NHS: Staff Numbers after Covid-19

Debate between Baroness Watkins of Tavistock and Lord Clark of Windermere

Thursday 4th March 2021 Grand Committee

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have for the number of National Health Service staff after the COVID-19 pandemic.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

The time limit for this debate is one hour.

[Lord Clark of Windermere (Lab) [V]]

My Lords, I count myself very fortunate to be introducing this Question. This is an invaluable parliamentary means whereby questions can be asked in a more discursive manner than usual and the Minister will listen and, we hope, provide answers. I shall make a couple of obvious general points.

The people of Britain love the NHS, as has been seen during the Covid-19 pandemic, but there were problems prior to the pandemic. I shall make three basic points to set the scene. The NHS is the fifth-largest employer in the world, yet we spend less on health as a percentage of our GDP than almost every other developed country in the world. To compound the situation domestically, there was a shortage of hospital beds prior to the pandemic. Indeed, we are bottom of the Euro league for intensive care beds, with 7.3 beds per 100,000 of population, compared with the best, Germany, with 33.8 beds—what a difference. Thus, prior to the previous cuts we were ill-prepared, and there have been too many cuts under the austerity measures of the early 21st century.

I am certain in my own mind that it was due only to the dedication, brilliance and sacrifice of NHS staff that we got through—and I mean all staff, from the top consultant to the most junior worker. And it has been at tremendous cost to many of them in stress, burnout and mental health challenges. We owe them a tremendous amount and I hope that, in his summing up, the Minister will confirm that this will be recognised when we have won the battle with Covid-19.

I will begin with nurses. Over the years, the Minister must have become tired of me pursuing him on the issue of nurses. I remain concerned. Currently, we are at least 40,000 nurses short. Over the next seven years we will face a shortfall of 108,000 nurses. I must ask the Minister very bluntly: will HMG drastically increase the training of fully qualified nurses? What discussions has he had to ensure the provision of the educational means to do so?

The Royal College of Nursing has conducted surveys and expressed deep concern about the exodus of qualified staff following the pandemic. I share that concern. Will the Minister push ahead and prepare plans to deliver what is necessary to persuade staff that they are valued, and to retain them in the NHS? According to the RCN survey, 35% of nurses are contemplating leaving the profession within the year. Will HMG also provide the NHS with the means to fund occupational health and psychological support, and, if necessary, breaks beyond annual leave?

Nurses are due a pay rise. They are currently worse off than they were a decade ago. Will HMG ensure that the upcoming pay settlement is really meaningful and commensurate with the ever-rising skills of nurses?

I turn now to GPs. If we are to meet the demands and expectations of the general public, we will have to increase the number of doctors, especially GPs. Does the Minister accept that we are still suffering in the training of doctors from the austerity years, over which his party presided? In spite of the modest increases of late to close the gap, does he accept that we face a shortfall of 7,000 GPs in the next two years? As a starter, we need to double the number of medical school places from 7,500 to 15,000 by the end of the decade.

I will move on from numbers to talk about processes. I am concerned about the reluctance of younger practitioners to enter general practice in many parts of the country, leaving it often to only elderly GPs to carry on as single practitioners, supplemented by agencies and bank locums. Do the Government really feel that that is satisfactory and sustainable?

I have a personal problem with this in Windermere at the surgery I am registered with. It operates from a fine purpose-built building but has been without a permanent GP for a number of years. It functions largely due to the skill, experience, training and commitment of nurse practitioners and other staff with specialist skills. Their work is supplemented by local doctors—if they can be persuaded to come. Five years ago, the practice was leased to a private company, OneMedical Group, 80 miles away in Leeds. Last autumn it took advantage of a break clause in its lease and surrendered it, and we are back to square one; it is far from a satisfactory situation.

The key issue is that younger GPs do not wish to buy into practices which might involve hundreds of thousands of pounds. I know a number of practices in Cumbria have had to undertake severe reorganisation and mergers simply to survive. In a letter to the Guardian on 1 March, a GP who has worked in the NHS for over 30 years made the same point, that younger GPs will not buy in to practices. I ask the Minister the most critical question that I am asking today: is this model, requiring such large financial commitments by individuals, suitable to the 21st century? Would the department do a preliminary examination of this problem?

The pandemic has changed so much, and we were found wanting. The years of austerity caused serious damage to our NHS. Only because of the beliefs of our NHS staff are we getting through it. One thing is clear: there is increased demand on our health service. There will have to be much change, including permanently increasing spending. The Government will have to recognise that what may have worked in the past may not do so in future. Models which have been sacrosanct may need to be examined and, if necessary, changed. All this is essential, with a radical White Paper bringing health and social care together. I ask the Minister: are the Government up to it?