Steve Brine
Yes. There is a part of the workforce plan, which the Select Committee discussed a little yesterday, which talks about how, every year, every member of staff should have a conversation with their employers about their pension arrangements and mental health and wellbeing. That is fantastic. I am sceptical as to how it is remotely possible in an organisation of this size. That does not mean that I do not think the ambition is right—I think that it is right—but it would be helpful to the House if the Minister touched on that in her wind-up.
The other point I make to my right hon. Friend, which I will also make later in my speech, is that we must remember that there are NHS employers, and ultimately the Government are the employer in the widest possible sense, but the direct employer when it comes to hospitals is the trusts, and they have a big role to play in retention and in workforce health and wellbeing. We sometimes duck away from saying that, but I say that here in the House as well as privately to the chief executive of my trust.
I am encouraged by the emphasis that the workforce plan places on prevention, which everybody knows is one of my great passions in life and politics. That will clearly be crucial, given the supply and demand challenges facing the health service at the moment. Prevention is, as colleagues know, a subject dear and close to the work of the Select Committee: we have launched a major inquiry into the prevention of ill health, with 10 work- streams. We have already done the vaccination workstream and have moved on to the healthy places—home and work—workstream. Details of that are available on the Health and Social Care Committee’s website.
Let me turn to some of the specifics in the Committee’s report and what action the Government have taken. One of our key recommendations was that
“the number of medical school places in the UK should be increased by 5,000 from around 9,500 per year to 14,500.”
The plan does that: it doubles medical school training places in England to 15,000 by 2031-32, which is extremely welcome. As I said to the Prime Minister last week at the Liaison Committee, I hope it is possible to make some of those new places available before September 2025, as it says in the plan. However, with a UCAS deadline of mid-October for a September 2024 start, that looks extremely challenging. We discussed that yesterday at the Select Committee. An update from the Minister on that would be welcome.
Mr Robin Walker (Worcester) (Con)
I congratulate my hon. Friend on his report. On the issue of making places available, the report talks about the 2018 to 2020 university cohort and the great success of those new university medical schools. The Government’s response echoes that. The university medical schools approved by the GMC since currently have no funded places, though they are open and are receiving students. Does he agree that it would be very welcome if there were some funded places available in those three new medical schools by the earlier deadline that he has suggested?
Steve Brine
I thank the Chair of the Education Committee for being a guest at yesterday’s session with the medical director of NHS England in our workforce special. He is right. The Prime Minister told me at the Liaison Committee, and the medical director said yesterday, that it will take time to scale up. Yesterday, the GMC chief executive talked about training capacity in scaling up the medical places. That is right and needs to be done. However, where the medical schools are ready—even with fairly modest numbers—for September ’24, it would be an incredibly good signal of intent from the Government to allow them to start then. The money is front-loaded, so the fiscal cycle should allow that to happen. Knowing my hon. Friend, he will not let this one go. I thank him for raising it.
Mr Robin Walker (Worcester) (Con)
It is a pleasure to speak in such a very well-informed debate. I thank my hon. Friend the Member for Winchester (Steve Brine), who chairs the Health Committee, for inviting me to guest with the Committee on the issues of the long-term workforce plan. I think in this, as in many other areas, there is a great deal of crossover between the work that we do on the Education Committee and the work that he does in the health space.
I join my hon. Friend in welcoming today’s announcement about the public service pay negotiations. It is very welcome news that the education unions have suspended strikes. I join him in urging the health unions to look very carefully at the offer on the table to try to do the same.
I want to raise a few points in this debate, and the first is not related to the meeting we had yesterday, nor necessarily to the main theme of the workforce plan, but it has come up through my work on the Education Committee: the pressing and urgent need to ensure that when we look at workforce, we include child and adolescent mental health services, and the resources and people available in that space. I have spoken to people at my health and care trust in Worcestershire, who interestingly told me that they feel that they are quite well resourced and have the relevant people to meet adult mental health needs, but that there is further work to be done to make sure they can adequately meet child and adolescent mental health needs. Everything I see from the school sector—including some pressures we are looking at as part of our inquiry into recruitment and retention for the teaching workforce—makes it clear that the pressing mental health pressure on schools is a big part of the challenge. Anything the Minister and the workforce plan can do to address that would be extremely welcome.
