Podiatry Workforce and Patient Care

Debate between John McDonnell and Will Quince

Tuesday 20th June 2023 Westminster Hall

[Will Quince]

I thank the hon. Member for his intervention, and I pay tribute to all those who volunteer. This is not the only area in our national health service where volunteers play an important role, but it is important that they are add-on and add value—supporting professionals as opposed to replacing professionals. That is why, at the heart of this debate, we must ensure that we have the podiatry workforce that we need across all four nations—although this debate is specifically focused, understandably, on England.

As the right hon. Member for Hayes and Harlington pointed out, demand for the NHS continues to grow. That is why we have already done a significant amount to invest in the education and training of our future workforce. NHS England—until recently, this was done by Health Education England—has worked extensively to enhance and modernise the podiatry profession. One central factor, which the right hon. Gentleman alluded to, is the development of the foot health standards for the education and training of the foot health support workforce.

However, I am certainly conscious that we have more to do. As part of that process, we developed the podiatry apprenticeship, which is a degree apprenticeship, and supported the implementation of that route into the profession. The numbers are still small, but they are growing, which is great to see. We are keen to promote that route into the profession, not least because it comes with significantly reduced costs for those taking part in the training.

With the promotion of more podiatry apprenticeships, we are offering a more diverse number of training options for students. Furthermore, the learning support fund, which the right hon. Member for Hayes and Harlington pointed to, provides all eligible nursing, midwifery and allied health professional degree students—including podiatrists—with a non-repayable training grant of a minimum of £5,000 per academic year. I say “minimum” because there is an additional hardship element to that of up to £3,000 per year, and additional support is available for childcare, dual-accommodation costs and, where appropriate, travel. The right hon. Gentleman specifically asked for an increase; there are no plans for that at present, but I will of course take that away and have a look at it.

[John McDonnell]

I am here if the Minister needs any assistance in—I was going to say beating—negotiating the Treasury into submission.

I think I mentioned a figure of one podiatrist to every 5,500 people, but I think that I have got that wrong; I think it is actually one to every 55,000 people. That is a huge demand that is placed on podiatrists.

On the Minister’s point regarding the bursary, the British Society of Rheumatology pointed out in one of its briefings that an estimated £15 million a year would be saved on the costs of rheumatoid arthritis if sufficient support was given, particularly through podiatrists. In our argument or discussion with the Treasury, this is therefore an investment that will save money, and we know that directly from the evidence that has been provided.

[Will Quince]

I thank the right hon. Gentleman for his intervention. We are constantly looking at those spend-to-save arguments in areas in the health service where it makes sense to invest. Following this debate, I will gladly look at the podiatry courses and see how over-subscribed or under-subscribed they are, because that may—or may not—help to make the case.

I just spoke about training. Training is important because, of course, we need to see new podiatrists coming in to practise. However, as the right hon. Gentleman mentioned, retention is as important as recruitment. As important as increasing numbers of podiatry trainees is, it is also important to retain the highly qualified, highly skilled, experienced people we already have practising podiatry in the NHS.

I am determined—I know that the Secretary of State is too, because we have had this conversation many a time—to ensure that staff in our NHS feel supported and that the NHS works to ensure that staff feel valued, both by individual organisations and across the system. We are working closely with NHS England—and indeed, through NHS England, with individual trusts—to ensure that that is happening. We regularly meet staff to get a better understanding of how they could better feel valued and supported in their workplace.

The actions of the NHS people plan and the NHS people promise are helping us to build the kind of culture that will go a long way towards helping to support and hold on to dedicated and hard-working colleagues. That very much includes a stronger focus on health and wellbeing and, importantly, on strengthening leadership. People often say that they do not leave trusts or organisations but their managers, so we must make sure that management culture is right. We also know from speaking to staff that it is vital to increase opportunities for flexible working.

One of the right hon. Gentleman’s other asks was on the long-term workforce plan. He is absolutely right. To help us ensure that we have the right numbers of staff with the right skills to transform services and deliver high-quality services that are fit for the future, we have commissioned NHS England to develop a long-term workforce plan for the NHS for the next five, 10 and 15 years.

