NHS Workforce

Tuesday 6th December 2022 Commons Chamber

[Mr Speaker]

I inform the House that I have not selected the amendment. I call the shadow Secretary of State for Health and Social Care.

12:55

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House recognises that the National Health Service is facing the worst workforce crisis in its history with a shortage of 9,000 hospital doctors and 50,000 nurses; condemns the Government’s failure to train enough NHS staff to tackle this crisis; regrets that, as a result, patients are finding it impossible to get a GP appointment, ambulance or operation when they need one; calls on the Government to end the 200-year-old non-domiciled tax status regime which currently costs taxpayers £3.2 billion a year; and further calls on the Government to use part of the funds raised to invest in the NHS workforce by doubling the number of medical training places, delivering 10,000 more nursing and midwifery clinical placements, training twice the number of district nurses per year and delivering 5,000 more health visitors to guarantee that the NHS has the staff to ensure every patient can access the care they need.

The NHS is facing the worst crisis in its history. Seven million people are waiting for NHS treatment, and they are waiting longer than ever before; 400,000 patients have been waiting for more than a year. Heart attack and stroke patients are waiting an hour for an ambulance, on average, when every minute matters. “24 Hours in A&E” is not just a TV programme; it is the grim reality facing patients in an emergency. Behind those statistics are people being held back from living their lives: people forced to give up work because they cannot stand the pain; young people, still bearing the scars of lockdown, unable to get the mental health support they need to step into adulthood; families losing loved ones for no other reason than that the NHS was unable to treat them in time.

My friend and colleague the shadow Leader of the House shared with me an email from one of her constituents. A patient with suspected cancer was urgently referred by his GP, which ought to mean being seen by a specialist within a fortnight. Four weeks later he had heard nothing. He phoned the hospital and was told, “two weeks currently means six weeks” and that he would be contacted, not seen, within the next two weeks. He has now had his appointment, during which the doctor identified cancerous cells. He has been told that he will wait up to eight months to have that cancer removed. He said that until waiting lists are down,

“more people will die unnecessarily from cancer. I hope not to be one of them.”

That is not uncommon. That is where we are. That is why Labour is today putting forward our plan to solve this crisis, make the NHS fit for the future, and get patients treated on time again.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Yesterday I spoke to a paramedic who had been with a patient with sepsis, waiting for two and a half hours to be taken in. There were 98 calls at that same Yorkshire hospital waiting to go in. Are we now post-crisis and in complete breakdown, and do we need Labour’s plans to come in now, and not have to wait?

[Wes Streeting]

I strongly agree with my hon. Friend. As the Leader of the Opposition has said, the NHS is not on its knees; it is on the floor. How many times were we told during the pandemic that restrictions were needed to stop the NHS falling over? It has now fallen over, and for the first time in its history people no longer feel certain that, when they phone 999 or arrive at A&E, they will be seen in time. It is the first time in our country’s history that people have not felt confident that emergency medicine will be there for them when they need it.

The Conservatives blame the crisis in the NHS on everything from the weather to the pandemic, and even NHS staff. Of course there is no doubt that the pandemic has made things worse, but the Government—the Conservative party—sent the NHS into the pandemic with 100,000 staff shortages. They spent a decade disarming the NHS, before sending it into the biggest fight it has ever faced. They cannot pretend that the NHS was well prepared. The problem for the Conservative party is that people are not stupid. Their memories are not that short. They know that the NHS was struggling to treat them on time before the pandemic, and they know who is to blame.

[Dr Luke Evans (Bosworth) (Con)]

Is not the point that health is devolved across four different nations, which are each led by a different party? Does this mean that the pandemic has hit all health services, including across the western world? This is a rising tide of the problem of the pandemic and dealing with an ageing population. This is not party political at all, and it is remiss of the hon. Gentleman to try to make it that. What does he say to that?

[Wes Streeting]

I would say two things. As I have already said, I accept that the pandemic made the challenge right across the United Kingdom worse. I also accept that, in every part of the United Kingdom, the NHS is under severe pressure. I would say two things in response. First, even if some of our friends on the SNP Benches do not want to acknowledge it, there is no doubt that every part of the United Kingdom would be better off with a Labour Government and every part of the NHS in every part of the United Kingdom would be better off if there were a Labour Government, because the investment that we are proposing in NHS staff today would benefit countries right across the United Kingdom. [Interruption.] In response to the outgoing hon. Member for Peterborough (Paul Bristow), do not say that politics does not make a difference. Do not expect the people to believe that somehow there was an inevitable sense of decline in the NHS. I am sure people remember that, when Labour was last in government, we delivered the shortest waiting times and the highest patient satisfaction in history.

[Paul Bristow (Peterborough) (Con)]

rose—

[Wes Streeting]

Is the hon. Member planning to cross the Floor? I look forward to hearing from him.

[Paul Bristow]

Certainly not. The hon. Member’s plan seems to be simply vote Labour—there is no detail to it and nothing else to it. I suggest that he looks at the good people of Wales, who suffer under a socialist healthcare system. They are certainly not very happy, are they?

[Wes Streeting]

I do not pretend that our plan is not vote Labour, but of course those are the means by which we get to better ends. What we propose today is the biggest expansion of the NHS workforce in history. I will explain how that will benefit patients across the country and how we will pay for it. I think that people in Peterborough, 2,788 of whom are waiting more than a month to see a GP, will welcome Labour’s plan for investment. That is why, after the next general election, Peterborough will have a Labour MP.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

I want to raise the case of my constituent, Mr Simpson, whose wife died last Tuesday after waiting 16 hours for an ambulance. On 29 November, his wife was confused. At 3 pm, he first called for an ambulance and was told that one might be sent and that he might hear from the service. At 6 pm, he rang the ambulance again. The person wanted to speak to his wife, but she was very confused and unable. He tried to give her a drink at 2.30 am; there was still no ambulance. His wife went to sleep, but she was still moving a bit. He fell asleep. He woke at 7.30 am and found that his wife was not moving; she had passed away. All the while they were still waiting for the ambulance to arrive. I do not believe for one moment that that happened because the ambulance service does not care. Does my hon. Friend agree that the service is desperately understaffed, desperately short of resources and in desperate need of adequate funding?

[Wes Streeting]

I thank my hon. Friend for raising that heartbreaking case. It is every family’s worst nightmare. All of us now know someone who is waiting for treatment. Many of us know someone who has called for an ambulance and waited for hours and hours—and, in some cases, given up on it and gone to hospital. I have spoken to ambulance service staff who, like many other staff across the NHS, feel a real sense of deep personal moral injury because they know that, despite their best efforts and busting a gut at work every single day, their best simply is not good enough because the system has collapsed. Ambulance turnaround times are not fast enough because A&E waiting times are too high. That is because people cannot see a doctor and the social care is not available, so the beds are full of people who are well enough to go home and would be better off at home. This is the problem in the NHS: the whole system is broken. I am afraid to say that political decisions made in this place by the Conservative party have led us to this tragic situation.

[Andy McDonald (Middlesbrough) (Lab)]

My hon. Friend is making an excellent case. At the James Cook University Hospital in Middlesbrough, the number of people still in hospital who could be discharged into social care amounts to three full wards. That is the situation that we have got to. It is a perfect storm, with ambulances queueing outside and people turning up at A&E because they cannot get to a GP. That will only ever be addressed if we also address staffing in our GP services to ensure that they can attract people who are offered Agenda for Change terms and conditions to alleviate the backlog. Does he agree that we need to invest in all the elements along that supply chain?

[Wes Streeting]

My hon. Friend is absolutely right. This is the tragedy of where we have got to on social care in particular. The Government have allocated half a billion pounds to alleviate pressure this winter, but not a penny of it has reached social care providers. Not a penny of it is currently being worked in action to try to deal with delayed discharges. I have no doubt whatsoever that one reason why it has taken so long from that commitment to getting money to the frontline is the constant churn of Ministers that we saw over the summer. The absolute circus that we saw in the Conservative party has had a direct impact on the competence of effective Government in this country. We now have ineffective Government, so even when the Government seek to do the right thing and allocate the resources, they cannot get the money out the door far enough because Ministers seem to change week in and week out.

[Jim Shannon (Strangford) (DUP)]

I commend the shadow Secretary of State for what he is saying. When it comes to staffing issues, one thing should clearly be done. Does he agree that part of the reason why we rely so heavily on agency staff is because our NHS staff have migrated to agency working, where there is less pressure, so the Government should spend less money on agency workers and give our NHS staff greater support and appropriate pay so that they can stay in the NHS?

[Wes Streeting]

I strongly agree with the hon. Gentleman. I will come shortly to talk about industrial action, but this should be at the heart of the Secretary of State’s thinking. The demands from staff trade unions, whether on pay, terms and conditions or the wider pay machinery, should be seen not just as a negotiation with staff unions but as a retention issue. We are losing staff faster than we can recruit them in some places—especially in areas such as midwifery—and if we lose the staff that we have, even Labour’s plans to undertake the biggest recruitment in the NHS’s history would not be as effective as they would be if we kept staff in the service today. That is why I urge the Secretary of State to treat those NHS staff with respect, get their representatives around the table, and negotiate a solution.

I am aware that the situation in the NHS in Northern Ireland is the worst that we see throughout the United Kingdom. The shadow Secretary of State for Northern Ireland, my hon. Friend the Member for Hove (Peter Kyle), visited NHS services in Northern Ireland only recently. I have no doubt that we need to get effective governance back up and running again in Northern Ireland as well. I urge the Government to discharge their responsibilities in that area, too. Certainly, when Labour was last in government, I do not remember Labour Prime Ministers taking such a complacent, lackadaisical or indeed absent approach to the governance of Northern Ireland. I hope that we can see a breakthrough of the deadlock so that the people of Northern Ireland get the Government they deserve in Stormont, as well as the United Kingdom getting the Government it deserves here in Westminster.

Waiting lists were already at a record 4.5 million before the pandemic. Ambulances were taking longer than is safe to reach patients in an emergency before the pandemic. Patients were waiting longer than four hours in A&E before the pandemic. The 18-week guarantee for elective treatment had not been met for four years before the pandemic, and more patients have waited longer than two months to start their cancer treatment every year since 2010. From the moment the Conservatives entered power, things began to deteriorate. It is not just that the Conservatives did not fix the roof while the sun was shining; they blew off the roof and ripped up the floorboards, and then they wonder why the storm did so much damage.

[Charlotte Nichols (Warrington North) (Lab)]

My hon. Friend mentioned cancer diagnosis rates. I believe he will be aware that one in four people diagnosed with pancreatic cancer dies within a month of their diagnosis, with 70% receiving no treatment at all because they die before they could be treated. Does he agree that cancer diagnosis rates are a disgrace and that early intervention, early diagnosis and early treatment are vital for people with all forms of cancer, particularly the most aggressive types such as pancreatic cancer, to have any chance of survival?

[Wes Streeting]

My hon. Friend is absolutely right. One reason why this country has much poorer cancer outcomes than many comparable economies is precisely because of late diagnosis. I know from my own experience how vital early diagnosis can be for good cancer outcomes. I am terrified by the fact that, within those 7 million patients waiting in the elective backlog, there will undoubtedly be cases of undiagnosed cancer and other conditions. If the NHS had eyes on the patients, they would be detected faster, patients would receive treatment much more quickly and the outcomes would be better. One of the tragedies for the NHS is that, because we do late diagnosis, we get more expensive and less effective treatment. If we could diagnose faster, patients would get better outcomes and taxpayers better value for money. That is the kind of reform to the model of care that Labour would like to see.

[Wera Hobhouse (Bath) (LD)]

On diagnosis, access to GPs is also a vital part of the puzzle. Is it not terrible that the Government are not listening to GPs, who say they need a different visa system? They cannot recruit enough GPs into the system because the Government are so stuck with these immigration rules, and the Home Office does not want to change certain parts of the visa system?

[Wes Streeting]

I am grateful for that intervention. We are in the worst of all worlds on immigration and the NHS. The Government try to have it both ways. They talk tough on rhetoric, so we end up with a very bureaucratic, ineffective and costly system, but because they fail to invest in our own homegrown talent, they are over-reliant on immigration from other countries, including those who desperately need their own doctors and nurses. I do not think it is good enough, after 12 years of Conservative Government, that we are turning away bright potential doctors, nurses and allied health professionals because the Government cannot be bothered to pull their finger out and train our own homegrown talent. We need to see improvement, so we that can draw the best international talent and make the system smooth, efficient and effective, but it is also crucial that we train our own homegrown talent.

Turning to more of the Conservatives’ excuses—we have heard the excuses of the pandemic—let us now look at the excuse they are planning to deploy this winter. There is no denying that this winter could be the most challenging the NHS has ever faced. The Royal College of Nursing, for the first time in its more than 100-year history, is planning to undertake strike action. Just this lunchtime we got strike dates from Unison, the GMB union and Unite the Union. That raises the question: why are the Government not even trying to stop the strikes in the NHS from going ahead? Surely, when the NHS already lacks the staff it needs to treat patients on time, the Government ought to be pulling out all the stops, getting around the table and negotiating to stop industrial action? So why aren’t they?

The Secretary of State said in Health questions earlier that his door is open—as if we can just sort of wander in off the street into the Department of Health and Social Care, where there will be a cup of tea and a biscuit waiting, and he will be just waiting for the negotiations. That is not how this works. Everyone knows that is not how it works. He had a nice little meeting with unions after the summer, after Labour complained that we had not seen a meeting between a Secretary of State and the unions since the right hon. Member for Bromsgrove (Sajid Javid). Goodness me, we have had three Secretaries of State since then—and two of them are the Secretary of State on the Front Bench today. Why on earth are they not sitting around the table and conducting serious negotiations? I will tell you why, Mr Deputy Speaker: they know that patients are going to suffer this winter and they do not have a plan to fix it, so instead of acting to improve care for patients and accept responsibility, they want to use nurses as a scapegoat in the hope that they avoid the blame. We can see it coming a mile off. It is a disgusting plan, it is dangerous and it will not work.

If I am wrong, perhaps Conservative Members could explain why the Government are not trying to prevent the strikes from going ahead. Perhaps they could explain why the Secretary of State ignored all requests from the health unions for meetings and conversations this summer while the ballot was under way. Perhaps they could explain what the Government’s plan for the NHS is this winter. Perhaps they could explain why a Government source told The Times newspaper that

“Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts”.

They said the quiet bit out loud and they gave the game away.

What else would explain the unedifying and embarrassing spectacle of the chair of the Conservative party going on national television to accuse nurses of doing the bidding of Vladimir Putin? I should not have to make this point, but nurses are not traitors to this country. They bust a gut day in, day out to look after all of us. We clapped them during the pandemic and now the nurses are clapped out. They are overworked, overstretched and undervalued by this Government. Let me say to the chairman of the Conservative party that he would speak with greater authority on what is in Britain’s national interests if he did his patriotic duty in his own tax affairs.

When it comes to sending a message to Vladimir Putin, why does the burden consistently fall on the working people in Britain? Why is it that NHS staff must make huge sacrifices because of the invasion of Ukraine, yet people who live in Britain but do not pay their fair share of taxes here do not have to lift a finger? When it comes to paying the bills, the first and last resort of this Conservative Government is always to pick the pockets of working people, yet the enormous wealth of tens of thousands of non-doms is left untouched. They may blame covid, they may blame health professionals, they may even blame the weather, but it is 12 years of Conservative mismanagement and under-investment that has left the NHS without the doctors, nurses and staff it needs, and patients are paying the price.

I am sure every Member of this House, indeed everyone in the country, knows someone who has been let down when they needed healthcare in recent months. They all say the same thing: the NHS staff were brilliant, but there simply are not enough of them. There is no NHS without the people to run it, yet today there are more vacancies in the NHS than ever before: 9,000 empty doctor posts, 47,000 empty nursing posts, and midwives leaving faster than they can be recruited. There are 4,600 fewer GPs than there were a decade ago, and the right hon. Member for Bromsgrove admitted last year that the Government are set to break their manifesto promise to recruit them back.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I was looking at a message from a constituent this morning who told that he went to A&E having waited four weeks for a GP appointment. Does that not speak to a lack of investment in the NHS workforce over 12 years and a lack of adequate planning? I know how hard GPs work in my constituency, but the lack of GP availability to staff surgeries and provide those appointments is placing unneeded pressure on A&E. That is on this Government’s watch.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. As we see so often with this Government, they make promises but break them. They try to fool the public into thinking they are delivering more GPs—or indeed more police officers—when it was the Conservative party that cut them. They try to give with one hand, but they take with the other, and after 12 years people have had enough.

Of course, it is not only the promise to recruit more GPs that the Conservatives are breaking. We had the promise of 40 new hospitals, which the Secretary of State repeated today, yet in response to the question posed by the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), the Secretary of State said that of those 40 new hospital schemes

“five hospital schemes are in construction, two are now completed and we aim to announce the next eight by the end of this year.”

So, where are the other 25? Where are these 40 new hospitals? As far as I can tell, they exist only in the imagination of the former Prime Minister. Yet the script has not changed—Ministers are still here claiming 40 new hospitals.

When I visited Leeds with the shadow Chancellor, my right hon. Friend the Member for Leeds West (Rachel Reeves), I saw a vast pile of dirt where a new building was due to go up. We heard today that the Government cannot even negotiate an agreement with the hospital to get the site working and get the new facilities built. With every minute, every month and every year of delay construction costs are going up, so taxpayers are left in the worst of all worlds: broken promises, no 40 new hospitals, and paying through the nose for the ones that are being built because of Government incompetence.