Let me turn to the very interesting Committee meeting I attended yesterday, which demonstrated the great achievement of the Health Committee, under its previous and current Chairs, in pressing for a long-term workforce plan. That is something to be celebrated, and its shows the role of this House and its cross-party Select Committees, including when it came to the weightiness of the document we were scrutinising. We heard some interesting and useful evidence about the recruitment challenge and the retention piece. I share the concerns of my hon. Friend the Member for Winchester, echoing the evidence that was given to the Committee, that there is more work to do on retention and that it will require a great determination from the NHS and Ministers to address those issues in the long run.
We also heard plenty of evidence—this has also been made clear to me on a local level—that recruitment, training and upskilling the workforce can play a key role in inspiring senior doctors to stay in and play their part in bringing forward the next generation. It was interesting to hear evidence from the General Medical Council and GPs about the benefits of those doctors being able to play a part in training the next generation. I have heard the same from many doctors within the Worcestershire Acute Hospitals NHS Trust and in our local primary care services in Worcestershire. It is one reason why we have a unanimous view from all the trusts across Worcestershire, Herefordshire, Gloucestershire and Dudley that they want to see a medical school up and running, training local students in Worcester, where we have a university that the Department values and recognises, to the extent that it has been the fastest growing nurse training university in the country over a number of years, and which the GMC has now approved to have a medical school—so far, so good; that is extremely welcome. I am grateful to the NHS and to Ministers for all the work that has gone into getting to that stage. We do, however, face a challenge.
My medical school, the Three Counties Medical School at Worcester, which serves a very large area of the country, is opening in September. It is bringing in students and has uniquely managed to find funding to support domestic students to start their medical training without funded places allocated by what used to be Health Education England and is now part of NHS England. The challenge is that the funding is finite. It has enough funding—which has been raised locally from local health trusts and charitable donations—to support a cohort of 20 students to start this September and to take them all the way through their training at the university, and hopefully onwards into the NHS.
Clearly, 20 students is not a large enough cohort to sustain a medical school, so alongside those 20 students in the first intake, there will be 28 international students. The evidence we heard yesterday was interesting on this point. I think we all recognise, and the report that the Select Committee published recognises, the benefit of international recruitment to the NHS. We absolutely want to attract talent, but we also need to recognise—as per the many arguments I have as Chair of the Education Committee when it comes to international students in general—that the majority of international students do leave; they do not necessarily stay and work long term in the NHS.
If we want to solve the recruitment and retention problem in the long run, we need to train more of our own doctors. We need to train those doctors locally. In health, just as in teaching, many people who train in a particular area are likely to stay in that area and pursue their careers there. That is also something that has been put to me over many years by my local trust and my local GPs as a reason to have a three counties medical school in Worcestershire.
I am very grateful for the support that the NHS and colleagues on the Front Bench have provided over the years in marching us up the hill to a position where the building is there, the university will be opening that medical school this year and the first students will be starting. That is fantastic.
My concern, and it is a concern shared by many colleagues—six Worcestershire MPs wrote to the Health Secretary last week about it—is that where the long-term plan, which is extremely welcome in most respects, sets out the plan to double medical training places, it carries the line:
“The first new medical school places will be available from September 2025.”
The three universities that have been given the go-ahead to host a medical school—Worcester, Brunel and Chester—have not yet had the opportunity to bid for funding places, so that date is frustrating. It means that, after the first year’s intake of locally trained domestic students at the Three Counties Medical School, we have the slightly bizarre potential for the following year’s intake to be entirely international students. I hope the NHS and Ministers can avert that, because it does not make sense from either a value for money or a long-term workforce planning perspective.
I appreciate that I did not give my hon. Friend the Minister advance notice of my intention to speak in this debate, so I do not expect her to be able to answer all my questions. However, I ask her to take this issue away and ensure that the Health Secretary looks very carefully at the letter he has received from all the Worcestershire MPs. I understand that the University of Worcester will also be writing to NHS England to make the case for additional funded places this year—that would be wonderful, but I appreciate that it would be very difficult—and for an allocation of funded places next year.
That is certainly something worth considering. It would help with recruitment, with retention and with some of the challenges that our local health service in Worcestershire has wrestled with for a long time—challenges that I am well aware of, having spoken to trust leaders and doctors in all areas of the NHS. Not only would it benefit us in Worcestershire, but it has the support and the placements are already there. That is crucial, because I understand the reasoning given in the NHS workforce plan is that the Government and the NHS need time to work out where the placements are and where they are required.
