Asked by
To ask His Majesty’s Government what assessment they have made of
the reasons why this year’s NHS spending on short-notice agency
doctors and nurses is 20 per cent higher than the previous year.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
My Lords, demand for temporary staff supplied through staff banks
and external agencies has increased. This is largely due to the
increase in activity involved in our service recovery plans. Even
taking account of recent increases, agency spend is still lower
than in 2015-16 as a result of measures introduced to control
spend. When adjusted for inflation, last year’s agency spend
reflects a 25% reduction compared to 2015-16.
(Lab)
My Lords, the shortage of NHS staff is unsustainable, as is the
NHS paying up to £5,200 for a single doctor shift. This year, in
addition to the £3 billion paid to agencies providing doctors and
nurses at short notice, a further £6 billion was spent on bank
staff when NHS staff were paid to do temporary shifts. What
cost-benefit analysis has there been of this expenditure,
compared with investing in recruitment, training and retention of
the workforce? Does the Minister agree that it would have been
much better if we had had, and actioned, the long-awaited and
costed NHS and social care workforce plan?
(Con)
I totally agree with the noble Baroness: it is always better to
invest in recruitment and retention, and that is what we are
doing. There is no cap on the number of nurse graduates, and we
have more than 70,000 in training right now. During the last
three years, we have increased the number of nurses by
32,000—well towards our target of 50,000—and the number of
doctors has increased by 4,000 in the last year alone. At the
same time, I welcome the long-term workforce plan. It is a
crucial tool going forward.
(CB)
My Lords, I have asked the Minister before about the NHS’s plans
to retain its clinical personnel. He has acknowledged the
importance of the issue but there seems to be no real urgency
attached to it. There is absolutely no good will among NHS
personnel towards the NHS as an institution—those are not my
words but the words of NHS staff. When is this crisis to be
addressed with the urgency which is so clearly required?
(Con)
I believe the urgency is there. This has been demonstrated more
than anything by the measures in the Autumn Statement and by the
long- term workforce plan, which will be reporting early in the
new year and is what we all want. Commitments are being made to
prioritise well-being, health, culture and leadership, and to
operationalise this as per the 2020 NHS People Plan. Do we need
to do more? Clearly. Is it a high priority? Yes.
(LD)
My Lords, the increase in agency staffing costs reflects the
Government’s failure to invest sufficiently in staff training and
recruitment over the years. To what extent does the Minister
believe that the change of course he has indicated—a staffing
plan and increased investment—will reduce agency costs in 2023?
(Con)
I think all of us in this House agree that these are long-term
plans. Part of the increase in agency costs is also because we
are trying to get more output and more activity. I am delighted
that there are 70,000-plus nurses in training, but it takes a
while for this to come through the pipeline. We are focused on
making sure that we continue to invest in this pipeline. There is
no cap on graduate or undergraduate places for nurses, and we
will continue to invest.
(Lab)
My Lords, I declare my interest as a member of the GMC. The
Minister has referred to the forthcoming workforce plan. Can he
assure me that it will actually put numbers on the future
training of different professional staff, together with a
commitment to funding these places?
(Con)
Again, I will check, but my understanding is that fundamental to
any plan is the number of new places needed and recruitment, both
internally, through graduate schemes, and externally.
Apprenticeships also provide an opportunity. I know we are not
taking up all our apprenticeship value; we refund some of it back
to the Treasury. There is clearly an opportunity here to get more
people on the pathway to becoming a nurse, so that anyone from
any walk of life can get on it.
(Con)
My Lords, have the Government made any assessment of sickness
absence rates among NHS staff and how that might be contributing
to increased agency costs?
(Con)
My noble friend is correct to bring this up; it has been an
issue. I am glad to say that sickness absences at the moment are
much closer to pre-pandemic levels, so I think we are coming down
the other side of the curve, so to speak. But undoubtedly it has
been an issue over the past year, when Covid has still been an
issue, which has caused more absenteeism and so the use of more
bank and agency staff.
(Lab)
My Lords, the Government have changed the pension rules for
doctors, creating an incentive for them to retire earlier. The
Government are committed to looking at that issue, but they do
not seem to be doing anything. When can we expect a change in
that policy so we can retain our doctors?
(Con)
The noble Lord is completely correct; we need to make sure that
this is one of the key retention elements. There is also the
issue of the hours doctors work: we know that, beyond a certain
level, they find it uneconomic. A high priority is looking at
what we can do on pension rules, or simply paying doctors the
equivalent amounts as a straight salary, to make sure that we
solve that problem.
(Con)
My Lords, the Opposition target the abolition of a particular tax
to raise funds to put into the NHS, but does my noble friend
believe that is the silver bullet they purport it to be?
(Con)
I thank my noble friend. I do not pretend to be an expert on tax,
but my understanding is that the so-called non-dom tax does not
end up increasing the revenue raised and would therefore have a
detrimental impact on the economy.
(LD)
My Lords, the Minister is putting a lot on the success of the new
workforce plan. Is part of the problem of gaps in staffing
numbers that, until recently, the Government refused repeated
requests for an NHS workforce plan?
(Con)
I do not know, is the honest answer. All I can say is that we are
doing it now, and I think we all welcome it as a good thing. That
has not stopped us investing in new places, and we have increased
the number of nurses by 32,000. So it is not as if we were not
heavily involved in recruiting and retaining staff in the
meantime, but it is great that we are now going to get it.
(Lab)
My Lords, does the Minister think that he might have had a better
chance of recruiting more nurses if there had not been a 20% drop
in real-term wages over the past 10 years?
(Con)
Clearly, salary is a very important part of all this, which is
why we have always followed the recommendations of the
independent pay review body, as Governments of all colours have
done since 1984. Clearly, it is that body’s job to look into all
such issues. Going forward, I am sure that we will continue to
support its findings and invest on the back of that.
(Con)
My Lords, a report from this House’s Public Services Committee
has suggested that demand will outstrip supply in the workforce
due to the demographics of this country. It suggests that the
Government should work closely with civil society and the private
sector to make sure that we are delivering public services. One
problem is that, often, the NHS does not work as well as it
should with civil society and private partners. Can my noble
friend go back to his department and find out what it and the NHS
are doing to make sure they work in tandem with civil society and
private providers, and can he comment on that today?
(Con)
I thank my noble friend and agree that, in looking to recruit so
many people, we need to consider every possible source. I
mentioned the private sector earlier, and there are also
apprenticeships. Noble Lords will remember that years ago, there
were two nurse entry levels, one for graduates and the SEN
scheme, which my mum was able to join, with a lower bar and
training on the job. We need that sort of modular training
approach, so that people can build up their qualifications as
they go through the system, and we need to welcome people who are
not graduates into the service. Those are all vital ways to get
the numbers we need into the workforce.
(Non-Afl)
My Lords, although we all acknowledge the acute shortage of
nurses right across the services, there are particular issues
with children’s palliative care services. How do the Government
intend to address this urgent priority?
(Con)
We are trying to address every area. As I mentioned, in the past
year alone there has been an increase of 9,000 in the number of
nurses. We have to make sure that that increase goes to every
area where it is needed, including children’s palliative care.
