NHS Long-term
Workforce Plan
Mr Speaker
I wish to thank the Secretary of State for Health and Social Care
for coming to the Chamber to make his statement. It is a pity
that the Prime Minister did not do so on Friday when the world
heard what he had to say before we did. The Prime Minister is a
Member of Parliament. He is answerable to the Members of
Parliament from all political parties. I have to say that his
behaviour was not acceptable. He may be the Prime Minister, but
the Members of Parliament should hear first. I am very pleased
that the Secretary of State is doing it the right way.
16:11:00
The Secretary of State for Health and Social Care ()
The Government note the comments that you have made from the
Chair, Mr Speaker.
Mr Speaker
I would love them to take what I have said on board.
That is also noted, Mr Speaker.
May I, on behalf of the Government, note the passing of the
former head of the civil service, ? He had a distinguished
career in public service, including as chief executive of
Sheffield Council and chair of King’s College Hospital NHS
Foundation Trust, as well as being head of the civil service. We
send our condolences to his family and friends both in Whitehall
and across the civil service.
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 lives 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 roll-out 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.
Mr Speaker
I call the shadow Minister.
16:21:00
(Leicester West) (Lab)
I thank the Health Secretary for advance sight of his statement.
I say “statement”, but what I really mean is “admission”—an
admission that, after 13 long years, the Conservatives have run
out of road, run out of ideas, and turned to Labour to clear up
the mess that they have made. Make no mistake: at its heart, this
is Labour’s workforce plan. It is a plan that we have called for
since last September; a plan that we have begged the Government
to adopt again and again. They say that imitation is sincerest
form of flattery, and I, for one, am relieved that the Government
have finally seen sense, but the question that the Health
Secretary and Conservative Members need to answer today is: what
on earth took them so long?
This week, the NHS celebrates its 75th anniversary as it faces
the biggest crisis in its history—a crisis that has been building
for years under this Government: a staff shortage of 154,000, 7.4
million patients stuck waiting for treatment, people across the
country finding it virtually impossible to see a GP, and families
desperately worried that if they need an emergency ambulance, it
just will not arrive on time. Ministers constantly blame covid
for those problems, but the truth is that waiting list numbers
were rising and staff shortages increasing long before the
pandemic struck.
Patients now want to know when they will finally see a
difference. Can the Health Secretary confirm that, under his
proposals, the NHS will not have the staff that it needs for at
least eight years? Does he now regret the cut in medical school
places that his Government brought in in 2013? Does he regret the
decision taken last summer to cut the number of medical school
places by 3,000 just when the NHS needed them most?
The Health Secretary claims that this is the first long-term NHS
workforce plan, but let me set the record straight. In 2000, the
last Labour Government produced a 10-year plan of investment and
reform—a plan that delivered not only 44,000 more doctors and
75,000 more nurses, but the lowest-ever waiting times and the
highest-ever patient satisfaction in the history of the NHS. That
was a golden inheritance that Conservative Members can only dream
of and that they have squandered through a decade of inaction and
incompetence.
Let me turn briefly to what is missing from the proposals.
Without a serious strategy to keep staff working in the NHS,
Ministers will be forever running to catch up with themselves.
Yet the Secretary of State has completely failed to put forward a
proper plan to end the crippling strikes that are having such a
huge impact on patient care. Six hundred and fifty thousand
operations and appointments have been cancelled because of
industrial action. Next week, junior doctors will walk out for
five days, followed by two days of consultants’ strikes. After
seven months of disruption, can the Health Secretary tell us when
he and the Prime Minister will finally do their job, sit down and
negotiate with staff, and bring an end to this Tory chaos?
The one part of Labour’s workforce plan that Ministers have not
stolen is our plan to fund it by scrapping the non-dom tax
status. In fact, when the Health Secretary was touring the media
studios yesterday, he was asked nine times how he was going to
pay for the plan and he completely failed to answer. He has had a
little more time to prepare, so I am going to try again. Will he
fund it through higher taxes, when we already have the highest
tax burden for 70 years, or will he fund it through higher
borrowing, when our nation’s debt is at record levels? Labour
will introduce plans only when we can show how they will be paid
for, because that is what taxpayers deserve. It is high time that
Conservatives did the same.
From the windfall tax to help for mortgage holders to a proper
plan for the NHS workforce, where Labour leads, the Conservatives
only follow. This tired, discredited Government have had their
day. The public know that it is time for change, and in their
hearts Government Members too know that it is time for change. It
is time for them to move aside and let Labour finally deliver.
