NHS and Social Care Workers

Baroness Merron Excerpts

Thursday 15th December 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it is a pleasure, as always, to follow the noble Lord, Lord Bird, who speaks as he finds. I congratulate the noble Lord, Lord Allan, on bringing this important debate to your Lordships’ House at such a crucial time. Just this week, the Institute for Fiscal Studies published a report that found that, even though the NHS has more staff on the payroll today than it did in 2019—something I am sure the Minister will want to remind us about—it is, however, treating fewer patients and backlogs are at a record high. I hope the Minister will offer some explanations as to why this is so when he comes to speak.

We know there is a recruitment and retention crisis across the NHS and social care sector, and on the day, as noble Lords have referred to, that nurses are taking unprecedented industrial action, it is worth reflecting on Health Foundation estimates that have found that, at the current rate of exodus from the workforce, by 2030-31 there will be a shortfall of 140,600 full-time nurses. On the point of nurses’ pay, which has been raised today by noble Lords including my noble friend Lord Davies, I raise with the Minister his reply TO a question I put yesterday, when he said:

“we have always followed the recommendations of the independent pay review body, as Governments of all colours have done since 1984.”—[Official Report, 14/12/22; col. 664.]

Will he review this assertion and come back to the House? To raise just one example, Chancellor George Osborne took the decision to override the public review body’s recommendation and put a freeze on all public sector pay. I look forward to hearing from the Minister on this point.

More broadly, with health and care staff well-being at an all-time low, and bearing in mind that the NHS lost more than 500,000 days to poor mental health in August alone, and the comments of the noble Lord, Lord Bird, about the importance of the prevention of ill health—something I very much agree with—how will the Government seek to tackle the root causes of absence due to poor mental health in our NHS and social care sector?

As the noble Lord, Lord Allan, and other noble Lords have said, for the past two years Ministers have promised us that a workforce strategy is coming. When will that actually be before us? As my noble friend Lord Davies reminded us, the Minister’s predecessor, the noble Lord, Lord Kamall, repeatedly promised, when we were discussing the Health and Care Act, that work was under way, it was all in hand and we did not need legislation to make it happen. Indeed, the Minister himself has repeatedly promised that the workforce plan will be coming soon, so perhaps we can hear some more facts. When will we know the timetable for publication and implementation? Will there be a formal consultation process? I know the Minister will understand that commissioners need to plan, and staff and patients need reassurance. So, when will this House and stakeholders see the timelines? How comprehensive will the plan be and, most importantly of all, will it be costed and fully funded? It really is time that we had some answers and some concrete dates for publication.

The two pillars of health and social care are inextricably linked. Social care is not just an add-on to NHS workforce needs, as we see from these alarming figures: there are 13,500 people who are in hospital as we speak and medically fit to leave but cannot be discharged, because of the lack of home and community support, particularly in domiciliary and care homes. We know that we have a problem before us. The backlog of social care assessments, estimated by ADASS at 500,000, means delayed assessments for people in need and their carers, and not enough funding or staffing to carry out these assessments or to ensure that the right support is available and can be provided and delivered. This means that people are taking up bed spaces and are in the wrong place, when they should be in their homes and in the community.

Worryingly, the latest NHS figures show that over 145,000 people in England have died while waiting for social care over the past five years. This is a very bad state of affairs, so can the Minister say why the £500 million promised some time ago to help support hospital discharge is being paid out only this month and next? As I and other noble Lords have repeatedly raised in this Chamber, why has there been delay when there is such an imperative for immediate action?

We know that care workers are paid poverty wages and leaving in droves; there are currently 165,000 vacancies in the social care sector. How will the Minister be encouraging people to join the sector? Will there be encouragement for existing care workers to stay when they face a lack of decent standards, fair pay and proper training?

On the matter of social care, I take this opportunity to commend the excellent report from your Lordships’ special Adult Social Care Committee, so ably chaired by my noble friend Lady Andrews. I hope the Minister will read the report carefully, if he has not done so already, as we will be pressing strongly for a full debate in your Lordships’ House as urgently as possible in the new year. When will the Government’s response be ready and published?

The report warns that the continued invisibility of the adult social care sector is damaging both to people who need social care and to the unpaid carers who provide care at a time of increasing need, rising costs and a shrinking workforce. There is also the failure of improved carer support and payment for vital care workers. If only all these absences could be put right, they could be the key to getting the extra staffing in place that is so desperately needed.

I want to ask the Minister about another authoritative report, which was actually commissioned by the Government. It is an academic research paper from the independent think tank the King’s Fund on tackling the NHS’s 7 million—the number who are waiting for care. This is a devasting report, warning that a “decade of neglect” by successive Conservative Administrations has weakened the NHS to the point that it will not be able to tackle the backlog. The King’s Fund reports that years of denying funding to the health service and the failure to address its growing workforce crisis has left it with too few staff, too little equipment and too many outdated and poorly maintained buildings to perform the amount of work that is needed. How do the Government respond to the findings of the very report that they commissioned?

Finally, just yesterday, 33 months after the World Health Organization declared Covid-19 to be a pandemic, the Guardian newspaper spent 33 hours inside the NHS, reporting from inside a hospital, an ambulance service, a pharmacy and a GP surgery. When responding to what turned out to be yet another exposé of how bad 33 hours on the front line of the NHS can be, the Royal College of Emergency Medicine’s president said that the single biggest issue exposed

“was the struggle to discharge medically fit patients”.

When we hear this from the lead emergency medicine doctor in the country—a cry for urgent action to bring reinforcements to the creaking health and care workforce—how will the Minister respond to that call?