NHS and Social Care Workers

Lord Allan of Hallam Excerpts

Thursday 15th December 2022 Lords Chamber

Asked by

[Lord Allan of Hallam]

To ask His Majesty’s Government what steps they are taking to support public sector workers in the NHS and the social care sectors, given reports of staff shortages and the effects of inflation on NHS and care budgets.

[Lord Allan of Hallam (LD)]

My Lords, it is clearly very timely that we are able to have this debate today, when the concerns of staff in the NHS are making the headlines. It follows a series of exchanges on related questions during the week. It may appear to the Minister that I am acting as something of an understudy to my noble friend Lady Brinton. If so, that is a correct impression as I hope to take over her position as the Front-Bench spokesperson from the new year, assuming that I pass muster today and am not fired before I start the job. Before I get on to my substantive remarks, I should declare a non-financial interest as a director of a not-for-profit called the Centre for Public Data, as I will touch on relevant issues during my comments.

I will start by talking about nurses’ pay. I will not rehash the arguments we have had through the week. The Minister has made his case for leaving decisions to the independent NHS Pay Review Body—I have read its report and it is certainly very thorough—but I ask him to reflect on whether this process works at a time of extraordinary inflation. I think it is correct to say that inflation is now higher than at any time during the review body’s existence; the last time we were close to this was in the early 1990s.

The Minister has argued that nurses can make their case for a rise that reflects the inflation we have had this year, during the next review process that will start in early 2023. That may indeed, and we hope it will, lead to a meaningful uplift in pay for 2023-24, but it will still leave nurses facing huge increases in the cost of living now, with the next award still some way off.

In a normal year of 2% or 3% inflation, people can carry those increased costs in the expectation of a later pay rise, but that will clearly be much harder for them when price rises are in the double digits and there is no prospect that they will come down across the board. It seems reasonable to look at whether the independent pay review process needs a mechanism that can be triggered in such exceptional circumstances; otherwise, the risk is that staff will feel that they cannot wait for pay to catch up with prices, that they will leave the service and that this will make the staff shortages that are the subject of this debate even worse. As staff shortages get worse, conditions get worse for those who remain.

On the social care side of the equation, I know that the Minister is acutely aware of the knock-on effects of there being too few places in social care for people who should be coming out of hospital. We have discussed that in Questions about the ambulance crisis—another thing that is coming to a head over the next few weeks and months.

It is just over a year since the Government published their strategy for reforming social care on 10 December 2021, but since then we have had two new Prime Ministers and seen major planks of that strategy jettisoned along the way. Yet the problems remain acute and are in need of long-term reform and commitments, just as they were in 2021.

I hope the Minister can shed more light today on how the Government intend to ensure that there are sufficient social care places, and especially how they can do this when local authority budgets are being squeezed and the care home providers face increased costs, all of which tends towards fewer rather than more social care places being available. The Health and Social Care Committee in another place estimated that we will need another 490,000 social care jobs by the early 2030s—all this while we are not even filling the current vacancies.

A key further element in the Government’s approach to improving NHS staffing is their new commitment to publish a long-term workforce plan. This has been widely welcomed, particularly the fact that the Government have committed to it being independently verified.

In that context, I encourage the Minister to consider two aspects of the plan in order to make it as useful as possible. First, it should be as rich and granular as possible in the data it provides on the workforce, so that groups who are interested in particular conditions can see what is happening in their area of interest. For example, Parkinson’s UK has been in touch, flagging that it finds it hard to understand the level of filled and vacant posts for staff specialising in the care of people with Parkinson’s. There is current data available from NHS Digital, but it does not have the granularity needed. It is a common complaint that, once you aggregate data or spread things out in averages, you often lose sight of the most important information. Knowing that there is a 10% average vacancy rate in a particular region is not especially helpful if there is a 30% vacancy rate in the area of concern. I hope the Minister is able to commit, in that process of workforce planning, to publishing as much granular data as possible.

Secondly, it is important that full datasets are made publicly available and regularly updated for that independent scrutiny to take place. The more that people are able to look at the data, the more robust the plan will become. NHS Digital has been publishing useful staffing data and releasing this under the open government licence, so that other people can reuse it. This model should be further developed as part of the workforce strategy, adding the projections that the Government are going to make and any other data that is being collected and used within the strategy. Transparency of this kind can be painful for a Government as people will query or challenge their data and models, but that pain will lead to improvement over time.

The final area I want to raise in this short debate is the tools that we provide to NHS and social care staff. This is a particular passion of mine, as I spent several happy years working for the NHS in the early part of my career, implementing information technology systems. Back then, we were plagued by major IT system failures—none of the systems I built were in that category, I might add. An excuse often used was that the size and scale of the NHS meant that it needed bigger and more complex systems than anyone else’s.

Fast-forward to 2022, and we can see that many services are operating at much greater scale than the NHS is today, and they are using tools that are fast and extremely user-friendly. When done well, IT systems make life easier for workers but, when done badly, they add to their stress and perceived workload. There are still too many instances of this latter effect in the NHS. In her article in the Guardian last week, Tara Porter described how poor IT meant that she ended up seeing fewer, not more, patients. This was a significant factor in the decision that she took to leave the NHS as a psychologist, after more than two decades working in the service.

I venture to quote Aldous Huxley in his 1946 introduction to Brave New World. He called for a world in which:

“Science and technology would be used as though, like the Sabbath, they had been made for man, not … as though man were to be adapted and enslaved to them.”


This maxim is well worth bearing in mind as we rightly continue to introduce new technology into health and social care. It should work for staff and patients, making their lives easier and improving outcomes; they should not end up feeling like they are working for the machines.

To conclude, I hope the Minister can reflect on the genuine problem of pay rises lagging behind living costs in times of extraordinary inflation. I would like to hear more about the Government’s current thinking on the long-term strategy for social care, after the recent chopping and changing we have seen since it was published. I hope that he can assure us that rich data will be made publicly available through the new workforce strategy so that others can independently verify it, and indeed do their own modelling. I do not expect him to have any quick fixes on the information technology solutions as this is such a long-running saga within the health service, but I look forward to engaging with him on this and other issues over the coming months.