Well, that really was a confused response. The hon. Lady began
with reference to Labour’s proposals and the claim that our plan
followed them. I took the precaution of bringing Labour’s
announcement with me to the Chamber. Members can look at it in
their own time, but it does not use the word “reform” once,
despite the fact that “Train, retain, reform” is a key part of
our proposals. Proposals for reform include moving from five-year
to four-year medical undergraduate training; the expansion of
roles such as physician associate; a significant expansion in the
use of apprenticeships; and flexibility for retiring consultants,
so that they can return to roles in, for example, out-patient
services. A wide range of reforms came about as a result of the
consultation with 60 different NHS organisations and are a key
feature of the plan, but in Labour’s proposals reform is not
mentioned once.
In addition, Labour’s proposals are for a 10-year period. Our
plan covers 15 years. Its proposal covered 23,000 additional
health roles; our proposal deals with 50,000. I could go on and
talk about the fact that the Labour proposal does not even
mention GP trainees. Labour Members keep coming to the House and
saying that primary care is important, but their proposals did
not even touch on the workforce with regard to GPs. They did not
even mention pharmacists, even though, as part of a primary care
recovery plan, a key chunk of our proposal is Pharmacy First. It
is extremely important that we can deliver services to patients
in innovative ways. The ultimate irony is that the shadow Health
Secretary, in one of his many interviews, including interviews to
promote his book, said that the NHS “must reform or die”. He said
that it must reform, yet Labour’s proposals do not mention reform
at all.
Labour welcomes the plan, but it goes on to say that it will take
too long to implement, while claiming that it is its plan, which,
again, points to the confusion among Labour Members. Let me
remind the House of what has been done. We had a manifesto
commitment for 50,000 additional nurses—we are on track to
deliver that, with 44,000 in place. We had a manifesto commitment
to have 26,000 additional roles in primary care, and we have met
that, with 29,000 roles in place. In 2018, we made a commitment
to five new medical schools in parts of the country where it is
hard to recruit. We have delivered that—a 25% expansion in the
number of medical students, who will come on stream in hospitals
next summer. However, as we celebrate the 75th anniversary of the
NHS, it is right that we also look beyond that to the longer-term
needs of the NHS. That is exactly what the plan does with its
doubling of medical places, but alongside that, it innovates by
embracing things like a medical apprenticeship so that we can
look at different ways of delivering training.
The hon. Lady talked about strikes, which is a further area of
confusion on the Labour Benches. Labour Members say that they do
not support a 35% pay rise for junior doctors, on the grounds
that the shadow Chancellor, the right hon. Member for Leeds West
(), says that they should not.
Either Labour Members want to support the junior doctors, or they
do not—once again, their position seems confused.
I will finish with one final area of confusion on the Labour
Benches. The hon. Lady talked about the elastic non-dom revenue
raiser, despite the fact that the former shadow Chancellor,
, has said that it would not raise the funds that are
claimed. He has said that it would do quite the opposite: it
would deter investment in the UK. In addition, Labour has already
spent those funds on a range of measures, such as the breakfast
clubs that Labour Members come to the House and talk about.
The reality is that it would not fund Labour’s proposals, whereas
we have made a commitment to back our plan with £2.4 billion of
funding from the Treasury.
This is a historic moment as we celebrate the 75th anniversary of
the NHS. It is a long-term commitment from a Government who are
backing the NHS through the biggest investment in the NHS
estate—over £20 billion —and a series of recovery programmes,
expanding our diagnostic capacity and our surgical hubs. That is
why the workforce plan is truly innovative. It does not just
train more staff or offer opportunities to retain more staff; it
reforms as well—something that is sadly lacking in Labour’s
proposals.
Mr Speaker
I call the Chair of the Select Committee.
(Winchester) (Con)
This is a serious piece of work, and it is very welcome. Despite
calls from people like me to get on with it, it was right for the
Government to take their time and get it right. The Select
Committee will scrutinise it—as we do—on 12 July.
The training piece is very strong. Doubling the number of medical
school places has to be right, and I am glad that the Secretary
of State thought of it. On retention, if we are saying—rightly, I
would contest—that it is not all about pay, what role does he
envisage the integrated care systems and, therefore, the trusts
having in supporting staff as he makes the “one workforce” that
is mentioned in section 5, with which I agree, come to pass?
Characteristically, my hon. Friend the Chair of the Health and
Social Care Committee makes an extremely pertinent point about
the role of the ICSs. As we move to place-based commissioning and
look to integrate more, the interplay between the workforces in
the NHS and in social care will be a key area where the ICSs will
be extremely important.