That high-level workforce plan will look at the mix and number of staff required across the country and will set out a number of actions and reforms that are needed to reduce those supply gaps and, importantly, improve retention. We have committed to publishing that plan shortly—and it will be shortly; I know it is soon. I am very keen to ensure that it is published, because I know how much work NHS England has put into it. In addition, the Chancellor committed that it will be independently verified. We have to make sure that we get it right.

The plan will also include projections for the number of professionals that will be needed, which goes directly to the right hon. Gentleman’s point—it will include podiatrists—and will take full account of improvements in retention and productivity that we plan and hope to see. I thank the right hon. Gentleman for securing this important debate. Through long-term planning, we are ensuring that the NHS has the robust and resilient podiatry workforce that it needs for the future.

The third and final question the right hon. Gentleman posed was on integrated care system guidance relating to allied health professionals. As tempting as it is to make policy on the hoof, that does not sit within my portfolio. I will commit to raise that with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), who is the Minister with responsibility for primary care. I will ask him to write to or meet the right hon. Gentleman.

We are working to ensure that we have the right people with the right skills in the right places and are working to ensure that they are well supported and looked after, so that they in turn can look after those who need our great NHS services and can keep delivering the great standard of care that people need now, but also in the future.

Question put and agreed to.

NHS Strikes

Debate between John McDonnell and Will Quince

Monday 6th February 2023 Commons Chamber

[Will Quince]

Yes, yes—but where exactly is the funding coming from? The hon. Gentleman rightly pushes me on the elective backlog and he rightly pushes me on urgent and emergency care, but every 1% is £700 million that I would have to find from our NHS budget. That is exactly why we have to ensure that the pay review body makes the recommendation from April that is affordable to the NHS and recognises and rewards NHS staff, taking account of recruitment and retention and some of the challenges that we face, but that is fair to taxpayers too. That is why I would encourage the unions to get involved and take part in that pay review body process, so we can get it right.

[John McDonnell (Hayes and Harlington) (Lab)]

The Minister says that opposition is the easiest job. Well, we are hoping he is soon performing it. When he opened his response this afternoon, he said that the Secretary of State was at a Cobra meeting, but would it not be more worthwhile if he negotiated and met the unions themselves? In advance of the next meeting for discussions of wages, maybe he could visit a picket line, because if Conservative Members visit the picket lines, they will find groups of staff—nurses and ambulance workers—who are extremely distressed. I have met many of them who were in tears—tears because they are worried about the patients whom they want to support, but also tears because many of them cannot survive doing the service they want to provide due to their low wages. Unless negotiations are started soon, the Government could do irreparable damage to the national health service, so the Secretary of State needs urgently to leave the Cobra meeting, sit down with the unions and start negotiating.

[Will Quince]

The right hon. Gentleman says that many who work in the NHS are worried about patients: I spend every single day worrying about patients; I spend every single day ensuring the NHS has the resources it needs to provide the level of care and service our constituents rightly expect. I have a budget, and that budget has already taken into consideration a 4.75% on average pay award, with more than 9% for some of the lowest earners. There is an independent pay review body process for a reason; it is only two months away, in April, and I encourage the unions to take part in it. Of course I meet with unions, and of course I do and will meet with nurses and those who work in our NHS. I believe some of the points the right hon. Gentleman makes are correct, and I know those who work in the NHS genuinely want to ensure we are attracting and retaining the very best; that is all the more reason for us to get it right, and the way to get it right is the independent pay review body process.

Draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

Debate between John McDonnell and Will Quince

Tuesday 6th December 2022 General Committees

[Will Quince]

I take your instruction on the passing of notes, Mr Bone; it will not happen again.