It is already clear that there are well over 100 placements available across Worcestershire, Gloucestershire, Dudley and Herefordshire for the medics when they come out of that training, so that problem is solved. It is already a four-year, graduate entry course, so the problem of long courses and things taking too long is also solved. I encourage colleagues on the Front Bench to engage with the request and see whether we can make the workforce plan even better by getting those funded places going at the universities that the General Medical Council has already determined are ready to go, to help meet the workforce challenge.
One other thing I would say, having listened to my hon. Friend the Member for Winchester and some of the debate yesterday on the Select Committee, is that no single Department has a monopoly on wisdom. As Select Committees, we are there not only to challenge and to criticise, but to welcome things when they go right. I was quite struck by the discussion of the importance of retaining trainers and the pressures currently facing them in the NHS, which the GMC raised concerns about.
We face a similar challenge in the education space, and the early career framework, designed to support teachers starting their careers in schools, is a very interesting model to look at—particularly when we look at the importance of mentoring and, for teachers, off-timetable hours to get that mentoring. There may be similar things that could be designed into the NHS; I would not claim to be any kind of an expert on that, but it is worth looking to see whether there are elements of that model that could even further strengthen the very welcome NHS long-term workforce plan.
The Minister for Social Care (Helen Whately)
My grandfather was a doctor, my mother was a doctor, my father was a surgeon and my aunt a nurse, so when I think of the NHS, I do not picture a hospital or an ambulance; I picture the people—the doctors, nurses, pathologists, radiologists, physios, healthcare assistants, porters and all the other people who make the NHS what it is. The NHS is its workforce, and the same is true for social care. Life is made possible for hundreds of thousands of people thanks to the hard work, skills and compassion of social workers, nurses, care workers, care home managers and all the other people who work in social care. That is why I welcome this chance to talk about our health and social care workforce.
I thank my hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, for his comments and for all his and his Committee’s work on their report. In the Government’s response to that report, we were right behind the key recommendation to publish workforce projections, and last week we put that into practice when we published the NHS long-term workforce plan. It is an ambitious plan to train many thousands more doctors, nurses and other health professionals; retain more of their talent and experience; and reform how they train and work to secure the future of the NHS, backed by an investment of £2.4 billion. I will not try to set out everything in that plan this afternoon, but I will share some of the highlights and respond to the points made by my hon. Friend the Member for Winchester and other hon. Members.
In brief, the plan forecasts the increase needed in the NHS workforce between now and 2037, and sets out how we will expand the numbers of doctors, nurses and other health professionals that we train. We will double the number of medical school places, boost the number of GP training places by 50%, increase the number of adult nurse training places by over 90%, and expand the number of dentists we train by 40%. We will widen the talent we bring into the NHS by increasing the number of staff trained as apprentices from 7%, as it is now, to 22% by 2032. That will give more people the opportunity to earn as they learn, widening access to healthcare careers to more people from different backgrounds.
However, as hon. Members have highlighted, the NHS is already full of talented people whose skills we want to retain. Of course, some people will always want to move on to new things or indeed retire, but the NHS can and must do better at retention. That is why we made retention an integral pillar of the long-term workforce plan. The NHS is the UK’s largest employer, and it should set a real example in how it cares for its staff. As the plan says, the NHS will do more to support people throughout their careers, increase opportunities to work flexibly, and look after its workforce’s own health and wellbeing.
My right hon. Friend the Member for Wokingham (John Redwood) spoke about the importance of individual trusts as employers, and the importance of their leaders and managers to staff retention. I very much agree with him about that—I have spoken about it previously in this House, probably as a Back Bencher. How well people are led and managed is probably the biggest determinant of their experience at work, and is therefore a big factor in retention. I would flag to my right hon. Friend that the Messenger review, which I expect he is familiar with, is excellent in this area, and the long-term workforce plan references that review’s recommendations. Taking them forward will be an important part of the plan.
I should also mention pay. Pay is not the only factor affecting recruitment and retention—in my many years of talking to NHS staff, I have heard far more often that having enough colleagues on their team is arguably the most important thing—but it does matter. NHS staff should be fairly rewarded for the work they do. That is why we listened and reached agreement on pay for staff on “Agenda for Change” contracts. Under that deal, over 1 million NHS staff, including nurses, paramedics, midwives and porters, have received a 5% pay rise and extra one-off payments. In addition, as we announced today, the Government have accepted the recommendations of the doctors’ and dentists’ remuneration body for this year in full.