The ICSs will have a particular role in the apprenticeship and
vocational training, which are key retention tools in those parts
of the country where it is hard to recruit, as well as in
offering more flexibility to staff. When I talk to NHS staff,
they often talk about having different needs at different stages
of their career—whether for childcare commitments, which relate
to the measures the Chancellor set out in the Budget, caring for
an elderly relative, or wanting to retire and work in more
flexible ways—and the ICSs have a key role to play in that. I
welcome my hon. Friend’s comment that this is a serious and
complex piece of work, and that it was right that we took our
time to get it correct.
(York Central)
(Lab/Co-op)
Despite the significant desert of dentists, I note from the plan
that we will not see an increase in dental training places next
year, the year after or the year after that, meaning that we will
not see more dentists for nearly another decade. We have a crisis
now, so what is the Secretary of State going to do about it?
We are already seeing a fifth more work than last year, due to
the flexibilities that the Under-Secretary of State for Health
and Social Care, my hon. Friend the Member for Harborough (Neil
O’Brien) announced, including the ability for dentists to take on
more work within their commission and the changes to the units of
dental activity pricing to better reflect more complex work. Of
course, we have 6.5% more dentists than in 2010, but we also
recognise that within the £3 billion budget, we want to go
further. That is why we are looking at proposals to go further
than the measures announced, but progress is being made, with a
fifth more activity than last year.
(Erewash) (Con)
I welcome the workforce plan and applaud NHS England’s ambition.
However, for the plan to be successful, it is vital that we
promote career options that often go unseen. I therefore urge my
right hon. Friend to work with the Education Secretary and NHS
England to ensure that young people are better informed about the
myriad opportunities in the allied health professions and as
healthcare scientists before choosing GCSE, A-level or university
options.
My hon. Friend raises a brilliant point. I do not know if Members
know, but there are 350 different types of role in the NHS. It is
really important that we get the right information to children
whose parents are perhaps not informed about those opportunities.
One point on which I slightly take issue with my hon. Friend is
that it is not just those at the start of their career who need
to be aware of the opportunities. This is about offering
opportunities to people throughout their careers to progress and
to take on more advanced roles. I strongly believe that we should
not define people’s future career by where they are at 21 or 22;
they should have the opportunity to progress. That is a key part
of the workforce plan, and I think it is a key Conservative
principle that they have that ladder of opportunity throughout
their time in the NHS.
(Walsall South) (Lab)
I associate myself with the remarks the Secretary of State made
about Bob Kerslake. He was a true public servant, and his death
is our loss.
What is the point of a workforce plan if the Secretary of State
is not actually talking to the workforce? When will he talk to
the junior doctors and the consultants? Can I also ask whether
the work on the workforce plan will start forthwith or sometime
in the future?
The fact that we are talking to the workforce is shown by the
fact that we have reached agreement with the largest workforce
group in the NHS.
indicated dissent.
The right hon. Lady, for whom I have a huge amount of respect, is
shaking her head, but it is a fact that the largest workforce
group in the NHS are those on “Agenda for Change”, which covers
more than 1 million healthcare workers from nurses, midwifes and
paramedics through to porters, cleaners and many others. We have
reached agreement with the NHS Staff Council, and those sums—the
5%, plus the lump sum in recognition of their tremendous work—is
going into pay packets this month. So we have reached agreement,
notwithstanding discussions with the junior doctors. They still
demand 35%, and that is not affordable.
(Halesowen and Rowley Regis)
(Con)
I welcome this long-term plan, particularly its recognition that
the skillsets required in the NHS over the next 10 or 15 years,
with the requirement for multidisciplinary working and
generalised clinical skills, are going to change. Does my right
hon. Friend agree that two things are needed for implementation?
One is to improve the sense of culture in the NHS, which could
lead to better retention. The second element is to ensure that
digital innovation, particularly the use of artificial
intelligence to improve clinical skills and other skills, is
rolled out more generally in the NHS. We need to diffuse that
innovation a lot more to support the critical new skillsets that
are required for a modern health service.
My hon. Friend is exactly right. As a former Health Minister, he
knows these issues extremely well. There is a requirement—this is
something the chief medical officer, Professor Sir , has spoken about—for more
generalist skills in the NHS, not least given that one in four
adults now has two or more health conditions. We need flexibility
to respond to changes not just in technology, but in service
design, which will evolve as well.
