Health and Care Bill

Lord Turnberg Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I draw attention to my previous career as a physician in various guises. Much more importantly, I welcome the noble Lord, Lord Stevens, and congratulate him on his maiden speech.

All Governments think they know what is best for the country and its population, and nowhere is that more obvious than in this Bill. It is full of valuable ideas and aspirations, which are undoubtedly welcome, but those aspirations are entirely dependent on two critical preconditions: first, stopping the damaging loss of clinical staff and, secondly, the rapid repair of the serious deficiencies in social care. That we have too few nurses and doctors in hospital and in general practice is obvious to anyone, and no one denies that we need a workforce plan for the future. Even though we know that similar plans have tended to be somewhat inaccurate in the past, we should make it a duty to have regular assessments of need every two years, as was called for in the other place.

But now the immediate problem is not so much recruitment but an unprecedented rate of loss of staff. There is a big hole in the bucket as staff have become overworked, frustrated and, far too often, at their wits’ end. Last year, we stood in the street and clapped our NHS staff in, but now, frankly, too many feel clapped out, so it is hardly surprising that nurses and doctors are tempted to leave the service. The average age of physicians retiring is now 58, according to the Royal College of Physicians, when it was 62 just two years ago. What a waste—and it is not helped by the ridiculous pension restrictions that mean the longer consultants continue to work, the more their pension is reduced. At the same time, nurses and support workers are too often in despair and GPs find themselves unable to cope with their growing workload.

Will the Minister now focus more on filling the hole than trying only to fill the bucket from the top? Will he consider new ways in which we can encourage retention: reducing non-clinical bureaucratic duties; introducing more attractive options during a clinical career; offering opportunities for nurses and doctors to come back into the service after retirement, perhaps into part-time sessional work; and sorting out the crazy rule on pensions that is such a disincentive to doctors? There is much that can be done now, through much more emphasis on retaining the workforce we have and on the return of those who have left.

I turn now to social care, which is in such a sorry state. Our patients in the NHS suffer too. According to the Royal College of Physicians, about 25% of medical beds are occupied by patients who would be much better off at home but who cannot get there. That is a quarter of beds used up when we desperately need more beds.

Of course, the White Paper on social care is a welcome step forward and, again, it is full of aspirations for the care workers on whom the service is entirely dependent. They do a tremendous job, and they deserve all the respect that we can give them, just as they respect those for whom they care. But it is clear that we do not give them that respect. It is not much wonder that they feel unappreciated, so that sickness and turnover rates are high, or that 42,000 care workers left the service in the last six months, according to the Nuffield Trust. We barely pay them enough, just around the living wage, but important though pay is, there is more to it than that. There is some training, run by their own organisation, but of course it is not mandatory. Just imagine being employed in such an important job for which there is no professional qualification, no official registration and no clear career pathway. In other words, it may seem to some a dead-end job.

I ask the Minister, as we have done many times in the past, whether he will offer our dedicated care workers the respect they deserve by making sure that they are paid at a rate commensurate with their responsibilities, that they can be registered, as every other health worker is, after a mandatory training programme, and that they have access to a career pathway in which they can see promotion as a reward for all their hard work. They deserve nothing less.