We see the tragic consequences of the shortages and broken promises in the NHS. My hon. Friend the Member for Rotherham (Sarah Champion) raised the tragic case today at Health questions of a five-year-old boy who had what his doctor described as the worst case of tonsilitis he had ever seen. He was turned away from hospital, with his parents told there were no beds and not enough doctors. His infection worsened and five-year-old Yusuf later passed away. His death certificate recorded the primary cause of his death as pneumonia and the secondary cause as tonsilitis. What kind of country are we living in when a five-year-old boy can die of tonsilitis? This is criminal.

I met Yusuf’s uncle, Zaheer Ahmed, last week, and I did not know what to say to that poor man and his grieving family, who lost that little boy in the most unimaginable circumstances. I invite the Secretary of State to meet Yusuf’s family to hear how that little boy was failed and to hear at first hand about some of their interactions with the NHS, which I thought were completely unacceptable and intolerable. On that note, I welcome the independent inquiry that has been committed to. That is really important for the family who have been failed in this heartbreaking case. We do not want to see more cases like that.

At the heart of the crisis in the NHS—as with so many of the problems facing our country—is a failure to plan. The NHS has not had a workforce plan since 2003. That would be unacceptable in a multinational company one one-hundredth the size of the NHS. The failure to plan means that short-term fixes are always favoured over what is in patients’ long-term interests. That is why the Government cut the nursing bursary and why, this summer, in the middle of the biggest crisis in the history of the NHS, they took the infuriating decision to cut a third of medical school places.

[Dr Luke Evans]

Will the hon. Gentleman give way?

[Wes Streeting]

The hon. Gentleman has been to medical school; does he think that it was a good idea to cut the number of places this summer?

[Dr Evans]

When we talk about Labour’s record on training, the hon. Gentleman may forget that, in 2007, the medical training application service ended up in judicial review. Many of my colleagues moved out of disciplines that they loved dearly because of Labour’s mess in making those plans. He has been speaking for almost half an hour, setting out his exposé of what is going on in the health service, but I am yet to hear a plan. I hope that he will spend the next half an hour telling us about the detailed plan of how we get to 10,000 new medical places, because when it comes to firms in hospitals, there is not enough space for medical students to get that experience, so I am looking for him to solve that problem.

[Wes Streeting]

The hon. Gentleman is not looking forward to me solving the problem half as much as I am looking forward to solving the problem. As far as I am concerned, the general election cannot come soon enough. I say to Government Members, “Be careful what you wish for”, because I intend, indeed, to set out Labour’s plans in detail. I am happy to stretch that to half an hour if that is where the demand takes us.

[Daisy Cooper (St Albans) (LD)]

rose—

[Wes Streeting]

I give way to my Liberal Democrat friend.

[Daisy Cooper]

I am grateful for a number of the interventions, not least the most recent one. Is it not true that, as hospital trusts meet with regard to the new hospital programme today, they will discuss how big the new hospitals should be? Given that we need more space to train the doctors and nurses of the future, does the hon. Member agree that it would be criminal if they tried to cut corners by planning hospitals that are smaller than they need to be?

[Wes Streeting]

I wholeheartedly agree. I seemed to hear from the Health Secretary this afternoon a one-size-fits-all approach from the Government, as though every hospital’s needs will be the same and we can import a standardised model for every hospital site. I would be happy to be proven wrong, and I would be even happier if the Secretary of State got the ball rolling on some plans that are already agreed, and on which trusts have spent a significant amount of time and taxpayers’ money. I would be even more delighted if we got some of those hospitals open, but I would wager that when we get to the end of the Government’s life, we will not have seen anything like 40 new hospitals delivered or even in the pipeline.

[Peter Dowd (Bootle) (Lab)]

My hon. Friend is making a compelling case. I think I know where we could get some of the money from for training places, and perhaps he will agree. We forgo about £3.2 billion in revenue from non-doms every year. There are 68,000 non-doms, there or thereabouts, which works out at about £44,000 a non-dom. Does he think that he could do much with that?

[Wes Streeting]

My hon. Friend has led me neatly towards setting out Labour’s plans, which rely on people who come to this country and make Britain their home actually paying their taxes here. That is the right and fair thing to do, and I think people across the country would agree that we need nurses more than we need non-doms.

[Charlotte Nichols]

I have listened with interest to what has been said about the new hospital building programme, not least because we have been waiting for a new hospital in Warrington for a very long time. We recently opened the new Health and Social Care Academy at Warrington & Vale Royal College with some of our town deal fund money, but surely people need excellent, cutting-edge training facilities to go into in a hospital once they leave the college. The Government’s lack of progress on building us a new hospital in Warrington undermines some of the other excellent work that we are doing locally to try to train up the people we need to fill those workforce shortages.

[Wes Streeting]

I totally agree, and I heard of a really awful case in Warrington the other day. A Warrington resident who contacted me said that they waited 12 hours in agonising pain in accident and emergency before giving up and going home after midnight because she simply could not take it any more. The A&E department was so packed that she could overhear other patients’ conversations with clinicians, including sensitive medical information. Those are the kinds of conditions that patients are experiencing and in which the poor NHS staff have to work. It is simply unacceptable.

[Claire Hanna (Belfast South) (SDLP)]

I thank the hon. Gentleman for being so generous in giving way. Does he agree that keeping the working environment safe is core to workforce planning, retaining the people who are trained and stopping spending eye-watering sums on agency nurses? He outlined many scenarios in which staff are forced to work in unsafe conditions. Does he agree that the core message coming from health unions is their desire to have appropriate staffing levels to provide the service on which all our constituents rely?

[Wes Streeting]

I strongly agree. In fact, I spoke to the general secretary of Unison last week. She said that as the unions look at safe staffing levels in critical services, in their determination to maintain patient safety in the event that industrial action goes ahead, they have found that on non-strike days, the NHS already operates at staffing levels below what the union would intend to operate on a strike day. That is an unbelievable state of affairs.

I am really worried about industrial action. Like patients across the country, I do not want industrial action to go ahead—it will mean ambulance delays, cancelled operations and even greater pressures on the NHS—but the tragedy is that we see the conditions that I just described every single day in the NHS. Pat Cullen from the Royal College of Nursing said, “We are striking for patients”. I have heard that line time and again from RCN members. It is partly about NHS staff’s pay and the conditions in which they work, but more than anything else, they are telling me that they voted for industrial action—some for the first time in their entire careers—because they have had enough and can no longer suffer the moral injury of going to work, slogging their guts out and going home petrified that, despite their best efforts, they still did not deliver the care that patients deserved. What an intolerable situation they find themselves in. Their backs are against the wall, and that is why the Government should negotiate.

[Yasmin Qureshi (Bolton South East) (Lab)]

My hon. Friend is making an excellent speech. Does he agree that it is completely reprehensible for Government Ministers, when talking about potential pay strikes by nurses, to say that by going on strike, they are somehow enabling Putin’s regime?

[Wes Streeting]

That was a reprehensible thing to say and it shows how desperately the Government are scraping the barrel to make excuses for their negligence and mismanagement of the NHS.

As I said, I found it astonishing that this summer, in the middle of the biggest crisis in the history of the NHS, the Government took the infuriating decision to cut a third of medical school places. Thousands more straight-A students in Britain who want to help have been turned away from training to become doctors. It is like the clip of the former Deputy Prime Minister Nick Clegg saying in 2010 that there was no point in building new nuclear power stations because they would not come online until 2022. This country needs Governments who think beyond short-term electoral cycles and put the long-term interests of the country first. That is the approach that Labour would take, but it has been sadly missing for the past 12 years.

Just as the Government failed to build our energy security, leaving us exposed to Putin’s war in Ukraine, they failed to train the staff the NHS need, leaving us exposed as the pandemic struck. Their failure to prepare has left us in the ludicrous situation in which UK universities are now offering medical degrees only to overseas students. That’s right: the Government are refusing to allow bright British students to achieve their dreams of becoming doctors, so Brunel University is forced to take exclusively students from overseas. The Chair of the Select Committee on Education, the hon. Member for Worcester (Mr Walker), has warned that there is a real risk that medical schools will

“only train overseas students who go off and get jobs elsewhere”.

What a criminal mismanagement of our higher education system. What a failure to plan to meet our staffing needs with our own home-grown talent.

[Taiwo Owatemi (Coventry North West) (Lab)]

My hon. Friend is making an excellent point. Given that there were nearly 30,000 medical school applications last year from British students who really want to study medicine, does he agree that it is absolutely disgraceful that the Government have a cap of 7,500? That shows that we are not investing in our workforce or in home-grown British doctors. It is appalling that the Government cannot see the importance of that.

[Wes Streeting]

I wholeheartedly agree. To deal with that problem—and, indeed, to satisfy the demands of the Conservative party, which looks to Labour for answers—we are putting forward a plan today to solve the crisis, to bring down waiting times, to get patients the treatment they need and to build a healthy society.

Where the Conservatives are holding the best and brightest students back from playing their part in the health of our nation, Labour will unleash their talent in the NHS: we will double medical school places, training 15,000 doctors a year so that patients can see a doctor when they need to. Where the Conservatives have left nurses working unsafe hours, unable to spend the time they need with patients to provide good care—where the Conservatives have left the NHS so short of midwives that expectant mothers are turned away from maternity units that do not have the capacity to deliver their child—Labour will act: we will train 10,000 more nurses and midwives every year.

We will go further. The way we deliver healthcare has to change. For many patients, a hospital is not the best place to be, yet in the past 12 years all the other parts of our health and care service have been eroded by underinvestment. When our society is ageing and people increasingly want to be cared for in the comfort of their own home, surrounded by their loved ones, why have four in 10 district nursing posts been cut? Labour is proud to have district nursing at the heart of our plans to modernise the NHS, and we will double the number of district nurses qualifying every year.

Many colleagues across the House have campaigned for years on the importance of the early years of a child’s development. All the evidence says that the first 1,000 days of a child’s life are vital to their development and life chances, yet the number of health visitors has been cut in half since 2015. Labour will ensure that every child has a healthy start to life, training 5,000 more health visitors. That is what our motion would deliver.

[Munira Wilson (Twickenham) (LD)]

The hon. Member raises children and early intervention, but one area he has not touched on is the tidal wave of cases relating to children and young people’s mental health. As we all see in our casework every week, children and young people who have not been treated early get worse and worse and therefore get referred to acute services. In the past year, referrals to child and adolescent mental health services have gone up almost 25% and consultant psychiatrist numbers have come down. In terms of early intervention, we are not seeing enough mental health support in our schools. In Richmond, we cannot recruit clinical psychologists even though we have the money to do so. Does the hon. Member agree that we really need to focus on the future of this country—our children—by training more psychiatrists, counsellors and psychologists?

[Wes Streeting]

I totally agree. We have had lots of perfectly good speeches from Conservative Prime Ministers over the past 12 years, and we have had more than our fair share of unbelievably bad Conservative Prime Ministers over the same period. One thing that each of those speeches has had in common is warm rhetoric and no delivery. We are not prepared to make the same mistake, so although it is not on today’s Order Paper, I am pleased to confirm that my right hon. and learned Friend the Leader of the Opposition has announced a mental health pledge that will mean 8,500 more mental health professionals being recruited. It will enable us to provide mental health hubs in every community, dedicated mental health support in every school and the aim of guaranteeing treatment within a month.

Our pledge will be transformational to mental health support in this country. It will particularly benefit young people, whose mental health and wellbeing have borne the brunt of the pandemic. It will really help to free up capacity for GPs and accident and emergency departments, which are increasingly seeing mental ill health cases coming through their door because the specialist support that people need is unavailable. Our plan, like our motion on today’s Order Paper, is fully costed and fully funded and will make a real difference to patients. Just as the Conservative party is welcome to steal Labour’s NHS workforce pledge, it is very welcome to steal our mental health plan too.

As well as recruiting the doctors, nurses and allied health professionals we need, we also need to keep the staff we have.

[Mike Amesbury (Weaver Vale) (Lab)]

Why does my hon. Friend think Government Members are so keen on protecting non-dom status? What is the interest there?

[Wes Streeting]

That is an excellent question that the Secretary of State is really well placed to answer. It is not as if people in Downing Street do not know what non-dom status is or how it is currently accessed. I do not know whether the Chancellor’s reluctance to abolish non-dom status is because he does not want bad relations with his next-door neighbour. We have all been in that situation—everybody needs good neighbours—but I think a little neighbourly discomfort on Downing Street is a price worth paying to improve the healthcare available to people on streets up and down the rest of the country.

We need to keep the staff we already have. On a visit to a hospital recently, I spoke to a nurse about whether she was planning to vote for industrial action. She said yes: pay was an issue, but what really motivated her decision was the stress, the burnout and going home at the end of the day with the moral injury of worrying that she had not delivered the care patients deserve because she was too overstretched. I asked her what would make the most difference. She said, “I just want to know that the cavalry is coming—that it is worth staying in the job because things are going to get better.” She knows how long it takes to train nurses—she has been through it herself—and how long it takes to train doctors. She can accept that, but what she cannot accept is a future in which, because we did not act today or because the incoming Government did not act after the general election, she is still working understaffed shifts in overstretched hospitals a decade down the line.

Labour’s message to NHS staff is that the cavalry is coming with Labour. We will train a new generation of doctors, nurses and midwives so that staff are not driven out of the service and patients are treated on time. Of course more can be done to keep staff from leaving. We have been calling on the Government for months to fix the perverse incentives in doctors’ pensions that are forcing them into early retirement. The Government have just launched a consultation that might lead to changes in spring 2023. What good is that when the NHS is on the cusp of the worst winter crisis in its history?

The Government announced in the autumn statement that, for the first time ever, they would count the number of staff the NHS need—a truly groundbreaking act! Counting the number of people we need is a good start, but Labour has committed to an independent workforce body that will look at retention and better professional development so that staff can build and progress their careers in the health service. With the number of care workers falling for the first time, where is the Government action to stop the exodus of care workers to places like Amazon? Providing fair pay and terms and conditions for care workers is not only the just thing to do, but one of the best things that the Government can do to ease pressure on the NHS.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

Is there not a need for urgent thinking about the impact of inflationary pressures on all the UK’s health systems in the UK? According to a report published yesterday by the Wales Governance Centre at Cardiff University, inflation will eat into the Welsh budget to the tune of £800 million next year and £600 million in 2024-25. Health is at the heart of the Welsh budget, and this will inevitably have a huge impact on health delivery in Wales. I am not sure what the English figures are, but the cash-terms increases in the autumn statement are highly unlikely to compensate for the inflationary pressures that will also affect the English health budget.

[Wes Streeting]

The hon. Gentleman is right: inflation is a big problem, and it is a problem made in Downing Street. We are all paying a very heavy price for more than a decade of Conservative mismanagement of the economy. Yes, we can all point to the spectacular success that was the mini-Budget, which crashed the economy and left everyone picking up the pieces, but even that does not explain more than a decade of low growth, low productivity and higher taxes. That is where the Conservative party has left us, and that is why it is not just a change of NHS policy we need, but a change of economic policy. Goodness me, the Conservatives have had enough goes at it. They have had enough Chancellors this year. Even The Spectator has lauded the shadow Chancellor as the Chancellor of the year, because she has the plan that the country needs. Business leaders know it, we know it, the country knows it, and I suspect that even Conservative Members know that it is true.

Let me now turn to our NHS workforce plan. When I say that it is a serious plan, the House should not just take my word for it. It has been endorsed by the Royal College of Physicians, the Royal College of Psychiatrists, and Universities UK. It has widespread and cross-party support. I was particularly pleased by the support expressed by one correspondent, who wrote in September:

“I very much hope the government adopts this on the basis that smart governments always nick the best ideas of their opponents. They also ditch the bad ones of their predecessors such as blocking an enlightened amendment to the Health Act that would have sorted out workforce planning”.

I should like to thank the Chancellor for his endorsement. I was with him in the Lobby to support that NHS workforce amendment when Conservative Members, no doubt including the Secretary of State, were voting the other way. May I invite the Secretary of State to use that quote in any future negotiations in which he engages at the Treasury? I am just trying to be helpful.

While the Secretary of State is there, perhaps he could suggest that the Treasury take a proper look at the non-dom tax status. The Chancellor admitted after the latest Budget that his team had not even calculated how much the tax status was costing the Treasury and how much scrapping it would raise, at the same time as expecting us to believe that it would not work and that the sums produced by independent academics would not add up, although he had not even bothered to commission Treasury sums of his own.

Politics is about choices. The Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, while millions of people cannot get a GP appointment or an operation when they need one. The Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, while millions of people are left waiting in agony on NHS waiting lists. And, of course, the Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, when they know that it is not just the health of the nation that is being harmed by record NHS waiting lists, but the health of our economy. Patients need treatment more than the wealthiest need a tax break. Those who live in Britain should pay their taxes. The Labour party is clear about where we stand: we need nurses, not non-doms.

We have a plan. The Conservatives do not. We have a record of delivering in government. The Conservatives do not. It is not just the House that faces a choice today; at the next election, the country will face a choice between more of the same with the Conservatives and the fresh start that Britain needs with Labour.

