The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)
My Lords, I thank the noble Lord, Lord Clark, for calling this debate and all noble Lords for their contributions. It is the first time I have had the opportunity to debate with the noble Baroness, Lady Emerton, which I hope will not be the last and that she does indeed continue contributing.
We all agree that the NHS is one of our great institutions. It spans political divides and brings people together, although apparently it does not bring together enough Ministers to satisfy the noble Baroness, Lady Walmsley. We are all rightly proud of our NHS and the staff who work incredibly hard for the good of patients. The quality and dedication of our NHS staff is why we have the best health service in the world. It is, as the noble Lord, Lord Clark, said, second to none. It is also a great privilege to have so many former NHS staff in this House speaking today, including the noble Lord, Lord MacKenzie, and the noble Baronesses, Lady Donaghy and Lady Emerton.
We as a Government do not pretend that everything is perfect, but we should be proud of the NHS’s many achievements: universal access; the progress we are making on improving cancer survival rates; transforming care for dementia and mental health; our strong primary care; research and development; and the quality of medical education and training, among many others. It is because of those achievements that the independent Commonwealth Fund recently rated the NHS as the best health system in the world for the second year in a row. Contrary to the accusation from the noble Lord, Lord Clark, I believe that this shows the very opposite: success. Of course, the NHS faces challenges, but it is doing well.
The first part of the title for today’s debate refers to the Government’s fiscal policy, so I want to begin by laying out the reasons for that policy and the actions taken within it. I will resist the urge to lecture, I hope, but I will point out the facts. In 2010, the coalition Government inherited one of the most challenging fiscal positions in the world. The Conservative and Liberal Democrat parties came together with a plan to reduce the deficit because we understood that a failure to do so would burden the next generation with debts which they had no hand in creating. It was fairness, particularly intergenerational fairness, which drove that policy.
We also understood that you cannot have strong public services without a strong tax base; and a strong tax base requires a strong economy, in which investors have confidence that the Government will be fiscally responsible and where it becomes easier to create and sustain jobs. That is what we, as a coalition and then as a Conservative Government, set out to do. Inevitably, this approach necessitated many difficult decisions, but we have now reduced the deficit by three-quarters, from 9.9% of GDP in 2010 to 2.3% in 2016-17. We forecast it to fall gradually to 1.1% in 2022-23, the lowest for 20 years. Employment is at a record high and the economy continues to grow.
As the noble Baroness, Lady Walmsley, pointed out, the greatest health policy is to reduce poverty, and having more people in work is a core part of that. It is because of those firm fiscal and economic foundations that we were able to protect and grow NHS budgets at the spending reviews in both 2010 and 2015. Furthermore, because we recognise that the NHS is under pressure right now, in the Budget last week we heeded calls for more funding, with £2.8 billion extra over the next three years to help the NHS meet its performance targets, and over the next five years a £3.5 billion programme of additional capital investment.
Several noble Lords, including the noble Baronesses, Lady Jolly and Lady Pitkeathley, and the noble Lord, Lord Warner, asked about the lack of mention of social care in the Budget. It is worth pointing out that we had two Budgets this year. In the previous Budget, in March, there was an announcement of £2 billion extra for social care. Indeed, we confirmed recently that there will be a Green Paper in the summer to take social care reform forward. It will deal with the issue of carers, as referred to by the noble Baroness, Lady Pitkeathley. I should point out that it has the continuity to build on suggestions made by Andrew Dilnot’s expert advisory group in the past.
As the noble Baroness, Lady Jolly, said, we need to look at the money. That means that funding in real terms on the health service will be £12.5 billion higher this year, £14.2 billion next year and £15.8 billion higher by 2020-21 compared with 2010-11.
Both the noble Lords, Lord Hunt and Lord Clark, cited Malcom Grant, Sir Bruce Keogh and others. I cite Jim Mackey, the head of NHS Improvement, who said, in the light of the Budget,
“news that the pay award will be funded in full is very welcome, as is additional revenue, starting this winter and over the next couple of years”.
As a consequence of the funding that we have put into the NHS, despite the necessary fiscal readjustment we had to undertake to reduce the historic deficit left in 2010, the proportion of public spending consumed by the NHS has grown. That is not an overblown statement; it is a fact, and it is a mark of this Government’s and this party’s commitment to our cherished NHS.