My hon. Friend is also right about the wider issues of culture. I
think the whole House was concerned about recent reports of
sexual assaults linked to the NHS. One of the key features of the
agreement we have reached with the NHS Staff Council is to work
more in partnership on violence against members of NHS staff. I
know there will be consensus in the House that that is
unacceptable, so we are working with trade union colleagues on
how we tackle it. Again, with racism, we still have too many
cases of concern. There are a number of areas of culture that we
are working constructively with trade union colleagues and others
to address.
(Sheffield Central)
(Lab)
I thank the Secretary of State for his comments about Bob
Kerslake, whose spell in public service included his time as
chief executive of Sheffield City Council. He continued to have
many roles in the city, where he will be much missed.
After this Government’s 13 years in charge, morale in the NHS is
clearly at rock bottom, with the value of pay falling, pressures
increasing and a record number of staff—almost 170,000—leaving
the NHS last year. The CEO of NHS Providers said that that must
be reversed, but all the Secretary of State talks about is a
little bit of working flexibility. Does he recognise that he has
to address the crisis in morale to stem the tide of people
leaving the NHS?
It is simply not correct to say that this is simply about
flexibility—for example, look at the very significant changes
made on pension tax. That was the No.1 demand of the British
Medical Association consultants committee, and the Government
agreed to it. A significant amount of work is going on. The NHS
people plan talked about not just flexibility but some of the
cultural points that are important. Some roles that have been
introduced need to expand, such as some of the advanced positions
like advanced clinical nurse or physician associate, where there
are opportunities for people to progress their careers. It is
worth pointing out that, once again, not a single Welsh Labour MP
has turned up to defend their party’s record in Wales. As we set
out a long-term workforce plan, we are setting out that ambition
for England, but we see very little from the Labour party in
Wales.
(Ashford) (Con)
I congratulate my right hon. Friend on this welcome announcement.
I was happy to join his celebration of the 75th anniversary in
the most practical way by visiting the new children’s emergency
department at the William Harvey Hospital in my constituency. It
is opening for patients this week and will be extremely welcome.
He will be aware that some of the problems of the NHS can be
solved only if we solve problems in the social care system as
well. I urge him to follow up this extremely useful and welcome
workforce plan for NHS workers with a similar idea for the social
care system, because unless we fix one, we will not fix the
other.
My right hon. Friend makes a valid point about the integration
between health and social care, and that was a flagship part of
the reforms in 2022, which brought the NHS and social care
together through the integrated care system. I join him in
welcoming the news about William Harvey Hospital, which is
extremely important to the local area. On social care more
widely, we must also be cognisant of the differences. The NHS and
social care employ roughly similar numbers at around 1.5 million
people, but one is one employer and the other is 15,000
employers, so the dynamics between the two are different. The
prioritisation of that integration is exactly right. That is why
my right hon. Friend the Chancellor announced up to £7.5 billion
for social care in the autumn statement, recognising that what
happens in social care has a big impact on discharge in hospitals
and hospital flow, which in turn impacts on ambulance handovers.
(St Albans) (LD)
After promises of new hospitals that have not got off the ground
and 6,000 more GPs that never came to pass, it is fair to say
that the British public will judge the Government on their
actions not their words. Let me press the Secretary of State
further on social care. He will remember that at the start of
this year, people were dying in the back of ambulances and in
hospital corridors, in part because people could not be
discharged from hospitals into social care. If the Government
believe, as I do, that we cannot fix the NHS if we do not fix
social care, will he also bring forward a workforce plan for our
social care sector?
That repeats the previous question, so I will not repeat the
answer. It is slightly ironic to call for a plan for a new
hospital programme and for a long-term workforce plan, and then
criticise us when we deliver on both of those, as we have done
with more than £20 billion of investment in the new hospitals
programme, which we announced last month, £2.4 billion in the
first ever long-term workforce plan and the biggest ever
expansion of workforce training in the history of the NHS. Of
course we need to take action in the short term to deal with the
consequences of the pandemic. That is what our recovery plan
does. The urgent emergency care plan that I announced in January
takes specific action on demand management in the community.
There are measures upstream on boosting capacity in emergency
departments and downstream on things such as virtual wards. A
huge amount of work is going on. We are putting more than £1
billion into 5,000 more permanent beds to get more bed capacity
into hospitals. On social care, in the autumn statement the
Chancellor committed up to £7.5 billion of further investment
over two years, and it was part of our reforms to better
integrate health and social care.
(Kettering) (Con)
I welcome the NHS long-term workforce plan and in particular its
emphasis on training, retention and reform. At the moment, about
a quarter of NHS staff are recruited from abroad. Can the
Secretary of State confirm to the House and my constituents that
this plan enables the development of a strong pool of homegrown
talent, so that we can reduce foreign recruitment more towards
10%, which would be a lot more sustainable for the long-term
future of the NHS?