13:44

[The Secretary of State for Health and Social Care (Steve Barclay)]

The hon. Member for Ilford North (Wes Streeting) said that Labour has a plan. Let us look at that plan. More than a fifth of the entire population of Wales are waiting for planned care, and 60,000 people in Wales are waiting for more than two years. So we can see exactly what Labour’s plan in government delivers. He asked us to remember when Labour was last in power, and we still do. We remember the letter that said there was no money left. [Interruption.] He has just had plenty of time in which to discuss these matters. I did not feel the need to hector him, because I thought his points had so many flaws that it was important for the House to be able to hear them. He obviously feels that he did not make his case effectively, and would like to have another go. Does he want to have another go?

[Wes Streeting]

indicated dissent.

[Steve Barclay]

He does not want to intervene, so let me deal first with what he left out. His speech, like his motion, ignored a number of salient points. He did not mention, for example, the autumn statement, which one would have thought was fairly significant, providing an extra £6.6 billion for the NHS over the next two years. The NHS Confederation, no less, has described the day of that settlement as a “positive day for the NHS”, and the chief executive of NHS England has said that it should provide “sufficient” funding to fulfil the NHS’s key priorities.

The hon. Gentleman chose not to mention that significant funding. He also—much to the surprise of the House, perhaps—chose not to mention the uplift for social care that was announced in the autumn statement. Opposition Members often call for more funding, so I would have thought that they would be keen to hear about the extra £6.6 billion of additional funding for the NHS, about the biggest funding increase for social care provided by any Government in history, and about the £8 billion that we have committed to elective care. That, bizarrely, was also missing from his speech. He talked about the backlogs—those in England, that is; the backlogs in Wales are much greater—but he did not talk about that £8 billion for elective care, which will fund the building of diagnostic centres and surgical hubs in the constituencies of many Opposition Members.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

rose—

[Steve Barclay]

I do not know whether there is a community diagnostic centre for a surgical hub in the hon. Lady’s constituency, but perhaps she will share with the House what extra investment is being made there.

[Debbie Abrahams]

As someone who worked in the NHS during the last period of Labour government, I was proud of being able to ensure that my constituents would have an appointment with a GP within 24 hours. I was proud of the fact that someone who needed elective care would receive it within 18 weeks. I was proud of the fact that the treatment of someone diagnosed with cancer would start within 60 days. That is not what is happening on the Secretary of State’s watch. Can he tell me why my constituency has fewer GPs than it had in 2015, along with an increase in demand? How is this delivering the quality care that I know we had on my watch and that of the last Labour Government?

[Steve Barclay]

We are investing in more doctors. We have 2,300 more doctors—a 3% increase. We also have 3% more nurses than we had last year. In fact, under the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), there was the biggest ever increase in medical undergraduate places—a 25% increase—along with the opening of five new medical schools. Of course, the training takes about seven years, so that is still in progress. As was pointed out during Health questions this morning, we are dealing with the consequences of the pandemic, which is why we are investing in more checks, scans and other procedures, and there will be an extra 9 million of those by March 2025.

[Emma Hardy]

The right hon. Gentleman might recall that, when he was previously Health Secretary before his short break, I raised concerns around the criteria to reside and the number of people remaining in Hull Royal Infirmary who were unable to move into adult social care. At the moment, we have 30% vacancies in adult social care. The problem is that, although the money is promised, it is not delivered. That is partly because of the chaos that we have seen in the Government. He must acknowledge that, although this money was promised, it was not delivered and that we have 30% vacancies in adult social care across Hull and East Riding. Those vacancies always increase before Christmas because retail makes an attractive offer to those same workers. The money has not been delivered in time, and those 30% vacancies are only going to increase. With the greatest respect to the Secretary of State, there is little point in making promises if they are not quickly delivered in time to make a difference.

[Steve Barclay]

The hon. Lady mentioned the summer, and I think she knows that I visited the Jean Bishop integrated care centre and looked at the great innovations and brilliant work that her constituents, among others, are doing there. I looked at how it is bringing social care and the NHS together through an integrated model and how there has been new investment, supported by the amazing fundraising within the local community and by NHS funding. It would be great to get a bit of balance about the amazing feedback I heard from both staff and patients at the Jean Bishop integrated care centre who are working innovatively. I hope the hon. Lady would agree that the innovation of a centre such as the Jean Bishop is what we need to see in more places across the NHS. To her wider point, there are challenges in social care; she raises a fair point. That is why, despite the many competing pressures that the Chancellor faces, he has allocated £500 million for this year. It is also why he then committed the £2.8 billion for next year and the £4.7 billion for the year after—the biggest ever increase in that funding. But it is not simply about the funding increase; it is also about using new models such as that integrated care model to deliver far better care.

[Dr Luke Evans]

Is that not precisely the point? The NHS will gobble up the money, so it is about how we use the system. The integrated care systems and integrated care boards—established through the White Paper that the NHS asked for—are doing exactly that. They are trying to join up primary care, secondary care, social care, preventive health, county councils and borough councils all in one place to make a better stand on how we can produce healthcare that is better for our constituents and better for the taxpayer. Will my right hon. Friend make sure that, when he goes to the integrated care board chairs, he gives them the chance to solve the problems and unleashes the power to do exactly that, because they know best?

[Steve Barclay]

My hon. Friend raises an extremely important point. It is not just about the significant funding increase that the Chancellor has allocated; it is also about how that funding is deployed, in particular through using population level data for the integrated care system to bring health and care together. One area that the hon. Member for Ilford North and I agree on is the impact of delayed discharges across health and our hospital trusts as a whole. We often see that manifested in ambulance handover times, which are so impacted by that.

On the investment that is going in, my hon. Friend the Member for Bosworth (Dr Evans) is right to say that it is also about how it is deployed. Again, missing from the Opposition motion was any reference to the commissioning of the former Labour Secretary of State, Patricia Hewitt, to look at how to take on board how that funding is spent in an integrated way. It would also be remiss of me not to draw the House’s attention to the £5.9 billion of capital funding that we are using to transform diagnostic services by making the most of new technologies and improving the equipment for our frontline staff, making it easier for them to deliver the patient outcomes that we need. That is investment, along with the investment in care, that this Government can be proud of.

In the motion, the shadow Secretary of State refers to a shortage of workforce, but he ignores the locum doctors and bank nurses that make up a significant proportion of the NHS workforce. He ignores the record numbers of doctors and nurses that we now have working in the NHS, with a 3% increase on last year in both doctors and nurses.

I am sure you will be surprised, Mr Deputy Speaker, given your background in Wales, to discover that we cannot see what the vacancy rate is in Wales because the Welsh Government stopped collecting workforce vacancy statistics in 2011. You would have thought that the motion would be an opportunity for the Opposition to encourage their Welsh colleagues, given the importance that they say applies to vacancy statistics. You would have thought they would be keen to see that information from across the Union of the United Kingdom. I thought that Labour was a party of the Union. Why would it not want to have that transparency across Wales on the vacancy figures? But the motion was silent on that point. Perhaps in closing, the relevant shadow Minister will make a commitment to encourage the Welsh Government to have that same level of transparency.

[Dr Evans]

The Secretary of State hits the nail on the head when it comes to comparing the different countries across the Union, because different countries choose to use different statistics on waiting times to manage their staffing. Does this not confirm the argument we should have a unified way of using those statistics across the four nations?

[Steve Barclay]

I very much agree. In fact, in the spirit of co-operation, I would be happy to write to Sir Ian Diamond at the Office for National Statistics to encourage that, if the Welsh Government were willing to make that commitment. I do not know whether the Opposition would be willing to sign up to encouraging the Welsh Government to have that level of transparency. They seem reticent about having that transparency.

[Karin Smyth (Bristol South) (Lab)]

Going beyond the party knockabout, I think that the issue of statistics across the Union is a really important one, and I have raised it in the House many times. Can the Secretary of State tell us what the vacancy rate is in North East Cambridgeshire?

[Steve Barclay]

Well, it depends on what we are talking about. Are we talking about doctors or nurses? Are we talking about locums? Are we talking about the churn within care? There is a range of factors. The reality is that we do not have a major hospital in North East Cambridgeshire. We are served by four different hospitals, at King’s Lynn, Peterborough, Hinchingbrooke and Addenbrooke’s. Someone particularly interested in data would need to look across those ranges.

[Karin Smyth]

rose—

[Steve Barclay]

Let me make some progress.

There is a fair list of omissions in the motion. It did not talk about how the Government are on track to deliver their manifesto commitment of 50,000 nurses by 2024, with nursing numbers over 32,000 greater than they were in September 2019, and the fact that there are over 9,300 more nurses and almost 4,000 more doctors than there were a year ago. There has also been a 47% increase in the number of consultants since 2010.

[Wera Hobhouse (Bath) (LD)]

The biggest problem for my constituents is access to GPs because there are not enough GPs in the system, so rather than talking about statistics, how can the Secretary of State make sure that my constituents can see a GP in time and not walk away in desperation because they cannot get an appointment?

[Steve Barclay]

I agree that it is not simply about statistics, but I think it is remiss not to point to the increase in doctor numbers, with 2,300 more in primary care—

[Karin Smyth]

Will the Secretary of State give way?

[Steve Barclay]

Can I just answer the hon. Member for Bath (Wera Hobhouse)? I have taken a number of interventions. The hon. Lady is intervening on an intervention.

We must look at the increase in doctors in primary care of over 2,300, and we currently have over 9,000 GP trainees, but the hon. Member for Bath’s wider point is correct. It is not simply about the number of GPs; it is about ensuring that the wider primary care force operate at the top of their licence. It is also about access for patients, and avoiding the 8 am Monday crunch when lots of people make calls at the same time. That is why we are looking at the better use of telephony in the cloud and the latest that technology offers. It is also why we have the opportunity, through Pharmacy First, to make better use of what the pharmacists throughout our pharmacy network can do. It is about increasing the number of GPs, yes, but it is about the wider workforce, the use of technology and the use of different patient pathways, too.

Another omission from the motion is that there are around 90,000 more GP appointments every working day, excluding covid vaccinations, than there were last year. When I hear people say that they cannot see their GP, it is worth putting it in context—[Interruption.] The shadow Secretary of State is chuntering again. Does he want to have another go?

[Wes Streeting]

I am surprised and grateful that the Secretary of State has given way. His position seems to be, “You’ve never had it so good.” People cannot get an appointment to see their GP, they are waiting for ambulances and they cannot get into A&E and be seen within a reasonable period of time, but under this Government patients have apparently never had it so good.

[Steve Barclay]

As the hon. Gentleman knows, I have been at pains to point to the huge pressure the pandemic has generated, which he seems unwilling to accept.

In Wales, 60,000 people have been on a waiting list for more than two years, which is a huge example of what a Labour Government deliver in practice. Everyone recognises the huge demand for GP appointments, and there is no single solution, but GPs are seeing more people. Forty per cent. of appointments are booked for the same day, and almost 40% of patients have continuity of care.

[Paul Bristow]

Does my right hon. Friend agree that the £45.6 billion invested in health and social care is a phenomenal investment? The key to addressing the challenge is to make sure the money is spent wisely. If a Labour Government were in charge of making sure the money is spent wisely, with their record of wasting public money, it would be like putting Dracula in charge of the blood bank.

[Steve Barclay]

My hon. Friend raises an important point. The Government have increased the funding, which will be used in new, innovative ways to deal with the huge challenge we face as a consequence of the pandemic. That is why we have the elective recovery plan, on which we hit our first milestone over the summer in terms of two-year waits. We have rolled out 91 community diagnostic centres, which have delivered more than 2 million tests and scans.

The workforce is, of course, a vital component of this mission, which is why the ambulance workforce has increased by more than 40% since 2010, but we recognise there are significant pressures, particularly as a consequence of delayed discharges, which are having such an impact on the wards and in A&E. That reads across into the challenge of ambulance handover delays.

[Margaret Greenwood (Wirral West) (Lab)]

I have spoken to nurses who tell me that, when they get to the end of a shift, insufficient staff arrive for the night shift, so they have to hang on. They are working extra hours without being paid because of the shortage of staff. What would the Secretary of State say to them? They are in such a stressful situation. They want to ensure the safety of their patients, but they simply do not have sufficient colleagues to do so.

[Steve Barclay]

The hon. Lady raises a fair point. Nurses are under huge pressure, and I want to say how much we respect and value the work they do. The pandemic has placed huge strain on the NHS, which manifests in the pressures staff face. I am ready to speak further to trade unions about many of these issues and their impact on staff—there are sometimes concerns about safety and staffing levels—and about how we can have better investment in tech and the NHS estate.

I was up in Liverpool the week before last, and £800 million has gone into the Royal Liverpool Hospital. What a difference that is making to working conditions. We need to see more of that investment elsewhere. A range of things are contributing to the very real pressures staff face, which is why we have committed to investment in capital, both on the estate and in areas such as tech, which can make such a difference to working conditions.

[Karin Smyth]

Will the Secretary of State give way?

[Steve Barclay]

The hon. Lady has had a go, so I will make some progress.

The hon. Member for Ilford North says that Labour would free up £3.2 billion by making changes in respect of non-doms—that was raised both at Question Time and in this debate. It will not surprise the House that the Opposition have now spent that money several times on their various pledges. His proposal ignores the fact that we need a tax system that is internationally competitive. His Majesty’s Revenue and Customs figures show that non-dom UK residents are liable to pay more than £6 billion in UK income tax, capital gains tax and national insurance contributions, so the proposal would leave us as a less attractive destination to people who, by their nature, are mobile and can go elsewhere. If they did, we would lose the tax they currently pay into the UK Exchequer.

The hon. Gentleman criticises the Government’s track record on medical training places, but it is worth reminding the House that it was this Government who, in 2018, funded a record 25% increase in medical school places and, in doing so, opened five new medical colleges. Of course, it will take time for that to bear fruit, and the first of those students will shortly enter the foundation programme training. This is an important investment for the long term, and it is why we now have a record number of medical students in training.

The motion covers nursing and midwifery placements. Here, too, we have seen progress, with more than 30,000 students accepting places on courses in England in the last year, a 28% increase compared with 2019. All eligible nursing and midwifery students will receive a non-repayable grant of at least £5,000 per academic year. NHS England has invested £127 million in the NHS maternity workforce and in improving neonatal care, on top of last year’s £95 million investment to fund 1,200 midwife posts and 100 consultant obstetrician posts.

As well as developing talent at home, we must also look to attract talent from abroad. In a motion focused on workforce, it is interesting that there seems to be no mention of recruiting from overseas. People hired from overseas make a fantastic contribution to our NHS, as I hope the House would agree. Unlike the Labour party, the Conservative party recognises the talent that international doctors, nurses and care workers offer, which is why we have been doing more international recruitment. It is interesting that the motion does not seem to welcome that fact, and does not seem keen on more international recruitment.

[Wera Hobhouse]

Will the Secretary of State give way?

[Steve Barclay]

The hon. Lady had a go earlier, but I will let her have a final go.

[Wera Hobhouse]

Yesterday I had a meeting with the Royal College of General Practitioners, which raised the issue of overseas talent wanting to work here and stay here. The Government and the visa system are making that very difficult. The Secretary of State might want to talk to the Royal College of General Practitioners about that point.

[Steve Barclay]

As part of making things easier, I set up a taskforce in the Department over the summer to look at how we can increase the numbers. We have increased the number of nurses recruited internationally, and care workers are on the shortage occupations list. If there are particular issues that the hon. Lady wishes to highlight, I would be happy to look at them with her, but we are keen to attract talent.

[Wes Streeting]

For clarity, is it the Secretary of State’s position that we are turning away thousands of talented people who want to study medicine and other health professional courses because we do not need them as we are recruiting from overseas?

[Steve Barclay]

No, of course not. The hon. Gentleman knows that is not the case. It is a bit like when he goes around the media to charge the Government with refusing to talk to the unions. Simply misrepresenting our position is not a fair reflection of Government policy.

The motion talks about workforce, and this Government have committed to increasing the number of international recruits in the NHS. The Leader of the Opposition seems to think we should not be encouraging that. That is the wider point to make. Of course, that sits alongside domestic recruitment, which is why, as I said a moment ago—again, the hon. Member for Ilford North has chosen to ignore this—we have had a 25% increase in medical undergraduate places, with five new medical colleges set up by the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May). That underscores this Government’s commitment to increasing the number of doctors in training.

[Chris Stephens (Glasgow South West) (SNP)]

The hon. Member for Bath (Wera Hobhouse) raised an important point about problems with the visa process, so will the Secretary of State outline what work he is doing with the Home Office to resolve some of these issues?

[Steve Barclay]

I discussed this issue with the Home Secretary this week: how we work together across Departments, not just on the visa system, but on other equities. For example, the amount of time spent by police on mental health is an issue of concern to not just the Home Office, but wider government. So there is scope across Departments to work more closely together and we are doing that, both on the issue of international recruitment, which is a key equity within the Department of Health and Social Care, and on mental health pressures on the police, which is an issue within the Home Office. That is how we are working more collaboratively across government, but we are clear that we are boosting the numbers in the short term while, in parallel, increasing the domestic supply of recruits, for example, with the boost in medical undergraduate places. We are also looking at what more we can do in areas such as apprenticeships: how we hire more nursing apprentices and boost supply through that as well.

Finally, the motion does not reflect the pay uplift that was awarded, where the Government accepted in full the recommendation of the independent NHS Pay Review Body. More than 1 million staff have seen an increase of at least £1,400 in their pay. Of course, that comes on top of the 3% rise last year, at a time when pay was frozen across the wider public sector.