I understand that there are huge concerns about the long-term sustainability of the health and social care services in the future. I understand the appeal of a royal commission, convention or some such although, like the noble Baroness, Lady Pitkeathley, I am sceptical about the need for it at this time. Several noble Lords have served Governments who have had commissions of this kind—and we know what those reports are doing, as she pointed out. Therefore, I think it is important for us just to move ahead. I recognise that my department’s response to the Lords Long-term Sustainability of the NHS Committee has been too slow. I have had a useful note from my officials during this debate which will enable me to commit to publish it very shortly.
As regards the workforce of the NHS, we all know, and have recognised today, that our growing and ageing population continues to create increased demand and activity, and this means that there has been a need to recruit more staff. We have been working hard to do this. That is why, as several noble Lords have pointed out, there are some 10,000 more nurses on wards and more midwives and health visitors. Over 50,000 nurses are in training and there is an increase in medical training places. Those are the facts. A particular example of our approach is the determination to transform the NHS workforce through apprenticeships. It was good to hear the noble Lord, Lord MacKenzie, welcome the fact that we recently announced an expansion in the numbers of nursing associates. Plans will see 5,000 nursing associates trained through the apprentice route in 2018 and 7,500 in 2019. I will certainly look at the issue of naming. It is quite wrong that they should be wrongly named because the name that they have been given is specific to the functions that they perform. I shall write to him on that issue. We expect that once this new route into nursing is established, up to 1,000 apprentice nurses could join the NHS every year, benefiting staff and patients.
We had the opportunity yesterday to discuss the issue of nurse bursaries and they evoke passionate responses across the House, not least from the noble Lord, Lord Clark, whose paramount concern I know is making sure that the NHS has the staff it needs to deliver the quality of care we all demand of it. I have outlined why we made changes in the system and do not suggest that anyone particularly wants to hear me reprise that, but it was done to put nursing on a more equitable basis with other university degrees. We moved away from centrally imposed number controls and financial limitations. Furthermore, through additional clinical placement funding announced this summer and further funding in October this year, around 5,000 more nursing students will be able to enter training through funded clinical placements each year to 2020-21. I certainly take on board the point that the noble Baroness, Lady Emerton, made about looking at their training and making sure that it is as multidisciplinary as possible. As a result, in the future NHS employers, as well as those in the independent, care and voluntary sectors, will have a larger pool of highly qualified homegrown staff available.
Noble Lords asked whether the NHS has enough staff. The most recent workforce figures show something like 30,000 more clinically qualified staff working in the NHS over the last seven years. We can argue about whether that is enough but it is more than a 60% increase at a time when, as we all know, there have been difficult fiscal decisions to make. We know that increased supply is only one part of the equation, which is why NHS Improvement has launched a new programme to improve staff retention and reduce leaver rates. This includes, among other things, targeted support for all mental health providers to improve the retention rates of all staff groups within these trusts, and an intensive package of clinically led support targeted at providers with above average leaver rates for nurses. However, as the noble Baroness, Lady Jolly, said, probably the greatest way to retain staff is to ensure that they are properly paid. That is why we have introduced the new national living wage to make sure that lower-paid staff groups in the NHS and social care, whose work the noble Baroness, Lady Donaghy, rightly lauded, see increases in their pay packets, and why I warmly welcome—as did my noble friend Lady Redfern—the commitment in the Budget to end the pay gap and to fund the Agenda for Change pay negotiation package that is agreed, subject to reasonable conditions about improved productivity, which, for example, might be to do with the better use of technology and demonstrable beneficial impacts on recruitment and retention. My noble friend Lady Redfern also pointed to the recent announcement we made on using NHS disposable surplus land to provide homes for staff. Again, that is a very welcome gesture.
We also need to attract back staff who have left the profession. The noble Baroness, Lady Jolly, asked particularly about this issue. I reassure her that, since September 2014, Health Education England has supported over 3,500 nurses to successfully complete the nursing return-to-practice programme and they are now ready for employment. It has also worked with the Government Equalities Office in creating a national allied health professional return-to-practice campaign to make 300 professionals available for the workforce in a couple of years’ time.