My hon. Friend is absolutely right. As we boost our domestic
workforce training, there will be scope to reduce the number
recruited internationally. From 1948 onwards, international
recruitment has always played an important role in the NHS, and
we are hugely grateful for the service offered by those recruited
internationally, but we also recognise that as demography changes
in other countries, there will be increasing competition for
healthcare workers around the world, so it is right that we boost
our domestic supply. That is what this plan does, and it is why
this is a historic moment for the NHS in making that long-term
commitment that will in turn reduce the demand on the
international workforce.
(Eltham) (Lab)
I, too, add my condolences to the family of Bob Kerslake, who did
excellent work in my borough tackling poverty. I would
congratulate the Secretary of State on this announcement if it
did not come 13 years into a Conservative Government. It is a bit
like Bobby Ewing coming out of the shower, the way the Secretary
of State is saying, “I’ve just realised there’s a crisis in the
NHS.” We went into covid with 2.4 million people on waiting
lists, which was a record. It is now up to 7.4 million. The
report itself says that we have 154,000 fewer staff than we need
today in the NHS. After 13 years in government, if the Tories
really cared about the NHS, it would not be in the state it is
in, would it?
The hon. Gentleman ignores the fact that since 2010, there has
been a 25% increase in the NHS workforce. More than a quarter of
a million more people now work in the NHS than was the case in
2010. There is a 50% increase in the number of consultants
working in the NHS today compared with 2010, but the reality is
that demand has increased as a result of an older population,
advances in medicine and in particular the demands of the
pandemic, and that is what we are responding to. We are also
taking measures in parallel. We are on track to deliver our
manifesto commitment for 50,000 more nurses, with 44,000 now in
place. We also have beaten our manifesto target on primary care,
with 29,000 additional roles in place. That means that people can
get to the specialist they need, which in turn frees up GPs for
those things that only GPs can do and ensures that patients can
access care much more quickly.
(Gainsborough) (Con)
According to the King’s Fund, the proportion of GDP taken by the
NHS has increased in the past 50 years from 3.4% to 8.2%. On the
same trajectory, in 50 years’ time, it will take a fifth of all
our GDP. That is totally unsustainable, especially as someone’s
only right, despite the fact they are paying ever increasing
amounts of tax, is to join the back of the queue. I ask again:
will the Secretary of State launch a study—and, if necessary,
appoint a royal commission—on fundamental reform of the whole
nature and funding of our health system, so that we can learn
from every other developed country, such as Australia, France,
Italy and Germany, where they unleash private sector investment
into healthcare and give people rights to their healthcare, while
ensuring that those who need it get free healthcare at the point
of delivery?
I hope my right hon. Friend is pleased to see the measures we are
taking with the Lord O’Shaughnessy review on clinical research
trials to make it easier and faster to do research in the NHS.
That in turn attracts private investment to the NHS. He will have
seen the announcement I made on Tuesday of £96 million for 93
different research projects, such as at Great Ormond Street
Hospital, where we have allocated £3.5 million for research into
rare conditions in children. That translates into research that
is then deployed, usually in adults. We are investing there, and
we are screening 100,000 children through Genomics England. We
have got a deal with Moderna and BioNTech so that we can have
bespoke cancer vaccines. On Monday, we rolled out national lung
cancer screening. Previously, in our most deprived communities we
were detecting lung cancer late—80% were diagnosed late—but in
those pilots we turned that on its head with 76% detected
earlier.
I know that my right hon. Friend, as a former Chair of the Public
Accounts Committee, will agree that by detecting earlier, not
only are patient outcomes far better but treatment is far
cheaper, whether that is for lung cancer or through our
innovation on HIV screening in emergency departments picking up
HIV in people who do not realise that they have it. When we treat
it early, the patient outcomes are better, and it is fiscally
much more sustainable. That is how we will address some of his
concerns.
(Walthamstow) (Lab/Co-op)
The Secretary of State could do something now—not in eight years’
time—to relieve the pressure on our NHS, and it has nothing to do
with pension funds. Figures from the Royal College of General
Practitioners show that 53% of GPs think they cannot work in a
flexible way to balance family and work commitments. It is little
wonder that GPs aged 35 to 44 are the biggest group on the
retention scheme who are leaving the profession—it does not take
a rocket scientist to work out that it is the mums.
