NHS: Staff Numbers after Covid-19

Lord Bethell Excerpts

Thursday 4th March 2021 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I am hugely grateful to the noble Lord, Lord Clark of Windermere, for securing this very important debate and I pay tribute to his campaign on this subject. I also thank all noble Lords who have spoken so well in such a short amount of time. There is clearly widespread agreement that building a resilient NHS workforce to meet the future needs of this nation is essential, and I completely agree.

I also echo the thanks of the noble Lord, Lord Clark, for the extraordinary contributions of health and care workers across the UK during the pandemic. It is important that we recognise their extraordinary efforts. With the exceptional success in the UK of the rollout of the vaccines programme, we are at last approaching a time when the worst of the pandemic is over and the NHS can return to its business as usual—caring for the nation and providing world-leading healthcare.

I will say a word about the long-term plan. A £3 billion, one-year package has been announced for 2021-22 as part of the spending review to support the NHS in tackling the impact of Covid-19. This will include £1 billion to address backlogs and tackle the long waiting lists raised by noble Lords, by facilitating up to a million extra checks, scans and additional operations.

As the NHS gets to grips with the backlog of care, it is essential that we continue to change the way we deliver healthcare over the next 10 years. All those who spoke about innovation are absolutely right in that regard. We have a road map to do just this in the NHS long-term plan, which clearly sets out a new service model for the 21st century: more care delivered in the community, digitally enabled primary and outpatient care, and a relentless focus on the health of the local population and reducing health inequalities. I reassure the right reverend Prelate the Bishop of Carlisle that the plan absolutely identifies how we can make better use of early diagnosis and technology potentially to improve preventive care, population health and patient care. This will be supported by new and integrated models of care, as laid out in the NHS Bill.

I shall say a few words about staff retention. To do these things, we need more staff, yes, but critically we need to hold on to those that we already have for longer, help them to recover from the herculean efforts of the pandemic, nurture their skills and enable them to provide the care to patients that drives their efforts. The commitment of staff and the wider impacts of the pandemic mean that the NHS continues to see much stronger retention rates.

Despite that, troubling issues need to be addressed to ensure that dedicated NHS staff have the best possible experience of work. The noble Baroness, Lady Tyler, made an absolutely fair point on the need for a holiday. Our black and minority ethnic staff, in particular, report some of the poorest workplace experiences. I remind the noble Baroness, Lady Thornton, that the NHS people plan sets out exactly the kind of programme that she called for to tackle these issues, and we will continue to strive every day to ensure improvement on that front.

I come to NHS workforce growth and planning. The workforce has increased by over 160,000 already since 2010, an increase of 16%. This growth continues to be a key focus to ensure that we meet the rise in demand for health and care services. The 2020 spending review provided £260 million to continue to grow the NHS workforce and support commitments made in the NHS long-term plan. Nursing is absolutely the most critical component in this vision. I am pleased to report to the noble Lord, Lord Clark, that we are on track to deliver 50,000 more nurses by the end of this Parliament and put the NHS on a trajectory to a sustainable long-term supply in future. The 50,000 commitment is underpinned by a robust delivery programme, which will be achieved through increased domestic and international recruitment, and improved retention. The latest NHS workforce statistics show that nurse numbers have increased by almost 10,600 from almost 289,200 to over 299,700 between December 2019 and December 2020.

To reassure the noble Lord, Lord Clark, and echo the noble Baroness, Lady Bennett, the future domestic pipeline is strong, with UCAS end-of-cycle data showing 25,000 student nurses enrolled on courses in 2020-21. This is a 27% increase. I must say to the noble Baroness, Lady Bennett, that we cannot give everyone a place. As I am sure she knows, the job is highly skilled; it is a very difficult vocation, and it is extremely hard work. Not everyone is suited to it. More recent UCAS data shows unique applicants to nursing and midwifery courses in 2021 have increased dramatically to 48,300, or by 34% compared with last year. I hope that that provides some reassurance to my noble friend Lady Wyld.