[Munira Wilson]

rose—

[Dr Luke Evans]

rose—

[Steve Barclay]

I will give way to the hon. Lady first and then to my hon. Friend.

[Munira Wilson]

One bit of feedback that my colleagues in outer London constituencies and I have had from health leaders in our area is that the high-cost area supplement, which is available for many inner-London boroughs but is not available for outer London boroughs, is causing huge problems with recruitment and retention. For example, somebody can earn £2,000 more for the same job in Wandsworth than they can in neighbouring Richmond or Merton. Health leaders are calling for a review of the high-cost area supplement, so is that something the Secretary of State is willing to look at?

[Steve Barclay]

The hon. Lady raises a fair point. That fund has been set up because there is an issue with how recruitment sometimes applies between different areas. We always face the challenge of where one draws that boundary, but I will of course look at specific data on any particular case she wants to raise. The fund is there more widely to recognise that often some areas—

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

rose—

[Steve Barclay]

I have said that I am going to give way to my hon. Friend the Member for Bosworth (Dr Evans), and then I am going to wrap up. As I was saying, sometimes there are areas where it is more difficult to recruit and we need to look at the data on that.

[Dr Evans]

When it comes to retention, pensions are a big issue, and the Opposition Front-Bench team have picked up on that. One recommendation from the Select Committee was to mandate for recycling to try to help with that. What other work is being done to try to ensure that senior colleagues with the most experience are incentivised to take on the extra lists and try to deal with the backlog, in all four corners of the country?

[Steve Barclay]

We are uniquely placed in having a Chancellor who has not only a deep understanding of health issues, but an understanding of recent Health and Social Care Committee reports. Obviously, that is an issue that we, with Treasury colleagues, will keep under review.

The motion ignores the vital work that the Government are doing to back health and care, the £6.6 billion of investment in our NHS that was announced in the autumn statement, and the social care investment of £2.8 billion and £4.7 billion next year. This Government are investing in our health and social care. We have always put the NHS workforce first and we always will.

14:14

[Chris Stephens (Glasgow South West) (SNP)]

It was noticeable that the Secretary of State talked very little about the workforce in the speech we have just heard, although he spoke about many other things. I want to confine my remarks to the workforce, staff wellbeing and their pay.

Let us recognise, first, the impact on the NHS and staff of not just decisions made in this place on the economy, but of Brexit—that cannot be ignored. For example, the director of the CBI has called on the UK to use immigration to solve worker shortages. The Secretary of State did touch on that, but we really need assurances about the work being done between the Department of Health and Social Care and the Home Office to resolve the many visa issues that the Royal College of GPs had outlined, as other Members have said. According to that research, 17% of international graduates are considering leaving the UK altogether as a result of the challenges they are facing within those visa processes.

Research by the Nuffield Trust has revealed that Brexit has worsened the UK’s acute shortages of doctors in key areas of care and led to more than 4,000 European doctors choosing not to work in the NHS in the UK. Martha McCarey, the lead author of that Nuffield Trust analysis, has said:

“The NHS has struggled to recruit vital specialists…and Brexit looks to be worsening longstanding workforce shortages in some professional groups.”

That has been backed up by a number of organisations that have those very concerns, because the challenges in health and social care are felt in many sectors. What we certainly do not need is some of the right-wing rhetoric on immigration that we hear in this place, because in many areas of the UK we need more rather than less migration.

Clearly, staff pay is a real concern. In Scotland, we have seen discussions between the Scottish Government and the trade unions; a pay offer is on the table to staff and the trade unions have recommended that the staff accept that latest offer. In England, as an excellent Unison briefing is outlining, we are seeing a number of NHS workers considering leaving the service because they do not believe they should be subjected to a pay rise of 70p an hour. That is a very real concern to them and I believe it is simply not enough—it is not enough when food inflation is at 16%, and we have the high energy costs and housing costs that many people across the country are being subjected to.

[Jamie Stone]

The hon. Gentleman is making an interesting contribution, and I am thinking about what he has just said about Scotland. The fact remains, as I illustrated in a question earlier today, that the consultant-led maternity service based in Caithness, which has a close connection to his family, was downgraded to its current deplorable state because it could not hire the people. He has just mentioned housing, and I believe that in order to fill the gaps in the most rural areas of the UK we are going to have to offer a more comprehensive package to encourage them, involving housing, something on the mileage rate people are paid and even transport. If we just go down the ordinary route of recruited people from overseas, they will tend to go to the more central parts of the UK, where there is housing and where transport is much easier. We cannot have the rural, faraway corners of the UK left out.

[Chris Stephens]

The hon. Gentleman knows of my affection for his constituency—many members of my family live there. He raises an important point about rural communities, and in relation not just to the NHS but to the other challenges he outlines. He makes a pertinent point about what all the health services need to consider when applying their services to the areas that he has the privilege of representing, and I thank him for that.

The Secretary of State talked about the autumn statement, but it will not deal with the increasing cost of food and energy, and all the other pressures facing staff. There must be a serious discussion about the NHS workforce, about retention, about giving staff career opportunities and also about wellbeing. I thank NHS staff for what they have done not just during the pandemic, but when I and family members have had health challenges. The work they do and the miracles they perform on a daily basis should be recognised in this place.

[Dr Evans]

It is worth stressing that point. For all the Daily Mail headlines about the NHS, we must not lose sight of all the good work that goes on unrecognised for the countless thousands of people who go to hospitals, GP surgeries or mental health services and get excellent care. If two patients are on similar pathways but one receives excellent care and the other receives poor care, should not the emphasis be on moving more towards excellent care and less—if not an outright stop—towards poor care?

[Chris Stephens]

The hon. Gentleman is right; everybody should have excellent care.

As we debate the NHS workforce, we need to recognise what the challenges of the workforce are: whether they are paid adequately and whether there is a real retention strategy. We need to ensure that we have as many staff as we can and that we pay them properly. I did not hear much from the Secretary of State about the state of play of the pay negotiations and what the Government are doing to try to resolve disputes. I see him sighing; he is more than welcome to intervene. [Interruption.] Oh, he was yawning. I am sorry. [Interruption.] Oh, he was not yawning either. He was making a facial expression. I do apologise. We really need a serious debate about pay for public sector workers, and NHS workers in particular.

[Richard Foord (Tiverton and Honiton) (LD)]

When we think about pay for NHS staff, we also need to consider pay for those who work in NHS dentistry. The Government claim to have reformed the NHS dentistry contract earlier this year, but they brought no new money to bear. Does the hon. Gentleman accept that the Government should be measuring not only the number of dentists who are employed to carry out NHS dentistry, but the number of hours that are committed to NHS dentistry? We need to see whether there is a correlation between that and the poor pay that they are receiving for NHS dentistry.

[Chris Stephens]

The hon. Gentleman makes an excellent point; it is all about pay. What he says about hours is pertinent as well. We know that NHS staff go the extra mile. We know that they work long hours, and we should recognise that. His point about the dentistry service is also important.

As I outlined earlier, the Scottish Government are listening to feedback from the trade unions on pay, and there is a new offer on the table. That means that, in Scotland, porters who are at the top of band 2 will be making £2,502 more a year, nurses or midwives at the top of band 5 will be making £2,431 more, and a paramedic at the top of band 6 will be making £2,698 more. Currently, that is the best deal across the UK, and it is significantly more than the uplift on offer in England—the average value in England is around 4.5%, whereas in Scotland it will be 7.5%.

The Secretary of State also had his usual kick at Wales, but it should be noted that the Welsh Health Minister and the Scottish Health Secretary have written to the UK Government, calling for additional funding this year to support pay deals for NHS staff. I wonder whether, in his response, the Minister will give us an update on the answer to that letter.

I will conclude, because I know that this is a heavily subscribed debate. It is important that we deal with the mental wellbeing of our NHS staff. The Scottish Government have published a wellbeing strategy. We need to show more compassionate and collaborative leadership across the health, social care and social work sectors on these islands. I shall leave it there, Mr Deputy Speaker. The SNP will be supporting the motion submitted by the Labour party today.

14:25

[Steve Brine (Winchester) (Con)]

It has been interesting to hear the exchanges between the Front Bench speakers, although I am surprised that there are not more Members in the Chamber for what is a very important debate. [Interruption.] Actually, where are they on both sides of the House? Given that this is the No. 1 priority of the Opposition, where are they?

[Richard Burgon (Leeds East) (Lab)]

Is it not the hon. Gentleman’s No. 1 priority?

[Steve Brine]

Without the heckling from the back row of the Labour Benches, I can say that this has always been my No. 1 priority.

Back in July, the Health and Social Care Committee, which I now chair, published a crucial report entitled, “Workforce: recruitment, training and retention in health and social care”—I urge colleagues across the House to take a look at it, if they have not already done so. We looked at workforce issues right across the NHS, and the findings were stark. The report found that the NHS workforce is facing the biggest challenge in its history. It made the same point about the social care workforce. Although social care is not the focus of today’s debate, it is important to stress, as others have during today’s opening exchanges, that the two sectors are closely intertwined and the workforce problems in the NHS cannot be considered in isolation.

We had NHS Providers before the Select Committee this morning to discuss the industrial action. I asked them whether they support the independent pay review process. I would have intervened on the shadow Secretary of State with that question, but his speech had already gone on for an hour, so I thought he deserved to sit down. More than 1 million NHS workers under Agenda for Change have had, as the Secretary of State said, a £1,400 pay rise this year. That has come out of the independent pay review process. The question I asked NHS Providers this morning, to which the answer was yes, was: do they still believe in the independent pay review process?

Either we have that process, we believe in it and we respect it, or we do not. Are we saying that we have that process and it sticks until something else comes along? If Ministers then become directly involved in negotiating pay for NHS workers, that is a very different proposition. That is not the place we want to be, although the Select Committee is very happy to scrutinise that proposal if it is coming from the Treasury Bench. I would be interested to hear in the winding-up speeches what the Labour party’s position is on the independent pay review process, because it is independent for a reason.

The Committee’s report cited research by the Nuffield Trust suggesting that the NHS in England could be short of 12,000 hospital doctors and more than 50,000 nurses and midwives. The number of people on a waiting list for treatment rose to a record of just over 7 million in September, and the 18-week target for treatment has not been met, as is well known and is on the record, since 2016. Yet, as our report noted, the demand on the sector continues to grow relentlessly. There are estimates that an extra 475,000 jobs will be needed in health by the early part of the next decade.

One of the Committee’s most urgent recommendations was that the Government should do proper workforce planning. We noted that without workforce plans that are independently verified and publicly available, there would be little confidence among the public, the profession or NHS workers themselves that the Government have a grip on the problem.

I must say that the Select Committee has not yet had a Government response to our workforce report—it is a little overdue. The Secretary of State is on the Front Bench, and I know he is busy, but hopefully he will take that back to his officials. We look forward to receiving that response, because it is important that Select Committees get responses to reports in as timely a manner as possible, notwithstanding the fact that there has been a change of Administration.

However, I am encouraged that the Government are paying attention to what the Committee recommended, and I was delighted to hear my predecessor in this role, now Chancellor of the Exchequer, say in his autumn statement that he agreed with himself—his words—and that the Government would now be publishing an independently verified workforce plan for the NHS for the next five, 10 and 15 years, something the Committee has long called for. The Treasury outlined that the plan would

“include measures to make the best use of training to get doctors, nurses and allied health professionals into the workforce, increase workforce productivity and retention.”

Excellent—that is progress.

Questions remain, however—maybe the Minister can touch on this in her winding-up speech—about what the independent workforce planning will look like in practice. We need to know more about who will provide the independent verification once the work has been done. I understand the work has largely been done by the NHS, but we need to know who will be doing the independent verification, when it will be published and how regularly it will be reviewed. When we know that, we will look forward to talking to him or her in the Select Committee.

Our report contained a number of other important and detailed recommendations about how to tackle the NHS workforce crisis. I do not want to go into all of them today—as I have said, the report is on the record and published in the House—but among them I wanted to highlight the radical review of working conditions that was touched on by both the shadow Secretary of State and the Secretary of State.

Work conditions are critical. We talked about the need to reduce the intensity of work felt by so many people in the service—which I hear about both as a constituency MP and as Chair of the Select Committee—and the need to boost retention and of course recruitment of people who are looking at where they might work when they have done training. We recommended that the review should start with an overhaul of flexible working, which would mean that NHS workers were not driven to join agencies or become locums to gain control over their working lives. I often hear those words, “We just need control over our working lives.”

We also said it is a huge problem that senior doctors are being forced to reduce their working contribution to the NHS or to leave it entirely because of the long-standing problem around pension arrangements, which was a problem when I was a Minister in the Department. We accept that the Government have made some progress on pensions, with changes to the taper rate and the annual allowance, and credit to them for that, but we note that the problem persists and have called on the Government in our workforce report to address it.

In that context, to give credit where it is due, I was very pleased to see on Monday that the Government have announced plans to amend NHS pension rules to retain senior doctors and encourage staff to return from retirement. The Secretary of State was slightly mocked when he said that was subject to a consultation, but that is how government works. If the hon. Member for Ilford North (Wes Streeting) were to become Secretary of State—I like him very much, but I hope he does not—he would also publish consultations, because that is how proper government is done, and he knows that. We look forward to seeing the Government response to that consultation, which I know the Secretary of State is keeping a keen eye on

The Secretary of State is right to say that there are a record number of doctors in training, with five new medical schools, two of them focused on training GPs. That is true, but the Select Committee will return to our workforce work next year, and we will be taking evidence from anyone who wishes to contribute about the cap on training places. I have said to Ministers and to No. 10 that I think the Government are going to have to look again at that issue. I hear in my constituency from bright young boys and girls who wish to train as medics, whose parents have maybe worked in the profession and who have that ambition for themselves. The cap is a problem.

My other point is about demand. We had somebody from the British Medical Association’s GP committee before the Select Committee this morning, as part of our ongoing inquiry into integrated care systems, who was talking about the NHS being underfunded. That depends on which end of the lens we look at, does it not? We spend £150 billion or so of taxpayers’ money on the NHS. We could spend £300 million; that would be a choice. We would have to fund it, of course, because we know what happens when people make unfunded spending pledges from the Dispatch Box—the markets go into meltdown, and rightly so.

We need to have a serious and honest conversation with ourselves about how much of our national wealth we wish to spend on our health service and whether that would achieve the desired outcomes. We are the fifth-largest spender on health services in the OECD, but we do not get the fifth-best outcomes. I can give the House a bit of an exclusive here, because in the new year the Select Committee will be launching a big inquiry into prevention. Anyone who knew me when I stood at the Dispatch Box as a Minister will know that cancer and prevention are the two things that most get me out of bed in the morning, so we will do a big piece of work on prevention.

My view and the view of many others is that the NHS will have long-term sustainability challenges if we do not get serious about prevention. I do not just mean returning to the argument around obesity and all the things I wrote about in the child obesity plan when I was a Health Minister, although they are important and I urge the Government not to backtrack on any of those policies but to implement them, because weight is a major problem in our ill health. We need to get upstream of ill health.

I will say more about this in the debate in the House on Thursday, but when the Committee returns to cancer work, we must look at future cancer and at getting upstream of cancers. At the moment, we want to diagnose quickly, but people have to have symptoms in order to be diagnosed quickly and then we need to treat very quickly as well, within the 28-day standard. The Secretary of State and I have talked several times already about how we need to get far ahead of that.

We need to bring together predictive medicines, biomarkers and some of the life sciences work that is going on with the NHS’s genomic strategy, and get ahead of some of the illnesses that drive ill health in our country. Without that, in my humble opinion, the NHS has long-term sustainability problems.

[Emma Hardy]

This is a perfect point for me to lobby the hon. Gentleman on also looking into diagnosis times for people with endometriosis, who are waiting on average seven and a half years to receive a diagnosis, and women’s health treatment generally. That would be a wonderful inquiry for his Select Committee to look into and take under observation.

[Steve Brine]

Duly lobbied, thank you. The hon. Lady has mentioned this to me many times before; I take the point on board and other members of the Committee in the Chamber will have heard her too.

In all the work that we are doing on the Select Committee, whether on ICSs, prevention or cancer, or the work done by my predecessor chairing the Committee, workforce is without question the common theme that runs through all of that. We cannot get away from that. I think there are encouraging signs that the Government are listening to the Committee, and of course we have a great advocate in No. 11 Downing Street and in the Secretary of State, who I was pleased to see reappointed to his position.

I urge the Government to continue to listen to the Select Committee. We are a cross-party Committee, looking at things in a sober, calm, evidence-based way, and we look forward to the Secretary of State coming to see us soon to talk about these issues. The invitation is always there, as he knows.

The workforce challenges that the NHS faces are the bottom line. Without tackling them, we are not going to move forward on many of the challenges that I know the system has. I welcome this debate; I hope we can keep it sober, keep the party politics out of it and focus on the NHS, because ultimately that is what our constituents demand of us.

14:39

[Ms Lyn Brown (West Ham) (Lab)]

Across north-east London, our population is set to grow by the total of the population of Dover in just the next five years. By 2042, the added population will be the size of Milton Keynes. We have the highest rate of NHS vacancies in London. We simply cannot go on without long-term workforce planning and investment in staff and in services. We have lost a large number of international staff since Brexit, and retention is a massive problem, with an annual staff turnover of almost 17% in the Government’s recruitment campaign for nurses.