When I asked the Secretary of State’s Department what he was
doing to monitor flexible working and whether we are getting
roles that people can do—not just sitting with their 16 hours but
finding ways to work and balance family—it said that it did not
monitor the situation. It was not even looking at it. We are
losing brilliant staff and wasting billions of pounds, and we
will have a delay before our constituents see the benefit of any
workforce plan unless that changes. I have listened to him and
looked at the statement that does not make a single mention of
childcare, although he did refer to it in passing. What will he
actually do not just for retirees but for doctors with families
to get them back into the NHS so that we can all benefit?
I think there is actually a lot of agreement between the hon.
Lady and I. She talked about the plan, and having read it a
number of times—that is part of my role—I know that childcare is
specifically referred to in the summary, no less, in terms of the
key issues that it goes on to set out. It goes into detail about
our proposals, including linking up to the NHS people plan and
greater flexibility in terms of roles and people retiring. One
aspect of the NHS Staff Council deal is the expansion of pension
abatement rules. So there is a huge amount.
The hon. Lady calls for more flexibility. I set out a number of
the areas, and she does not seem to realise that there are three
sections to the plan, with the second being all about giving
greater flexibility to help retain our staff. So the plan
addresses the points she raises; that just does not seem to be
the answer she wants to hear. As for flexibility being important
to mums, yes it is, and the NHS has a largely female workforce,
but it is also important to dads. It is important to all NHS
staff that we have that flexibility.
(North East Bedfordshire)
(Con)
The NHS today, at 1.4 million employees, is the fifth-largest
employer in the world, and if the ambitions in this welcome plan
are met, it will be the largest employer in the world. That
raises the question of how effective the management of those
human resources is. It is a little disappointing that there is so
little commentary in the plan on two important management issues:
the ambitions on improving the quality of management systems, and
particularly clarification of decision rights and
responsibilities; and the quality of accounting control systems
and how the NHS seeks to improve them. Will my right hon. Friend
ensure that the NHS looks at those two important matters?
Those are both fair points. I know that my hon. Friend comes at
this with great commercial experience, and I hope he knows that I
have an interest in those issues. Just to reassure him, the plan
is iterative; it is not a one-off. It is a framework from which
we will do further work. Indeed, one of the areas that I am often
criticised for is my interest in data and variation in data
across the NHS—he and I probably agree on that more than some of
those who are critical. That speaks to his point—the Chair of the
Health and Social Care Committee’s point relates to this—that in
a system the size of the NHS, data on the performance of the
integrated care boards and their role in terms of the workforce
is one area that the House will want to return to.
(Slough) (Lab)
We know a Government are out of ideas when they copy the
Opposition’s plan to train the doctors and nurses that the NHS so
desperately needs. The majority of those policies will not be
implemented until after the general election—long after the
British public have booted the Conservatives out of power because
of their industrial-scale incompetence, which included crashing
the economy.
The Secretary of State will be aware that the NHS is short of
more than 150,000 staff right now. Will he take responsibility
for those shortages and admit that, had the Government acted more
than a decade ago, the NHS would have the staff that it needs
right now?
All I can say is that the hon. Gentleman clearly has not read the
plan. If he had, he would have seen that it is developed by NHS
England. That the Labour party is claiming authorship of it is
slightly odd. As I pointed out in response to the shadow Health
Minister, the hon. Member for Leicester West (), Labour’s plan fails to mention reform at all, or GP
training or physios. Our plan is 15 years, Labour’s is 10; it is
a fraction of the size and it is flawed in many other ways. This
plan has been developed by NHS England with contributions from 60
different organisations across the NHS. That is why it has been
so widely welcomed by many in the NHS, who have called for it for
some time.
(Scunthorpe) (Con)
We have a superb new accident and emergency in Scunthorpe, and we
are pressing ahead with plans for a large, state-of-the-art
community diagnostic centre. I have lived locally all my life,
and those are some of the most significant upgrades we have seen
in a generation. But there are things to do—we certainly need
more NHS dentists. Would the Secretary of State consider a tie-in
so that newly qualified dentists spend a minimum percentage of
their time delivering NHS care?
I am pleased to see those services going into Scunthorpe. That
underscores the investment we are making now while preparing for
the long term, through the largest ever expansion in workforce
training in the NHS’s history. My hon. Friend is right about the
importance of tie-ins. Let me explain why that matters in
particular for dentists: around two thirds of dentists do not go
on to do NHS work. That is why the plan has looked at tie-ins for
dentistry, which we will explore in the weeks and months ahead.