On primary care, we are equally committed to growing the workforce and expanding the number of appointments available to patients. This will mean improved access to GP services and bigger teams of staff. On the reservations expressed by the noble Lord, Lord Clark, on the GP model, we are completely open to change: we have already looked very carefully at the independent review partnership model, the GP fellowship scheme and other schemes for GPs. But, with record numbers of GPs being recruited at the moment, it is too early to call time on the successful existing model. We have committed at least an additional £1.5 billion in cash terms for general practice over the next four years for additional staff. We will grow the workforce by 6,000 more doctors and 26,000 more primary care professionals. As of December 2020, there were 438 more full-time equivalent doctors compared with a year before.

Education was raised by many noble Lords. The Government have funded an extra 1,500 undergraduate medical school places per year in England—a rise of 25%. I reassure the noble Lords, Lord Willis and Lord Green, that the number of medical school training places will rise to 7,500 each year. We have also delivered five brand-new medical schools: in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury.

My noble friend Lady Wyld made extremely good points on the importance of perinatal care—a subject in which we share a keen interest.

UCAS data shows that there has been a large increase in the number of applicants to study medicine this year, with almost 5,000 additional applicants compared with 2020.

International recruitment was raised by a number of noble Lords. There is excellent growth in our domestic workforce, but we do still value the workers from all over the world who are playing a leading role in the NHS’s efforts to tackle coronavirus and save lives. We have made £80 million available for the recruitment of overseas nurses and the recruitment of healthcare support workers. Trusts are working hard to fill these nursing positions.

To the noble Lord, Lord Jones, I say that there is nothing ethical about blacklisting healthcare staff from certain countries.

In response to the noble Baroness, Lady Jolly, I say that I do not have the precise number to hand, and I suspect that it is not in the public realm, but I will try to find it and send a note to her. Perhaps I can reassure her that the supply of international nurses wanting to work in the NHS remains strong and, in spite of travel bans in some places, we are seeing more nurses arrive all the time. We have recently published our code of practice for the international recruitment of healthcare professionals, which will ensure that the UK is a world leader in ethical international recruitment and will, I hope, go some way to reassure the noble Lord, Lord Jones.

I reassure my noble friend Lady Altmann that we are also doing more to attract people into social care. We ran a national recruitment campaign across broadcast, digital and social media. The latest phase in the campaign was launched in early February, highlighting the vital role that the social care workforce has played during the pandemic.

On pay, while most pay rises will be paused in the rest of the public sector for 2021-22, the Government recognise, as does the noble Baroness, Lady Thornton, the uniquely challenging impact of Covid-19 on the NHS, so we will continue to provide pay rises for NHS workers, including nurses. For recommendations on pay we are looking to the independent pay review body and will carefully consider its recommendations when we receive them.

A number of noble Lords touched on staff coming back from retirement, which has been raised in previous debates. The noble Lord, Lord Hunt, raised this point. I acknowledge that former healthcare professionals came forward in extraordinary numbers to support the NHS during Covid-19, and we are enormously grateful for their response. Due to the postponement of elective care, the skills and experience of many of these professionals were not deployed at the time—the noble Lord, Lord Hunt, was entirely right to make that point. We need to understand the reasons for that more clearly and to learn lessons for the future—I acknowledge that. In many areas, hospitals preferred to make more use of their existing staff rather than take on unfamiliar staff in a time of pressure, where teams were dependent on trusting relationships to manage the crisis. In future we need to ensure established ongoing relationships at local level, so that when the need comes again—as I am sure it will—this invaluable and public-spirited resource can be quickly deployed to ease pressures.

I am confident that there is the potential to build a permanent legacy through the development of a form of NHS and care reserve, which could help former healthcare professionals remain part of the NHS family, keep their skills up to date and provide additional support in times of pressure. NHS England has been piloting models for an NHS reserve across the regions of England. NHSEI has established seven pilots, one in each region of England. It is drawing on the learning from these pilot sites, the experience of the Bring Back Staff programme and five subject-specific national framework task and finish groups to investigate the best way forward to make additional flexible workforce resources available to the NHS.

I finish by reassuring noble Lords that growing and supporting the NHS workforce is a key priority for this Government. The breadth of our work, which I have only touched on today, should be a testament to the Government’s focus on this essential mission.