We have the highest spend on agency staff in the region—10% of some staffing budgets goes to agencies. But even with all that money being spent, our operating theatres are struggling to find enough bank and agency staff to fill the gaps. How on earth are we going to tackle the backlog if our theatres cannot be used to full capacity? How are we going to get patients in and out of hospital quickly if their operations are being delayed?

In Newham, maternity is one of the worst affected NHS services. As we know, high-quality accessible maternity care saves lives, and local need is massive. We have very high levels of poverty, as well as demographic pressures from our rapid population growth. There is a 19% vacancy rate on our maternity wards; almost a fifth of roles have no one to do the job, so non-specialist nurses are filling in for midwives. Surely, that has an impact on the quality of care. Sometimes, even women who have been assessed as having a higher risk cannot be admitted because there are, frankly, not enough fully staffed beds, so they are sent home instead, with an obvious increased risk.

One of our birth units is being closed repeatedly so that staff can transfer elsewhere and keep hospital services running. Those forced closures took place for almost 10% of the year to August. Surely, that increases costs for the NHS, as lower-risk births end up having to take place in hospital.

Every part of the NHS is creaking, and we are getting closer to collapse because workforce issues have been neglected. We have known that these problems have been getting worse for years now, exacerbated by austerity. This ain’t just about midwives and doctors; there is a shortage of admin staff, too, which is leading to a higher number of antenatal appointments being missed. So, when patients have to go into hospital even though they could be treated more effectively in less expensive settings, and when appointments are missed and preventive care does not take place, what happens? Costs go up for our NHS. The Government’s failure to recruit and retain enough staff is making our NHS less effective in terms of value for public money and is, let us face it, putting lives at risk, too.

In north-east London, we have the most diverse integrated care system population and the highest birth rate in the country. We know that if maternity patients do not get the care that they need, the risks are high. We have all heard the terrible statistics about women from black communities being four times more likely to die in childbirth than women from white communities. If we are to address that shameful injustice and end those deaths, Newham is one of our frontlines. But the reality is that our response is being held back and women put in greater danger because our NHS simply does not have the staff. The Government need to understand that many of those difficulties could get even worse without change. As we know, so many of our health and care staff are simply exhausted. They are working all the harder to fill in for vacancies. Often, they are offered less flexible work because the demand on services is so acute and no one can fill in the gaps.

A decade of austerity and the cost of living crisis have taken a huge toll. Locally, 17% of our skilled and experienced nursing staff are over 55. Many of those who keep our services going—or barely running—do not have many working years left in them. We can see that this is completely and utterly unsustainable. The dedication of our NHS staff, for which we rightly praised them so highly during the pandemic, has its limits. How much closer to collapse will our NHS get if these pressures continue to build? How many more patients will be let down? Frankly, a Labour Government cannot come soon enough.

14:46

[Paul Bristow (Peterborough) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests. It is a great honour to follow the hon. Member for West Ham (Ms Brown), who I thought spoke very movingly about the challenges faced by communities in her constituency. West Ham is not a million miles away from Peterborough, and I recognise some of the challenges that she identified, especially the horrible disparity between black women giving birth and their white counterparts—that is a stark statistic. She spoke passionately about that, and I think we would all recognise it—especially me, as a father of two young daughters.

In one of my first speeches as a Member of this House, I stood here and spoke about our NHS as someone who had worked in healthcare and public policy on and off for 20 years. I said that every two or three years, politicians stand up and say that the NHS needs more money, more capacity and a plan. When I made that speech—about three years ago now—I said that we cannot have another situation whereby we stand in the House asking again for more money, more capacity and a plan. Ultimately, that is exactly what we are doing. And so it goes on.

I understand that we have had a covid pandemic in the meantime; I understand that we have to recover from something that was extraordinary. But we have to make sure that the NHS is able to make the most of the budgets that it has. We have listened to quite a few contributions from the Labour party, including that of the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). I cannot quite be sure whether he was asking for more money or saying that the investment in our NHS was not enough. As a result of the covid pandemic, the Government are putting an extra £45.6 billion of investment into healthcare. That is an extraordinary amount of money.

Indeed, the Institute for Fiscal Studies says that by 2024, healthcare will account for 44% of day-to-day Government spending. I understand that that does not include capital funding, but that 44% of day-to-day Government spending leaves just 56% for everything else—that is an extraordinary statistic. We have to make sure that we get value for money out of the money going in. Yes, we have the £44.6 billion that is going in, but another £3.7 billion is also being spent on capacity. What does that say to us? It says that we need to increase productivity in our NHS and get the most out of the money that we are putting in.

The King’s Fund has found relatively recently that the annual average growth in productivity in our NHS increased from 0.7% in the 1980s to only 1.2% by 2012-13, and we need to do much better. When I say “we”, I am talking not about the individuals working for our NHS—doctors, nurses, allied health professionals; people on the ground—I am talking about the system as a whole. We need to do much better, and I want to suggest a few things that may help.

The first is ensuring that clinicians and those working in our NHS operate and practise at the top of their licences, and that we make better use of other healthcare professionals, such as nurse practitioners, and of things that have been around for a long time, such as nurse-led prescribing. Why does my wife, if she does not want another child and she wants to take contraception seriously and go back on the pill, need to have that prescribed by a GP? That does not need to be done by a doctor; it could easily be done by a pharmacist or at least a nurse in a practice. That does not require a face-to-face GP appointment, especially when we have shortages of GP appointments.

Some GP practices are doing fantastic work. I refer to the Thistlemoor surgery, which I have mentioned in this House on a number of occasions. I think that Dr Neil Modha and everyone who works there would be embarrassed by the number of occasions I talk about them in this place. That GP surgery serves up to 35,000 people in my constituency, of whom 80% do not have English as a first language. Those there pride themselves that if someone turns up who was unable to get a face-to-face appointment by ringing up, they will do everything they can to see that person on the day, and in the vast majority of cases that happens. How do they do it, with such a huge demographic challenge with the number of people who do not have English as a first language? They do it through effective use of admin staff. They have a number of people who work in the admin department in triaging who speak a variety of different languages from the communities that the surgery represents. By the time the patient is with the GP or relevant healthcare professional, they already know pretty much everything about the patient, what symptoms they are presenting with and what might be done to help them. It is an excellent surgery doing excellent things in my city.

I also want to talk about surgical and cath lab capacity. Perhaps I am naive, but we seem to spend lots of money to create that capacity in our NHS, yet for a significant period of time, it is just not being used. We are increasing the productivity of those places by making sure that they operate throughout the day, and in certain cases throughout the night, but a consultant I spoke to relatively recently said that it was still very common for consultants to operate only one day a week in cath labs. I understand that they have lots of important things they need to be doing with their time, including training the people of tomorrow, and that being a surgical consultant is not just about surgery time, but goodness me we need to be doing a lot better than one day a week. We need them to be treating patients, powering through lists and doing what they need to do.

A lot of this is about investing in innovation, too. Lots of procedures, such as nurse-led endoscopy, do not necessarily need to be done by a consultant at the top of their game. We need to be investing in systems and technologies that allow us to have more day cases, rather than more expensive in-patient services. This all seems like common sense, but the same debate about increasing productivity has been going on for about 20 years in the NHS, and these are some of the arguments I have been making for a number of years, not just inside this House, but outside it.

I also want to talk about pharmacy. During the pandemic, pharmacy was often the only visible sign of the NHS on our high street. It is right that we make more effective use of pharmacy and pharmacists. I speak to pharmacists in my constituency, and they want to do more. They did so much during the pandemic, particularly with vaccinations, and they can do so much more. My plea is to use our pharmacies as much as we possibly can.

Another issue I want to raise while I have the House’s attention is that we spend a lot of money on organisations such as the National Institute for Health and Care Excellence and Getting It Right First Time. We put a lot of responsibility in the hands of doctors, clinicians, patient organisations and all those involved in creating policies, commissioning policies, service specification and all the rest of it, but often we then go away and ignore them. I do not understand why we do that. GIRFT identifies sensible ways that the NHS can save money and get better outcomes for patients, but most of the time that is not replicated across the system, and I just do not understand why. Of course local decision making is important, but if something works in Peterborough, it will work in Torquay. We can certainly increase productivity, patient outcomes and save money by doing the things that those organisations tell us to do.

Similarly, we do not quite have the 24/7, seven days a week NHS system that many of us would want. There are far too many elements of our NHS that only seem to operate between 9 and 5 on weekdays. Unfortunately, when someone presents with a serious episode, such as myocardial infarction, stroke or whatever, they will not wait until 9 o’clock on a Monday morning to get the most appropriate treatment. We need a system that is truly 24/7, 365 days a year.

I pay tribute to what my hon. Friend the Member for Winchester (Steve Brine) said about prevention, which was spot on. A lot of the things I have talked about on increasing productivity relate to treatment within the NHS itself, whether in an acute or primary care setting, but if we are to make significant productivity or value for money savings in the NHS, we need to stop people presenting at hospital when they do not need to. A lot of that will be achieved by people looking after themselves and having the information available to them, through investment in public health. I asked today in the Health and Social Care Committee whether these integrated care systems looked like a true partnership among public health, primary care, acute care and social care. The jury is still out on that one, but we definitely need significant investment in prevention, and I am looking forward to taking part in that inquiry.

I end with this. I have talked a little about what I think needs to happen, and I have done it rather constructively, I hope Members from all parts of the House agree. Despite the fact that there are probably severe differences between both sides of this House, all of us want a national health service and systems in place that are working as they should be, and all of us want to see a fully funded, appropriately funded and appropriately staffed national health service. Significant progress has been made: the Chancellor of the Exchequer, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who was previously Chair of the Health and Social Care Committee, has said that he will accept the idea of an official workforce target being put in place. That is a huge step forward.

Some significant gains, and investment, have been made in our NHS. The number of people working in our NHS is going up. With a little consensus about the solutions we need for our national health service, such as those that I have suggested, we can ensure that it goes on and prospers.

[Mr Deputy Speaker (Mr Nigel Evans)]

As there are only people on the Opposition Benches remaining to speak, I will try to do without a time limit. That may be hope over expectation, but none the less, if people stick to around about seven minutes, that should be okay, because we will be starting the wind-ups no later than ten-past 4, with any anticipated vote at about half-past 4.

12:38

[Taiwo Owatemi (Coventry North West) (Lab)]

Many Members will remember that the Health and Social Care Committee recently published a report on the NHS workforce—a report that the Government frustratingly chose to ignore. As workforce shortages stand at unprecedented levels right across the NHS, with the latest figures revealing that there are more than 133,000 vacancies in England alone, I thought it might be useful to remind the Government of some of the report’s key recommendations.

First, the Government are failing to provide our NHS nurses with the essentials that anyone would need to do their job properly. In short, they are serving up poor working conditions, year in, year out. At the bare minimum, all nurses across the NHS should have easy access to hot food and drink, free parking or easy access to work and spaces to rest, shower and change, but the Government cannot even get that right.

I have repeatedly raised with the Department of Health and Social Care and the Prime Minister the fact that NHS staff at Coventry’s University Hospital are paying an astronomical £600 per year simply to park at work. In the middle of a cost of living crisis, it is outrageous that Coventry’s NHS heroes are out of pocket because the Government choose to do vanishingly little to improve their situation. I again call upon the Department of Health and Social Care to look closely at this situation and scrap these unfair parking charges for good.

Is it really any surprise that the Government’s current target of recruiting 50,000 nurses has been woefully missed when they are treated so poorly? It is unacceptable that many NHS nurses are struggling to feed their families, pay their rent and heat their homes. Some nurses are even resorting to using food banks this winter. I urge the Government to look closely at how they can better pay and treat NHS staff this year and next, so that we can finally reverse this worrying trend.

Our beloved NHS, which I had the honour of working for as a senior cancer pharmacist before being elected, is on its knees as a result of 12 years of Conservative neglect and mismanagement. Many services are crumbling. Pay has failed to keep up for years, and morale among nurses is in a truly terrible place. That is exactly why the Royal College of Nursing has been pushed into taking industrial action this month and why the Government must stop the mud-slinging and instead work with nurses to resolve this crisis.

Secondly, the Government must take urgent action to improve maternity care. For over a decade, the Conservatives have failed midwives across my community, and now we are all paying the price. We need a robust, fully funded maternity workforce plan, and the Government must commit to recruiting and retaining the workforce at the level set out in the forthcoming report by the Royal College of Obstetricians and Gynaecologists. Labour has made it crystal clear that we would train at least 10,000 additional nurses and midwives each year to tackle the crisis that currently exists in maternity care. Labour has also committed to a historic expansion of the NHS workforce, to plug the gaps created by this Government.

The Government must also improve diversity in the recruitment of midwives, to improve the standard of care that black, Asian, mixed-race and minority ethnic women receive throughout pregnancy, birth and the post-natal period. By increasing diversity across the NHS, we can guarantee better standards of care for everyone, regardless of their background or ethnicity. Labour’s women and equalities team has routinely pushed for reforms that would improve how everyone experiences healthcare in this country, so when will the Government catch up?

Lastly, as the newly elected chair of the all-party parliamentary pharmacy group, I want to highlight an opportunity that the Government have failed to grasp: better use of community pharmacists. As a trained pharmacist, I know that the sector is crying out for more responsibilities to become the first port of call for patients who need advice and treatment. That would help to rebalance the workload across primary care, bring healthcare back into the community, reduce the pressures on GPs and hospitals and deliver healthcare that is much more prevention focused.

Any plan for the future of pharmacy must ensure that all pharmacists have adequate access to supervision and training, along with clear structures for professional career development into advanced and consultant-level practice to help to deliver this. That way, community pharmacists can play a much larger and more effective role in delivering healthcare. Until this Government properly mobilise pharmacies, we will struggle to reduce waiting times, clear NHS backlogs or improve patient access to GPs, so I desperately want to see action here. Every Member here today understands that our NHS workforce faces a range of big challenges. Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point.

[Paul Bristow]

I completely share the hon. Lady’s sentiments about making better use of community pharmacists. She talked about better support and resources being available for pharmacists to do just that, but what specific things does she think need to happen to get the ball rolling?

[Taiwo Owatemi]

That is an excellent question. I could be here for hours explaining what I would like to see, but essentially, what I and many in the profession would like to see is an understanding and full use of the various skills that pharmacists have. We talked about this in the Health and Social Care Committee today: I would like pharmacists to be involved in providing clinical care—for example, a diabetes workshop or a cardio blood pressure workshop. We have seen other countries do that. In Alberta, Canada, community pharmacists are involved in the whole of the hypertension management; it is taken away from GPs and brought into the community, because it is more accessible in a community pharmacy.

Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point, but the Government are seemingly ignoring that. I hope that the Government urgently sit up, take note and look at how they plan to address our workforce needs, to ensure that our beloved NHS staff are no longer ignored.

12:38

[Sam Tarry (Ilford South) (Lab)]

For the first time in its 106-year history, the Royal College of Nursing has taken the monumental decision to take strike action. They have not taken that decision lightly, because no worker does, but this Government have pushed them to the brink. Ministers have had weeks to find a resolution, but they have rejected all offers of formal negotiations. As the RCN said, all meetings with the Government have seen Ministers sidestep the serious issues of NHS pay and patient safety. Do not be mistaken: they have the power and the responsibility to address this dispute, but they choose not to for self-serving political gains. They have seen that workers in rail, the Royal Mail, BT, universities and across the public and private sectors are now prepared to fight back because they are so sick of what this Government have been doing. They know full well that these disputes will have to end in pay rises for the workers of this country.

These are not the days of the miners’ strikes when the mines could just be closed because they were not needed any more. We are always going to need hospitals, we are always going to need railways, we are always going to need schools and we are always going to need universities. People are beginning to fight back and stand up, and it is time that the Government listened very carefully, especially in their so-called red wall seats.

At the height of the pandemic, every Thursday night the Prime Minister, the Health Secretary and Members across the House clapped for our NHS heroes and praised their immense effort on the frontline of the pandemic, but clapping does not pay a single bill. This dispute has highlighted the total hypocrisy at the heart of this Government. Once praised as heroes, nurses are now treated dreadfully. Ministers have sought to ratchet up the rhetoric, with the right hon. Member for Stratford-on-Avon (Nadhim Zahawi) seemingly seeking to present NHS workers as hostile agents of a foreign power, ludicrously and disgracefully dismissing industrial action as “helping Putin.” Get real! These are nurses, not agents of a foreign power. The Health Secretary has said that pay demands are “neither reasonable nor affordable”, while utterly refusing to engage with nurses’ unions over their demands, only offering a paltry 3% pay rise when inflation is well above 11%. According to The Times, instead of looking for a resolution to this dispute,

“Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts over the winter”.

[Anthony Browne (South Cambridgeshire) (Con)]

The hon. Gentleman talked about the difference between the pay offer and inflation. If all public sector workers were given a pay rise in line with inflation, it would cost the equivalent of a 4.5p rise in the basic rate of income tax. Does he support that, or would he pay for such big pay rises in other ways?

[Sam Tarry]

Our Front-Bench team have clearly set out a number of proposals, including taxing non-doms, which would seek to address the lack of funding in our NHS. I will not get into the specifics, but putting money into the pockets of ordinary people will clearly bring more revenue into the Treasury. The truth is that nurses have not had a real pay rise for more than a decade. The most experienced frontline nurses are now £10,000 a year worse off in real terms than in 2008, effectively meaning that they are working one day a week free of charge—how many days does the hon. Gentleman work free of charge?