(Battersea) (Lab)
Despite what the Secretary of State says, the Conservatives have
finally admitted that they are out of ideas, and are adopting
Labour’s workforce plan. The NHS is short of more than 150,000
staff right now. More worryingly, the plan includes no mention of
eye health, despite the crisis. In ophthalmology, 80% of eye
units do not have enough consultants to meet current demand. Will
the Secretary of State say how many years it will take for the
NHS to have enough ophthalmologists? Why will he not back my Bill
for a national eye health strategy for England, which will seek
to tackle the crisis in eye health?
The question started by saying that we do not want plans for the
future, we want to deal with the present, and finished by asking
if we can have a plan for the future rather than for the present.
The plan sets out significant additional numbers. Significant
investment is going into eye services here and now. Let me give
the House one example: at King’s Lynn hospital, in addition to
our investment in a new hospital to replace the reinforced
autoclaved aerated concrete hospital, and in addition to the new
diagnostic centre, I had the opportunity in the summer to open a
new £3 million eye centre, which is doubling the number of
patients who receive eye care in King’s Lynn. That is just one
practical example of our investment in eye services now.
(Cleethorpes) (Con)
May I add my words of condolence for , who served on the greater
Grimsby regeneration board, which oversees regeneration in the
Grimsby-Cleethorpes area? We greatly valued his experience and
advice. Following the question from my hon. Friend the Member for
Scunthorpe (), it is important that
we tie in dentists—and I would suggest GPs—to NHS services, but
could they also be directed to areas of greatest need, such as
northern Lincolnshire?
The Under-Secretary of State for Health and Social Care, my hon.
Friend the Member for Harborough (Neil O'Brien) is looking at how
we deliver more services within the existing contract, and at
what incentives and reforms can be put in place to ensure that
the parts of the country that find it hardest to recruit dentists
are best able to do so, through both our domestic supply and
international recruitment.
(Strangford) (DUP)
I welcome the Secretary of State’s statement and the positivity
he is trying to bring forward. The NHS workforce plan has
concluded that the number of places in medical schools each year
will rise from some 7,500 to 10,000, but in Northern Ireland it
is a very different story: I know it is a devolved matter, but
the Royal College of Nursing is facing cuts that could result in
the number of places falling to 1,025 per academic year. Will the
extra money that the Secretary of State announced be subject to
Barnett consequentials? I know he is always keen to promote all
this great United Kingdom of Great Britain and Northern Ireland
together, so what discussions has he had with the Northern
Ireland Department of Health and the Northern Ireland Assembly to
ensure that Northern Ireland is not left behind? When we are
crying out for staff, our students should have a real opportunity
to learn and work in the NHS field.
Barnett consequentials will apply to the £2.4 billion funding
over the five years. In respect of new roles, regulatory changes
apply on a UK-wide basis. The plan itself is for the NHS in
England, but we stand ready to work with partners across the
United Kingdom where there is shared learning on which we can
work together.
(South West Bedfordshire)
(Con)
I am really pleased to see the 50% increase in the number of
annual training places for GPs—it is music to my ears—but they
will need somewhere to work. The £20 billion for the hospital
programme is great, but when I look at section 106 applications
for my constituency, I still see health getting a tiny proportion
compared with education and the environment. May I have an
assurance from the Secretary of State that as we increase the
number of GPs in the primary care team, they will not have to
scrabble around trying to get little bits of money for planning
applications here and there, but that there will be a guaranteed
capital budget for new doctors, in the way that we are sorting
that out for hospitals?
My hon. Friend raises a perfectly valid point. As we expand the
primary care workforce, there is a capital consequence. The 50%
expansion he talks about builds on the expansion from 2,100 in
training in 2014 to 4,000 now, so there has already been an
expansion, but we are taking that further by 50%—and on the
higher figure. His point about section 106 applications is
absolutely valid, and that is part of the primary care recovery
plan. I understand that he is discussing the importance of
getting that funding in place with the Under-Secretary of State
for Health and Social Care, my hon. Friend the Member for
Harborough.
(Easington) (Lab)
Given the number of pressures and crises that our NHS faces, it
would be a mistake for the Secretary of State to be seen as
complacent in how he delivered his workforce plan. Our job as MPs
is to speak the truth to power, so I want to raise with him the
lack of cancer treatment capacity, particularly in radiotherapy.
International comparators suggest that between 55% and 60% of
cancer patients should be able to access radiotherapy either
directly or in tandem with other treatments. Currently, only 27%
do. What is the Secretary of State doing to increase the size of
the highly specialised and relatively small radiotherapy
workforce? The target is for 85% of patients to start their first
treatment within 62 days of an urgent GP referral. What is the
current figure?