We should not forget that the NHS pension scheme is one of the best that can be found, and we have made it more flexible to make the most of the experience of staff who are particularly close to retirement. Since April, former NHS staff claiming NHS pension scheme benefits can return to work and rejoin the scheme, and from October we will introduce a partial retirement option that gives more flexibilities to staff, meaning that patients will benefit from their skills for longer. We have already acted on the tax treatment of pensions, which we know is a factor in the decision of some doctors and other NHS staff to retire early or reduce their hours. My hon. Friend the Member for Winchester referred to that as the BMA’s No. 1 ask.
The final part of the plan I will mention is reform, because as care changes, so must how we work and, indeed, how we train staff. That is why the plan includes reforms to training, such as increasing the number of apprentices, which I mentioned; increasing the focus on generalist skills alongside specialisms; increasing the share of training in settings outside of hospitals, such as GP surgeries; adopting more blended learning and the use of simulation; and making sure that we get the right duration of training programmes. When it comes to how people work in the NHS, the places that people receive care are changing, with more care outside of hospital and closer to home. As such, the plan envisions a faster rate of increase in the number of staff working outside of hospitals, with the mental health workforce growing fastest, followed by community and primary care. In fact, over the period of the plan, the NHS community workforce is planned to double.
The way people work will also change, with staff working more in integrated teams coming together from different parts of the NHS and, indeed, together with social care. Joining up care is better for patients and their families. It is more effective, but also more efficient.
On productivity, all of this will be supported by new technology. We will use advances in technology in how we train and in how people work. We will use technology such as AI to support clinicians, increase efficiency and improve patient care, so giving staff the gift of time—time to spend with patients.
Equally important in our future health and care system is our social care workforce. As my hon. Friend the Member for Winchester said, this is indeed something I am passionate about. I have heard many calls, including today, for a social care workforce plan. The good news is that we are well under way with substantial social care workforce reforms. They were first set out in the White Paper, “People at the Heart of Care”, and then described in more detail in our next steps plan published in April. We are investing £250 million in reforming care as a career, with a new care qualification, specialist training courses for experienced care workers and a new career structure for care workers to support career progression.
Those reforms build on the work we are already doing to build the social care workforce, with record funding available for local authorities to spend on social care—up to £7.5 billion announced in the autumn Budget—which, through the fees local authorities pay, supports care providers to pay their staff better in turn. The reforms also build on our introduction of Care Quality Commission assurance of local authorities’ care duties and our introduction of the care worker visa, so that care providers can draw on international recruitment.
On that point, I will pick up on the intervention made by the hon. Member for St Albans (Daisy Cooper) on the question of exploitation of international recruits. I think that is very serious, and I am very concerned about it. I say that against the backdrop that, as we know from the data from Skills for Care, the number of care workforce vacancies is falling—that very good news was published yesterday—coupled with what I hear from the many care providers I speak to, which is that international recruitment is really helping fill vacancies and meet the care needs of our society.
In general, I know that care providers are working very hard to support the international workforce they are recruiting, but I am very disappointed that we have heard stories of exploitation at a minority of care providers. I do not want anyone working in health or social care to be exploited. That is why we have provided guidance to people who are receiving a care worker visa on their employment rights and how to seek help. We are also funding local support to be provided to international recruits into social care, and we are working across Government—including my Department, working particularly with the Home Office—on tackling exploitation.
All in all, I would say that what we are doing to support the social care workforce is working. The number of care vacancies is falling, retention is improving and care is on the path to getting the recognition it deserves.
In closing, I thank the Chair of the Health and Social Care Committee for welcoming the NHS long-term workforce plan. I was very glad to hear him say that many boxes had been ticked by the plan. I hope my response has provided him and other hon. Members with further assurance. The NHS long-term workforce plan is historic in its ambition to recruit, retain and reform the NHS workforce. Our social care workforce reforms are also ambitious to make care work a profession that gets the recognition it deserves. The workforce are the heart of our national health service and social care. All that skill, compassion and dedication is essential to the lives of people up and down the country, and that is why we are looking and planning ahead to secure the future of our health and social care system.
Madam Deputy Speaker (Dame Eleanor Laing)
To conclude the debate, I call Steve Brine.