[Carla Lockhart (Upper Bann) (DUP)]

The hon. Gentleman is making a powerful point about nurses. He will be aware that their role has evolved significantly and they are often now asked to do more training and more work on the same pay. Does he agree that it is unfair to demand more while paying the same?

[Sam Tarry]

Absolutely. My little sister is a nurse who works in palliative care in Southend, Essex. During the pandemic, her job was to help lots of people to experience the least suffering as they met the end of their life. The mental health of nurses has been broken, there is increased stress, and bank staff are being used—all as a result of nurses being so devalued that the Government have taken away their bursaries. We have a huge crisis, but one obvious fix would be to sort that out. Of course I agree that we have to listen and value our nurses.

[Paul Bristow]

Will the hon. Gentleman give way?

[Sam Tarry]

I will make some headway, because plenty of other hon. Members want to speak.

It is not just about pay: workforce shortages are at unprecedented levels across the NHS. The latest figures reveal that there are now more than 133,000 vacancies in England alone—more than a third of which are in nursing—which is an all-time high and a record for this country under the Government. The vacancy rate in registered nursing is running at nearly 12%, which is an increase from 10.5% in the same period of the previous year. A key factor in the failure to attract and retain enough staff is the Government’s inability to provide workers with a decent pay rise. Some 68% of trusts report that staff are leaving for better terms and conditions elsewhere.

[Paul Bristow]

The hon. Gentleman spoke about nurses’ pay and how they deserve more. We would all like to give nurses more money, but how does he account for the fact that the Welsh Labour Government are giving exactly the same pay award as proposed by this Government?

[Sam Tarry]

I cannot speak for the Welsh Government, but if we look at their record—the times that they have been returned to office with a stonking majority, and the fact that there are no strikes on their railways, which they had the guts to take into public ownership; they called it what it was—I would much rather be living under them than the appalling Government we have.

The impact of those shortages on existing staff is enormous. Reports by Unison have repeatedly highlighted the acute strain that understaffing has put on the workforce, with stress and burnout rife among NHS staff. That predates covid, which demonstrates the immense damage done by a decade or more of Conservative Governments and the failure of successive Governments and Prime Ministers to invest in the workforce or take workforce planning seriously. As the RCN has said, the dispute is about not just pay, but patient safety, which is key for all of us. Staffing levels are so low that patient care is being compromised; only paying nursing staff fairly will bring the NHS to a point where it can recruit and retain people to address those issues.

I have visited my local hospital, King George Hospital, on many occasions and I have heard about the impact of staff shortages and pay cuts on staff and patients alike. Recently, for once, I went to open some new services in paediatric emergency and radiology—something positive after 20 years of campaigning for our local NHS in Ilford—yet the staff were still overstretched, run ragged and demoralised. They just want the support that they need to care for their patients, which means pay recognition and ensuring fair practices at work without undermining their working conditions.

I spoke to staff who, during the worst of the pandemic, received food donations from the local community just to get by. That should never, ever be allowed to happen and makes it even more sickening to hear about the outright corruption on the other side of this House and the despicable corrupt PPE deals with people like Baroness Mone. People in Ilford are sick and tired of that because of the attacks on our local services. We even had to stand up and campaign for our local ambulance station not to be shut down under the Government’s measures.

Conservative Members seek to present nurses’ demands as unreasonable and undeliverable, and have asked nurses to tighten their belts even further, while they have allowed the pay of the wealthy to explode. This year, FTSE 100 CEOs collected an average of 109 times the pay of ordinary workers—that is part of the answer to where we get the money to pay the people who actually keep our country off its knees. Where is the Government’s commitment to pay restraint when it comes to high pay and those sorts of people? How many Conservative Members have fat cat salaries and executive directorships, and coin it in left, right and centre?

[Anthony Mangnall (Totnes) (Con)]

You all have second jobs!

[Sam Tarry]

I do not think a single person sitting on the Opposition Benches has a second job.

The truth is that NHS staff pay demands are reasonable and fair. Nurses’ pay is down by £4,300 and paramedics’ pay is down by £5,600. One in three nurses cannot afford to heat their homes or feed their families. NHS staff are at breaking point. When I met NHS Unite members from Guy’s and St Thomas’s Hospitals—I welcome any hon. Member to come with me and speak to them, because they are just across the river from this House—they were justifiably furious about the way that for too long, they and their colleagues have been exploited and abused by the Government, as they see it.

Staff are the backbone of the NHS, and if they break, so does the NHS. As the RCN general secretary said:

“Nursing staff have had enough of being taken for granted, enough of low pay and unsafe staffing levels, enough of not being able to give our patients the care they deserve.”

Allowing the NHS to collapse will cost the country considerably more, financially and in national wellbeing—as we are already seeing on the Government’s watch—than the rightful pay demands of NHS staff. If our NHS is not providing the care that we need, the costs are far greater, as is economically demonstrable.

Many hon. Members on both sides of the House believe that the NHS is our greatest institution. We cannot take it for granted and it is well worth fighting for. Conservative Members have the power to stop this dispute; to sit down with the trade unions; to face the nurses and NHS staff; and to negotiate a fair deal to prevent misery, ensure patient safety and save the NHS. If the Government will not do it, they should resign now, because a Labour Government will save the NHS and support NHS staff.

[Taiwo Owatemi]

On a point of order, Mr Deputy Speaker. I want to put on the record that my mum is a practising nurse.

[Mr Deputy Speaker (Mr Nigel Evans)]

I think we would all be proud to make that declaration, which stands on the record. We must now look to a speaking time of six minutes or thereabouts, or less if you can, to give everybody fair time. Please focus and, if you take interventions, do not add time on mentally.

15:17

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

In Hull West and Hessle, 1,730 people are waiting more than 28 days to see a GP and 6,225 are waiting more than 14 days. The ratio of GPs to patients in Hull is one of the lowest in the country, which is fuelling some of the many problems that we are seeing in accident and emergency. That is combined with the concerns that I raised with the Secretary of State about the delay to discharge; the 30% vacancies in our adult healthcare sector; and the delay in money that the Government promised to adult healthcare services, which means that delays are only increasing. I am incredibly concerned about what will happen over the winter.

I will focus my remarks on my concerns about radiotherapy, about which I have written to the Minister of State, Department of Health and Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately). With respect, I wrote to her on 3 September and received a reply on 28 November, which is disappointing on such a serious matter. I raise that issue today because, in August, I received an update from the Humber and North Yorkshire cancer alliance about the state of radiotherapy. For those who are unfamiliar, radiotherapy is used to treat and kill cancer cells and to shrink tumours. It is often used in the early stages of cancer.

In the briefing note that the Humber and North Yorkshire cancer alliance sent me, which I can only assume it sent to other Members of Parliament, it says:

“It is expected that the radiotherapy position at HUTH will worsen through the year. The reduced capacity obviously could pose a risk to patients (from a health and wellbeing perspective, as well as from a patient experience perspective).”

The reason it wrote to me to tell me of its concerns about radiotherapy is the shortages we have in the area. It says that the percentage of Hull University Teaching Hospitals NHS Trust patients who began radiotherapy as their first definitive treatment for cancer and who did so within 62 days of an urgent referral for suspected cancer—within 62 days of an urgent referral—was 22% in July, 50% in June and 29% in May, compared with over 50% previously. The percentage of HUTH patients who received radiotherapy following their first definitive treatment within the 31-day target was 44%. So the majority of people are not being seen for their cancer treatment within the 31-day target, and only 22% of people sent for urgent referrals for suspected cancer are being seen.

The reason for this is given in the briefing note, which says:

“Many of HUTH’s therapeutic radiographers have left the profession to pursue a better work-life balance, while those who have remained in their roles have also sought improved work-life balance by seeking roles closer to where they live to reduce commute times.”

That is the reason people are leaving—to seek a better work-life balance. It is not because they do not care or they do not wish to continue to treat people, but because they simply cannot maintain it at this level. The note says that

“staffing shortages is an issue experienced across the country.”

It also says—this is a key point because the Government’s defence is often that the pandemic has caused all these problems:

“Therapeutic radiography has been considered a vulnerable profession for years.”

Pre-pandemic we were having problems with radiographers, but no action was taken, and this is still considered a problem right now.

I wrote to the Minister and the Secretary of State about this, quoting from the briefing note. I sent the letter on 3 September, and I said:

“I am sure you will agree that the evidently increased waiting time for potential life-saving or life-prolonging treatment is extremely concerning.”

I understand that Hull University Teaching Hospitals NHS Trust is doing everything it possibly can. It has taken on two apprentices to be trained up as radiographers, but we all understand that we cannot instantly produce the radiographers we need. As I say, I sent the letter on 3 September, and it was also signed by my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) and my hon. Friend the Member for Kingston upon Hull East (Karl Turner). It took the Minister until 28 November to reply, even though I started the letter by saying:

“I am writing having received a very worrying update from the Humber and North Yorkshire Cancer Alliance regarding a reduction in services”

in my constituency.

In her reply, the Minister admitted:

“HUTH advises that, to protect existing staff and maintain the service, it was necessary to reduce capacity to sustainable levels, which has in turn led to the inability to reach specific targets and a growing waiting list.”

So this is a problem that the Government are well aware of, despite their delay in responding to it. It is a problem that has been around for years, and it is a problem that is literally a matter of life and death. If people do not get the cancer treatment they need when they need it, we know the consequences. The failure to deal with and address the NHS workforce is not just a mild inconvenience; it is an incredibly serious matter that has been a long time coming and a damning indictment of 12 years of Conservative mismanagement of our NHS.

15:24

[Bell Ribeiro-Addy (Streatham) (Lab)]

The importance of this debate should not be understated because the NHS is in a dire state, and that is largely the result of a severe staffing crisis. Other than the generally inept economic policies we have seen from the Government, there is no denying that the Brexit deal has had a direct impact on staffing numbers, and that chronically low pay and poor working conditions have resulted in an exodus of staff leaving the NHS to work in the private sector, work abroad or leave the healthcare profession entirely.

I would like to start with one of the most undervalued groups in our NHS, which is the first that most of us meet in modern Britain—the midwife. The Royal College of Midwives has estimated that it has an existing and long-standing shortage of more than 2,000 midwives, and that for every 30 who are trained, NHS England loses 29. Vacancies for nurse positions are estimated to be at an all-time high, with a survey at the start of the year finding that 57% of nursing staff across healthcare settings are thinking about quitting or actively planning to quit their jobs.

With figures such as these, we cannot blame existing staff for wanting to leave or blame others for not wanting to fill these vacancies, particularly when we see the TUC’s estimates that, since the Conservatives took office in 2010, midwives have had a total real-terms pay cut of £5,657, nurses’ pay is down by £4,310 in real terms and the pay of all doctors is down by about 7.4%. We cannot forget the thousands of non-medical staff, who are often overlooked, but are integral to keeping the NHS running. Cleaners, security guards, porters and other important workers have, along with other NHS staff, faced real-terms cuts in pay since 2010.

Is it any wonder that the NHS waiting list has now tipped to over 7 million? When we hear of the scale of the vacancies, can we really be surprised that some A&E patients are left waiting for over 12 hours, or that ambulances are repeatedly failing to meet their target response times? The staffing crisis in the NHS is having a dire impact on patient safety, and if we are going to tackle the NHS backlog, address the crisis in staff recruitment and retention, and bring the NHS back to the standard it should be, we first and foremost have to address pay. We cannot be gaslighting nurses by saying that they should drop their pay demands to send a message to Putin, which is absolutely ridiculous.

We have to pay nurses what they are worth, and if the Government were not aware of what they are worth, the pandemic should have shown them. We called them key workers because we could not do without them, yet the Government justify their pay by calling them low-skilled workers. There is no such thing as low-skilled work; there is only low-paid work. All work is skilled when it is done well, and our NHS staff are the best example of this. On the contrary, Ministers, who are paid multiple times more but who have shown little skill in running the country, if the cost of living crisis and the economic situation are anything to go by, are completely different. They get paid so much more, but we cannot see their sense of skill in running this country.

In the past year, a number of NHS personnel have been taking strike action against low pay, and nurses will be striking later this month for the first time in the Royal College of Nursing’s 106-year history, while ambulance staff have announced their strike today. If that does not show us the scale of the crisis facing workers in the NHS, I do not know what does. No one wants to have to take strike action, least of all the workers in our NHS, but the dire situation of chronic underpayment and poor conditions is leaving them no choice. This Government have left them no choice. When we have 27% of NHS trusts operating food banks for their staff, when one in three nurses is taking out a loan to feed their family and when NHS staff across the board are severely underpaid, of course they are at the point of saying that enough is enough.

No one goes to work for the NHS for the money, but it cannot be fair to expect people to live on poverty wages. If the Government want to address this crisis in recruitment and retention, they must get over this ideological aversion to paying public sector workers what they are worth. That means committing to a proper cost of living pay rise, and setting out plans to reverse a decade of real-term cuts in pay for our NHS workers.

14:21

[Daisy Cooper (St Albans) (LD)]

Let us imagine what this debate could have been. If the former Prime Minister—the former former Prime Minister, I should say—had accepted the workforce amendment to the Health and Care Bill 13 months ago, this debate could have been so different. The Government could have crunched the numbers, NHS frontline workers would know that the cavalry was coming, and patients would be able to see light at the end of the tunnel. Instead, here we are as Members of Parliament with a roll-call of horror stories, because somehow, in 2022, waiting more than 12 hours for an ambulance is the new normal. How on earth has it come to this?

We know that there are workforce problems in every part of our health and social care sector and every corner of our country, whether general practice, dentistry, pharmacies, midwifery, nursing—all are overstretched and understaffed. But it is midwives who send me their most distressed emails, because they often train for their dream job, only to be plagued by nightmares that they have not done enough to help new mothers and their babies in their time of need.

Just last week I spoke with paramedics and other ambulance staff as I took a three-hour ride out with my local ambulance service. At 7 o’clock in the morning we were called to see the first patient. That patient had been waiting at home, on the floor, since 6 pm the night before—13 hours. Before we could get to see that patient, we were called to a more urgent call. When we finally got to the hospital with that second patient, the paramedics checked the list of patients who had arrived at the hospital. They were distressed that they had not been able to get to that first call, and wanted to make sure that another ambulance had done so. They were exhausted. They said that in a 12-hour shift they may get only one 20-minute break. They were exhausted because there are not enough staff.

For most of my constituents, day in, day out, access to their GP really matters, and too many of them are struggling. That is no wonder, because the Government said they had a target of recruiting 6,000 more GPs, but they have admitted within three years that they will fail to meet that target. It is frustrating for patients, but it is also dangerous for GPs and their staff. This summer we heard reports from Walton-on-Thames in Surrey, where police had been called to a GP surgery because people were making threats of physical violence. That is surely unacceptable. Where is the urgent drive to recruit and retain our GPs?

How on earth will we retain and motivate highly trained professionals when our hospitals are on the verge of collapse? Up and down the country there are hospitals in dire need of repair. In Eastbourne—I see the hon. Member for Eastbourne (Caroline Ansell) is in her place—there have been concerns for a long time about whether the hospital may or may not be coming. It was recently reported by some staff that they had been told—allegedly—that a new hospital was even a bare-faced lie.

[Caroline Ansell (Eastbourne) (Con)]

I thank the hon. Lady for advising me ahead of the debate that she might mention the hospital in my constituency. I am not sure of her particular interest in Eastbourne, although it was named by Time Out as its place to visit in 2023. For the benefit of those in my constituency who may be following this debate, am I pleased to share that, in relation to the workforce—the matter before us today—there has been a 25% increase in full-time staff over the past 10 years. That is a 10-year increase in nurses and midwives, a 10-year increase in doctors and dentists, and a 10-year increase in allied health professionals. They also report £20 million—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It is important to have fairly short interventions.

[Caroline Ansell]

Thank you, Madam Deputy Speaker. Is the hon. Lady therefore pleased and relieved to hear that, despite staff concerns that there would not be a new hospital, there has been a run of incredibly positive meetings and we are assured that, in the words of the chief executive, “once-in-a-generation” investment is coming?

[Daisy Cooper]

The hon. Lady asks about my particular interest, and she will be aware that as the Liberal Democrat spokesperson for health and social care I have asked the Government on 10 occasions about releasing funds for my local trust, and other hospital trusts across the UK, for the new hospital programme that the Conservatives promised in 2019.

Other hospital trusts are deeply concerned about the lack of progress on the new hospital programme. In Sutton, for example, St Helier Hospital was built before world war two. My own trust, West Hertfordshire Teaching Hospitals NHS Trust, which covers St Albans, Watford and Hemel Hempstead, has buildings that are life-expired. I have been there a number of times and seen the extraordinary work by professionals in my local hospital trust. We had the first virtual ward during the pandemic, and we have two robotics suites. We also have a lift that breaks down right next to the ward that treats children who are ill. When that lift breaks down, ambulances have to be stationed outside one side of the hospital so that they can drive around to the other side. This is completely unacceptable.

Will the Minister confirm that all of those hospitals right across the UK—wherever they may be—will get the funding they were promised under the new hospital programme and that there will not be delays and penny-pinching? A Conservative Member no longer in his place asked where we would train all of the planned thousands more doctors and nurses. If there is any penny-pinching on the size of our new hospitals, they certainly will not get trained in our area.