To take the hon. Gentleman’s first point, the plan does not get
into individual specialties. That was a Health Committee
recommendation, which I have discussed with the Committee’s
Chair, my hon. Friend the Member for Winchester (). There is a clear reason for
that. Within the framework of numbers, the impact of AI and
service design will evolve over the 15 years, so it is right that
we commit to the number and then the NHS take that work forward
with individual specialities and have discussions with the royal
colleges.
The hon. Gentleman made a perfectly valid point about boosting
capacity. We have already rolled out 108 of the 160 community
diagnostic centres that we have committed to deliver. We are also
looking to innovate, and I will give two practical examples. Our
deal with Moderna, which is looking at individual bespoke
vaccines for hard to treat cancers such as pancreatic cancer,
will allow us to get ahead on that. We are already seeing a
significant reduction in cervical cancer as a result of
prevention measures. Likewise, by going into deprived communities
with a high preponderance of smoking, the lung cancer screening
programme is detecting lung cancer, which often presents late,
much earlier, which in turn is having a significant impact on
survival rates.
(Wirral West) (Lab)
I recently met a constituent who raised the issue of children’s
oral health and shared with me her concerns about the staffing
crisis in specialist paediatric dentistry. According to the
Government’s own statistics, which were released in March, 29.3%
of five-year-olds in England have enamel and/or dentinal decay,
and the figure was as high as 38.7% in the north-west. The
workforce plan talks of expanding dentistry training places by
24% by 2028-29, and by 40% by 2031-32. I note the Secretary of
State’s response to my hon. Friend the Member for Easington
(). However, there is no
specific mention of specialist paediatric dentistry in the plan,
so what will the Secretary of State do to help those children who
are desperate for specialist dental treatment right now?
Without repeating my previous answer on specialty, we are
boosting a number of areas. There are 5,000 more doctors and
almost 13,000 more nurses this year than last year. I have
already touched on increasing the numbers in primary care. There
are 44,000 more nurses, so we are on track to deliver our
manifesto target of 50,000. There are 25% more within the
workforce of the NHS compared with 2010. We are boosting the
workforce overall. The plan is iterative and further work will go
into which specialities are developed and how resource is
prioritised as services are redesigned.
(North Shropshire) (LD)
The Secretary of State will be aware that the recruitment and
retention issues facing the NHS are particularly bad in rural
areas. We felt the brunt of that in North Shropshire, with some
of the worst ambulance waiting times, cancer treatment rates and
diabetic care rates in the country. The plan does not go into
much detail on what will be done to help rural areas, but it does
acknowledge that by 2037, a third of all over-85s will live in
rural places. I urge the Secretary of State to rural-proof this
plan and to find ways to work on both the retention and the
recruitment of healthcare professionals across the whole spectrum
in North Shropshire and the rest of rural Britain.
The hon. Lady raises a fair point. It also applies to the issue
of stroke. The elderly population has increased in many coastal
and rural communities. That has created significant pressure: for
legacy reasons, services are often in other parts of the country.
We have five new medical schools in place, and we have looked at
those parts of the country where it is often hard to recruit.
Part of the expansion will be to look further at what services
are needed in different areas. The hon. Lady’s point also speaks
to that raised by the Chair of the Health and Social Care
Committee. By giving greater autonomy to place-based
commissioning through the integrated care systems, we will enable
people at a more local level to design the services and the
workforce that they need, and that includes the flexibilities
required to retain local staff.
(Oldham East and
Saddleworth) (Lab)
I welcome the workforce plan. Given that it has taken 13 years,
one tends to wonder why it has taken so long, but then of course
we remember that there is a general election on the horizon.
Page 121 sets out a labour productivity rate of 1.5% to 2% per
year. That has never been achieved by the NHS or any other
comparable health system, so what assumptions is the Health and
Social Care Secretary making in relation to achieving that?
First, this is a plan developed by colleagues in NHS England, so
these are assumptions that have been agreed by those who lead
within the NHS. It is about ensuring that people operate at the
top of their licence. It is about having new and expanded roles,
such as advanced practitioners and associate roles, that allow
people to progress in their careers and, in doing so, freeing up
capacity for senior clinicians, who often spend time doing things
that do not need to be done by people in those roles.
Of course, there are also rapid changes in technology. We often
talk about the developments in artificial intelligence, and I
have touched on developments in the life sciences industry. I
have also mentioned advances in screening and genomics. All those
developments will in turn help us to prevent health conditions,
and treating those conditions early will be not only better for
the patient, but better value for money for the taxpayer.