I come to the Brexit section—we have to do it. Several noble Lords asked about the impact of Brexit. I think it would be churlish of me to point out that 80% of the vote in the most recent general election was for parties whose manifestos committed us to leaving the European Union. But, more importantly, if noble Lords look at the data on EU staff in post in the National Health Service and compare it from the month of the referendum to a year later, they will see that there was actually a small increase in the number of EU staff working in the NHS. I take this opportunity to send a message to those staff that we value them, want them to stay and want to deal with the issue of citizens’ rights with the EU as soon as possible in the next phase of negotiation.
If we want to deliver world-class staff, we need enough of them. We need them to stay in the service and have working conditions that will allow them to thrive, professionally and personally. This is why our manifesto committed us to encourage flexible working, improve health and well-being and take action against those who attack or abuse NHS staff. The NHS has to keep pace with increasing demand but it cannot do this if it is out of step with the demands of modern family life. We know that caring responsibilities are most likely to fall to women, who make up around two-thirds of the NHS workforce. As the noble Baroness, Lady Donaghy, pointed out, inflexibility leads staff to work for agencies, diverting resources away from the NHS which could be invested in the permanent workforce. I reassure the noble Lord, Lord Clark, that we are reducing spend on agencies. He was right to point to the jargon in my Written Answer to him. I was obviously having an off day and did not spot it—either that or I have gone native, but I am usually quite good at striking it out. I think the point that it was trying to make was that you can recruit agency staff, but the agencies must first be approved. However, we could certainly have expressed that better. Our aim is to discourage the use of agencies by improving the staff banks that trusts use, making it easier for staff to work flexibly, pick up extra shifts at short notice and be paid quickly. Next year, we will pilot a new network of modern staff banks across the NHS. I give noble Lords an example of how that is working. Milton Keynes had very low take-up of bank shifts, leading to a disproportionate reliance on agencies. It developed a new system, including an app, and, as a result, shifts filled within 30 minutes of being advertised on the app and agency shifts reduced from historic high levels of 600 per week down to 300. That is impressive but I think we can do more.
It is also crucial that employers pay close attention to and invest in the health and well-being of their staff. Reducing sickness absence improves productivity, the quality and continuity of patient care and saves money. That is why NHS England’s commissioning for quality and innovation initiative will allow for quicker access to a range of health services such as musculoskeletal and mental health services for NHS staff.
Bullying can be one the greatest causes of ill health and staff unhappiness and, unfortunately, we know that bullying rates in the NHS are too high. It is completely unacceptable, which is why in July 2016 senior NHS leaders and the Social Partnership Forum developed a collective call for action. We are committed to working with the health system and, critically, trade union leaders through the Social Partnership Forum to tackle violence and abuse against staff. That is a key priority.
The Government have also been supporting Chris Bryant MP’s Bill in its passage through Parliament. The Bill, drafted with the assistance of the Home Office and the Ministry of Justice, will provide police and courts with effective powers to deal with those who use violence against emergency workers. Everybody in the House will agree that it is completely unacceptable that staff should be at risk of harm, simply for doing their job. Employers have a duty of care to all their staff and must take all the necessary steps, including disciplinary action where required, to put a stop to it.
The noble Lord, Lord Hunt, made a point about subsidiary companies. I am not aware of that issue but I will certainly investigate it and write to him; I will place a copy of the letter in the Library.
In conclusion, despite the difficult but necessary decisions that this Government and the coalition Government before them had to take, NHS funding is at record levels, with more doctors, more nurses on wards and more operations being performed than ever before. Survival rates are at a record high. Last year, the NHS treated more people than ever, which was possible only through the commitment and dedication of NHS staff.
However, we understand that we cannot rest on our laurels, and that the NHS must continue to attract and keep the staff it needs to be the best it can be. Staff choose a career in the NHS not just because of pay, but because they want to help to improve the lives of the patients who rely on them, whether in hospital or in the community. We want to create an NHS in which staff want to work and feel valued for that work, where they are motivated and feel safe, and where bullying and harassment are not tolerated. With record funding and innovative policy solutions, this Government are committed to delivering that as the NHS reaches its 70th year.