Our NHS and social care need people, tech, beds and buildings. There is no silver bullet to solving all of the issues in our NHS and social care, but getting some proper workforce planning in place would be the closest thing to that. That is why my Liberal Democrat colleagues and I are happy to support the motion.

15:35

[Richard Burgon (Leeds East) (Lab)]

Just two years ago, in the middle of the greatest public health crisis in decades, millions of people came out to clap for the nurses, doctors and other NHS workers who were putting their lives on the line to save the lives of others. As people will remember, Conservative Members were only too happy to be seen joining in the applause. How times have changed.

We now have Tory Ministers wheeled out on the media to attack those same NHS workers with sick claims that their planned action for fair pay is aiding Putin’s abhorrent war on Ukraine. Those disgraceful remarks appear to be the opening salvo in a Tory propaganda war that seeks to blame NHS workers for the deep crisis in our health service. The Tories will attack nurses, as they do every other worker forced to defend their pay and conditions. But nurses did not create the NHS staffing crisis. Nurses did not create record NHS waiting lists. Nurses did not underfund our NHS. Nurses did not hand tens of billions of pounds that should have gone to the NHS over to the private sector, including in corrupt contracts. Whoever the Tories try to blame, the simple truth is this: it is 12 years of Conservative party rule that has created the crisis in our NHS.

At its core is a crisis in the NHS workforce, with workforce shortages at an unprecedented level across the NHS. The statistics are eye-watering, with 133,000 NHS vacancies in England alone and a record high of 47,000 nursing vacancies. This Tory-created staffing crisis is why patients are struggling to get a GP appointment, why heart attack patients face ambulance waiting times of more than an hour and why many are not getting the life-changing operations they urgently need.

Today we will vote on an important policy to scrap the non-dom tax status that is exploited by the super-rich to avoid £3.2 billion in taxes every year. Scrapping that, as Labour advocates, could fund a long-term plan to train enough NHS staff. For example, it could double the number of medical training places and deliver 10,000 more nursing placements.

The Tories should back that plan to put the NHS before non-doms and invest in our NHS instead of lining the pockets of the super-rich. It is a plan that would help bring about a long-term solution to this crisis. For the next two years that they are in government—that is all it will be—they should take the action needed to address the workforce crisis in the immediate term, and we cannot solve that unless we resolve the NHS pay crisis.

A third of public sector workers are actively considering leaving their jobs, and pay is a key factor in that. Key workers in our NHS still earn thousands of pounds a year less in real terms than in 2010. For example, nurses’ real pay is down by £5,200 compared with 2010, while hospital porters’ real pay is down by £2,500. Now the Government expect it to fall even further.

Staff, however much they love their jobs, simply cannot afford to stay in them. Their pay is not covering their essentials. Hospitals are even having to open up food banks for staff. That falling pay is why, over the coming weeks, nursing staff and—it was announced today—ambulance staff will be taking industrial action. Nursing staff do not want to take action, but they feel they have been left with no choice because Government Ministers will not even meet them to discuss pay.

Nurses hope that the Government will listen and open up the pay talks so that they do not have to go out on strike, but if they do strike, they will have public support and I will go and support them. It is not too late for the Government to avoid strikes. They have chosen strikes over negotiations, but they can stop this at any point. The Government need to open up the talks and they need to pay NHS workers properly. They need to give NHS workers the pay rise they deserve.

14:21

[Karin Smyth (Bristol South) (Lab)]

In 1948, at the dawn of the NHS, we were around 50,000 nurses short. By the 1960s, 40% of junior doctors were from India, Bangladesh, Pakistan and Sri Lanka. Thousands came from the Caribbean. It is estimated that by the 1970s, 12% of British nurses were Irish nationals, my own family among them. My Aunt Margaret Carter came to Stockport and my cousin Maureen McNulty came to Leeds. Britain welcomed them; they were not invaders. We trained them, we gave them accommodation, we offered them prospects. In the three decades I have worked in the NHS, the hundreds of nurses I have worked with remember their first job. They remember being greeted and welcomed. They remember their new belts. They remember it with great pride. We welcomed them nationally and, crucially, we welcomed them locally. We supported them with accommodation, transport and decent prospects.

In January 2019, the then Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), made a statement about the long-term plan and the recommendations. Like the Secretary of State today, he talked about the largest increase in health spending. What he failed to admit, as did the Secretary of State today, was that we had witnessed a decade of the lowest growth the NHS had ever had. In particular, it badly hit public health, capital spending—why we have a £10 billion backlog on maintenance—and workforce education and training. Even if we skirt over the suppression of Exercise Cygnus and pandemic planning, we entered the pandemic unprepared. That is why we had rushed, ad hoc, WhatsApp-panicked procurement processes—about which we will hear much more later today. That is why 2020 was so bad.

Members do not have to take my word for it. In June 2019, following that earlier statement, Baroness Harding and Sir David Behan, chair of Health Education England, gave evidence to the Health and Social Care Committee. I recommend that hon. Members read it. I totally agreed with Baroness Harding that the way we solve the workforce crisis is all about staff retention. It is all about people feeling that their careers were not being developed and that they did not have an opportunity to get on. At the time, retention rates were higher in any other profession. It was also noted that if we had kept at 2012 retention levels, we would have had 16,000 more nurses in 2019 than we had at the time. That is the problem.

There are solutions and we have heard some of them today, but they are a mix of the national and the local. At national level, we need to welcome people. We will always need overseas recruitment, but upwards of 80% of NHS staff are homegrown. We need to incentivise retention—it is cheaper, it is quicker, it is the smart thing to do. The reasons for loss of staff are well known. The Government need to revisit the Augar review. They need to notice what has happened with the loss of bursaries. We need to involve further and higher education in that retention work.

We also need to look at regional solutions. The Lansley Act, the Health and Social Care Act 2012, destroyed the regional architecture but there is still a role, still some semblance of a network, possibly grouping ICSs—we talked about that today—where NHS England could have a role without the performance stick. The emergency planning architecture, which was ignored at the beginning of the pandemic but still exists in some places and did rise to the challenge, linking local authorities and public health, could offer a skeleton of a service to co-operative supportive networks above trust and ICS level. But eventually everything is local. Just as we welcome people nationally and have national support structures to retain staff, we absolutely have to do things locally. We need to look at housing, transport, progression and, as has been said, pay and retention.

I am not particularly interested in the large figures that have been bandied around today, including the millions of people on waiting lists and the 165,000 social care vacancies; I want to know what is happening in Bristol. I want to know what is happening to GP waiting times in Whitchurch, Bedminster and Bishopsworth. I want to know the vacancy rates at the Bristol Royal Infirmary and Southmead Hospital. When I asked the Secretary of State about the vacancy rate in North East Cambridgeshire, obviously, he could not answer, because none of us in this House can answer that question. As MPs, we should know the scale of the problem in our constituencies and, frankly, we do not. We need to know and to communicate to local people what the problem is. We need to help with the local situation and priorities, and we have to build our way out of it.

There are no easy solutions, but there is a path. Sadly, the Government have not even started on that path. If we are to keep spending ever more of our country’s wealth on the NHS and care system—as we will, although it would help if we had grown the economy more in the last 10 years—local people must have a say in that. They have to understand the trade-offs and, crucially, be able to hold someone to account locally for the parlous state of our waiting lists.

15:45

[Rebecca Long Bailey (Salford and Eccles) (Lab)]

The national health service is facing one of the worst workforce crises in its history. The decentralisation and deliberate marketisation of large parts of the health service, the driving down of staff pay, 12 years of austerity and so-called efficiency savings have brought frontline services to the brink of collapse.

A report by the Health Foundation revealed that the UK has spent around 20% less per person on health each year than similar European countries over the past decade. As a result of sustained real-terms pay cuts, some hospitals have food banks for staff, some are handing out welfare packages, and there are even reports of NHS staff sleeping in their cars as they cannot afford the fuel to and from work. It is no surprise that there are more than 133,000 vacancies across the NHS.

However, instead of helping to address the pressures faced by an overworked, underpaid and demoralised NHS workforce, the Government appear to be deliberately picking a fight with the trade unions representing those key workers by fiercely resisting entirely reasonable pay claims. There is genuine desperation out there among those workers and other key workers like them who are experiencing the definition of in-work poverty. They are not able to afford the basics of food, clothing, housing and privatised utility bill payments. It is therefore no surprise that they are left with no option but to publicly voice their desperation over low pay, unmanageable workloads and patient safety.

GMB, Unison and Unite have confirmed this week that there will be national walk-outs across the ambulance service. Nurses will strike this month for the first time in their 106-year history; they simply cannot take any more. The Royal College of Nursing’s last shift survey report found that eight in 10 shifts were unsafe, and 83% of nursing staff surveyed said that staffing levels on their last shift were not sufficient to meet all patients’ needs safely and effectively. For context, an experienced nurse’s salary has fallen 20% in real terms since 2010.

As we heard, midwives are balloting for strike action. A recent survey carried out by the Royal College of Midwives shows that more than half of staff are considering leaving the profession, citing inadequate staffing levels and concern for the quality and safety of care that they can deliver. It also estimates that the UK is short of more than 3,500 midwives.

The NHS workforce was rightly lionised by the British public for their selfless devotion and service during the pandemic, yet the abject response of the Government is to unleash yet more austerity on public services that are already cut to the bone, and to further hold down the wages of hard-pressed workers. We had reference to the autumn statement today but, staggeringly, although those workers continue to suffer, hidden in the depths of that statement was not an admittance of culpability for the current economic crisis or a plan to reverse NHS decline, but a massive tax cut on bank profits. The bank surcharge was cut from 8% to just 3%. That comes on top of the removal of the cap on bankers’ bonuses a few months ago and the abject refusal to abolish non-dom tax status. As my hon. Friend the Member for Ilford North (Wes Streeting) said at the start of the debate, the Government made choices—and the choice they made was to prioritise the interests of a select few over the interests of the NHS, patient safety and the welfare of workers in the health service.

Today the Government have the opportunity to recognise their gross misjudgment and make the right choice. They have the opportunity to increase resources across the NHS and set out an urgent workforce plan with measures to increase retention and support staff. They have the opportunity to introduce an immediate restorative pay rise for NHS staff that reflects the value that society places on their vital work. They must also award recruitment and retention premiums to new entrants and existing staff and provide financial support for those who are studying to become NHS professionals.

NHS staff are ringing the alarm and saying that funding, pay and patient safety are inextricably linked. They are the true heroes. They do not ask for thanks; they do what they do day in, day out without fanfare because they truly care. It is time the Government showed them the respect they deserve.

15:50

[Holly Lynch (Halifax) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Salford and Eccles (Rebecca Long Bailey), who made an incredibly powerful speech.

I do not think I am being dramatic when I say that a genuine sense of fear has set in across the country about being in a position of needing to use the NHS. Almost every family now have a story about how they or, even worse, a loved one have needed to access care and have had a very difficult experience. People’s experiences range from waiting at A&E to waiting for an ambulance, from being unable to get a dentist appointment when they were in pain and urgently needed one to facing a wait years long to see a specialist. One member of my team called up on 25 November and was told, “You’re in luck: there’s been a cancellation at the GP’s, so they’ll book you an appointment—but it’s for a telephone consultation on 20 December.” The chronic pressures in staffing across the board are affecting healthcare in every part of the country.

[Margaret Greenwood]

This afternoon we have heard some horrendous stories about people waiting for ambulances: hideous delays of 16 hours or more for people in pain and sometimes truly tragic circumstances. Does my hon. Friend agree that that shows the abject failure of this Government to provide a health service that we can all be proud of?

[Holly Lynch]

My hon. Friend is absolutely right. Not only is there a massive impact on patient safety and care, with detrimental outcomes for patients, but there is a loss of service to others: while paramedics and ambulances wait outside A&E, there is an impact on care for all the other people who need that provision. My hon. Friend makes a really powerful point.

I want to focus on some key areas of the NHS workforce, starting with midwifery. The chief executive of the Royal College of Midwives, Gill Walton, has told the Health and Social Care Committee that England is more than 2,000 midwives short of the numbers it needs, and the situation is getting worse. The RCM’s analysis shows that midwife numbers fell by a further 331 in the year to November 2022. We need a plan because, as other hon. Members have said, the staffing shortages are driving further staffing shortages. More than half of all midwives surveyed by the RCM said that they were considering leaving their job, with 57% saying that they would leave the NHS in the next year.

In November last year, I joined a March with Midwives rally in Halifax, where midwives held up signs that they had made themselves and that said things like, “I’m a physically and mentally exhausted midwife”, and, “I can’t keep saying sorry for no beds, no midwives, no support and no time”. What really brought home how it is not just about the impact of short staffing on patients and patient safety was the signs that midwives’ children had made themselves. One sign said, “My Mum falls asleep on the driveway after work”. It was made by a girl who told me that she had come out of the house one morning ready for school, only to find that her mum had driven home after a nightshift, pulled on to the driveway and fallen asleep in the car because she was so exhausted. A younger child had made a sign that simply said, “Mummy being late from work equals me being a lonely kid”.

Case studies conducted by the Royal College of Midwives highlighted not just the strain on the service, but the strain in the workforce and their families. A midwife called Julia said:

“We’re reducing the time we give to women, having to close facilities, reduce antenatal education, postnatal visits cut to a minimum. Stretched physically is one thing, you can rest your body eventually when home, but the mind, the mind does not have an easy off switch. The constant unrealistic expectations on maternity staff is damaging their mental health, it’s impacting on the wider service and it’s putting women, babies and families hopes and dreams in danger.”

This is why a Labour Government with a commitment to train 10,000 additional nurses and midwives every year cannot come fast enough.

[Karin Smyth]

My hon. Friend is making some excellent points, particularly about the impact of those exhaustion levels on families. In my speech I spoke about the recruitment of families who looked forward to their jobs and were proud of working in the NHS. That is important to bringing future generations into the health service, and giving encouragement to young people in schools. It is still a fantastic career, but does my hon. Friend agree that helping young people not to be deterred by that negative publicity and helping them through training routes is a crucial way of solving the current workforce problems?

[Holly Lynch]

We have all told stories about the NHS heroes in our constituencies today, but my hon. Friend is right about the need to transform that into an attractive skills plan. Some of the midwives and their children whom I met were extremely proud to be in NHS families. Every member of those families is affected by that shared sense of pride, but also by that shared sense of exhaustion, and there are problems for the whole family when there are problems for the NHS worker. My hon. Friend has made a powerful point.

[Emma Hardy]

As I pointed out in my speech when I was talking about radiotherapy, the reason people are leaving the profession is to do with the work-life balance. It is not just a question of the number of people who are leaving midwifery, but a question of the number of people in midwifery who are reducing their hours to try to achieve that balance. Does my hon. Friend agree that something is seriously amiss when people have not fallen out of love with the job, but are simply finding that they cannot do the job while also maintaining the home life that they need?

[Holly Lynch]

Once again, my hon. Friend is absolutely right, as I know when I meet those children of NHS staff who hold up signs saying, “When my mummy is late home it means that I am a lonely kid”. As other Members have pointed out, when NHS workers are exhausted at the end of a shift but find that the cavalry is not arriving and there is no one to take over, they cannot walk out of their jobs as other people might be able to. They have to stay and deliver patient safety, rather than leaving those patients at risk. Questions about the life-work balance and childcare—who will feed the kids when they get home?—are not easy questions for workers in that position to answer.

We have to transform the experiences of mothers and families using maternity services. Like almost every other parent who has had to use those services in recent years, I can say that it is a massive worry. You are told, “Once your waters have broken and your contractions are this regular, come to the hospital”, but even after that point I kept being asked not to come to the hospital, because there was only one bed left and it might be needed for someone else. That is the last thing you want to hear when you are in labour. Worrying about staffing and bed shortages compounds what is already one of the most stressful experiences that women—indeed, parents—can go through.

Let me now say something about paramedics, and all those working on the frontline of our ambulance services. I have worked closely with paramedics, in particular with the GMB’s union representative, Sarah Kelly, on the Protect the Protectors campaign, and I have spent a day out with paramedics, seeing just how relentless their days are. Analysis carried out by the GMB found that there were 7.9 million calls for an ambulance in 2010-11, but by 2021-22 that had risen to 14 million, a pretty staggering increase of 77%. The monthly handover delays report from the Association of Ambulance Chief Executives reveals that the performance of ambulance services fell to its lowest ever level in October. The report shows that, across the month, 169,000 hours of ambulance crew time were lost due to delays. That meant that paramedics could not answer over 135,000 calls for help. That number represented 23% of ambulance services’ total potential capacity to respond to 999 calls. All three of these metrics are the worst in the NHS’s history.

Staff have balloted for industrial action, and we can see how they do not feel listened to and that they are carrying so much responsibility. My hon. Friend the Member for Ilford North (Wes Streeting) has already made this point powerfully from the Dispatch Box. None of us here in the Chamber today has to face the reality multiple times a day of knowing that, no matter how hard we work, there could be fatal consequences for the vulnerable people we are looking after because the system in which we work is fundamentally failing. We do not carry that burden; we ask the paramedics, and all NHS staff, to carry it.

