undoubtedly the case
that we cannot have safe staffing in the NHS if we do not have
the right number of staff. We cannot meet the increasingly
complex care needs of patients with not just one, two or three
but sometimes four comorbid conditions if we do not have staff
with the right skills and in the right numbers to meet those care
needs.
We talk often of building new hospitals and of our programme of
capital investment in hospitals, but unless we have the right
numbers to staff those hospitals, we will not be able to deliver
safe care. In every constituency represented in this Chamber, we
recognise that there are staff shortages in the local NHS. We
recognise particular challenges in the medical workforce among
fully qualified GPs—over the past seven years the number of
full-time equivalent GPs has fallen. We recognise challenges in
the midwifery workforce, which were brought tragically to our
attention by the Ockenden report, and we recognise challenges in
areas such as intensive care and paediatrics and throughout the
health service.
The problem with health workforce planning is that Governments
see the NHS in electoral cycles, but workforce is much more
complicated than that. From starting medical school to becoming a
consultant it takes perhaps 15 years, and to become a fully
qualified GP takes about 10 or 11 years. It is important that we
have a genuine independence to the process of workforce planning.
I have great faith in Health Education England and I am sure it
will produce a good report and assessment, but unfortunately it
will be doing so with one hand tied behind its back, because it
must do so within the confines of the financial envelope in which
it is working, and it lacks the genuine independence to say what
the NHS really needs.
If we care about patients and about the future of the NHS and its
needs, true independence in a report on workforce is required.
That is in the best interests of patients, of the health and care
workforce and of the future of our health service. I hope the
Minister will reconsider.
7.45pm
(Boston and Skegness)
(Con)
When I spoke on workforce issues on this Bill last time, I said I
was prepared to support the Government’s position on the basis of
what the Minister and the Secretary of State had said. The Whips
do not need to worry too much, because that remains the case, but
I feel a huge amount of sympathy for my right hon. Friend the
Member for South West Surrey () and Lords amendment 29B.
Fundamentally, if the Government are not prepared to accept what
the House of Lords has proposed, they are making their
relationship with NHS staff and those associated with the NHS
somewhat more difficult.
I ask the Minister to ensure that he doubles down on the
commitment he made previously to engage relentlessly, publicly
and as extensively as possible with that workforce. If the
Government do not do that, there will never be that sense that
the cavalry is coming over the hill.
When my right hon. Friend the Member for South West Surrey was
Secretary of State, we established a new medical school in
Lincoln—a huge achievement of his, and one I continue to try to
take as much credit for as possible. However, saying to doctors
in my local constituency, who are working so hard at the Pilgrim
Hospital in Boston and in Skegness, that we are recruiting more
people locally who will be able to make a difference is a
challenge, because they do not yet see it on the wards. Part of
that, as has been said, is because it takes such a long time to
train people and bring them to fruition.
(Gloucester) (Con)
A number of us have been successfully lobbied by the Royal
College of Nursing in our own constituencies, showing us the
figures—a shortage of 250 nurses in our A&E at the hospital
in Gloucester—and staff surveys showing that morale is not where
it should be. Does he agree that those things are influencing why
some of us are not happy with the Government’s position?
I agree that the Government need to continue to address that
issue in the way I have described, through more extensive
engagement to try to demonstrate some of what is happening.
That brings me to my second point—I will try to stick to the
original time limit—which is that these issues are about trust.
We need trust with the NHS workforce. As my right hon. Friend the
Member for West Suffolk () said, with reconfiguration it
is very often the case, as it is in my constituency, that even
though the data says we will save lives by moving a service from
Boston to Lincoln or vice versa, we need to engage with local
communities, because right now they simply do not believe that a
service that is further away may yet save lives. That does not
ring true, and often the data is not yet there.
I simply appeal to my hon. Friend the Minister to deliver on what
he said at the Dispatch Box about engaging with the profession,
because that is essential to try to improve the morale that the
pandemic has damaged so much. I also appeal to him to ensure that
local NHS organisations engage with local people, because only
that will win public support for the reconfiguration that is so
essential for our NHS both locally and nationally.
With the leave of the House, I would like to thank right hon. and
hon. Members who have spoken in this debate. I am grateful to the
shadow Minister, the hon. Member for Bristol South (), and indeed to the hon. Member
for Ellesmere Port and Neston (), with whom we spent many
happy hours over many weeks in Bill Committee.
I also put on record my gratitude to the amazing Bill team in the
Department, with whom it has been a pleasure and a privilege to
work on this piece of legislation. They have done an amazing
job.
I thank my right hon. Friend the Member for West Suffolk (), under whose leadership we
saw the genesis of this Bill, and whom it was a pleasure to work
with and work for over a long period of time.