Let me answer a number of the points made by the hon. Member for Enfield North, starting with dentistry more generally. Our aim is to ensure that everyone has timely access to NHS dentistry and that dentistry is an appealing career choice. In too many parts of our country, people do not have access to a dentist in the way that they should. In July this year, we announced a package of improvements designed specifically to increase access to dental services across England. That includes better remuneration, guidance on how patients should expect to attend for check-ups, and measures that enable dentists to make better use of staff in their dental teams. Of course, training has to be part of that. Health Education England undertook a three-year review of education and training as part of its 2021 “Advancing Dental Care” review. It is now implementing its four-year dental education review programme to improve recruitment and retention.

The hon. Member for Enfield North rightly raised internationally trained staff, who have been part of our NHS since its inception and continue to play a vital role. We are doing everything we can to invest in growing our domestic workforce and move towards a more sustainable domestic supply. We are training more, retaining more and encouraging staff who have left to return. Having said that, ethical international recruitment remains a key element of achieving our workforce commitments. As the hon. Lady will know, we have recently recommitted to publishing our NHS long-term plan, which is a commission for NHS England. As the Chancellor of the Exchequer set out in the autumn statement, it will be independently verified.

The hon. Member for Coventry North West asked about the performers list. Although it is not directly relevant, Mr Bone, perhaps you will indulge me for one moment, so that I can explain what we are doing. The Department is currently reviewing the National Health Service (Performers Lists) (England) Regulations 2013—that is, the route by which a dentist can become registered to undertake NHS services—to identify where regulatory requirements could be streamlined and simplified while maintaining the high professional standards that ensure patient safety. Any proposed legislative changes will be subject to consultation.

I think the question raised by the right hon. Member for Hayes and Harlington follows a number of emails that we received overnight. These related to the essence of this statutory instrument, which is about closing a loophole. I understand why people are exercised about that. I do not know the exact figures from the consultation, but it is on that exact point where we expect there will have been a higher percentage that we disagreed with, but I am happy to write to the right hon. Member and the Committee with the exact percentages of people who responded in a particular way. On that one point, I will go into detail because, although we recognise the opposition to that proposal, we intend to take forward this amendment in the interests of patient safety.

[John McDonnell]

Will the Minister write to us, with regard to not that specific proposal, but the generality? If we could receive a breakdown on that, that would be really useful. Can he say at this stage—sometimes, inspiration does come via notes—whether the majority were in favour or opposed?

[Will Quince]

My understanding is that, on this particular point around dental care professional registration with the GDC, the majority were opposed. That is the one major point where we disagreed with the consultation response.

If it is helpful to the right hon. Member for Hayes and Harlington, I will explain why. The change introduces fairness and consistency between UK and international routes because UK dentists cannot qualify or apply to join the DCP register using their dentistry qualification in other countries. I make clear that international dentists already registered as DCPs with the GDC will still be able to maintain their registration following these changes, but the amendment will allow the GDC to process applications from dentists to join the register as DCPs that are received until this order comes into force, which is likely to be in the spring. It guarantees that any live DCP title applications—I suspect those are the driver of some of the emails we received last night—submitted before the legislation has passed will still be processed.

Although we recognise that the majority of respondents to the consultation disagreed with the proposals and many argued that international dentists are already qualified, or have enough clinical experience, to work as a DCP, others also highlighted that in some cases overseas qualified dentists work as dental care professionals outside the UK, and in many countries there is not a separate job title for dental care professionals.

However, in the UK the GDC recognises dentists and DCPs as distinct professions; they undertake similar but different tasks. I understand from the GDC that the majority of such applications from international dentists are, in any event, unsuccessful. This reinforces that one of the GDC’s priorities must be on ensuring that only suitably qualified people join the profession here in the UK, in the interest of patient safety.

I hope that my answers to those questions—notwithstanding the exact point on the numbers and percentages of people that objected on particular points, which I will write to the Committee about—will provide sufficient reassurance. The order promotes flexibility for the General Dental Council and the Nursing and Midwifery Council as independent statutory regulators to fulfil their duties in developing and maintaining robust and proportionate international registration processes. I commend the order to the Committee.

Question put and agreed to.