We know that, in addition to this, too many workers—after making such an exhausting contribution to the NHS—are facing financial hardship for their efforts. Like in midwifery and other areas of the NHS, research indicates that one in 1,000 ambulance workers have left since 2018 to seek a better work-life balance or better pay, or to take early retirement. It is not that workers are asking for more pay for the sake of it; it is because inflation is at 11%, energy bills have gone through the roof and the cost of fuel to enable them to get to work has shot up. The National Institute of Economic and Social Research has predicted that around 30,000 households could see their monthly mortgage repayments become greater than their monthly income in the months ahead. If the Government got a grip of these factors, they would not have so many workers being forced to ask for more pay just to make ends meet. I ask the Government to please speak to workers, to work with their trade unions and to work through their concerns, which are very real.

Turning to NHS dentistry, I presented a petition to the Government on 1 November on access to NHS dental care, signed by 549 people online as well as a number of signatures in hard copy—some are still coming into my office. Like all MPs, I have had so much casework in recent months where local people simply cannot see an NHS dentist. The British Dental Association says that more than 43 million dental appointments were lost between April 2020 and April 2022, including more than 13 million appointments for children.

Dentistry is now the No. 1 issue raised with HealthWatch, with almost 80% of the people who contact the organisation saying that they find it difficult to access dental care. The General Dental Council says that almost a quarter of the population—24%—report having experienced dental pain in the last 12 months. More locally, HealthWatch in Calderdale contacted every dental practice across Calderdale last year to establish whether they were willing to accept new NHS patients, whether they would register a child and whether they were offering routine appointments. Every dental practice told HealthWatch that it could not currently register a new NHS patient of any age. It is the same story.

Data from the British Dental Association reveals that 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. For every dentist leaving the NHS entirely, 10 are reducing their NHS commitment by 25% on average. A BDA survey from May 2022 shows that 75% of dentists plan to reduce the amount of NHS work they do next year, with almost half planning to change career, seek early retirement or enter fully private practice. As in other areas of the NHS, the combination of pressures and remuneration is driving what remains of a depleted workforce away. It is a self-defeating cycle that the Government have to step in to break.

Other Members have made points today about the potential of community pharmacies. Having worked in a pharmacy when I was in the sixth form doing my A-levels, it became clear to me that this was often the longest standing and most trusted relationship that members of the community had with a healthcare professional. The pharmacy was the shopfront that was always open during the pandemic, where people could go and meet somebody who knew them and knew their circumstances. That really is the value of community pharmacies. We know they have the capacity to do so much more, and hon. Members on both sides of the House have spoken about unlocking that potential and relieving some of the pressure on A&E departments and GP surgeries by empowering community pharmacies to deliver the work they are best placed to deliver because of their deep roots in our communities.

Labour has a plan for the NHS. It is costed, comprehensive and will save the NHS. In today’s debate, the Government have not had the humility even to acknowledge that there is a problem in the NHS, never mind having a plan of action. That is why a Labour Government cannot come soon enough.

16:05

[Margaret Greenwood (Wirral West) (Lab)]

It is clear that we have a crisis in NHS staffing. For the very first time in its 106-year history, members of the Royal College of Nursing have voted for strike action in their fight for fair pay and safe staffing. I express my solidarity with them. They do not do this lightly. Consecutive Conservative Governments have brought them to this situation.

Staff shortages are putting immense pressure on the NHS. There were more than 133,000 vacancies in the NHS in England in September 2022, up from around 103,000 the year before. There were more than 47,000 registered nursing vacancies in September, about 8,500 more than in March, and there were more than 9,000 medical staff vacancies in September, over 1,000 more than in March.

We all know things were bad before the pandemic, but an already extremely serious situation has got worse. This staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce we need, and it is leading to very high levels of stress for staff and extraordinarily long waiting lists for patients.

Two weeks ago, I led a Westminster Hall debate on NHS staffing. Numerous organisations provided briefings in advance of that debate, and I will share some of their concerns about staff shortages, the pressures on the NHS and the impact they are having on workers and patients. Their observations reflect the depth of the crisis in the NHS, along with the complexity of medicine and the immense level of expertise in this country. The Government really should listen to them.

Research by the British Medical Association points to a lack of doctors in comparison with other nations. The average number of doctors per 1,000 people in the OECD’s EU nations is 3.7, but England has just 2.9. Meanwhile, Germany has 4.3.

Parkinson’s UK has said:

“People with Parkinson’s are facing huge waiting times for diagnosis, mental health support, check-ups and medication reviews. This is due to critical shortages of NHS staff across England who are available to see people with Parkinson’s. Problems with finding healthcare professionals who understand the condition and accessing the right specialist services have been exacerbated by the pandemic. Waiting times for a consultant after diagnosis are up to two years in some areas.”

The Royal College of Midwives has expressed serious concerns that the NHS in England has 800 fewer midwives than it did at the time of the 2019 general election and that

“midwife numbers are falling in every region of England.”

According to the latest census by the Royal College of Physicians

“52%—more than half—of advertised consultant physician posts were unfilled in 2021. That is the highest rate of unfilled posts since records began, and of the 52%, 74% went unfilled due to a lack of any applicants at all.”

The Royal College of Speech and Language Therapists has said:

“Speech and language therapy services across the entire age range are facing unprecedented demand and there are simply not enough speech and language therapists currently to meet the level of demand.”

Last year’s report by the British Society for Rheumatology found that

“chronic workforce shortages mean departments lack sufficient staff to provide a safe level of care.”

This means

“patients are experiencing progressively worse health, leading to unnecessary disability and pain.”

Cancer Research UK has pointed out that

“critical staff shortages impact all aspects of cancer care”—

I would have thought the Secretary of State would like to listen to what Cancer Research UK has to say. It highlights:

“In 2020-21, £7.1 billion was spent on agency and bank staff to cover gaps in the NHS workforce, an increase of almost £1 billion from an already enormous £6.2 billion spent the year before. This is money that could be spent on training and recruiting full-time equivalent NHS staff, but instead is”—

being used—

“in an attempt to mitigate chronic NHS staff shortages.”

Unison has said it is

“very concerned that NHS services are in a dire state due to there being insufficient staff numbers available to deliver safe patient care.”

It points out:

“While the government has belatedly accepted the need for an independent assessment of the numbers of health professionals needed in future, they repeatedly refused to write such plans into the Health and Care Act 2022, despite a broad coalition of more than 100 healthcare organisations calling for this.”

The TUC is calling on the Government to put in place

“an urgent Retention Package, with a decent pay rise at its heart.”

The 2022 pay award is well below current inflation levels, so it amounts to a real-terms pay cut. The TUC went on to say:

“The 2022 pay uplift needs to be set at a level which will retain existing staff within the NHS”,

is attractive to new recruits,

“and recognises and rewards the skills…of health workers.”

In recent weeks, we have seen announcements of industrial action from other organisations representing NHS workers, including Unite the union, Unison and the GMB. In addition, the Chartered Society of Physiotherapy is balloting members and the British Medical Association will ballot next year. As with the Royal College of Nursing, this is not being done lightly. NHS workers care deeply about patients and the service as a whole, but they can also see that the NHS is at breaking point. It is notable that, in a recent poll of 6,000 adults carried out on behalf of Unite, 73% of respondents supported NHS and care workers receiving pay rises that keep up with the cost of living.

The Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on and planning and delivering a well-resourced, well-staffed NHS, the Conservatives have focused their energy on not one but two major reorganisations of the NHS, designed to open it up to privatisation. This ideological agenda is causing immense suffering to patients and great stress for staff.

The Health and Care Act 2022 provided for the revoking of the national tariff and its replacement with a new NHS payment scheme. The national tariff is a set of rules, prices and guidance that covers the payments made by commissioners to secondary healthcare providers for the provision of NHS services. Engagement on the NHS payment scheme is ongoing, with a statutory consultation due to begin this month. Given the requirement in the Act for NHS England to consult each relevant provider, including private providers, before publishing the scheme, I am very concerned that this may well be a mechanism through which private health companies will have the opportunity to undercut the NHS. If that happens, one inevitable outcome would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector. I ask the Minister to give us an assurance that that will not be used in that way.

As I have said, the Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on planning and delivering a well-resourced, well-staffed NHS, they have focused on a privatisation. In the second reorganisation, they held a consultation, allegedly, when NHS staff were working incredibly hard during the pandemic. It was very unfair to carry out a consultation while the people to be affected most by it were dealing with the worst public health crisis we have seen.

The staffing crisis has been created by the Conservatives on their watch. The comprehensive workforce plan announced in the autumn statement is due to be published next year. It is long overdue and it will need to be backed up by sufficient resources. In the meantime, the Government bear a responsibility in relation to how the NHS fares this winter. They have the opportunity to avert industrial action and should do all in their power to do so. They must support those who work in the service and make sure that NHS workers receive a fair pay rise.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

16:13

[James Murray (Ealing North) (Lab/Co-op)]

There can be no doubt that the NHS is in crisis. We have heard shocking stories today from hon. Members about what their constituents are having to endure. Each and every one of these deeply distressing stories helps to confirm the devastating impact of the Conservatives’ neglect of the NHS. Patients deserve so much better than this Government and everyone who works in the NHS deserves so much better, too, for the invaluable work they do.

We all know that from the experience we have in our constituencies, as we have heard so powerfully today. My hon. Friend the Member for West Ham (Ms Brown) spoke powerfully and in detail about the impact of vacancies in the NHS, particularly in maternity services, in her constituency and the surrounding areas. My hon. Friend the Member for Coventry North West (Taiwo Owatemi) spoke about the role of community pharmacists and the wider struggles that NHS workers face. She was speaking with particular authority, given her background in the NHS before becoming an MP. My hon. Friend the Member for Ilford South (Sam Tarry) spoke about the severe impact of vacancies and exhaustion in nursing after 12 years of the Conservatives.

My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke about the impact that workforce shortages were having, even before the pandemic, on crucial radiotherapy services in her constituency and beyond. My hon. Friend the Member for Streatham (Bell Ribeiro-Addy) spoke about the scale of the crisis that we face in NHS recruitment and retention. My hon. Friend the Member for Leeds East (Richard Burgon) rightly mentioned those shameful attacks by Conservative Ministers on nurses.

My hon. Friend the Member for Bristol South (Karin Smyth) spoke with great experience, having spent three decades working in the NHS, about the growing crisis of retention over the past decade. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) spoke about the NHS crisis and set it in the context of the Government’s unfair decision in the recent autumn statement. My hon. Friend the Member for Halifax (Holly Lynch) gave a wide-ranging and powerful speech that drew attention to the genuine sense of fear among people across the country at the prospect of not being able to access vital NHS services. My hon. Friend the Member for Wirral West (Margaret Greenwood) made it clear that the staffing crisis in the NHS is the failure of 12 years of the Conservatives.

Madam Deputy Speaker, that is the truth. The Conservatives have spent 12 years running down the NHS and letting our economy fall further and further behind, but, make no mistake, this is not inevitable. After 1997, Labour not only grew the economy 1.5 times the rate that the Conservatives subsequently managed, but delivered an NHS to be proud of, and we are proud of our record.

Although the challenges now are even greater than they were in the late ‘90s, if we take office at the next election, we will, again, deliver a modern, sustainable NHS that is fit for the future that we face. We know that, to make the NHS fit for the future, it needs a prescription of reform and sustainable funding from a growing economy. For our economy to grow, we need to start getting our public services back on track, too. As my hon. Friend the shadow Health Secretary set out, one of the first steps that a new Labour Government will take to get the NHS back on track is to deliver a workforce plan that addresses the root cause of the crisis it is in.

Under our plan, we would double the number of medical school places to 15,000 a year. We would double the number of district nurses qualifying each year. We would train 5,000 new health visitors a year and we would create 10,000 more nursing and midwifery clinical placements each year, too—all part of a long-term workforce plan for our NHS.

[Steve Brine]

On the doubling of the number of medical school places, can the hon. Gentleman tell me what the cost of that is, especially as the shadow Chancellor is so handily sitting next to him? It would be helpful for those of us on the Select Committee to put the price tag on that one.

[James Murray]

All the pledges that the Opposition make are fully costed and fully funded. [Interruption.] If the hon. Gentleman waits one second, I will address that point. Today is about political choices. It is not just a political choice of whether we invest in the NHS; it is a political choice of how we pay for it. That is why we have made it clear that, to pay for our NHS workforce expansion plan, Labour would abolish the unfair, outdated non-dom tax status. Non-dom tax status is passed down through people’s fathers and it costs the public purse £3.2 billion a year, while failing to support economic growth in the UK. Under the current arrangements, a small group of high-income people who live in the UK are able to avoid paying tax on their overseas income for up to 15 years. We would abolish that 200-year-old tax loophole and introduce a modern scheme for people who are genuinely living in the UK for short periods. We believe that if a person makes Britain their home, they should pay their taxes here.

[Paul Bristow]

My hon. Friend the Member for Winchester (Steve Brine) asked the hon. Gentleman a very specific question about the exact cost of doubling the number of places at medical school. Is the hon. Gentleman able to confirm the exact cost of that—not the non-dom cost, but the exact cost of doubling the number of medical places?

[James Murray]

I thank the hon. Gentleman for his intervention. I have set out that scrapping the non-dom status would raise £3.2 billion, and that our workforce expansion plan would cost £1.6 billion, so we would be well able to afford that measure from the amount of money that we have raised from scrapping this outdated, unfair tax loophole.

Non-dom status should have no place in our modern tax system. It is unfair. When the Government are making working people pay more tax, it is simply wrong to allow wealthy people with overseas income to continue to benefit from an outdated tax break. It is also bad for UK business: the loophole prevents non-doms from being able to invest their foreign income in the UK, as bringing it here means it becomes liable for UK tax. Abolishing non-dom status would end that barrier to UK investment—and, as I have said, raise £3.2 billion, money we would use to put towards priorities including expanding the NHS workforce.

To be honest, we would have thought abolishing non-dom status, replacing it with a modern system and using the money to strengthen the NHS and economy would be a no-brainer. What is it about this Conservative Government, led by the right hon. Member for Richmond (Yorks) (Rishi Sunak), that makes them so reluctant to close that loophole? Last week, during the rushed debates on the Government’s autumn Finance Bill, I asked Treasury Ministers to confirm whether the Prime Minister had been consulted on the option of abolishing non-dom status and whether it was ever considered as an option for last week’s Finance bill. I also asked whether, when the current Prime Minister was Chancellor, he had ever recused himself from discussions on the matter, for obvious reasons.

I put these questions to Treasury Ministers on three separate occasions last week, but they refused each time even to acknowledge the questions, never mind answer them. For a Minister to overlook a set of questions once might be an oversight, but to ignore them three times looks like something else. Perhaps the Minister will today show that they have nothing to hide by answering the questions I have raised.

In the autumn statement and last week’s Finance Bill, the Chancellor chose to leave non-dom status untouched, while picking the pockets of working people, including nurses, with stealth taxes such as freezing income tax thresholds and pushing up council tax. Today, the Secretary of State for Health only mounted a brief defence of non-dom status; I wonder whether his colleague from the Treasury will, in her closing remarks, repeat some of the defences that Treasury Ministers tried to set out last week.

Last week, Ministers tied themselves in knots trying to find a justification for the £3.2 billion tax break for non-doms. They tried to pretend that the Government's investment relief is working, when only 1% of non-doms invest their overseas income in the UK in any given year, and last week they tried to win praise for ending permanent non-dom status, while keeping quiet about the new loophole they created, which allows people to use trusts to retain non-dom benefits permanently.

The truth is that, unless the Conservatives vote with us today to abolish non-dom status once and for all, the British people will be clear that no amount of reason or common sense will get this Government to come round. The British people need a fresh start and a new Labour Government that would take those fairer choices on tax to support the stronger NHS we so desperately need.

The NHS is an achievement we share together as a country and one that we all have a personal relationship with. We all want to know that when we have medical symptoms, concerns or needs, the NHS will be there for us. We want to know it will be there as a publicly funded service, free at the point of use, able to provide us with the high-quality help we need. That is what I wanted to know in my early 20s, when I started to notice symptoms of what would later be diagnosed as myasthenia gravis, a rare neurological condition that caused muscle weakness throughout my body.

After the best care I could have hoped for from my brilliant consultant and his team and colleagues at the National Hospital for Neurology and Neurosurgery in Queen Square, I have been symptom-free for many years now, but the memory of first feeling those symptoms and then finding my way towards the right treatment sticks with me. I would never want anyone to feel symptoms like mine and not be sure whether the NHS would be there to help.

We all know stories like that. We all need the NHS to diagnose and treat us when we are worried. We all need to be able to turn to the NHS so that we get that treatment in good time. We all connect with the NHS through our own lives and the lives of our family and friends. That is why the NHS matters so much to us all and why we are so determined to deal with the crisis the NHS is facing and to make sure it is ready for the modern challenges we face.

At the heart of our vision for the country are stronger public services and stronger economic growth. We know that getting public services back on track will support a growing economy, which will in turn support modern, sustainable public services. Before us today we have a chance to end the unfair 200-year-old tax loophole, which lets a small number of people avoid tax on overseas income, and use the money saved to fund one of the biggest workforce expansion plans in the history of the NHS. That is the choice in front of us today, and I urge all MPs to do the right thing by backing our plan.

Royal Assent

[Madam Deputy Speaker (Dame Rosie Winterton)]

I have to notify the House, in accordance with the Royal Assent Act 1967, that His Majesty has signified his Royal Assent to the following Acts:

Identity and Language (Northern Ireland) Act 2022

Product Security and Telecommunications Infrastructure Act 2022

Counsellors of State Act 2022

Northern Ireland (Executive Formation etc) Act 2022