On reconfigurations, and on tackling modern slavery and supply
chains, I hope and believe that these measures attract support
across the House, and therefore will not reprise the case for
them here.
In respect of workforce planning, I join my hon. Friend the
Member for Boston and Skegness () and many others who have
spoken in highlighting our gratitude to the NHS workforce and our
recognition of the pressures they have faced, particularly over
the past two to two and a half years, but also more broadly. That
is why we have not only put in place the measures I outlined to
deliver an assessment through Health Education England of the
needs of the workforce and the framework for growing it, but
rather than waiting for that, already put in place measures to
continue to significantly increase the workforce.
Will the Minister give way?
Yes—it is the only intervention I will take, but I promised my
hon. Friend.
When I visit the elective orthopaedics team at Royal Hampshire
County Hospital in Winchester later this week, I suspect that
they will not tell me that the workforce is not one of the things
on their worry list, so it is regrettable that the Government
cannot accept amendment 29B. They are obviously going to get
their way and win the vote, but will the Minister and his team
reflect on the argument that has been had between the two Houses
over the past year and, in that spirit, take this issue forward?
It is not going away, I need to have an answer for the team on
Friday, and what I am hearing right now is not going to satisfy
them.
I hope I can reassure my hon. Friend that I always reflect
carefully not just on what he says and what my right hon. Friend
the Member for South West Surrey () says, but on what the other
place, and other hon. and right hon. Members on either side of
this House, say.
I hope I have provided the majority of colleagues with sufficient
reassurance about the steps the Government are already taking and
our commitment to ensuring that we have the right number of
people working in the NHS, coupled with the increases in staffing
that we have already delivered and continue to deliver. I hope
that the House will again agree that the substantial work already
being undertaken by the Government to improve workforce planning
is leading to the improvements we all seek, and I therefore urge
hon. Members to reject their lordships’ amendment.
We also ask that amendments 80, 80P and 80Q are rejected and
amendments 80A to 80N are accepted in lieu. The cap on care costs
clause is key to this Government ending unpredictable care costs
for everyone by introducing a universal £86,000 cap. That must
stand part of the Bill, alongside the necessary further
amendments 80A to 80N, and we encourage hon. Members to back us
on this.
This Bill is an important step forward in evolving our health and
care system to meet future needs, and it comes from a Government
who are clear in both their record and their future plans in
their support for our NHS. I hope that the other place will heed
the large majorities with which this House has already sent these
measures back to it, and I hope that we will do so again this
evening. We always listen to the other place, but we believe that
this House has, on multiple occasions and hopefully again this
evening, expressed a clear view of our position on these
matters.
Question put, That this House disagrees with Lords amendment 29B
in lieu.
[Division 260
The House divided:
Ayes
278
Noes
182
Question accordingly agreed to.
Held on 25 April 2022 at
7.53pm](/Commons/2022-04-25/division/6C0780E8-CE7E-4DA3-ABC6-E02FFEA834EC/CommonsChamber?outputType=Names)
Lords amendment 29B in lieu disagreed to.
8.06pm
More than one hour having elapsed since the commencement of
proceedings on the Lords message, the proceedings were
interrupted (Programme Order, 30 March).
The Deputy Speaker put forthwith the Questions necessary for the
disposal of the business to be concluded at that time (Standing
Order No. 83G).
Resolved,
That this House disagrees with Lords amendments 30B and 108B to
the words restored to the Bill, and agrees to Government
amendments (a) to (i) in lieu.—(.)
Resolved,
That this House disagrees with Lords amendment 48B in lieu and
agrees Government amendment (a) in lieu.—(.)
Motion made, and Question put,
That this House insists on its disagreement with Lords amendment
80, insists on Commons amendments 80A to 80N in lieu, and
disagrees with Lords amendments 80P and 80Q.—(.)
[Division 261
The House divided:
Ayes
282
Noes
183
Question accordingly agreed to.
Held on 25 April 2022 at
8.07pm](/Commons/2022-04-25/division/6E3EA533-E893-4196-883C-D8D784D2B783/CommonsChamber?outputType=Names)
Motion made, and Question put forthwith (Standing Order No.
83H(2)), That a Committee be appointed to draw up Reasons to be
assigned to the Lords for disagreeing to their amendment 29B and
for insisting on disagreement to Lords amendment 80, for
insisting on amendments 80A to 80N in lieu and for disagreeing to
Lords amendments 80P and 80Q;
That , , , , , and be members of the
Committee;
That be the Chair of the
Committee;
That three be the quorum of the Committee.
That the Committee do withdraw immediately.—(Miss Dines.)
Question agreed to.
Committee to withdraw immediately; reasons to be reported and
communicated to the Lords.
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