NHS and Social Care Workers

Lord Markham Excerpts

Thursday 15th December 2022 Lords Chamber

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

I thank noble Lords. I particularly thank the noble Lord, Lord Allan, for introducing the debate. I look forward to working with him, just as I have enjoyed working with the noble Baroness, Lady Brinton—I hope he does pass muster. I am pleased to respond to this Question for Short Debate on the steps we are taking to support the NHS and social care workforce. We all agree that this is an important issue and that we are all indebted to the people who work tirelessly in our health and care services.

Helping the health and social care workforce manage their mental health and well-being is important and we are committed to helping staff recover. That is why we encourage adult social care providers to invest in mental health and well-being services for their staff. The NHS People Plan and the NHS People Promise set out a comprehensive range of actions to prioritise staff well-being. Boards, leaders, non-exec directors and managers across the NHS are being asked specifically to consider the health and well-being of all their staff as a priority.

As the winter approaches, we know that the system has not rested over the summer. It has been fighting the pandemic for years and we know the drain that that has caused. We know that this winter, with rising cases of Covid and flu, we are putting more pressures on staff, alongside the pressures of the cost of living. We understand those pressures and the need to support the workforce. I will try to answer some of the questions more directly later, but we understand the need for the £500 million fund to help with discharge and workforce support.

We understand the importance of pay in making people feel looked after in what they do. We have accepted the recommendations of the latest independent pay review body in full. I apologise if I made a mistake. I thank the noble Baroness for kindly and gently putting that forward. I will go away and make sure I correct that. I thank her again for the way that was put forward.

We have given more than 1 million non-medical NHS workers a pay rise of at least £1,400 this year, which is equivalent to 4% to 5%. We deeply regret that some feel the need to take industrial action despite that. I will address the specific questions on the pay review and the impact of inflation later.

This is more difficult with care workers, because they are paid by people outside our control, so to speak. Our only hope is that with around 70% of the total payments in this area going to wages, the £2.8 billion and £4.7 billion of additional funding will find their way into the pockets of the people who need it. That is something we will encourage. At the end of the day, if you cannot recruit and motivate a workforce, you will not have the care you need—it is simple.

Alongside looking after our staff, we know that demands on the NHS and social care are increasing. Expanding the workforce has to be a priority. While the numbers are increasing—I will not repeat the statistics I often give out—we know we need to do more in this space.

I may be going a little off-piste here, but I think we can be more creative and flexible in the way we do that. I do not think we are making enough use of apprenticeships and other routes in. I give the example of my mother, who left school at 15 with no qualifications, became a mother with three kids and then, in her 30s, found a way into nursing, first as an SEN—an easy entry path—and then as an SRN. Eventually, she became a midwife and worked for more than 20 years in the health service. We need more of those sorts of routes.

Would it not be great if we had a modular system so that a person working at a dentist’s for two years could qualify as a dental nurse? Instead of working in Wetherspoons for most of their training, their part-time work could be in that profession, using and honing their skills. Would it not be great if a dental nurse who was good at their job knew that their qualifications were part of the way towards becoming a dentist? The team is looking at those modular systems in terms of that flexibility. Training and development is clearly a key part. We are funding more places. In the nurse space, it is not limited. There are more than 70,000 nurses in training as part of that, but clearly the workforce plan needs to set out whether we need to be doing more in this space.

I know that we all welcome the workforce plan and I appreciate the comments from all Members of the House, particularly those opposite, that have for a long time been, quite rightly, that we need to do it. I think that we are all pleased that we are doing it. I completely accept the need to ensure that it is detailed enough to be useful, for want of a better word, and that it needs to be iterative, which will involve other people. I understand that such transparency brings pain, because you have inputs from other people who do not always agree with you. However, you get a better product at the end of it. I am afraid that I cannot give more information on a timetable yet, but I will press for more information.

I accept that inflation makes annual pay reviews more difficult. That is the problem with inflation. We have tried to make exceptions for the nurses in the past. Offering what I hope is a sensible view, as we were saying in the debate yesterday, April is not that long away. If we could expedite a process for the independent pay review body, maybe that would be a sensible way forward, where people feel that there is recognition of the impact that inflation has. Sometimes inflation can mean that you need quicker answers than you might normally expect.

On the social care space and the long-term strategy, I know that Minister Whately is very focused on this, to an amazing degree of detail, and on the impact of that £500 million fund and the results. I accept that it took a while to get that money out, and I partially take the blame. We wanted to ensure that it was going out in the right places, which took a bit more time. I hope and expect it to have been worth that time to ensure that it is targeted in the right place. That £500 million is the first instalment, with up to £2.8 billion next year, particularly in the places that work.

I know that it is a favourite thing for the noble Baroness, Lady Brinton, to bring quotes to the Chamber. I liked this one, and look forward to hearing more, particularly as Aldous Huxley is one of my favourite authors. Clearly, we need to make science and technology work for the NHS and not the other way round. On the point around productivity and the IFS, candidly, a lot of that is down to poor systems and the work that must be done to improve that, as the IFS rightly states. We are looking to address these things through the estates programme and the £10 billion per year capital spend, which is a big increase on previous years. In some areas, productivity has gone backwards, but in many areas it has not. We must understand what conditions are enabling us to increase productivity and how we can use that to help those areas that are not as productive as before to catch up and overtake.

I will try to answer some of the other questions. On pensions, as the noble Lord, Lord Davies, mentioned, there will be a further debate on this in the new year. It is a serious issue that, let us face it, we need a solution for, because we know it means that people are voting with their feet and leaving the service. Clearly, we need a solution to it all. It is something that we are taking seriously, with detailed work. We can discuss it further in the new year.

I have to admire the passion for prevention in the speech from the noble Lord, Lord Bird. One of the pleasures of this job is sharing an office with, or being fairly close to, Chris Whitty, and seeing many of the things that he brings such intelligence and value to. If you speak to him about prevention, he will talk about his concern right now for those people who missed out on heart checks—the 50 to 65 year-old cohort who did not have a heart check during Covid. That is one of the things that needs to be high up the list of the things to address in the prevention agenda.

On the other points, I will need to give the noble Baroness some more detail in writing on the findings of the report she mentioned. Given that we are running out of time, as ever, I will provide a detailed response to anything I have not managed to cover.

In conclusion, I again thank noble Lords. I agree with the sentiment that it would have been nice to have had a lot more contributions, but through this programme of work, including by supporting care employers and commissioners, we are helping to build the robust and resilient workforce the NHS and social care systems need for the future. We are working to ensure that the country has the right people, with the right skills and in the right places, and that they are well supported and looked after so that they can in turn look after those who need our great NHS and social services.